Objective Assessment of Postural Control After Lower-Limb Amputation: A Pilot Study

Abstract

Introduction Postural control might be impaired after lower-limb amputation (LLA) and contributes to a high incidence of falling in individuals with LLAs with the risk of an injury occurring. There is no agreement on which objective assessment method is most appropriate for quantifying postural control during rehabilitation. Attention should be pointed to which test is most accurate at detecting a change in postural control after a given intervention. The objective of this quantitative prospective cohort pilot study was to compare four balance tests to determine their feasibility in detecting a change in postural control in persons with LLA (transtibial and transfemoral) during rehabilitation and prosthesis fitting. Methods Four different balance tests were used as primary outcomes before and after a 4-week rehabilitation program (n = 5). The tests used were Berg Balance Scale (BBS), Timed Up and Go (TUG), and force plate measurements in standing and seated position (FPMstand + seat). Secondary outcome was quality of life assessed by the EuroQol, 5 dimensions, 5 levels (EQ-5D-5L) questionnaire. Results All participants improved in BBS, TUG, and FPMstand. FPMseat showed varying results. The EQ-5D-5L questionnaire showed a slight improvement in quality of life in accordance with the changes in primary outcome measures. Conclusions A change in postural control during rehabilitation and prosthesis fitting in individuals with LLAs may be assessed by BBS, TUG, and FPMstand. A criterion standard for quantifying postural control is lacking. Hence, a combination of tests to measure and detect a change in postural control can be used. Present pilot study finds that BBS, TUG, and FPMstand may be measurements used for assessment of changes in postural control in the rehabilitation of individuals with LLAs.

Quantitative methods used to evaluate balance, postural control, and the fear of falling in lower limb prosthesis users: A systematic review

“…Looking at the protocols and tests, the most commonly found was the Berg Balance Scale, or selected items of the Berg Balance Scale (Figure 2). 14,31,73,80-82,93,94,103,107,118-120,138-140,144,147-168 Timed Up and Go 76,107,117,144,145,148,149,151,162,163,165,169-180 and Limits of Stability tests 12,13,20,25,30,37,42,46,47,59,71,72,74,83,84,89 were common (Figure 2). One leg stance test appeared with various names in about some studies.…”

“…Studies that explicitly stated limitations or confounders were just over two-thirds of the total (Table 2),. 13,14,19–22,24,28–56,71,74,76,77,80–95,108,109,115–132,140–145,147–165,169–180,182–184,188–191,193–198 The most commonly mentioned limitation was small sample size, 20,22,24,28,29,32,33,35,37,39,40,42,45,47,52,54-57,74,80,82,86,87,89,93,95,109,118,119,121,123,126,129,141,143,145,148,149,154-159,161,164,169,172,183,198 followed by generalizability issues, 14,19-21,34,38,41,42,44,52-56,80,81,87,89,109,127-130,142,148,151,155,156,162,171,175-177,184,188,189,191,193,196 recall bias, 14,148,150,157,171,173,182,184 heterogeneous groups, 29,42,54,89,142,174,176,177 homogenous groups, 21,38,39,44,45,91,164 and convenience samples. 14,161,176,177,196…”

“…13,14,19-24,71-79,114,118-121,139,140,143,144,147-163,169-178,181,188,189,193-197,230,231 A quarter reported validity directly associated with prosthesis users. 13,14,19-24,71,72,74,76,118,119,139,140,144,147-162,169-178,181,189,193-195 Similarly, for reporting reliability, where about a third reported any reliability, 14,20,22,24-27,71-85,118-120,139,140,143-145,147-163,169,171-178,181,188,193-197,231,232 about a quarter reported reliability directly associated with prosthesis users. 6,14,20,22,24-27,71,72,74,76,80,118,119,139,140,144,147-151,153-162,169,171-178,181,193-195…”

“…13,110 Some few studies used plantar force sensor insoles, 50,[112][113][114]139 inertial or accelerometer sensors, 95,[140][141][142] instrumented mat or walkway, 117,124,143 or a plantar pressure platform (Figure 2). 49,61,111,[144][145][146] Looking at the protocols and tests, the most commonly found was the Berg Balance Scale, or selected items of the Berg Balance Scale (Figure 2). 14,31,73,[80][81][82]93,94,103,107,[118][119][120][138][139][140]144, Timed Up and Go 76,107,117,144,145,148,149,151,162,163,…”

Modelos computacionales en la posturografía

“…De hecho, el parámetro de amplitud de oscilación del CoP en el lado no amputado en dirección AP fue el predictor más fuerte para discriminar la estabilidad entre los grupos estudiados. Esta observación concuerda tanto con Overgaard et al, 2018como con Claret et al, 2019, quienes demostraron que los amputados presentan un control postural deficiente, revelado en la estructura espacial y temporal de su dinámica de CoP durante la bipedestación estática, así mismo que la pierna no amputada de los amputados compensa las limitaciones mecánicas y la pérdida de somatosensibilidad en la prótesis. [39]…”