Falls in Older Persons With Limb Loss
Condition: Amputation; Elderly
Study type: Observational

Summary: 
      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 and 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.
    

Detailed description: 
      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 two age- and gender-matched groups:
      1) older unilateral prosthesis users and 2) able-bodied controls.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Older ambulatory individuals with or without unilateral below-knee amputation
      
Keywords: Artificial Limbs; Amputation; Accidental Falls; Stability; Balance; Gait; Electromyography