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Effects of a Hydraulic Knee Joint on Energy Consumption, Gait and Patient Satisfaction in Trans-Femoral Amputees

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Effects of a Hydraulic Knee Joint on Energy Consumption, Gait and Patient Satisfaction in Trans-Femoral Amputees Fizyoterapi Rehabilitasyon. 2009; 20(3):169-177 Effects of a hydraulic knee joint on energy consumption, gait and patient satisfaction in trans-femoral amputees Özlem ÜLGER, Semra TOPUZ, Kezban BAYRAMLAR [Ülger Ö, Topuz S, Bayramlar K. Effects of a hydraulic knee joint on energy consumption, gait and patient satisfaction in trans-femoral amputees. Fizyoter Rehabil. 2009;20(3):169-177. Diz üstü amputelerde hidrolik diz ekleminin enerji tüketimi, yürüyüş ve hasta memnuniyeti üzerine etkisi.] Research Article Purpose: This study was planned to investigate the effects of a hydraulic knee joint on gait, energy consumption and patient satisfaction in trans-femoral amputees. Material and methods: Ten patients with a mean age of 22.7±9.4 years who had undergone amputations due to traffic accidents and used prostheses with a mechanic knee joint, polyester quadrilateral socket and dynamic foot initially were included in the study. The patients were fitted with prostheses including a hydraulic knee joint, quadrilateral acrylic socket and a dynamic foot. Gait TM was assessed using Biodex Gait Trainer 2 and energy consumption by a 6-minute walk test, quality of life was assessed with the Nottingham Health Profile (NHP), balance was assessed with Berg Balance Scale with each type of prosthesis. A patient satisfaction questionnaire (SATPRO) was also applied. Results: The results showed that the prostheses with a hydraulic knee joint and new socket enabled the amputees to walk closer to normal than their previous prostheses did (p<0.05). Energy consumption of the patients was lower when the hydraulic knee joint was used compared to the mechanical knee joint (p<0.05). According to the NHP, there were no significant differences between the two types of prosthesis except for pain (p>0.05). The patients who used hydraulic knee joints stated that they were more comfortable when using prostheses with this type of joint according to SATPRO (p<0.05). Conclusion: It was shown that energy consumption decreased, subjects’ satisfaction increased and gait was near normal by the use of hydraulic knee joint in trans-femoral amputees. It can be concluded that hydraulic knee joint usage can provide convenience to patients clinically. Key words: Amputees, Gait, Energy metabolism, Personal satisfaction. Diz üstü amputelerde hidrolik diz ekleminin enerji tüketimi, yürüyüş ve hasta memnuniyeti üzerine etkisi Ö Ülger, S Topuz Hacettepe University, Amaç: Bu çalışma diz üstü amputelerde hidrolik diz ekleminin enerji tüketimi, yürüyüş ve hasta Faculty of Health Sciences, memnuniyeti üzerine olan etkisini incelemek amacıyla planlandı. Gereç ve yöntem: Çalışmaya, Department of Physical Therapy and amputasyon nedeni trafik kazası olan, yaş ortalamaları 22.70±9.4 yıl olan, daha önce mekanik Rehabilitation diz eklemli, polyester quadrilateral soket ve dinamik ayaklı diz üstü protez kullanan toplam 10 PT, PhD olgu alındı. Olgulara hidrolik diz eklemli, akrilik quadrilateral soket ve dinamik ayaklı diz üstü protez yapıldı. Olgular her iki protezleri ile, Biodex Gait Trainer 2TM ile yürüyüş, 6 dakikalık K Bayramlar Hacettepe University, yürüme testi ile enerji tüketimleri, Nottingham Sağlık Profili ile yaşam kalitesi, Berg denge Faculty of Health Sciences, skalası ile denge ve protez memnuniyet anketi (SATPRO) ile hasta memnuniyeti açısından Department of Physical Therapy and değerlendirildiler. Sonuçlar: Elde edilen veriler göre olguların hidrolik diz eklemli protezleriyle Rehabilitation normale daha yakın yürüdükleri gözlendi (p<0.05). Enerji tüketimleri açısından olgular PT, PhD, Assoc Prof karşılaştırıldığında hidrolik diz eklemi kullanıldığında enerji tüketimlerinin mekanik diz eklemine göre daha az olduğu saptandı (p<0.05). Nottingham Sağlık Profiline göre ağrı dışında diğer alt Address correspondence to: gruplarda iki eklem arasında fark olmadığı belirlendi (p>0.05). Hasta memnuniyeti yönünden Doç. Dr. Kezban Bayramlar Hacettepe University, olgulara bakıldığında, hidrolik diz eklemi kullanıldığında protezlerini daha rahat hissettikleri tespit Faculty of Health Sciences edildi (p<0.05). Tartışma: Bu çalışmada, hidrolik diz eklemi kullanımının enerji tüketimini Department of Physical Therapy and azalttığı, hasta memnuniyetini artırdığı ve normale yakın bir yürüyüşü paternini geliştirdiği ve bu Rehabilitation, 06100 Samanpazarı, avantajları açısından klinik kullanım açısından hastalara kolaylık sağlayacağı sonucuna varıldı. Ankara, Türkiye E-mail: [email protected] Anahtar kelimeler: Ampute, Yürüyüş, Enerji metabolizması, Memnuniyet. www.fizyoterapi.org/journal 170 Fizyoterapi Rehabilitasyon 20(3) 2009 Amputation causes significant gait insufficient governmental and private insurance abnormalities. As the amputation level increases systems are of concerns for clinicians while functional level decreases, energy consumption prescribing prosthesis. It is obvious that more increases and abnormal gait characteristics become scientific researches are needed to enhance social evident. Trans-femoral amputees suffer loss of the re-integration of amputees into community life knee and ankle joints and their abilities related to and to change the current perspectives of gait.1-4 Gait abnormalities including impaired rehabilitation teams. Therefore, the aim of this climbing up and down stairs, asymmetric gait, study was to investigate the effects of the use of reduced gait speed, and increased energy hydraulic knee joints on gait, energy consumption consumption.4-8 Most of the time even standing and patient satisfaction in trans-femoral amputees. may be difficult for these amputees. To be able to stand and walk properly and to gain a higher level MATERIALS AND METHODS of activity with lesser energy consumption, trans- femoral amputees need stronger extremity muscles, wider joint motion and an appropriate Subjects prosthesis with which these can be achieved.9 To Ten patients aged 18-25 years who had had solve these problems or to prevent their unilateral trans-femoral amputations due to traffic occurrence, the prosthesis and its components, accident, and were using prostheses with a especially an appropriate knee joint, are of great mechanic knee joint (Otto Bock, 3R15), importance. Gait speed has been increased by the quadrilateral socket (polyester lamination), and use of pneumatic knee joints and swinging phase dynamic foot (Otto Bock, 1D10) were included in symmetry has been improved.9 Energy the study. Inclusion criteria were as follows: usage consumption will decrease by allowing a gait of prosthesis functionally for at least two years, pattern closer to normal, active standing and having completed prosthetic training upon maintaining the balance easily. All these receiving an initial prosthesis, and being graded as improvements will affect the patient’s motivation 3 [the patient has the ability or the potential to and acceptance of prosthesis and increase move with the prosthesis with variable cadence satisfaction.3,4,9 Stump and socket compatibility is and can simultaneously negotiate most another important factor that may contribute to environmental barriers. He/she also has the ability the patient’s satisfaction. Ensuring the conformity to move about open areas and can undertake of the patient’s stump in the socket, prevention of occupational, therapeutic and other activities that any pressure and the development of any do not expose the prosthesis to above-average sensitivity, are also important.10 mechanical demands. This also includes those Reintegration of amputees into the patients who have an increased need for security community and enabling their independence in due to secondary conditions (additional handicaps, activities of daily living are possible through special living circumstances) in connection with appropriate selection of prosthetic components, medium to high mobility activities. In comparison achieving appropriate prosthetic alignment, and to healthy individuals, the amount of time and the successful prosthetic training. The increasing trend distance that he/she can walk are limited only in of using mobility grading systems also seems to non-essential ways)] according to the Otto Bock have an important contribution in determining mobility grading system.11 prosthetic components. In our country specific The patients were fitted with trans-femoral utilization of more functional components is not prostheses including hydraulic knee joints (Otto always possible. Thus, the absence of a guideline Bock, 3R60 EBS Knee Joint), dynamic feet, and presenting flow-charts for proper selection of quadrilateral sockets (acrylic lamination). In prosthetic components, few number of evidence Turkey, mechanic knee joints are routinely based studies conducted by native researchers and prescribed for trans-femoral amputees regardless www.fizyoterapi.org/journal Fizyoterapi Rehabilitasyon 20(3) 2009 171 of their functional level. The logic behind this lies of the amputated side, the score of the ambulation in their suitability for amputees with low to index, and parameters like the inequalities between moderate functional levels. They are amputated and intact sides, the gait cycle, and gait recommended for patients with up to 100 kg of speed were determined. body weight and with moderate functional A six-minute walk test was performed. Energy demands.11 Therefore, all the patients in our study consumption was calculated by applying a six- were using mechanical knee joints prior to the minute walking test to subjects using the two study. prostheses and was expressed
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