Factors leading to falls in transfemoral prosthesis users: a case series of prosthesis-side stumble recovery responses.
Amputation
Commercial prostheses
Gait biomechanics
Trip
Journal
Journal of neuroengineering and rehabilitation
ISSN: 1743-0003
Titre abrégé: J Neuroeng Rehabil
Pays: England
ID NLM: 101232233
Informations de publication
Date de publication:
13 Jul 2024
13 Jul 2024
Historique:
received:
13
11
2023
accepted:
11
06
2024
medline:
14
7
2024
pubmed:
14
7
2024
entrez:
13
7
2024
Statut:
epublish
Résumé
Falls due to stumbling are prevalent for transfemoral prosthesis users and may lead to increased injury risk. This preliminary case series analyzes the transfemoral prosthesis user stumble recovery response to highlight key deficits in current commercially-available prostheses and proposes potential interventions to improve recovery outcomes. Six transfemoral prosthesis users were perturbed on their prosthetic limb at least three times while walking on a treadmill using obstacle perturbations in early, mid and late swing. Kinematic data were collected to characterize the response, while fall rate and key kinematic recovery metrics were used to assess the quality of recovery and highlight functional deficits in current commercially-available prostheses. Across all participants, 13 (54%) of the 24 trials resulted in a fall (defined as > 50% body-weight support) with all but one participant (83%) falling at least once and two participants (33%) falling every time. In contrast, in a previous study of seven young, unimpaired, non-prosthesis users using the same experimental apparatus, no falls occurred across 190 trials. For the transfemoral prosthesis users, early swing had the highest rate of falling at 64%, followed by mid-swing at 57%, and then late swing at 33%. The trend in falls was mirrored by the kinematic recovery metrics (peak trunk angle, peak trunk angular velocity, forward reach of the perturbed limb, and knee angle at ground contact). In early swing all four metrics were deficient compared to non-prosthesis user controls. In mid swing, all but trunk angular velocity were deficient. In late swing only forward reach was deficient. Based on the stumble recovery responses, four potential deficiencies were identified in the response of the knee prostheses: (1) insufficient resistance to stance knee flexion upon ground contact; (2) insufficient swing extension after a perturbation; (3) difficulty initiating swing flexion following a perturbation; and (4) excessive impedance against swing flexion in early swing preventing the potential utilization of the elevating strategy. Each of these issues can potentially be addressed by mechanical or mechatronic changes to prosthetic design to improve quality of recovery and reduce the likelihood a fall.
Sections du résumé
BACKGROUND
BACKGROUND
Falls due to stumbling are prevalent for transfemoral prosthesis users and may lead to increased injury risk. This preliminary case series analyzes the transfemoral prosthesis user stumble recovery response to highlight key deficits in current commercially-available prostheses and proposes potential interventions to improve recovery outcomes.
METHODS
METHODS
Six transfemoral prosthesis users were perturbed on their prosthetic limb at least three times while walking on a treadmill using obstacle perturbations in early, mid and late swing. Kinematic data were collected to characterize the response, while fall rate and key kinematic recovery metrics were used to assess the quality of recovery and highlight functional deficits in current commercially-available prostheses.
RESULTS
RESULTS
Across all participants, 13 (54%) of the 24 trials resulted in a fall (defined as > 50% body-weight support) with all but one participant (83%) falling at least once and two participants (33%) falling every time. In contrast, in a previous study of seven young, unimpaired, non-prosthesis users using the same experimental apparatus, no falls occurred across 190 trials. For the transfemoral prosthesis users, early swing had the highest rate of falling at 64%, followed by mid-swing at 57%, and then late swing at 33%. The trend in falls was mirrored by the kinematic recovery metrics (peak trunk angle, peak trunk angular velocity, forward reach of the perturbed limb, and knee angle at ground contact). In early swing all four metrics were deficient compared to non-prosthesis user controls. In mid swing, all but trunk angular velocity were deficient. In late swing only forward reach was deficient.
CONCLUSION
CONCLUSIONS
Based on the stumble recovery responses, four potential deficiencies were identified in the response of the knee prostheses: (1) insufficient resistance to stance knee flexion upon ground contact; (2) insufficient swing extension after a perturbation; (3) difficulty initiating swing flexion following a perturbation; and (4) excessive impedance against swing flexion in early swing preventing the potential utilization of the elevating strategy. Each of these issues can potentially be addressed by mechanical or mechatronic changes to prosthetic design to improve quality of recovery and reduce the likelihood a fall.
Identifiants
pubmed: 39003469
doi: 10.1186/s12984-024-01402-0
pii: 10.1186/s12984-024-01402-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
117Subventions
Organisme : NIH HHS
ID : R01HD088959
Pays : United States
Informations de copyright
© 2024. The Author(s).
Références
Verma SK, Willetts JL, Corns HL, Marucci-Wellman HR, Lombardi DA, Courtney TK. Falls and fall-related injuries among community-dwelling adults in the United States. PLoS ONE. 2016;11(3):0150939.
doi: 10.1371/journal.pone.0150939
Talbot LA, Musiol RJ, Witham EK, Metter EJ. Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury. BMC Public Health. 2005;5:1–9.
doi: 10.1186/1471-2458-5-86
Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, Koch ML, Trainor K, Horwitz RI. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994;331(13):821–7.
doi: 10.1056/NEJM199409293311301
pubmed: 8078528
Leamon TB, Murphy PL. Occupational slips and falls: more than a trivial problem. Ergonomics. 1995;38(3):487–98.
doi: 10.1080/00140139508925120
pubmed: 7729391
Hunter SW, Batchelor F, Hill KD, Hill A-M, Mackintosh S, Payne M. Risk factors for falls in people with a lower limb amputation: a systematic review. Pm &r. 2017;9(2):170–80.
Miller WC, Speechley M, Deathe B. The prevalence and risk factors of falling and fear of falling among lower extremity amputees. Arch Phys Med Rehabil. 2001;82(8):1031–7.
doi: 10.1053/apmr.2001.24295
pubmed: 11494181
Miller W, Deathe A. A prospective study examining balance confidence among individuals with lower limb amputation. Disabil Rehabil. 2004;26(14–15):875–81.
doi: 10.1080/09638280410001708887
pubmed: 15497916
Miller WC, Deathe AB, Speechley M, Koval J. The influence of falling, fear of falling, and balance confidence on prosthetic mobility and social activity among individuals with a lower extremity amputation. Arch Phys Med Rehabil. 2001;82(9):1238–44.
doi: 10.1053/apmr.2001.25079
pubmed: 11552197
Miller WC, Speechley M, Deathe AB. Balance confidence among people with lower-limb amputations. Phys Ther. 2002;82(9):856–65.
doi: 10.1093/ptj/82.9.856
pubmed: 12201800
Gauthier-Gagnon C, Grisé M-C, Potvin D. Enabling factors related to prosthetic use by people with transtibial and transfemoral amputation. Arch Phys Med Rehabil. 1999;80(6):706–13.
doi: 10.1016/S0003-9993(99)90177-6
pubmed: 10378500
Hafner BJ, Willingham LL, Buell NC, Allyn KJ, Smith DG. Evaluation of function, performance, and preference as transfemoral amputees transition from mechanical to microprocessor control of the prosthetic knee. Arch Phys Med Rehabil. 2007;88(2):207–17.
doi: 10.1016/j.apmr.2006.10.030
pubmed: 17270519
Kahle JT, Highsmith MJ, Hubbard SL. Comparison of nonmicroprocessor knee mechanism versus c-leg on prosthesis evaluation questionnaire, stumbles, falls, walking tests, stair descent, and knee preference. J Rehabil Res Dev. 2008;45(1):1.
doi: 10.1682/JRRD.2007.04.0054
pubmed: 18566922
Culver SC, Vailati LG, Goldfarb M. A primarily-passive knee prosthesis with powered stance and swing assistance. In: 2022 International Conference on Rehabilitation Robotics (ICORR), pp. 1–6. IEEE; 2022.
Blumentritt S, Schmalz T, Jarasch R. The safety of c-leg: biomechanical tests. JPO J Prosthet Orthot. 2009;21(1):2–15.
doi: 10.1097/JPO.0b013e318192e96a
Crenshaw JR, Kaufman KR, Grabiner MD. Trip recoveries of people with unilateral, transfemoral or knee disarticulation amputations: initial findings. Gait & Posture. 2013;38(3):534–6.
doi: 10.1016/j.gaitpost.2012.12.013
Crenshaw JR, Kaufman KR, Grabiner MD. Compensatory-step training of healthy, mobile people with unilateral, transfemoral or knee disarticulation amputations: a potential intervention for trip-related falls. Gait & Posture. 2013;38(3):500–6.
doi: 10.1016/j.gaitpost.2013.01.023
Eng JJ, Winter DA, Patla AE. Intralimb dynamics simplify reactive control strategies during locomotion. J Biomech. 1997;30(6):581–8.
doi: 10.1016/S0021-9290(97)84507-1
pubmed: 9165391
Highsmith MJ, Kahle JT, Bongiorni DR, Sutton BS, Groer S, Kaufman KR. Safety, energy efficiency, and cost efficacy of the c-leg for transfemoral amputees: a review of the literature. Prosthet Orthot Int. 2010;34(4):362–77.
doi: 10.3109/03093646.2010.520054
pubmed: 20969495
Fuenzalida Squella SA, Kannenberg A, Brandão Benetti Â. Enhancement of a prosthetic knee with a microprocessor-controlled gait phase switch reduces falls and improves balance confidence and gait speed in community ambulators with unilateral transfemoral amputation. Prosthet Orthot Int. 2018;42(2):228–35.
doi: 10.1177/0309364617716207
pubmed: 28691574
King ST, Eveld ME, Martínez A, Zelik KE, Goldfarb M. A novel system for introducing precisely-controlled, unanticipated gait perturbations for the study of stumble recovery. J Neuroeng Rehabil. 2019;16:1–17.
doi: 10.1186/s12984-019-0527-7
Eng JJ, Winter DA, Patla AE. Strategies for recovery from a trip in early and late swing during human walking. Exp Brain Res. 1994;102:339–49.
doi: 10.1007/BF00227520
pubmed: 7705511
Schillings A, Van Wezel B, Mulder T, Duysens J. Muscular responses and movement strategies during stumbling over obstacles. J Neurophysiol. 2000;83(4):2093–102.
doi: 10.1152/jn.2000.83.4.2093
pubmed: 10758119
Eveld ME, King ST, Vailati LG, Zelik KE, Goldfarb M. On the basis for stumble recovery strategy selection in healthy adults. J Biomech Eng. 2021;143(7).
Shirota C, Simon AM, Kuiken TA. Recovery strategy identification throughout swing phase using kinematic data from the tripped leg. In: 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, pp. 6199–6202. IEEE; 2014.
Sawers A, McDonald CL, Hafner BJ. A survey for characterizing details of fall events experienced by lower limb prosthesis users. PLoS ONE. 2022;17(7):0272082.
doi: 10.1371/journal.pone.0272082
Eveld ME, King ST, Zelik KE, Goldfarb M. Factors leading to falls in transfemoral prosthesis users: a case series of sound-side stumble recovery responses. J Neuroeng Rehabil. 2022;19(1):1–24.
doi: 10.1186/s12984-022-01070-y
Smith A. The serial sevens subtraction test. Arch Neurol. 1967;17(1):78–80.
doi: 10.1001/archneur.1967.00470250082008
pubmed: 6026175
Pavol MJ, Owings TM, Foley KT, Grabiner MD. Mechanisms leading to a fall from an induced trip in healthy older adults. J Gerontol A Biol Sci Med Sci. 2001;56(7):428–37.
doi: 10.1093/gerona/56.7.M428
O’Connor CM, Thorpe SK, O’Malley MJ, Vaughan CL. Automatic detection of gait events using kinematic data. Gait & Posture. 2007;25(3):469–74.
doi: 10.1016/j.gaitpost.2006.05.016
Crenshaw JR, Rosenblatt NJ, Hurt CP, Grabiner MD. The discriminant capabilities of stability measures, trunk kinematics, and step kinematics in classifying successful and failed compensatory stepping responses by young adults. J Biomech. 2012;45(1):129–33.
doi: 10.1016/j.jbiomech.2011.09.022
pubmed: 22018682
Grabiner MD, Bareither ML, Gatts S, Marone J, Troy KL. Task-specific training reduces trip-related fall risk in women; 2012.
Pijnappels M, Reeves ND, Maganaris CN, Van Dieen JH. Tripping without falling; lower limb strength, a limitation for balance recovery and a target for training in the elderly. J Electromyogr Kinesiol. 2008;18(2):188–96.
doi: 10.1016/j.jelekin.2007.06.004
pubmed: 17761436
Rosenblatt NJ, Marone J, Grabiner MD. Preventing trip-related falls by community-dwelling adults: a prospective study. J Am Geriatr Soc. 2013;61(9):1629–31.
doi: 10.1111/jgs.12428
pubmed: 24028366
Paran I, Nachmani H, Melzer I. A concurrent attention-demanding task did not interfere with balance recovery function in standing and walking among young adults-an explorative laboratory study. Hum Mov Sci. 2020;73: 102675.
doi: 10.1016/j.humov.2020.102675
pubmed: 32927228
Nachreiner NM, Findorff MJ, Wyman JF, McCarthy TC. Circumstances and consequences of falls in community-dwelling older women. J Women’s Health. 2007;16(10):1437–46.
doi: 10.1089/jwh.2006.0245
Decullier E, Couris C, Beauchet O, Zamora A, Annweiler C, Dargent-Molina P, Schott A-M. Falls’ and fallers’ profiles. J Nutr Health Aging. 2010;14:602–8.
doi: 10.1007/s12603-010-0130-x
pubmed: 20818477