Postural Sway in Lower Extremity Amputees and Older Adults May Suggest Increased Fall Risk in Amputees

Overview

Journal Can Prosthet Orthot J

Date 2023 Aug 24

PMID 37614402

Authors

H Bateni

Affiliations

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Abstract

Background: Falls can be detrimental to overall health and quality of life for lower extremity amputees. Most previous studies of postural steadiness focus on quantification of time series variables extracted from postural sway signals. While it has been suggested that frequency domain variables can provide more valuable information, few current studies have evaluated postural sway in amputees using frequency domain variables.

Methodology: Participants were assigned to 3 groups: lower extremity amputation (n=6), healthy young adults (n=10), and healthy older adults (n=10). Standing barefoot on a force platform, each individual completed 3 trials of each of 3 standing conditions: eyes open, eyes closed, and standing on a foam balance pad. Time and frequency domain variables of postural sway were computed and analyzed.

Results: Comparison of older adults, younger adults, and amputees on the three conditions of standing eyes open, eyes closed, and on foam revealed significant differences between groups. Mean mediolateral (ML) sway distance from the center of pressure (COP), total excursions and sway velocity was significantly higher for amputees and older adults when compared to young adults (p<0.05). Furthermore, power of sway signal was substantially lower for both amputees and older adults. When compared to that of older adults, postural steadiness of amputees was more affected by the eyes closed condition, whereas older adults' was more affected when sensory and proprioceptive information was perturbed by standing on foam.

Conclusion: Our findings showed that fall risk is greater in amputees than in young adults without amputation. Additionally, amputees may rely more heavily on visual information than proprioceptive information for balance, in contrast to older and young adults without amputation.

Citing Articles

Effect of transcranial magnetic stimulation on postural control of individuals with major depressive disorder: A case report.

Bateni H, Soltani E, Ali K, Zhou H, Shad M SAGE Open Med Case Rep. 2023; 11:2050313X231153757.

PMID: 36816824 PMC: 9932753. DOI: 10.1177/2050313X231153757.

References

Arifin N, Abu Osman N, Ali S, Wan Abas W . The effects of prosthetic foot type and visual alteration on postural steadiness in below-knee amputees. Biomed Eng Online. 2014; 13(1):23. PMC: 3975715. DOI: 10.1186/1475-925X-13-23. View

Grise M, 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. View

de Haart M, Geurts A, Huidekoper S, Fasotti L, van Limbeek J . Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study. Arch Phys Med Rehabil. 2004; 85(6):886-95. DOI: 10.1016/j.apmr.2003.05.012. View

Hilliard M, Martinez K, Janssen I, Edwards B, Mille M, Zhang Y . Lateral balance factors predict future falls in community-living older adults. Arch Phys Med Rehabil. 2008; 89(9):1708-13. PMC: 2953551. DOI: 10.1016/j.apmr.2008.01.023. View

Buckley J, ODriscoll D, Bennett S . Postural sway and active balance performance in highly active lower-limb amputees. Am J Phys Med Rehabil. 2002; 81(1):13-20. DOI: 10.1097/00002060-200201000-00004. View

Giacomini P, Sorace F, Magrini A, Alessandrini M . [Alterations in postural control: the use of spectral analysis in stability measurement]. Acta Otorhinolaryngol Ital. 1998; 18(2):83-7. View

Bateni H . Changes of postural steadiness following use of prefabricated orthotic insoles. J Appl Biomech. 2012; 29(2):174-9. DOI: 10.1123/jab.29.2.174. View

Felcher S, Stinner D, Krueger C, Wilken J, Gajewski D, Hsu J . Falls in a Young Active Amputee Population: A Frequent Cause of Rehospitalization?. Mil Med. 2015; 180(10):1083-6. DOI: 10.7205/MILMED-D-14-00450. View

MacBRIDE A, Rogers J, Whylie B, Freeman S . Psychosocial factors in the rehabilitation of elderly amputees. Psychosomatics. 1980; 21(3):258-61, 265. DOI: 10.1016/S0033-3182(80)73701-5. View

10.

Ku P, Abu Osman N, Wan Abas W . Balance control in lower extremity amputees during quiet standing: a systematic review. Gait Posture. 2013; 39(2):672-82. DOI: 10.1016/j.gaitpost.2013.07.006. View

11.

Tjon S, Geurts A, vant Pad Bosch P, Laan R, Mulder T . Postural control in rheumatoid arthritis patients scheduled for total knee arthroplasty. Arch Phys Med Rehabil. 2000; 81(11):1489-93. DOI: 10.1053/apmr.2000.9627. View

12.

Winter D, Prince F, Frank J, Powell C, Zabjek K . Unified theory regarding A/P and M/L balance in quiet stance. J Neurophysiol. 1996; 75(6):2334-43. DOI: 10.1152/jn.1996.75.6.2334. View

13.

Maki B, Holliday P, Topper A . A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J Gerontol. 1994; 49(2):M72-84. DOI: 10.1093/geronj/49.2.m72. View

14.

Sturnieks D, Delbaere K, Brodie M, Lord S . The influence of age, anxiety and concern about falling on postural sway when standing at an elevated level. Hum Mov Sci. 2016; 49:206-15. DOI: 10.1016/j.humov.2016.06.014. View

15.

Wong C, Chen C, Blackwell W, Rahal R, Benoy S . Balance ability measured with the Berg balance scale: a determinant of fall history in community-dwelling adults with leg amputation. J Rehabil Med. 2014; 47(1):80-6. DOI: 10.2340/16501977-1882. View

16.

Maurer C, Peterka R . A new interpretation of spontaneous sway measures based on a simple model of human postural control. J Neurophysiol. 2004; 93(1):189-200. DOI: 10.1152/jn.00221.2004. View

17.

Lafond D, Corriveau H, Hebert R, Prince F . Intrasession reliability of center of pressure measures of postural steadiness in healthy elderly people. Arch Phys Med Rehabil. 2004; 85(6):896-901. DOI: 10.1016/j.apmr.2003.08.089. View

18.

Miller W, Deathe A, 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. View

19.

Miller W, 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. View

20.

Duarte M, Sternad D . Complexity of human postural control in young and older adults during prolonged standing. Exp Brain Res. 2008; 191(3):265-76. DOI: 10.1007/s00221-008-1521-7. View