Energy Consumption in Lower Extremity Amputees: Review Article

Yıl 2024, Sayı: 3, 21 - 29, 30.09.2024

Cem Samut , Ebru Çalık Kütükcü , Semra Topuz

https://doi.org/10.69563/hititsaglikderg.1433564

Öz

Purpose: The aim of this review is to summarise and report the results of studies investigating the energy consumption of individuals with lower limb amputation.
Methods: Using the keywords selected in accordance with the purpose of our study, scientific studies on energy consumption in lower extremity amputees were identified and analysed in order to reveal the methods used in the evaluation of energy consumption, the factors affecting energy consumption, and the differences between healthy individuals and individuals with lower extremity amputation in terms of energy consumption.
Results: The use of prostheses after amputation may show some biomechanical changes in the body depending on the level of the existing amputation and as a result, adaptation mechanisms develop at varying rates on both healthy and amputee sides. These adaptations, whose main purpose is to compensate for the lost joint, muscle and sensorimotor inputs, occur especially following lower limb amputations and cause secondary pathologies that affect the entire kinetic chain in the long term. Individuals with lower limb amputation expend excessive energy during walking in order to compensate for biomechanical changes and functional inadequacies due to inadequacies in physical fitness and decreased dynamic balance.
Conclusions: Changing physical parameters negatively affect the centre of gravity, the ability to walk and the natural kinematics of gait. These changes may cause an increase in energy consumption at varying rates depending on the physical capacity of the individuals, their participation in activities of daily living, the type of prosthesis or assistive device they use and the speed at which they walk. When individuals using prostheses were compared with healthy individuals in terms of energy consumption, it was found that individuals using prostheses spent more energy while walking at a lower speed. It has been stated that the decrease in self-selected walking speeds of people with amputation is a compensation method developed to prevent increased metabolic expenditure.

Anahtar Kelimeler

Adolescent, adolescent health, risky health behaviors, nursing

Alt Ekstremite Amputelerinde Enerji Tüketimi: Derleme Makale

Öz

Amaç: Bu derlemenin amacı; alt ekstremite amputasyonu olan bireylerin enerji tüketimini araştıran çalışmaları özetlemek ve sonuçlarını bildirmektir.

Yöntem: Çalışmamızın amacına uygun olarak seçilmiş olan anahtar kelimeleri kullanarak enerji tüketiminin değerlendirilmesinde kullanılan yöntemlerin, enerji tüketimine etki eden faktörlerin, sağlıklı ve alt ekstremite amputasyonu olan bireylerin enerji tüketimi açısından farklılıkların ortaya konulması açısından alt ekstremite amputelerinde enerji tüketimi ile ilgili yapılmış bilimsel çalışmalar belirlenerek incelendi.

Sonuçlar: Amputasyonu takiben protez kullanımı ile birlikte vücut, amputasyon seviyesine göre biyomekaniksel değişiklikler göstermekte ve bunun sonucunda hem sağlıklı hem ampute tarafta adaptasyon mekanizmaları geliştirmektedir. Temel amacı kaybedilen eklem, kas ve sensorimotor girdiyi kompanse etmek olan bu adaptasyonlar, özellikle alt ekstremite amputasyonlarını takiben gerçekleşmekte ve uzun vadede tüm kinetik zinciri etkileyen sekonder patolojilerin ortaya çıkmasına neden olmaktadır. Alt ekstremite amputasyonu olan bireyler yürüyüş sırasında biyomekanik değişiklikler ve fiziksel uygunluktaki yetersizlikler ile dinamik dengenin azalmasına bağlı olarak gelişen fonksiyonel yetersizliklerini kompanse edebilmek amacıyla aşırı enerji harcamaktadırlar.

Tartışma: Değişen fiziksel parametreler ağırlık merkezini, yürüyebilme yeteneğini ve yürüyüşün doğal kinematiğini olumsuz yönde etkilemektedir. Bu değişikler bireylerin fiziksel kapasitesine, günlük yaşam aktivitelerine katılımına, hangi tip protez veya yardımcı cihaz kullandıklarına ve hangi hızda yürüdüklerine bağlı olarak değişen oranlarda enerji tüketiminde artışa neden olabilmektedir. Enerji tüketimi açısından protez kullanan bireyler sağlıklı bireylerle karşılaştırıldığında, protez kullanan bireylerin daha düşük hızda yürürken daha yüksek enerji harcadıkları tespit edilmiştir. Amputasyonlu kişilerin kendi seçtikleri yürüyüş hızlarındaki azalmanın, artmış metabolik harcamaların önüne geçmek için geliştirdikleri bir kompansasyon yöntemi olduğu belirtilmiştir.

Anahtar Kelimeler

Diz altı amputasyon, Enerji tüketimi, Ampute

Kaynakça

• Algun C. Amputelerde rehabilitasyon. Algun C. ed. Ortez ve protez kullanan hastalarda rehabilitasyon. Ankara: Öztek matbaacılık 1998:53-8. (t.y.).
• Balaban B. Yürüme Analizi: Temel Kavramlar ve Uygulama. Fiziksel Tıp ve Rehabilitasyon, (Eds) Beyazova M, Kutsal YG. 3rd ed. Ankara. Güneş Tıp Kitapevleri. 2016, pp 291-302. (t.y.).
• Brychta, R., Wohlers, E., Moon, J., & Chen, K. (2010). Energy expenditure: Measurement of human metabolism. IEEE Engineering in Medicine and Biology Magazine: The Quarterly Magazine of the Engineering in Medicine & Biology Society, 29(1), 42-47. https://doi.org/10.1109/MEMB.2009.935463
• Corio, F., Troiano, R., & Magel, J. (2010). The Effects of Spinal Stabilization Exercises on the Spatial and Temporal Parameters of Gait in Individuals With Lower Limb Loss. JPO: Journal of Prosthetics and Orthotics, 22, 230-236. https://doi.org/10.1097/JPO.0b013e3181f2f905
• De Frang, R. D., Taylor, L. M., & Porter, J. M. (1991). Basic data related to amputations. Annals of Vascular Surgery, 5(2), 202-207. https://doi.org/10.1007/BF02016758
• Donachy, J. E., Brannon, K. D., Hughes, L. S., Seahorn, J., Crutcher, T. T., & Christian, E. L. (2004). Strength and endurance training of an individual with left upper and lower limb amputations. Disability and Rehabilitation, 26(8), 495-499. https://doi.org/10.1080/09638280410001663067
• Duygu, S. Ç., Erbahçeci̇, F., Durutürk, N., & Yemi̇şçi̇, O. Ü. (2021). Transtibial Amputasyonu Olan Bireylerde Spinal Stabilizasyon Egzersizlerinin Enerji Harcaması Üzerine Etkisinin İncelenmesi: Pilot Çalışma. Türkiye Klinikleri Sağlık Bilimleri Dergisi, 6(4), 810-819. https://doi.org/10.5336/healthsci.2020-79617
• Gailey, R., Allen, K., Castles, J., Kucharik, J., & Roeder, M. (2008). Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use. Journal of Rehabilitation Research and Development, 45(1), 15-29. https://doi.org/10.1682/jrrd.2006.11.0147
• Gailey, R. S., Clark, C. R. Physical therapy management of adult lower limb amputees. Atlas of limb prosthetics: Surgical, prosthetic and rehabilitation principles. 2th edition, Bowker JH, Michael JW. St. Louis, editors. Baltimore: Mosby Year 6. (t.y.).
• Garcia, M., Lima, J., Junior, J., Freire, H., Mazilão, J., & Vicente, E. (2015). Energy expenditure and cardiovascular response to traumatic lower limb amputees’ gait. Fisioterapia em Movimento, 28, 259-268. https://doi.org/10.1590/0103-5150.028.002.AO06
• Genin, J. J., Bastien, G. J., Franck, B., Detrembleur, C., & Willems, P. A. (2008). Effect of speed on the energy cost of walking in unilateral traumatic lower limb amputees. European Journal of Applied Physiology, 103(6), 655-663. https://doi.org/10.1007/s00421-008-0764-0
• Göktepe, A. S., Cakir, B., Yilmaz, B., & Yazicioglu, K. (2010). Energy expenditure of walking with prostheses: Comparison of three amputation levels. Prosthetics and Orthotics International, 34(1), 31-36. https://doi.org/10.3109/03093640903433928
• Hagberg, K., Häggström, E., & Brånemark, R. (2007). Physiological cost index (PCI) and walking performance in individuals with transfemoral prostheses compared to healthy controls. Disability and Rehabilitation, 29(8), 643-649. https://doi.org/10.1080/09638280600902869
• Houdijk, H., Blokland, I. J., Nazier, S. A., Castenmiller, S. V., van den Heuvel, I., & IJmker, T. (2021). Effects of Handrail and Cane Support on Energy Cost of Walking in People With Different Levels and Causes of Lower Limb Amputation. Archives of Physical Medicine and Rehabilitation, 102(7), 1340-1346.e3. https://doi.org/10.1016/j.apmr.2021.02.007
• Isakov, E., Burger, H., Gregoric, M., & Marincek, C. (1996). Stump length as related to atrophy and strength of the thigh muscles in trans-tibial amputees. Prosthetics and Orthotics International, 20(2), 96-100. https://doi.org/10.3109/03093649609164425
• King, A. (2007). Chris Kirtley, Clinical Gait Analysis: Theory and Practice, Churchill Livingstone (2006) 328 pages, £39.99, ISBN 0-4431-0009-8. Physiotherapy, 93, 84-84. https://doi.org/10.1016/j.physio.2006.03.002
• Lagana FJ, Weiner RI. When amputation is necessary: Preoperative assessment and surgery. In: Lusardi MM, Nielsen CC, eds. Orthotics and prosthetics in rehabilitation. 1st Ed. USA: Butterworth-Heinemann Press 2000:363-77. (t.y.).
• Loiret, I., Villa, C., Dauriac, B., Bonnet, X., Martinet, N., Paysant, J., & Pillet, H. (2019). Are wearable insoles a validated tool for quantifying transfemoral amputee gait asymmetry? Prosthetics and Orthotics International, 43(5), 492-499. https://doi.org/10.1177/0309364619865814
• Lusardi MM, Owens LLF. Postoperative and preprosthetic care. In: Lusardi MM, Nielsen CC, eds. Orthotics and prosthetics in rehabilitation. 1st Ed. USA: Butterworth-Heinemann Press 2000:395-419. (t.y.).
• Mengelkoch, L., Kahle, J., & Highsmith, M. (2014). Energy Costs & Performance of Transtibial Amputees & Non-amputees during Walking & Running. International journal of sports medicine, 35. https://doi.org/10.1055/s-0034-1382056
• Miller, R. H., & Russell Esposito, E. (2021). Transtibial limb loss does not increase metabolic cost in three-dimensional computer simulations of human walking. PeerJ, 9, e11960. https://doi.org/10.7717/peerj.11960
• Mutlu, A., Kharooty, M. D., & Yakut, Y. (2017). The effect of segmental weight of prosthesis on hemodynamic responses and energy expenditure of lower extremity amputees. Journal of Physical Therapy Science, 29(4), 629-634. https://doi.org/10.1589/jpts.29.629
• Nielsen CC. Etiology of amputation. In: Lusardi MM, Nielsen CC, eds. Orthotics and prosthetics in rehabilitation. 1st Ed. USA: Butterworth-Heinemann Press 2000:327-36. (t.y.).
• Panesar, B. S., Morrison, P., & Hunter, J. (2001). A comparison of three measures of progress in early lower limb amputee rehabilitation. Clinical Rehabilitation, 15(2), 157-171. https://doi.org/10.1191/026921501669259476
• Rose, J., Gamble, J. G., Lee, J., Lee, R., & Haskell, W. L. (1991). The energy expenditure index: A method to quantitate and compare walking energy expenditure for children and adolescents. Journal of Pediatric Orthopedics, 11(5), 571-578.
• Sellegren, K. R. (1982). An Early History of Lower Limb Amputations and Prostheses. The Iowa Orthopaedic Journal, 2, 13-27.
• Seth, M., & Lamberg, E. (2017). Standing balance in people with trans-tibial amputation due to vascular causes: A literature review. Prosthetics and Orthotics International, 41(4), 345-355. https://doi.org/10.1177/0309364616683819
• Silverman, A. K., Fey, N. P., Portillo, A., Walden, J. G., Bosker, G., & Neptune, R. R. (2008). Compensatory mechanisms in below-knee amputee gait in response to increasing steady-state walking speeds. Gait & Posture, 28(4), 602-609. https://doi.org/10.1016/j.gaitpost.2008.04.005
• Starholm, I. M., Mirtaheri, P., Kapetanovic, N., Versto, T., Skyttemyr, G., Westby, F. T., & Gjovaag, T. (2016). Energy expenditure of transfemoral amputees during floor and treadmill walking with different speeds. Prosthetics and Orthotics International, 40(3), 336-342. https://doi.org/10.1177/0309364615588344
• Stout, J., & Koop, S. (2004). Energy expenditure in cerebral palsy. CLINICS IN DEVELOPMENTAL MEDICINE, 146-164.
• Strath, S. J., Swartz, A. M., Bassett, D. R., O’Brien, W. L., King, G. A., & Ainsworth, B. E. (2000). Evaluation of heart rate as a method for assessing moderate intensity physical activity. Medicine and Science in Sports and Exercise, 32(9 Suppl), S465-470.
• Sümer, A., Onur, E., Altınlı, E., Çelik, A., Çağlayan, K., & Köksal, N. (2008). Alt Ekstremite Amputasyonlarında Klinik Deneyimlerimiz. Journal of Turgut Ozal Medical Center, 15(3), Article 3.
• Swanberg, K. M., Clark, A. M., Kline, J. E., Yurkiewicz, I. R., Chan, B. L., Pasquina, P. F., Heilman, K. M., & Tsao, J. W. (2011). Enhanced left-finger deftness following dominant upper- and lower-limb amputation. Neurorehabilitation and Neural Repair, 25(7), 680-684.
• Şimşek İE, Şener G, Yakut Y. Unilateral alt ekstremite amputelerinde Protez Memnuniyeti Anketi’nin Türkçe güvenirliği ve geçerliği: pilot çalışma. Fizyoter Rehabil. 2010;21(2): 81-86.
• Ülger, Ö., Topuz, S., Bayramlar, K., Erbahçec, F., & Yakut, Y. (2009). Diz altı amputelerde klasik yürüme eğitimi ve Biodex Gait Trainer 2TM ile yapılan yürüme eğitiminin karşılaştırılması.
• van Schaik, L., Geertzen, J. H. B., Dijkstra, P. U., & Dekker, R. (2019). Metabolic costs of activities of daily living in persons with a lower limb amputation: A systematic review and meta-analysis. PloS One, 14(3), e0213256.
• Wezenberg, D., van der Woude, L. H., Faber, W. X., de Haan, A., & Houdijk, H. (2013). Relation between aerobic capacity and walking ability in older adults with a lower-limb amputation. Archives of Physical Medicine and Rehabilitation, 94(9), 1714-1720.
• Yavuzer, G. (2014). Yürüme analizi ve temel kavramlar. TOTBİD Dergisi, 13(4), 304-308.
• Ziegler-Graham, K., MacKenzie, E. J., Ephraim, P. L., Travison, T. G., & Brookmeyer, R. (2008). Estimating the prevalence of limb loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation, 89(3), 422-429.