@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2017;9(2):79-84

Background
… [1, 2]. Asymmetric loading models and asymmetric movements in people under the knee amputation lead to the asymmetric activity of the muscles around pelvis and lumbopelvic [3]. … [4-11]. Individuals with unilateral amputation of lower extremities have asymmetric stiffness of the trunk muscles into sagittal and frontal plates [12]… [13-16]. Side bending, axial rotation and pressure on the lumbar vertebrae in people with lower limb amputation cause pressure on the vertebral spinal passive tissues such as fasts, which ultimately causes lumbar pain [17]. … [18-20].
Previous Studies
So far, various studies have examined the effect of prosthesis on the kinematic and kinetics of the knee and thigh joint. However, according to the authors' knowledge, there is no research that simultaneously examines the length of muscle fibers and muscle strength around the knee and thigh joints.
Aim(s)
The purpose of this study was to evaluate the effect of under knee prosthesis on muscle production force and the force of contact joint of knee and thigh during walking in patients with lower limb amputation
Research type
This is a semi-experimental study.
Research society, place and time
In 2015, 10 non-veteran male under-knee amputees referred to the Technical Orthopedic Clinic of the Rehabilitation School of Isfahan University of Medical Sciences were selected.
Sampling method and number
10 non-veteran male under-knee amputees were selected by convenience sampling method.
Used devices&materials
To measure the kinematic walking variables, Qualisys Motion Analysis System (made by Qualysis, Switzerland) containing seven cameras was used. The cameras were placed on either side of a sidewalk and 4 meters from the center of force plate. A 10-meter walking path was considered in the laboratory with a 600-by-500-mm Kistler force plate (AA 9260 model, manufactured by Kistler, Switzerland) in the middle of the track. A calibration space was considered which was located in the center of the base of this cubic space. The distance from the starting point to the subjects was 5 meters. 20 markers reflecting the infrared light with a diameter of 14 mm were placed on the anterior surface of the iliac spit, the upper posterior side of the iliac spit, internal and external epicondylitis in the two right and left sides, heel, the head of the first and fifth metatarsals, and the acromioclavicular joint in the two right and left sides. The placement of markers on the body was based on the protocol approved by the University of Strathclyde. The frequency of data collection was 120 Hz. The data was filtered downstream by frequency of 10 Hz [21]. The recording of kinematic data was done using Qualysis Track Manager 2.7 (Qualysis, Switzerland) software. The Qualysis Track Manager Software output was transmitted to OpenSIM 3 software (Stanford University, USA) for the purpose of examining the muscle strength and the joint contact force. … [22, 23]. After calibrating the cameras and force plate, the anthropometric data of the subjects including weight, height, leg length, knee width, distance between the upper anterolateral left and right thoracic and right and left ankle width were recorded. Then, the subject was walking along the path and the image of the markers during walking was recorded along with the data of force plate. Qualisys software was used to record standing and oscillation phases during the walking cycle. After calibrating the cameras and installing markers, the subject was walking along the designated path with shoes. Walking of subjects were repeated five times, and in each of these variables, the average of three repetitions was considered for statistical calculation. To avoid fatigue, there were 30 seconds of rest between two successive repetitions. The results of the research indicate the high reliability of the pressure center oscillation in both the sagittal and coronal plates [24-26] and the repetition of the test for five times is acceptable criteria for the evaluation of kinematic and kinetic variables [27]. Data was analyzed by SPSS 22 software using independent t-test.
Findings by Text
The subjects had a mean age of 48.00±2.97 years, the mean weight of 77.34±10.10 kilogram and mean height of 173.87±3.64 centimeter (Table 1). There was no statistically significant difference between average step length, speed of walking, and cadence between two healthy and prosthesis sides (p<0.05). However, the mean percentage of stent time in healthy side was significantly higher than prosthesis side (p=0.001) and the mean percentage of oscillation time on the healthy side was significantly lower than the prosthesis side (p=0.04). The applied forces were higher in the anterior-posterior, vertical, and internal-external directions in both thigh and knee joints as well as force produced by the selected muscles of lower extremity in the healthy side than the prosthesis side. However, this increase was not statistically significant (p<0.05). Also, the forces of thigh extension, thigh abductor, thigh flexor, and knee extensor were 356.1, 387.3, 237.3 and 247.9 Newton respectively that were higher in the healthy side compared to the prosthesis side. However, no significant difference was observed between the two sides (p<0.05; Table 2).
Main comparison to the similar studies
Past research has shown that the prosthetic leg has less movement in the ankle than the ankle in the healthy leg [23], and there is no ability to perform flexion denture movement in the prosthetic ankle. Therefore, people with prosthetic leg use different strategies when they walk and keep the pelvis in prosthesis side higher in order to compensate for the disability in the ankle flexion dorsiflexion and to prevent collision with the ground in the oscillation phase [24]. This prevents the oscillating claw from falling to the ground. This mechanism makes the healthy side ankle in amputees produce power one-third more than the ankle of healthy people [25]. Also, the ankle of prosthesis side produce less power than the ankle of healthy people [26], and thus, in order to compensate for the decrease in the appendages in the prosthetic leg, an increase in the work of the healthy thigh extensors is made [25]. … [27].
Suggestions
It is suggested that in the design of future studies, an electromyography device be used to simultaneously measure muscle activity.
Limitations
The lack of electromyography device for simultaneous measurement of muscle activity is one of the limitations of this research.
Conclusions
The use of one-way prosthesis under the knee during walking leads to an increase in the percentage of weight bearing time on the healthy side, and the lower limb joints in the healthy side are somewhat affected by excess overload, which results from the greater activity of the lower extremity muscles.
Acknowledgments
The authors of this article thank the Musculoskeletal Research Center of the Faculty of Rehabilitation of Isfahan University of Medical Sciences and the Research Deputy of this university who took over the cost of the project.
Conflict of interest
No conflicts of interest have been reported by the authors of the article.
Ethical Permissions
This study was approved by the Ethics Committee of Isfahan University of Medical Sciences.
Funding Sources
Research Deputy of Isfahan University of Medical Sciences has taken over the cost of this project.

TABLES and CHARTS

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