Falls Sustained During Inpatient Rehabilitation After Lower Limb Amputation

Pauley, Tim; Devlin, Michael; Heslin, Kathleen

doi:10.1097/01.phm.0000219119.58965.8c

Cited by 71 publications

(93 citation statements)

References 26 publications

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“…People with a leg amputation have a greater risk of falling than the general public. The reported incidences of falls are 20% to 32% during rehabilitation [10,34] and 52% within the community [29]. The increased rate of falling in individuals with lower limb amputations is not surprising because they tend to perform very poorly on balance-related functional tests [7,8,49].…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…10,11,40,41 Older adults aged 85 and over with amputations may have different rehabilitation goals than those aged between 65 and 88 years. A study by von Faber et al 42 showed that older adults aged 85 and over value well-being and social functioning higher than physical or psychocognitive functioning.…”

Section: Discussionmentioning

confidence: 99%

“…One study found that 20% of service users were likely to have a fall following amputation, mostly occurring between 7 am and 3 pm, with 18% of those resulting in injury. 11 Moreover, the mean survival of older patients with lower limb amputations is very low ranging between two and five years. 12 Hence, it has been suggested that health professionals need to focus on early coordinated postamputation rehabilitation programmes to avoid risk of further deterioration and failure among older adults with amputations and increase longevity.…”

Section: Is Occupational Therapy Practice For Older Adults With Lowermentioning

confidence: 99%

Is occupational therapy practice for older adults with lower limb amputations evidence-based? A systematic review

Spiliotopoulou

Atwal

2012

Prosthetics &Amp; Orthotics International

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Background: Although occupational therapists are integral to the rehabilitation process of people with amputations, the effectiveness of the occupational therapy intervention for older adults with lower limb amputations has not been investigated. Objectives: To identify the effectiveness of the occupational therapy interventions with older adults aged 65 years and older with lower limb amputations. Study Design: Systematic review. Methods: A systematic search was conducted in CINAHL, PUBMED, OTSEEKER and OTDBASE from January 1985 to January 2011. The eligible papers were critiqued using a typology, which involved designation of levels of evidence and quality markers. Results: The databases yielded 2,664 potential publications. Of these, only two were included in the final review. These studies suggested that the frequency of the occupational therapy sessions was found to be statistically significantly related to prosthesis use and that service users perceived positive benefits about the provision of stump boards. Both studies had limitations resulting in a need for further investigation in these areas. Conclusion: Research evidence on the occupational therapy interventions with this population is limited and scarce. Occupational therapists need to take urgent action to address the identified evidence-based gaps in order to devise informed targeted rehabilitation programmes for this client group. Clinical relevanceThis systematic review has contributed to the understanding of the occupational therapy practice in the rehabilitation of older adults with lower limb amputations. It has highlighted gaps in evidence that occupational therapists need to address urgently in order to inform their rehabilitation programmes with this client group.

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“…tarafından yapılan çalışmada, 1267 ampute hastanın 260'ının en az bir kez düştüğü (%20,5) ve top- lam 374 düşmenin de 67 (%17,9)'sinin bir veya daha fazla sakatlanmayla sonuçlandığı bildirilmiştir. 13 Amputasyon rehabilitasyonu; hastanın optimal fonksiyonel kapasitesini yeniden kazandır-maya yönelik olarak, preoperatif dönemde başlayan ve postoperatif dönemde devam eden çalışmaların tümüdür. Bu dönem hastaya uygulanan çeşitli egzersizleri, mobilizasyon eğitimini, geçici ve kalıcı protez uygulamalarını içeren ve ayrıca hastada mevcut osteoartrit, osteoporoz, postür bozukluğu, kas-iskelet sistemi ağrıları gibi problem yaratan diğer durumları da değerlendiren bir süreçtir.…”

Section: Resi̇munclassified

A Challenging Case for Rehabilitation: Transfemoral Amputation, Femur Fracture and Complex Regional Pain Syndrome in a Patient with Stroke

Akselim¹,

Köseoğlu²,

Öken³

et al. 2016

Turkiye Klinikleri J Case Rep

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L iteratürde aynı hastada inme ve alt ekstremite amputasyonunun bir arada bulunması sık rastlanan bir durumdur. Bu iki komorbiditenin birlikteliğinin prevalansı %8,5-18 arasındadır. 1İnme için risk faktörü olan kontrolsüz diabetes mellitus (DM), hipertansiyon (HT), sigara ve hiperlipidemi, aynı zamanda kardiyak hastalıklar, alt ekstremite amputasyonu, periferik nöropati gibi diğer vasküler hastalıklar için de ortak risk faktörleridir. Bu nedenle vasküler etiyolojiye bağlı olarak ampute olmuş hastalarda; kardiyak hastalık, periferik damar hastalığı ve serebrovasküler olay (SVO) sonucu inme tablosuna sık rastlanabilmektedir. Beklenen yaşam süresinin artması ve ileri yaşa bağlı gelişen ortak risk faktörleri nedeni ile bu komorbiditelerin birlikteliğinde de artış beklenmektedir.

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Falls Sustained During Inpatient Rehabilitation After Lower Limb Amputation

Cited by 71 publications

References 26 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

Is occupational therapy practice for older adults with lower limb amputations evidence-based? A systematic review

A Challenging Case for Rehabilitation: Transfemoral Amputation, Femur Fracture and Complex Regional Pain Syndrome in a Patient with Stroke

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