Kim Sol-Bi, Ko Chang-Yong, Son Jinho, Kang Sungjae, Ryu Jeicheong, Mun Museong
J Back Musculoskelet Rehabil. 2017;30(2):371-381. doi: 10.3233/BMR-160736.
Management of a knee contracture is important for regaining gait ability in transtibial amputees. However, there has been little study of prosthesis training for enhancing mobility and improving range of motion in cases of restricted knee extension.
This study aimed to evaluate the effects of adaptive training for an assist device (ATAD) for a transtibial amputee with a knee flexion contracture (KFC). A male transtibial amputee with KFC performed 4 months of ATAD with a multidisciplinary team. During the ATAD, the passive range of motion (PROM) in the knee, amputee mobility predictor (AMP) assessment, center of pressure (COP) on a force plate-equipped treadmill, gait features determined by three-dimensional motion analysis, and Short-Form 36 Item Health Survey (SF-36) scores were evaluated.
Following ATAD, PROM showed immediate improvement (135.6 ± 2.4° at baseline, 142.5 ± 1.7° at Step 1, 152.1 ± 1.8° at Step 2, 165.8 ± 1.9° at Step 3, and 166.0 ± 1.4° at Step 4); this was followed by an enhanced COP. Gradually, gait features also improved. Additionally, the AMP score (5 at baseline to 29 at Step 4) and K-level (K0 at baseline to K3 at Step 4) increased after ATAD. Along with these improvements, the SF-36 score also improved.
ATAD could be beneficial for transtibial amputees by relieving knee contractures and improving gait.
膝关节挛缩的管理对于恢复胫部截肢者的步态能力很重要。然而，对于在膝关节伸展受限的情况下通过假肢训练来提高活动能力和改善活动范围的研究很少。
本研究旨在评估适应性辅助装置训练（ATAD）对一名患有膝关节屈曲挛缩（KFC）的胫部截肢男性患者的效果。一名患有KFC的男性胫部截肢者在多学科团队的指导下进行了4个月的ATAD训练。在ATAD训练期间，评估了膝关节的被动活动范围（PROM）、截肢者活动能力预测指标（AMP）评估、配备测力板的跑步机上的压力中心（COP）、通过三维运动分析确定的步态特征以及简明健康状况调查（SF-36）评分。
ATAD训练后，PROM立即得到改善（基线时为135.6±2.4°，第1步时为142.5±1.7°，第2步时为152.1±1.8°，第3步时为165.8±1.9°，第4步时为166.0±1.4°）；随后COP得到增强。步态特征也逐渐改善。此外，ATAD训练后AMP评分（基线时为5分，第4步时为29分）和K级别（基线时为K0，第4步时为K3）有所提高。随着这些改善，SF-36评分也有所提高。
ATAD通过缓解膝关节挛缩和改善步态，可能对胫部截肢者有益。
