The Effect of a Microprocessor Prosthetic Foot on Function and Quality of Life in Transtibial Amputees Who Are Limited Community Ambulators
Abstract
The typical Veteran who has his/her leg amputated is not the fit athlete that you read about in magazines or see on television, but an older person with vascular disease and diabetes who suffered a trauma, such as dropping a heavy object on their foot resulting in a non-healing wound that leads to gangrene and ultimately amputation. This typical Veteran amputee has trouble walking with an artificial leg (prosthetisis) and is limited to walking indoors and/or outdoors with the ability to traverse low-level environmental barriers such as curbs, stairs, or uneven surfaces with the use of a prosthesis. Prosthetics are made of multiple components including a foot. There are many different types of prosthetic feet on the market. To help the Veteran amputee return to his/her normal activities of daily living, the prosthetic foot must safely match his/her needs. Recent prosthetic innovation has focused on the needs of the very active amputee who wants to run and participate in high intensity activity, not the needs of the typical amputee. In fact, the basic design of the most widely prescribed foot for the below knee amputee dates back more than 40 years. This foot does not lift the toe when taking a step, like during normal human walking. To compensate for this, the amputee is forced to alter his/her step by either bending his/her hip or knee to raise his/her leg higher or by swinging it out to the side. In either case, their balance is thrown off and the risk of falling greatly increases. Unfortunately more than half of all amputees fall each year, and 75% of them fall multiple times. Forty percent of these falls result in injury and some (20%) require medical attention as a direct result. Further, approximately half of all amputees report a fear of falling. Falling and fear of falling often lead to activity avoidance which may, in turn, lead to a decreased quality of life. Although avoiding activities with a high risk of falling may be beneficial, extreme avoidance of activity may lead to a cycle of inactivity, making the individual weaker and frailer, which in turn can lead to additional health problems, including more falling. One of the newest prosthetic feet on the market is the microprocessor controlled prosthetic foot (MPF) designed to raise the toe when stepping forward, which, theoretically, should make walking easier and safer by reducing the risk of falling. Unfortunately, the MPF is currently not prescribed for the typically functioning below knee amputee because of guidelines that limit its prescription to higher functioning individuals. Therefore, the purpose of this study is to determine if exchanging a typically prescribed prosthetic foot for an MPF will provide a suitable alternative for the typical Veteran amputee and improve their walking efficiency, safety, and quality of life. A limitation of the MPF is that it is a heavier prosthesis and the added ankle motion may be difficult for the typical amputee to get used to, thus it may pose some associated risk. Nevertheless, we believe with proper training, the typical Veteran amputee would benefit from an opportunity to use an MPF prosthesis. For this study, we will recruit a group of 54 typical Veteran below knee amputees who currently walk with a prosthesis. We will provide half of them (27) with an MPF and the appropriate training and compare them over a 6-month period of time to the other half who will only receive training on their current prosthetic foot. We will test all of the Veterans three times over the course of the study to evaluate their functional performance, ambulatory safety (including risk of falls and fall history), and quality of life. The Memphis metropolitan area is an ideal location to conduct this study because, according to the Centers for Disease Control and Prevention, both the rate of amputation and diabetes (12%) is higher than the national average (9%). This study is of vital importance to all typical a
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Apr 04, 2016
- Source ID
- W81XWH1510470
Entities
People
- Audrey Zucker-levin
Organizations
- United States Army
- VA Boston Healthcare System