scholarly journals Measuring Balance Abilities of Transtibial Amputees Using Multiattribute Utility Theory

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Xueyi Zhang ◽  
Zhicheng Liu ◽  
Guixing Qiu
Keyword(s):  
Center Of Pressure ◽  
Research Question ◽  
Measurement Techniques ◽  
Ceiling Effect ◽  
Balance Model ◽  
Rank Test ◽  
Multiattribute Utility ◽  
Ceiling Effects ◽  
Transtibial Amputees ◽  
Balance Index

Background. Berg Balance Scale (BBS) can be considered the standard for assessment of functional balance but has a noted ceiling effect in active transtibial amputees (TTAs). Development of ceiling-free measures based on quantitative measurement techniques that is suitable for patients in any experience levels, yet sensitive enough to capture improvements in any stage of prosthetic rehabilitation, is needed. Research Question. Does a scoring scheme based on Multiattribute Utility (MAU) theory assess balance abilities of multileveled TTAs comparable to BBS? Methods. A case-control study including 28 participants (8 novice TTAs, 10 experienced TTAs, and 10 healthy controls) was conducted. Guided by MAU theory, a novel balance model was developed and initially validated by Spearman correlation between index-generated scores and expert assigned scores, providing preliminary evidence of validity. Floor/ceiling effects were tested, and between-group comparisons of static/dynamic balance were conducted by paired t -test or Wilcoxon signed-rank test depending on data distribution normality. Results. BBS score was correlated with computed balance index ( r = 0.847 , p < 0.001 ). The BBS score of novice/experienced TTAs was 39/54, and the computed balance index was 38/75. A ceiling effect of BBS (30%) was observed in the experienced TTA group, whereas no ceiling effects were found for the computed index in any combination of TTA groups. Group differences between novice and experienced TTAs were observed in center of pressure (COP) ellipse shift area, COP path length, COP average velocity, gait speed, and cadence (all p < 0.05 ). Significance. Evidence from first stage validation of the proposed MAU balance model indicated that the model performed well. This proposed method can monitor the progress of balance for varied experience-leveled TTAs and provide clinicians with useful information for assessing the rehabilitation training.

scholarly journals Precise Answers to Vague Questions: Issues With Interactions

2021 ◽  
Vol 4 (2) ◽  
pp. 251524592110073
Author(s):  
Julia M. Rohrer ◽  
Ruben C. Arslan
Keyword(s):  
Correct Answer ◽  
Research Question ◽  
Wrong Answer ◽  
Know How ◽  
Psychological Theories ◽  
Ceiling Effects

Psychological theories often invoke interactions but remain vague regarding the details. As a consequence, researchers may not know how to properly test them and may potentially run analyses that reliably return the wrong answer to their research question. We discuss three major issues regarding the prediction and interpretation of interactions. First, interactions can be removable in the sense that they appear or disappear depending on scaling decisions, with consequences for a variety of situations (e.g., binary or categorical outcomes, bounded scales with floor and ceiling effects). Second, interactions may be conceptualized as changes in slope or changes in correlations, and because these two phenomena do not necessarily coincide, researchers might draw wrong conclusions. Third, interactions may or may not be causally identified, and this determines which interpretations are valid. Researchers who remain unaware of these distinctions might accidentally analyze their data in a manner that returns the technically correct answer to the wrong question. We illustrate all issues with examples from psychology and issue recommendations for how to best address them in a productive manner.

Transducer-based comparisons of the prosthetic feet used by transtibial amputees for different walking activities: a pilot study

2012 ◽  
Vol 36 (2) ◽  
pp. 203-216 ◽  
Author(s):  
Edward Schreiber Neumann ◽  
Kartheek Yalamanchili ◽  
Justin Brink ◽  
Joon S Lee
Keyword(s):  
Clinical Decision Making ◽  
Research Question ◽  
Case Series ◽  
Clinical Decision ◽  
Residual Limb ◽  
Convenience Sample ◽  
Loading Patterns ◽  
Prosthetic Feet ◽  
Transtibial Amputees ◽  
Resultant Forces

Background: Knowledge of transtibial residual limb force and moment loading during gait can be clinically useful. The research question was whether a transducer attached between the socket and pylon can be used to detect differences in loading patterns created by prosthetic feet of different design and different walking activities in real-world environments outside the gait lab. Objectives: To develop methods for obtaining, processing, analyzing and interpreting transducer measurements and examining their clinical usefulness. Study Design: Case series design. Methods: A convenience sample of four K3-K4 transtibial amputees and a wireless tri-axial transducer mounted distal to the socket. Activities included self-selected comfortable speed walking, and ascending and descending ramps and steps. Measurements taken about three orthogonal axes were processed to produce plots of normalized resultant force versus normalized resultant moment. Within-subject differences in peak resultant forces and moments were tested. Results: Loading patterns between feet and subjects and among the activities were distinctly different. Optimal loading of peak resultant forces tentatively might occur around 25% and 69% to73% of stance during self-selected comfortable walking. Ascending and descending ramps is useful for examining heel and forefoot response. Conclusions: Force-moment plots obtained from transducer data may assist clinical decision making. Clinical relevance A pylon-mounted transducer distal to the socket reveals the moments and forces transmitted to the residual limb and can be used to evaluate the loading patterns on the residual limb associated with different foot designs and different everyday activities outside the gait lab.

scholarly journals Dynamic Balancing Responses in Unilateral Transtibial Amputees Following Outward-Directed Perturbations During Slow Treadmill Walking Differ Considerably for Amputated and Non-Amputated Side

2021 ◽  
Author(s):  
Andrej Olenšek ◽  
Matjaž Zadravec ◽  
Helena Burger ◽  
Zlatko Matjačić
Keyword(s):  
Stance Phase ◽  
Center Of Pressure ◽  
Center Of Mass ◽  
Reaction Force ◽  
Dynamic Balancing ◽  
Transtibial Amputation ◽  
Control Subjects ◽  
Foot Strike ◽  
Transtibial Amputees ◽  
Proprioceptive Function

Abstract BackgroundDue to disrupted motor and proprioceptive function lower limb amputation imposes considerable challenges associated with balance and greatly increases risk of falling in case of perturbations during walking. The aim of this study was to investigate dynamic balancing responses in unilateral transtibial amputees when they were subjected to perturbing pushes to the pelvis in outward direction at the time of foot strike on non-amputated and amputated side during slow walking.MethodsFourteen subjects with unilateral transtibial amputation and nine control subjects participated in the study. They were subjected to perturbations that were delivered to the pelvis at the time of foot strike of either the left or right leg. We recorded trajectories of center of pressure and center of mass, durations of in-stance and stepping periods as well as ground reaction forces. Statistical analysis was performed to determine significant differences in dynamic balancing responses between control subjects and subjects with amputation when subjected to outward-directed perturbation upon entering stance phases with non-amputated or amputated side.ResultsWhen outward-directed perturbations were delivered at the time of foot strike of the non-amputated leg, subjects with amputation were able to modulate center of pressure and ground reaction force similarly as control subjects which indicates application of in-stance balancing strategies. On the other hand, there was a complete lack of in-stance response when perturbations were delivered when the amputated leg entered the stance phase. Subjects with amputations instead used the stepping strategy and adjusted placement of the non-amputated leg in the ensuing stance phase to make a cross-step. Such response resulted in significantly higher displacement of center of mass. ConclusionsResults of this study suggest that due to the absence of the COP modulation mechanism, which is normally supplied by ankle motor function, people with unilateral transtibial amputation are compelled to choose the stepping strategy over in-stance strategy when they are subjected to outward-directed perturbation on the amputated side. However, the stepping response is less efficient than in-stance response. To improve their balancing responses to unexpected balance perturbation people fitted with passive transtibial prostheses should undergo perturbation-based balance training during clinical rehabilitation.

scholarly journals Computerized Adaptive Testing for Patient Reported Outcomes in Ankle Fracture Surgery

2018 ◽  
Vol 39 (10) ◽  
pp. 1192-1198 ◽  
Author(s):  
Elizabeth B. Gausden ◽  
Ashley Levack ◽  
Benedict U. Nwachukwu ◽  
Danielle Sin ◽  
David S. Wellman ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Patient Reported Outcomes ◽  
Computerized Adaptive Testing ◽  
Adaptive Testing ◽  
Ceiling Effect ◽  
Significant Difference ◽  
Patient Reported ◽  
Ceiling Effects ◽  
Clinically Significant ◽  
Fracture Surgery

Background: Advantages of using computerized adaptive testing (CAT) include decreased survey-burden, diminished floor and ceiling effect, and improved ability to detect the minimal clinical significant difference (MCID) among patients. The goal of this study was to compare the legacy patient-reported outcome measures (PROMs) to the Patient-Reported Outcomes Measurement Information System (PROMIS) scores in terms of ability to detect clinically significant changes in patients who have undergone surgery for ankle fractures. Methods: Patients who underwent osteosynthesis for an unstable ankle fracture between 2013-2016 and completed legacy outcome scores (Foot and Ankle Outcome Score [FAOS], Olerud and Molander Ankle Score [OMAS], and Weber Score) along with the PROMIS Physical Function (PF) and PROMIS Lower Extremity (LE) CATs postoperatively were included. Correlation between the scores at 3-month, 6-month, and 1-year intervals, as well as floor and ceiling effects, in addition to MCIDs were calculated for each instrument. A total of 132 patients were included in the study. Results: There was no observed floor or ceiling effect in either the PROMIS PF or the PROMIS LE scores. Clinically significant changes in the PROMIS LE score were detected in patients between 6-month and 12-month postoperative visits ( P = .0006), whereas the reported OMAS score and Weber scores did not identify a clinically significant difference between patients at their 6-month and 12-month visit. Conclusion: The results of this study indicate that the PROMIS LE was superior for evaluating patients following ankle fracture surgery in terms of lower floor and ceiling effects and greater ability to distinguish clinically significant changes in patients between time points following surgery. Level of Evidence: Level III, comparative study.

scholarly journals Measurement of Perceived Physician Empathy in Orthopedic Patients

2019 ◽  
Vol 7 (4) ◽  
pp. 600-606 ◽  
Author(s):  
Mark Hendrik Franciscus Keulen ◽  
Teun Teunis ◽  
Joost Teunis Pieter Kortlever ◽  
Gregg Alan Vagner ◽  
David Ring ◽  
...  
Keyword(s):  
Factor Loading ◽  
Ceiling Effect ◽  
Adherence To Treatment ◽  
Factors Associated ◽  
Advantages And Disadvantages ◽  
Ceiling Effects ◽  
Patient’S Perception ◽  
Orthopedic Patients ◽  
Physician Empathy ◽  
Care Measure

Background: Empathy is a key component of a therapeutic relationship. Perceived empathy and compassion are associated with patient satisfaction, reduced symptoms, and adherence to treatment. Objective: To assess the advantages and disadvantages of the validated Jefferson Scale of Patient’s Perception of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy (CARE) tools. Methods: Eighty-four patients completed the JSPPPE and the CARE measure. With Pearson’s correlation and exploratory factor analysis, we measured the underlying construct. Flooring and ceiling effects were measured. Multivariable models were created to assess factors associated with both measures. Results: The high interquestionnaire correlation (rho = 0.70) and factor loading (0.77) confirm that the JSPPPE and CARE measure the same construct. The CARE (55%) had a higher ceiling effect than JSPPPE (18%). Both JSPPPE (partial R2 = 0.53, 95% confidence interval [CI]: 0.38-0.64) and CARE (partial R2 = 0.60, 95% CI: 0.46-0.69) accounted for similar amounts of variation in satisfaction with the orthopedic surgeon. Conclusion: Perceived empathy accounts for a substantial amount of the variation in satisfaction. The JSPPPE measures the same construct as CARE with a lower ceiling effect. Because both questionnaires have considerable ceiling effects, a new questionnaire might help to study factors associated with a more empathetic experience.

scholarly journals The links between implementing ISA 540 and mitigating the practice of smoothing reported net earnings using write-offs of accounts receivable and inventory by reporting entities in Poland

2016 ◽  
Vol 2016 (87(143)) ◽  
pp. 129-142
Author(s):  
Andrzej Piosik
Keyword(s):  
Positive Impact ◽  
Research Question ◽  
Income Smoothing ◽  
Rank Test ◽  
Accounting Earnings ◽  
Accounts Receivable ◽  
Signed Rank ◽  
Effective Manner ◽  
Signed Rank Test ◽  
Accounting Earnings Management

The paper addresses the question of the links between implementing ISA 540 and mitigating the practice of smoothing reported net earnings using write-offs of accounts receivable and inventory by reporting en-tities in Poland. The research question stems from the previous analysis carried out by the author in which evidence was provided that reporting entities in Poland in the period 2000–2010 effectively used write-offs of accounts receivable and inventory in order to mitigate fluctuations of reported net earnings. This paper provides evidence that before implementing ISA 540 reporting entities used write-offs of receivables and inventory for income smoothing in effective manner, however in the period after implementing the standard (2009–2014) no link was observed between the write-offs and reduced fluctuations of reported net earnings. The research has been carried out using Wilcoxon signed-rank test used to check equality of medians of mean deviations of net earnings before write-offs of receivables and inventory and mean deviations of net earnings after write-offs. For the period before implementing ISA 540 there are grounds to reject the hy-pothesis of equality of medians of mean deviations of net earnings, however in the post-adoption period there is no justification to reject the hypothesis of equality of medians. The research provides evidence of positive impact of ISA 540 mitigating the processes of accounting earnings management. The indicated regularity does not apply to banks, because within this group of companies we have not observed the use of write-offs of loan receivables in order to reduce the variability of net earnings before implementing ISA 540 and in the period following the implementation of the standard.

Peak and ceiling effects in final-product analysis of mastoidectomy performance

2015 ◽  
Vol 129 (11) ◽  
pp. 1091-1096 ◽  
Author(s):  
N West ◽  
L Konge ◽  
P Cayé-Thomasen ◽  
M S Sørensen ◽  
S A W Andersen
Keyword(s):  
Virtual Reality ◽  
Surgical Simulation ◽  
Ceiling Effect ◽  
Virtual Reality Simulator ◽  
Single Session ◽  
Product Analysis ◽  
Maximum Score ◽  
Training Tool ◽  
Ceiling Effects ◽  
Better Than

AbstractBackground:Virtual reality surgical simulation of mastoidectomy is a promising training tool for novices. Final-product analysis for assessing novice mastoidectomy performance could be limited by a peak or ceiling effect. These may be countered by simulator-integrated tutoring.Methods:Twenty-two participants completed a single session of self-directed practice of the mastoidectomy procedure in a virtual reality simulator. Participants were randomised for additional simulator-integrated tutoring. Performances were assessed at 10-minute intervals using final-product analysis.Results:In all, 45.5 per cent of participants peaked before the 60-minute time limit. None of the participants achieved the maximum score, suggesting a ceiling effect. The tutored group performed better than the non-tutored group but tutoring did not eliminate the peak or ceiling effects.Conclusion:Timing and adequate instruction is important when using final-product analysis to assess novice mastoidectomy performance. Improved real-time feedback and tutoring could address the limitations of final product based assessment.

scholarly journals Dynamic balancing responses in unilateral transtibial amputees following outward-directed perturbations during slow treadmill walking differ considerably for amputated and non-amputated side

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Andrej Olenšek ◽  
Matjaž Zadravec ◽  
Helena Burger ◽  
Zlatko Matjačić
Keyword(s):  
Stance Phase ◽  
Center Of Pressure ◽  
Center Of Mass ◽  
Reaction Force ◽  
Dynamic Balancing ◽  
Transtibial Amputation ◽  
Control Subjects ◽  
Foot Strike ◽  
Transtibial Amputees ◽  
Proprioceptive Function

Abstract Background Due to disrupted motor and proprioceptive function, lower limb amputation imposes considerable challenges associated with balance and greatly increases risk of falling in presence of perturbations during walking. The aim of this study was to investigate dynamic balancing responses in unilateral transtibial amputees when they were subjected to perturbing pushes to the pelvis in outward direction at the time of foot strike on their non-amputated and amputated side during slow walking. Methods Fourteen subjects with unilateral transtibial amputation and nine control subjects participated in the study. They were subjected to perturbations that were delivered to the pelvis at the time of foot strike of either the left or right leg. We recorded trajectories of center of pressure and center of mass, durations of in-stance and stepping periods as well as ground reaction forces. Statistical analysis was performed to determine significant differences in dynamic balancing responses between control subjects and subjects with amputation when subjected to outward-directed perturbation upon entering stance phases on their non-amputated or amputated sides. Results When outward-directed perturbations were delivered at the time of foot strike of the non-amputated leg, subjects with amputation were able to modulate center of pressure and ground reaction force similarly as control subjects which indicates application of in-stance balancing strategies. On the other hand, there was a complete lack of in-stance response when perturbations were delivered when the amputated leg entered the stance phase. Subjects with amputations instead used the stepping strategy and adjusted placement of the non-amputated leg in the ensuing stance phase to make a cross-step. Such response resulted in significantly larger displacement of center of mass. Conclusions Results of this study suggest that due to the absence of the COP modulation mechanism, which is normally supplied by ankle motor function, people with unilateral transtibial amputation are compelled to choose the stepping strategy over in-stance strategy when they are subjected to outward-directed perturbation on the amputated side. However, the stepping response is less efficient than in-stance response.

scholarly journals A systematic review of variables used to assess clinically acceptable alignment of unilateral transtibial amputees in the literature

2018 ◽  
Vol 232 (8) ◽  
pp. 826-840
Author(s):  
Nahid Tafti ◽  
Fatemeh Hemmati ◽  
Reza Safari ◽  
Mohammad Taghi Karimi ◽  
Farzad Farmani ◽  
...  
Keyword(s):  
Gait Cycle ◽  
Center Of Pressure ◽  
Selection Criterion ◽  
Standing Position ◽  
Alignment Quality ◽  
Standing Posture ◽  
Bias Assessment ◽  
Prosthetic Alignment ◽  
Research Questions ◽  
Transtibial Amputees

Prosthetic alignment is a subjective concept which lacks reliability. The outcome responsiveness to prosthetic alignment quality could help to improve subjective and instrument assisted prosthetic alignment. This study was aimed to review variables used to assess clinically acceptable alignment in the literature. The search was done in some databases including: Google Scholar, PubMed, EBSCO, EMBASE, ISI Web of Knowledge and Scopus. The first selection criterion was based on abstracts and titles to address the research questions of interest. The American Academy of Orthotics and Prosthetics checklists were used for paper risk of bias assessment. A total of 25 studies were included in this study. Twenty-four studies revealed the critics of standing position or walking to locate clinically acceptable alignment, only one study measured outcomes in both situations. A total of 253 adults with transtibial amputations and mean age of 48.71 years participated in included studies. The confidence level of included studies was low to moderate, and before–after trial was the most common study design (n = 19). The joint angle, load line location with respect to joints and center of pressure–related parameters were reported as sensitive outcomes to prosthetic alignment quality in standing posture. The amount of forces at various parts of gait cycle and time of events were sensitive to prosthetic alignment quality during walking. Standing balance and posture and temporal parameters of walking could help to locate clinically acceptable alignment.

Display Content Adaptation Using a Force Sensitive Office Chair

2011 ◽  
Vol 3 (3) ◽  
pp. 8-17
Author(s):  
Andreas Riener
Keyword(s):  
Center Of Pressure ◽  
Research Question ◽  
Force Sensor ◽  
Content Adaptation ◽  
Cursor Control ◽  
Non Invasive ◽  
Usability Assessment ◽  
Screen Content ◽  
Display Content ◽  
Office Chair

In this paper, the author introduces a novel method for non-invasive, implicit human-computer interaction based on dynamically evaluated sitting postures. The research question addressed is whether or not the proposed system is able to allow for non-obtrusive screen content adaptation in a reading situation. To this end, the author has integrated force sensor array mats into a traditional office chair, providing sitting postures/gestures of the person seated in real time. In detail, variations in the center of pressure were used for application control, starting more generally with usability assessment of cursor control, breaking them down to simple(r) pan and zoom of screen content. Preliminary studies have indicated that such a system cannot get close to the performance/accuracy of keyboard or mouse, however its general usability, e.g., for handicapped persons or for less dynamic screen content adaptation, has been demonstrated and some future potential has been recognized.

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