PubMed · 850699
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R A Persons. 1977. Stump model an educational device.. https://doi.org/10.1093/ptj%2F57.5.528
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Instrumentation to measure accurately the stresses at the interface of a residual limb and prosthetic socket has a strong potential for use in prosthetic treatment. As a tool in the clinical setting, the device would allow a clinician to identify sites of excessive loading, information which could then be combined with clinical assessment of skin quality to determine regions of potential skin breakdown. Stress distributions for different prosthetic designs could be compared, facilitating a clinician's judgement to determine the optimal design for a patient. The instrumentation would have additional use in research as an evaluation tool for computer-based finite-element (FE) models. Stump-socket FE models predict stress distributions for proposed socket designs, thus offering advantages over interface stress measurement because evaluation can be conducted before a prosthesis is fabricated or put on an amputee patient. However, FE models must first be proven valid against experimental measurements before they can be considered accurate predictors of interface stresses. Current interface stress measurement techniques are described, with a concentration on a physical explanation of the advantages and limitations with each technique. New emerging technologies are discussed which are instruments that have been described but for which no data collected on amputees have been reported in the literature. The important new features of those technologies are also discussed.
A skin-stretching device (SSD) which is designed to harness the viscoelastic properties of the skin using incremental traction is described. It has proved to be of value in securing closure, within 72 h, of an open high below-knee guillotine stump wound which did not heal during a period of 2 months after amputation. The skin-stretching device provided healthy, durable and sensate skin for stump coverage. Hospitalization time was shortened and an early post-surgical prosthetic fitting and ambulation was achieved.
Transcranial magnetic stimulation over the motor cortex was used to construct a map of the effective sites on the scalp from which short-latency electromyogram responses could be evoked in muscles proximal to either an amputation stump (two subjects) or an ischemically anesthetized forearm (two subjects). At rest, the maps were larger and the responses bigger when stimulating contralateral to the amputated arm or after anesthesia than they were in the intact arm or before anesthesia. However, this difference disappeared when the maps were constructed during a small tonic voluntary contraction of the target muscle. We conclude that reorganisation of the corticospinal projection to a muscle at rest may no longer be present during activity. If so, this calls into question the possible functional benefits of such reorganisation in the control of movement after peripheral damage.