Jesse Brown VA Medical Center, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Department of Biomedical Engineering, Northwestern University, McCormick School of Engineering, Evanston, IL, USA.
Jesse Brown VA Medical Center, Chicago, IL, USA.
Clin Biomech (Bristol). 2023 Oct;109:106104. doi: 10.1016/j.clinbiomech.2023.106104. Epub 2023 Sep 22.
Limited research has focused on older prosthesis users despite the expected compounded effects of age and amputation on sensorimotor function, balance, and falls. This study compared sensorimotor factors and standing balance between older individuals with and without transtibial amputation, hypothesizing that prosthesis users would demonstrate worse sensorimotor function. Secondarily we assessed the relationship between standing balance and somatosensation in prosthesis users.
Thirteen persons with unilateral transtibial amputation (71.7 years) and 10 able-bodied controls (71.7 years) participated in this cross-sectional observational study. Passive joint range-of-motion, muscle strength, proprioception (joint position sense), tactile sensitivity, and standing balance (center-of-pressure sway) were compared between groups. A multiple linear regression analysis assessed the relationship between proprioception and balance (without vision) in prosthesis users.
Our hypotheses were generally not supported, with the only differences being reduced joint range-of-motion and strength in prosthesis users (with large effect sizes), but comparable sensation and balance. Notably, prosthesis users demonstrated better proprioception than controls as reflected through better joint position sense when the limb was non-weight bearing. Worse amputated limb proprioception was associated with better standing balance in prosthesis users.
Older prosthesis users have impaired passive joint motion and muscle strength compared to controls that could challenge their ability to position and control the amputated limb to avoid falls during daily activities. However, their better amputated limb proprioception might help counteract those limitations by leveraging sensory feedback from the suspended limb. The relationship between amputated limb proprioception and standing balance suggests a nuanced relationship that warrants further study.
尽管年龄和截肢对感觉运动功能、平衡和跌倒的复合影响预计会更大，但针对老年假体使用者的研究有限。本研究比较了有和没有胫骨截肢的老年人的感觉运动因素和站立平衡，假设假体使用者的感觉运动功能会更差。其次，我们评估了假体使用者站立平衡和本体感觉之间的关系。
13 名单侧胫骨截肢者（71.7 岁）和 10 名健康对照者（71.7 岁）参与了这项横断面观察性研究。比较了两组之间的被动关节活动范围、肌肉力量、本体感觉（关节位置感）、触觉灵敏度和站立平衡（压力中心摆动）。多元线性回归分析评估了假体使用者本体感觉与（无视觉）平衡之间的关系。
我们的假设总体上没有得到支持，唯一的区别是假体使用者的关节活动范围和力量减小（具有较大的效应量），但感觉和平衡相当。值得注意的是，当肢体不负重时，假体使用者的关节位置感更好，表明他们的本体感觉比对照组更好。假肢肢体本体感觉较差与假体使用者的站立平衡较好相关。
与对照组相比，老年假体使用者的被动关节运动和肌肉力量受损，这可能会影响他们在日常活动中定位和控制假肢的能力，以避免跌倒。然而，他们更好的假肢肢体本体感觉可能通过利用来自悬空肢体的感觉反馈来帮助抵消这些限制。假肢肢体本体感觉和站立平衡之间的关系表明存在复杂的关系，需要进一步研究。
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