Bodyweight distribution between limbs, muscle strength, and proprioception in traumatic transtibial amputees: a cross-sectional study.

OBJECTIVES: To evaluate how transtibial amputation (TT) affects bodyweight distribution, voluntary knee joint position sense (JPS), and quadriceps (QUA) and hamstrings (HAM) strength in prosthetized patients. METHODS: Only TT patients who had been prosthetized for more than one year were included, and an age-paired able-bodied group was used as control. The participants stood on force plates with their eyes open to measure bodyweight distribution between the limbs. Knee voluntary JPS was assessed by actively reproducing a set of given arbitrary joint angles using a video analysis approach, and QUA and HAM strength were assessed isometrically with a hand-held dynamometer. RESULTS: Sixteen TT subjects (age: 39.4±4.8 years) and sixteen age-paired control subjects (age: 38.4±4.3 years) participated in the study. The amputees supported their bodyweight majorly on the sound limb (54.8±8.3%, p<0.001). The proprioceptive performance was similar between the amputated (absolute error (AE): 2.2±1.6°, variable error (VE): 1.9±1.6°, constant error (CE): -0.7±2.0°) and non-amputated limbs (AE: 2.6±0.9°, VE: 2.1±0.9°, CE: 0.02±2.3°), and was not different from that of control subjects (AE: 2.0±0.9°, VE: 1.4±0.4°, CE: -1.1±1.7°). There was a considerable weakness of the QUA and HAM in the amputated limb compared with the sound limb and control subjects (p<0.001 both). CONCLUSIONS: The asymmetric bodyweight distribution in the transtibial amputees was not accompanied by a reduction in knee proprioception. There was significant weakness in the amputated limb, which could be a potential issue when designing rehabilitation programs.

Bodyweight distribution between limbs, muscle strength, and proprioception in traumatic transtibial amputees: a cross-sectional study

OBJECTIVES: To evaluate how transtibial amputation (TT) affects bodyweight distribution, voluntary knee joint position sense (JPS), and quadriceps (QUA) and hamstrings (HAM) strength in prosthetized patients. METHODS: Only TT patients who had been prosthetized for more than one year were included, and an age-paired able-bodied group was used as control. The participants stood on force plates with their eyes open to measure bodyweight distribution between the limbs. Knee voluntary JPS was assessed by actively reproducing a set of given arbitrary joint angles using a video analysis approach, and QUA and HAM strength were assessed isometrically with a hand-held dynamometer. RESULTS: Sixteen TT subjects (age: 39.4±4.8 years) and sixteen age-paired control subjects (age: 38.4±4.3 years) participated in the study. The amputees supported their bodyweight majorly on the sound limb (54.8±8.3%, p<0.001). The proprioceptive performance was similar between the amputated (absolute error (AE): 2.2±1.6°, variable error (VE): 1.9±1.6°, constant error (CE): -0.7±2.0°) and non-amputated limbs (AE: 2.6±0.9°, VE: 2.1±0.9°, CE: 0.02±2.3°), and was not different from that of control subjects (AE: 2.0±0.9°, VE: 1.4±0.4°, CE: -1.1±1.7°). There was a considerable weakness of the QUA and HAM in the amputated limb compared with the sound limb and control subjects (p<0.001 both). CONCLUSIONS: The asymmetric bodyweight distribution in the transtibial amputees was not accompanied by a reduction in knee proprioception. There was significant weakness in the amputated limb, which could be a potential issue when designing rehabilitation programs.

Senso de posição articular, força e distribuição de carga entre os membros inferiores em amputação transtibial-estudo transversal / Assessment of Sense of joint position, strength and load distribution among lower limbs in amputated patients at transtibial level

A amputação é definida como a retirada, geralmente cirúrgica, total ou parcial de um membro do corpo. As amputações traumáticas correspondem a aproximadamente 20% das amputações de membros inferiores não eletivas, sendo a amputação no nível transtibial o tipo mais frequente. Estudos anteriores já demonstraram alterações na sensibilidade do coto de amputação e quadro de hipotrofia muscular causada pelo desuso, tendo como principal consequência a deficiência de força. Diante disso, é importante identificar a influência da amputação na propriocepção, força e distribuição de carga entre os membros de pacientes com amputação transtibial de etiologia traumática. Objetivo: Avaliar alterações na distribuição de carga, propriocepção e capacidade de produção de força muscular dos músculos do joelho em indivíduos usuários de prótese devido à amputação no nível transtibial de origem traumática. Métodos: Estudo transversal no qual participaram 16 voluntários amputados, protetizados há mais de um ano e 16 indivíduos não amputados, que compuseram o grupo-controle. Os grupos foram avaliados através dos questionários de Perfil de Atividade Humana e Escala de Tegner para avaliar o perfil de atividade física. Os pacientes foram também avaliados em relação à distribuição de carga entre os membros, propriocepção, através do senso de posição articular, e força isométrica, na flexão e extensão dos joelhos. Resultados: Este estudo demonstrou que o grupo de pacientes amputados apresenta maior debilidade física. Observou-se que o membro amputado recebe menos peso corporal, não possui deficiência na propriocepção e apresenta força da musculatura isquiotibial maior quando comparados com os demais grupos. Conclusão: A amputação não provoca deficiência na propriocepção, mas acarreta um quadro de limitação física. Apesar disso, os músculos isquiotibiais apresentam mais força quando comparados com os demais grupos avaliados, o que torna interessante o desenvolvimento de mais estudos sobre a influência da amputação na biomecânica do ser humano

Amputation is generally defined as the surgical, total or partial removal of a body member. Traumatic amputations account for about 20% of non-elective lower limb amputations, with amputation at the transtibial level being the most frequent type. Previous studies have already shown changes in sensitivity of the amputation stump and muscle hypotrophy caused by disuse, with the main consequence being the strength deficit. Therefore, it is important to gain further insight into influence of amputation on proprioception, strength and load distribution among members of the transtibial amputee of traumatic etiology. Objective: To evaluate changes in load distribution, proprioception and muscle strength production capacity of knee muscles in prosthesis users due to amputation at transtibial level of traumatic origin. Methods: The study included 16 amputee volunteers who had been prosthetized for more than one year, and 16 non-amputees, who comprised the control group. The groups were submitted to the Human Activity Profile (HAP) and Tegner Scale questionnaires to assess their physical activity profile in addition to tests who evaluated load distribution, proprioception, through the sense of articular position, and isometric force, in flexion and knee extension. Results: Our study showed that the amputee group is physically impaired. We also noted that amputated limb receives less body weight, has no proprioceptive deficit, and has greater hamstring muscle strength when compared to other groups. Conclusion: Amputation does not cause proprioceptive deficit but causes physical limitation. Nevertheless, the hamstring muscles are stronger when compared to the other groups evaluated which makes interesting the development of further studies on the influence of amputation on human physiology

Construção de um software protótipo para auxílio na terapia do paciente ortopédico em uso de anticoagulante / Developing a prototype software to aid the therapy of an orthopedic patient using anticoagulant drugs / Desarrollo de un software prototipo para ayudar a la terapia del paciente ortopédico en uso de anticoagulantes

Objetivo: descrever as etapas de desenvolvimento de um protótipo que sirva como base para a futura construção de um software que possibilite aos profissionais da saúde, no âmbito hospitalar, prestar assistência com vistas à segurança do paciente ortopédico em uso de medicamento anticoagulante. Método: este estudo se fundamentou no conceito do ciclo de vida de prototipação em suas fases iniciais de planejamento e definição dos requisitos necessários para a futura construção de um software. Resultados: o uso da ferramenta Microsoft Access® para a construção do instrumento apresentou, como resultado parcial, quatro páginas, inicialmente, referentes ao registro e à terapêutica propostos para utilização do enfermeiro e do médico no tratamento com anticoagulante do paciente admitido na clínica de ortopedia. Conclusão: a avaliação desse recurso como base para construção de um software será objeto de estudo posterior.(AU)

Objective: to describe the development stages of a prototype that serves as a basis for future construction of software that enables health care professionals, within hospitals, to provide assistance with a view to the safety of orthopedic patients using anticoagulant medication. Method: this study was based on the concept of prototyping lifecycle in its early stages of planning and definition of requirements for future construction of software. Results: using the Microsoft Access® tool for constructing the instrument had, as a partial outcome, four pages, initially, related to the registration and treatment proposed to be used by the nurse and the physician when providing a patient admitted to the orthopedic clinic with anticoagulant drug treatment. Conclusion: the evaluation of this resource as a basis for developing software will be conducted in further studies.(AU)

Objetivo: describir las etapas de desarrollo de un prototipo que sirva como base para la futura construcción de un software que posibilite a los profesionales de la salud, dentro de los hospitales, prestar asistencia con miras a la seguridad del paciente ortopédico utilizando medicación anticoagulante. Método: este estudio se basó en el concepto del ciclo de vida de prototipos en sus primeras etapas de planificación y definición de requisitos para la futura construcción de un software. Resultados: el uso de la herramienta Microsoft Access® para construir el instrumento presentó, como un resultado parcial, cuatro páginas, inicialmente, para el registro y el tratamiento propuestos para uso del enfermero y del médico para atención con anticoagulante de un paciente ingresado en la clínica ortopédica. Conclusión: la evaluación de este recurso como base para el desarrollo de un software se llevará a cabo en un estudio posterior.(AU)