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PubMed2001

A comparison of trans-tibial amputee suction and vacuum socket conditions.

Daily volume loss of the stump leads to a poor fit of the prosthetic socket. A method of preventing this volume loss and maintaining a good fit was developed. A vacuum (-78 kPa) was drawn on the expulsion port of a total surface-bearing suction socket to hold the liner tightly against the socket. Stump volume of 10 trans-tibial amputees was measured prior to and immediately after a 30 minute walk with normal and vacuum socket conditions. Under the normal condition, the limb lost an average of 6.5% of its volume during the walk. In contrast, with the liner held tightly by vacuum, the limb gained an average of 3.7% in volume. It is believed that the difference observed between conditions resulted from a greater negative pressure developed during the swing phase of gait with the vacuum condition. X-rays revealed that the limb and tibia pistoned 4 mm and 7 mm less, respectively, under the vacuum condition. The combination of reduced pistoning and maintenance of volume is thought to account for the more symmetrical gait observed with the vacuum.

Adult↗
PubMed2006

Prescription of the first prosthesis and later use in children with congenital unilateral upper limb deficiency: A systematic review.

BACKGROUND: The prosthetic rejection rates in children with an upper limb transversal reduction deficiency are considerable. It is unclear whether the timing of the first prescription of the prosthesis contributes to the rejection rates. OBJECTIVE: To reveal whether scientific evidence is available in literature to confirm the hypothesis that the first prosthesis of children with an upper limb deficiency should be prescribed before two years of age. We expect lower rejection rates and better functional outcomes in children fitted at young age. METHODS: A computerized search was performed in several databases (Medline, Embase, Cinahl, Amed, Psycinfo, PiCarta and the Cochrane database). A combination of the following keywords and their synonyms was used: "prostheses, upper limb, upper extremity, arm and congenital". Furthermore, references of conference reports, references of most relevant studies, citations of most relevant studies and related articles were checked for relevancy. RESULTS: The search yielded 285 publications, of which four studies met the selection criteria. The methodological quality of the studies was low. All studies showed a trend of lower rejection rates in children who were provided with their first prosthesis at less than two years of age. The pooled odds ratio of two studies showed a higher rejection rate in children who were fitted over two years of age (pooled OR = 3.6, 95% CI 1.6 - 8.0). No scientific evidence was found concerning the relation between the age at which a prosthesis was prescribed for the first time and functional outcomes. CONCLUSION: In literature only little evidence was found for a relationship between the fitting of a first prosthesis in children with a congenital upper limb deficiency and rejection rates or functional outcomes. As such, clinical practice of the introduction of a prosthesis is guided by clinical experience rather than by evidence-based medicine.

Age Factors↗
PubMed2001

Acquired limb deficiencies. 4. Troubleshooting.

UNLABELLED: This self-directed learning module offers practical analyses of and solutions for common clinical problems of amputees. It is part of the chapter on acquired limb deficiencies in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The information presented here has been designed to be useful also to other interested professionals, including prosthetists, physical therapists, occupational therapists, and nurses. Topics covered include the management of typical obstacles encountered in upper limb amputees, and the diagnosis and treatment of phantom and residual limb pain. Diagnostic and treatment approaches to skin breakdown in the transtibial amputee and to knee instability in the transfemoral amputee are also presented. OVERALL ARTICLE OBJECTIVE: To analyze common clinical problems of amputees.

Amputation, Surgical↗
PubMedDate not supplied

Knee rotation-plasty for malignant musculoskeletal tumors occurring around the knee joint.

BACKGROUND: In addition to the wide excision of malignant musculoskeletal tumor around the knee joint, surgical methods, such as total knee arthroplasty and knee rotation-plasty are available. Therefore, this study was undertaken to clarify the usefulness of knee rotation-plasty. MATERIALS AND METHODS: At the Chiba Cancer Center, knee rotation-plasty was performed in 27 patients with malignant musculoskeletal tumor around the knee joint. Patients were divided into two groups: Group S, in which operations were performed as salvage surgery (8 patients), and Group I, in which operations were performed as initial surgery (19 patients). The lower limb function was investigated in 17 patients (7 patients in Group S and 10 patients in Group I). The lower limb function was assessed by the Knee Evaluation System of International Symposium on Limb Salvage and the Knahr's assessment. RESULTS: Lower limb function in Group S measured an average of 25.7 points (85.6%), while the lower limb function in Group I measured an average of 23.6 points (78.7%). The majority of patients in both groups were capable of walking without a cane or doing light exercise with below-the-knee prosthesis, revealing good lower limb function. CONCLUSION: Whether it is performed as salvage or initial surgery, knee rotation-plasty can be useful method for reconstruction of the knee after wide excision of malignant musculoskeletal tumor around the knee joint.

Adolescent↗
PubMed1985

Functional performance after tibial rotationplasty.

We measured muscle strength, joint motion, and gait parameters and determined the electromyographic activities of the ankle and knee during walking, running, and stair-climbing in two children who had had a tibial rotationplasty for osteosarcoma of the distal end of the femur. Both had marked loss of strength in the plantar flexors on the side of the prosthesis compared with the sound side, although electromyographic recordings showed that the rotated calf muscles, to a substantial degree, had assumed the function of extensors of the prosthetic knee. Despite some abnormalities in gait, both children walked at speeds that were comparable to those of normal children. They could also run, climb stairs by stepping up with both limbs, and participate in many recreational activities. The functional abilities of these children suggested that rotationplasty, in patients with a similar lesion, is a worth-while alternative to above-the-knee amputation.

Artificial Limbs↗
PubMed1993

Quality of life following lower limb amputation for peripheral arterial disease.

Lower limb amputations for peripheral arterial disease are performed predominantly on an elderly population with poor social support and concomitant medical problems. The effect of amputations on the quality of life of this population has not been properly assessed. The quality of life of 149 amputees from one hospital was evaluated using the Nottingham Health Profile and compared to that of a control group matched for age and sex. One hundred and thirty (87%) amputees and 115 (77%) controls responded to the questionnaire. Amputees reported significantly more problems with mobility, social isolation, lethargy, pain, sleep and emotional disturbance than controls (p < 0.001). However, mobility was the only significant independent factor after matched logistic regression analysis (p < 0.001). The differences in social isolation and emotional distress lost their significance after adjustment for mobility. The overall quality of life following lower limb amputation for peripheral arterial disease is poor, but much of this is secondary to restricted mobility. Rehabilitation following amputation should therefore focus on attempts to improve mobility.

Activities of Daily Living↗
PubMedDate not supplied

[Creation of a weight-bearing leg stump and the fitting for a prosthesis].

Whether for functional or cosmetic reasons in oncologic patients, following amputation or severe crush injuries of the lower limbs with complete severance of vessels and nerves, microsurgery enables a weight-bearing lower limb or femoral stump to be created if such a result cannot be achieved by transplanting plantar skin with an intact vessel-nerve bundle. When first fitting a prosthesis in a patient with a weight-bearing lower leg stump created by autologous grafting of plantar skin employing the microsurgical method, it is advisable initially to partially relieve the grafted covering tissue in the prosthesis shaft. However, as soon as the transplanted skin flap has recovered full sensitivity it is advisable ti fit a limb supported on the end of the stump. It is then longer necessary to support the prosthesis on the ischium or the trochanter major. Fitting of a prosthesis of this type permits optimal rehabilitation.

Adolescent↗
PubMed2005

Psychosocial adjustment in Swedish children with upper-limb reduction deficiency and a myoelectric prosthetic hand.

AIM: To study psychosocial adjustment and mental health in children with upper-limb reduction deficiency and a myoelectric prosthetic hand. METHODS: Sixty-two parents of children aged 8 to 18 y old answered a questionnaire concerning competence and behaviour/emotional problems in their children. Of the 62 children, 37 adolescents aged 11 to 18 y old answered questionnaires concerning competence, problems and mood state. The results were compared with Swedish normative data. The children were divided into five groups based on degree of myoelectric prosthetic use. RESULTS: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand showed social competence and behaviour/emotional problems similar to Swedish standardized norms. However, withdrawn behaviour was significantly higher in all children, social competence was significantly lower in girls, and social activities were significantly lower in older children with upper-limb reduction deficiency. There was a significant difference between prosthetic use groups. Non-users had significantly more delinquent behaviour problems than full-time users. There was an interaction between gender and prosthetic use in their affect on competence and behaviour/emotional problems, yielding two contrasting patterns. CONCLUSION: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand are as well adjusted psychosocially as their able-bodied peers. There are indications, however, of social stigmata related to the deficiency, which have to be considered differently in boys and girls.

Adolescent↗
PubMed2002

The bionic man: restoring mobility.

Bionics engineers are making increasingly bold and successful use of their tools to restore mobility to persons with missing or nonfunctional limbs. These tools include the latest materials, minielectronics and megacomputers, advanced robotic mechanisms, and algorithms. With crucial help from their pioneering users, they are learning how and where the residual sensorimotor system can be tapped in order to transmit its intents to replacement or reactivated body parts.

Animals↗
PubMed1988

Memory plastics for prosthetic and orthotic applications.

Shrink forming prosthetic sockets from memory plastics offers several advantages over existing techniques. The manual skill requirement is reduced relative to drapeforming flat sheet while compared with the Rapidform process, the requirement for a purpose built vacuum forming machine is eliminated. Two methods for producing thermoplastic sockets from heat shrinkable preforms are described. One uses established heat shrink technology and crosslinked thermoplastics. The second based on blowmoulding simplifies preform manufacture relative to existing techniques by reducing it to a single stage operation. Shrink formed sockets have been produced for three application areas concerned with the lower limb namely load bearing sockets, flexible ISNY type and rigid transparent check sockets. Static testing has demonstrated the ability of shrink formed, load bearing sockets to surpass Philadelphia Static Load Levels (ISPO, 1978) while fatigue testing has indicated a capability for long service life.

Artificial Limbs↗
PubMed1989

Prosthetic limb use in Australia 1981-1985 under the Free Limb Scheme.

A study has been made of data on 19,421 prosthetic limbs prescribed for 12,143 Australians under the Free Limb Scheme in the years 1981-1985. These prostheses consisted of 18,119 legs and 1,302 arms. The mean age of the lower limb prosthesis user was 52.8 and the upper limb prosthesis user 31.3 years. Males outnumbered females by 3 to 1 in the upper limb prosthesis users, and 2.8 to 1 with lower limb prosthesis users. Below-knee prostheses, patellar-tendon-bearing and thigh-lacing prostheses, made up 58.7% of all prostheses prescribed in the time span. Below-elbow prostheses were the commonest upper limb prostheses with children being the most frequent users. Comparisons with other studies of large number of prosthesis users show an older mean age in Australia and more below-knee prosthesis users than in American studies.

Adolescent↗
PubMed1999

Issues of importance reported by persons with lower limb amputations and prostheses.

The purpose of this paper is to report prosthesis-related issues of importance that were identified by a diverse group of persons living with lower limb amputations (LLA) and prostheses. These perceptions and themes validate some old assumptions and challenge others, report both common and unusual experiences, and indirectly identify the information level of our respondents concerning prostheses. Persons with LLA were identified from computerized rosters at a level one regional trauma center and at the VA Puget Sound Health Care System-Seattle, Division. Inclusion criteria specified that respondents were to: 1) be one or more years post-unilateral amputation at the Syme's level (ankle disarticulation) or higher, 2) use their prosthesis at least 5 days a week, 3) read English, and 4) be able to provide informed consent. Respondents completed the Prosthesis Evaluation Questionnaire-field version (PEQ) and the standard form (SF)-36, a health status measure. Of 114 persons who agreed to participate, 92 (85% male, mean age 55 years) responded to the questionnaire and graded the personal importance of various characteristics and qualities of their prosthesis. The number of years since their last amputation ranged from 1 to 53 years. Four Themes of Interest were identified from responses to open-ended questions about living with a prosthesis. These themes included the fit of the socket with the residual limb, aspects of the mechanical functioning of the prosthesis, other nonmechanical qualities, and advice about adaptation to life with a prosthesis with support from others. Future research is recommended to adjust aspects of the fit of the prosthesis with the residual limb. Implementing periodic check-up visits could uncover problems and eliminate unnecessary suffering.

Activities of Daily Living↗
PubMed2003

[Amputations, walking and prosthesis development].

Deficiency or loss of limbs is bound to human history. From the beginning of the human race, prosthetics solutions have been researched for amputations. With the mutilation of the lower limb, walking, one of the most important functions in the human being is lost. The main object of surgical amputation is not only to save the life, but also to create a new organ, the stump, in order to adapt a prosthetic limb, so that the patient is able to walk again. Most prostheses in the past have been lost like useless objects. Some models that have been saved for the clinical practice, allow us to present the biggest advances in prosthetic technique evolution in last time.

Amputation, Surgical↗
PubMed1983

[The effect of prolonged hypokinesia on hemodynamics and myocardial contraction in patients with ischemic heart disease after amputation of the extremities].

Echocardiographic investigation revealed changes in central hemodynamics and myocardial contractility, associated with lasting hypokinesia, in coronary patients after the amputation of a limb that differed significantly from those recorded in patients with intact limbs. Amputation of a limb, lasting hypokinesia, physical overstrain, negative emotions, disorders of myocardial electric and contractile functions, central and peripheral hemodynamic disorders all contribute to the risk of coronary disease, myocardial infarction and death in post-amputation patients.

Adolescent↗
PubMed1995

Gait initiation of persons with below-knee amputation: the characterization and comparison of force profiles.

The purpose of this study was to characterize gait initiation of persons with leg amputation and determine whether prosthetic alignment was a critical parameter in the initiation process. Gait initiation was chosen for study because of the difficult neuromuscular demands placed on the body in negotiating the transition from stance to ambulation. In this investigation, ground reaction force data were collected on seven persons with below-knee amputation. These subjects underwent a series of gait initiation trials while varying prosthetic alignment. An analysis of the data demonstrated key elements in the gait initiation process, including the motion of the center of gravity in preparation for steady-state walking. Significant asymmetries in the force profiles of the residual and nonamputated limbs were also found; gait initiation forces were consistently higher for the prosthetic limb and the timings of maxima and minima were indicative of an intact limb preference. Relatively small changes in prosthesis alignment proved not to have statistically significant effects on generalized force parameters. This result is consistent with the findings of other studies that gait initiation is a motor program with certain invariant characteristics.

Aged↗
PubMed2002

The use of snowboard boot bindings in a hip disarticulation prosthesis.

This report describes a new technique for fastening a hip disarticulation socket. It was developed at the request of the patient who needed to fasten his prosthesis using only one hand, because of a left upper limb disability. Snowboard boot bindings were secured to the socket of the prosthesis and allowed it to be securely fastened and released using his dominant hand only. The design of the bindings permitted a high closing force with minimum one-handed effort by the user.

Adult↗
PubMedDate not supplied

State-of-the-art methods for geometric and biomechanical assessments of residual limbs: a review.

A review is presented on the state-of-the-art methods for geometric and biomechanical assessments of residual limb tissues. Residual limb assessments are needed throughout different stages of prosthetic management, namely preamputation, residual limb maturation, prosthetic design, prosthetic fitting, and subsequent follow-ups. Geometric assessments include the monitoring of the volumetric change as the residual limb matures after amputation. Geometric and biomechanical assessments of the residual limb are important considerations in prosthetic design. Quantitative geometric and biomechanical assessments are becoming more important in the development of a computer-aided system for prosthetic socket design. It is noted that, except for the external shape measurements of residual limbs, most of the instruments used in residual limb assessment are not particularly cost-effective for clinical applications in prosthetics. Further developments are needed to facilitate the incorporation of the internal geometric assessments and biomechanical assessments into the current computer-aided design systems for clinical prosthetics.

Amputation Stumps↗