CHARACTERISTICS OF THE GAIT AND DYNAMIC BALANCE OF WOUNDED MILITARY PERSONNEL WITH CONSEQUENCES OF TRAUMATIC BRAIN INJURY AND TRANSTIBIAL AMPUTATION AS AN INDICATOR OF THE EFFECTIVENESS OF THE PHYSICAL THERAPY PROGRAM

Abstract

Objective. To determine the effectiveness of the developed comprehensive physical therapy program in terms of gait parameters and related activities in wounded servicemen with consequences of mild traumatic brain injury and transtibial amputation during the stage of primary prosthetics. Materials and methods. 94 men were examined: control group (CG, n = 32) without pronounced musculoskeletal disorders; experimental group (EG, n = 62) with transtibial amputation and consequences of traumatic brain injury, randomized to EG1 (n = 32; standard 8-week adaptation program to a temporary prosthesis) and EG2 (n = 30; 8-week individualized program taking into account neurological and orthopedic status, a combination of balance training with biofeedback, strength, flexibility, walking in difficult conditions; 4 weeks inpatient + 4 weeks under remote supervision). Assessment: Functional Gait Assessment (FGA), Locomotor Capabilities Index-5, 6-minute walk test (distance, fatigue according to Borg). Results. Compared with the CG, the injured demonstrated a pronounced deficit in gait and dynamic balance. After the intervention, the total Functional Gait Assessment in EG1 increased by 18,9%, while in EG2 by almost 50% (p < 0,05), with the largest increases in coordination-complex tasks: narrow support area (93,5%), stepping over an obstacle (80,7%), changing speed (58,2%), moving backwards (68.2%), stairs (48,5%). According to the Locomotor Capabilities Index-5, both groups improved their daily mobility, but EG2 consistently prevailed in terms of effect size: climbing/descending several steps without handrails (136,4/144,4%), overcoming a curb (101,7%), walking in bad weather (109,9%), and walking on uneven terrain (101,3%) (all p < 0,05). When performing the 6-minute test, the distance increased by 24,9% (EG1) and 30,4% (EG2), while fatigue decreased by 14,0 and 33,2%, respectively (p < 0,05), which indicates an increase in endurance and a decrease in energy expenditure when walking. Conclusions. The developed individualized physical therapy program provides significantly better results than the standard one: a significant increase in gait, dynamic balance, and functional independence, pronounced gains in tasks with high demands on sensorimotor control, and significant improvements in the six-minute test. It is advisable to implement the program in the standards of primary prosthetics with a home stage under remote support.