{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T22:45:13Z","timestamp":1783723513418,"version":"3.55.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"5-6","license":[{"start":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T00:00:00Z","timestamp":1676505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","award":["W81XWH-15-2-0071 OP140104"],"award-info":[{"award-number":["W81XWH-15-2-0071 OP140104"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,18]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Recent military conflicts have resulted in a significant number of lower extremity injuries to U.S. service members that result in amputation or limb preservation (LP) procedures. Service members receiving these procedures report a high prevalence and deleterious consequences of falls. Very little research exists to improve balance and reduce falls, especially among young active populations such as service members with LP or limb loss. To address this research gap, we evaluated the success of a fall prevention training program for service members with lower extremity trauma by (1) measuring fall rates, (2) quantifying improvements in trunk control, and (3) determining skill retention at 3 and 6 months after training.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Forty-five participants (40 males, mean [\u00b1SD] age, 34\u2009\u00b1\u20098\u2009years) with lower extremity trauma (20 with unilateral transtibial amputation, 6 with unilateral transfemoral amputation, 5 with bilateral transtibial amputation, and 14 with unilateral LP procedures) were enrolled. A microprocessor-controlled treadmill was used to produce task-specific postural perturbations which simulated a trip. The training was conducted over a 2-week period and consisted of six 30-minute sessions. The task difficulty was increased as the participant\u2019s ability progressed. The effectiveness of the training program was assessed by collecting data before training (baseline; repeated twice), immediately after training (0 month), and at 3 and 6 months post-training. Training effectiveness was quantified by participant-reported falls in the free-living environment before and after training. Perturbation-induced recovery step trunk flexion angle and velocity was also collected.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Participants reported reduced falls and improved balance confidence in the free-living environment following the training. Repeated testing before training revealed that there were no pre-training differences in trunk control. The training program improved trunk control following training, and these skills were retained at 3 and 6 months after training.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This study showed that task-specific fall prevention training reduced falls across a cohort of service members with diverse types of amputations and LP procedures following lower extremity trauma. Importantly, the clinical outcome of this effort (i.e., reduced falls and improved balance confidence) can lead to increased participation in occupational, recreational, and social activities and thus improved quality of life.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usad005","type":"journal-article","created":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T12:33:56Z","timestamp":1676550836000},"page":"980-987","source":"Crossref","is-referenced-by-count":6,"title":["Fall Prevention Training for Service Members With an Amputation or Limb Salvage Following Lower Extremity Trauma"],"prefix":"10.1093","volume":"189","author":[{"given":"Kenton R","family":"Kaufman","sequence":"first","affiliation":[{"name":"Mayo Clinic, Motion Analysis Laboratory , Rochester, MN 55905,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily J","family":"Miller","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Motion Analysis Laboratory , Rochester, MN 55905,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M","family":"Deml","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Motion Analysis Laboratory , Rochester, MN 55905,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riley C","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Center for the Intrepid\u2014Brooke Army Medical Center , San Antonio, TX 78219,","place":["USA"]},{"name":"Department of Kinesiology and Nutrition\/Bioengineering, University of Illinois-Chicago, Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, MD 20817,","place":["USA"]},{"name":"Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D","family":"Grabiner","sequence":"additional","affiliation":[{"name":"University of Illinois-Chicago , Chicago, IL 60607,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilynn","family":"Wyatt","sequence":"additional","affiliation":[{"name":"Naval Medical Center San Diego, Motion Analysis Laboratory , San Diego, CA 92134,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire Z","family":"Zai","sequence":"additional","affiliation":[{"name":"Naval Medical Center San Diego, Motion Analysis Laboratory , San Diego, CA 92134,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor","family":"Kingsbury","sequence":"additional","affiliation":[{"name":"Naval Medical Center San Diego, Motion Analysis Laboratory , San Diego, CA 92134,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan L","family":"Tullos","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Nutrition\/Bioengineering, University of Illinois-Chicago, Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, MD 20817,","place":["USA"]},{"name":"Department of Rehabilitation, Walter Reed National Military Medical Center , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian C","family":"Acasio","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Nutrition\/Bioengineering, University of Illinois-Chicago, Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda, MD 20817,","place":["USA"]},{"name":"Department of Rehabilitation, Walter Reed National Military Medical Center , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin E","family":"Mahon","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Walter Reed National Military Medical Center , Bethesda, MD 20814,","place":["USA"]},{"name":"DoD-VA Extremity Trauma and Amputation Center of Excellence , Joint Base San Antonio Fort Sam Houston, TX 78234,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad D","family":"Hendershot","sequence":"additional","affiliation":[{"name":"Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["USA"]},{"name":"Department of Rehabilitation, Walter Reed National Military Medical Center , Bethesda, MD 20814,","place":["USA"]},{"name":"DoD-VA Extremity Trauma and Amputation Center of Excellence , Joint Base San Antonio Fort Sam Houston, TX 78234,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher L","family":"Dearth","sequence":"additional","affiliation":[{"name":"Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["USA"]},{"name":"Department of Rehabilitation, Walter Reed National Military Medical Center , Bethesda, MD 20814,","place":["USA"]},{"name":"DoD-VA Extremity Trauma and Amputation Center of Excellence , Joint Base San Antonio Fort Sam Houston, TX 78234,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,2,16]]},"reference":[{"issue":"2","key":"2025012403045828000_R1","first-page":"18","article-title":"Medical evacuations from Operation Iraqi Freedom\/Operation New Dawn, active and reserve components, U.S. Armed Forces, 2003-2011","volume":"19","author":"AFHSC) AFHSC","year":"2012","journal-title":"MSMR"},{"issue":"2","key":"2025012403045828000_R2","doi-asserted-by":"publisher","first-page":"138","DOI":"10.2106\/JBJS.K.00734","article-title":"The Military Extremity Trauma Amputation\/Limb Salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma","volume":"95","author":"Doukas","year":"2013","journal-title":"J Bone Joint Surg Am"},{"issue":"11\u201312","key":"2025012403045828000_R3","doi-asserted-by":"publisher","first-page":"e907","DOI":"10.1093\/milmed\/usz107","article-title":"Physical therapy practice patterns for military service members with lower limb loss","volume":"184","author":"Farrokhi","year":"2019","journal-title":"Mil Med"},{"issue":"9","key":"2025012403045828000_R4","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1053\/apmr.2001.25079","article-title":"The influence of falling, fear of falling, and balance confidence on prosthetic mobility and social activity among individuals with a lower extremity amputation","volume":"82","author":"Miller","year":"2001","journal-title":"Arch Phys Med Rehabil"},{"issue":"12","key":"2025012403045828000_R5","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.2522\/ptj.20150566","article-title":"Use of perturbation-based gait training in a virtual environment to address mediolateral instability in an individual with unilateral transfemoral amputation","volume":"96","author":"Sheehan","year":"2016","journal-title":"Phys Ther"},{"issue":"10","key":"2025012403045828000_R6","doi-asserted-by":"publisher","first-page":"3076","DOI":"10.1007\/s11999-014-3664-0","article-title":"Task-specific fall prevention training is effective for warfighters with transtibial amputations","volume":"472","author":"Kaufman","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"1 Suppl","key":"2025012403045828000_R7","doi-asserted-by":"publisher","first-page":"S120","DOI":"10.1097\/TA.0b013e3182219225","article-title":"Return to running and sports participation after limb salvage","volume":"71","author":"Owens","year":"2011","journal-title":"J Trauma"},{"key":"2025012403045828000_R8","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1152\/physrev.1989.69.4.1199","article-title":"Optimization locomotion and gaits in the vertebrates","volume":"69(4)","author":"Alexander","year":"1989","journal-title":"Physiol Rev"},{"issue":"2","key":"2025012403045828000_R9","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.apmr.2006.10.030","article-title":"Evaluation of function, performance, and preference as transfemoral amputees transition from mechanical to microprocessor control of the prosthetic knee. 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