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PubMed1988

Comparison of myoelectric and conventional prostheses for adolescent amputees.

We questioned whether myoelectric prostheses were a reasonable alternative to conventional prostheses for adolescents with unilateral, congenital, below-elbow amputations in respect to fit, function, cosmesis, and cost. Ten patients were studied. Each received a physical, functional, and psychosocial evaluation prior to prosthetic fitting. The physical evaluation included myopotential, residual limb length and circumference, active range of motion, terminal device grasp force, and mechanical range. The functional evaluation consisted of a questionnaire of 38 bimanual activities. The psychosocial evaluation included an assessment of both the patient and the family. Following prosthesis fabrication, each patient received 10 days of training, a 3-month checkup, and a 6-month reevaluation. Wearing patterns, perception of cosmesis, change in physical attributes of the residual limb, and functional performance were documented. Results indicate that for these subjects myoelectric prostheses with a hand were an acceptable alternative to conventional prostheses with a hook.

Activities of Daily Living↗

PubMed1986

Alignment of lower-limb prostheses.

Alignment of a prosthesis is defined as the position of the socket relative to the other prosthetic components of the limb. During dynamic alignment the prosthetist, using subjective judgment and feedback from the patient, aims to achieve the most suitable limb geometry for best function and comfort. Until recently it was generally believed that a patient could only be satisfied with a unique "optimum alignment." The purpose of this systematic study of lower-limb alignment parameters was to gain an understanding of the factors that make a limb configuration or optimum alignment, acceptable to the patient, and to obtain a measure of the variation of this alignment that would be acceptable to the amputee. In this paper, the acceptable range of alignments for 10 below- and 10 above-knee amputees are established. Three prosthetists were involved in the majority of the 183 below-knee and 100 above-knee fittings, although several other prosthetists were also involved. The effects of each different prosthetist on the established range of alignment for each patient are reported to be significant. It is now established that an amputee can tolerate several alignments ranging in some parameters by as much as 148 mm in shifts and 17 degrees in tilts. This paper describes the method of defining and measuring the alignment of lower-limb prostheses. It presents quantitatively established values for bench alignment position and the range of adjustment required for incorporation into the design of new alignment units.

Adult↗

PubMed2005

Surgical options for children with osteosarcoma.

Osteosarcoma is the most common solid tumour of childhood. Chemotherapy has substantially improved survival, but surgical resection remains essential for cure. Limb-salvage surgery is now common and can be done for up to 85% of children with osteosarcoma. The main surgical challenge in children is how to reconstruct the limb after removal of the tumour. Knowledge of probable outcomes, risks, and benefits of each surgical option is essential for comparison of reconstruction with amputation, which is still the safest and most suitable option in some children.

Amputation, Surgical↗

PubMed1997

Tibia-hindfoot osteomusculocutaneous rotationplasty with calcaneopelvic arthrodesis for extensive loss of bone from the proximal part of the femur. A report of two cases.

We report a new technique to create an effective lower extremity weight-bearing stump for two patients who had extensive segmental loss of femoral bone proximal to the distal femoral condyles. One patient had previously had complete resection of the proximal part of the femur because of an infection following the insertion of a custom femoral replacement and hip arthroplasty prosthesis. The other patient had had débridement of the femur from the subcapital line to the femoral condyles because of post-traumatic osteomyelitis after failure of a reconstruction with a massive allograft. Both patients were managed with a tibia-hindfoot osteomusculocutaneous rotationplasty after transtarsal (Chopart) amputation, with calcaneopelvic arthrodesis to create stable fixation of the extremity to the pelvis; this fixation allowed flexion, extension, abduction, and adduction of the hip by means of the retained tibiotalar and subtalar joints. At the time of the latest follow-up (at thirty-three and forty-four months), both patients were bearing full weight, without pain, with the use of a standard above-the-knee-amputation prosthesis. We report this procedure as a useful alternative to disarticulation at the level of the hip in patients who have massive loss of femoral bone and destruction of the hip joint in association with scarred and previously infected soft tissues and are not considered to be candidates for other forms of limb-preservation reconstruction. The patient must be willing to accept the equivalent of a low above-the-knee amputation and recognize the potential value of a weight-bearing stump.

Adult↗

PubMed1997

Am I better off with out it?: a case study of a patient having a trans-tibial amputation after 52 years of chronic lower limb ulceration and pain.

This case study looks at a 71-year-old man who had 52 years of chronic lower limb pain and ulceration secondary to radiotherapy for an osteosarcoma. It discusses some issues surrounding amputation in such a case and raises early preoperative involvement by a multidisciplinary amputee rehabilitation team as a mandatory arm of management.

Aged↗

PubMedDate not supplied

Treatment of longitudinal deficiency affecting the femur: comparing patient mobility and satisfaction outcomes of Syme amputation against extension prosthesis.

Patients with proximal focal femoral deficiency or longitudinal deficiency affecting the femur were selected from a large regional center. Twenty-eight such patients were identified and were divided into two groups depending on how their condition was managed. Group 1 had opted for the surgical approach of ankle disarticulation (Syme amputation) and the fitting of an above-the-knee prosthesis. The patients in group 2 had been managed in a nonsurgical fashion using an extension prosthesis. They were asked about their level of mobility using the recognized Locomotor Index and their overall satisfaction using self-designed questions. The two groups' scores were similar for mobility whether using their prosthesis or not, but group 1 had lower satisfaction scores than group 2. Current opinion advocates the use of surgery in the management of proximal focal femoral deficiency because it is believed to have better cosmetic and functional results, but in the authors' comparison similar scores for mobility were shown. The nonsurgical extension prosthesis was associated with fewer musculoskeletal and residual limb problems, fewer problems with public transport, and greater satisfaction than Syme amputation. Overall, this small study suggests that the nonsurgical approach is preferable.

Adolescent↗

PubMed1976

A miniaturized load cell for lower extremity amputees.

The PRS-Moore Load Cell for below-knee and above-knee amputees that gives an audible warning when the wearer applies more than the predetermined weight on the affected limb is described. The sensing unit is a screw-adjustable compression spring that is enclosed in a machined housing that fits inside a machined base. Several prototypes have been produced and are now undergoing clinical analysis.

Artificial Limbs↗

PubMed1989

Noninvasive measurement of the stiffness of tissue in the above-knee amputation limb.

In order to characterize the mechanical properties of the soft tissue in above-knee amputations, nine subjects were measured with a Doppler ultrasound system. Measurements were made at four locations: anterior, posterior, lateral, and medial. The characterizations included tissues up to 2.5 cm deep. The average posterior moduli are significantly greater than the anterior and lateral parameters. No significant difference was found among moduli from the medial zone compared to other areas. Superficial tissue had a significantly higher modulus than the tissue beneath. A simple method for transducer placement produced repeatable results. The present technique proved to be useful with patients in good health, and with no severe residual limb complications. The information generated with the ultrasonic device may aid in prosthesis fitting and will be used in a Computer-Aided Design (CAD) system as well as in other clinical applications.

Amputation, Surgical↗

PubMed2003

Prosthetic prescription in the Netherlands: an observational study.

Prosthetic prescription for lower limb amputees and the methodology used are primarily based on empirical knowledge. Clinical expertise plays an important role that can lead to an adequate prescription; however, a clear evidence based motivation for the choices made cannot be given. This can lead to local prescription variations with regard to overuse or underuse of prosthetic care and a lack of transparency for consumers and health insurance companies. Hence a clinical guideline may lead to a more consistent and efficient clinical practice and thus more uniformly high quality care. The purpose of this study was to get insight into potential similarities in prescription criteria in clinical practice in the Netherlands. Secondly, the authors were interested to know if prosthetic prescription was primarily based on the level of activity or intended use of the prosthesis. As part of the development of a consensus-based clinical guideline a multi-centred, cross-sectional study was carried out in order to observe the prosthetic prescription for a group of lower limb amputees. Therefore prescription data were collected from 151 amputees with trans-femoral amputation, knee disarticulation or trans-tibial amputation. Results of the multiple logistic regression show no relationship between the activity level and any of the variables included in the equation such as the hospital or medical doctor in Physical and Rehabilitation Medicine (MD in P&RM), prosthetic components, age of the amputee or reason of amputation. The criteria used are merely based on the clinical expertise and local experience whereas the actual prescriptions differ from location to location. In conclusion the development of a clinical guideline for prosthetic prescription in lower limb amputation is recommended. The information gained from this observational study will be used in a clinical guideline procedure for prosthetic prescription in the Netherlands.

Aged↗

PubMed1993

Successful voluntary grasp and release using the cookie crusher myoelectric hand in 2-year-olds.

We examined the ability of two 2-year-old children with limb deficiency to demonstrate grasp and release while using the cable-operated voluntary opening hook-hand and the externally powered single-site myoelectric Cookie Crusher system. The Cookie Crusher circuit is an electronic package that causes the prosthetic hand to open in response to muscle contraction and closes (as if crushing a cookie) when the muscle is relaxed. Both children were consistently good prosthetic wearers, beginning with their initial passive devices and progressing through their cable-operated hooks and hands. However, before they began to use the Cookie Crusher (Subject 1 at 25 months, Subject 2 at 30 months), neither had developed voluntary grasp or release in spite of 3 to 12 months' use of cable-operated voluntary opening prehensors. Both children developed a voluntary grasp and release for the first time within minutes of starting to use the Cookie Crusher. The more adept of the two children, a girl with a traumatic above-elbow amputation, showed prehensile function with the Cookie Crusher during play. The spontaneous use of the Cookie Crusher may be related to the predominance of associated reactions in young children. As children play bimanually, associated movements of the nondominant extremity often occur and, in the case of children with limb deficiencies fitted with Cookie Crusher prehensors, these associated reactions result in successful grasp and release. We will continue to follow the choice of effective control schemes in these children as they mature.

Amputation, Traumatic↗

PubMed1996

A review of prosthetic interface stress investigations.

Over the last decade, numerous experimental and numerical analyses have been conducted to investigate the stress distribution between the residual limb and prosthetic socket of persons with lower limb amputation. The objectives of these analyses have been to improve our understanding of the residual limb/prosthetic socket system, to evaluate the influence of prosthetic design parameters and alignment variations on the interface stress distribution, and to evaluate prosthetic fit. The purpose of this paper is to summarize these experimental investigations and identify associated limitations. In addition, this paper presents an overview of various computer models used to investigate the residual limb interface, and discusses the differences and potential ramifications of the various modeling formulations. Finally, the potential and future applications of these experimental and numerical analyses in prosthetic design are presented.

Amputation, Surgical↗

PubMed1997

Analysis of a vertical compliance prosthetic foot.

Mechanical testing of the Re-Flex VSP Foot was conducted on the pylon alone and on the pylon and forefoot system. Values for spring and damping correspond well to values reported in the literature for spring and damping of physiological limbs. Pylon stiffness was 49.4 kN/m for a 600 N subject and 91.4 kN/m for an 800 N subject. The vertical stiffness of the pylon and forefoot together was 31.9 kN/m and 37.8 kN/m, respectively. Gait parameters of two persons with transtibial amputation who used vertically compliant feet for walking, jogging in place, and curb descent were investigated. Ground reaction forces, vertical trunk movement, event timing, and pylon compression were observed. The spring-loaded telescoping pylon was immobilized for half the trials. The trials were repeated the following week with the vertical compliance feature mobilized. Significant differences in vertical trunk motion and timing were found between the prosthetic limb and normal limb, as might be expected. Vertical compliance appeared to cause little change in gait parameters during normal walking. The largest differences appeared during the higher impact events such as fast walking and jogging in place.

Adult↗

PubMed2002

The biomechanical effects of the inclusion of a torque absorber on trans-femoral amputee gait, a pilot study.

This paper reports on a pilot study investigating the effects on the gait of two transfemoral amputees of to the inclusion of a torque absorber (TA) and its location relative to the knee unit. Both subjects carried out gait tests with a prosthesis with no TA with, a TA proximal to the knee unit and with a TA distal to the knee unit. Three-dimensional gait analysis was carried out to establish the kinematic and kinetic gait parameters of both the prosthetic and sound side. It was found that the TA did not significantly affect the sagittal kinetic and kinematic parameters of the sound or the prosthetic side. However, for one subject the axial rotation of the socket relative to the foot was significantly greater with the TA. It was concluded that by using the methodology of this pilot study, it is possible to investigate the rotations in the transverse plane within the prosthetic limb and pelvis. Further, including a TA may reduce the relative motion between the stump and the socket and therefore may decrease skin breakdown due to diminished shear forces.

Amputation, Surgical↗

PubMed1996

The influence of lower-extremity muscle force on gait characteristics in individuals with below-knee amputations secondary to vascular disease.

BACKGROUND AND PURPOSE: The purpose of this study was to establish the relationship between isometric muscle force and temporal-spatial gait characteristics for individuals who have had a below-knee amputation secondary to vascular disease. SUBJECTS: Twenty-two individuals (15 male, 7 female) with dysvascular below-knee amputations participated. The male subjects were aged 35 to 72 years (x=59.6, SD=11.1), and the female subjects were aged 54 to 68 years (x=60.5, SD=5.1). Methods. The subjects underwent stride analysis during free-speed and fast walking, as well as bilateral isometric force testing of their remaining hip, knee, and ankle muscles. RESULTS: Stepwise regression analysis revealed that hip extensor force on the amputated side was the only predictor of both free speed (gamma=.50) and fast speed (gamma=.72). Hip abduction force of the sound++ limb was correlated with cadence for both free-speed trials (gamma=.57) and fast-speed trials (gamma=.57). Sound-side knee extensor force was related to free-speed stride length (gamma=.44), whereas residual-limb knee extensor force predicted stride length during fast walking (gamma=.67). CONCLUSION AND DISCUSSION: These results indicate that adequate force is necessary in both residual and sound limbs to improve functional gait ability and that ther hip extensors and abductors and the knee extensors should be emphasized in the rehabilitation of individuals with below-knee amputations.

Adult↗

PubMedDate not supplied

Basic theory, design, and preliminary evaluation of a laser scanner for shape sensing below-the-knee amputees.

A scanner which produces surface profiles of residual limbs from below-the-knee amputees was constructed and evaluated. The scanner uses a turntable mounted laser to define a surface profile line, a charge-coupled-device video camera to view the profile, and a custom designed video processing board to extract profile data. A microcomputer is used to control data acquisition and provides the rapid processing capability necessary to resolve scan profile data into a three-dimensional numerical description of the surface in a timely and cost effective manner. Flexibility of use as well as positional accuracy and reproducibility indicate that the laser scanner is well suited to the task of surface scanning of residual limbs for below-the-knee amputees. Additionally, the laser profile scanning technique can be applied to other regions of the body where a mathematical description of the surface is useful, such as in radiotherapy treatment planning.

Amputees↗

PubMed1987

An alternative design of extension prosthesis.

Some patients with a congenitally shortened lower limb can be fitted with a total contact socket of one piece construction, dispensing with the need for removable panels or split socket construction. This gives advantages in weight, strength and cosmesis. The technique is described and compared with those conventionally used.

Artificial Limbs↗

PubMed1982

Stride kinematics and knee joint kinetics of child amputee gait.

As a few quantitative data exist characterizing the gait of child lower extremity amputee (CLEA), this study provides such data by examining selected kinematic and kinetic variables during locomotion. Five unilateral CLEA were analyzed in an experimental design which comprised 3 different speeds of walking, 2 types of prosthetic feet (SACH-foot and an experimental CAPP-foot), and normal versus prosthetic limbs for a total of 104 trials. Cinematographic data and footprint information where used to quantify walking speed and uniplanar lower extremity angles. A rigid-body, linked model was used to evaluate the extent and range to thigh and leg motion and moments of force at the knee joint. The kinematic and kinetic characteristics of CLEA gait were affected significantly by variations in walking speed. Stride length, step length, and walking velocity decreased and stride width increased when the children used the experimental foot component; as speed of walking increased, stride length and step length increased with both prosthetic feet. Foot angles increased with walking velocity except for fast walking with the experimental foot component. Joint angles were significantly different between the normal and prosthetic limb. The only significant limb angle differences between the 2 prosthetic feet were in maximum hip flexion and the total range of thigh movement; the experimental foot elicited less hip flexion and and smaller range of thigh movement.

Amputees↗

PubMed1986

On embodiment: a case study of congenital limb deficiency in American culture.

The relationship of mind and body is an issue of importance for Western medicine and psychiatry. An area to which this problem particularly applies is that of physical disability. In evaluating treatment of persons with physical disabilities, the concept of "adjustment" in social psychology may not deal sufficiently with ambiguities arising in varied cultural settings. The related concept of "stigma" in sociology is also limited, covering the cosmetic aspect of the mind-body relationship only. This paper applies the more abstract and inclusive concept of "embodiment" from the phenomenological movement in philosophy to the life history of a 35-year-old American woman born with quadrilateral limb deficiencies. The resulting description of her functioning and self-image over time calls into question the cultural assumptions of rehabilitation medicine and highlights the more general cultural demands upon persons with severe physical disabilities in the United States since the 1950s.

Adult↗