Assessment of balance abilities in patients with unilateral transtibial amputations in the pre-prosthetic phase of rehabilitation after balance exercises

  • Igor Jovic Academy of Applied Studies Belgrade, The College of Health Sciences, Serbia; Special Hospital for Rehabilitation and Orthopedic Prosthetics, Belgrade, Serbia
  • Igor Simanic Special Hospital for Rehabilitation and Orthopedic Prosthetics, Belgrade, Serbia; Academy of Applied Studies Belgrade, The College of Health Sciences, Serbia https://orcid.org/0000-0001-9181-2554
  • Milutin Radotic Special Hospital for Rehabilitation and Orthopedic Prosthetics, Belgrade, Serbia
  • Mirjana Vitaz Special Hospital for Rehabilitation and Orthopedic Prosthetics, Belgrade, Serbia; Academy of Applied Studies Belgrade, The College of Health Sciences, Serbia
Keywords: unilateral transtibial amputation, pre-prosthetic rehabilitation, balamce exercises, balance abilities

Abstract


Introduction: Unilateral transtibial amputations are among the most frequent amputations , representing a major rehabilitation problem that requires the involvement of a greater rehabilitation team. In order to solve this kind of rehabilitation problem and make the patient with transtibial amputation functionally capable, it is necessary to implement an adequate program of balance exercises. Balance exercises in the pre-prosthetic phase of rehabilitation are of crucial importance in achieving better neuromuscular control, stability and functional mobility of patients with unilateral transtibial amputations.

Objective: To evaluate the impact of the applied balance exercises on the patients' balance abilities. Method: In the research, exercise programs applied were classified into easy, medium and difficult exercises, and along with a set of exercises, the subjects were exposed to various tests to assess the ability of patients to maintain balance: the test of reactive postural control, the test of the risk of falling in persons with amputations, functional reach test and balance intensity scale. Testing was performed before and after the applied balance exercise programs. 25 respondents participated in the research, patients of the ''Special Hospital for Rehabilitation and Orthopedic Prosthetics'', who participated by signing the voluntary informed consent form of the patients in the research.

Results: At the end of the period scheduled for practicing balance reactions, all subjects from the experimental group independently maintained balance during perturbations on the balance board, so that subjects who had a worse grade during the first attempt to maintain balance on the balance board achieved a more positive grade from the previous one.

Conclusion:  Balance exercises in persons with unilateral transtibial amputations contributed to a higher level of functional abilities, mobility and stability in activities of daily life.

References

Farlie MK, Robins L, Haas R, Keating JL, Molloy E, Haines TP. Programme frequency, type, time and duration do not explain the effects of balance exercise in older adults: a systematic review with a meta-regression analysis. British journal of sports medicine 2019;53(16):996-1002. doi:10.4103/jfmpc.jfmpc_295_192.

Freyler K, Gollhofer A, Colin R, Brüderlin U, Ritzmann R. Reactive balance control in response to perturbation in unilateral stance: interaction effects of direction, displacement and velocity on compensatory neuromuscular and kinematic responses. PLoS one 2015;10(12):e0144529. doi:10.1371/journal.pone.0144529

Wong CK, Varca MJ, Stevenson CE, Maroldi NJ, Ersing JC, Ehrlich JE. Impact of a four-session physical therapy program emphasizing manual therapy and exercise on the balance and prosthetic walking ability of people with lower-limb amputation: a pilot study. JPO: Journal of Prosthetics and Orthotics 2016;28(3):95-100. doi:10.1097/jpo.0000000000000099

Vrieling AH, Van Keeken HG, Schoppen T, Otten E, Hof AL, Halbertsma JP, Postema K.Balance control on a moving platform in unilateral lower limb amputees. Gait & Posture 2008;28(2), 222–8. doi:10.1016/j.gaitpost.2007.12.002

Zhang X, Liu Z, Qiu G. Measuring balance abilities of transtibial amputees using Multiattribute Utility theory. BioMed Research International 2021;2021. doi:10.1155/2021/8340367

Seth M, Lamberg E. Standing balance in people with trans-tibial amputation due to vascular causes: A literature review. Prosthetics and Orthotics International 2017;41(4):345-55. doi: 10.1177/0309364616683819

Welch TD, Ting LH. Mechanisms of motor adaptation in reactive balance control. PloS one 2014 May 8;9(5):e96440

Kim Y, Vakula MN, Bolton DA, Dakin CJ, Thompson BJ, Slocum TA, Teramoto M, Bressel E. Which exercise interventions can most effectively improve reactive balance in older adults? a systematic review and network meta-analysis. Frontiers in Aging Neuroscience 2022;13:764826. doi:10.3389/fnagi.2021.764826

Lacroix A, Kressig RW, Muehlbauer T, Gschwind YJ, Pfenninger B, Bruegger O, Granacher U. Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial. Gerontology 2016;62(3):275-88. doi:10.1159/000442087

McCrum C, Bhatt TS, Gerards MH, Karamanidis K, Rogers MW, Lord SR, Okubo Y. Perturbation-based balance training: principles, mechanisms and implementation in clinical practice. Frontiers in Sports and Active Living 2022;4:1015394. doi:10.3389/fspor.2022.1015394

Moisan G, Miramand L, Younesian H, Turcot K. Balance control deficits in individuals with a transtibial amputation with and without visual input. Prosthetics and Orthotics International 2022;46(2):134-9. doi:10.1097/pxr.0000000000000086

Hermodsson Y, Ekdahl C, Persson BM, Roxendal G. Standing balance in trans-tibial amputees following vascular disease or trauma: a comparative study with healthy subjects. Prosthetics and Orthotics International 1994;18(3):150-8 doi:10.3109/03093649409164400

Ku PX, Osman NA, Abas WA. Balance control in lower extremity amputees during quiet standing: A systematic review. Gait & Posture 2013;39(2): 672–82. doi:10.1016/j.gaitpost.2013.07.006

Mishra S, Qureshi MD, Jethwani D, Dadgal R, Chitale N. Efficacy of Static Stabilization Exercises along with Progressive Resistive Exercises on Balance and Quality of Life in Elderly Population: A Study Protocol. Indian Journal of Forensic Medicine & Toxicology 2021;15(2). doi:10.37506/ijfmt.v15i2.14432

Jayakaran P, Johnson GM, Sullivan SJ, Nitz JC. Instrumented measurement of balance and postural control in individuals with lower limb amputation: a critical review. International Journal of Rehabilitation Research 2012;35(3):187-96. doi:10.1097/MRR.0b013e3283550ff9

Allin LJ, Brolinson PG, Beach BM, Kim S, Nussbaum MA, Roberto KA, Madigan ML. Perturbation-based balance training targeting both slip-and trip-induced falls among older adults: a randomized controlled trial. BMC geriatrics 2020;20:1-3. doi:10.1186/s12877-020-01605-9

Srivastava K, Chaudhury S. Rehabilitation after amputation: psychotherapeutic intervention module in Indian scenario. The Scientific World Journal 2014;2014. doi.org/10.1155/2014/469385

De Luccia N, Pinto MD, Guedes JP, Albers MT. Rehabilitation after amputation for vascular disease: a follow-up study. Prosthetics and orthotics international 1992;16(2):124-8. doi: 10.3109/03093649209164324

Wainapel SF. Rehabilitation of the older amputee. Journal of the American Geriatrics Society 1997;45(8):1033. doi: 10.1111/j.1532-5415.1997.tb02982.x

Krause A, Freyler K, Gollhofer A, Stocker T, Brüderlin U, Ritzmann R. Neuromuscular and kinematic adaptation in response to reactive balance training–a randomized controlled study regarding fall prevention. Frontiers in Physiology 2018;9:384520. doi:10.3389/fphys.2018.01075

Miller WC, Speechley M, Deathe AB. Balance confidence among people with lower-limb amputations. Physical therapy 2002;82(9):856-65. doi:10.1093/ptj/82.9.856

Resnik L, Borgia M. Reliability of outcome measures for people with lower-limb amputations: distinguishing true change from statistical error. Physical therapy 2011;91(4):555-65. doi:10.2522/ptj.20100287

Knott M, Mead S. Facilitation technics in lower extremity amputations. Physical Therapy 1960;40(8):587-9. doi:10.1093/ptj/40.8.587

Laura Hak and others, Stepping Asymmetry Among Individuals With Unilateral Transtibial Limb Loss Might Be Functional in Terms of Gait Stability, Physical Therapy 2014;94(10):1480–8. doi:10.2522/ptj.20130431

Houdijk H, van Ooijen MW, Kraal JJ, Wiggerts HO, Polomski W, Janssen TW, Roerdink M. Assessing gait adaptability in people with a unilateral amputation on an instrumented treadmill with a projected visual context. Physical therapy 2012;92(11):1452-60. doi:10.2522/ptj.20110362

Published
2024/03/29
Section
Original Scientific Paper