scholarly journals Locomotor Performance During Rehabilitation of People With Lower Limb Amputation and Prosthetic Nonuse 12 Months After Discharge

2016 ◽  
Vol 96 (7) ◽  
pp. 985-994 ◽  
Author(s):  
Caroline E. Roffman ◽  
John Buchanan ◽  
Garry T. Allison
Keyword(s):  
Lower Limb ◽  
Clinical Utility ◽  
Screening Tool ◽  
Area Under The Curve ◽  
Lower Limb Amputation ◽  
Step Test ◽  
Limb Amputation ◽  
Locomotor Performance ◽  
Walk Test ◽  
Four Square

AbstractBackgroundIt is recognized that multifactorial assessments are needed to evaluate balance and locomotor function in people with lower limb amputation. There is no consensus on whether a single screening tool could be used to identify future issues with locomotion or prosthetic use.ObjectiveThe purpose of this study was to determine whether different tests of locomotor performance during rehabilitation were associated with significantly greater risk of prosthetic abandonment at 12 months postdischarge.DesignThis was a retrospective cohort study.MethodData for descriptive variables and locomotor tests (ie, 10-Meter Walk Test [10MWT], Timed “Up & Go” Test [TUGT], Six-Minute Walk Test [6MWT], and Four Square Step Test [FSST]) were abstracted from the medical records of 201 consecutive participants with lower limb amputation. Participants were interviewed and classified as prosthetic users or nonusers at 12 months postdischarge. The Mann-Whitney U test was used to analyze whether there were differences in locomotor performance. Receiver operating characteristic curves were generated to determine performance thresholds, and relative risk (RR) was calculated for nonuse.ResultsAt 12 months postdischarge, 18% (n=36) of the participants had become prosthetic nonusers. Performance thresholds, area under the curve (AUC), and RR of nonuse (95% confidence intervals [CI]) were: for the 10MWT, if walking speed was ≤0.44 ms−1 (AUC=0.743), RR of nonuse=2.76 (95% CI=1.83, 3.79; P<.0001); for the TUGT, if time was ≥21.4 seconds (AUC=0.796), RR of nonuse=3.17 (95% CI=2.17, 4.14; P<.0001); for the 6MWT, if distance was ≤191 m (AUC=0.788), RR of nonuse=2.84, (95% CI=2.05, 3.48; P<.0001); and for the FSST, if time was ≥36.6 seconds (AUC=0.762), RR of nonuse=2.76 (95% CI=1.99, 3.39; P<.0001).LimitationsMissing data, potential recall bias, and assessment times that varied were limitations of the study.ConclusionsLocomotor performance during rehabilitation may predict future risk of prosthetic nonuse. It may be implied that the 10MWT has the greatest clinical utility as a single screening tool for prosthetic nonuse, given the highest proportion of participants were able to perform this test early in rehabilitation. However, as locomotor skills improve, other tests (in particular, the 6MWT) have specific clinical utility. To fully enable implementation of these locomotor criteria for prosthetic nonuse into clinical practice, validation is warranted.

The benefits of using a vacuum-assisted socket system to improve balance and gait in elderly transtibial amputees

2014 ◽  
Vol 40 (1) ◽  
pp. 83-88 ◽  
Author(s):  
C Beatriz Samitier ◽  
Lluis Guirao ◽  
Maria Costea ◽  
Josep M Camós ◽  
Eulogio Pleguezuelos
Keyword(s):  
Standard Deviation ◽  
Berg Balance Scale ◽  
Activity Level ◽  
Step Test ◽  
Limb Amputation ◽  
Walk Test ◽  
Timed Up And Go ◽  
Balance Scale ◽  
Four Square ◽  
Transtibial Amputees

Background:Lower limb amputation leads to impaired balance, ambulation, and transfers. Proper fit of the prosthesis is a determining factor for successful ambulation. Vacuum-assisted socket systems extract air from the socket, which decreases pistoning and probability of soft-tissue injuries and increases proprioception and socket comfort.Objectives:To investigate the effect of vacuum-assisted socket system on transtibial amputees’ performance-based and perceived balance, transfers, and gait.Study design:Quasi-experimental before-and-after study.Methods:Subjects were initially assessed using their prosthesis with the regular socket and re-evaluated 4 weeks after fitting including the vacuum-assisted socket system. We evaluated the mobility grade using Medicare Functional Classification Level, Berg Balance Scale, Four Square Step Test, Timed Up and Go Test, the 6-Min Walk Test, the Locomotor Capabilities Index, Satisfaction with Prosthesis (SAT-PRO questionnaire), and Houghton Scale.Results:A total of 16 unilateral transtibial dysvascular amputees, mean age 65.12 (standard deviation = 10.15) years. Using the vacuum-assisted socket system, the patients significantly improved in balance, gait, and transfers: scores of the Berg Balance Scale increased from 45.75 (standard deviation = 6.91) to 49.06 (standard deviation = 5.62) ( p < 0.01), Four Square Step Test decreased from 18.18 (standard deviation = 3.84) s to 14.97 (3.9) s ( p < 0.01), Timed Up and Go Test decreased from 14.3 (standard deviation = 3.29) s to 11.56 (2.46) s ( p < 0.01). The distance walked in the 6-Min Walk Test increased from 288.53 (standard deviation = 59.57) m to 321.38 (standard deviation = 72.81) m ( p < 0.01).Conclusion:Vacuum-assisted socket systems are useful for improving balance, gait, and transfers in over-50-year-old dysvascular transtibial amputees.Clinical relevanceThis study gives more insight into the use of vacuum-assisted socket systems to improve elderly transtibial dysvascular amputees’ functionality and decrease their risk of falls. The use of an additional distal valve in the socket should be considered in patients with a lower activity level.

scholarly journals Impairment Variables Predicting Activity Limitation in Individuals with Lower Limb Amputation

2010 ◽  
Vol 34 (1) ◽  
pp. 73-84 ◽  
Author(s):  
Michele A. Raya ◽  
Robert S. Gailey ◽  
Ira M. Fiebert ◽  
Kathyrn E. Roach
Keyword(s):  
Muscle Strength ◽  
Lower Limb ◽  
Activity Limitation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Outcome Variable ◽  
Walk Test ◽  
Personal Factors ◽  
Six Minute Walk Test ◽  
Minute Walk

The purpose of this study was to determine whether measures of impairment (i.e., muscle strength, balance), personal factors (i.e., comorbidities, demographic information) and amputation specific variables (i.e., time since amputation, cause of amputation, level of amputation) were able to predict performance on the six-minute walk test, a measure of activity limitation, in individuals with lower limb amputation. A total of 72 individuals with lower limb amputation ranging in age from 21–83 were tested for balance, limb muscle strength and function. Medical comorbidities were recorded and activity limitation was measured using the six-minute walk test. Data were analyzed and multivariate relationships were examined using multiple linear regression. Impairment variables of strength, balance, subject demographics, time since amputation, cause of amputation and level of amputation were all significant predictors and explained 72% of the variance in the outcome variable. Strength of the hip extensors was the strongest predictor, accounting for 30.9% of the total variance. Multiple factors impact six minute walk scores in individuals with lower limb amputation. Impairments in hip strength and balance appear to be the two most significant. The findings of this study support the use of the six-minute walk test to underscore impairments of the musculoskeletal system that can affect ambulation ability in the amputee.

scholarly journals Explaining modified 2-min walk test outcomes in male Veterans with traumatic or nontraumatic lower-limb amputation

2016 ◽  
Vol 53 (6) ◽  
pp. 1035-1044 ◽  
Author(s):  
Brian J. Loyd ◽  
Thomas T. Fields ◽  
Ryan O. Stephenson ◽  
Jennifer Stevens-Lapsley ◽  
Cory L. Christiansen
Keyword(s):  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Walk Test ◽  
Male Veterans ◽  
Test Outcomes

The 2-minute walk test as a measure of functional improvement in persons with lower limb amputation

2001 ◽  
Vol 82 (10) ◽  
pp. 1478-1483 ◽  
Author(s):  
Dina Brooks ◽  
Janet Parsons ◽  
Judith P. Hunter ◽  
Michael Devlin ◽  
Janice Walker
Keyword(s):  
Lower Limb ◽  
Lower Limb Amputation ◽  
Functional Improvement ◽  
Limb Amputation ◽  
Walk Test ◽  
Minute Walk

A randomized controlled trial to evaluate the feasibility of the Wii Fit for improving walking in older adults with lower limb amputation

2016 ◽  
Vol 31 (1) ◽  
pp. 82-92 ◽  
Author(s):  
Bita Imam ◽  
William C Miller ◽  
Heather Finlayson ◽  
Janice J Eng ◽  
Tal Jarus
Keyword(s):  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Walk Test ◽  
Wii Fit ◽  
Randomized Controlled ◽  
End Of Treatment ◽  
Perceived Benefit ◽  
Walking Capacity ◽  
Minute Walk

Objective: To assess the feasibility of Wii.n.Walk for improving walking capacity in older adults with lower limb amputation. Design: A parallel, evaluator-blind randomized controlled feasibility trial. Setting: Community-living. Participants: Individuals who were ⩾50 years old with a unilateral lower limb amputation. Intervention: Wii.n.Walk consisted of Wii Fit training, 3x/week (40 minute sessions), for 4 weeks. Training started in the clinic in groups of 3 and graduated to unsupervised home training. Control group were trained using cognitive games. Main Measures: Feasibility indicators: trial process (recruitment, retention, participants’ perceived benefit from the Wii.n.Walk intervention measured by exit questionnaire), resources (adherence), management (participant processing, blinding), and treatment (adverse event, and Cohen’s d effect size and variance). Primary clinical outcome: walking capacity measured using the 2 Minute Walk Test at baseline, end of treatment, and 3-week retention. Results: Of 28 randomized participants, 24 completed the trial (12/arm). Median (range) age was 62.0 (50-78) years. Mean (SD) score for perceived benefit from the Wii.n.Walk intervention was 38.9/45 (6.8). Adherence was 83.4%. The effect sizes for the 2 Minute Walk Test were 0.5 (end of treatment) and 0.6 (3-week retention) based on intention to treat with imputed data; and 0.9 (end of treatment) and 1.2 (3-week retention) based on per protocol analysis. The required sample size for a future larger RCT was deemed to be 72 (36 per arm). Conclusions: The results suggested the feasibility of the Wii.n.Walk with a medium effect size for improving walking capacity. Future larger randomized controlled trials investigating efficacy are warranted.

The effect of a supervised community–based exercise program on balance, balance confidence, and gait in individuals with lower limb amputation

2017 ◽  
Vol 41 (5) ◽  
pp. 446-454 ◽  
Author(s):  
Carol A Miller ◽  
Jennifer E Williams ◽  
Katey L Durham ◽  
Selena C Hom ◽  
Julie L Smith
Keyword(s):  
Lower Limb ◽  
Repeated Measures ◽  
Exercise Program ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Walking Ability ◽  
Walk Test ◽  
Community Based ◽  
Balance Confidence ◽  
Confidence Scale

Background:Many individuals with lower limb loss report concern with walking ability after completing structured traditional rehabilitation.Objectives:The purpose of this study was to explore the impact of a supervised community–based exercise program on balance, balance confidence, and gait in individuals with lower limb amputation.Study design:Repeated measures.Methods:The supervised exercise program was offered biweekly for 6 weeks. The GAITRite System by CIR Systems, Inc., the Figure-of-8 Walk Test, and Activity-specific Balance Confidence Scale were used to measure clinical outcomes pre- and post-intervention.Results:In total, 16 participants with lower limb amputation (mean age: 50.8 years) completed the study. A multivariate, repeated measures analysis of variance indicated a statistically significant effect of training across six clinical outcome measures ( F(6, 10) = 4.514, p = .018). Moderate effect sizes were found for the Figure-of-8 Walk Test ( η2= .586), Activity-specific Balance Confidence Scale ( η2= .504), and gait velocity at comfortable walking speed ( η2= .574). The average increase in gait speed was clinically meaningful at .14 m/s.Conclusion:The supervised community–based exercise program implemented in this study was designed to address specific functional needs for individuals with lower limb loss. Each participant experienced clinically meaningful improvements in balance, balance confidence, and walking ability.Clinical relevanceThe provision of a supervised community–based exercise program, after traditional rehabilitation, provides opportunity to offer a continuum of care that may enhance prosthetic functional ability and active participation in the community for individuals with lower limb amputation.

A pilot study examining measures of balance and mobility in children with unilateral lower-limb amputation

2014 ◽  
Vol 40 (1) ◽  
pp. 65-74 ◽  
Author(s):  
Emma Feick ◽  
Peggy-Rae Hamilton ◽  
Marlene Luis ◽  
Melissa Corbin ◽  
Nancy M Salback ◽  
...  
Keyword(s):  
Pilot Study ◽  
Energy Expenditure ◽  
Postural Control ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Walk Test ◽  
Cost Index ◽  
Targeted Interventions

Background:Individuals with unilateral lower-limb amputation (LLA) have altered structure and physiology of their lower limbs which impairs their balance, mobility, physical function and participation in physical activities. As part of (re)habilitation, focus is given to improving gait and balance in order to enhance overall mobility, function, self-efficacy, and independence. However, the relationships amongst body impairments and physical activity limitations remain unclear, particularly in the pediatric population.Objective:To provide an examination of the relationships among balance and mobility measures in children with unilateral lower-limb amputation and able-bodied children.Study design:Cross-sectional prospective comparative pilot study.Methods:Spatiotemporal gait parameters and standing postural control were evaluated in children with lower-limb amputation (n = 10) and age-matched able-bodied children (n = 10) in a laboratory-based setting. Clinical tests for mobility and balance consisted of the 10-m walk test, the 6-min walk test, and the Community Balance and Mobility scale. Energy expenditure was estimated during the 6-min walk test using the Physiological Cost Index. Analysis included comparing variables between able-bodied and lower-limb amputation groups, as well as examining the correlations among them.Results:Walking speed, distance, and functional balance (p < 0.05) were significantly diminished in children with lower-limb amputation compared to able-bodied children. For children with lower-limb amputation, reduced energy expenditure was associated with narrower step width and more symmetrical gait; better postural control and balance were associated with faster walking speeds (p < 0.05).Conclusion:A greater clinical understanding of gait and balance deficits in this population may help to improve rehabilitation outcomes and overall functional mobility.Clinical relevanceImproved understanding of deficits in children with lower-limb amputation (LLA) may lead to more targeted interventions and facilitate clinical decision-making in rehabilitation settings for this population. The findings contribute to the limited literature and provide a basis to further examine suitable clinical outcome measures to be used in children with LLA.

Group-based telerehabilitation intervention using Wii Fit to improve walking in older adults with lower limb amputation (WiiNWalk): A randomized control trial

2021 ◽  
pp. 026921552110612
Author(s):  
Gordon Tao ◽  
William C. Miller ◽  
Janice J. Eng ◽  
Elham Esfandiari ◽  
Bita Imam ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Performance ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Walk Test ◽  
Balance Confidence ◽  
Wii Fit ◽  
Lower Limb Prosthesis ◽  
Limb Prosthesis

Objective Determine efficacy of the novel WiiNWalk intervention on walking-related outcomes in older adults with lower limb amputation. Design Multi-site, parallel, evaluator-masked randomized controlled trial. Setting Home-setting in three Canadian cities. Participants Community-dwelling lower limb prosthesis users over 50 years of age. Interventions The WiiNWalk group (n = 38) used modified Wii Fit activities for prosthetic rehabilitation. The attention control group (n = 33) used Big Brain Academy: Wii Degree, comprising of cognitive activities. Both groups completed a 4-week supervised phase with three 1-h sessions/week in groups of three overseen by a clinician via videoconferencing and a 4-week unstructured and unsupervised phase. Main Measures Primary outcome was walking capacity (2 min walk test); secondary outcomes were balance confidence (activities-specific balance confidence scale), dynamic balance (four-step square test), and lower limb functioning (short physical performance battery). Outcomes were compared across time points with repeated measures analysis of covariance, adjusting for baseline and age. Results Mean age was 65.0 (8.4) years, with 179.5 (223.5) months post-amputation and 80% transtibial amputation. No group difference in a 2 min walk test with an effect size: 1.53 95% CI [−3.17, 6.23] m. Activities balance confidence was greater in the WiiNWalk group by 5.53 [2.53, 8.52]%. No group difference in the four-step square test −0.16 [−1.25, 0.92] s, nor short physical performance battery 0.48 [−0.65, 1.61]. A post-hoc analysis showed the greatest difference in balance confidence immediately after an unsupervised phase. Conclusions The WiiNWalk intervention improved balance confidence, but not walking-related physical function in older adult lower limb prosthesis users. Future rehabilitation games should be specific to the amputation context. Clinical Trial Registration number, NCT 01942798.

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