Gait speed as an indicator of prosthetic walking potential following lower limb amputation

Background: The relationship between gait speed and prosthetic potential (K-level classifications) and function has not been explored among people transitioning from hospital rehabilitation to the community. Objectives: To examine gait speed at discharge from inpatient rehabilitation among people prescribed a prosthetic leg after unilateral lower limb amputation, and associations between gait speed, prosthetic potential and functional ability. Study design: Cohort. Methods: Gait speed (10-m walk test), K-level (Amputee Mobility Predictor) and Functional Independence Measure motor were compared for 110 people (mean (standard deviation) age: 63 (13) years, 77% male, 71% transtibial amputation, 70% dysvascular causes). Results: Median (interquartile range) gait speed and Functional Independence Measure motor were 0.52 (0.37–0.67) m/s and 84 (81, 85), respectively. Median (IQR) gait speed scores for each K-level were as follows: K1 = 0.17 (0.15–0.19) m/s, K2 = 0.38 (0.25–0.54) m/s, K3 = 0.63 (0.50–0.71) m/s and K4 = 1.06 (0.95–1.18) m/s. Median (IQR) FIM-Motor scores for each K-level were as follows: K1 = 82 (69–84), K2 = 83 (79–84), K3 = 85 (83–87) and K4 = 87 (86–89). Faster gait speed was associated with higher K-level, higher FIM-Motor, being younger, male and having transtibial amputation with nonvascular aetiology. Conclusion: Gait speed was faster among each higher K-level classification. However, gait speeds observed across all K-levels were slower than healthy populations, consistent with values indicating high risk of morbidity and mortality. Clinical relevance Factors associated with faster gait speed are useful for clinical teams considering walking potential of people with lower limb prostheses and those seeking to refine prosthetic rehabilitation programmes.

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Demographics and discharge outcomes of dysvascular and non-vascular lower limb amputees at a subacute rehabilitation unit: a 7-year series

Australian Health Review ◽

10.1071/ah14042 ◽

2015 ◽

Vol 39 (1) ◽

pp. 76 ◽

Cited By ~ 6

Author(s):

Heather R. Batten ◽

Suzanne S. Kuys ◽

Steven M. McPhail ◽

Paulose N. Varghese ◽

Jennifer C. Nitz

Keyword(s):

Length Of Stay ◽

Lower Limb ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Community Services ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Discharge Outcomes ◽

Social Demographics ◽

Lower Limb Amputees

Objective To examine personal and social demographics, and rehabilitation discharge outcomes of dysvascular and non-vascular lower limb amputees. Methods In total, 425 lower limb amputation inpatient rehabilitation admissions (335 individuals) from 2005 to 2011 were examined. Admission and discharge descriptive statistics (frequency, percentages) were calculated and compared by aetiology. Results Participants were male (74%), aged 65 years (s.d. 14), born in Australia (72%), had predominantly dysvascular aetiology (80%) and a median length of stay 48 days (interquartile range (IQR): 25–76). Following amputation, 56% received prostheses for mobility, 21% (n = 89) changed residence and 28% (n = 116) required community services. Dysvascular amputees were older (mean 67 years, s.d. 12 vs 54 years, s.d. 16; P < 0.001) and recorded lower functional independence measure – motor scores at admission (z = 3.61, P < 0.001) and discharge (z = 4.52, P < 0.001). More non-vascular amputees worked before amputation (43% vs 11%; P < 0.001), were prescribed a prosthesis by discharge (73% vs 52%; P < 0.001) and had a shorter length of stay (7 days, 95% confidence interval: –3 to 17), although this was not statistically significant. Conclusions Differences exist in social and demographic outcomes between dysvascular and non-vascular lower limb amputees. What is known about the topic? Lower limb amputation occurs due to various aetiologies. What does this paper add? Lower limb amputee rehabilitation over 7 years was investigated, comprising 425 admissions, 80% due to dysvascular aetiology. Personal and social demographics, and discharge outcomes are compared by aetiology. What are the implications for practitioners? Demographic and discharge outcome differences exist between dysvascular and non-vascular lower limb amputees. Twenty-one percent were required to change residence and 28% required additional social supports. Discharge planning should begin as soon as possible to limit time spent waiting for new accommodation or major modifications for current homes. Lower limb amputees are not homogeneous, so care should be taken if extrapolating from combined amputee aetiologies or from one aetiology to another.

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Are people with lower limb amputation changing? A seven-year analysis of patient characteristics at admission to inpatient rehabilitation and at discharge

Disability and Rehabilitation ◽

10.1080/09638288.2018.1492033 ◽

2018 ◽

Vol 41 (26) ◽

pp. 3203-3209

Author(s):

Heather Batten ◽

Suzanne Kuys ◽

Steven McPhail ◽

Paulose Varghese ◽

Allison Mandrusiak

Keyword(s):

Lower Limb ◽

Inpatient Rehabilitation ◽

Patient Characteristics ◽

Lower Limb Amputation ◽

Limb Amputation

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The Relationship Between Vestibular Sensory Integration and Prosthetic Mobility in Community Ambulators With Unilateral Lower Limb Amputation

Physical Therapy ◽

10.1093/ptj/pzaa091 ◽

2020 ◽

Author(s):

Jennifer Lučarević ◽

Ignacio Gaunaurd ◽

Sheila Clemens ◽

Paulina Belsky ◽

Lauren Summerton ◽

...

Keyword(s):

Lower Limb ◽

Sensory Integration ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Clinical Test ◽

Timed Up And Go ◽

Convenience Sample ◽

The Relationship ◽

Step Turn ◽

Degree Step

Abstract Objective The modified Clinical Test of Sensory Interaction and Balance (mCTSIB) is used to clinically assess vestibular sensory integration (VSI), the process by which the central nervous system integrates vestibular afference to maintain balance. The rate and effects of impaired VSI (IVSI) on prosthetic mobility in people with lower limb amputation (LLA) is unknown. The objective of this study was to use the mCTSIB to classify VSI in active community ambulators with LLA and to examine the relationship between IVSI and prosthetic mobility, as measured by the Component Timed Up and Go (cTUG) test. Methods This was a cross-sectional study with a convenience sample of 130 community ambulators with unilateral LLA. Classification of VSI was determined based on a time-based pass/fail mCTSIB performance. Participants were classified as having normal sensory integration (NSI) if they could balance for 30 seconds in every mCTSIB condition. Participants who failed condition 4 exclusively were classified as IVSI. Prosthetic mobility, as measured by the cTUG, was compared between NSI and IVSI groups. Results Of the 130 participants, 29 (22%) were classified as IVSI and 95 (73%) were classified as having NSI. Prosthetic mobility significantly differed between IVSI and NSI groups, with IVSI participants performing all components of the cTUG significantly slower. Medium to large effect sizes were found between groups during cTUG. Conclusions These results suggest that 1 in 5 community ambulators with LLA have IVSI, with associated limitations in balance confidence and prosthetic mobility. Impact The ability to integrate vestibular information was found to have a strong relationship with prosthetic mobility in active community ambulators with LLA, especially with performing a 180-degree step turn. Physical therapists can use the mCTSIB to classify sensory integration during prosthetic rehabilitation and develop an appropriate balance intervention. Lay Summary Active adults with LLA can use information from their senses to maintain their standing balance. Adults with LLA who have difficulty balancing on foam with closed eyes were slower to get in and out of a chair, walk, and perform a 180-degree step turn.

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Relationship between upper limb motor function and activities of daily living after removing the influence of lower limb motor function in subacute patients with stroke: A cross-sectional study

Hong Kong Journal of Occupational Therapy ◽

10.1177/1569186120926609 ◽

2020 ◽

pp. 156918612092660

Author(s):

Haruka Yamamoto ◽

Kazuya Takeda ◽

Soichiro Koyama ◽

Keisuke Morishima ◽

Yuichi Hirakawa ◽

...

Keyword(s):

Activities Of Daily Living ◽

Motor Function ◽

Upper Limb ◽

Lower Limb ◽

Daily Living ◽

Functional Independence Measure ◽

Functional Independence ◽

Motor Score ◽

Cross Sectional ◽

The Relationship

Background Previous studies have reported a relationship between upper limb motor function and activities of daily living. However, their relationship after removing the influence of lower limb motor function has not been clarified. Objective This study aimed to investigate the relationship between Fugl-Meyer assessment upper limb and total Functional Independence Measure motor score and between Fugl-Meyer assessment upper limb and each item contained in Functional Independence Measure motor score after eliminating the influence of the motor function of the affected lower limb. Methods This retrospective cross-sectional study included 58 subacute stroke patients. To investigate the relationship between the Fugl-Meyer assessment upper limb and total Functional Independence Measure motor score before and after removing the influence of Fugl-Meyer assessment lower limb, Spearman’s rank correlation coefficient and partial correlation analysis were used. Additionally, the relationship between Fugl-Meyer assessment upper limb and each item of Functional Independence Measure motor score after removing the influence was assessed. Results Before removing the influence of Fugl-Meyer assessment lower limb, Fugl-Meyer assessment upper limb was strongly correlated with total Functional Independence Measure motor score (r = 0.74, p < 0.001). However, it became weak after removing the influence (r = 0.27, p = 0.04). Regarding each item of Functional Independence Measure motor score, Fugl-Meyer assessment upper limb was correlated with grooming (r = 0.27, p = 0.04), bathing (r = 0.28, p = 0.03), dressing upper body (r = 0.33, p = 0.01), dressing lower body (r = 0.31, p = 0.02), and stair-climbing (r = 0.31, p = 0.02) after removing the influence. Conclusion These findings suggest that the relationship between the upper limb motor function and activities of daily living is strongly influenced by lower limb motor function.

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Prognostic Differences for Functional Recovery After Major Lower Limb Amputation: Effects of the Timing and Type of Inpatient Rehabilitation Services in the Veterans Health Administration

PM&R ◽

10.1016/j.pmrj.2010.01.012 ◽

2010 ◽

Vol 2 (4) ◽

pp. 232-243 ◽

Cited By ~ 26

Author(s):

Margaret G. Stineman ◽

Pui L. Kwong ◽

Dawei Xie ◽

Jibby E. Kurichi ◽

Diane Cowper Ripley ◽

...

Keyword(s):

Functional Recovery ◽

Lower Limb ◽

Inpatient Rehabilitation ◽

Veterans Health Administration ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Rehabilitation Services ◽

Veterans Health ◽

Health Administration

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Predicting prosthetic use in elderly patients after major lower limb amputation

Prosthetics and Orthotics International ◽

10.1177/0309364611430885 ◽

2012 ◽

Vol 36 (1) ◽

pp. 45-52 ◽

Cited By ~ 24

Author(s):

Monica Spruit- van Eijk ◽

Harmen van der Linde ◽

Bianca Buijck ◽

Alexander Geurts ◽

Sytse Zuidema ◽

...

Keyword(s):

Elderly Patients ◽

Lower Limb ◽

Geriatric Patients ◽

Lower Limb Amputation ◽

Skilled Nursing Facilities ◽

Limb Amputation ◽

Phantom Pain ◽

Nursing Facilities ◽

Transtibial Amputation ◽

Skilled Nursing

Background: The main determinants of prosthetic use known from literature apply to the younger patient with lower limb amputation. Studies aimed at identifying determinants of outcome of lower limb amputation in elderly patients with multimorbidity that rehabilitate in skilled nursing facilities (SNFs) are scarce. Objectives: To predict prosthetic use and physical mobility in geriatric patients admitted to SNFs for rehabilitation after lower limb amputation and the impact of multimorbidity. Study Design: Prospective design. Methods: Univariate and multivariate logistic and linear regression analyses were used to identify determinants that were independently related to prosthetic use and the timed-up-and-go test (TUG test). Results: Of 55 eligible patients, 38 had complete assessments on admission and at discharge. Fifty per cent was provided with a prosthesis. Multimorbidity was present in 53% of the patients. Being able to ambulate independently, and having a transtibial amputation (rather than a higher level of amputation), without phantom pain determined prosthetic use (R2=56%), while cognitive abilities, low amputation level, and pre-operative functional abilities were independently associated with the TUG test (R2=82%). Conclusions: Elderly patients referred to an SNF for prosthetic training have a high probability of using a prosthesis when having an independent ambulation after transtibial amputation, without phantom pain. These patients should be considered for prosthetic training. Clinical relevance This study gives more insight into the outcomes of geriatric patients with lower limb amputation after rehabilitation in skilled nursing facilities. This is the first study that focuses on determinants of prosthetic use in these elderly patients, often with multimorbidity.

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