A low-cost easily implementable physiotherapy intervention clinically improves gait implying better adaptation to lower limb prosthesis: a randomized clinical trial.

Lower limb amputation highly impacts the lives of individuals. The inability to walk due to difficulties in adapting to wearing prosthesis can potentially result in physical degeneration and comorbidity in this population. In this randomized clinical trial study, we investigated if a low-cost and easily implementable physiotherapy intervention was effective in improving gait performance and adaptation to lower limb prosthesis in individuals with an amputation. A total of 26 individuals participated in the study, 16 with lower limb amputation and 10 without amputation. Participants with amputation were further divided in intervention and control groups. The intervention group underwent a rehabilitation protocol aimed at strengthening muscles and improving prosthesis adaptation. Muscle strengthening targeted the hip segment, prioritizing the abdominal muscles, hip flexors, extensors, adductors and abductors, followed by cicatricial mobilization and weight-bearing on the stump for desensitization. Assessment and measures were performed across the kinetic and kinematic parameters of gait. In the comparison between pre-and post-intervention, a significant increase in gait speed (0.68-2.98, 95% CI, 1.83, effect size ES) and cadence (0.56-2.69, 95% CI, 1.63, ES) was found between groups and time points. Step (0.73-3.11, 95% CI, 1.92, ES) and stride length (0.62-2.84, 95% CI, 1.73) increased between pre- and post-intervention, while in the control group both variables remained smaller. The intervention group decreased stance phase as a percentage of gait cycle between pre- and post-intervention (- 1.33-0.62, 95% CI, - 36, ES), while it increased in the control group. Improvement in a combination of important gait parameters indicates that the intervention protocol promoted the adaptation to prosthesis and the functional independence of individuals with lower limb amputation. It is recommended that the participants continue receiving follow-up assessments and rehabilitation interventions.

Patients with chronic high spinal cord injury can be safely treated with neuromuscular electrical stimulation: cardiovascular function is unaffected / Pacientes com lesão crônica alta da medula espinhal podem ser tratados de forma segura com estimulação elétrica neuromuscular: a função cardiovascular não é afetada

OBJECTIVE: To identify changes in blood pressure and heart rate in individuals with chronic paraplegia undergone neuromuscular electrical stimulation treatment. METHOD: Design: Observational prospective. Participants: Twenty individuals with chronic paraplegia (neurological level above T6) belonging to two different groups (G1 and G2) were submitted to an upper limb exercise test. G1 patients (n=13) had been treated with neuromuscular electrical stimulation (25Hz, pulses of 300µs, 100V) for 2 years or more, at least once a week; G2 patients (n=7) did not receive neuromuscular electrical stimulation treatment; G3 individuals (n=6) were healthy volunteers. Procedures: Arterial blood pressure and heart rate were measured during four phases of the exercise test: at initial rest, during warmup, during the exercise itself, and at rest after the exercise. RESULTS: Systolic and diastolic blood pressures showed no statistical difference between groups. In the comparison between exercise phases, regardless of the group, systolic pressure was significantly higher and diastolic pressure significantly lower at the end of the exercise itself, when compared to all other phases. Resting heart rate was significantly lower in healthy controls vs. G1 and G2, which were not significantly different between themselves. Exercise increased heart rate in all groups. CONCLUSION: This study showed that the groups are normotensive and homogeneous in their results; heart rate was higher in both paraplegic groups compared to healthy controls, but no difference was found between treated vs. untreated groups. Thus, neuromuscular electrical stimulation is a safe and effective way to treat individuals with chronic paraplegia.

OBJETIVO: Identificar mudanças na pressão arterial e frequência cardíaca em indivíduos com paraplegia crônica tratados com estimulação elétrica neuromuscular. MÉTODO: Estudo prospectivo observacional. Participantes: vinte indivíduos com paraplegia crônica (nível neurológico acima de T6) pertencentes a dois diferentes grupos (G1 e G2) foram submetidos a um teste de exercício de membros superiores. Os pacientes do G1 (n = 13) haviam sido tratados com estimulação elétrica neuromuscular (25 Hz, pulsos de 300 µs, 100 V) por 2 anos ou mais, pelo menos uma vez por semana; os pacientes do G2 (n = 7) não receberam o tratamento com estimulação elétrica neuromuscular; os indivíduos do G3 (n = 6) eram voluntários saudáveis. Procedimentos: A pressão sanguínea arterial e a frequência cardíaca foram medidas durante quatro fases do teste de exercício: no repouso inicial, durante o aquecimento, durante o exercício e no repouso após o exercício. RESULTADOS: As pressões arteriais sistólica e diastólica não apresentaram diferença estatística entre os grupos. Na comparação entre as fases do exercício, independentemente do grupo, a pressão sistólica foi significativamente maior e a pressão diastólica significativamente menor no final do exercício, em comparação com todas as outras fases. A frequência cardíaca em repouso foi significativamente menor em controles saudáveis ​​versus G1 e G2, que não foram significativamente diferentes entre eles mesmos. O exercício aumentou a frequência cardíaca em todos os grupos. CONCLUSÃO: Este estudo mostrou que os grupos são normotensos e homogêneos em seus resultados; a frequência cardíaca foi maior em ambos os grupos paraplégicos em comparação com controles saudáveis, mas nenhuma diferença foi encontrada entre os grupos tratados versus os não tratados. Assim, a estimulação elétrica neuromuscular é uma maneira segura e eficaz de tratar indivíduos com paraplegia crônica.