Risk Factors, Frequency, and Causes of Falling in Geriatric Persons Who Has Had a Limb Removed by Amputation

Uneven walking surfaces pose challenges to balance, especially in individuals with lower extremity amputation. The purpose of this study was to determine if lateral stability of persons with unilateral transtibial amputation (TTA) is compromised when walking on a loose rock surface. Thirteen TTA and 15 healthy controls walked over level ground and over a loose rock surface at four controlled speeds. Dependent measures, including medial-lateral center of mass (COM) motion, step width variability, lateral arm swing velocity, and mean and variability of the minimum margins of stability (MOSmin), were compared between subject groups and across conditions. TTA had greater average MOSmin than Control subjects (p = 0.018). TTA exhibited decreased MOSmin on their prosthetic limbs compared to their intact limbs (p = 0.036), while Control subjects did not exhibit side to side differences. Both groups increased MOSmin with increasing walking speed (p ≤ 0.001). There was no difference in the average MOSmin between walking surfaces (p = 0.724). However, the variability of MOSmin was greater on the rocks compared to level ground. Both subject groups increased step width, step width variability, COM range of motion and peak COM velocity when walking on the rock surface. TTA exhibited greater variability of both step width and MOSmin, which suggests that they made larger step-to-step, corrective responses, more often, to achieve the same average result.

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“…Environmental factors like uneven terrain contribute to instability [3] and increase the frequency of falling [4]. …”

Section: Introductionmentioning

confidence: 99%

Frontal plane dynamic margins of stability in individuals with and without transtibial amputation walking on a loose rock surface

et al. 2013

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“…Over half of community-living individuals with LLL report having fallen in the past year and 49.2% report a fear of falling [2]. Ulger et al (2010) found that 80% of geriatric amputees had fallen within the past year, with 64% falling more than once [3]. These impairments in balance control carry an immense cost to an individual’s functional mobility at home and in the community [4,5], lowering their health-related quality of life [6].…”

Section: 0 Introductionmentioning

confidence: 99%

“…The smaller the stability margin, the more likely the individual is to lose their balance [34]. Based on reported deficits in balance control in individuals with lower limb loss [2,3], we hypothesized that individuals with unilateral TTLL would have a smaller stability margin compared to unimpaired age-matched controls. We further hypothesized that individuals with unilateral TTLL would display greater asymmetries between legs in maintaining their stability margin.…”

Section: 0 Introductionmentioning

confidence: 99%

Individuals with transtibial limb loss use interlimb force asymmetries to maintain multi-directional reactive balance control

Bolger

Ting

Sawers

2014

Clinical Biomechanics

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Background Deficits in balance control are one of the most common and serious mobility challenges facing individuals with lower limb loss. Yet, dynamic postural balance control among indivdiuals with lower limb loss remains poorly understood. Here we examined the kinematics and kinetics of dynamic balance in individuals with unilateral transtibial limb loss. Methods Five individuals with unilateral transtibial limb loss, and five age- and gender-matched controls completed a series of randomly applied multi-directional support surface translations. Whole-body metrics, e.g. peak center-of-mass displacement and net center-of-pressure displacement were compared across cohorts. Stability margin was computed as the difference between peak center-of-pressure and center-of-mass displacement. Additionally, center-of-pressure and ground reaction force magnitude and direction were compared between the prosthetic, intact, and control legs. Findings Peak center-of-mass displacement and stability margin did not differ between individuals with transtibial limb loss and controls for all perturbation directions except those loading only the prosthetic leg; in such cases the stability margin was actually larger than controls. Despite similar center-of-mass displacement, greater center-of-pressure displacement was observed in the intact leg during anterior-posterior perturbations, and under the prosthetic leg in medial-lateral perturbations. Further, in the prosthetic leg, ground reaction forces were smaller and spanned fewer directions. Interpretation Deficits in balance control among indivdiuals with transtibial limb loss may be due to their inability to use their prosthetic leg to generate forces that are equal in magnitude and direction to those of unimpaired adults. Targeting this force-generating deficit through technological or rehabilitation innovations may improve balance control.

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“…Falls induced by loss of balance are common in individuals with lower extremity amputations and can lead to serious injuries and decreased balance confidence [1–5]. Improving the ability to respond to a loss of balance is integral in reducing fall related injuries.…”

Section: Introductionmentioning

confidence: 99%

Assessing preparative gait adaptations in persons with transtibial amputation in response to repeated medial-lateral perturbations

et al. 2014

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Preventing loss of balance in individuals with transtibial amputation is important, as they are susceptible to a high frequency of fall related injuries. In order to validate fall prevention and balance therapies, methods to assess gait stability must be developed. Kinematic, temporal-spatial, and center of mass data from six healthy young participants with transtibial amputation were collected during treadmill walking during exposure to 10 randomly ordered discrete medial-lateral perturbations. The 20 strides prior to each perturbation were assessed for anticipatory changes. The only consistent postural adjustment made as a result of the perturbations was a significantly lowered center of mass height (p = 0.016).

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Risk Factors, Frequency, and Causes of Falling in Geriatric Persons Who Has Had a Limb Removed by Amputation

Cited by 25 publications

References 19 publications

Frontal plane dynamic margins of stability in individuals with and without transtibial amputation walking on a loose rock surface

Frontal plane dynamic margins of stability in individuals with and without transtibial amputation walking on a loose rock surface

Individuals with transtibial limb loss use interlimb force asymmetries to maintain multi-directional reactive balance control

Assessing preparative gait adaptations in persons with transtibial amputation in response to repeated medial-lateral perturbations

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