Falls in Older Persons With Limb Loss
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 65 - 85 |
| Updated: | 3/17/2019 |
| Start Date: | February 2, 2017 |
| End Date: | March 31, 2020 |
| Contact: | Matthew J Major, PhD |
| Email: | Matthew.Major2@va.gov |
| Phone: | (312) 569-6166 |
Sensory-Motor Mechanisms Underlying Fall Risk in Transtibial Amputees
Lower limb prosthesis users are known to be at a substantially increased fall risk compared
to able-bodied individuals. The interaction between increased fall risk, reduced balance
confidence and high prevalence of a fear of falling often leads to restricted mobility and
loss of independence. Critically, the cause of these falls and the role that inherent balance
plays in fall risk is poorly understood. This study proposes to identify key differences in
balance and mobility between older below-knee prosthesis users who have fallen twice or more
in the past 12 months and those who have fallen once or less, and compare both groups to data
from able-bodied individuals. By further understanding the differences between these groups
and relationships between fall risk and various outcome measures, intervention techniques can
be developed to improve functional balance. An improvement in upright balance will reduce the
occurrence of falls and fall related injuries in this veteran population, as well as increase
their participation in daily activities and improve their quality of life.
to able-bodied individuals. The interaction between increased fall risk, reduced balance
confidence and high prevalence of a fear of falling often leads to restricted mobility and
loss of independence. Critically, the cause of these falls and the role that inherent balance
plays in fall risk is poorly understood. This study proposes to identify key differences in
balance and mobility between older below-knee prosthesis users who have fallen twice or more
in the past 12 months and those who have fallen once or less, and compare both groups to data
from able-bodied individuals. By further understanding the differences between these groups
and relationships between fall risk and various outcome measures, intervention techniques can
be developed to improve functional balance. An improvement in upright balance will reduce the
occurrence of falls and fall related injuries in this veteran population, as well as increase
their participation in daily activities and improve their quality of life.
Previous studies have shown that persons with transtibial amputations (TTA) are at a
substantially increased risk of falling as compared to able-bodied age-matched controls and
have reduced confidence in their balance, both contributing to their restricted mobility and
daily activity. This risk increases with progressing age, as aging affects musculoskeletal
and somatosensory systems that are vital to controlling upright balance (i.e., maintaining
the body center-of-mass (BCoM) within the limits of the base-of-support) and are already
compromised in persons with TTA. An important consequence of elevated fall incidence is an
increased risk of fall-related injuries that may lead to lost participation and independence.
The effects of reduced sensory-motor function on upright balance in older adults has been
extensively studied and led to development of effective assessment tools and intervention
strategies to minimize fall risk. However, the dearth of similar studies and relatively poor
understanding of the effects of additional complications from TTA on upright balance have
significantly hampered progress towards addressing this important concern for Veterans with
TTA. Consequently, this limits knowledge of predictive factors of falls among these
prosthesis users and for informing therapeutic interventions that enhance functional balance.
Therefore, the primary objective of this research is to develop an improved understanding of
the sensory-motor mechanisms underlying upright balance and fall risk in older Veterans with
TTA. The proposed study will compare differences between three age- and gender-matched
groups: 1) amputees who reported two or more falls in the past 12 months, 2) amputee controls
(one fall or less in the past 12 months), and 3) able-bodied controls.
substantially increased risk of falling as compared to able-bodied age-matched controls and
have reduced confidence in their balance, both contributing to their restricted mobility and
daily activity. This risk increases with progressing age, as aging affects musculoskeletal
and somatosensory systems that are vital to controlling upright balance (i.e., maintaining
the body center-of-mass (BCoM) within the limits of the base-of-support) and are already
compromised in persons with TTA. An important consequence of elevated fall incidence is an
increased risk of fall-related injuries that may lead to lost participation and independence.
The effects of reduced sensory-motor function on upright balance in older adults has been
extensively studied and led to development of effective assessment tools and intervention
strategies to minimize fall risk. However, the dearth of similar studies and relatively poor
understanding of the effects of additional complications from TTA on upright balance have
significantly hampered progress towards addressing this important concern for Veterans with
TTA. Consequently, this limits knowledge of predictive factors of falls among these
prosthesis users and for informing therapeutic interventions that enhance functional balance.
Therefore, the primary objective of this research is to develop an improved understanding of
the sensory-motor mechanisms underlying upright balance and fall risk in older Veterans with
TTA. The proposed study will compare differences between three age- and gender-matched
groups: 1) amputees who reported two or more falls in the past 12 months, 2) amputee controls
(one fall or less in the past 12 months), and 3) able-bodied controls.
Inclusion Criteria:
Inclusion criteria for the recruitment of subjects with below knee amputation include:
- Transtibial amputation
- Daily use of their clinically-prescribed prosthesis for ambulation without an
assistive device
- Classified as Medicare Functional Classification Level K2- defined as a patient who
"has the ability or potential for ambulation with the ability to traverse low-level
environmental barriers such as curbs, stairs, or uneven surfaces - a typical community
ambulator"
- Experience walking with a prosthesis for at least one year
- Residuum and amputated side in good condition (e.g., no adherent scars, lesions,
ulcers, infections)
- Normal or corrected vision
- Able to walk a 10 m distance and stand quietly for 40 seconds without undue fatigue or
health risk
Inclusion criteria for the recruitment of able-bodied controls include:
- Normal or corrected vision
- Able to walk a 10 m distance and stand quietly for 40 seconds without undue fatigue or
health risk
- Suffered one or no falls in the previous 12 months
Exclusion Criteria:
Exclusion criteria for all recruited subjects (i.e., limb loss and control) include:
- Musculoskeletal (apart from amputation in the case of amputee subjects) and/or
vestibular pathologies that would affect balance and/or stability
- Currently on medication that might affect proprioception and/or balance (e.g., drugs
that are ototoxic, such as certain Aminoglycosides and pain killers)
- Cognitive deficits that preclude understanding of the instructions required to conduct
the test
We found this trial at
1
site
Chicago, Illinois 60612
Principal Investigator: Matthew J. Major, PhD
Phone: 312-569-6166
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