The relationship of hip strength to walking and balance performance in unilateral lower limb prosthesis users differs by amputation level.

Background: Safe and efficient locomotion is a frequently stated goal of lower limb prosthesis users, for which hip strength may play a central yet poorly understood role. Additional research to identify associations between hip strength, balance, and mobility among transtibial and transfemoral prosthesis users is required.

Objective: To test whether residual and/or intact limb isometric hip strength was associated with lower limb prosthesis users' walking speed, endurance, and balance.

Evaluating fall event definitions relative to lower limb prosthesis users' lived experiences.

Purpose: Evaluate specific elements of previously proposed fall and near-fall definitions to determine whether they fully capture lower limb prosthesis (LLP) users' lived experiences.

Methods: Semi-structured interviews were conducted with 24 LLP users. Interview transcripts were reviewed, coded, and analyzed using deductive thematic analysis to identify shared experiences and inform revisions to previously reported definitions.

Falls perceived as significant by lower limb prosthesis users are generally associated with fall consequences rather than circumstances.

Purpose: To determine if falls perceived as significant by lower limb prosthesis (LLP) users were associated with fall circumstances and/or consequences.

Materials And Methods: The circumstances and consequences of LLP users' most significant fall in the past 12-months were collected using the Lower Limb Prosthesis User Fall Event Survey. Participants rated fall significance from 0 (not significant) to 10 (extremely significant), which was then dichotomized into "low" and "high".

Age, Cognitive Task, and Arm Position Differently Affect Muscle Synergy Recruitment but have Similar Effects on Walking Balance.

Age modifies walking balance and neuromuscular control. Cognitive and postural constraints can increase walking balance difficulty and magnify age-related differences. However, how such challenges affect neuromuscular control remains unknown.

After scaling to body size hip strength of the residual limb exceeds that of the intact limb among unilateral lower limb prosthesis users.

Background: Hip muscles play a prominent role in compensating for the loss of ankle and/or knee muscle function after lower limb amputation. Despite contributions to walking and balance, there is no consensus regarding hip strength deficits in lower limb prosthesis (LLP) users. Identifying patterns of hip muscle weakness in LLP users may increase the specificity of physical therapy interventions (i.

The number of falls recalled in the past year and balance confidence predict the frequency of injurious falls by unilateral lower limb prosthesis users.

Introduction: Several personal characteristics have been associated with an increased risk of injurious falls by lower limb prosthesis (LLP) users. To date, however, none have been used to effectively predict the occurrence of injurious falls.

Objective: To develop a model that could predict the number of injurious falls over the next 6 months and identify fall-related circumstances that may increase the odds of a fall being injurious in unilateral LLP users.

A survey for characterizing details of fall events experienced by lower limb prosthesis users.

Despite their importance to fall prevention research, little is known about the details of real-world fall events experienced by lower limb prosthesis users. This gap can be attributed to the lack of a structured, population-specific fall survey to document these adverse health events. The objective of this project was to develop a survey capable of characterizing the circumstances and consequences of fall events in lower limb prosthesis users.

Direction of attentional focus in prosthetic training: Current practice and potential for improving motor learning in individuals with lower limb loss.

Objective: Adopting an external focus of attention has been shown to benefit motor performance and learning. However, the potential of optimizing attentional focus for improving prosthetic motor skills in lower limb prosthesis (LLP) users has not been examined. In this study, we investigated the frequency and direction of attentional focus embedded in the verbal instructions in a clinical prosthetic training setting.

Normalization alters the interpretation of hip strength in established unilateral lower limb prosthesis users.

Background: Valid comparisons of muscle strength between individuals or legs that differ in size requires normalization, often by simple anthropometric variables. Few studies of muscle strength in lower-limb prosthesis users have normalized strength data by any anthropometric variable, potentially confounding our understanding of strength deficits in lower-limb prosthesis users. The objective of this pilot study was to determine the need for as well as effectiveness and impact of normalizing hip strength in lower-limb prosthesis users.

Beam width and arm position but not cognitive task affect walking balance in older adults.

Detection of changes in dynamic balance could help identify older adults at fall risk. Walking on a narrow beam with its width, cognitive load, and arm position manipulated could be an alternative to current tests. Therefore, we examined additive and interactive effects of beam width, cognitive task (CT), and arm position on dynamic balance during beam walking in older adults.

Recalled Number of Falls in the Past Year-Combined With Perceived Mobility-Predicts the Incidence of Future Falls in Unilateral Lower Limb Prosthesis Users.

Objective: Falls are a frequent and costly concern for lower limb prosthesis (LLP) users. At present, there are no models that clinicians can use to predict the incidence of future falls in LLP users. Assessing who is at risk for falls, therefore, remains a challenge.

Performance-based balance tests, combined with the number of falls recalled in the past year, predicts the incidence of future falls in established unilateral transtibial prosthesis users.

Background: Falls are common and consequential events for lower limb prosthesis (LLP) users. Currently, there are no models based on prospective falls data that clinicians can use to predict the incidence of future falls in LLP users. Assessing who is at risk for falls, and thus most likely to need and benefit from intervention, remains a challenge.

Fall-related events in people who are lower limb prosthesis users: the lived experience.

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 video or tele-conferencing. Focus group transcripts were coded and analyzed using methods adapted from a grounded theory approach to identify themes.

Characterizing Practice Effects in Performance-Based Tests Administered to Users of Unilateral Lower Limb Prostheses: A Preliminary Study.

Background: Performance-based tests are viewed as a gold standard for measuring physical capability. Practice effects, however, may threaten their predictive, discriminative, and evaluative applications. Despite these potential consequences, practice effects have received limited attention in users of lower limb prostheses (LLP).

Generalization of motor module recruitment across standing reactive balance and walking is associated with beam walking performance in young adults.

Background: Recent studies provide compelling evidence that recruiting a common pool of motor modules across behaviors (i.e., motor module generalization) may facilitate motor performance.

Older adults reduce the complexity and efficiency of neuromuscular control to preserve walking balance.

Healthy aging modifies neuromuscular control of dynamic balance. Challenging tasks could amplify such modifications, providing clinical insights. We examined the effects of age and walking condition difficulty on neuromuscular control of walking balance.

Strength deficits in lower limb prosthesis users: A scoping review.

Background: Strength deficits may play a central role in the severity of balance, mobility, and endurance impairments in lower limb prosthesis users. A body of literature detailing the scope and specifics of muscle weakness in lower limb prosthesis users is emerging, but has yet to be summarized. A synopsis of strength deficits, and their impact on functional abilities in lower limb prosthesis users, may inform rehabilitation and research needs.

Interrater and Test-Retest Reliability of Performance-Based Clinical Tests Administered to Established Users of Lower Limb Prostheses.

Objective: A major barrier to reducing falls among users of lower limb prostheses (LLP) has been an absence of statistical indices required for clinicians to select and interpret scores from performance-based clinical tests. The study aimed to derive estimates of reliability, measurement error, and minimal detectable change values in performance-based clinical tests administered to unilateral LLP users.

Methods: A total of 60 unilateral LLP users were administered the Narrowing Beam Walking Test, Timed ``Up and Go'' (TUG), Four Square Step Test (FSST), and 10-Meter Walk Test on 2 occasions, 3 to 9 days apart.

Ensuring accurate estimates of step width variability during treadmill walking requires more than 400 consecutive steps.

Falls to the side are associated with significant morbidity, including increased risk of hip and radius fracture. Although step width variability, as measured by standard deviation, has been hypothesized to be associated with falls to the side, there is little supporting evidence. The extent to which such a relationship could be reliably established, however, is dependent on the accuracy with which step width, and thus step width variability, is measured.

Conventional administration and scoring procedures suppress the diagnostic accuracy of a performance-based test designed to assess balance ability in lower limb prosthesis users.

Background: Practice effects have been observed among performance-based clinical tests administered to prosthesis-users. Their impact on test applications remains unknown.

Objective: To determine whether scoring a clinical balance test using conventional procedures that do not accommodate practice effects reduces its diagnostic accuracy relative to scoring it using recommended procedures that do accommodate practice effects.

Using Clinical Balance Tests to Assess Fall Risk among Established Unilateral Lower Limb Prosthesis Users: Cutoff Scores and Associated Validity Indices.

Background: Clinicians are routinely required to make decisions about fall risk among lower limb prosthesis (LLP) users. These decisions can be guided by standardized clinical balance tests but require population- and test-specific cutoff scores and validity indices to categorize individuals as probable fallers or nonfallers on the basis of test performance. Despite the importance of cutoff scores and validity indices to clinical interpretation of clinical balance test scores, they are rarely reported for LLP users.

Frequency and Circumstances of Falls Reported by Ambulatory Unilateral Lower Limb Prosthesis Users: A Secondary Analysis.

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.

Neuromuscular determinants of slip-induced falls and recoveries in older adults.

Is there a neuromuscular basis for falls? If so, it may provide new insight into falls and their assessment and treatment. We hypothesized that falls and recoveries from a laboratory-induced slip would be characterized by differences in multimuscle coordination patterns. Using muscle synergy analysis, we identified different multimuscle coordination patterns between older adults who fell and those who recovered from a laboratory-induced "feet-forward" slip.

Validation of the Narrowing Beam Walking Test in Lower Limb Prosthesis Users.

Objective: To evaluate the content, construct, and discriminant validity of the Narrowing Beam Walking Test (NBWT), a performance-based balance test for lower limb prosthesis users.

Design: Cross-sectional study.

Setting: Research laboratory and prosthetics clinic.