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Biomedical subjects

R O Ham

Publications and source records attributed to R O Ham.

5 recordsLinked to original sources
PubMed1997

Powered wheelchairs: are we enabling or disabling?

Following the unsuccessful issue of three powered indoor National Health Service (NHS) wheelchairs, a survey was carried out of 40 users in a London wheelchair service to identify the problems with issue and possible areas for improvement to practice. The survey identified improvements that were necessary both from the service and the manufacturers' booklets. The improvements include the issue of written instructions and information to complement verbal instruction given at handover. Such information should be as interesting to read as possible, make use of appropriate language and diagrams (especially in area where English is often not the first language), colour, text and print size to maximise comprehension to these severely disabled users and often their elderly relatives or carers. The importance of the role of the rehabilitation engineer in training the user, giving instruction at handover and annual review are highlighted to ensure that the equipment remains working, suitable and up to date for the individual's needs. Training in interpersonal and communication skills and the importance of recall should also be emphasised. The implementation of the findings should lead to increasing contact with the service by the user, reduction in repair and replacement costs, regular review, correct supply and will therefore enable users to increase their independence with appropriate equipment.

Persons with Disabilities↗
PubMed1989

A five-year review of referrals for prosthetic treatment in England, Wales and Northern Ireland, 1981-85.

Patients undergoing amputation and who are considered to be suitable for an artificial leg are referred to the Disablement Services Centres (formerly called the Artificial Limb and Appliance Centres). This article reviews the referrals to the 23 centres in England, Wales and Northern Ireland over the five-year period 1981-85. The results show that there has been a decrease in the number of both upper and lower limb referrals and a 4% increase in the primary cause of amputation, arteriosclerosis. Centres that are the busiest, those seeing the greatest and fewest number of arteriosclerosis and diabetic referrals and those being referred the largest numbers of above, below and knee level amputations are identified.

Amputation, Surgical↗
PubMed1987

Limb perfusion in the lower limb amputee--a comparative study using a laser Doppler flowmeter and a transcutaneous oxygen electrode.

Accurate and objective assessment of amputation level in the lower limb plays an important role in patient management. Laser Doppler flowmetry (LDF) is a new and noninvasive technique for skin blood flow measurement and has been used pre-operatively in 25 patients undergoing amputation for vascular disease and in five normal controls. Baseline flux measurements were made at room temperature on the medial aspect of legs and then again after local heating of the skin for five minutes. Transcutaneous oxygen measurements were made at the same site for comparison and amputation level in patients selected on this basis. Significant differences (p less than 0.001) in TcPO2 values were found between controls (10.9 +/- 0.5 kPa), below-knee (BK) amputees (6.0 +/- 1.5 kPa) and above-knee (AK) amputees (1.5 +/- 0.6 kPa). Baseline LDF flux did not differ significantly between any group. Heated flux values did however show a significant difference (p less than 0.005) between controls (52.4 +/- 23.5) and both BK (20.6 +/- 9.2) and AK groups (8.1 +/- 7.7) and also between the amputee groups. The relative increase in flux (heated flux/baseline flux) differed significantly between the BK (3.3 +/- 1.5) and AK (1.2 +/- 0.3) groups (p less than 0.001) and between these two and the controls (11.2 +/- 5.4) (p less than 0.001). The correlation between relative increase in flux and TcPO2 was 0.7 (p less than 0.001). It is concluded that laser Doppler flowmetry used in conjunction with thermal stressing could provide a quick, simple and non-invasive method for objectively determining amputation level in the lower limb.

Amputees↗
PubMed1987

The effect of adjuvant oxygen therapy on transcutaneous pO2 and healing in the below-knee amputee.

The effects on tissue oxygenation of postoperative adjuvant oxygen have been studied in a group of 20 patients undergoing below-knee (BK) amputation for vascular disease. Ten patients received no therapy, the remainder receiving 28% oxygen for 48 hours following surgery. The results showed that the transcutaneous pO2 in the amputation flaps fell significantly by some 20 mmHg (p less than 0.01) following surgery and that this fall was prevented by the use of adjuvant oxygen. The fall was not observed in the non-amputated limbs. TcpO2 took almost two weeks to reach its pre-operative levels in the amputated limbs. The effect on stump healing of adjuvant oxygen therapy was investigated in a randomized controlled trial in a series of 39 patients undergoing BK amputation. There were 22 patients in the control (untreated) group and 17 in the treated group (adjuvant oxygen for 48 hours). In the treated group 14 patients healed primarily and three amputations failed. In the untreated group 14 limbs healed primarily, one secondarily and there were 7 failures. The pre-operative transcutaneous values in the stumps which failed (26 mmHg +/- 14) was significantly lower (p less than 0.005) than in those which healed (40 mmHg +/- 9). The mean pre-operative TcpO2 in the patients in whom healing occurred in the treated group (35 mmHg +/- 10) was significantly lower (p less than 0.001) than the mean pressure observed in the untreated group (44 mmHg +/- 9).

Aged↗