INTRODUCTION: Over half of all people with lower limb amputation (LLA) experience at least one fall annually. Furthermore, the majority of LLAs result from dysvascular health complications, contributing to balance deficits. However, fall-related research specific to dysvascular LLA remains limited. OBJECTIVE: To characterize falls among adults with dysvascular LLA, using an existing Fall-Type Classification Framework and to describe the functional characteristics of participants across the framework categories. DESIGN: Secondary data analysis from two randomized controlled trials. SETTING: Outpatient setting. PARTICIPANTS: People (n = 69) 6 months to 5 years from dysvascular lower extremity amputation, who were ≥50 years of age and independently ambulatory using a prosthesis. INTERVENTION: None. OUTCOME: Descriptions of self-reported falls were collected on a weekly basis for 12 weeks, and analyzed using an existing Fall-Type Classification Framework. Fall frequencies, estimated count, and estimated proportions were compared across all framework categories, with 95% confidence intervals. Functional measures (Timed Up and Go, Two Minute Walk, Five Meter Walk, and average step count) were collected, and averages for each participant who experienced a fall were calculated. RESULTS: Thirty participants (43.5%) reported 42 falls within 12 weeks. A variety of fall types were described. Incidence of falls was highest for intrinsic destabilization sources, from incorrect weight shift patterns during transfer activities. CONCLUSION: Patients with dysvascular LLAs experience a variety of fall types. The high frequency of intrinsically sourced, incorrect weight-shift falls during transfer activities emphasizes the need to focus rehabilitation efforts on improving postural control in patients with dysvascular LLAs during activities such as reaching, turning, and transferring.

BACKGROUND: Between-limb step length asymmetry is common following transtibial amputation (TTA) and contributes to negative health consequences. There are limited evidence-based interventions targeting reduced gait asymmetry for people with TTA. Split-belt treadmill walking with asymmetrical belt speeds has successfully reduced gait asymmetry in other patient populations. However, individuals with non-traumatic TTA have critical health-related impairments that may influence the ability to respond to split-belt treadmill walking. RESEARCH QUESTION: Do people with acquired, non-traumatic TTA adapt and retain a more symmetrical gait pattern in response to split-belt treadmill walking? METHODS: Step length asymmetry was measured during split-belt treadmill walking. Eight participants walked under two alternating belt speed conditions: symmetrical (3 sets; Baseline, TIED1, TIED2) and asymmetrical belt speeds (5 sets; SPLIT1-5). One-way repeated-measures ANOVA with post-hoc Tukeys HSD tests were used to assess adaptation and short-term retention of step length symmetry. Adaptation was assessed as the level of asymmetry during TIED walking following repeated exposure to SPLIT walking. Retention was measured as the change in level of asymmetry during each set of SPLIT walking. RESULTS: Significant adaptation to split-belt walking was observed from late Baseline to early TIED1 and early TIED2. Between-limb step length asymmetry decreased from late Baseline (5.3 ± 3.4) to early TIED1 (-9.4 ± 3.6) and this change was sustained between early TIED1 and early TIED2 (-11.2 ± 3.1) (ANOVA F = 73.043, p < .001). Adaptations were retained as step length asymmetry decreased from early SPLIT1 (48.5 ± 5.3) to early SPLIT3 (31.4 ± 3.5) to early SPLIT5 (23.9 ± 5.1) (ANOVA F = 35.284, p < .001). SIGNIFICANCE: Individuals with non-traumatic TTA are capable of gait adaptation to split-belt walking and short-term retention of adaptations after removal of the asymmetrical belt speeds. Adaptability of step length symmetry is possible without modification to the prosthetic limb. Split-belt walking should be tested as a potential intervention to help people with acquired, non-traumatic TTA increase between-limb step symmetry.

BACKGROUND: Lower-limb amputation (LLA) due to non-traumatic vascular etiology is linked to extremely low physical activity and high disability. OBJECTIVE: To test the feasibility of a biobehavioral intervention designed to promote physical activity. DESIGN: A randomized, single-blind feasibility trial with a crossover design. SETTING: Veterans Administration Medical Center. PARTICIPANTS: Military veterans (age: 65.7 [7.8] years; mean [standard deviation]) with nontraumatic lower-limb amputation (LLA), randomized to two groups: GROUP1 (n = 16) and GROUP2 (n = 15). Both groups had similar baseline amputation characteristics (level of amputation and time since amputation). INTERVENTIONS: Twelve weekly, 30-minute telehealth sessions of physical activity behavior-change intervention, with GROUP1 participating in weeks 1-12 and GROUP2 in weeks 13-24. GROUP1 noncontact phase in weeks 13-24 and GROUP2 attention control telehealth phase in weeks 1-12. MAIN OUTCOME MEASURES: Feasibility (participant retention, dose goal attainment, intervention acceptability [Intrinsic Motivation Inventory [IMI] Interest and Enjoyment scale], safety) and signal of efficacy (free-living physical activity [accelerometer-based average daily step count], Late Life Function and Disability Index - Disability Scale [LLFDI-DS]). RESULTS: Participant retention rate was high (90%), with three participants lost to follow-up during the intervention period. Dose goal attainment was low, with only 10% of participants achieving an a priori walking dose goal. Intervention was rated as acceptable, with mean IMI Interest and Enjoyment score (5.8) statistically higher than the null value of 5.0 (P = .002). There were no between-group differences in adverse event rates (falls: P = .19, lower extremity wounds: P = .60). There was no signal of efficacy for change in average daily step count (d = -0.15) or LLFDI-DS (d = -0.22 and 0.17 for frequency and limitations scales, respectively). CONCLUSIONS: Telehealth delivered biobehavioral intervention resulted in acceptable participant retention, low dose goal attainment, high participant acceptability, and low safety risk, while having no signal of efficacy (physical activity, disability) for people with nontraumatic LLA.