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Results for “ARTIFICIAL LIMB”

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PubMed1976

Limb deficiencies and prosthetic devices.

The child with a congenital limb deficiency is best managed by an interdisciplinary clinic team, which can see him early and work with parents and agencies to provide adequate and early prosthetic prescriptions. Terminal transverse limb deficiencies are generally fitted similarly to the patient with acquired amputation at the same level. Other deficiencies often require nonstandard prosthetic devices in association with corrective or conversion surgery.

Artificial Limbs↗

PubMed1983

Gait patterns in above-knee amputee patients: hydraulic swing control vs constant-friction knee components.

Multiple displacement patterns, stride dimensions, and temporal components during slow, free-speed, and fast walking were compared in the same seven above-knee amputees using prostheses with constant-friction knee components and using hydraulic swing-control knee components. During walking with the hydraulic-type prostheses, the amputees showed a wider range of walking speeds, improvement in the equality of the durations of successive swing and stance phases, and greater uniformity of forward progression. Improvements toward normal were also seen in several of the displacement patterns of the prosthetic limb during walking with the hydraulic knee. Several gait abnormalities persisted with both types of prostheses.

Adult↗

PubMed1993

A functional and psychosocial assessment of patients with post-Sudeck atrophy amputation.

Twelve patients with reflex sympathetic dystrophy were referred to a comprehensive orthopaedic rehabilitation center after failure of conservative management. Ten underwent amputation of the affected limb and, although functional improvement occurred in the patients undergoing lower limb amputation, psychosocial dysfunction persisted. All the patients required psychological support. In cases of post-Sudeck amputation, early orthopaedic diagnosis and referral to a comprehensive treatment center are recommended. In the 12 cases described here, apart from the obvious limb pathology, severe psychological inadequacies were found to be present.

Activities of Daily Living↗

PubMed1990

Method for the design and analysis of a non-linear anisotropic lower limb prosthetic socket.

A simplified computer-based structural analysis procedure has been developed for evaluating the stresses in a lower limb prosthetic socket when subjected to external loads. This technique has been tested by studying a simple linear axisymmetric shell subjected to uniform loads. It was found that the stress and strain distribution obtained are close to those determined by a finite element technique. The method that has been proposed involves an incremental procedure, which can be used to analyse the behaviour of a prosthetic socket of irregular shape made from non-linear anisotropic materials. By employing the proposed procedure to study an example, in which a simplified lower limb prosthetic socket is subject to internal pressure and frictional forces, the effects of the material non-linearity have been found to be significant.

Artificial Limbs↗

PubMed2006

Limb deficiency and prosthetic management. 1. Decision making in prosthetic prescription and management.

UNLABELLED: This self-directed learning module highlights decision making in prosthetic management in pediatric and adult patients. This chapter reviews classification of congenital limb deficiency and management of congenital pediatric upper-extremity amputees. Differences in management of amputees of various ages from infancy to old age is discussed. Case examples are used to formulate prosthetic prescriptions for transradial limb deficiency as well as knee disarticulation and transtibial level amputations. Common prosthetic gait deviations and anticipated functional levels are evaluated. OVERALL ARTICLE OBJECTIVE: To discuss prosthetic prescription and management in congenital limb deficiency and acquired amputations for patients of various ages.

Adult↗

PubMed1994

Increased limb salvage by the use of unconventional foot amputations.

PURPOSE: Limb salvage in the presence of ischemic foot necrosis requires revascularization followed by debridement or partial foot amputation. Necrosis extending beyond the toes and metatarsal heads may require the use of unconventional types of amputations. METHODS: Over a 15-year period 2105 ischemic limbs were treated with infrainguinal revascularization. In 98 cases, extensive foot necrosis was than managed with amputations, including 59 modified Chopart, 14 Lisfranc, 17 Pirogoff and 8 Syme amputations. Patients were not allowed to bear weight for several days to weeks. RESULTS: Skin flap necrosis in 14 cases was managed successfully by debridement and skin grafting. Ambulation required the use of a "clamshell" prosthesis and foot spacer. The overall limb salvage rate in this group was 84% (82 of 98). In general, the modified Chopart amputation most frequently produced ambulatory limb salvage and is technically easier to perform than a Syme amputation. Patient satisfaction and long-term ambulatory function was highest with the modified Chopart. CONCLUSION: Ischemic foot necrosis extending beyond the limits of conventional transmetatarsal amputation need not be treated with major amputation. This requires the surgeon to be well versed in the use of less common types of partial foot amputations. Acceptable limb salvage and good functional results may be attained by the motivated patient and surgeon with the use of these procedures in the revascularized limb.

Activities of Daily Living↗

PubMed1999

Knee disarticulation.

Knee disarticulation is a muscle balanced amputation level that can be used in patients with diabetes, peripheral vascular disease, and trauma. Patients who are capable of sitting in a chair retain an excellent platform for sitting, a lever arm for transfer, and are unlikely to have joint contractures develop. In patients who are ambulatory and have vascular disease and in patients with trauma, this amputation level provides a well padded residual limb that allows distal endbearing. The use of a four bar linkage prosthetic knee joint confers intrinsic knee joint stability during walking.

Adult↗

PubMed1994

Re: A paper entitled "Normal and shear stresses on a residual limb in a prosthetic socket during ambulation: comparison of finite element results with experimental measurement," by JE Sanders and CH Daly, published in the Journal of Rehabilitation Research and Development, Vol. 30 No. 2, pp 191-204, 1993.

Explore the source record for details and available documents.

Amputation Stumps↗

PubMed1997

Prosthesis satisfaction outcome measurement in pediatric limb deficiency.

OBJECTIVE: To describe the development and initial psychometric properties of a new outcome measure to assess satisfaction with prosthesis in children with limb deficiencies. DESIGN: Parents of children with limb deficiency were surveyed during routine outpatient clinic visits. SETTING: Two outpatient pediatric clinics. PARTICIPANTS: Ninety-seven parents of children with limb deficiency aged 1 to 17 years. MAIN OUTCOME MEASURE: The newly developed Child Amputee Prosthetics Project-Prosthesis Satisfaction Inventory (CAPP-PSI). RESULTS: Internal consistency reliability is high. Zero-order correlations with prosthesis wear/use patterns and with parent ratings of prosthesis appearance provide support for the construct validity of the CAPP-PSI. CONCLUSION: The CAPP-PSI is a promising, brief, parent-administered inventory for the assessment of prosthesis satisfaction in children with limb deficiency. It may be useful in future research for predicting prosthesis wear and use patterns in this population.

Activities of Daily Living↗

PubMed2001

Optimal surgical preparation of the residual limb for prosthetic fitting in below-knee amputations.

A well-performed below-knee amputation can result in a high level of patient satisfaction and function. The potential for a successful result and independent ambulation is good after a transtibial amputation, with approximately 70% to 100% of patients being able to ambulate independently after this procedure. A properly fitted and appropriately designed prosthesis is integral to the achievement of these goals. The approaches and techniques discussed here are essential in optimally preparing the residual limb for prosthetic fitting. Attention to factors such as the preoperative evaluation and the surgical technique can ensure the best possible outcome for amputation patients.

Amputation, Surgical↗

PubMed1985

Usefulness of footprint-sequence analysis in lower-limb amputees.

Clinicians evaluated the usefulness of footprint-sequence analysis in 25 lower-limb amputees who were all prostheses wearers. The patients walked at a comfortable speed with their usual walking aids along a 2.24-m footprint-recording strip. Each patient's physical therapist and physician indicated on visual-analogue scales how useful they judged both raw and derived data to be in problem solving and as documentation for future comparison. Both groups of clinicians found this type of analysis moderately useful. We found no significant difference, but moderate correlation (r = .61, p less than .01), between their estimates of usefulness for problem solving and for future documentation. They considered the derived data slightly, but significantly, more useful than the raw data (t = 4.20, p less than .001). We found no significant difference or correlation between the estimates of physical therapists and those of physicians. The clinicians ranked pressure distribution, stride width, step length, foot angle, and stride length in order of perceived usefulness. Footprint-sequence analysis appears to be a moderately useful adjunct to the evaluation and documentation of the walking problems of lower-limb amputees. Both raw and derived data should be made available to the physical therapists and physicians caring for these patients.

Adolescent↗

PubMed2000

The role of the inertia tensor in kinesthesis.

We report experiments directed at the ability of humans to perceive the spatial orientation of occluded objects, to position an occluded limb relative to targets or directions in the environment, and to match the spatial orientation of occluded contralateral limbs. Results suggest that each of these abilities is tied to the inertial eigenvectors of each object or limb, which correspond to the object's or limb's principal axes of rotational inertia. It is suggested that the mechanisms supporting the perception of intact limbs, neuropathic or anesthetized limbs, prosthetic devices, and hand-held tools and implements via kinesthesis may be one and the same--the detection of movement-produced physical invariants such as the inertia tensor. While the research reported presently has focused on the perception of intact limbs and hand-held objects, future research should be directed at possible generalizations of this work to a variety of clinical populations, including those involving peripheral neuropathies and prosthetic devices.

Arm↗

PubMedDate not supplied

Use of the Delphi Technique for developing national clinical guidelines for prescription of lower-limb prostheses.

The aim of this project was the development of evidence- and consensus-based clinical practice guidelines for lower-limb prosthesis prescription for achieving transparency and consensus among clinicians, manufacturers, and insurance companies. This article describes a modified Delphi Technique, which is based on different methods of collecting evidence, and its role in the development of national clinical guidelines for prosthesis prescription. We used a multimethod approach to develop guidelines for the clinical practice of prosthesis prescription for lower-limb amputees. The Delphi Technique was central in the process, and the panel was made up of experts from three key disciplines on a national level. Our approach involved various methods: a systematic review, a survey of national clinical practice on prosthesis prescription, and interviews with experts. These activities resulted in 45 postulates about prosthesis prescription. The views of the national expert panel were then presented at a consensus development conference. The participants in the Delphi Technique sessions reached a consensus on 37 of the postulates on prosthesis prescription for lower-limb amputees. The postulates were categorized according to amputation level and partitioned into different domains. The total process resulted in the development of draft clinical guidelines comprising guidance for prescribing prostheses for the lower limb. The scope and applicability of these guidelines will have to be measured and evaluated in future work.

Amputees↗

PubMed1967

Fitting of temporary prosthetic limbs immediately after amputation.

Better fit and function of prosthetic limbs is promoted when section and closure is done with attention to the prospective use of the stump as a pad for seating the limb. Preservation of tissue, fixing muscles to bone under physiologic tension, and making sure that bone ends are well covered with tissue are important to the comfort and usefulness of the limb that is to be fitted to the stump. Immediate application of a plaster-cast to form a total-contact socket for seating a temporary prosthetic limb, then early standing, weight-bearing and walking aid in healing and in shaping the stump to the permanent prosthetic socket it will ultimately occupy.

Amputation Stumps↗

PubMed1990

Control of functional electrical stimulation with extended physiological proprioception.

The use of functional electrical stimulation (FES) of muscle for paraplegic locomotion, or grasp augmentation in tetraplegia, is limited by the variability in muscle response to stimulation as a result of several external and internal factors. Previous approaches to this problem have used position-servo controllers, which have been shown to function satisfactorily in the laboratory. However, such systems will fail should obstacles be encountered or should the stimulation hardware develop a fault. To prevent such potentially dangerous failures some form of sensory feedback is required. This paper describes the first application of a technique known as extended physiological proprioception (EPP) to the control of FES to compensate for muscle response variability and provide proprioceptive feedback via the appropriate sensory pathways. In the experimental system described, a paraplegic subject controlled the extension of his paralysed knee by shoulder protraction. A Bowden cable linked the two joints, and a dynamometer in this cable was used to derive the control signal for a computer-controlled stimulator which delivered surface stimulation to the quadriceps muscle group. Modelling and parameter identification were performed by analysis of the step response, and the controller was designed from consideration of the root locus. The advantages of the system, in terms of improved proprioceptive feedback and reduced limb-positioning error were assessed in a test of joint positioning accuracy with vision occluded. The EPP system showed improvements over both open and closed-loop position-servo controllers.

Artificial Limbs↗

PubMed1999

Altered kinetic strategy for the control of swing limb elevation over obstacles in unilateral below-knee amputee gait.

Our goal was to document the kinetic strategies for obstacle avoidance in below-knee amputees. Kinematic data were collected as unilateral below-knee traumatic amputees stepped over obstacles of various heights in the walking path. Inverse dynamics were employed to calculate power profiles and work during the limb-elevation and limb-lowering phases. Limb elevation was achieved by employing a different strategy of intra-limb interaction for elevation of the prosthetic limb than for the sound limb, which was similar to that seen in healthy adult non-amputees. As obstacle height increased, prosthetic side knee flexion was increased by modulating the work done at the hip, and not the knee, as seen on the sound side. Although the strength of the muscles about the residual knee was preserved, the range of motion of that knee had previously been found to be somewhat limited. Perhaps more importantly, potential instability of the interface between the stump and the prosthetic socket, and associated discomfort at the stump could explain the altered limb-elevation strategy. Interestingly, the limb-lowering strategy seen in the sound limb and in non-amputees already features modulation of rotational and translational work at the hip, so an alternate strategy was not required. Thus, following a major insult to the sensory and neuromuscular system, the CNS is able to update the internal model of the locomotor apparatus as the individual uses the new limb in a variety of movements, and modify control strategies as appropriate.

Adaptation, Physiological↗

PubMedDate not supplied

Temporal symmetries during gait initiation and termination in nondisabled ambulators and in people with unilateral transtibial limb loss.

This study investigated the temporal characteristics of gait initiation and gait termination. Ten nondisabled adult volunteers and ten people with unilateral transtibial limb loss performed starting and stopping for slow, normal, and fast walking speeds. We used kinematic and anthropomorphic data to determine the body center of mass (BCOM) position of each subject. The BCOM acceleration was derived by double-differentiating the position data. An averaged BCOM acceleration was calculated by a filtering of the instantaneous acceleration data at a cutoff frequency set by the cadence for elimination of the step-to-step variation. We used this averaged acceleration to calculate the time the volunteers needed to initiate and terminate gait. The results support the hypothesis that both nondisabled ambulators and the subjects with unilateral transtibial limb loss initiate and terminate gait in approximately two steps, regardless of the steady-state walking speed.

Adult↗

PubMedDate not supplied

State-of-the-art research in lower-limb prosthetic biomechanics-socket interface: a review.

Scientific studies have been conducted to quantify attributes that may be important in the creation of more functional and comfortable lower-limb prostheses. The prosthesis socket, a human-machine interface, has to be designed properly to achieve satisfactory load transmission, stability, and efficient control for mobility. The biomechanical understanding of the interaction between prosthetic socket and the residual limb is fundamental to such goals. The purpose of this paper is to review the recent research literature on socket biomechanics, including socket pressure measurement, friction-related phenomena and associated properties, computational modeling, and limb tissue responses to external mechanical loads and other physical conditions at the interface. There is no doubt that improved biomechanical understanding has advanced the science of socket fitting. However, the most recent advances in the understanding of stresses experienced at the residual limb have not yet led to enough clinical consensus that could fundamentally alter clinical practice. Efforts should be made to systematically identify the major discrepancies. Further research should be directed to address the critical controversies and the associated technical challenges. Developments should be guided to offer clinicians the quantification and visualization of the interaction between the residual limb and the prosthetic socket. An understanding of comfort and optimal load transfer as patterns of socket interface stress could culminate in socket design expert systems.

Amputation Stumps↗