Specificities of prosthetic and orthotic rehabilitation in amputees with head injury

Abstract

Background/Aim. The prosthetic-orthotic rehabilitation (POR) of amputees with head injury within the polytrauma presents a specific entity. The number of traumas caused by the traffic and the low-intensity war conflicts, increases constantly. The aim of our study was to examine the influence of complications on the POR duration and outcome in polytrauma amputees with head injury (PTAHI) recording complications at the beginning and during the POR. Methods. The study was carried out on the patients divided into two groups of 35 polytrauma male patients each of corresponding age with unilateral transfemoral amputation caused by the war injury. The experimental group consisted of the amputees with head injury. Standard clinical techniques and procedures, as well as special functional evaluation techniques were used. Results. The PATHI started POR with a greater number of complications (average rate 7.29 vs 5.11 per patient; W = 928.000: Z = 3.730: p = 0.000). There was a highly significant positive correlation between this number and the Barthel Score value change (Fx, H, p < 0.01), and negative significant correlation considering prosthetic use and functional capacity test values (Fx, H p < 0.05). On admision, the amount of complications defined for the value 4 of POR outcome was significantly higher than values 2 and 3, respectively (H = 8.948; df = 2; p = 0.011). The PTAHI developed significantly more frequently complications during rehabilitation (X2 = 1.061; df = 1; p < 0.01). The proportion of the examinees with the value 4 who developed complications during rehabilitations was significantly higher than those with value 2 (Fp = 3.406; df1 = 2; df2 = 67; p = 0.038). The rehabilitation of the PTAHI lasted significantly longer (average 259.09 vs 183.63 days; W = 923.500; Z = -3.748; p = 0.000). Conclusion. The PTAHI including head injuries started prostheticorthotic rehabilitation with more prosthetic complications and their psychological status was worse, resulting in the longer duration of rehabilitation whereas the outcome itself was poor. The value 4 of the prosthetic-orthotic rehabilitation outcome can be expected more often in patients developing complications during rehabilitation.Uvod/Cilj. Protetickoortoticka rehabilitacija (POR) osoba sa amputiranim ekstremitetom sa kraniocerebralnom povredom (KCP) u sklopu politraume predstavlja poseban entitet. Sa porastom saobracajnog traumatizma, ali i oruzanih sukoba niskog intenziteta, rehabilitacija postaje sve aktuelnija. Cilj rada bio je utvrdjivanje znacaja komplikacija za tok i ishod POR kod politraumatizovanih bolesnika sa amputiranim ekstremitetom sa KCP. Metode. Istrazivanje je obuhvatilo 70 bolesnika muskog pola, odgovarajuceg zivotnog doba, sa jednostranom transfemoralnom amputacijom, posledicom ratne traume, koji su bili podeljeni u dve grupe po 35 ispitanika. Eksperimentalnu grupu cinili su ispitanici sa KCP. Koriscene su standardne klinicke tehnike i postupci i posebne tehnike evaluacije funkcionalne onesposobljenosti. Rezultati. Politraumatizovani bolesnici sa amputiranim ekstremitetom sa KCP zapocinjali su POR sa vecim brojem komplikacija (prosecno 7,29 vs 5,11 po ispitaniku; W = 928,000; Z = -3,730; p = 0,000). Povezanost ovog broja sa vrednostima promene Bartel skora bila je pozitivna i visokoznacajna (Fx, H, p < 0,01), a sa vrednostima testa funkcionalne osposobljenosti za proteze negativna i znacajna (Fx, H, p < 0,05). Vrednosti broja komplikacija na prijemu za ocenu 4 ishoda rehabilitacije bile su znacajno vece nego za ocene 2 i 3 (H = 8,948; df = 2; p = 0,011); visokoznacajno cesce razvijali su komplikacije tokom rehabilitacije (X2 = 1,061; df = 1; p < 0,01). Proporcija ispitanika sa komplikacijama tokom rehabilitacije i ocenom 4 bila je znacajno veca nego sa ocenom 2 (Fp = 3,406; df1 = 2; df2 = 67; p = 0,038) i trajala je visokoznacajno duze (prosecno 259,09 vs 183,63 dana; W = 923,500; Z = -3,748; p = 0,000). Zakljucak. Politraumatizovani bolesnici sa amputiranim ekstremitetom sa KCP zapocinjali su POR sa vecim brojem protetickih komplikacija i losijim psihickim statusom, zbog kojih je ona trajala duze, a ishod je bio losiji. Kod ispitanika sa komplikacijama tokom rehabilitacije moze se cesce ocekivati ocena 4 za uspeh rehabilitacije.