A Prosthetic Foot Test-Drive Strategy for Improving Stability and Falls-Related Outcomes in Veterans with Leg Amputations
Abstract
Objectives and Rationale: Use of a prosthesis allows many people who experience lower leg amputation to regain functional abilities, but walking may be more difficult, and impaired balance and falls are common. In addition to the potential for falls that cause injuries, even fear of falling often restricts participation in desired activities and important social roles. While the human foot and ankle are able to adapt to different commonly encountered environmental terrains (for example, uneven ground and side slopes), the ability to navigate these terrains poses greater challenges for people with loss of the foot and ankle (i.e., below-knee amputation). There is initial evidence to suggest that the stiffness of prosthetic feet during walking affects stability and balance. However, while there are many different types of prosthetic feet on the commercial market, there is limited evidence to guide which types of feet help the most with balance and stability. We therefore propose to study the effect of different types of prosthetic feet on stability and fall-related outcomes in Veterans with lower limb loss. Additionally, the current process for selecting the optimal prosthetic foot relies on clinician experience and typically does not allow people with lower limb loss to try out different kinds of prosthetic feet. We therefore also propose to study a test-drive strategy for selecting prosthetic feet to make the process inclusive of the priorities and preferences of individuals with lower limb loss. Intervention: Participants with lower limb loss will walk with three different types of commonly prescribed prosthetic feet (with different front-to-back and side-to-side properties) in the laboratory. Then they will wear each of the prosthetic feet home for 2 weeks. Participants will also walk with a robotic prosthetic foot (i.e., multiaxial prosthetic foot emulator, Humotech, Inc.) that mimics the mechanical properties of these commercial prosthetic feet without the time and cost of physically changing feet. In the proposed work, we will test the ability of the emulator to accurately reproduce the experience of wearing the corresponding commercial (actual) prosthetic feet. We will accomplish this by testing whether trying different emulated or actual feet for a brief period in the laboratory (like could be done in the clinic) can accurately predict longer-term dynamic balance and perceived stability after wearing each foot in the community for 2 weeks. Applicability of the Research: This research aims to help people with leg amputations. Approximately one million people in the United States are living with leg amputations, and this number is projected to more than double by 2050. Over 17,200 U.S. Service members have been medically evacuated due to battle- or musculoskeletal-related injuries sustained during Operations Iraqi Freedom (OIF), Enduring Freedom (OEF), and New Dawn (OND). The number of Veterans with amputations who are receiving treatment in Department of Veterans Affairs (VA) facilities has more than tripled (now 80,000) since the year 2000. There has also been a recent 48% increase in the total number of Veteran amputee patient clinic visits nationally (with a 78% increase in Veterans who served in OIF/OEF/OND). Improving stability and reducing falls in this growing population is clearly of great importance. The proposed research could help resolve longstanding uncertainty in the prescription of prosthetic feet. Unfortunately, it is difficult to generalize the benefits of a particular foot across different patients, each with unique abilities, goals, and terrains that they typically encounter. Trial and error with actual commercial prosthetic feet can be inefficient given the time and expense required for the purchasing and fitting of prosthetic feet. The emulator could provide a means to explore a range of feet in a very short period of time. This approach would also give patients a chan
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010291
Entities
People
- David C Morgenroth
Organizations
- Seattle Institute for Biomedical and Clinical Research
- United States Army