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PubMed1975

Prosthetic restoration in congenital lower limb deficiency. A case study.

We presented a synopsis of a young girl with congenitally deficient limb who underwent seven corrective surgical procedures and fabrication of a specially designed and constructed prosthesis. The surgical procedures are detailed as in the total rehabilitation approach. We have provided plastic laminated orthoses and prostheses to many patients with congenitally deficient upper and lower limbs. An additional paper will detail our experience with a series of plastic laminated orthoses and prostheses in patients with congentally deficient upper and lower extremities.

Amputation, Surgical↗

PubMed1985

Lengthening of a short traumatic femoral stump.

A case is reported in which a severe open injury of the thigh eventually required amputation of the lower limb. Lengthening of the short proximal femoral stump was achieved by turning over a flap comprising bone and soft tissue, with sensation, from the ipsilateral leg.

Adult↗

PubMed1984

A critical review of amputation in vascular patients.

A study was made of 53 patients who underwent amputation for peripheral vascular disease over a 5-year period at West Virginia University Medical Center. The follow-up period ranged from 1 to 6 years. Data concerning operative deaths, risk factors, use of prosthetic devices, and ultimate self-sufficient living were obtained. The functional outcome for this group of patients was encouraging with modern prosthetic fitting and social rehabilitation. Approximately 75% of the patients were returned to a useful life with a prosthetic limb or in a wheelchair. Amputation is a less desirable alternative than successful revascularization, but with the prostheses available today, amputation does not foreshadow a dismal existence.

Adult↗

PubMed2004

Plantar foot pressure responses to changes during dynamic trans-tibial prosthetic alignment in a clinical setting.

Alignment of a lower limb prosthesis refers to the spatial orientation of the prosthetic components and socket with respect to one another. During the process of dynamic alignment, a prosthetist repeatedly modifies this spatial orientation and observes the amputee's resulting walking pattern, eventually arriving at an alignment that is judged to be optimal. Quantification of the effect of each alignment modification and correlation of the magnitude of modification with the changes in gait could improve understanding of the process and promote an evidential base for practice. This investigation quantified bilateral plantar foot pressures in six trans-tibial amputee subjects during the process of dynamic alignment at prosthetists' clinics during regularly scheduled appointments. Outcomes of changes in prosthetic alignment during the clinical dynamic alignment process were determined to be quantifiable via plantar pedobarography. Changes in the angle between the pylon and the socket in the frontal plane produced predictable shifts in foot pressure between medial and lateral foot regions under the prosthesis, and typically shifted pressure to the lateral region of the contralateral foot, regardless of the direction of the modification. Temporal parameters revealed that subjects initially adopt a conservative locomotor pattern after an alignment change but within a few steps begin to refine their gait and approach more symmetrical single limb support times. Plantar pedobarography provides the clinician with potentially useful information to augment dynamic alignment and provides a tangible record of the results of the process.

Adult↗

PubMed1983

Rotationplasty of the lower limb for congenital defects of the femur.

The operative technique for combined fusion of the knee and rotationplasty of the limb in the management of congenital deficiency of the femur is presented. The technique described allows earlier definitive prosthetic fitting of a child with proximal femoral deficiency; it has reduced the number of operative procedures needed to obtain the optimal function from that deficient limb; and it has enabled these procedures to be performed at an earlier age. The technique differs from those previously described and represents a significant improvement in management of the patient with femoral deficiency.

Arthrodesis↗

PubMed2006

Review of research on prosthetic devices for lower extremity amputation.

The literature on lower extremity prostheses from 1989 to 2006 has been reviewed in this article. New technologies, such as the microprocessor-controlled prosthetic knees and energy-storing/return prosthetic feet, are recent advances in the prosthetic field. Despite the extensive research to date in the areas of socket design and manufacturing, and alignment of prostheses for optimum gait analyses, problems persist in the field. Difficulties in obtaining a comfortable socket fit, prostheses weight and alignment guidelines, and the ability to rapidly manufacture a prosthetic socket that can accommodate the changing sizes of the residual limb persist. Furthermore, no prosthetic device can adjust to the typical movements of the human gait. These areas provide opportunities for further research and development.

Amputation, Surgical↗

PubMed1994

Biomechanical assessment of below-knee residual limb tissue.

In vivo indentation properties of the residual limb tissues of a group of senior subjects with below-knee (BK) amputation were measured and compared with those of nondisabled young adults. It was found that differences attributable to site variations, states of muscular activity, and the differences between the nondisabled young group and the group consisting of the seniors with amputation were all noted to be highly significant statistically. However, paired comparison between the residual limb and the sound contralateral limb of the senior group showed no significant difference. Residual limb properties measured right before the first prosthetic measurements and fittings and those measured at the first outpatient follow-up were found to be slightly different.

Adult↗

PubMed2006

Limb deficiency and prosthetic management. 2. Aging with limb loss.

UNLABELLED: This self-directed learning module highlights the issues faced by people aging with limb loss. It is part of the study guide on limb deficiency and vascular rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the impact that limb loss has on health and physical function throughout the life span. Case examples are used to illustrate what effect limb loss in childhood or young adulthood has on the incidence and management of new impairments or disease processes commonly associated with aging. OVERALL ARTICLE OBJECTIVE: To discuss the impact of early-life limb loss on the incidence and management of physiologic and functional changes associated with aging.

Adolescent↗

PubMed2000

Effects of changes in cadence, prosthetic componentry, and time on interface pressures and shear stresses of three trans-tibial amputees.

OBJECTIVE: To evaluate the effects of changes in cadence, prosthetic componentry, and time on interface pressures and resultant shear stresses in trans-tibial amputee case studies. DESIGN: Interface stresses were monitored using custom-designed instrumentation at 13 sites on three subjects with unilateral trans-tibial amputation walking with patellar-tendon-bearing prosthetic limbs. BACKGROUND: Previous studies suggested that week-to-week residual limb changes altered interface stresses more than did alterations in prosthetic alignment. No studies investigating effects of changes in cadence or componentry on interface stress distributions nor comparing their influence with week-to-week changes have been conducted previously. METHODS: Five different prosthetic componentry configurations were tested at each of three cadences in four sessions. Data were analysed for the magnitudes and timings of peak pressures and resultant shear stresses as well as corresponding resultant shear angles. RESULTS: None of the three cadences or five componentry configurations consistently induced significantly (P<0.05) higher or lower interface stress magnitudes for all subjects. However, an Aluminium Pylon/SACH Foot combination compared with an AirStance (pneumatic shank)/Seattle LightFoot unit induced later peak interface stress timings as a percentage of stance phase. Higher and more frequent interface stress changes were seen between the weekly sessions than between different cadences or between different componentry configurations. CONCLUSION: The amputees' capabilities to compensate for week-to-week residual limb changes were less than those for intra-session cadence or componentry alterations. RELEVANCE: Results suggest that effective techniques to accommodate week-to-week residual limb fluctuations could have a greater impact on maintaining consistent interface stress distributions than do adjustments in cadence or componentry.

Adult↗

PubMed2002

Influence of rotators on the kinematic adaptations in stubby prosthetic gait.

We report on the results of gait analysis in a patient with bilateral knee disarticulation amputations who used short nonarticulated prosthetic limbs (stubbies) to meet his ambulation needs over an extended period. To compensate for the loss of knee and ankle articulations, exaggerated pelvic obliquity (hip hiking), transverse pelvic rotation, and hip abduction were needed to ensure limb clearance and a functional step length. The addition of rotators to the prostheses improved gait velocity and reduced the perceived exertion of walking by favorably altering center of mass energetics.

Adult↗

PubMed1996

Rehabilitation of the older lower limb amputee: a brief review.

OBJECTIVE: To review outcomes, over the last 25 to 30 years, of prosthetic rehabilitation in the older patient with a major lower limb amputation. DESIGN: Literature review of articles and reports about lower limb amputation, using key words elderly amputee rehabilitation, and lower limb amputation, through a computerized Medline Search. CONCLUSIONS: Age alone should not determine prosthetic rehabilitation. Comorbidities and general health are important determinants. The more proximal the amputation, the more energy is demanded from the cardiovascular and pulmonary systems for prosthetic gait. Changes in surgical technique and revascularization procedures have allowed preservation of the knee, which decreases energy demands and allows more older patients a chance to undergo rehabilitation for ambulation. Although the ratio of below knee (transtibial) amputations to above knee (transfemoral) amputations has increased, overall postsurgical mortality (10-30%), long term survival (40-50%@2 years, 30-40%@5 years), and risk of loss of the contralateral leg (15-20%@2 years) has not changed significantly since the 1960s. Despite the lack of improvement in survival as a result of the systemic vascular disease, the older patient can benefit from rehabilitation efforts with goals of prosthetic ambulation or simply cosmesis. The shortened longevity emphasizes the need for timely rehabilitation to enhance the quality of the remaining years. The geriatrician can add to the presurgical care and preprosthetic phase of rehabilitation by attention to the problems common to the older patient, i.e., multiple comorbidities, polypharmacy, immobility, and depression. Postoperatively, early mobilization is crucial to avoid the deleterious effects of immobility in the older person. Further investigations into the psychosocial issues and cost benefits of limb loss and prosthetic rehabilitation are needed. In addition, comparison of the various rehabilitation protocols and the impact of cardiac resting before rehabilitation are needed.

Age Factors↗

PubMed1997

Mobility of persons after traumatic lower limb amputation.

The objective of this study was to determine the influence of time span since amputation on mobility of persons experiencing traumatic lower limb amputation. A special questionnaire was sent to such persons and responses were analysed statistically. The subjects comprised 223 persons after traumatic lower limb amputation, residents of Slovenia. We discovered that 186 (74.2%) are using their prosthesis for more than 7 hours per day, 109 (52.2%) are able to walk outdoors without crutches, and 129 (57.8%) climb more than 20 stairs per day. In addition, those who are walking without crutches, walking longer distances, still cycling and driving a care are, on average, 5-10 years younger than the others. However, around one-third of persons who were young at the time of amputation face limitations of mobility later in life. A total of 76 (35.3%) are able to walk only up to 500 m out of doors, 38 (18.2%) can walk only with a pair of crutches, 62 (29.7%) need a cane or one crutch, and 37 (16.6%) cannot climb stairs. We conclude that successful fitting and usage of a prosthesis by persons after lower limb amputation promotes independent walking and mobility in everyday life. The level of independence achieved is related to time span since amputation.

Activities of Daily Living↗

PubMed2000

Upper extremity myoelectric prosthetics.

Myoelectric control of upper limb prostheses has proven to be an effective and efficient means of controlling prosthetic components. This means of control has been used extensively for over 30 years, during which time these systems have become reliable and durable in most situations. Myoelectric control, or any other prosthetic control scheme, should not be considered as the optimal control for arm prostheses, but rather as one of the several effective ways of producing desired function. Advanced clinical practice calls for a blending of all control schemes, as appropriate, to allow the prosthesis to serve the intentions of the user efficiently and with little mental effort. Technology continues to change, bringing with it new and sometimes better ways of fitting amputees. Microprocessors and programmable controllers have opened new and exciting avenues for improvement in function. New, and as of yet unidentified, electronic and mechanical advances are certainly on the horizon. There is much work to be done before upper limb prostheses rightfully are called arm replacements. But progress is occurring and advances are being made toward the goal of replacing the function and appearance of that marvelous tool, the human arm.

Activities of Daily Living↗

PubMed1976

[Fibula aplasia and associated malformations. 62 cases].

The authors have studied 62 cases of aplasia of hypoplasia of the fibula. They note that developmental abnormalities affect the whole of the lower limb. They describe the evolution of the bony deformities and of anomalies of the soft tissues. They conclude that discrepancy in limb length is the major factor in the prognosis and that it increases uniformally. Surgery is indicated even when a definitive prosthesis is planned. The possibility of leg lengthening must be approached with caution.

Adolescent↗

PubMed1992

Influence of failed arterial reconstruction on the outcome of major limb amputation.

BACKGROUND: Unsuccessful vascular repair may further preexisting limb ischemia and thus increase the risk of revascularization procedures. METHODS: The results of 94 primary major amputations (group A) have been analyzed and compared with 112 secondary ablations (group B) carried out after failed revascularization efforts. All patients suffered from chronic critical ischemia (grades III and IV) of the lower extremities. In group A the severity of ischemic symptoms was more pronounced (trophic changes in 80% vs 66% in group B), and a preponderance for older age, diabetes mellitus, and incidence of cardiac failure and cerebrovascular insufficiency was evident. RESULTS: In patients undergoing secondary amputation the final transection level was adversely affected by preceding unsuccessful reconstructive attempts. In spite of the better risk profile, 30% of patients in group B were subjected to above-knee amputation compared with 13% of patients in group A. The aggravated limb ischemia caused by graft failure is reflected by the decrease of the mean ankle systolic pressure index from 0.27 to 0.13 (before and after failed revascularization attempts). Although more amputations at the below-knee level were performed initially in group A, primary wound healing was obtained among these subjects in 68% of patients (compared with only 39% for patients in group B). CONCLUSIONS: In a substantial number of cases preexisting limb ischemia may be promoted by failed attempts at vascular reconstruction, thus leading to severe wound healing complications and a higher level of amputation.

Aged↗

PubMed1987

Prosthetic rehabilitation in bilateral high above elbow amputation.

Rehabilitation in patients with bilateral high above elbow amputation presents a considerable prosthetic problem. A patient with high upper arm amputations after a high-voltage injury is presented. He was successfully fitted with multifunctional myoelectric hand prostheses. The problems in rehabilitation of adult bilateral arm amputees are discussed and the value of fitting these patients with electrically powered prostheses is assessed. The balance between technical and clinical aspects is discussed in relation to patient acceptance. In our case good acceptance and functional benefit was noted. The fact is stressed that the bilateral upper extremity amputee can regain considerable physical function with the fitting of suitable prostheses, even if the limb remnants are short and provide little or no function. An extensive team approach at specialized centres will favour the results.

Adult↗

PubMed2003

Study of the different types of actuators and mechanisms for upper limb prostheses.

Research in the area of actuators and mechanisms has shown steadily growing technological advances in externally activated upper limb prostheses. From among the actuators, advances include the use of piezoelectric materials, special metal alloys, polymers, and new motor applications, while the advances in mechanisms include mechanical designs based on the anatomy of the human hand and improvements in the way these components are combined. These efforts are aimed at meeting the need for anthropomorphic and functional prosthetic devices that enable patients to carry out basic daily tasks more easily and reduce the rejection rate of prostheses. This article technically discusses the several types of actuators and mechanisms, listing their main characteristics, applications, and advantages and disadvantages, and the current state of research in the area of rehabilitation of upper limb functions through the use of active prostheses. Comparisons of these devices are made with regard to the main criteria of construction and operation required to achieve optimal prosthetic performance.

Artificial Limbs↗

PubMedDate not supplied

Icelandic-Swedish-New York above-knee prosthetic sockets: pediatric experience.

The Icelandic-Swedish-New York (ISNY) above-knee prosthetic socket affords juvenile amputees improved comfort, function, and appearance. The flexible polyethylene socket and rigid frame facilitate accommodation to longitudinal and circumferential limb growth. Review of 10 subjects revealed that all who had worn pelvic band suspension with prior prosthesis having rigid sockets could use total or partial suction to suspend prostheses having ISNY sockets.

Adolescent↗