Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Transtibial Amputasyonu Olan Bireylerde Spinal Stabilizasyon Egzersizlerinin Enerji Harcaması Üzerine Etkisinin İncelenmesi: Pilot Çalışma
Effects of Spinal Stabilization Exercises on Energy Expenditure in Individuals with Transtibial Amputation: Pilot Study
Senay ÇEREZCİ DUYGUa, Fatih ERBAHÇECİb, Neslihan DURUTÜRKa, Oya ÜMİT YEMİŞÇİc
aBaşkent Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, Ankara, TÜRKİYE
bHacettepe Üniversitesi Fizyoterapi ve Rehabilitasyon Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, Ankara, TÜRKİYE
cBaşkent Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon ABD, Ankara, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2021;6(4):810-9
doi: 10.5336/healthsci.2020-79617
Article Language: TR
Full Text
ÖZET
 Amaç: Alt ekstremite amputasyonu kas-iskelet sisteminde hızlı değişikliklere neden olur. Bu değişikliklerin etkisiyle normal ambulasyonla kıyaslandığında, protez ile ambulasyon için enerji gereksinimi daha yüksektir. Harcanan enerjinin optimizasyonu için protezin segmental yükünün azaltılması, farklı protez komponentlerinin tercih edilmesi gibi yöntemler vurgulansa da bilgimiz dâhilinde egzersiz türlerinin etkisi araştırılmamıştır. Mevcut çalışmanın amacı, unilateral transtibial amputasyonu olan bireylerde klasik fizyoterapi programı ile birlikte uygulanan spinal stabilizasyon egzersizlerinin enerji harcaması üzerine etkisini araştırmaktı. Gereç ve Yöntemler: Çalışmaya unilateral transtibial amputasyonu olan 12 birey dâhil edilerek rastgele olarak 2 gruba ayrıldı. Kontrol grubundaki bireylere 8 hafta boyunca amputasyonu olan bireylere ilişkin temel egzersizler, çalışma grubundaki bireylere ise temel egzersizlerle beraber spinal stabilizasyon egzersizleri uygulandı. Egzersiz eğitimi öncesi ve sonrası, 6 dakika stepper testi sırasında oksijen tüketimi ve enerji tüketimi ölçümü indirekt kalorimetre cihazı (Cosmed Fitmate Pro, Roma, İtalya) ile gerçekleştirildi, ayrıca test öncesi ve sonrası Modifiye Borg Skalası ile yorgunluk algılamaları değerlendirildi, derin spinal kasların kuvveti 'Stabilizer Basınç GeriBildirim Ünitesi' (Chattanooga Group Inc, U.S.) ile ve algılanan mobilite düzeyi Protez Değerlendirme Anketi'nin Mobilite alt skalası ile değerlendirildi. Bulgular: Yapılan analizler sonucunda maksimum oksijen tüketiminin (p=0,003), derin spinal kasların kuvvetinin (p=0,003) ve algılanan mobilite düzeyinin (p=0,004) egzersiz programı sonucunda gruplar içindeki değişimleri, 2 grup arasında istatistiksel olarak anlamlı düzeyde farklı olduğu bulundu. Enerji harcaması ve oluşan yorgunluk seviyelerindeki değişim 2 grup arasında anlamlı bulunmadı (sırasıyla p=0,076; p=0,102). Sonuç: Çalışmamızda sonuç olarak, spinal stabilizasyon egzersizlerinin amputasyonu olan bireylerin, rehabilitasyon programına dâhil edilmesinin egzersiz kapasitesini ve mobilite düzeyinin artırmada etkili olabileceği görüldü. İleride daha fazla olgu ile spinal stabilizasyon egzersiz eğitiminin etkilerinin belirlemesine ihtiyaç vardır.

Anahtar Kelimeler: Amputasyon; enerji metabolizması; rehabilitasyon; egzersiz tedavisi; amputeler
ABSTRACT
 Objective: Lower limb amputation causes rapid changes in the musculoskeletal system. With the effect of these changes, the energy requirement for ambulation with prosthesis is higher compared to normal ambulation. Although methods such as reducing the segmental load of the prosthesis and choosing different prosthetic components are emphasized for the optimization of the energy expenditure, within our knowledge, the effect of exercise types has not been investigated. The aim of the present study was to investigate the effect of spinal stabilization exercises applied together with the basic physiotherapy program on energy expenditure in individuals with unilateral transtibial amputation. Material and Methods: Twelve individuals with unilateral transtibial amputation were included in the study and randomly divided into two groups. Basic exercises for individuals with amputation were applied to individuals in the control group, and spinal stabilization exercises were applied to individuals in the study group together with basic exercises for 8 weeks. Before and after exercise training, during the 6 Minute Stepper Test, oxygen consumption and energy expenditure were measured with an indirect calorimeter device (Cosmed Fitmate Pro, Rome, Italy), and fatigue perceptions were evaluated with the 'Modified Borg Scale' before and after the test, strength of deep spinal muscles were assessed with the 'The Stabilizer Pressure Biofeedback Unit' (Chattanooga Group Inc, U.S.) and the perceived mobility level assessed with the 'Mobility' subscale of the 'Prosthesis Evaluation Questionnaire'. Results: It was found that as a result of the exercise programs, the prograssion in the maximum oxygen consumption (p=0.003), deep spinal muscle strength (p=0.003) and perceived mobility level (p=0.004) within the groups were found to be statistically significant. The difference in energy expenditure and fatigue levels was not found statistically significant between two groups (respectively p=0.076; p=0.102). Conclusion: As a result of our study, it is seen that the inclusion of spinal stabilization exercises in the rehabilitation program of individuals with amputation may be effective in increasing exercise capacity and mobility level. The effects of spinal stabilization exercise training need to be determined with more cases in the future.

Keywords: Amputation; energy metabolism; rehabilitation; exercise therapy; amputees
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