Purpose To explore lived experiences, and identify common themes as well as vocabulary associated with fall-related events in lower limb prosthesis (LLP) users.Materials and methods Five focus groups of LLP users from across the United States were conducted remotely via video or tele-conferencing. Focus group transcripts were coded and analyzed using methods adapted from a grounded theory approach to identify themes.Results Focus group participants (n = 25) described experiences associated with fall-related events that resulted in the identification of six themes: (1) memories of fall-related events are shaped by time and context, (2) location and ground conditions influence whether falls occur, (3) some activities come with more risk, (4) fall-related situations are multi-faceted, and often involve the prosthesis, (5) how LLP users land, but not the way they go down, tends to vary, and (6) not all falls affect LLP users, but some near-falls do.Conclusion Consideration for where LLP users fall, what they are doing when they fall, how they fall, what occurs as a result of a fall, and how well memory of a fall persists may enhance recording and reporting of falls, contribute to development of improved fall risk assessment tools, and inspire the design and function of prosthetic componentry for patient safety.Implications for rehabilitationFalls are a common problem in lower limb prosthesis (LLP) users that can lead to adverse health outcomes.Concerns over near falls, not just falls, may merit greater attention from rehabilitation professionals.Elements of the lived experience that appear unique to LLP users include the role of prosthetic fit, function, and comfort in losing and/or recovering balance; as well as the tendency of LLP users to modify rather than stop or avoid activities associated with falls.
Individuals with stroke usually show reduced muscle activities of the paretic leg and asymmetrical gait pattern during walking.To determine whether applying a resistance force to the nonparetic leg would enhance the muscle activities of the paretic leg and improve the symmetry of spatiotemporal gait parameters in individuals with poststroke hemiparesis.Fifteen individuals with chronic poststroke hemiparesis participated in this study. A controlled resistance force was applied to the nonparetic leg using a customized cable-driven robotic system while subjects walked on a treadmill. Subjects completed 2 test sections with the resistance force applied at different phases of gait (ie, early and late swing phases) and different magnitudes (10%, 20%, and 30% of maximum voluntary contraction [MVC] of nonparetic leg hip flexors). Electromyographic (EMG) activity of the muscles of the paretic leg and spatiotemporal gait parameters were collected.Significant increases in integrated EMG of medial gastrocnemius, medial hamstrings, vastus medialis, and tibialis anterior of the paretic leg were observed when the resistance was applied during the early swing phase of the nonparetic leg, compared with baseline. Additionally, resistance with 30% of MVC induced the greatest level of muscle activity than that with 10% or 20% of MVC. The symmetry index of gait parameters also improved with resistance applied during the early swing phase.Applying a controlled resistance force to the nonparetic leg during early swing phase may induce forced use on the paretic leg and improve the spatiotemporal symmetry of gait in individuals with poststroke hemiparesis.
The purpose of this study was to examine the effects of combined pelvic corrective force and visual feedback during treadmill walking on paretic leg muscle activity and gait characteristics in individuals with post-stroke hemiparesis. Fifteen chronic stroke participants completed visual feedback only and combined pelvic corrective force and visual feedback conditions during treadmill walking. Each condition included: 1-minute baseline, 7-minute training with visual feedback only or additional pelvic corrective force, 1-minute post training, 1-minute standing break, and another 5-minute training. EMGs from the paretic leg muscles and step length were measured. Overground walking was evaluated before treadmill walking, immediately and 10 minutes after treadmill walking. Greater increases in integrated EMG of all muscles, except vastus medialis and tibialis anterior, were observed with the application of additional pelvic corrective force compared to visual feedback only during treadmill walking. Overground walking speed significantly increased after treadmill training with combined pelvic correction force and visual feedback, but was not significant for the visual feedback only condition. Voluntary weight shifting with additional pelvic corrective force enhanced paretic leg muscle activities and improved gait characteristics during walking. Individuals with post-stroke hemiparesis could adapt feedforward control and generalize the adaptation to overground walking.
Locomotor training using treadmill has been shown to elicit significant improvements in locomotor ability for some children with cerebral palsy (CP), the functional gains are relatively small and it requires greater involvement from a physical therapist. Current robotic gait training systems are effective in reducing the strenuous work of a physical therapist during locomotor training, but are less effective in improving locomotor function in some children with CP due to the limitations of the systems. Thus, a 3D cable-driven robotic gait training system was developed and tested in five children with CP through a 6 week of long-term gait training. Results indicated that both overground walking speed and 6 minute walking distance improved after robot assisted treadmill training through the cable-driven robotic system, and partially retained at 8 weeks after the end of training. Results from this pilot study indicated that it seems feasible to conduct locomotor training in children with CP through the 3D cable-driven robotic system.
To explore real-life experiences of people with osteoarthritis (OA) to increase understanding of how they perceive contributing factors to falls, circumstances at time of falls, and consequences of falls.Four focus groups of 3-7 people with OA from the Chicago, IL, USA, and neighboring areas were conducted remotely via web-based videoconferencing. Inclusion criteria included history of falls in previous 12 months and hip and/or knee OA. Focus group transcripts were coded and analyzed using a modified grounded theory approach to identify themes.Focus group participants (n = 17) described experiences associated with fall-related events that resulted in the identification of four themes: (1) perception of falls and fall risks can be influenced by OA symptoms, (2) ability to remember circumstances of falls are influenced by consequences, (3) behaviors and attitudes that address OA symptoms and avoidance of falls are similar and (4) OA symptoms and falls have common psychological impacts on lives.Our study highlights how people with OA define falls, perceive contributing factors to falls, and describe general and OA-related factors that contributed to their fall experiences. The shared experiences contributed to the creation of themes that represented various aspects of the circumstances and impact of falls. Consideration for the identified themes may enhance recording and reporting of falls, contribute to development of improved fall risk assessment tools, and prioritize research into the biopsychosocial effects of falls in people with OA.IMPLICATIONS FOR REHABILITATIONInformation about circumstances of a fall such as location, activity, and symptoms of osteoarthritis may be beneficial in creating tailored fall prevention training and education.Falls are a common problem for people with lower limb osteoarthritis that can lead to negative changes in activity and quality of life.The psychological impact of osteoarthritis symptoms may be contributing to fear of falling and decrease participation in daily activities.Awareness of the perceptions people with osteoarthritis have about their symptoms may provide educational and training opportunities to address the benefits of different therapeutic treatments.Awareness of perceptions people with osteoarthritis have about their risk of falling may provide educational and training opportunities to address the benefits of different therapeutic treatments.
Abstract Background More than 50% of lower limb prosthesis (LLP) users report falling at least once a year, placing them at high risk for adverse health outcomes such as decreased mobility and diminished quality of life. Efforts to decrease falls in LLP users have traditionally focused on developing clinical tests to assess fall risk, designing prosthetic components to improve patient safety, and identifying risk factors to recognize potential fallers. Little attention has been directed toward recording, reporting, and characterizing the circumstances of falls in LLP users. Identifying the most common types of falls could help guide and prioritize clinical and research needs. Objective To characterize the frequency and circumstances of falls reported by unilateral LLP users. Design Secondary analysis of data from 2 cross‐sectional studies. Setting Outpatient clinic and research laboratory. Participants Ambulatory unilateral transtibial and transfemoral LLP users (N = 66). Intervention None. Outcome A fall‐type classification framework was developed based on biomechanical theory and published falls terminology. Self‐reported falls and accompanying narrative descriptions of LLP users’ falls in the previous 12 months were analyzed with the framework. Frequencies, estimated proportions, and estimated counts were compared across fall circumstances using 95% confidence intervals. Results Thirty‐eight participants (57.6%) reported 90 falls during the previous year. All reported falls were successfully categorized using the proposed framework. Most falls occurred from disruptions to the base of support, intrinsic destabilizing factors, and a diverse set of fall patterns. Walking on level terrain was the most common activity at the time of a fall. Conclusion This secondary analysis showed that falls remain frequent in ambulatory LLP users and that clinicians and researchers might wish to prioritize falls owing to disruptions of the base of support that occur while walking. Additional research with a larger sample is required to confirm and expand these results. Level of Evidence III
To determine whether repeat exposure to force perturbations during treadmill training can induce long-term retention of improved step length and overall improvements in locomotor function in persons with spinal cord injury.Fourteen patients with spinal cord injury were recruited and randomly assigned to swing resistance or swing assistance training groups. A controlled swing resistance or assistance force, for resistance or assistance training groups, respectively, was applied to both legs through a cable-driven robotic system during treadmill training. Each participant trained 3 times per week for 6 weeks. Step length, walking speed, 6-minute walking distance, and other clinical assessments were evaluated before and after 6 weeks of training and 8 weeks after the end of training.A significant increase in step length was observed after 6 weeks of resistance training (P = 0.04). Step length tended to increase after assistance treadmill training, but the change was not significant (P = 0.18). The changes in step length and functional gains had no significant difference between 2 groups.Repeat exposure to swing resistance during treadmill training may induce a prolonged retention of increased step length, although it remains unclear whether swing resistance versus assistance is more effective in inducing increased step length.
The aim of the study was to determine whether applying an assistance force to the pelvis and legs during treadmill training can improve walking function in children with cerebral palsy.Twenty-three children with cerebral palsy were randomly assigned to the robotic or treadmill only group. For participants who were assigned to the robotic group, a controlled force was applied to the pelvis and legs during treadmill walking. For participants who were assigned to the treadmill only group, manual assistance was provided as needed. Each participant trained 3 times/wk for 6 wks. Outcome measures included walking speed, 6-min walking distance, and clinical assessment of motor function, which were evaluated before, after training, and 8 wks after the end of training, and were compared between two groups.Significant increases in walking speed and 6-min walking distance were observed after robotic training (P = 0.03), but no significant change was observed after treadmill training only. A greater increase in 6-min walking distance was observed after robotic training than that after treadmill only training (P = 0.01).Applying a controlled force to the pelvis and legs, for facilitating weight-shift and leg swing, respectively, during treadmill training may improve walking speed and endurance in children with cerebral palsy.Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) discuss the importance of physical activity at the participation level (sports programs) for children with cerebral palsy; (2) contrast the changes in walking ability and endurance for children in GMFCS level I, II and III following sports programs; and (3) identify the impact of higher frequency of sports program attendance over time on walking ability.Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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