MODERN APPROACHES TO PHYSICAL THERAPY FOR INDIVIDUALS WITH TRANSTIBIAL AMPUTATION
DOI:
https://doi.org/10.32782/2221-1217-2025-2-04Keywords:
amputation, therapeutic exercises, phantom pain, lower limb, mirror therapyAbstract
Physical therapy for individuals with lower limb amputation, particularly at the transtibial level, is a relevant area of modern rehabilitation, especially under conditions of armed aggression against Ukraine. As a result of military actions, the number of wounded is rapidly increasing among both military personnel and the civilian population, who require comprehensive rehabilitation support from multidisciplinary teams of specialists. Purpose of the study: to determine modern approaches to physical therapy for individuals with transtibial amputation. The study employed theoretical research methods: analysis, comparison, induction, deduction, and systematization. The staged nature of the rehabilitation process in individuals with limb amputation ensures the integrity and consistency of measures aimed at restoring functional status, adapting to changed environmental conditions, and returning to socially active life. Physical therapy during the pre-prosthetic period acquires special significance, as it is a key component of post-amputation recovery, ensuring improvement in functioning, lower limb motor function, physical capabilities, and adaptation to new living conditions. In addition to physical aspects, physical therapy programs indirectly influence the patients’ psycho-emotional state, promoting social reintegration, maintaining autonomy, and fostering motivation for an active lifestyle. The synthesis of scientific studies shows that leading Ukrainian and international researchers currently prioritize a comprehensive multidisciplinary approach that combines physical therapy, psychoemotional support, individualized prosthetic adaptation, objective outcome assessment, and advanced bioengineering technologies to achieve maximum reintegration of individuals with lower limb amputation. At the same time, there is a need to develop a comprehensive, individualized, and scientifically grounded physical therapy program for individuals with transtibial lower limb amputation during the pre-prosthetic period, taking into account the local context.
References
1. Коробко Л., Маркович О., Чижишин Б. Фахова медична допомога фізичного терапевта з профілактики контрактур після ампутації нижніх кінцівок. Physical Culture and Sport: Scientific Perspective. 2022. Вип. 2. С. 81–84. DOI: https://doi.org/10.31891/pcs.2022.2.13
2. Краснояружський А., Михальчук С. Комплексна фізична реабілітація при ампутації нижніх кінцівок в період підготовки до протезування. Фізична реабілітація та рекреаційно-оздоровчі технології. 2016. № 2. С. 43–44.
3. Нагорна О., Дехтерук В. Фізична терапія хворих після ампутації нижніх кінцівок. Реабілітаційні та фізкультурно-рекреаційні аспекти розвитку людини. 2020. № 6. С. 23–27.
4. Ніканоров О., Крикунов О. Особливості фізичної терапії військовослужбовців з ампутацією нижніх кінцівок. Спортивна медицина, фізична терапія та ерготерапія. 2023. № 2. С. 84–87. DOI: https://doi.org/10.32652/spmed.2023.2.84-87
5. Одинець Т., Бєлов Є., Ванюк О. Фізична терапія військовослужбовців після ампутацій. Physical Culture and Sport: Scientific Perspective. 2023. Вип. 4. С. 46–49. DOI: https://doi.org/10.31891/pcs.2023.4.6
6. Скоропліт С., Михневич К., Замятін П., Хорошун Е., Бородай В., Тертишний С. та ін. Особливості сучасної бойової травми та організації медичної допомоги. Харківська хірургічна школа. 2022. № 6 (117). С. 51–63.
7. Bowering K.J., O’Connell N.E., Tabor A., Catley M.J., Leake H.B., Moseley G.L. et al. The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. Journal of Pain. 2013. Vol. 14. No. 1. P. 3–13. DOI: https://doi.org/10.1016/j.jpain.2012.09.007
8. Brunelli S., D’Auria L., Stefani A., Giglioni F., Mariani G., Ciccarello M. et al. Is mirror therapy associated with progressive muscle relaxation more effective than mirror therapy alone in reducing phantom limb pain in patients with lower limb amputation? International Journal of Rehabilitation Research. 2023. Vol. 46. No. 2. P. 193–198. DOI: https://doi.org/10.1097/MRR.0000000000000582
9. Brunelli S., Morone G., Iosa M. et al. Efficacy of progressive muscle relaxation, mental imagery, and phantom exercise training on phantom limb: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation. 2015. Vol. 96. No. 2. P. 181–187. DOI: https://doi.org/10.1016/j.apmr.2014.09.035
10. Casale R., Damiani C., Rosati V. Mirror therapy in the rehabilitation of lower-limb amputation: are there any contraindications? American Journal of Physical Medicine and Rehabilitation. 2009. Vol. 88. No. 10. P. 837–842. DOI: https://doi.org/10.1097/PHM.0b013e3181b74698
11. Chan B.L., Witt R., Charrow A.P., Magee A., Howard R., Pasquina P.F., Heilman K.M., Tsao J.W. Mirror therapy for phantom limb pain. New England Journal of Medicine. 2007. Vol. 357. No. 21. P. 2206–2207. DOI: https://doi.org/10.1056/NEJMc071927
12. Kayssi A., Dilkas S., Dance D.L., de Mestral C., Forbes T.L., Roche-Nagle G. Rehabilitation trends after lower extremity amputations in Canada. PM&R. 2017. Vol. 9. No. 5. P. 494–501. DOI: https://doi.org/10.1016/j.pmrj.2016.09.009
13. Limakatso K., Madden V.J., Manie S., Parker R. The effectiveness of graded motor imagery for reducing phantom limb pain in amputees: a randomised controlled trial. Physiotherapy. 2020. Vol. 109. P. 65–74. DOI: https://doi.org/10.1016/j.physio.2019.06.009
14. Mahulkar S.S., Telang P.A., Arora S.P. Rehabilitation of a patient after a transtibial amputation: a case report. Cureus. 2022. Vol. 14. No. 10. P. e30773. DOI: https://doi.org/10.7759/cureus.30773
15. Malgor R.D., Alahdab F., Elraiyah T.A., Rizvi A.Z., Lane M.A., Prokop L.J. et al. A systematic review of treatment of intermittent claudication in the lower extremities. Journal of Vascular Surgery. 2015. Vol. 61. No. 3 Suppl. P. 54S–73S. DOI: https://doi.org/10.1016/j.jvs.2014.12.007
16. Miller C.A., Williams J.E., Durham K.L., Hom S.C., Smith J.L. The effect of a supervised community-based exercise program on balance, balance confidence, and gait in individuals with lower limb amputation. Prosthetics and Orthotics International. 2017. Vol. 41. No. 5. P. 446–454. DOI: https://doi.org/10.1177/0309364616683818
17. Morgan S.J., Liljenquist K.S., Kajlich A., Gailey R.S., Amtmann D., Hafner B.J. Mobility with a lower limb prosthesis: experiences of users with high levels of functional ability. Disability and Rehabilitation. 2022. Vol. 44. No. 13. P. 3236–3244. DOI: https://doi.org/10.1080/09638288.2020.1851400
18. Murray C.D., Havlin H., Molyneaux V. Considering the psychological experience of amputation and rehabilitation for military veterans: a systematic review and meta synthesis of qualitative research. Disability and Rehabilitation. 2023. Vol. 46. No. 6. P. 758–771. DOI: https://doi.org/10.1080/09638288.2023.2182915
19. Nolan L. A training programme to improve hip strength in persons with lower limb amputation. Journal of Rehabilitation Medicine. 2012. Vol. 44. No. 3. P. 241–248. DOI: https://doi.org/10.2340/16501977-0921
20. Nugent K., Payne M. W., Viana R., Unger J., Hunter S. W. A concern for falling impacts quality of life for people with a lower limb amputation. International Journal of Rehabilitation Research. 2022. Vol. 45, No. 3. P. 253–259. DOI: https://doi.org/10.1097/MRR.0000000000000537
21. Panyi L.K., Lábadi B. Psychological adjustment following lower limb amputation. Orvosi Hetilap. 2015. Vol. 156. No. 39. P. 1563–1568. DOI: https://doi.org/10.1556/650.2015.30257
22. Resnik L., Borgia M., Silver B., Cancio J. Systematic review of measures of impairment and activity limitation for persons with upper limb trauma and amputation. Archives of Physical Medicine and Rehabilitation. 2017. Vol. 98, No. 9. P. 1863–1892.e14. DOI: https://doi.org/10.1016/j.apmr.2017.01.015
23. Rierola-Fochs S., Ochandorena-Acha M., Merchán-Baeza J.A., Minobes-Molina E. The effectiveness of graded motor imagery and its components on phantom limb pain in amputated patients: a systematic review. Prosthetics and Orthotics International. 2024. Vol. 48. No. 2. P. 158–169. DOI: https://doi.org/10.1097/PXR.0000000000000293
24. Roberts E., Burhani L., Lankester R., Mobbs A., Tigert C., Vanvelzen T. et al. A qualitative study examining prosthesis use in everyday life in individuals with lower limb amputations. Prosthetics and Orthotics International. 2021. Vol. 45. No. 4. P. 296–303. DOI: https://doi.org/10.1097/PXR.0000000000000021
25. Rodrigues D.F., Machado P.A.P., Martins T., Carvalho A.L.R.F., Pinto C.M.C.B. Self-care dependency assessment of person with lower limb amputation: an exploratory study. Revista Latino-Americana de Enfermagem. 2024. Vol. 32. P. e4332. DOI: https://doi.org/10.1590/1518-8345.7424.4331
26. Rothgangel A., Braun S., Winkens B., Beurskens A., Smeets R. Traditional and augmented reality mirror therapy for patients with chronic phantom limb pain (PACT study): results of a three-group, multicenter single-blind randomized controlled trial. Clinical Rehabilitation. 2018. Vol. 32. No. 12. P. 1591–1608. DOI: https://doi.org/10.1177/0269215518785948
27. Ruan Q.Z., Chang J., Pak D., Supra R., Yazdi C., Kollenburg L. et al. Literature review: mechanism, indications, and clinical efficacy of peripheral nerve stimulators in lower extremity pain. Current Pain and Headache Reports. 2024. Vol. 28. No. 6. P. 469–479. DOI: https://doi.org/10.1007/s11916-024-01240-8
28. Saini U.C., Soni S., Mehra A., Shubhankar B.U., Bansal A., Suri N. et al. Evaluation of short-term functional mobility outcomes in patients with traumatic lower limb amputations: a prospective cohort study in India. Journal of Bodywork and Movement Therapies. 2025. Vol. 41. P. 115–120. DOI: https://doi.org/10.1016/j.jbmt.2024.11.015
29. Schafer Z.A., Perry J.L., Vanicek N. A personalized exercise programme for individuals with lower limb amputation reduces falls and improves gait biomechanics: a block randomized controlled trial. Gait and Posture. 2018. Vol. 63. P. 282–289. DOI: https://doi.org/10.1016/j.gaitpost.2018.04.030
30. Schafer Z.A., Vanicek N. A block randomized controlled trial investigating changes in postural control following a personalized 12-week exercise programme for individuals with lower limb amputation. Gait and Posture. 2021. Vol. 84. P. 198–204. DOI: https://doi.org/10.1016/j.gaitpost.2020.12.001
31. Scholl L., Schmidt A., Alfuth M. Efficacy of mirror therapy in patients with phantom pain after amputation of a lower limb: a systematic literature review. Zeitschrift für Orthopädie und Unfallchirurgie. 2024. Vol. 162. No. 6. P. 566–577. DOI: https://doi.org/10.1055/a-2188-3565
32. Sinha R., van den Heuvel W.J., Arokiasamy P. Adjustments to amputation and an artificial limb in lower limb amputees. Prosthetics and Orthotics International. 2014. Vol. 38. No. 2. P. 115–121. DOI: https://doi.org/10.1177/0309364613489332
33. Ülger Ö., Yıldırım Şahan T., Çelik S.E. A systematic literature review of physiotherapy and rehabilitation approaches to lower-limb amputation. Physiotherapy Theory and Practice. 2018. Vol. 34. No. 11. P. 821–834. DOI: https://doi.org/10.1080/09593985.2018.1425938
34. van Schaik L., Hoeksema S., Huvers L.F., Geertzen J.H.B., Dijkstra P.U., Dekker R. The most important activities of daily functioning: the opinion of persons with lower limb amputation and healthcare professionals differ considerably. International Journal of Rehabilitation Research. 2020. Vol. 43, No. 1. P. 82–89. DOI: https://doi.org/10.1097/MRR.0000000000000392
35. Wasser J.G., Vincent K.R., Herman D.C., Vincent H.K. Potential lower extremity amputation-induced mechanisms of chronic low back pain: role for focused resistance exercise. Disability and Rehabilitation. 2020. Vol. 42, No. 25. P. 3713–3721. DOI: https://doi.org/10.1080/09638288.2019.1610507
36. Wong C.K., Ehrlich J.E., Ersing J.C., Maroldi N.J., Stevenson C.E., Varca M.J. Exercise programs to improve gait performance in people with lower limb amputation: a systematic review. Prosthetics and Orthotics International. 2016. Vol. 40. No. 1. P. 8–17. DOI: https://doi.org/10.1177/0309364614546926
37. Wukich D.K., Ahn J., Raspovic K.M., La Fontaine J., Lavery L.A. Improved quality of life after transtibial amputation in patients with diabetes-related foot complications. International Journal of Lower Extremity Wounds. 2017. Vol. 16. No. 2. P. 114–121. DOI: https://doi.org/10.1177/1534734617704083
38. Yıldırım M., Kanan N. The effect of mirror therapy on the management of phantom limb pain. Agri. 2016. Vol. 28. No. 3. P. 127–134. DOI: https://doi.org/10.5505/agri.2016.48343
39. Zhang L., Yang H. The influence of comprehensive rehabilitation on the quality of life in veterans with chronic pain: a randomized controlled trial. Journal of Trauma and Acute Care Surgery. 2021. Vol. 94. No. 2. P. 156–163.
