Targeting Balance Confidence as a Strategy to Increase Integration and Improve Outcomes in Users of Lower-Limb Prostheses
Abstract
We are proposing to develop and evaluate a rehabilitation method to increase balance confidence and promote community participation in lower limb prosthesis users. Low balance confidence occurs when an individual perceives they have limited ability to maintain their balance when performing specific tasks of daily living, and this misperception is a prevalent problem in lower limb prosthetic users. The fact that many lower limb prosthetic users report low balance confidence cannot be ignored. A person’s belief in their ability to safely engage in a task can strongly influence their choice to engage in that task and to do so independently. In fact low balance confidence is a strong predictor of prosthetic use and community participation (e.g., number of and extent of social interactions and travels outside of the home). Accordingly, improving balance confidence could significantly improve community integration (i.e., participation) and overall quality of life. While balance confidence is certainly related to functional abilities, the two are not highly correlated. It is possible to improve functional ability (balance and gait) as a result of rehabilitation, without concurrently improving balance confidence. For example, in one study of persons receiving their first lower limb amputation, balance confidence 3 months after discharge form rehabilitation was not significantly different than at discharge even though walking ability significantly improved over that time. Further, balance confidence at discharge was a strong predictor of community participation 3 months later. This suggests that (1) it is important to introduce therapies to promote balance confidence during rehabilitation since balance confidence may not change thereafter and (2) interventions to address low balance confidence may need to target both functional abilities as well as beliefs regarding these abilities. The objective of this study is to demonstrate that an intervention combining physical therapy (PT) exercise to improve function with cognitive behavioral therapy (CBT) to address fears and thoughts associated with low confidence and activity restriction can significantly improve balance confidence and in turn promote community participation in lower limb prosthesis. Participants in the study will be current lower limb prosthesis users with unilateral, transtibial amputation who report low balance confidence. Participants will be assigned to either a control group (that receives no intervention) or an intervention group. The intervention involves eight 1.25-hour visits to a laboratory and completion of structured, at-home assignments that ask the participants to record activities they avoided during the week and the thoughts they had at the time. During each intervention session, participants will engage in 45 minutes of active video games that function to improve balance and gait. They will then speak with a clinical psychologist about their at-home assignments. Subject-specific exercises that target tasks that were identified as fear-inducing on the homework assignments will also be practiced. Prior to and after the intervention, participants will complete surveys asking about confidence levels and community participation. They will also wear monitors on their prosthetic that can track where and how often activities are engaged in. They will also wear monitors on their prosthetic that can track where and how often they engage in activities. This assessment will be repeated 2 and 4 months after completing the intervention, and values will be compared to those of the control group. The ultimate applicability of the intervention includes incorporation within the initial rehabilitation stages following prosthetic prescription in order to increase confidence when learning to use the device. This would have several direct benefits to the prosthesis user. It would allow them to maximize reintegration into in the community and not feel li
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710697
Entities
People
- Noah Rosenblatt
Organizations
- Rosalind Franklin University of Medicine and Science
- United States Army