ASSESSMENT OF POSTURAL STABILITY, BALANCE AND KINESIOPHOBIA IN MILITARY PERSONNEL WITH TRANSTIBIAL AMPUTATION COMBINED WITH TRAUMATIC BRAIN INJURY SEQUELAE FOLLOWING A PHYSICAL THERAPY PROGRAM
DOI:
https://doi.org/10.67034/2786-8354.2026.20.2.04Keywords:
physical therapy, military personnel, transtibial amputation, traumatic brain injury, neurology, traumatology, postural stability, kinesiophobia, balance impairment, risk of fallingAbstract
Introduction. To evaluate the effectiveness of a physical therapy program based on changes in postural stability, balance, and kinesiophobia in military personnel with traumatic brain injury sequelae and transtibial amputation.
Materials and Methods. The study involved 94 male servicemen of the Armed Forces of Ukraine. The control group consisted of 32 apparently healthy combat veterans. The experimental cohort included 62 servicemen with transtibial amputation and sequelae of mild traumatic brain injury (mTBI), who were randomized into two subgroups: experimental group 1 (EG1) (n=32), which received a standard rehabilitation program, and experimental group 2 (EG2) (n=30), for which a comprehensive physical therapy program was developed taking into account the consequences of the combined injury. The intervention lasted 8 weeks. Outcome measures included stabilometric parameters, the Modified Clinical Test of Sensory Interaction on Balance (m-CTSIB), Berg Balance Scale (BBS), Activities-specific Balance Confidence Scale (ABC Scale), Falls Efficacy Scale (FES), and Tampa Scale for Kinesiophobia (TSK).
Results. Prior to the intervention, patients with transtibial amputation and TBI sequelae demonstrated statistically significant impairments in postural control compared with the control group (p<0.05), manifested by an increase in center of pressure (CoP) sway area under eyes-open conditions to 225.17±11.09 mm² in EG1 and 216.71±10.15 mm² in EG2 versus 96.75±4.10 mm² in the control group, as well as an increase in CoP velocity to 17.62±0.84 mm/s and 18.10±1.12 mm/s, respectively, compared with 5.75±0.61 mm/s in the control group (p<0.05). Following physical therapy, improvements were observed in both experimental groups; however, significantly greater changes were demonstrated in EG2 (p<0.05). In EG2, the CoP sway area decreased from 216.71±10.15 mm² to 162.43±10.14 mm² (25.0%), while CoP velocity decreased from 18.10±1.12 mm/s to 9.19±0.53 mm/s (49.2%). The m-CTSIB performance in the Foam Surface, Eyes Closed condition increased from 13.11±0.67 s to 23.44±0.68 s (78.8%; p<0.05). BBS scores improved from 22 [19; 25] points to 38 [35; 40] points, and ABC Scale scores increased from 46.19±3.52% to 70.05±2.13%. At the same time, FES and TSK scores decreased from 70 [65; 73] points to 43 [39; 48] points and from 54 [50; 58] points to 35 [31; 40] points, respectively (p<0.05).
Conclusions. Military personnel with transtibial amputation combined with traumatic brain injury sequelae exhibit marked impairments in postural stability, balance, and psychofunctional status. The comprehensive physical therapy program resulted in statistically significant improvements in stabilometric and functional outcomes and contributed to reductions in kinesiophobia and fear of falling.
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