Effect of Lower Limb Muscle Fatigue on Fall Risk for Transfemoral Amputee: A Pilot Study

Safee, Mohd Khairuddin Mohd; Osman, Noor Azuan Abu

doi:10.1155/2021/4357473

Cited by 3 publications

(1 citation statement)

References 39 publications

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“…An experiment that implemented “fatigue protocols” on lower-limb muscles, consisting of a repeated sit-to-stand task, reported that muscle endurance affects spatiotemporal and kinematic features of gait in healthy subjects ( Barbieri et al, 2013 ). These changes in gait characteristics increase the risk of falling ( Mohd Safee and Abu Osman, 2021 ) and localized tissue injury ( Kumar, 2001 ). Endurance is dependent on the intensity of muscle contractions ( West et al, 1995 ).…”

Section: Introductionmentioning

confidence: 99%

Characterization of muscle recruitment during gait of bilateral transfemoral and through-knee persons with limb loss

Benton

Amiri

Henson

et al. 2023

Front. Bioeng. Biotechnol.

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Introduction: Due to loss in musculoskeletal capacity, there is an increased burden on the residual limbs of bilateral transfemoral and through-knee persons with limb loss. This reduced capacity is associated with an increased cost of walking that is detrimental to functionality. Compensatory gait strategies are adopted by this population. However, how these strategies relate to specific muscle recruitment is not known. The primary aim of this study is to characterize muscle recruitment during gait of this population. The secondary aim is to assess whether the measured kinematics can be actuated when the endurance of specific muscles is reduced and if this is the case, which alternative muscles facilitate this.Methods: 3D gait data and high-resolution magnetic resonance images were acquired from six bilateral transfemoral and through-knee persons with limb loss. Subject-specific anatomical muscle models were developed for each participant, and a validated musculoskeletal model was used to quantify muscle forces in two conditions: during normal gait (baseline) and when muscles, which were identified as functioning above a “healthy” level at baseline, have a reduced magnitude of maximum force capacity (reduced endurance simulation). To test the hypothesis that there are differences in muscle forces between the baseline trials and the simulations with reduced muscular endurance, a Bonferroni corrected two-way ANOVA with repeated measures was completed between the two states.Results: The baseline analysis showed that the hip flexors experience relatively high muscle activations during gait. The reduced endurance simulation found two scenarios. First, for 5 out of the 12 simulations, the baseline kinematics could not be reproduced with the reduced muscular capacity. Second, for 7 out of 12 cases where the baseline kinematics were achieved, this was possible with compensatory increased activation of some muscles with similar functions (p ≤ 0.003).Discussion: Evidently, due to the loss of the ankle plantar flexors, gait imposes a high demand on the flexor muscle group of the residual limb. This study highlights how the elevated cost of gait in this population manifests in muscle recruitment. To enhance functionality, it is critical to consider the mechanical demand on the hip flexors and to develop rehabilitation interventions accordingly.

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Section: Introductionmentioning

confidence: 99%

Characterization of muscle recruitment during gait of bilateral transfemoral and through-knee persons with limb loss

Benton

Amiri

Henson

et al. 2023

Front. Bioeng. Biotechnol.

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Immersive virtual reality applied to the rehabilitation of patients with lower limb amputation: a small randomized controlled trial for feasibility study

Steckel,

Schwertner,

Bücker

et al. 2024

Virtual Reality

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Limb amputation significantly impacts the socioeconomic and health aspects of affected individuals, with clinical issues such as phantom limb pain (PLP), phantom limb telescopy (PLT), residual limb pain (RLP), and decreased balance necessitating improved treatments. Although interventions utilizing Immersive Virtual Reality (IVR) have been explored, conducting Randomized Clinical Trials (RCT) within this population presents challenges. This study serves as a feasibility study derived from a small RCT, aiming to investigate the effects of an IVR intervention protocol on individuals with lower limb amputation (LLA) while addressing methodological challenges and exploring alternative study designs. Participants were randomly assigned to either the Control Group (CG), receiving no intervention, or the Intervention Group (IG), undergoing 16 IVR sessions over 8 weeks, with twenty-one participants completing the protocol. Sessions involved observing physical exercises via a head-mounted display. All participants were assessed for pain and balance pre- and post-intervention. IG participants were also evaluated for pain, sense of presence in the virtual environment, and cybersickness on intervention days. Results indicated a significant negative correlation between RLP and time since amputation in the Intervention Group. Analysis of results between IG and CG post-assessment suggests potential benefits of IVR in improving balance and reducing PLT. Despite challenges related to sample size and participant retention, multicenter collaborations and home-based interventions are proposed to mitigate these limitations. This feasibility study lays a foundation for future research aiming to optimize VR interventions for improved outcomes in patients with LLA.

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Complications of major lower limb amputations before prosthetic provision at a tertiary care rehabilitation facility

Atallah,

Qureshi,

Nawaz

et al. 2024

Prosthetics &Amp; Orthotics International

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Background: Although postoperative complications of lower limb amputations and complications related to prosthetics are well known, complications before prosthetic fitting are less often emphasized in literature. There are no Saudi studies documenting the complications before prosthetic fitting where there is high rise in dysvascular amputation, and early prosthetic provision remains a challenge. Objectives: To investigate the complications following major lower limb amputations (MLLAs). Study design: Retrospective study. Methods: One hundred thirty-six electronic files for individuals with major lower limb amputations were reviewed. Individuals visiting the primary limb loss clinic for the first time, who have not been fitted with a prosthesis before, were included. Results: Muscle weakness was the most common complication (55.1%), followed by edema (52.9%), while infection was found to be the least frequent (5.1%). Age was significantly associated with etiology (p value < 0.001), usage of assistive device (p value = 0.002), and complications (p value = 0.013). Complications were also significantly associated with time since amputation (p value = 0.001). In addition, etiology was significantly associated with the usage of assistive device (p value = 0.012). Conclusions: Muscle weakness and edema were the most common complications after MLLA in a cohort of patients with median onset of 8.5 ± 6.8 months since amputation. Presence of various complications in MLLAs before prosthetic evaluation reflect gaps of care including delayed prosthetic evaluation. National strategies need to be introduced to promote early rehabilitation interventions, prevent complications, and improve quality of life of individuals with MLLAs.

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Effect of Lower Limb Muscle Fatigue on Fall Risk for Transfemoral Amputee: A Pilot Study

Cited by 3 publications

References 39 publications

Characterization of muscle recruitment during gait of bilateral transfemoral and through-knee persons with limb loss

Characterization of muscle recruitment during gait of bilateral transfemoral and through-knee persons with limb loss

Immersive virtual reality applied to the rehabilitation of patients with lower limb amputation: a small randomized controlled trial for feasibility study

Complications of major lower limb amputations before prosthetic provision at a tertiary care rehabilitation facility

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