Prasath Jayakaran

Instrumented Measurement of Balance and Postural Control in Individuals with Lower Limb Amputation: A Critical Review.

Measurement of balance and postural performance that underpins activities of daily living is important in the rehabilitation of individuals with a lower limb amputation (LLA), and there are a number of methods and strategies available for this purpose. To provide an evidence-based choice of approach, this review aims to critically review the tasks and outcome measures utilized in studies investigating static and dynamic balance using instrumented measurement devices in individuals with a LLA. A systematic search was conducted on multiple databases using keyword or subject headings appropriate to the respective database. Articles investigating static or dynamic balance in adults with LLA by means of instrumented measures were considered for the review. A total of 21 articles were included in the review. The static balance ability of individuals with an LLA has been investigated thoroughly, but their dynamic balance attributes remain relatively unexplored. Although the individual studies do provide valuable information on balance ability in the LLA, the heterogeneity in study designs and measures did not allow an overall analysis of the tasks and the outcome measures used. On the basis of these findings, this review provides an insight into the measurement of balance in amputees to inform novice researchers and clinicians working with individuals with an LLA.

Test-Retest Reliability of the Sensory Organization Test in Older Persons With a Transtibial Amputation

To determine the test‐retest reliability of the Sensory Organization Test (SOT) in older persons with a unilateral transtibial amputation.

Influence of a Walking Aid on Temporal and Spatial Parameters of Gait in Healthy Adults

To determine the effect of using a walking aid on temporal and spatial parameters of gait when used for balance versus support on the dominant and nondominant hand side.

Postural Control in Response to Altered Sensory Conditions in Persons With Dysvascular and Traumatic Transtibial Amputation

OBJECTIVE To compare the postural control of persons with a dysvascular transtibial amputation and traumatic transtibial amputation with able-bodied adults with and without a dysvascular condition in altered sensory testing conditions. DESIGN Cross-sectional study. SETTING University balance clinic. PARTICIPANTS The study participants (N=35) included: participants with a dysvascular transtibial amputation (n=9), participants with a traumatic transtibial amputation (n=9), age-matched able-bodied adults without a dysvascular condition (n=9), and able-bodied adults with a dysvascular condition (n=8). INTERVENTIONS Six Sensory Organization Test (SOT) conditions, which included standing with eyes open (condition 1) and closed (condition 2) on a static force platform with visual surround; standing with eyes open on a static force platform with movable visual surround (condition 3); standing with eyes open (condition 4) and closed (condition 5) on a movable force platform with static visual surround; and standing with eyes open on a movable force platform with movable visual surround (condition 6). MAIN OUTCOME MEASURES Bilateral anteroposterior (AP) and mediolateral (ML) center of pressure variables, namely root mean square distance (RMSD) and mean velocity (mVel), for each of the 6 SOT conditions. RESULTS The dysvascular transtibial amputation group demonstrated a higher AP RMSD (P≤.04) on the sound side than did the able-bodied adults without a dysvascular condition and the able-bodied adults with a dysvascular condition in SOT conditions 1 and 2, respectively. Both the dysvascular transtibial amputation group and the traumatic transtibial amputation group demonstrated a higher AP RMSD (P≤.002) than the able-bodied adults without a dysvascular condition in SOT conditions 3 and 4. The dysvascular transtibial amputation group showed higher AP mVel (P≤.002) on the sound side for SOT conditions 2 and 3, whereas both amputation groups showed higher AP mVel for SOT conditions 1 and 4 than the able-bodied adults with and without a dysvascular condition. CONCLUSIONS Postural control of the dysvascular transtibial amputation group was not different than the traumatic transtibial amputation group in challenging sensory conditions. However, when compared with the groups of able-bodied adults with and without a dysvascular condition, postural strategies distinct with amputation etiology were observed.

Turning performance in persons with a dysvascular transtibial amputation

Background and aim: Turning is an inherent problem in all lower limb amputees and more so in older dysvascular amputees. This study aimed to compare the turning performance of dysvascular amputees with that of the traumatic amputees. Technique: Six dysvascular transtibial amputees (69.83 ± 6.3 years) and six traumatic transtibial amputees (68.3 ± 6.6 years) completed the Step Quick Turn test of the NeuroCom® Balance Master and the Timed Up and Go Test. The measures used for comparison were as follows: turn time and turn sway of Step Quick Turn test, turning 180° to both the prosthetic and sound side and time taken to complete the Timed Up and Go Test. Discussion: The Mann–Whitney U test demonstrated a significant difference (p < 0.05) between the dysvascular and traumatic groups in turn sway to the prosthetic (70.7 ± 14.2 and 43.3 ± 9.7) and sound sides (72.5 ± 16.1 and 43.5 ± 8.2). Similar results were observed in turn time to the prosthetic (4.1 ± 1.4 and 1.7 ± 0.46) and sound sides (4.0 ± 1.3 and 2.1 ± 0.5). No significant difference was observed for the Timed Up and Go Test. Clinical relevance The observed differences suggest that dysvascular amputees are less able to adapt to the challenges associated with turning. More attention is required in the rehabilitation of dysvascular amputees in turning tasks particularly towards the prosthetic side.

Effect of Land-based Generic Physical Activity Interventions on Pain, Physical Function, and Physical Performance in Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis

Objective The aim of this study was to evaluate the effects of land-based generic physical activity interventions on pain, physical function, and physical performance in individuals with hip/knee osteoarthritis, when compared with a control group that received no intervention, minimal intervention, or usual care. Methods A systematic search for randomized controlled trials on 11 electronic databases (from their inception up until April 30, 2016) identified 27 relevant articles. According to the compendium of physical activities, interventions were categorized into: recreational activities (tai chi/Baduajin—6 articles), walking (9 articles), and conditioning exercise (12 articles). Results Meta-analysis for recreational activity (n = 3) demonstrated significant mean difference (MD) of −9.56 (95% confidence interval [CI], −13.95 to −5.17) for physical function (Western Ontario and McMaster Universities Arthritis Index) at 3 mos from randomization. Pooled estimate for walking intervention was not significant for pain intensity and physical performance but was significant for physical function (n = 2) with a MD of −10.38 (95% CI, −12.27 to −8.48) at 6 mos. Meta-analysis for conditioning exercise was significant for physical function (n = 3) with a MD of −3.74 (95% CI, −5.70 to −1.78) and physical performance (6-minute walk test) with a MD of 42.72 m (95% CI, 27.78, 57.66) at 6 mos. The timed stair-climbing test (n = 2) demonstrated a significant effect at 18 mos with a MD of −0.49 secs (95% CI, −0.75 to −0.23). Conclusion Very limited evidence to support recreational activity and walking intervention was found for knee osteoarthritis, in the short-term on pain and physical function, respectively.

Concurrent validity of the Sensory Organization Test measures in unilateral transtibial amputees

Background and Aim: The physical asymmetries associated with a prosthesis raises the question of validity of the Sensory Organization Test (SOT) measures (equilibrium score (ES) and strategy score (SS)) in lower limb amputees. This study explores the validity of these measures in transtibial amputees by correlating with their corresponding centre of pressure (COP) excursion/velocity measures. Technique: Fifteen transtibial amputees (69.5 ± 6.5 years) completed three trials for each of the six SOT conditions. Discussion: The Spearman’s rank correlation coefficients between ESs and global COP excursion/velocity measures ranged from 0.52 to 0.71 for Conditions 1, 4 and 5, 0.79 to 0.85 for Conditions 2 and 3, and 0.39 to 0.43 for Condition 6. The coefficients for SSs ranged between 0.78 and 0.97 for Conditions 1 to 5 and 0.55 to 0.67 for Condition 6. The corresponding sound and prosthetic side COP variables demonstrated varying strengths of association with ES and SS. Clinical relevance Of the two clinical measures examined, the SSs are strongly reflective of COP excursion/velocity measures and these findings have application in the interpretation of SOT when evaluating balance in transtibial amputees.

Non-pharmacological management of phantom limb pain in lower limb amputation: a systematic review

Background: The incidence and severity of phantom limb pain (PLP) does not differ much between the extremities of amputation. However, its impact on functional ability and quality of life in lower limb amputation may be different, as prosthetic weight bearing is a key component in the movement and functional rehabilitation of individuals with a lower limb amputation. Objective: To evaluate the evidence for effectiveness or efficacy of non-pharmacological interventions in the management of PLP in adults with lower limb amputation. Methods: A comprehensive literature search conducted on 11 electronic databases, from their inception to 25 March 2016 identified 626 potentially relevant articles. Full-text randomised controlled trials in English which examined any form of non-pharmacologic intervention for managing PLP in lower limb amputees were included. The data with regard to characteristics of the studies, participants, intervention and outcome measures and overall statistical result were extracted. The Cochrane ‘Risk of bias assessment tool’ was used to assess the bias of all included articles. Results: Four studies met the final criteria to be included in the review. Four treatment techniques had been used in the treatment of 204 patients with lower limb amputation. Two trials showed a positive impact of intervention on PLP compared to control group. Risk of bias varied across studies, and only one included study was assessed as having a low risk of bias. Conclusion: The review identified lack of evidence to support non-pharmacological interventions in the management of PLP. Adequately powered high-quality trials are needed in this area to inform rehabilitation.

Comparison of self-reported physical activity levels and quality of life between individuals with dysvascular and non-dysvascular below knee amputation: A cross-sectional study

BACKGROUND Decreased physical ability of individuals with a dysvascular amputation when compared with non-dysvascular counterpart may impact on their ability to participate in regular physical activity and concomitant quality of life. OBJECTIVE To compare physical activity, quality of life (QoL), and perceptions towards exercise between individuals with dysvascular and individuals with non-dysvascular amputation. METHODS A random sample of individuals identified from the New Zealand Artificial Limb Service database, aged 18 years and over, with a unilateral below-knee amputation due to a dysvascular condition (n = 61) and trauma (n = 116) completed the self-reported survey. Main constructs measured were: self-reported physical activity levels (MET-hours/day); quality of life (EuroQoL); perceptions towards exercise (Exercise Barriers and Benefits Scale [EBBS]); mobility capability (Locomotor Capability Index [LCI]) and a customized screening questionnaire. RESULTS Significant differences (p ≤ 0.05) were observed between dysvascular and non-dysvascular groups for total MET-hours/day [13.2 ± 12.7; 27.0 ± 23.2], LCI [36.3 ± 17.7; 49.9 ± 13.7], EuroQoL [72.1 ± 21.7; 80.9 ± 19.3] and EBBS [78.5 ± 10.3; 85.0 ± 14.3]. Cause of amputation, age, experience with the prosthesis, presence of co-morbidities and LCI were significant (p ≤ 0.008) correlates (simple linear regression) of MET-hours/day. Age was the only significant correlate in multivariable model with 0.43 MET-hours/day [F (5,161) = 9.28; p < 0.001], for each 1-year increase in age. CONCLUSION Physical activity levels and quality of life of individuals with dysvascular amputation were lower when compared with non-dysvascular amputation. Person-centred behavioural interventions to increase physical activity levels are needed to decrease the risk for developing long-term co-morbidities and to lessen the effects of co-morbidities already present in this population.

Is knee pain information on YouTube videos perceived to be helpful? An analysis of user comments and implications for dissemination on social media

Objective There is little research that characterises knee pain related information disseminated via social media. However, variances in the content and quality of such sources could compromise optimal patient care. This study explored the nature of the comments on YouTube videos related to non-specific knee pain, to determine their helpfulness to the users. Methods A systematic search identified 900 videos related to knee pain on the YouTube database. A total of 3537 comments from 58 videos were included in the study. A categorisation scheme was developed and 1000 randomly selected comments were analysed according to this scheme. Results The most common category was the users providing personal information or describing a personal situation (19%), followed by appreciation or acknowledgement of others’ inputs (17%) and asking questions (15%). Of the questions, 33% were related to seeking help in relation to a specific situation. Over 10% of the comments contained negativity or disagreement; while 4.4% of comments reported they intended to pursue an action, based on the information presented in the video and/or from user comments. Conclusion It was observed that individuals commenting on YouTube videos on knee pain were most often soliciting advice and information specific to their condition. The analysis of comments from the most commented videos using a keyword-based search approach suggests that the YouTube videos can be used for disseminating general advice on knee pain.