Muscle synergies during exercise and functional movement of unilateral transtibial amputees
Date
2024-03
Authors
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Journal ISSN
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Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: A biomechanically informed approach to rehabilitating individuals with a unilateral transtibial amputation (UTTA) holds promise for optimizing functional outcomes and enhancing overall quality of life. This thesis delves into the personal experiences of individuals with UTTA, scrutinizes healthcare professionals' (HCP) rehabilitation approaches, and considers various biomechanical factors. A unique aspect of this work involves muscle synergy analysis which refers to the understanding of co-ordinated activation of groups of muscles working together for specific movements. In individuals with UTTA, the loss of the lower limb influences neuromuscular co-ordination required for gait and functional activities. Differentiating muscle synergies between affected and unaffected sides offers insights to refine rehabilitation guidelines, improving exercise prescription for enhanced muscle recruitment and coordination, ultimately leading to better functional outcomes.
METHODS This study consisted of two main parts. The first employed bespoke questionnaires to understand the challenges and perceptions of individuals and common rehabilitation exercises utilized by healthcare professionals. The second incorporated biomechanical evaluation of individuals with a UTTA during daily activities and common rehabilitation exercises. Questionnaires, distributed within South Africa via email to lower limb amputees, Prosthetists, Physiotherapists, Biokineticists and Occupational therapists. The biomechanical evaluation recruited 10 individuals with a UTTA within the Western Cape, South Africa for a once-off session. Participants performed a balance protocol, sit-to-stands stand-to-sits, walking at a self-paced and fixed speed (4km.hr-1), bridge, and squat. RESULTS Reported challenges by lower limb amputees (n = 28) included difficulties in activities like walking on uneven surfaces, on the beach, and climbing stairs, influenced by factors like fear of falling, altered proprioception, and mechanical limitations of the prosthetic limb. Healthcare professionals (n = 134) identified various exercises for UTTA rehabilitation, including balance, bridge, knee extension, hip abduction, and squats. Muscle recruitment for these exercises partially aligned with the biomechanical evaluation results. Biomechanical evaluation of ten individuals with UTTA (7 men and 3 women, 41 ± 12 years of age) revealed significant differences between different balance conditions of the modified Clinical test for Sensory Integration and balance when assessing the distances travelled in an anterior/posterior direction (p < 0.05). Differences were observed in the symmetry index of vertical ground reaction forces during the Sit-to-stand, Stand-to-sit, Squat and walking when comparing affected and unaffected sides. Similar observations were made when comparing muscle activation across the different tasks. The analysis demonstrated that, in general, two muscle synergies were required for most activities and exercises, except for walking, which needed only one muscle synergy to explain over 90% of the movement. CONCLUSION
In conclusion, a biomechanically informed approach to the rehabilitation of unilateral transtibial amputees may optimize functional outcomes and improve the overall well-being of this population. Analysing muscle synergies, understanding the challenging activities, aligning rehabilitation practices, and emphasizing neuromuscular co-ordination, enables healthcare professionals to tailor individualised rehabilitation plans. This personalized approach can enhance muscle recruitment, improve functional performance, boost confidence, and facilitate better integration into daily activities, ultimately fostering a higher quality of life for individuals with limb loss.
AFRIKAANSE OPSOMMING: ‘n Rehabilitasie strategie wat die biomeganiese navorsing ingelig word vir die rehabilitasie van persone met eensydige transtibiale amputasies (UTTA) skyn 'n belowende manier te wees om funksionele uitkomste van die rehabilitasie program te optimeer en die algehele lewenskwaliteit van die deelnemers te verbeter. Hierdie benadering het die persoonlike ervarings van UTTA, die gesondheidsorgpersoneel se benadering tot rehabilitasie, en verskeie biomeganiese faktore en neuromuskulêre oorwegings in ag geneem om te bepaal of rehabilitasiepraktyke verbeter kan word. 'n Unieke fokus van hierdie studie was die gebruik van spiersinergie-analise om die aantal spiersinergieë te bepaal wat benodig word om 'n reeks daaglikse aktiwiteite en algemene rehabilitasie-oefeninge uit te voer. Spiersinergie verwys na die gekoördineerde aktivering van verskillende spiergroepe om spesifieke bewegings uit te voer. Die verlies aan die onderste ledemaat beïnvloed die neuromuskulêre koördinasie wat UTTA benodig vir loop en funksionele aktiwiteite. Om die verskille in spiersinergieë tussen die geaffekteerde en ongeaffekteerde kante te verstaan, kan addisionele insette lewer om oefeningvoorskrif vir rehabilitasie programme te verbeter, om spieraktivering en -koördinasie te verbeter, wat lei tot beter funksionele uitkomste.
AFRIKAANSE OPSOMMING: ‘n Rehabilitasie strategie wat die biomeganiese navorsing ingelig word vir die rehabilitasie van persone met eensydige transtibiale amputasies (UTTA) skyn 'n belowende manier te wees om funksionele uitkomste van die rehabilitasie program te optimeer en die algehele lewenskwaliteit van die deelnemers te verbeter. Hierdie benadering het die persoonlike ervarings van UTTA, die gesondheidsorgpersoneel se benadering tot rehabilitasie, en verskeie biomeganiese faktore en neuromuskulêre oorwegings in ag geneem om te bepaal of rehabilitasiepraktyke verbeter kan word. 'n Unieke fokus van hierdie studie was die gebruik van spiersinergie-analise om die aantal spiersinergieë te bepaal wat benodig word om 'n reeks daaglikse aktiwiteite en algemene rehabilitasie-oefeninge uit te voer. Spiersinergie verwys na die gekoördineerde aktivering van verskillende spiergroepe om spesifieke bewegings uit te voer. Die verlies aan die onderste ledemaat beïnvloed die neuromuskulêre koördinasie wat UTTA benodig vir loop en funksionele aktiwiteite. Om die verskille in spiersinergieë tussen die geaffekteerde en ongeaffekteerde kante te verstaan, kan addisionele insette lewer om oefeningvoorskrif vir rehabilitasie programme te verbeter, om spieraktivering en -koördinasie te verbeter, wat lei tot beter funksionele uitkomste.
Description
Thesis (DPhil)--Stellenbosch University, 2024.