Effect of concurrent training in unilateral transtibial amputees using Paralympic athletes as a control group

Abstract Context: Transtibial Amputation (TA) predisposes to a sedentary lifestyle. Objectives: To evaluate the efficiency of a short-term (8-week) Concurrent Training (CT) program in Unilateral Transtibial Amputees (UTA) and to compare it with the physical condition of a group of Paralympic athletes in preparation for the Rio de Janeiro Paralympics. Design: This was a longitudinal, prospective and controlled trial study. Methods: Thirty-four male subjects with UTA and using prostheses for six months or more were selected for this study. They were divided into two groups: Group 1 (G1) - 17 non-athlete and untrained UTA and Group 2 (G2) - 17 paralympic athletes with active UTA in the training phase. G1 was evaluated before and after eight weeks of CT and G2 made a single evaluation for control. All were submitted to anamnesis, clinical evaluation (blood pressure, electrocardiogram, and heart rate) and cardiopulmonary exercise testing on a lower limb cycle ergometer, and isokinetic knee dynamometry. The CT of G1 included resistance exercise and aerobic interval training on a stationary bicycle and G2 followed the training of the Paralympic teams. Results: Patients were retested by the same methods after CT. The two most important central dependent variables (maximal oxygen uptake and muscular strength) increased by 22% and knee extensor and flexor strength by 106% and 97%, respectively. Conclusion: After eight weeks of CT, there was an improvement in general functional condition, muscle strength, and cardiorespiratory performance improving protection against chronic diseases and quality of life.

Effects of Tactile Vibration Feedback System on Balance Function and Walking Ability of Unilateral Transtibial Amputees with Prostheses / 中国康复理论与实践

Objective:To observe the effect of the tactile vibration feedback system on the balance and walking function of the unilateral transitional amputees with prostheses. Methods:From October, 2019 to November 2020, eleven unilateral transtibial amputees with prostheses were selected from our hospital. They performed daily activities for three hours wearing tactile vibration feedback system designed by our department. The patients were evaluated by Performance Oriented Mobility Assessment (POMA), gait analysis and outdoor 1000 meters complex road walking test before and after treatment. Results:The balance score of the POMA improved (Z = -2.264, P < 0.05), the gait score and total score of the POMA increased significantly (|t| > 6.249, P < 0.001) after treatment. Gait analysis showed that the step length of the affected side improved, the bilateral step time and double support phase shortened, and the walking speed increased (|t| > 2.250, |Z| > 2.756, P < 0.05) after installation. The outdoor 1000 meters complex road walking test showed that the total steps, energy consumption and time decreased (|t| > 2.412, |Z| > 2.045, P < 0.05). All the patients finished the trail, and no discomfort appeared. Conclusion:The tactile vibration feedback system could safely and effectively improve the balance and walking function of the unilateral transtibial amputees with prostheses.

What is the Quality of Life of Transtibial Amputees in Brunei Darussalam?

@#Introduction: Lower limb amputations have a profound impact on the quality of life (QoL) of the patients. This study was done to assess the QoL of patients with transtibial (below-the-knee) amputations (TTA) and transtibial amputees fitted with prosthesis. Materials and Methods: A case-control study of patients who had undergone TTA from 2015 to 2018 was conducted in Raja Isteri Pengiran Anak Saleha Hospital (RIPAS). Complete data was available for 30 subjects and it was compared with 30 diabetic, non-amputee patients matched for age and gender. QoL was assessed using the RAND 36Item Health Survey (SF-36) and the functional outcome of prosthesis-fitted transtibial amputees was assessed using the Houghton Scale. Results:Almost all cases of TTA were a result of vascular problems related to diabetes and chronic renal disease (n=29; 97%). Eighteen (60%) participants were fitted with prosthesis and 15 (50%) reported having phantom pain. QoL of participants was found to be significantly lower than that of age and sex-matched diabetic non-amputees with regards to physical functioning, role limitation due to physical health, emotional well-being, social functioning, and bodily pain. The mean Houghton Score for participants fitted with prosthesis was 4.89 (SD= 2.83) suggesting low functional outcome. Conclusion: TTA has a negative impact on the QoL of patients, especially in terms of functionality. The availability of prosthesis does not significantly improve the quality of life except in the physical functioning domain. Emotional well-being should be emphasised more in the rehabilitation process as this study found poor emotional well-being among participants.

Walking Ability of Unilateral Transtibial Amputees with Prostheses / 中国康复理论与实践

Objective To investigate walking ability of amputees with unilateral transtibial prosthesis. Methods From April to Decem-ber, 2016, 20 unilateral transtibial amputees (patients) and 20 healthy adults (controls) were tested with L test, balance test, 6-minute walk test (6MWT) and 1000 m walking outdoor on various terrain. Results There was no significant difference in time of L test between the am-putees wearing Solid Ankle Cushion Heel (SACH) and Storage Foot (t=0.675, P>0.05). In balance tests, there was no significant difference in the total track length, confidence ellipse area, maximum horizontal deviation and maximum vertical deviation between the patients and the controls (t0.05). Each parameter was significantly different in 6MWT between them (t>2.774, P4.130, P<0.001). Conclusion The walking ability of the unilateral transtibial ampu-tees wearing prostheses is different from normal people. The transtibial prosthetic feet that the amputees wear may impact their walking abil-ity.

Avaliação da força muscular, da atividade muscular e das alterações metabólicas de amputados transtibiais / Assessment of muscle strength, muscle activity and metabolic changes of patients with transtibial amputation

Objetivo: Reunir os achados na literatura sobre eletromiografia, força muscular e alterações metabólicas em amputados transtibiais. Métodos: Revisão da literatura, realizada no período de janeiro a março de 2014, com pesquisa nas bases de dados eletrônicas: Pubmed, Scielo, Lilacs, BVS, Dedalus e BCE; utilizando-se as palavras-chave: amputado transtibial, EMG, abaixo do joelho, amputados, força muscular, gasto energético e frequência cardíaca, além de seus correspondentes na língua inglesa. Resultados: Foram identificados 144 artigos. Após análise e avaliação, 33 artigos foram selecionados. A demanda metabólica apresenta-se maior durante a marcha de indivíduos amputados em comparação a não amputados. Para o estudo eletromiográfico nessa população são utilizados, principalmente, os músculos bíceps femoral e reto femoral. O torque foi a variável mais descrita por sua relação direta com a força muscular. Conclusão: Os sinais EMG estão fortemente relacionados ao modo como o amputado. (AU)

Objective: To assemble findings in the literature regarding electromyography, muscle strength and metabolic alterations in patients with transtibial amputations. Methods: Literature review from January to March 2014 in Pubmed, Scielo, Lilacs, BVS, Dedalus and BCE databases; the following key words were used: transtibial amputee, sEMG, below the knee, amputees, muscle strength, energy expenditure and its Portuguese equivalents. Results: 144 articles were identified. After subsequent analysis and evaluation, 33 were selected. Metabolic demand appears to be increased during amputees gait in comparison to non-amputees subjects. Concerning EMG studies, the main muscles used in this population are both biceps femoris and rectus femoris. Torque was the most described variable for its directly relation with muscle strength. Conclusion: EMG signals are strongly related to the transtibial amputee locomotion. The proper prosthesis selection may reduce metabolic demand. (AU)

Thorax, pelvis and hip pattern in the frontal plane during walking in unilateral transtibial amputees: biomechanical analysis

Background: Lower limb amputees exhibit postural control deficits during standing which can affect their walking ability. Objectives: The primary purpose of the present study was to analyze the thorax, pelvis, and hip kinematics and the hip internal moment in the frontal plane during gait in subjects with Unilateral Transtibial Amputation (UTA). Method: The participants included 25 people with UTA and 25 non-amputees as control subjects. Gait analysis was performed using the Vicon(r) Motion System. We analyzed the motion of the thorax, pelvis, and hip (kinematics) as well as the hip internal moment in the frontal plane. Results: The second peak of the hip abductor moment was significantly lower on the prosthetic side than on the sound side (p=.01) and the control side (right: p=.01; left: p=.01). During middle stance, the opposite side of the pelvis was higher on the prosthetic side compared to the control side (right: p=.01: left: p=.01). Conclusions: The joint internal moment at the hip in the frontal plane was lower on the prosthetic side than on the sound side or the control side. Thorax and pelvis kinematics were altered during the stance phase on the prosthetic side, presumably because there are mechanisms which affect postural control during walking. .

Walking Ability of Bilateral Transtibial Amputees Assisted with Prostheses / 中国康复理论与实践

@#Objective To compare the walking ability between bilateral transtibial amputees and normal controls, and develope reference indexes of bilateral transtibial amptees' walking ability while wearing prostheses. Methods 11 bilateral transtibial amputees served as amputation group, 12 normal subjects served as controls. The indoor gait characteristics, outdoor time cost and energy consumption, and static balance of both groups were evaluated. Results After the indoor gait analysis, the average self-selected-speed of the amputees was 1.07 m/s, while the self-selected-speed of the normal people was 1.29 m/s. When the subjects walked with their self-selected-speed, there were significant differences in some of the gait spatial and temporal parameters between 2 groups (P<0.05). When the subjects walked on a specially designed 1 km outdoor trail, differences of energy consumption and time cost were also observed (P<0.05). Static balance presented no significant difference between 2 groups (P>0.05). Conclusion The walking ability of the bilateral transtibial amputees wearing prostheses is different from normal people. Quantitative evaluation of walking ability can provide more accurate reference for the rehabilitation of amputees.

Efficacy of removable rigid dressing after transtibial amputation in diabetes mellitus patients.

Background: The aim of this study was to evaluate the RRD’s efficacy in decreasing stump edema and pain compared to elastic bandage for diabetic mellitus patients after transtibial amputation. Methods: Interventional research was using consecutive sampling. Subjects were randomized into two groups: RRD and elastic bandage. Twenty-three subjects were analyzed. Stump edema volume was measured by the amount of water spilled out from volume glass. Elastic bandage was reapplied every 4 hours and RRD was refitted every 7 days during evaluation time. Stump edema volume was evaluated every 7 days during the 8 week observation. Results: There was a significant decrease of stump volume in RRD group during the first and second week (p = 0.03, p = 0.01) and the edema decreasing time was also significant (p = 0.03). The average decrease of edema volume in RRD was 63.85% of second week and in the elastic bandage group was 34.35%. There were a tendency of pain reduction time in RRD group (4.83 ± 1.95 weeks) compared to elastic bandage group (5.18 ± 2.31weeks). Cox regression result of decreasing edema volume time was 3.088 (CI 95%: 1.128 – 4.916). Conclusion: This study found that there was stump edema volume acceleration in RRD group, it was three times faster for stump to become not edematous compared to elastic bandage group. There was a tendency of faster decreasing stump pain in RRD group than elastic bandage group, eventhough this result was not statistically significant.

Comparison between the Barefeet Gait and the Shoe Gaitin the Transtibial Amputees

OBJECTIVE: The aims of this study were to evaluate gait patterns in transtibial amputees with the barefeet relative to the shoe and also to identify the differences between their gait patterns of two different types of prosthetic feet. METHOD: An optoelectronic motion analysis of gait was done in six transtibial amputees using both the SACH foot and the single axis foot. In both cases we compared the state of the barefeet with the shod. RESULTS: The gait abnormalities which were observed during the barefeet gait with the SACH foot showed knee joint hyperextension of 9.9+/-2.0 degrees and the loss of ankle plantar flexion at the early stance phase. When the single axis foot was used, there was a reduction in knee flexion thrust from 9.9+/-3.7 degrees to 7.2+/-3.8 degrees and also in plantar flexion from 9.9+/-2.8 degrees to 7.0+/-2.1 degrees during the early stance phase. CONCLUSION: There were significant gait abnormalities during the barefoot walking state in transtibial amputees with the SACH foot. We observed that gait patterns have been improved when the single axis prosthetic foot was used.