The development and reliability testing of the Functional Lower-Limb Amputee Gait Assessment.

OBJECTIVE: The study purpose was three-fold: (a) to describe the development of the Functional Lower-Limb Amputee Gait Assessment, (b) to determine its reliability with two groups of raters, physical therapists, and certified prosthetists, and (c) to determine the agreement on its results between the two groups. DESIGN: A reliability study. SETTING: Institution for higher education. PARTICIPANTS: Five physical therapists and five certified prosthetists. INTERVENTION: Not applicable. MAIN MEASURE: The gait of people with unilateral lower limb amputation was evaluated using the Functional Lower-Limb Amputee Gait Assessment. Kappa statistic was used to analyze reliability. RESULTS: The intra-rater reliability of nine gait deviations in the physical therapists' group and eight in the certified prosthetists' group was between moderate and almost perfect agreement (kappa = .41-1). In the physical therapists' group, the inter-rater reliability of four gait deviations was moderate (kappa = .41-.6). In the certified prosthetists' group, the inter-rater reliability of six gait deviations was moderate to substantial (kappa = .41-.8). Three gait deviations achieved moderate agreement in both groups of clinicians (kappa = .41-.6). CONCLUSIONS: Most gait deviations included in the Functional Lower-Limb Amputee Gait Assessment appear stable over time when used by the same clinician. Six gait deviations in the certified prosthetists' group and four in the physical therapists' group may be used by multiple clinicians, and three gait deviations may be used across both professions to assist in communication and collaboration on the best course of treatment for a patient with a unilateral lower limb amputation.

Inspiratory Muscle Performance Is Related to Seated Balance Function in People With Spinal Cord Injury: An Observational Study.

OBJECTIVE: To examine the relationship between inspiratory muscle performance (IMP) and functional sitting balance (FSB) in persons with chronic spinal cord injury (SCI). We hypothesized that a moderate correlation would be found between IMP and FSB and that individuals with better balance would have better IMP. DESIGN: The SCI-specific modification of the Function in Sitting Test (FIST-SCI) measured FSB. The IMP measures included (1) maximal inspiratory pressure (MIP), (2) sustained MIP (SMIP), and (3) inspiratory duration. Upper extremity motor score (UEMS) and level of injury (LOI) were taken from International Standards for Neurological Classification of Spinal Cord Injury examinations. Spearman correlational analyses assessed relationships among these factors in the sample (N=37). Mann-Whitney U tests explored differences between 2 comparison group pairs (tetraplegia group [TG] vs paraplegia group [PG]; independent transfer group [ITG] vs assisted transfer group [ATG]). Regression analysis examined variables predictive of FSB in the TG. SETTING: Research facility. PARTICIPANTS: Volunteers with tetraplegia (n=21, American Spinal Injury Association Impairment Scale (AIS) A=8, B=7, C=6) and paraplegia (n=16, AIS A=9, B=4, C=3) (N=37). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: IMP, LOI, UEMS, FIST-SCI. RESULTS: UEMS, MIP, SMIP, and LOI had moderate to high correlations with FIST-SCI scores (ρ=0.720 (P<.001), 0.480 (P=.003), 0.467 (P=.004), 0.527 (P=.001), respectively). UEMS, MIP, and FIST-SCI scores were higher in the PG and ITG than the TG and ATG, respectively (PG vs. TG P values=<.001, .008, .002, respectively, and ITG vs. ATG P values=<.001, .032, <.001, respectively). Further, SMIP and UEMS predicted FIST-SCI balance scores in the TG, accounting for 55% of total variance (P<.001) (FIST-SCI=11.88+0.03 [SMIP]+0.425 [UEMS]). CONCLUSIONS: The relationship between IMP and balance appears preserved after SCI. FSB was predicted, in part, via UEMS and SMIP in the TG. Future research should focus on the effect of SCI-based breathing interventions on FSB.

Inspiratory Muscle Performance and Anthropometric Measures-Novel Assessments Related to Pulmonary Function in People with Spinal Cord Injury: A Pilot Study.

OBJECTIVE: To investigate the feasibility and validity of using the novel axillary:umbilical (A:U) ratio and sustained maximal inspiratory pressure (SMIP) as supplementary measures in the assessment of respiratory function in people with spinal cord injury. DESIGN: Pilot study with a single day of data collection. All measurements were taken with participants in their personal wheelchairs to best represent normal functioning and positioning for each individual. SETTING: Research institution. PARTICIPANTS: A convenience sample of 30 community dwelling volunteers with chronic spinal cord injury (C2-T12, American Spinal Injury Association Impairment Scale A-D) participated. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants underwent anthropometric measurements (trunk height, abdominal circumference, axillary circumference) and assessment of inspiratory muscle performance, incluidng maximal inspiratory pressure, SMIP, and inspiratory duration, as well as standard pulmonary function tests. RESULTS: The A:U ratio and SMIP were recorded for all participants. The SMIP was significantly related to more respiratory performance measures than the maximal inspiratory pressure (P<.05) and the A:U ratio was significantly related to more respiratory performance measures than any other anthropometric measure (P<.05). Additionally, an A:U ratio cutoff point detected individuals with a peak expiratory flow ≥ 80% of their predicted value with a sensitivity and specificity of 85.7% and 91.3%, respectively (area under the curve: 0.92). CONCLUSIONS: It is feasible to capture the A:U Ratio and SMIP in individuals with spinal cord injury. Further, the strong significant relationships of SMIP and the A:U ratio to respiratory performance measures suggests their clinical importance in the pulmonary assessment and risk stratification of people with chronic spinal cord injury.

Feasibility and Preliminary Efficacy of a Multimodal Approach to Increase Physical Activity in Older Adults With Memory Complaints: The Education for Action Study.

In this randomized controlled pilot trial, the authors explored the feasibility, technology compliance, and preliminary efficacy of the Education for Action (EDU-ACT), a multimodal intervention combining evidence-based strategies of physical activity (PA) education and coaching in PA levels over 4 weeks between EDU-ACT and control groups. The authors also assessed pre-post changes in neurocognitive function, functional mobility and dual-task performance, sleep and quality of life. Thirty-two sedentary older adults with memory complaints (age = 66 ± 5.3) completed the study (EDU-ACT = 18 and control = 14). The EDU-ACT adherence rate was 95%, and compliance of daily PA reporting was, on average, 22.7 days (94.6%). The EDU-ACT group demonstrated a significantly greater number of steps, processing speed, and dual-task performance when compared with controls (p < .05). In this study, a multimodal, evidence-based, low-cost intervention was feasible, well-accepted, with high adherence and compliance rates, and effective at promoting clinically meaningful increases in PA, for at least 1 month postintervention, in older adults with memory complaints.

The Utility of the 2-Minute Walk Test as a Measure of Mobility in People With Lower Limb Amputation.

OBJECTIVES: To establish reference values for the 2-minute walk test (2-MWT) distance and gait speed in people with a lower limb amputation (LLA) who are prosthetic ambulators. Also, to describe the differences in distance and gait speed between sexes, causes of amputation, levels of amputation, health risk classification, functional levels, and age groups. DESIGN: Cross-sectional study. SETTING: National meeting for people with lower limb amputation. PARTICIPANTS: A convenience sample of unilateral people (N=101; 47 men, 54 women; mean age ± SD, 50.9±14.3 y) with an LLA; 48 had a transtibial amputation and 53 had a transfemoral amputation. Participants were classified as either limited community ambulators, community ambulators, or those who exceed basic ambulation skills (K2, n=7; K3, n=70; K4, n=24). INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: 2-MWT performance (ie, distance and gait speed). RESULTS: The mean ± SD 2-MWT distance and gait speed for the entire sample was 143.8±37.5 meters (range, 49-259 m) and 72.1±18.8 meters per minute (range, 25-130 m/min), respectively. Men walked farther (distance: men, 154.2±34.2 m; women, 134.4±38.1 m) and faster (gait speed: men, 77.3±17.1 m/min; women, 67.4±19.1 m/min) than women (P<.05). The mean ± SD 2-MWT distance for K4, K3, and K2 level participants was 177.9±31.1 meters, 138.4±28.5 meters, and 81.7±26.9 meters, respectively. Functional level K4 participants performed better than K3 participants (P<.05), and K3 participants performed better than K2 participants (P<.05). People with transtibial amputation walked farther than those with transfemoral amputation (152.9±43.0 m vs 135.6±43.0 m) (P<.05). The distance and speed ambulated by those participants classified in the very high health risk group was worse than those categorized as being at an increased high health risk group (P<.05) and the no increase health risk group (P<.05). The performance of participants older than 70 years old was inferior to the performance of all younger age groups. CONCLUSIONS: Reference values for the 2-MWT distance and gait speed were established in people with LLA who are prosthetic ambulators. Significant differences in the 2-MWT performance were found between sexes, causes of amputation, levels of amputation, health risk classification, functional levels, and age groups.

The Component Timed-Up-and-Go test: the utility and psychometric properties of using a mobile application to determine prosthetic mobility in people with lower limb amputations.

OBJECTIVE: Using a custom mobile application to evaluate the reliability and validity of the Component Timed-Up-and-Go test to assess prosthetic mobility in people with lower limb amputation. DESIGN: Cross-sectional design. SETTING: National conference for people with limb loss. SUBJECTS: A total of 118 people with non-vascular cause of lower limb amputation participated. Subjects had a mean age of 48 (±13.7) years and were an average of 10 years post amputation. Of them, 54% ( n = 64) of subjects were male. INTERVENTION: None. MAIN MEASURE: The Component Timed-Up-and-Go was administered using a mobile iPad application, generating a total time to complete the test and five component times capturing each subtask (sit to stand transitions, linear gait, turning) of the standard timed-up-and-go test. The outcome underwent test-retest reliability using intraclass correlation coefficients (ICCs) and convergent validity analyses through correlation with self-report measures of balance and mobility. RESULTS: The Component Timed-Up-and-Go exhibited excellent test-retest reliability with ICCs ranging from .98 to .86 for total and component times. Evidence of discriminative validity resulted from significant differences in mean total times between people with transtibial (10.1 (SD: ±2.3)) and transfemoral (12.76 (SD: ±5.1) amputation, as well as significant differences in all five component times ( P < .05). Convergent validity of the Component Timed-Up-and-Go was demonstrated through moderate correlations with the PLUS-M ( rs = -.56). CONCLUSION: The Component Timed-Up-and-Go is a reliable and valid clinical tool for detailed assessment of prosthetic mobility in people with non-vascular lower limb amputation. The iPad application provided a means to easily record data, contributing to clinical utility.

Integrating Health Promotion Into Physical Therapy Practice to Improve Brain Health and Prevent Alzheimer Disease.

BACKGROUND AND PURPOSE: Alzheimer disease is the most common cause of dementia, and brain pathology appears years before symptoms are evident. Primary prevention through health promotion can incorporate lifestyle improvement across the lifespan. Risk factor assessment and identifying markers of disease might also trigger preventive measures needed for high-risk individuals and groups. SUMMARY OF KEY POINTS: Many potential risk factors are modifiable through exercise, and may be responsive to early intervention strategies to reduce the downward slope toward disability. Through the use of common clinical tests to identify cognitive and noncognitive functional markers of disease, detection and intervention can occur at earlier stages, including preclinical stages of disease. Physical activity and exercise interventions to address modifiable risk factors and impairments can play a pivotal role in the prevention and delay of functional decline, ultimately reducing the incidence of dementia. This article discusses prevention, prediction, plasticity, and participation in the context of preserving brain health and preventing Alzheimer disease and related dementias in aging adults. RECOMMENDATIONS FOR CLINICAL PRACTICE: Rehabilitation professionals have opportunities to slow disease progression through research, practice, and education initiatives. From a clinical perspective, interventions that target brain health through lifestyle changes and exercise interventions show promise for preventing stroke and associated neurovascular diseases in addition to dementia. Physical therapists are well positioned to integrate primary health promotion into practice for the prevention of dementia and other neurological conditions in older adults.

Comparing physical therapist clinical specialists to experienced nonspecialists on physical activity education for patients with heart failure: A modified retrospective cohort study.

Background and Aims: The purpose of this study was to compare the knowledge and practices of specialist and experienced nonspecialist physical therapists in performing patient education about physical activity with patients with heart failure (HF). Methods: Responses on a nationwide anonymous online survey were used to compare specialist and experienced nonspecialist physical therapists on knowledge and frequency of providing physical activity related education to patients hospitalized with acutely decompensated HF. Responses to survey items were scored on 5-point scales ranging from "Strongly agree" to "Strongly disagree" or "Always" to "Never." Mann-Whitney U statistics were used to compare specialist and experienced nonspecialist responses and Wilcoxon signed-ranks tests were used to examine the gap between knowledge and practice. Results: Twenty-seven specialists and 43 experienced nonspecialists completed the survey. Both groups were similar in age, and experience treating patients hospitalized with acutely decompensated HF. Both groups "strongly agree" that they had the required knowledge and skills to educate patients with HF on the physical activity topics. However, specialists more often than experienced nonspecialists provided education on topics such as how to monitor vital signs during physical activity ("most of the time" vs. "about half of the time") that promoted patient confidence and safety during exercise. Specialists demonstrated a smaller gap between knowledge and frequency of providing patient education than experienced nonspecialists on three of the four patient education topics. Conclusion: Specialist physical therapists treating patients with HF in the inpatient hospital setting provided patient education on physical activity at a level more closely matching their skills and the clinical practice guideline than did experienced nonspecialists. Physical therapy clinical specialists practicing in the inpatient hospital setting may improve patient outcomes and lower costs to the health care system by improving physical activity adherence and thereby may reduce avoidable hospital readmissions.

The association between social networks and functional recovery after stroke.

BACKGROUND AND PURPOSE: Social determinants of health (SDOH), including social networks, impact disability and quality of life post-stroke, yet the direct influence of SDOH on functional change remains undetermined. We aimed to identify which SDOH predict change on the modified Rankin Scale (mRS) within 90 days after stroke hospitalization. METHODS: Stroke patients from the Transitions of Care Stroke Disparities Study (TCSDS) were enrolled from 12 hospitals in the Florida Stroke Registry. TCSDS aims to identify disparities in hospital-to-home transitions after stroke. SDOH were collected by trained interviewers at hospital discharge. The mRS was assessed at discharge, 30- and 90-day post-stroke. Multinomial logistic regression models examined contributions of each SDOH to mRS improvement or worsening (compared to no change) from discharge to 30- and 90-day, respectively. RESULTS: Of 1190 participants, median age was 64 years, 42% were women, 52% were non-Hispanic White, and 91% had an ischemic stroke. Those with a limited social support network had greater odds of functional decline at 30 days (aOR = 1.39, 1.17-1.66), adjusting for age and onset to arrival time and at 90 days (aOR = 1.50, 1.10-2.05) after adjusting for age. Results were consistent after further adjustment for additional SDOH and participant characteristics. Individuals living with a spouse/partner had reduced odds of functional decline at 90 days (aOR = 0.74, 0.57-0.98); however, results were inconsistent with more conservative modeling approaches. CONCLUSION: The findings highlight the importance of SDOH, specifically having a greater number of individuals in your social network in functional recovery after stroke.

Motor proficiency, strength, endurance, and physical activity among middle school children who are healthy, overweight, and obese.

PURPOSE: To compare motor proficiency, strength, endurance, and physical activity among children from minority backgrounds who were healthy weight (HW), overweight (OW), or obese (OB). METHODS: Eighty-six children, aged 10 to 15 years, of mostly Hispanic ethnicity, participated. Children were categorized according to body mass index-for-age percentile. Bruininks-Oseretsky Test of Motor Proficiency (BOT2) Short Form, Sit-to-Stand (STS), Timed Up and Down Stairs, and 6-Minute Walk Test (6MWT) were administered. Physical activity was measured by using activity monitors. RESULTS: Forty-five percent of children were classified as OW/OB. Children who were OB had lower mean BOT2, STS, and 6MWT performance than children of HW. Among children who were OW/OB, daily mean steps were lower and sedentary minutes higher than children of HW. In children who were OW/OB, body mass index was negatively correlated with BOT2, STS, and abdominal curls. CONCLUSION: Children who are OB demonstrate greater impairments in motor proficiency, strength, and endurance and participate in less physical activity than peers of HW.

Inspiratory Muscle and Functional Performance of Patients Entering Cardiac Rehabilitation after Cardiac Valve Replacement.

Limited research has examined inspiratory muscle performance (IMP) and functional performance (FP) of patients after valve replacement surgery (VRS). The purpose of this study was to examine IMP as well as several measures of FP in patients post-VRS. The study results of 27 patients revealed that patients undergoing transcatheter VRS were significantly (p = 0.01) older than patients undergoing minimally invasive or median sternotomy VRS with the median sternotomy VRS group performing significantly (p < 0.05) better than the transcatheter VRS group in the 6-min walk test, 5x sit-to-stand test, and sustained maximal inspiratory pressure. The 6-min walk test and IMP measures in all groups were significantly (p < 0.001) lower than predicted values. Significant (p < 0.05) relationships were found between IMP and FP with greater IMP being associated with greater FP. Pre-operative and early post-operative rehabilitation may improve IMP and FP post-VRS.

The Use of Movement Scripts for Clinical Reasoning in Physical Therapist Education and Practice.

The purpose of this Perspective is to present an application of script-based reasoning to physical therapist education and practice. Illness script-based reasoning has been described as a cognitive strategy for medical practitioners to diagnose and manage health conditions. Analogous to this medical model of patient management, "movement scripts" can be used by physical therapists in clinical reasoning. Movement scripts use features of the human movement system to recognize, categorize, and substantiate clinical problems and can be used to facilitate the development of master adaptive learners across the spectrum of physical therapist education and practice. Movement scripts are also consistent with the concept of the "human body as teacher" as the signature pedagogy proposed by the National Study of Excellence and Innovation in Physical Therapy Education. Movement of the human body, as captured by the concept of the human movement system, is a vehicle for lifelong adaptive learning for the physical therapist. Script-based learning and practice are consistent with other elements of this model, including practice-based learning and the creation of adaptive expertise. As the role of the movement system as a guide to physical therapist practice continues to evolve, movement scripts can provide a structure to facilitate development of clinical reasoning skills for physical therapist practice and education.

Using theoretical frameworks to examine fall history and associated prosthetic mobility in people with nondysvascular lower limb amputation.

BACKGROUND: Over a million people live with lower limb amputation (LLA) in the United States, and many of them will experience a fall in the next year. The aim of this study was to use existing theoretical frameworks in an attempt to organize the complex interactions of reported fall history and prosthetic mobility in community-ambulating people with LLA. METHODS: Self-reported fall rate and fall circumstances were recorded in a cross-section of people with unilateral LLA due to nondysvascular causes. Self-report and performance-based standardized outcome measures assessed prosthetic mobility and balance confidence. All variables were considered and appropriately placed within a proposed International Classification of Functioning, Disability, and Health framework while using a fall-type classification framework to classify fall circumstances. RESULTS: Information from 69 participants was analyzed. The reported fall rate was at 46%, with those with transfemoral amputation reporting significantly more falls than those with transtibial amputation ( P = 0.001). Tripping over an object was the most common cause (62.5%), and fallers reported significantly lower perceived prosthetic mobility than nonfallers ( P = 0.001). Despite reporting high levels of balance confidence, results indicate that all groups of fallers and nonfallers are at increased fall risk according to performance-based prosthetic mobility score cutoffs. CONCLUSIONS: Community-dwelling people with nondysvascular LLA are at increased fall risk. Classifying fall-related variables using theoretical frameworks provides a means to structure more informative fall risk surveys for people with LLA in an attempt to identify those at greater risk for falling and its potential detrimental effects.

Adherence to and impact of home-based high-intensity IMT in people with spinal cord injury: a pilot study.

STUDY DESIGN: The pilot study was completed in 5 phases (Control and 4 phases of IMT) incorporating assessments at Baseline 1 (BL1), BL2, Follow-up 1 (F1), F2, F3, and F4. OBJECTIVE: To assess the adherence and impact of a daily high-intensity (80% of max) inspiratory muscle training (IMT) home program with once weekly supervision for people with spinal cord injury (SCI). SETTING: Assessments: research institution or zoom. IMT: participant's home. METHODS: Participants completed daily IMT in IMT Phase 1 and 2, once weekly in IMT Phase 3, self-selected frequency in IMT Phase 4. All phases had one weekly supervised session except IMT Phase 4. Primary outcomes included adherence and a difficulty score [DS (0- not difficult to 10- the most difficult)]. Secondary outcomes included respiratory function and seated balance. RESULTS: Data from 10 people with chronic SCI (>1 year) (Cervical level of injury: 6, AIS: A-B, injury duration: 10.9 years 95% CI [3.9, 18.1]) were used in the analysis. Participants completed 69% of their training days in IMT Phase 1 and 65% overall reporting an average DS of 7.4 ± 1.4. Only one participant completed training during IMT Phase 4. One participant's training load was reduced due to suspected overtraining. Maximal inspiratory pressure (MIP), sustained MIP (SMIP), and total power (TP), improved significantly (p < 0.05) from BL2 to F1. CONCLUSION: Our data suggest that people with SCI can perform high-intensity IMT at home to improve inspiratory performance. It is strongly recommended that participants be intermittently monitored for adherence and safety. CLINICALTRIALS: gov Registration number: NCT04210063.

Age and Gender Differences in Injuries and Risk Factors in Elite Junior and Professional Tennis Players.

BACKGROUND: Elite tennis athletes experience injuries throughout the entire body. Impairments in trunk stability, lower limb flexibility, and hip range of motion (ROM) are modifiable risk factors that can impact injuries and performance. Information on nonmodifiable risk factors such as age and gender is limited. The purpose of this investigation was to provide information on risk factors to direct clinical decision-making and injury prevention and rehab programming in this population. HYPOTHESIS: Prevalence and location of injuries will differ by age group and gender. Trunk stability, lower limb flexibility, and hip ROM will differ by age group and gender. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A de-identified database (n = 237; females = 126) from the United States Tennis Association High Performance Profile (HPP) 2014-2015 was used for the analysis. Subjects were elite junior and professional tennis players (mean age 14.6 [range, 9-27] years). The HPP is a tennis-specific assessment and questionnaire that includes retrospective information on injury history. Subjects were categorized by injury, gender, and age. Injury locations were classified by region. Trunk stability measures included drop vertical jump (DVJ), single-leg squat, and prone and side planks. Lower limb measures included hamstring, quadriceps and hip flexor flexibility, and hip rotation ROM. RESULTS: A total of 46% of athletes reported an injury. Significant differences were found for injury prevalence and location by age group. Adolescent athletes (age 13-17 years) had more trunk injuries, while adult athletes (age ≥18 years) had more lower limb injuries. Adolescent athletes performed worse on DVJ, dominant side plank, and hamstring flexibility compared with young (age ≤12 years) and adult athletes. Significant gender differences in hip ROM included internal rotation on both the dominant and nondominant sides. CONCLUSION: Impairments in trunk stability, lower limb flexibility, and hip rotation ROM may affect both health and performance outcomes in this population. Elite tennis athletes may benefit from additional off court programming to address trunk and lower limb impairments. CLINICAL RELEVANCE: Adolescent elite tennis athletes may be at higher risk of trunk injuries. Age, gender, injury history, and impairments should be considered with all assessments and programming.

Moving from Strategy to Process: An Iterative and Formative Approach to Integrating the IASP Pain Curriculum Guidelines into an Established Physical Therapy Program.

Studies suggest that pain education in physical therapy (PT) programs is often insufficient to adequately prepare graduates to understand and manage pain. The International Association for the Study of Pain recently published updated curriculum guidelines for PT pain education (PCGs), and adoption of these PCGs will improve standardization of pain education in PT curricula. However, implementation of the PCGs will require programs to overcome key barriers including: 1) faculty competence with current pain science, 2) faculty alignment and collective commitment to addressing all domains in the PCGs, and 3) time and space in the curriculum for additional content delivery. The purpose of this article is to describe the process-driven approach used in implementing the PCGs within an established PT program, emphasizing the strategies used to overcome existing barriers. Kern's Six-Step Approach to Curriculum Development, experiential learning theory, and reflective practice were the guiding theoretical models used to develop processes and overcome existing barriers. The iterative process used for curriculum integration of the PCGs improved faculty buy-in and alignment, allowed for optimal selection of resources to support the faculty, and provided the program with qualitative and quantitative data that will continue to drive curriculum management.

Inertial sensor-based measures of gait symmetry and repeatability in people with unilateral lower limb amputation.

BACKGROUND: People with lower limb amputation often walk with asymmetrical gait patterns potentially leading to long-term health problems, ultimately affecting their quality of life. The ability to discreetly detect and quantify the movement of bilateral thighs and shanks using wearable sensor technology can provide additional insight into how a person walks with a lower limb prosthesis. This study investigated segmental symmetry and segmental repeatability of people with unilateral lower limb amputation, examining performance of the prosthetic and intact limbs. METHODS: Gyroscope signals were recorded from four inertial measurement units worn on bilateral lower limb segments of subjects with unilateral lower limb amputation during the 10-m walk test. Raw angular velocity signals were processed using dynamic time warping and application of algorithms resulting in symmetry measures comparing similarity of prosthetic to intact limb strides, and repeatability measures comparing movement of one limb to its consecutive strides. FINDINGS: Biomechanical differences in performance of the prosthetic and intact limb segments were detected with the segmental symmetry and segmental repeatability measures in 128 subjects. More asymmetries and less consistent movements of the lower limbs were exhibited by subjects with transfemoral amputation versus transtibial amputation (p < .004, Cohen's d = 0.65-1.1). INTERPRETATION: Sensor-based measures of segmental symmetry and segmental repeatability were found to be reliable in detecting discreet differences in movement of the prosthetic versus intact lower limbs in amputee subjects. These measures provide a convenient tool for enhanced prosthetic gait analysis with the potential to focus rehabilitative and prosthetic interventions.

Variables that Influence Basic Prosthetic Mobility in People With Non-Vascular Lower Limb Amputation.

BACKGROUND: There exists a dearth of evidence on rehabilitation factors that influence prosthetic mobility in people with lower limb amputation (LLA). Examining variables that contribute to prosthetic mobility can inform rehabilitation interventions, providing guidance in developing more comprehensive care for these individuals. OBJECTIVE: To determine the influence of modifiable and non-modifiable variables related to LLA and their impact on prosthetic mobility, using the International Classification of Functioning, Disability and Health (ICF) model. Secondarily, to determine if personal factors and self-reported balance and mobility are predictive of Component timed-up-and-go (cTUG) performance. DESIGN: Cross-sectional study of a convenience sample. SETTING: National conference. PARTICIPANTS: People (N=68) with non-vascular causes of unilateral LLA. METHODS: Assessment of anthropometrics, mobility, bilateral hip extensor strength, hip range of motion, single limb balance, and self report measures. Lasso linear regression and extreme gradient boosting analyses were used to determine influence of variables on prosthetic mobility. MAIN OUTCOME MEASURE: Timed performance of the cTUG. RESULTS: The following five variables were found to influence basic prosthetic mobility (P ≤ .05) in people with transtibial amputation: hip extensor strength, hip range of motion, single limb balance, waist circumference, and age. In the transfemoral cohort, number of comorbidities and waist circumference primarily influenced prosthetic mobility. Additionally, 66% of the variance in cTUG total time for the entire sample could be explained by simply regressing on level of amputation, number of comorbidities, age and Activities-specific Balance Confidence scale score, all variables easily collected in a waiting room. CONCLUSION: Variables that are modifiable with physical therapy intervention including hip extensor strength, hip range of motion, single limb balance, and waist circumference significantly influenced basic prosthetic mobility. These variables can be affected by targeted rehabilitation interventions and lifestyle changes. LEVEL OF EVIDENCE: II.

Effectiveness of an Evidence-Based Amputee Rehabilitation Program: A Pilot Randomized Controlled Trial.

BACKGROUND: Despite the prevalence of lower limb amputation (LLA), only a small percentage of people with LLA actually receive physical therapy post amputation and are rehabilitated to their full potential level of function. There is a need for the development of a rehabilitation program that targets impairments and limitations specific to people with LLA. OBJECTIVE: The objective of this study was to determine whether the Evidence-Based Amputee Rehabilitation program would improve functional mobility of people with unilateral transtibial amputation (TTA) who have already completed physical therapy and prosthetic training. DESIGN: This study was a randomized, wait-list control, single-blinded pilot clinical trial. SETTING: This study researched participants who had received postamputation rehabilitation to varying degrees, either in an inpatient and/or outpatient settings. PARTICIPANTS: The participants in this study included veterans and nonveterans with unilateral TTA due to dysvascular disease and trauma. INTERVENTION: This study included a prescription-based rehabilitation program for people with amputations. MEASUREMENTS: Results were measured with The Amputee Mobility Predictor with (AMPPro) and without a prosthesis (AMPnoPro) and 6-Minute Walk Test (6MWT) at baseline and at the end of the 8-week intervention. RESULTS: The intervention group improved on the AMPPro scores (36.4 to 41.7), AMPnoro scores (23.2 to 27.1), and 6MWT distance (313.6 to 387.7 m). The effect size for the intervention was very large (1.32). In contrast, the wait-list control group demonstrated no change in AMPPro scores (35.3 to 35.6), AMPnoPro scores (24.7 to 25.0), and 6MWT distance (262.6 m to 268.8 m). LIMITATIONS: The sample size was small. A total 326 potential candidates were screened with 306 unable to meet inclusion criteria or unwilling to participate. CONCLUSION: People with unilateral TTA who received Evidence-Based Amputee Rehabilitation program demonstrated significant improvement in functional mobility, with most participants (66.7%) improved at least 1 K-level (58.3%) and greater than the minimal detectable change (66.7%).

Comparison of Single-Session Dose Response Effects of Whole Body Vibration on Spasticity and Walking Speed in Persons with Spinal Cord Injury.

Spasticity affects approximately 65% of persons with spinal cord injury (SCI) and negatively impacts function and quality of life. Whole body vibration (WBV) appears to reduce spasticity and improve walking function; however, the optimal dose (frequency/duration) is not known. We compared single-session effects of four different WBV frequency/duration dose conditions on spasticity and walking speed, in preparation for a planned multi-session study. Thirty-five participants with motor-incomplete SCI received four different doses of WBV: high frequency (50 Hz)/short duration (180 s), high frequency/long duration (360 s), low frequency (30 Hz)/short duration, and low frequency/long duration, plus a control intervention consisting of sham electrical stimulation. In all conditions, participants stood on the WBV platform for 45-s bouts with 1 min rest between bouts until the requisite duration was achieved. The frequency/duration dose order was randomized across participants; sessions were separated by at least 1 week. Quadriceps spasticity was measured using the pendulum test at four time points during each session: before, immediately after, 15 min after, and 45 min after WBV. Walking speed was quantified using the 10-m walk test at three time points during each session: baseline, immediately after, and 45 min after WBV. In the full group analysis, no frequency/duration combination was significantly different from the sham-control condition. In participants with more severe spasticity, a greater reduction in stretch reflex excitability was associated with the high frequency/long duration WBV condition. The sham-control condition was associated with effects, indicating that the activity of repeated sitting and standing may have a beneficial influence on spasticity. TRIAL REGISTRATION: NCT02340910 (assigned 01/19/2015).