Comparing the Effects of Dual‐Task Gait Testing in New and Established Ambulators With Lower Extremity Amputations

Wiley - Tập 10 Số 10 - Trang 1012-1019 - 2018
Courtney Courtney, Michael W.C. Michael W.C., Jeffrey D. Jeffrey D., Ricardo Ricardo, Susan W. Susan W.

Tóm tắt

AbstractBackgroundGait is a complex process that involves coordinating motor and sensory systems through higher‐order cognitive processes. Walking with a prosthesis after lower extremity amputation challenges these processes. However, the factors that influence the cognitive‐motor interaction in gait among lower extremity amputees has not been evaluated. To assess the interaction of cognition and mobility, individuals must be evaluated using the dual‐task paradigm.ObjectiveTo investigate the effect of etiology and time with prosthesis on dual‐task performance in those with lower extremity amputations.DesignCross‐sectional study.SettingOutpatient and inpatient amputee clinics at an academic rehabilitation hospital.ParticipantsSixty‐four individuals (aged 58.20±12.27 years; 74.5% male) were stratified into 3 groups; 1 group of new prosthetic ambulators with transtibial amputations (NewPA) and 2 groups of established ambulators: transtibial amputations of vascular etiology (TTA‐vas), transtibial amputations of nonvascular etiology (TTA‐nonvas).InterventionsNot applicable.Main Outcome MeasuresTime to complete the L Test measured functional mobility under single and dual‐task conditions. A serial arithmetic task (subtraction by 3s) was paired with the L Test to create the dual‐task test condition. Single‐task performance on the cognitive arithmetic task was also recorded. Dual‐task costs (DTCs) were calculated for performance on the cognitive and gait tasks. Analysis of variance determined differences between groups. A performance‐resource operating characteristic (POC) graph was used to graphically display DTCs.ResultsGait performance was worse under dual‐task conditions for all groups. Gait was significantly slower under dual‐task conditions for the TTA‐vas (P < .001), TTA‐nonvas (P < .001), and NewPA groups (P < .001). However, there was no between‐group difference for gait DTC. The 3 groups tested did not differ in the amount of cognitive DTC (DTCcog). Dual‐task conditions also had a negative impact on cognitive task performance for the TTA‐nonvas (P = .02) and NewPA groups (P < .001). The TTA‐vas group had a slight improvement during dual‐task conditions and has a positive DTCcog as a result (P = .04). However, no between‐group differences were seen for DTCcog. The POC graph demonstrated that many individuals had a decrease in performance on both tasks; however, the gait task was prioritized for the majority (56.2%) of participants.ConclusionsCognitive distractions while walking pose challenges to individuals regardless of etiology, level of amputation, or time with the prosthesis. These findings highlight that individuals are at risk for adverse events when performing multiple tasks while walking.Level of EvidenceII

Tài liệu tham khảo

Treweek S., 1998, Three measures of functional outcome for lower limb amputees: A retrospective review, Prosthet Orthot Int, 22, 178, 10.3109/03093649809164482 10.1053/apmr.2001.25153 10.1016/j.apmr.2012.04.011 Johnson V., 1995, Pre and post‐amputation mobility of trans‐tibial amputees: Correlation to medical problems, age and mortality, Prosthet Orthot Int, 19, 159, 10.3109/03093649509167999 10.1067/mva.1986.avs0040321 10.1016/S0003-9993(96)90303-2 Latlief G., 2014, Physical Medicine and Rehabilitation Patient‐Centered Care, 409 10.2165/00007256-199520040-00001 10.1053/apmr.2001.24295 10.1001/jama.297.1.77 Kayssi A., 2016, A Canadian population‐based description of the indications for lower‐extremity amputations and outcomes, Can J Surg, 59, 99, 10.1503/cjs.013115 10.1016/j.apmr.2007.11.005 10.3109/09638288.2012.667190 Deathe A.B., 2005, The L Test of functional mobility: Measurement properties of a modified version of the Timed “Up & Go” Test designed for people with lower‐limb amputations, Phys Ther, 85, 626, 10.1093/ptj/85.7.626 10.1097/00002060-199811000-00022 10.1080/09602010903519652 10.1191/0269215503cr641oa 10.1016/j.gaitpost.2007.12.002 Beauchet O., 2006, Gait and dual‐task: Definition, interest, and perspectives in the elderly, Psychol Neuropsychiatr Vieil, 4, 215 10.1016/S0966-6362(01)00156-4 10.1007/s00221-003-1468-7 10.1016/j.apmr.2016.06.012 10.1080/09638280802509579 10.2340/16501977-0393 Abernethy B., 1988, Dual‐task methodology and motor skills research: Some applications and methodological constraints, J Hum Mov Stud, 14, 101 10.1037/0033-2909.116.2.220 10.1002/mds.21720 10.1037/h0027242 10.1016/j.neubiorev.2010.08.008 10.1111/j.1468-1331.2009.02612.x 10.1016/j.gaitpost.2011.08.014 10.1093/gerona/52A.4.M232 10.1093/gerona/55.1.M10 Geurts A.C., 1991, From the analysis of movements to the analysis of skills, J Rehabil Sci, 4, 9 10.1093/gerona/51A.3.M116 10.1136/jnnp.2003.016014 10.1093/ageing/afm011 10.1016/j.jns.2006.05.010 10.2522/ptj.20090043 10.1093/gerona/63.12.1335 10.1159/000445831 10.1111/j.1532-5415.2012.04209.x 10.1080/00222895.1994.9941670 Geurts A.C., 1991, Dual‐task assessment of reorganization of postural control in persons with lower limb amputation, Arch Phys Med Rehabil, 72, 1059 Braddom R.L., 2011, Physical Medicine and Rehabilitation DeLisa J.A., 2010, DeLisa′s Physical Medicine & Rehabilitation 10.1111/j.1532-5415.2005.53221.x 10.1155/2013/186106 10.1093/gerona/50A.1.M28 10.1016/S0003-9993(02)04807-4 C.A.Frengopoulos.Dual‐task gait assessment in lower extremity amputees.Master's thesis University of Western Ontario June 2017. 10.2522/ptj.20100114 10.1155/2015/591475 10.1016/0010-0285(75)90004-3 Hunter S.W., 2017, Risk factors for falls in people with a lower limb amputation: A systematic review, Phys Med Rehabil, 9, 170 10.1016/j.apmr.2016.06.012 10.1016/S0966-6362(01)00141-2 10.3389/fnhum.2015.00225
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Wiley

Tập 10 Số 10

1012-1019

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