Bilateral changes in somatosensory sensibility after unilateral below-knee amputation

Kavounoudias, Anne; Tremblay, Camille; Gravel, Denis; Iancu, Andreea; Forget, Robert

doi:10.1016/j.apmr.2004.10.030

Cited by 50 publications

(44 citation statements)

References 36 publications

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“…The focus of the rehabilitation program was to increase the ability of the subjects to respond to large postural perturbations and perform the recovery steps necessary to avoid a fall. The training method used in this study allowed patients with amputations to learn how to perform a complex motor task in a safe environment and maintain gait stability despite the poor somatosensory feedback from their prosthesis and residual limb [9,16,20,22]. This type of training is not addressed in most rehabilitation programs and, to our knowledge, has not previously been used to retrain persons with lower limb amputation.…”

Section: Discussionmentioning

confidence: 99%

Task-specific Fall Prevention Training Is Effective for Warfighters With Transtibial Amputations

Kaufman

Wyatt

Sessoms

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Key factors limiting patients with lower extremity amputations to achieve maximal functional capabilities are falls and fear of falling. A task-specific fall prevention training program has successfully reduced prospectively recorded trip-related falls that occur in the community by the elderly. However, this program has not been tested in amputees. Questions/purposes In a cohort of unilateral transtibial amputees, we aimed to assess effectiveness of a falls prevention training program by (1) quantifying improvements in trunk control; (2) measuring responses to a standardized perturbation; and (3) demonstrating retention at 3 and 6 months after training. Second, we collected patientreported outcomes for balance confidence and falls control. Methods Fourteen male military service members (26 ± 3 years) with unilateral transtibial amputations and who had been walking without an assistive device for a median of 10 months (range, 2-106 months) were recruited to participate in this prospective cohort study. The training program used a microprocessor-controlled treadmill designed to deliver task-specific postural perturbations that simulated a trip. The training consisted of six 30-minute sessions delivered over a 2-week period, during which task difficulty, including perturbation magnitude, increased as the patient's ability progressed. Training effectiveness was assessed using a perturbation test in an This study was funded by the Department of Defense Grant Number W81X-WH-11-2-0058 (Log No. DM090896) and the Navy Bureau of Medicine and Surgery, Wounded, Ill, and Injured Program. Approved for public release; distribution is unlimited. This research was conducted in compliance with all applicable federal regulations governing the protection of human subjects (protocol NMCSD.2001.003 and Protocol NHRC.2001.0031). The institution of one or more of the authors (MDG) has a patent on technology (ActiveStep TM ; Symbex, Lebanon, NH, USA) noted in this manuscript. One of the authors (MDG) is an inventor of the ActiveStep TM system but has no conflicts of interest to declare with regard to the present study. The views expressed are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® immersive virtual environment. The key outcome variables were peak trunk flexion and velocity, because trunk kinematics at the recovery step have been shown to be a determinant of fall likelihood. The patient-reported outcomes were also collected using questionnaires. The effectiveness of the rehabilitation program was also assessed by collecting data before perturbation training and comparing the key outcome parameters with those measured immediately after perturbation training (0 months) as well as both 3 and 6 months posttraining. Results Mean trunk flexion angle and velocity significantly improved after participating in the ...

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Section: Discussionmentioning

confidence: 99%

Task-specific Fall Prevention Training Is Effective for Warfighters With Transtibial Amputations

Kaufman

Wyatt

Sessoms

et al. 2014

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…They also report an increased fear of falling [5] and reduced social participation because of this fear [6]. In persons with a unilateral transtibial amputation due to trauma or vascular disease, poor sensation has been identified not only in the side of the amputation but also in the contralateral foot and knee [7]. This has been identified as another factor contributing to decreased balance and safety [8].…”

Section: Introductionmentioning

confidence: 99%

Can vibratory feedback be used to improve postural stability in persons with transtibial limb loss?

Rusaw¹,

Hagberg²,

Nolan³

et al. 2012

JRRD

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Abstract-The use of vibration as a feedback modality to convey motion of the body has been shown to improve measures of postural stability in some groups of patients. Because individuals using transtibial prostheses lack sensation distal to the amputation, vibratory feedback could possibly be used to improve their postural stability. The current investigation provided transtibial prosthesis users (n = 24, mean age 48 yr) with vibratory feedback proportional to the signal received from force transducers located under the prosthetic foot. Postural stability was evaluated by measuring center of pressure (CoP) movement, limits of stability, and rhythmic weight shift while participants stood on a force platform capable of rotations in the pitch plane (toes up/toes down). The results showed that the vibratory feedback increased the mediolateral displacement amplitude of CoP in standing balance and reduced the response time to rapid voluntary movements of the center of gravity. The results suggest that the use of vibratory feedback in an experimental setting leads to improvements in fast open-loop mechanisms of postural control in transtibial prosthesis users.

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“…As prosthesis users have postural reorganization [20,35,55], which is likely to affect other muscles than those of the lower limb, future studies are warranted to see whether there are more proximal structures that are able to mediate postural responses in this population. As complex interactions between both limbs are responsible for coordinated response [48] and persons with unilateral amputation have contralateral sensory changes following their amputation [60], it is possible that the sensory structures of the intact limb had an effect on the results. By exploring the sensory structures of the remaining limbs in more detail with validated tools (e.g., monofilament testing), it might be possible to identify the interaction between sensory acuity and bilateral postural response.…”

Section: Discussionmentioning

confidence: 99%

“…Yet, regardless of position, the TTA group had increased latency in the intact limb. Bilateral sensory changes [14,60] and postural reorganization [55] previously shown in transtibial prosthesis users may be factors influencing this delayed EMG response in the intact limb. Given that the stretch reflex of the ankle can elicit an EMG response within 40 ms of perturbation, the results suggest there was no spinal reflex elicited for either of the groups.…”

Section: Discussionmentioning

confidence: 99%

Bilateral electromyogram response latency following platform perturbation in unilateral transtibial prosthesis users: Influence of weight distribution and limb position

Rusaw

Hagberg²,

Nolan³

et al. 2013

JRRD

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Abstract-Appropriate muscular response following an external perturbation is essential in preventing falls. Transtibial prosthesis users lack a foot-ankle complex and associated sensorimotor structures on the side with the prosthesis. The effect of this lack on rapid responses of the lower limb to external surface perturbations is unknown. The aim of the present study was to compare electromyogram (EMG) response latencies of otherwise healthy, unilateral, transtibial prosthesis users (n = 23, mean +/-standard deviation [SD] age = 48 +/-14 yr) and a matched control group (n = 23, mean +/-SD age = 48 +/-13 yr) following sudden support-surface rotations in the pitch plane (toes-up and toes-down). Perturbations were elicited in various weight-bearing and limb-perturbed conditions. The results indicated that transtibial prosthesis users have delayed responses of multiple muscles of the lower limb following perturbation, both in the intact and residual limbs. Weight-bearing had no influence on the response latency in the residual limb, but did on the intact limb. Which limb received the perturbation was found to influence the muscular response, with the intact limb showing a significantly delayed response when the perturbation was received only on the side with a prosthesis. These delayed responses may represent an increased risk of falling for individuals who use transtibial prostheses.

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Bilateral changes in somatosensory sensibility after unilateral below-knee amputation

Cited by 50 publications

References 36 publications

Task-specific Fall Prevention Training Is Effective for Warfighters With Transtibial Amputations

Task-specific Fall Prevention Training Is Effective for Warfighters With Transtibial Amputations

Can vibratory feedback be used to improve postural stability in persons with transtibial limb loss?

Bilateral electromyogram response latency following platform perturbation in unilateral transtibial prosthesis users: Influence of weight distribution and limb position

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