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

Abstract

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.

Investigation of the correlation between knee joint position sense and physical functional performance in individuals with transtibial amputation

“…6 As the time since amputation increases, the deterioration of joint position sense may be caused by arthritic changes in the joint after amputation, the stump-socket relationship, changes in the mass of the limb, and changes in the effort required to move the limb. 4,30 Further investigation of the factors associated with joint position sense in individuals with lower-extremity amputation may enable better fulfillment of prosthesis or exercise-related needs.…”

“…3 Impaired knee proprioception has also been reported in traumatic amputees, which could be due to the loss of mechanoreceptors during the traumatic event and during surgery. 2,4…”

“…3 Impaired knee proprioception has also been reported in traumatic amputees, which could be due to the loss of mechanoreceptors during the traumatic event and during surgery. 2,4 Knee joint position sense is essential for correct modulation and activation of muscles, thereby ensuring adequate neuromuscular control of the knee joint and ultimately the performance of physical tasks. When the joint position sense and acuity decrease, functional performance also decreases.…”

“…10 Studies conducted to date that have evaluated knee joint position in individuals with transtibial amputation have reached conflicting results. 2,4,11 Nevertheless, from the perspective of rehabilitation professionals and patient expectations, the most important thing about proprioception is its effect on the functional performance and independence of the person. Good functional performance in individuals with lower-extremity amputation enables independent activities of daily living, improves quality of life, and lowers the risk of falling.…”