Comparative Effects of Core Stabilization Exercises and Augmented Visual Feedback on Hip Strategy of Intact and Prosthetic Leg in Lower Limb Amputee

Document Type : Original article

Authors

1 Department of Master of Motor behavior, Alzahra University, Tehran, Iran

2 Department of Motor Behavior, Faculty of Physical Education and Sport Sciences, University of Al Zahra, Tehran, Iran

Abstract

Backgroundand Aim: The lower limb amputees, due to the loss of limb, generally use hip strategy to control balance instead of ankle strategy. The present study aimed to evaluate the effect of a lower limb training protocol consisting of core stabilization exercises with and without augmented visual feedback on balance control strategies of prosthetic leg and the sound leg in below knee amputees.
Materials and Methods: Based on the inclusion criteria, 21 amputees were invited to voluntarily take part in the current quasi-experimental study with pretest-posttest protocol. They were randomly divided into three groups of control, core stabilization exercises, and core stabilization exercises using augmented visual feedback. Involvement of hip strategy in the balance control of the groups, in the intact limb, and prosthetic limb were determined using Dynamic Computer Posturography.
Results: The results of analysis of variances using repeated measures showed significant differences (p=0.001) between the hip strategy scores of intact limb and prosthetic limp after training interventions. Bonferroni post hoc test indicated higher average scores in both training groups compared with that for control group. Between two training groups, the group with augmented visual feedback showed even a better score (p=0.001) using hip strategies to control balance. The strategy in both legs for core stabilization exercise group with visual feedback was more efficient compared with core stability exercise group without feedback.
Conclusion: The results showed that core stabilization exercises can improve pelvic control strategy to maintain balance in the intact leg and prosthetic leg of thr amputee. Using augmented feedback will improve the strategy application even more. 

Keywords

Main Subjects

References

  1. Sai AJ, Gallagher JC, Smith LM, Logsdon S. Fall predictors in the community dwelling elderly, a cross sectional and prospective cohort study. Journal of Musculoskeletal and Neuronal Interactions. 2010; 10[2]:142-50.##
  2. Sahrmann Sh. Diagnosis and Treatment of Movement Impairment Syndromes. 1st edition. London: Mosby 2002: 166.##
  3. Bruno M, Matheus JW, Generosi AR, Marco AV, Junior CP. Effect of muscle fatigue on posture control in soccer Players during the short-pass movement. Review Brasilian Cineantropometria Desempenho Hum 2011; 13[5]: 348-53.##
  4. Mancini M. Horak F B.”The relevance of clinical balance assessment tools to differentiate balance deficits”. Eur J Phys Rehabil Med. Author manuscript; available in PMC 2011 Jun 1.##
  5. Wollacott, M., Shamway –Cook. Attention & The control of posture & gait: a review of emeringarea of research. gait &posture.2002;16,1-14.##
  6. Almås, H.. Omvårdnad vid amputation. I Almås, H. [red]. Klinisk omvårdnad. 2002;2 [p. 695-710]. Stockholm: Liber AB##
  7. Chadderton HC .Prostheses, pain and sequelae of amputation, as seen by the amputee .Prosthet Orthot Int .1978 Apr; 2[1]:12-4.##
  8. Azma K,Sedigh H. assesment Chronic musculoskeletal complications in veterans with amputated in both lower limbs. Journal of Medicine veteran. 2010;Year 2 [8].##
  9. Hak L, Jaap H. Dieen v, Wurff Pvd, Maarten R. Prins, Mert A, Peter J. Beek, Houdijk H. Walking in an Unstable Environment: Strategies Used by Transtibial Amputees to Prevent Falling During Gait. Archives of Physical Medicine and Rehabilitation 2013;94:2186-93##
  10. Eakin CL, Quesada PM, Skinner H. Lower-limb proprioception in above-knee amputees. Clin Orthop Relat Res. 1992; Nov[284]:239-46.##
  11. Schmidl M, Beltrami G, Zambarbieri D, Verni G. Centre of pressure displacements in transfemoral amputees during gait. Gait Posture. 2005 Apr;21[3]:255-62.##
  12. Hof AL, Van Bockel RM, Schoppen T, Postema K. Control of lateral balance in walking. Experimental findings in normal subjects and above-knee amputees. Gait Posture. 2007 Feb;25[2]:250-8.##
  13. Shirota C, Simon, A M. and Kuiken, T A.. Transfemoral amputee recovery strategies following trips to their sound and prosthesis sides throughout swing phase. Shirota et al. Journal of NeuroEngineering and Rehabilitation. 2015; 12:79.##
  14. Hlavackova P, Franco C, Diot B, Vuillerme N. Contribution of each leg to the control of unperturbed bipedal stance in lower limb amputees: new insights using entropy. PLoS One. 2011;6[5]:e19661.##
  15. Jones SF, Twigg PC, Scally AJ, Buckley JG. The gait initiation process in unilateral lower-limb persons with amputation when stepping up and stepping down to a new level. Clin Biomech [Bristol, Avon]. 2005;20[4]:405-13. doi:10.1016/j.clinbiomech.2004.11.018 PMID:15737448.##
  16. Sethy, D., Kujur, E.S., Sau, K. Effect of balance exercise on balance control in unilateral lower limb amputees. The Indian Journal of Occupational Therapy. 2009;7 [3]: 63-68.##
  17. Barnett C.T., Vanicek N ., Polman R.C.J. Postural responses during volitional and perturbed dynamic balance tasks in new lower limb amputees. 2013; A longitudinal study.##
  18. Bottini G, Karnath HO, Vallar G, Sterzi R, Frith CD, Frackowiak RS, et al. Cerebral representations for egocentric space: functional–anatomical evidence from caloric vestibular stimulation and neck vibration. Journal of Brain. 2001; 124: 1182-96.##
  19. Watson M, Peck M. A pilot study of the immediate effects of mirror feedback on sitting postural control in normal healthy adults. Physiother Res Int. 2008;13:204.##
  20. Vaillant J, Vuillerme N, Janvy A, Louis F, Juvin R, Nougier V. Mirror versus stationary cross feedback in controlling the center of foot pressure displacement in quiet standing in elderly subjects. Arch Phys Med Rehabil. 2004;85:1962-5.##
  21. Chan BL, Witt R, Charrow AP. Mirror therapy for phantom limb pain. N Engl J Med. 2007;357:2206–2207.##
  22. Winstein CJ, Gardner ER, McNeal DR, et al. Standing balance training: effect on balance and locomotion in hemiparetic adults. Arch Phys Med Rehabil. 1989;70:755–762.##
  23. Shumway-Cook A, Anson D, Haller S. Postural sway biofeedback: its effect on reestablishing stance stability in hemiplegic patients. Arch Phys Med Rehabil. 1988;69:395– 400.##
  24. Tilak M, Isaac SA, Fletcher J, Vasanthan LT, Subbaiah RS, Babu A, Bhide R, Tharion G. 'Mirror Therapy and Transcutaneous Electrical Nerve Stimulation for Management of Phantom Limb Pain in Amputees - A Single Blinded Randomized Controlled Trial'. 2015 Apr 1. doi: 10.1002/pri.1626.##
  25. Hlavackova P., Fristios J., Cuisinier R., Pinsault N., Janura M., Vuillerm N. Effects of mirror feedback on upright stance control in elderly transfemoral amputees. Arch Phys Med Rehabilitation. 2009;90[11]:1960–1963.##
  26. Shumway cook A.W. Motor control theory and practical application. Philadelphia: 2001;Lippincott williams & wilkinse.##
  27. Day BL, Steiger MJ, Thompson PD, Marsden CD. Effect of vision and stance width on human body motion when standing: implications for afferent control of lateral sway. J Physiol 1993; 86 [10]:99-479.26##
  28. Talebian S,Aliyaee G, Bagheri H, Hadian M. assessment changes to the control strategy seeks to increase of walking speed. Tehran university of medical science. 2004; 62, No. 7, pages 556 to 564. [in pearsion]##
  29. Matthys K, Smits M, Van der Geest JN, Van der Lugt A, Seurinck R, Stam HJ, Selles RW. Mirror-induced visual illusion of hand movements: a functional magnetic resonance imaging study. Arch Phys Med Rehabil 2009; 90:675-81##
  30. Fukumura K, Sugawara K, Tanabe S, Ushiba J, Tomita Y. Influence of mirror therapy on human motor cortex. Int J Neurosci. 2007; 117[7]:1039-1048.##
  31. Touzalin-Chretien P, Dufour A. Motor cortex activation induced by a mirror: evidence from lateralized readiness potentials. J Neurophysiol. 2008; 100[1]:19-23.##
  32. Dornan J, Fernie GR, Holliday PJ. Visual input: its importance in the control of postural sway. Arch Phys Med Rehabil. 1978; 59 [12]: 586-91.##
The Scientific Journal of Rehabilitation Medicine
Volume 6, Issue 1
March and April 2017
Pages 62-73

Files

History

  • Receive Date: 04 December 2015
  • Revise Date: 09 April 2016
  • Accept Date: 25 April 2016
  • First Publish Date: 21 March 2017

Share

How to cite

Statistics