DIFFERENCES IN HIP MUSCLE STRENGTH AND STATIC BALANCE IN PATIENTS WITH TRANSFEMORAL AMPUTATIONS CLASSIFIED AT DIFFERENT K-LEVELS: A PRELIMINARY CROSS-SECTIONAL STUDY

BACKGROUND: Following amputation, patients with lower limb amputations (LLA) are classified into different functional mobility levels (K-levels) ranging from K0 (lowest) to K4 (highest). However, K-level classification is often based on subjective criteria. Objective measures that are able to differentiate between K-levels can help to enhance the objectivity of K-level classification. OBJECTIVE(S): The goal of this preliminary cross-sectional study was to investigate whether differences in hip muscle strength and balance parameters exist among patients with transfemoral amputations (TFA) assigned to different K-levels. METHODOLOGY: Twenty-two participants with unilateral TFA were recruited for this study, with four participants assigned to K1 or K2, six assigned to K3 and twelve assigned to K4. Maximum isometric hip strength of the residual limb was assessed in hip flexion, abduction, extension, and adduction using a custom-made diagnostic device. Static balance was investigated in the bipedal stance on a force plate in eyes open (EO) and eyes closed (EC) conditions. Kruskal-Wallis tests were used to evaluate differences between K-level groups. FINDINGS: Statistical analyses revealed no significant differences in the parameters between the three K-level groups (p>0.05). Descriptive analysis showed that all hip strength parameters differed among K-level groups showing an increase in maximum hip torque from K1/2-classified participants to those classified as K4. Group differences were also present in all balance parameters. Increased sway was observed in the K1/2 group compared to the K4 group, especially for the EC condition. CONCLUSION: Although not statistically significant, the magnitude of the differences indicates a distinction between K-level groups. These results suggest that residual limb strength and balance parameters may have the potential to be used as objective measures to assist K-level assignment for patients with TFA. This potential needs to be confirmed in future studies with a larger number of participants. Layman's Abstract Patients with lower limb amputation (LLA) are classified into different mobility levels, so-called K-levels, which are ranging from K0 (lowest) to K4 (highest). K-level classification is relevant for the patients as it determines the type of prosthetic components available. However, K-level can vary greatly based on the clinician or orthopedic technician individual assessment. Objective data from physical performance tests can help to improve K-level classification. Therefore, muscle strength tests of the amputation stump as well as balance tests were performed in this study to determine whether these parameters have the potential to support K-level classification. Twenty-two participants with a thigh amputation participated in the study (four K1/2-, six K3- and twelve K4-participants). Hip muscle strength on the amputation side was assessed as well as static balance in the double leg stance with eyes open and eyes closed. Analysis of the data showed that all hip strength parameters differed between the K-level groups, with maximum strength increasing from the K1/2 group to the K4 group. Group differences were also seen in the balance parameters with greater body sway for the K1/2 group when compared to the K4 group, especially when participants had their eyes closed. These results show that muscle strength tests of the residual limb and static balance tests may serve as additional measures to improve K-level assignment for patients with LLA. This was only an initial study and further studies with a larger number of participants are required to confirm these results. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/37456/28905 How To Cite: John S, Orlowski K, Mrkor K.U, Edelmann-Nusser J, Witte K. Differences in hip muscle strength and static balance in patients with transfemoral amputations classified at different K-levels: A preliminary cross-sectional study. Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 1, No.5. https://doi.org/10.33137/cpoj.v5i1.37456 Corresponding Author: Stefanie John,Department of Sports Science, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany.E-Mail: [email protected] ID: https://orcid.org/0000-0001-6722-7195

Literature Review : Pengaruh Terapi Latihan Metode Bobath Terhadap Keseimbangan Statis Pada Pasien Stroke

Stroke is a neurological disorder which is has become the main factor in causing movement and body function disorder ini adults. The Problem occur freqentely in the patient in the balence disoreders ini accrying out activities and stiffness in the estremities. One of the physiotherapy apptoaches in by applying bobath method in impove the static balance. It aims to analyze the effect of bobath method exercise therapy on static balance in stroke patients from many articles. in this study the writer had scarched some articels via PubMed adn Google Scholar articles according to inclusion and exclusion criteria which are then reviewed. From that analyzed articles. It got the mean value pre intervenstion and after it. the average value in the treatment group before the intervention was given was 14.403 and after being given the intervention was 16.593, the obtained velue was 0.007. These results show the intervention bobath method can improve the ability of static balance in stroke patients. The method in proven can improve standing balance in stroke patients. So that it is highly recomended to implement this method as the physiotherapy intervention expesially in stroke patient based on the cometence.Keywords: Stroke; bobath method; static balance AbstrakStroke adalah gangguan neurologis yang menjadi faktor paling utama penyebab gangguan gerak dan fungsi tubuh pada orang dewasa. Permasalahan pada pasien stroke antara lain adanya gangguan keseimbangan dalam melakukan aktifitas dan kekakuan dalam ektremitas. Salah satu pendekatan fisioterapi untuk meningkatkan keseimbangan statis adalah metode bobath. Study ini bertujuan untuk menganalisa pengaruh terapi latihan metode bobath terhadap keseimbangan statis pada pasien stroke berdasarkan dari berbagai artikel. Pencarian artikel melalui PubMed dan Google Scholar Articles untuk menemukan artikel sesuai kriteria inklusi dan eksklusi yang kemudian dilakukan review. Dari hasil artikel yang dianalisa nilai mean sebelum diberikan intervensi didapatkan rata – rata 14.403 dan sesudah diberikan intervensi sebesar 16,593. Hasil p velue sebesar 0,007. Hasil tersebut menunjukan bahwa intervensi metode bobath dapat meningkatkan kemampuan keseimbangan statis pada pasien stroke. Metode bobath dapat meningkatkan keseimbangan berdiri pada pasien stroke. Metode bobath dapat digunakan sebagai intervensi fisioterapi khususnya pasien stroke sesuai dengan kompetensi.Kata kunci: Stroke; metode bobath; keseimbangan statis

Proprioceptive Training to Improve Static and Dynamic Balance in Elderly

Background: The risk of falls is a major cause of disability in older adults. A single fall, for the elderly, increases the risk of frequent falls and often causes an increased fear of falling again, which can become debilitating. Objectives: The purpose of the present study was to test the effects of 12 weeks of proprioceptive training on the static and dynamic balance of older adults who have experienced at least one fall without compromising consequences. Method: The sample consisted of older adults, aged 60 to 80 years, randomly divided into two groups: an experimental group, which followed a proprioceptive training protocol at a physiotherapy studio, and a control group, which did not observe any treatment. Static and dynamic balance assessment was performed pre-and post-intervention. The tests administered were the Berg Balance Test for the evaluation of static balance, and the Four-Square Step Test, for dynamic balance. A questionnaire to assess confidence and fear of falling was administered at the end of the protocol. Independent sample t-test was performed to analyze differences between groups and two-way ANOVA to test the null hypothesis of no change different over time between groups (interaction intervention × time). A Chi-Square was performed to analyze perceptions. Conclusions: The results showed that 12 weeks of proprioceptive training effectively improved dynamic and static balance in older adults. The perceptions of the experimental group were more positive than the other one, in terms of the importance of physical activity to prevent the risk of falls, fear of falling again, and experience of falls during the last 12 weeks.

THE EFFECTS OF TRAINING ON DIFFERENT SURFACES, ON BALANCE AND GAIT PERFORMANCE IN STROKE HEMIPLEGIA

ABSTRACT Although many studies have focused on balance exercises for elderly or stroke patients, no comprehensive studies have investigated the use of training on different surfaces (TDS) with analysis of gait performance in elderly male stroke patients. The active properties of balance and subjective reporting of functional gait ability were used to identify the effects of TDS. Static balance (SB), dynamic balance (DB) and gait analysis was measured in 30 elderly stroke patients. The patients were divided into the TDS group (n=15) and a control group (CG, n=15). Fifteen elderly stroke patients underwent TDS five times a week for 12 weeks. The data was analyzed using repeated measures analysis of variance. Significant differences were observed between the two groups (TDS and Control): SB (p < 0.0001), DB (OSI: p < 0.0001, APSI: p < 0.001, MLSI: p < 0.004) and gait analysis (right: temporal step time: p < 0.0001, temporal cycle time: p < 0.001, temporal double support time: p < 0.0001; left: temporal step time: p < 0.0001, temporal cycle time: p < 0.0001, temporal double support time: p < 0.0001). TDS in elderly male stroke patients suggests that the characteristics of gait performance in these patients may be improved by increasing static balance, dynamic balance and gait velocity. It is hoped that the results of this trial will provide new information on the effects of TDS on balance stability and gait ability in stroke patients, through changes in stability of the lower extremities. Level III, Case-control Study.

Assessment of the Development of Fine Motor Skills, Balance Function and Static Kinetic Stability in Elementary Schoolchildren

Background: Assessment of the development of fine motor skills (FMS), static balance (SB), and static kinetic stability (SKS) in elementary schoolchildren reflects the extent of their school readiness. Objective: To evaluate the development of children at the initial stage of systematic learning. Materials and methods: Fine motor skill tests were conducted in 117 children using a modified “Little House” technique; static balance was tested in 150 children using the stork pose balance test, and static kinetic stability was tested in 147 children by analyzing stability of the body standing while rotating around the vertical axis. Results: We established that fine motor skills were age appropriate in only 19.0 % (95 % CI: 8.9–29.1 %) of first and 17.0 % (95 % CI: 7.4–26.5 %) of second-year pupils. Low static kinetic stability was observed in 37.5 % (95 % CI: 25.6–49.4 %) of first graders and 38.8 % (95 % CI: 30.9–46.7 %) of second graders. The level of static balance was below the average in 65.7 % (95 % CI: 54.3–77.0 %) of first graders and 37.3 % (95 % CI: 26.9–47.8 %) of second graders. Developmental delays in FMS, SB and SKS were 1.2–3.9 times more frequent in boys than in girls. Conclusion: Our findings demonstrate that the development of FMS, SKS and SB in contemporary elementary schoolchildren is below the average level. The results may become the basis for elaboration of appropriate preventive programs and technologies in order to improve school readiness in children.

Vojta Approach Affects Neck Stability and Static Balance in Sitting Position of Children With Hypotonia

Purpose: In this study, the effect of the Vojta approach on neck stability and static balance in children with hypotonia was studied.Methods: Seventeen children with hypotonia were randomly divided into the Vojta approach group (n=9) and the general physical therapy group (n=8). Each group was applied intervention for 30 minutes per session, 3 times a week, for a total of 4 weeks. Ultrasonography was used to measure deep neck flexor muscle thickness, craniovertebral angle (CVA) to measure neck alignment along the spine segment, and Balancia software program to measure static balance.Results: In the Vojta approach group, the deep neck flexor muscle thickness was significantly increased (P<0.05), and the CVA was significantly improved (P<0.05). In addition, path area among static balance was significantly improved (P<0.05).Conclusions: The Vojta approach can be suggested as an effective intervention method for improving neck stability and static balance in children with hypotonia.

Effects of Short-Term Dynamic Balance Training on Postural Stability in School-Aged Football Players and Gymnasts

Static and dynamic balance abilities enable simple and complex movements and are determinants of top athletic performance. Balance abilities and their proficiency differ fundamentally with respect to age, gender, type of balance intervention, and type of sport. With this study, we aim to investigate whether 4weeks of dynamic balance training (DBT) improves static balance performance in school-aged gymnasts and football players. For this purpose, young male gymnasts (n=21) and male football players (n=20) completed an initial static balance assessment consisting of two one-legged stance (left and right foot) and two two-legged stance (eyes open and eyes closed) tasks. Subsequently, all participants underwent a 4-week intervention. DBT consisting of nine individual tasks was performed two times per week. Another static balance assessment followed 1day after the last training session and retention was assessed 2weeks later. Dynamic balance scores and total path length were analyzed via rank-based repeated measures designs using ANOVA-type statistics. The influence of factors GROUP and TIME on the static and dynamic balance performance was examined. Prior to DBT, young gymnasts showed better static balance performance than football players. However, after intervention, both groups improved in both one-legged stance tasks and also had high retention rates in these tasks. No significant improvements were seen in either group in the two-legged balance tests. Both groups improved in the dynamic balance tasks, although no differences in learning rates were evident. Our findings imply an inter-relationship between both static and dynamic balance components. Consequently, training regimes should include both balance components to facilitate early development of balance ability.