INFLUENCE OF PHYSICAL THERAPY INTERVENTIONS ON STRUCTURAL AND FUNCTIONAL PARAMETERS OF MUSCLE TISSUE IN MILITARY PERSONNEL WITH SEQUELAE OF TRAUMATIC BRAIN INJURY AND TRANSTIBIAL AMPUTATION

Abstract

Topicality. The consequences of traumatic brain injury (TBI) in military personnel combined with transtibial amputation are associated with generalized muscle atrophy, reduced muscle strength, and impaired neuromuscular regulation, which complicate prosthetic rehabilitation and limit functional recovery.
The goal of the work is to evaluate the effectiveness of a comprehensive physical therapy program based on structural and functional parameters of muscle tissue in military personnel with TBI sequelae and transtibial amputation.
Materials and methods. A total of 94 military personnel were examined. The experimental group (n=62) was divided into two subgroups: EG1 (n=32), which received standard rehabilitation, and EG2 (n=30), which underwent a comprehensive physical therapy program. The control group consisted of 32 apparently healthy individuals. The developed program lasted 8 weeks and included resistance, functional, and coordination exercises, balance training with biofeedback, gait training, and independent home-based sessions. Assessment was performed using musculoskeletal ultrasound and digital dynamometry (isometric strength) to evaluate structural and functional characteristics of muscle tissue.
Research results. Following physical therapy, significantly greater improvements were observed in EG2 compared to EG1. Muscle thickness increased in EG2 as follows: biceps brachii by 49.3% (p<0.05), brachioradialis by 21.4% (p<0.05), rectus femoris of the intact limb by 19.5% (p<0.05), and rectus femoris of the residual limb by 65.9% (p<0.05), whereas corresponding increases in EG1 were 14.1%, 14.8%, 13.4%, and 25.1%, respectively. Isometric elbow flexion strength of the dominant arm increased by 42.6% in EG2 versus 14.4% in EG1 (p<0.05), elbow extension by 46.9% versus 17.3% (p<0.05), and shoulder abduction by 34.2% versus 17.7% (p<0.05). Post-intervention values in EG2 approached those of the control group, while EG1 remained significantly lower.
Conclusions. The comprehensive physical therapy program is more effective than standard rehabilitation, as it provides significantly greater recovery of muscle mass and strength. This effect is likely is attributed to its multicomponent impact on muscle hypertrophy, neuromuscular activation, and sensorimotor integration, taking into account the specific features of combined injury.