Factors leading to falls in transfemoral prosthesis users: a case series of sound-side stumble recovery responses.
Factors leading to falls in transfemoral prosthesis users: a case series of sound-side stumble recovery responses.
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导致经股置换假肢使用者跌倒的因素：声侧趔趄恢复反应案例系列。
DOI：
10.1186/s12984-022-01070-y
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发表时间：
2022-09-23
影响因子：
5.1
通讯作者：
Goldfarb, Michael
中科院分区：
文献类型：
--
作者：
Eveld, Maura E.;King, Shane T.;Zelik, Karl E.;Goldfarb, Michael
股骨假体使用者的高坠落率与受伤风险、医疗费用和对坠落的恐惧有关。更好地了解跌倒情况(例如，参与者的年龄、假体类型、侧面绊倒和扰动的摆动阶段)如何影响经股动脉假体使用者，可以提供对反应缺陷的洞察，并为跌倒预防干预提供信息。6名单侧股动脉假体使用者在摆动早、中、晚三个阶段分别经历了患肢的障碍扰动。每种反应的跌倒结果、恢复策略和运动学都被记录下来，以表征(1)股骨头假体使用者的恢复与跌倒，(2)假体使用者的恢复与健康成人的恢复。在26次绊倒中，15次导致跌倒，6名股骨头假体使用者中有5名至少摔倒一次。相比之下，在之前发表的一项对7名健康成年人的研究中，使用相同的实验设备，包括214个绊倒，没有参与者摔倒。两个年龄最大的假体使用者每次跌倒后都会摔倒，摇摆中期的绊倒导致最多的跌倒，假体类型与策略/摔倒结果无关。康复的假体使用者在摆动早期采用抬起策略，在摆动后期采用下降策略，在摆动中期采用抬高或下降/延迟下降的策略，但与健康对照组相比，对侧(假体侧)大腿外展和躯干屈曲增加。如果被绊倒的(声音)肢体在抬起步骤中没有达到足够的大腿/膝盖屈曲以充分清除障碍物，或者如果假肢在最初的声音侧抬起或放下步骤后没有促进成功的台阶反应，就会发生跌倒。这样的反应通常导致较小的步长，较少的前脚定位，以及较高的躯干前屈/屈曲速度。引入训练(例如，肌肉力量或特定于任务的运动技能)和/或修改辅助设备(例如，下肢假体或外骨骼)可以改善经股动脉假体使用者的反应。具体地说，训练或外骨骼辅助可以帮助促进足够的大腿/膝关节屈曲以进行抬起；训练或假体辅助可以提供支撑-肢体抵消力矩以帮助抬起；训练或假体辅助可以帮助启动并安全地完成假体摆动。网上版载有补充材料，可在10.1186/s12984-022-01070-y查阅。
Transfemoral prosthesis users’ high fall rate is related to increased injury risk, medical costs, and fear of falling. Better understanding how stumble conditions (e.g., participant age, prosthesis type, side tripped, and swing phase of perturbation) affect transfemoral prosthesis users could provide insight into response deficiencies and inform fall prevention interventions. Six unilateral transfemoral prosthesis users experienced obstacle perturbations to their sound limb in early, mid, and late swing phase. Fall outcome, recovery strategy, and kinematics of each response were recorded to characterize (1) recoveries versus falls for transfemoral prosthesis users and (2) prosthesis user recoveries versus healthy adult recoveries. Out of 26 stumbles, 15 resulted in falls with five of six transfemoral prosthesis users falling at least once. By contrast, in a previously published study of seven healthy adults comprising 214 stumbles using the same experimental apparatus, no participants fell. The two oldest prosthesis users fell after every stumble, stumbles in mid swing resulted in the most falls, and prosthesis type was not related to strategy/fall outcomes. Prosthesis users who recovered used the elevating strategy in early swing, lowering strategy in late swing, and elevating or lowering/delayed lowering with hopping in mid swing, but exhibited increased contralateral (prosthetic-side) thigh abduction and trunk flexion relative to healthy controls. Falls occurred if the tripped (sound) limb did not reach ample thigh/knee flexion to sufficiently clear the obstacle in the elevating step, or if the prosthetic limb did not facilitate a successful step response after the initial sound-side elevating or lowering step. Such responses generally led to smaller step lengths, less anterior foot positioning, and more forward trunk flexion/flexion velocity in the resulting foot-strikes. Introducing training (e.g., muscle strength or task-specific motor skill) and/or modifying assistive devices (e.g., lower-limb prostheses or exoskeletons) may improve responses for transfemoral prosthesis users. Specifically, training or exoskeleton assistance could help facilitate sufficient thigh/knee flexion for elevating; training or prosthesis assistance could provide support-limb counteracting torques to aid in elevating; and training or prosthesis assistance could help initiate and safely complete prosthetic swing. The online version contains supplementary material available at 10.1186/s12984-022-01070-y.
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影响因子：
2.1
作者：
Kim, Janis;Major, Matthew J.;Sawers, Andrew
通讯作者：
Sawers, Andrew
影响因子：
2.2
作者：
Kim, Janis;McDonald, Cody L.;Sawers, Andrew
通讯作者：
Sawers, Andrew
影响因子：
1.5
作者：
Mundell, Benjamin;Kremers, Hilal Maradit;Kaufman, Kenton
通讯作者：
Kaufman, Kenton
影响因子：
9.2
作者：
Lenzi, Tommaso;Cempini, Marco;Kuiken, Todd
通讯作者：
Kuiken, Todd
DOI：
10.1682/jrrd.2007.04.0054
发表时间：
2008-01-01
影响因子：
--
作者：
Kahle, Jason T.;Highsmith, M. Jason;Hubbard, Sandra L.
通讯作者：
Hubbard, Sandra L.