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

Carlos Henrique da Silva Fontes Filho, Conrado Torres Laett, Ubiratã Faleiro Gavilão, José Carlos de Campos Jr, Dângelo José de Andrade Alexandre, Victor R A Cossich, Eduardo Branco de Sousa, Carlos Henrique da Silva Fontes Filho, Conrado Torres Laett, Ubiratã Faleiro Gavilão, José Carlos de Campos Jr, Dângelo José de Andrade Alexandre, Victor R A Cossich, Eduardo Branco de Sousa

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.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1. Overview of the experimental conditions.…
Figure 1. Overview of the experimental conditions. a) Representative set-up to video recording during the joint position sense and strength evaluation. The black circles represent the Styrofoam balls used to measure distance and angles. The squares represent the positions used to set the hand-held dynamometer. b) Step-by-step representation of the joint position sense, b-1: demonstrated the start position ∼90° of knee flexion, b-2: the experienced position, b-3: the subject returning to the start position and waiting for the evaluator’s subsequent commands, b-4: the reproduced position. The difference between the reproduced and experienced positions were used for calculating proprioception indices. The angles 45° and 30° are example values.
Figure 2. A flow diagram of the…
Figure 2. A flow diagram of the recruitment, total eligible participants, and the final sample in the study.

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