Submaksimal Egzersizin Statik Postural Adaptasyonlar ve Bel Ağrısı Üzerine Etkisi: Transtibial ve Transfemoral Amputelerin Karşılaştırılması

Yıl 2022, Cilt: 9 Sayı: 2, 527 - 552, 31.08.2022

Ecem Kaya , Nilüfer Kablan , Yaşar Tatar

https://doi.org/10.21020/husbfd.974379

Öz

Amaç: Transtibial (TTA) ve Transfemoral (TFA) amputelerde görülen statik postural adaptasyonları ve submaksimal egzersizin postür ile bel ağrısı üzerine etkisini değerlendirmek ve karşılaştırmaktır.
Gereç ve Yöntem: Prospektif olarak yapılan araştırmaya, tek taraflı transtibial (n:14; yaş:36,36±12,15 yıl) ve transfemoral (n:15; yaş:27,36±7,60 yıl) ampütasyona sahip erkek olgular dahil edilmiştir. Postüral parametrelerin ölçümü ayakta serbest duruş ile her iki ekstremiteye eşit ağırlık verilmiş duruş pozisyonunda, ADIBAS Posture (Physical TECH, Barselona, İspanya) ile elde edilen görüntülerin analizi yoluyla gerçekleştirilmiştir. Submaksimal egzersiz amacıyla 6 Dakika Yürüme Testi yapılmış; tüm değerlendirmeler submaksimal egzersiz sonrasında tekrar edilmiştir. Bel bölgesi ağrısı Wong-Baker Ağrı Skalası ile değerlendirilmiştir.
Bulgular: TTA grupta, submaksimal egzersiz öncesinde, serbest duruşta elde edilen sağlıklı ve ampute taraf lordoz açısı arasındaki fark anlamlı bulunmuştur (p:0,019). Submaksimal egzersizi takiben Spina İliaca Posterior Superior düzlem açısı iki duruş pozisyonu arasında anlamlı düzeyde farklılık göstermiştir (p:0,041). TFA grupta, submaksimal egzersiz öncesinde, omuz düzlem açısı duruş pozisyonları arasında anlamlı fark göstermiştir (p:0,015) ve bu durum egzersizi takiben devam etmiştir (p:0,003). Egzersiz sırasında katedilen mesafe TTA’lar lehine yüksek bulunmuştur (p<0,001). Ağrı submaksimal egzersizi takiben her iki grupta da anlamlı düzeyde artmıştır (p<0.05).
Sonuç: Çalışmanın sonuçları amputasyon seviyesinin statik postural adaptasyonların gelişiminde ayırt edici bir etkiye sahip olmadığını göstermiştir. Benzer şekilde, submaksimal egzersizin postür ve bel ağrısı üzerine etkisinin amputasyon seviyesinden etkilenmediği tespit edilmiştir. Erken dönem rehabilitasyon uygulamaları ile postüral adaptasyonların ve bel ağrısının semptom şiddeti düşürülebilir hatta önlenebilir.

Anahtar Kelimeler

amputasyon, asimetri, postür, submaksimal egzersiz

Destekleyen Kurum

Sağlık Bilimleri Üniversitesi, Bilimsel Araştırma Projeleri Koordinatörlüğü

Proje Numarası

2020/102

Teşekkür

Veri toplama sürecinde vermiş oldukları destekten dolayı Uluslararası Doktorlar Derneği Yönetim Kurulu Üyelerine ve Fizyoterapist Zehra AKPINAR’a teşekkür ederiz.

The Effect of Submaximal Exercises on Static Postural Adaptations and Back Pain: Comparison of Transtibial and Transfemoral Amputees

Öz

Objective: To evaluate and compare static postural adaptations and the effect of submaximal exercise on posture and back pain in Transtibial (TTA) and Transfemoral (TFA) amputees.
Materials and Methods: In prospective study, male participants with unilateral transtibial (n: 14; age: 36.36±12.15 years) and transfemoral (n:15; age:27.36±7.60 years) amputation were included. Postural parameters were measured by analyzing images taken from ADIBAS Posture (Physical TECH, Spain) in free standing and standing where the body weight was evenly distributed to extremities. 6-Minute Walk Test was performed as submaximal exercise; all evaluations were repeated after exercise. Back pain was assessed by Wong-Baker Pain Scale.
Results: In TTA group, before submaximal exercise, in free standing, the difference between intact and amputated side lordosis angle was found significant (p: 0.019). Following the submaximal exercise, the plane angle of Spina Iliaca Posterior Superior differed significantly between standing positions (p: 0.041). In TFA group, the shoulder plane angle showed significant difference between the stance positions before the submaximal exercise (p: 0.015) and this situation continued after the exercise (p: 0.003). The distance covered in submaximal exercise is higher in favor of TTAs (p<0.001). Pain increased significantly following submaximal exercise in both groups (p<0.05)
Conclusion: The results of the study showed the level of amputation does not have a distinctive effect on the development of static postural adaptations. Similarly, it was determined the effect of submaximal exercise on posture and back pain are not affected by the level of amputation. With early rehabilitation program, adaptations and back pain can be reduced, even prevented.

Anahtar Kelimeler

amputation, asymmetry, posture, submaximal exercises

Proje Numarası

2020/102

Kaynakça

• Actis, J. A., Nolasco, L. A., Gates, D. H. & Silvermann, A. K. (2018). Lumbar loads and trunk kinematics in people with a transtibial amputation during sit-to-stand. Journal of Biomechanics, 69, 1-9.
• Adamczyk, P. G. & Kuo, A.D. (2009). Redirection of center-of-mass velocity during the step-to-step transition of human walking. The Journal of Experimental Biology, 212, 2668-2678.
• American Thoracic Society. (2002). ATS Statement: The Six-Minute Walk Test. American Journal of Respiratory and Critical Care Medicine, 166, 111-117.
• Aruin, A. S., Nicholas, J. J. & Latash, M.L. (1997). Anticipatory postural adjustments during standing in below-the-knee amputees. Clinical Biomechanics, 12(1), 52-59.
• Bae, T. S., Choi, K., Hong, D. & Mun, M. (2007). Dynamic analysis of above-knee amputee gait. Clinical Biomechanics, 22, 557-566.
• Been, E. & Kalichman, L. (2014). Lumbar lordosis. Spine, 14(1), 87-97.
• Bellmann, M., Blumentritt, S., Pusch, M., Schmalz, T. & Schönemeier, M. (2017). The 3D L . A . S . A . R .–A new generation of static analysis for optimising prosthetic and orthotic alignment. Measuring Technology, 18-25.
• Bruijn, S.M., Meijer, O.G., Van Dieen, J. H., Kingma, I. & Lamoth, C. J. (2008). Coordination of leg swing, thorax rotations and pelvis rotations during gait: The organisation of total body angular momentum. Gait & Posture, 27, 455-462.
• Clemens, S. M., Kim, K. J., Gailey, R., Kirk-Sanchez, N., Kristal, A. & Gaunaurd, I. A. (2020). Inertial sensor-based measures of gait symmetry and repeatability in people with unilateral lower limb amputation. Clinical Biomechanics, 72, 102-107.
• Clemens, S. M., Klute, G. K., Kirk-Sanchez, N., Raya, M. A., Kim, K. J., Gaunaurd, I. A., ve diğ. (2018). Temporal-spatial values during a 180° step turn in people with unilateral lower limb amputation. Gait & Posture, 63, 276-281.
• Devan, H., Carman, A. B., Hendrick, P., Hale, L. & Ribeiro, D. C. (2015). Spinal, pelvic, and hip movement asymmetries in people with lower limb amputation: Systematic review. Journal of Rehabilitation Research and Development, 52(1), 1-20.
• Devan, H., Dillon, M. P., Carman, A. B., Hendrick, P., Hale, L., Boocock, M., ve diğ. (2017). Spinal and pelvic kinematics during gait in people with lower limb amputation, with and without low back pain: An exploratory study. Journal of Prosthetics and Orthotics, 29(3), 121-129.
• Devan, H., Hendrick, P., Ribeiro, D. C., Hale, L. A. & Carman, A. (2014). Asymmetrical movements of the lumbopelvic region: Is this a potential mechanism for low back pain in people with loweR limb amputation? Medical Hypotheses, 82(1), 77–85.
• Dite, W., Connor, H. J. & Curtis, H.C. (2007). Clinical identification of multiple fall risk early after unilateral transtibial amputation. Archives of Physical Medicine and Rehabilitation, 88(1), 109-114.
• Duclos, C., Roll, R., Kavounoudias, A., Mongeau, J. P., Roll, J. P. & Forget, R. (2009). Postural changes after sustained neck muscle contraction in persons with a lower leg amputation. Journal of Electromyography and Kinesiology, 19, 214-222.
• Dunk, N.M., Lalonde, J. & Callaghan, J. P. (2005). Implications for the use of postural analysis as a clinical diagnostic tool: reliability of quantifying upright standing spinal postures from photographic images. Journal of Manipulative and Physiological Therapeutics, 28(6), 386-392.
• Esposito, E. R., Rábago, C. A. & Wilken, J. (2018). The influence of traumatic transfemoral amputation on metabolic cost across walking speeds. Prosthetics and Orthotics International, 42(2), 214-22.
• Esposito, E. R. & Wilken, J. M. (2014). The relationship between pelvis-trunk coordination and low back pain in individuals with transfemoral amputations. Gait & Posture, 40, 640-646.
• Facione, J., Villa, C., Borrini, L., Thomas, M., Truffaut, S., Rogez, D., ve diğ. (2019). Spinopelvic sagittal alignment of patients with transfemoral amputation. European Spine Journal, 28, 1920-1928.
• Ferreira, E. A., Duarte, M., Maldonado, E. P., Bersanetti, A.A. & Marques, A.P. (2011). Quantitative assessment of postural alignment in young adults based on photographs of anterior, posterior and lateral views. Journal of Manipulative and Physiological Therapeutics, 34(6), 371-380.
• Fon, G. T., Pitt, M. J. & Thies, A. C. (1980). Thoracic kyphosis: Range in normal subjects. American Journal of Roentgenology, 134, 979-83.
• Friel, K., Domholdt, E. & Smith, D. G. (2005). Physical and functional measures related to low back pain in individuals with lower-limb amputation: An exploratory pilot study. Journal of Rehabilitation Research and Development, 42(2), 155-165.
• Gailey, R., Allen, K., Castles, J., Kucharik, J. & Roeder, M. (2008). Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use. Journal of Rehabilitation Research and Development, 45(1), 15-30.
• Gailey, R. S., Roach, K. E., Applegate, E.B., Cho, B., Cunniffe, B., Licht, S., ve diğ. (2002). The amputee mobility predictor: An instrument to assess determinants of the lower-limb amputee’s ability to ambulate. Archives of Physical Medicine and Rehabilitation, 83, 613-627.
• Gandevia, S. C. (1998). Neural control in human muscle fatigue: changes in muscle afferents, motor neurones and motor cortical drive. Acta Physiologica Scandinavica, 162, 275-283.
• Gaunaurd, I., Gailey, R., Hafner, B. J., Gomez-Marin, O. & Kirk-Sanchez, N. (2011). Postural asymmetries in transfemoral amputees. Prosthetics and Orthotics International, 35(2), 171-180.
• Gitter, A., Paytner, K., Walden, G. & Darm, T. (2002). Influence of rotators on the kinematic adaptations in stubby prosthetic gait. American Journal of Physical Medicine and Rehabilitation, 81, 310-314. Hayran, M. & Hayran M. (2018). Sağlık araştırmaları için temel istatistik (2. Baskı). Ankara: Omega.
• Hendershot, B. D., Bazrgari, B. & Nussbaum, M. A. (2013). Persons with unilateral lower-limb amputation have altered and asymmetric trunk mechanical and neuromuscular behaviors estimated using multidirectional trunk perturbations. Journal of Biomechanics, 46(11), 1907-1912.
• Hendershot, B. D. & Nussbaum, M. A. (2013). Persons with lower-limb amputation have impaired trunk postural control while maintaining seated balance. Gait & Posture, 38, 438-442.
• Hendershot, B. D., Shojaei, I., Acasio, J. C., Dearth, C. L. & Bazrgari, B. (2018). Walking speed differentially alters spinal loads in persons with traumatic lower limb amputation. Journal of Biomechanics, 70, 249-254.
• Johannesson, A., Larsson, G. U., Ramstrand, N., Turkiewicz, A., Wirehn, A. B. & Atroshı, I. (2009). Incidence of lower-limb amputation in the diabetic and nondiabetic general population. Diabetes Care, 32(2), 275-280.
• Karademir, M., Karavelioğlu, E., Boyacı, G. M. & Eser, O. (2014). Omurgada sagi̇ttal dengeni̇n önemi̇ ve spi̇nopelvi̇k parametreler. The Journal of Turkish Spinal Surgery, 25:139-148.
• Lahiri, S. & Das, P. G. (2012). Reliability of the six-minute walk test in individuals with transtibial amputation. Indian Journal of Physiotherapy & Occupational Therapy, 6(2), 105-107.
• Lamoth, C. J., Meijer, O. G., Wuisman, P. I., Van Dieen, J. H., Levin, M. F. & Beek, P. J. (2002). Pelvis-thorax coordination in the transverse plane during walking in persons with nonspecific low back pain. Spine, 27(4), 92-99.
• Leroux, M. A., Zabjek, K., Simard, G., Badeaux, J., Coillard, C. & Rivard, C. H. (2000). A Noninvasive anthropometric technique for measuring kyphosis and lordosis: An application for idiopathic scoliosis. Spine, 25(13), 1689-1694.
• Littman, A.J., Thompson, M. L., Arterburn, D. E., Bouldin, E., Haselkorn, J. K., Sangeorzan, B. J., ve diğ. (2015). Lower limb amputation and body weight changes in men. Journal of Rehabilitation Research and Development, 52(2), 159-170.
• Massie, D. L. & Haddox, A. (1999). Influence of lower extremity imbalances on the lumbar spine. Athletic Therapy Today, 4(2), 46-51.
• Morgenroth, D. C., Segal, A. D., Zelik, K. E., Czerniecki, J. M., Klute, G. K., Adamczyk, P. G., ve diğ. (2011). The effect of prosthetic foot push-off on mechanical loading associated with knee osteoarthritis in lower extremity amputees. Gait & Posture, 34, 502-507.
• Morrissy, R. T., Goldsmith, G. S., Hall, E. C., Kehl, D. & Cowie, G.H. (1990). Measurement of the Cobb angle on radiographs of patients who have scoliosis. Evaluation of intrinsic error. Journal of Bone and Joint Surgery, 72, 320-327.
• Nardone, A., Tarantola, J., Giordano, A. & Schieppati, M. (1997). Fatigue effects on body balance. Electroencephalography and Clinical Neurophysiology, 105, 309-320.
• Norris, J. A., Marsh, A. P., Smith, I. J., Kohut, R. I. & Miller, M. E. (2005). Ability of static and statistical mechanics posturographic measures to distinguish between age and fall risk. Journal of Biomechanics, 38, 1263-1272.
• Pedrinelli, A., Saito, M., Coelho, R. F., Fontes, R. B. & Guarniero, R. (2002). Comparative study of the flexor and extensor muscles of the knee through isokinetic evaluation in normal subjects and patients subjected to transtibial amputation. Prosthetics and Orthotics International, 26(3), 195-205.
• Petrofsky, J. S., Laymon, M. & Lee, H. (2013). Effect of heat and cold on tendon flexibility and force to flex the human knee. Medical Science Monitor, 19, 661-667.
• Porto, A. B. & Okazaki, H. A. (2018). Thoracic Kyphosis and Lumbar Lordosis Assessment by Radiography and Photogrammetry: A Review of Normative Values and Reliability. Journal of Manipulative and Physiological Therapeutics, 41 (8), 712-723.
• Prieto, T. E., Myklebust, J. B., Hoffmann, R. G., Lovett, E. G. & Myklebust, B. M. (1996). Measures of postural steadiness : Differences between healthy young and elderly adults. IEEE Transactions on Biomedical Engineering, 43(9), 956-966.
• Ramírez-Moreno, J., Revilla, J. R., Reyes, M., Clapés, A. & Escalera, S. (2012). Système ADIBAS ® Posture : Mesure de La Posture En 3D Avec Multicapteur Kinect ®.
• Wilhoite, Sydni., Williams, Shonterious., Cook, Jordan, & Ryan, Greg. (2020). Rehabilitation, Guidelines, and Exercise Prescription for Lower Limb Amputees. Strength and Conditioning Journal, 42 (2), 95-102.
• Reyes, M., Clapes, A., Ramirez, J., Revilla, J. R. & Escalara, S. (2021). Automatic digital biometry analysis based on depth maps. Computers in Industry, 64 (2013), 1316-1325.
• Rusaw, D. & Ramstrand, N. (2011). Motion-analysis studies of transtibial prosthesis users : A systematic review. Prosthetics and Orthotics International, 35(1), 8-19.
• Schmalz, T., Blumentritt, S. & Jarasch, R. (2002). Energy expenditure and biomechanical characteristics of lower limb amputee gait: The influence of prosthetic alignment and different prosthetic components. Gait & Posture, 16, 255-63.
• Segui, G. & Moreno, J. R. (2021). Global physiotherapy approach to thoracolumbar junction syndrome. A case report. Journal of Bodywork & Movement Therapies, 25, 6-15.
• Shojaei, I., Hendershot, B. D., Acasio, J. C., Dearth, C. L., Ballard, M. & Bazrgari, B. (2019). Trunk muscle forces and spinal loads in persons with unilateral transfemoral amputation during sit-to-stand and stand-to-sit activities. Clinical Biomechanics, 63, 95-103.
• Singla, D., Veqar, Z. & Hussain, M. E. (2017). Photogrammetric assessment of upper body posture using postural angles: A literature review. Journal of Chiropractic Medicine, 16 (2), 131-138.
• Silvermann, A. K., Fey, N. P., Portillo, A., Walden, J. G., Bosker, G. & Neptune, R. R. (2008). Compensatory mechanisms in below-knee amputee gait in response to increasing steady-state walking speeds. Gait & Posture, 28, 602-609.
• Somerville, E. (1952). Rotational lordosis: The development of the single curve. Journal of Bone & Joint Surgery, 34(3), 421-427.
• Varrecchia, T., Serrao, M., Rinaldi, M., Ranavolo, A., Conforto, S., De Marchis, C., ve diğ. (2019). Common and specific gait patterns in people with varying anatomical levels of lower limb amputation and different prosthetic components. Human Movement Science, 66, 9-21.
• Wasser, J. G., Herman, D. C., Horodyski, M., Zaremski, J. L., Tripp, B., Page, P., ve diğ. (2017). Exercise intervention for unilateral amputees with low back pain: study protocol for a randomised, controlled trial. Trials, 18, (630), 1-11.
• Wong, D., Baker, C. (2001). Smiling face as anchor for pain intensity scales. Pain, 89(2), 295-297.
• Wong, C. K., Benoy, S., Blackwell, W., Jones, S. & Rahal, R. (2012). A comparison of energy expenditure in people with transfemoral amputation using microprocessor and nonmicroprocessor knee prostheses: A systematic review. Journal of Prosthetics and Orthotics, 24(4), 202-208.
• Zambrano-Cristancho, L. K., Alfonso-Mora, M. L., Castellanos-Garrido, A.L., Sánchez-Vera, M. A. Rodríguez-Prieto, I. E. (2021). Interobserver reliability in three scales used in photogrammetry to measure lumbar lordosis. Fisioterapia, 43 (2021), 186-191.