PubMed Health⌕ Search

Biomedical subjects

Michael Devlin

Publications and source records attributed to Michael Devlin.

9 recordsLinked to original sources
PubMed2006

Driving pedal reaction times after right transtibial amputations.

OBJECTIVES: To determine if right transtibial amputees have the potential to safely operate the foot pedals of a vehicle with their prosthetic foot, and to determine which of 4 driving techniques is associated with the fastest reaction times. DESIGN: Repeated measures. SETTING: Outpatient amputee clinic. PARTICIPANTS: Ten subjects with right-sided, transtibial amputations. INTERVENTION: Brake pedal response times were measured using 4 different driving techniques: right-sided accelerator with (1) prosthesis operating both the accelerator and brake pedals, (2) prosthesis operating the accelerator and left foot operating the brake, (3) left foot operating both the accelerator and brake, and (4) left-sided accelerator with the left foot operating both the accelerator and brake. MAIN OUTCOME MEASURES: Reaction time, movement time, total response time, and pedal configuration preference. RESULTS: Total response times were slowest using a 2-footed driving technique (P<.001). Total response times were comparable using a left-sided accelerator versus the prosthesis. Using the left foot to operate both the accelerator and brake in a conventional right-footed accelerator design led to the fastest reaction (P<.001) and total response times (P<.01), although it is unclear if this is a realistic driving technique for all amputees. CONCLUSIONS: Our results suggest that right transtibial amputees should be instructed not to drive with a 2-footed technique, and that they have similar pedal response times using their prosthesis when compared with a left-sided accelerator.

Adult↗
PubMed2006

Return to driving after lower-extremity amputation.

OBJECTIVES: To study driving behaviors after major lower-extremity amputations and to determine which factors influence return to driving after amputation. DESIGN: A cross-sectional study. SETTING: Data were collected from patients attending an outpatient amputee and prosthetics clinic between February 2001 and September 2001. PARTICIPANTS: A convenience sample (N=123). Inclusion criteria were: age greater than 18 years, unilateral or bilateral major lower-extremity amputation, minimum 1 year since prosthetic fitting, and active automobile driver within 6 months prior to amputation. Subjects had an average age of 63.4+/-12.1 years and were on average 6.8+/-8.3 years since amputation. Common causes for amputation were peripheral vascular disease (73.2%), trauma (13.8%), and tumor (12.2%). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Driving habits after lower-extremity amputation. RESULTS: Overall, 80.5% of participants were able to return to driving an average of 3.8 months after amputation, although the majority reported a decreased driving frequency. Female sex (odds ratio [OR]=.08; 95% confidence interval [CI], .02-.34), age of 60 years or greater (OR=.16; 95% CI, .03-.74), right-sided amputation (OR=.13; 95% CI, .03-.52), and preamputation driving frequency of less than every day (OR=.18; 95% CI, .05-.69) were all significantly related to a reduced likelihood of return to driving postamputation. Items that did not have a statistically significant association with return to driving included level of amputation, reason for amputation, preamputation automobile transmission, and accessibility to public transit. Subjects with left-sided amputation had significantly fewer concerns about driving, while those with a right amputation frequently required vehicle modifications (40.6%) or switch to a left-foot driving style for braking (81.3%) and accelerating (65.6%). Common barriers to return to driving included preference not to drive, fear and/or lack of confidence, and related medical conditions. CONCLUSIONS: The majority of subjects with major lower-extremity amputation were able to return to driving after major lower-extremity amputation. Major automobile modifications are commonly performed by right-sided amputees. Several predictors of return to driving and barriers preventing return to driving were identified.

Aged↗
PubMed2006

Falls sustained during inpatient rehabilitation after lower limb amputation: prevalence and predictors.

OBJECTIVE: The purpose of this study is to identify risk factors for falling and fall-related injury among a group of inpatients undergoing rehabilitation after major lower limb amputation. DESIGN: Retrospective cohort. RESULTS: Out of 1267 patients, 260 (20.5%) fell at least once. There were a total of 374 falls, 67 (17.9%) of which resulted in one or more injuries. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated for factors significantly associated with falling, including age of > or =71 yrs (OR = 1.40, 95% CI = 1.02-1.89), lengths of stay of 22-35 days (OR = 2.97, 95% CI = 1.14-7.72) or >5 wks (OR = 6.07, 95% CI = 2.34-15.71), four or more comorbidities (OR = 1.93, 95% CI = 1.09-3.41), cognitive impairment (OR = 1.68, 95% CI = 1.02-2.78), two or more as-needed medications (OR = 1.81, 95% CI = 1.02-3.21), benzodiazepines (OR = 2.22, 95% CI = 1.24-3.96), and opiates (OR = 5.76, 95% CI = 3.29-10.09). Factors significantly associated with fall-related injuries included bilateral amputation (OR = 3.68, 95% CI = 1.49-9.05) and falls during the day shift (OR = 2.63, 95% CI = 1.24-5.57). CONCLUSIONS: One in five patients with lower limb amputation will likely experience at least one fall during inpatient rehabilitation, with 18% sustaining an injury. Ongoing research is required to develop appropriate intervention strategies to ameliorate the risk of falling during inpatient rehabilitation.

Accidental Falls↗
PubMed2004

Houghton Scale of prosthetic use in people with lower-extremity amputations: Reliability, validity, and responsiveness to change.

OBJECTIVE: To evaluate the responsiveness to change and the floor and ceiling effects of the Houghton Scale. DESIGN: One-week and 3-month test-retest to evaluate reliability, validity, and responsiveness to change. SETTING: Amputee rehabilitation program. PARTICIPANTS: Persons (N=125) with unilateral or bilateral lower-extremity amputation who were wearing a prostheses: 1 group (n=49) for the reliability component and another group (n=76) for the responsiveness and validity component. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Responsiveness to change, ceiling and floor effects, and reliability and convergent validity. RESULTS: Evaluation of responsiveness to change (n=76) showed that the total score increased from a mean +/- standard deviation of 6.14+/-2.40 at discharge to 7.70+/-2.62 (P<.001) at follow-up 3 months later. Floor and ceiling effects were not detected for the overall score but were noted for the individual subscales. The internal consistency was moderate at discharge (Cronbach alpha=.71) and follow-up (Cronbach alpha=.70). The Houghton Scale correlated significantly, although moderately, with the physical composite score of the Medical Outcomes Study 36-Item Short-Form Health Survey (r=.393, P<.01) and the 2-minute walk test at admission (r=.620, P<.01) and discharge (r=.653, P<.01). The reliability (intraclass correlation coefficient=.96) of the Houghton Scale was high (n=49). CONCLUSIONS: The Houghton Scale is appropriately responsive to change in prosthetic use in individuals with lower-limb amputation after rehabilitation.

Activities of Daily Living↗
PubMed2003

Does increased prosthetic weight affect gait speed and patient preference in dysvascular transfemoral amputees?

OBJECTIVES: To determine if increased prosthetic weight affects gait speed in dysvascular transfemoral amputees and to see if there is any patient preference for lighter versus heavier prostheses. DESIGN: Randomized prospective double-blind crossover trial. SETTING: Outpatient, tertiary care, amputee clinic in Ontario, Canada. PARTICIPANTS: A convenience sample of 10 subjects with unilateral transfemoral amputations because of peripheral vascular disease. All subjects were independent community ambulators over 50 years old. INTERVENTION: Seemingly identical weights of 150g (placebo weight), 770g, and 1625g were added to the prosthesis 14cm below the knee joint. MAIN OUTCOME MEASURES: Two-minute walk test (2MWT) and subject preference. RESULTS: The 2MWT results were not significantly influenced by weight added (mean, 53.4+/-28.4m, 55.1+/-28.9m, and 52.8+/-26.7m for 150g, 770g, and 1625g of added weight, respectively). Subject preference revealed that more than half preferred a weighted prosthesis over the "placebo" weight (5 subjects preferred 770g added, 4 subjects preferred 150g added, 1 preferred 1625g added). CONCLUSIONS: Short-term intervention with increased prosthetic mass had no significant adverse affect on gait speed, and more than half of the subjects preferred an added mass condition.

Aged↗
PubMed2002

Patient preference and gait efficiency in a geriatric population with transfemoral amputation using a free-swinging versus a locked prosthetic knee joint.

OBJECTIVE: To investigate patient preference, walking speed, and prosthetic use in a geriatric population with transfemoral amputation using a free-swinging prosthetic knee or a locked knee joint. DESIGN: Before-after trial. SETTING: Ambulatory patients at an amputee rehabilitation facility. PARTICIPANTS: A convenience sample of 14 geriatric individuals with a unilateral dysvascular transfemoral amputation (age range, 61-80y), who were using a prosthesis with a free-swinging knee in the community, 3 months after discharge from an amputee rehabilitation program. INTERVENTION: Change from a free-swinging knee to a locked knee. MAIN OUTCOME MEASURES: Patient preference, distance walked in 2 minutes, and prosthetic use as measured by the Houghton Scale. RESULTS: Eleven of 14 participants preferred the locked knee. Irrespective of preference, the mean 2-minute walk distance was 44.9 +/- 28.9m with the free-swinging knee and 54.4 +/- 35m with the locked knee (P = .001). Prosthetic use was greater with the locked knee (7.8 +/- 2.2) than with the free-swinging knee (6.6 +/- 2.5) (P = .01). CONCLUSIONS: Most geriatric participants with transfemoral amputation preferred locked knees and walked faster and used their prostheses more when using a locked knee prosthesis.

Aged↗
PubMed2002

Interruptions to amputee rehabilitation.

OBJECTIVES: To determine the frequency of interruptions to inpatient amputee rehabilitation, and to identify the causes, risk factors, and consequences of these interruptions. DESIGN: Retrospective cohort study. SETTING: Inpatient amputee rehabilitation service. PATIENTS: A total of 254 consecutive patients admitted within 90 days of amputation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patient age, gender, comorbid medical conditions, amputation type(s), days from amputation to admission, admission Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) score, rehabilitation length of stay (LOS), whether a prosthesis was fabricated, discharge destination, discharge Houghton Scale score, discharge 2-minute walk test, and discharge SF-36 score. RESULTS: Interruptions occurred in 76 patients (30%). Impaired stump healing caused 46 (18%) interruptions and acute medical illness caused 26 (10%); 4 (2%) interruptions were because of other causes. Higher incidence of interruption was associated with female gender, peripheral vascular disease, and decreased days from amputation to rehabilitation. The majority of patients with interruptions (60/76, 79%) returned to complete rehabilitation. Patients with interruptions had significantly longer rehabilitation LOS (48.5 vs 37.0d, P<.001), but functional outcome measures at rehabilitation discharge were similar between those patients who returned to complete rehabilitation after interruption and those patients without interruption. CONCLUSIONS: Interruptions to amputee rehabilitation are common and result in longer rehabilitation LOS but do not adversely affect rehabilitation outcomes in those who are able to return to complete rehabilitation. No subgroup of patients with exceptionally high incidence of interruption could be identified.

Amputees↗
PubMed2002

Reliability of the two-minute walk test in individuals with transtibial amputation.

OBJECTIVE: To determine inter- and intrarater reliability of the two-minute walk test (2MWT) in individuals with transtibial amputation. DESIGN: Prospective; test-retest method by a pair of trained physical therapists. SETTING: Two regional amputee rehabilitation centers in Canada. PARTICIPANTS: Thirty-three subjects (23 men, 10 women; mean age +/- standard error, 63.6+/-2.0y) with transtibial amputation; 6 in outpatient rehabilitation, 27 in inpatient rehabilitation. The most common primary diagnoses were peripheral vascular disease (n=15) and diabetes (n=11). INTERVENTIONS: Each subject performed a total of four 2MWTs, 1 test for each rater, on 2 consecutive days at approximately the same time of day. Subjects were given at least a 20-minute rest between tests. The order of raters was randomized on the first day and reversed for the next day. The walk tests were performed in the same enclosed corridors with the same starting point for all tests. The subjects were familiar with the test or were given 1 or more practice tests at least 1 day before testing. Subjects were allowed to walk with a mobility aid of their choice. Raters used a digital stopwatch to time the tests and a calibrated wheel with a counter to measure the distance walked in meters. The raters were blinded to each other's scores. MAIN OUTCOME MEASURE: Distance walked in 2 minutes (in meters). RESULTS: Within-rater reliability was high (intraclass correlation coefficient [ICC],.90-.96). Between rater reliability was also high (ICC.98-.99). Analysis of variance (ANOVA) showed a significant effect for day of test (P<.001) in the inpatient group but no effect for therapist (P=.098) or for interaction of day and therapist (P=.710). Similarly, in the outpatient group, ANOVA showed a significant effect for day (P=.013) but no effect for therapist (P=.259) or interaction of day and therapist (P=.923). CONCLUSION: Although the 2MWT showed evidence of inter- and intrarater reliability in individuals with unilateral below-knee amputation, the distance walked in 2 minutes continued to improve over time. This improvement was not solely the result of a training and learning effect.

Activities of Daily Living↗