Article

OBJECTIVE: To describe adaptation strategies
in terms of joint power or work in the amputated and intact leg of patients with
a transtibial (TT) or transfemoral (TF) amputation. DATA SOURCES: MEDLINE,
CINAHL, Physiotherapy Evidence Database, Embase, and the Cochrane Register of
Controlled Trials were searched. Studies were collected up to November 1, 2010.
Reference lists were additionally scrutinized. STUDY SELECTION: Studies were
included when they presented joint power or work and compared (1) the amputated
and intact legs, (2) the amputated leg and a referent leg, or (3) the intact leg
and a referent leg. Eligibility was independently assessed by 2 reviewers. A
total of 13 articles were identified. DATA EXTRACTION: Data extraction was
performed using standardized forms of the Cochrane Collaboration. Methodologic
quality was independently assessed using the Downs and Black instrument by 2
reviewers. The possibility of data pooling was examined. Significant differences
found in studies that could not be pooled are also presented. DATA SYNTHESIS:
Significant results (P<.05). For work TT, for the concentric work total stance
phase knee, the amputated was less than the intact/referent side, and the
referent was less than the intact side. For the eccentric knee extensor (K1)
phase, the amputated was less than the intact side, and the intact was greater
than the referent side. For the concentric knee extensor (K2) phase, the
amputated/referent was less than the intact side. For the concentric work total
stance phase hip, the amputated/intact was greater than the referent side. For
the concentric hip extensor (H1) phase, the amputated/intact was greater than the
referent side. For power TT,
for the peak power generation stance phase knee, the
amputated was less than the referent side. For peak power generation swing phase
knee, the amputated was less than the referent side.
For the eccentric knee
flexor (K4) phase, the amputated was less than the intact side. For the eccentric
hip flexor (H2) phase, the amputated was greater than the intact side. For work
TF, for the concentric plantar flexor (A2) phase, the referent was less than the
intact side. For the H1 phase, the referent was less than the intact side. For
the H2 phase, the amputated was greater than the intact/referent side, and the
referent was greater than the intact side. For power TF, for the K2 phase, the
referent was less than the intact side. Sensitivity analysis did not alter the
conclusions. CONCLUSIONS: Adaptations were seen in the amputated and intact legs.
TT and TF use remarkably similar adaptation strategies at the level of the hip to
compensate for the loss of plantar flexion power and facilitate forward
progression. At the knee level, adaptations differed between TT and TF.
CI - Copyright (c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS