Upper limb loss may impair locomotor stability, increase fall risk

CHICAGO — Bilateral arm restriction may increase ground reaction moments associated with instability, metabolic cost of walking and medial-lateral body center-of-mass excursion, according to data presented here at the American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium. Additionally, unilateral arm restriction could increase contralateral arm swing.

“Evidence suggests that upper limb loss may impair locomotor stability and increase fall risk,” Matthew J. Major, PhD, of the Northwestern University Prosthetics-Orthotics Center, said. “Upper limb research [is] primarily concerned with prostheses function [and] there is no literature on falls in persons with upper limb loss. The purpose of this study was to quantify fall prevalence and evaluate the association between clinically relevant patient factors and falls.”

Researchers conducted a study of 109 adults who completed an online survey of fall history, prosthesis use and perceived health and function. The researchers also used the Balance Confidence Scale. After data were checked for inconsistencies, the researchers conducted binary logistic regression analysis to characterize participants as fallers or non-fallers, based on multiple independent variables.

According to the findings, 45.7% of participants fell at least once within the past year. Of those who fell, 62.5% fell at least twice and 46.4 percent were injured from a fall. Falls were predominantly the results of trips, slips or loss of balance, Major said. “[This] suggests an undocumented health hazard in this patient group and [the] need for future work to understand underlying mechanic mechanisms of falls and stability.”

The relatively small sample size, a limited set of variables, the use of retrospective fall data and online data collection may have limited findings in the study, Major said, but he added that “this research offers initial insights and future studies could provide more in-depth data.” – by Shawn M. Carter


Major MJ. Falls in person with upper limb loss. Presented at: American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium; March 1-4, 2017; Chicago.

Disclosure: Major reports he received grant and research support from the Northwestern University Department of Physical Medicine and Rehabilitation Department and the U.S. Department of Veterans Affairs.

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