Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, Florida; and California State University Dominguez Hills, Department of Orthotics and Prosthetics, Carson, California.
Miami Veterans Affairs Healthcare System, Miami, Florida; and Department of Physical Therapy, Miller School of Medicine, University of Miami.
Phys Ther. 2020 Aug 12;100(8):1333-1342. doi: 10.1093/ptj/pzaa091.
The modified Clinical Test of Sensory Interaction and Balance (mCTSIB) is used to clinically assess vestibular sensory integration (VSI), the process by which the central nervous system integrates vestibular afference to maintain balance. The rate and effects of impaired VSI (IVSI) on prosthetic mobility in people with lower limb amputation (LLA) is unknown. The objective of this study was to use the mCTSIB to classify VSI in active community ambulators with LLA and to examine the relationship between IVSI and prosthetic mobility, as measured by the Component Timed Up and Go (cTUG) test.
This was a cross-sectional study with a convenience sample of 130 community ambulators with unilateral LLA. Classification of VSI was determined based on a time-based pass/fail mCTSIB performance. Participants were classified as having normal sensory integration (NSI) if they could balance for 30 seconds in every mCTSIB condition. Participants who failed condition 4 exclusively were classified as IVSI. Prosthetic mobility, as measured by the cTUG, was compared between NSI and IVSI groups.
Of the 130 participants, 29 (22%) were classified as IVSI and 95 (73%) were classified as having NSI. Prosthetic mobility significantly differed between IVSI and NSI groups, with IVSI participants performing all components of the cTUG significantly slower. Medium to large effect sizes were found between groups during cTUG.
These results suggest that 1 in 5 community ambulators with LLA have IVSI, with associated limitations in balance confidence and prosthetic mobility.
The ability to integrate vestibular information was found to have a strong relationship with prosthetic mobility in active community ambulators with LLA, especially with performing a 180-degree step turn. Physical therapists can use the mCTSIB to classify sensory integration during prosthetic rehabilitation and develop an appropriate balance intervention.
Active adults with LLA can use information from their senses to maintain their standing balance. Adults with LLA who have difficulty balancing on foam with closed eyes were slower to get in and out of a chair, walk, and perform a 180-degree step turn.
改良版临床感觉相互作用和平衡测试（mCTSIB）用于临床评估前庭感觉整合（VSI），即中枢神经系统整合前庭传入以维持平衡的过程。下肢截肢（LLA）患者感觉整合障碍（IVSI）对假肢活动度的影响速度和程度尚不清楚。本研究的目的是使用 mCTSIB 对活跃的社区步行者中的 VSI 进行分类，并检查 IVSI 与组件计时起立行走测试（cTUG）测量的假肢活动度之间的关系。
这是一项横断面研究，采用单侧 LLA 的社区步行者便利样本。根据基于时间的通过/失败的 mCTSIB 表现来确定 VSI 的分类。如果参与者能够在每个 mCTSIB 条件下平衡 30 秒，则将其归类为具有正常感觉整合（NSI）。仅在第 4 项条件下失败的参与者被归类为 IVSI。使用 cTUG 比较 NSI 和 IVSI 组之间的假肢活动度。
在 130 名参与者中，29 名（22%）被归类为 IVSI，95 名（73%）被归类为 NSI。IVSI 和 NSI 组之间的假肢活动度有显著差异，IVSI 参与者在 cTUG 的所有组件上的表现都明显较慢。组间 cTUG 存在中到大量效应量。
这些结果表明，在活跃的社区步行者中，每 5 名 LLA 患者中就有 1 名患有 IVSI，并且在平衡信心和假肢活动度方面存在相关限制。
在活跃的社区步行者中，下肢截肢者的前庭信息整合能力与假肢活动度有很强的关系，尤其是在进行 180 度步转弯时。物理治疗师可以使用 mCTSIB 在假肢康复期间对感觉整合进行分类，并制定适当的平衡干预措施。
下肢截肢的活跃成年人可以使用来自感官的信息来保持其站立平衡。在泡沫上闭眼平衡困难的下肢截肢成年人，从椅子上进出、行走和进行 180 度步转弯的速度都较慢。
