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Proper signal sources for prosthetic limb control are the premises in designing upper extremities with high effectiveness and multi-degree of freedom(DOF). With an overview of input sources adopted in prosthetic design, this paper reviews comprehensively on characters of signals available for arm control.
With further improvements of the prehospital rescue systems, an increasing number of patients with extreme injuries such as traumatic hemipelvectomy are admitted to trauma centers alive. The accepted definition of traumatic hemipelvectomy is: unstable ligamentous or osseous hemipelvic injury with rupture of the pelvic neurovascular bundle (open or closed integuments). A review of the literature up to 1995 yielded on 48 surving cases with such an injury. A review of 2002 consecutive patients after pelvic fractures treated from 1972-1994 at the Medical School Hannover, resulted in the identification of 11 traumatic hemipelvectomies with four survivors. The purpose of the study was the analysis of the early clinical course of the patients after traumatic hemipelvectomy and the evaluation of the late outcome of the survivors. All accessible clinical and radiological data were reviewed for the preclinical and primary clinical treatment, concomitant injuries, cause of death and complications. The survivors are under continuous follow-up at our institution and were evaluated on average 5.5 years (range 2-7 years) after trauma. All patients were managed with early and aggressive shock therapy by an emergency physician, hemorrhage control with manual compression of the wound and a short transit time to a trauma center. Immediate surgical hemostasis was attempted in all cases. Despite this, four patients died within the first 4 h secondary to uncontrollable bleeding. Another three died between 2 days and 5 weeks after accident from complications of septic or hemorrhagic shock. In four patients a limb-saving procedure was attempted. Three of these died early, and in the remaining case secondary hemipelvectomy was necessary due to sepsis and paralyses. After primary surgical completion of the hemipelvectomy, three of four patients survived. The late result was good in two children and moderate in one adult (ambulatory and socially reintegrated). A bad result occurred in one male after secondary surgical completion of the hemipelvectomy (social deterioration and drug abuse). A strict protocol has to be set for the primary treatment of a traumatic hemipelvectomy. It includes immediate prehospital hemostasis by local pressure, advanced shock therapy and prompt transfer to a trauma center. In-hospital procedures include immediate surgical hemostasis and debridement. When the criteria or traumatic hemipelvectomy are fulfilled, surgical completion of the hemipelvectomy is mandatory. Limb-saving procedures endanger the patient's life. Early and frequent second-look operations minimize wound healing problems. Early psychological support for the patient and family is advantageous for personal well-being and social reintegration.
Two cases of Poland's syndrome are reported in whom myoelectric prostheses have been used. The rare congenital sporadic disorder of Poland's syndrome characterized by absence of pectoralis major and varying degrees of ipsilateral upper limb deficiency has been reported by various authors (Rasjad and Sutiaksa, 1991, Gausewitz et al, 1984; David, 1982; Ireland et al, 1976). Management of the upper limb deficiency depends on the degree of functional and cosmetic disability. We report two cases of Poland's syndrome where myoelectric prostheses have been successfully used. We have been unable to find any published report of the use of a myoelectric prosthesis in Poland's syndrome.
The last few decades have produced significant improvements in the design of upper limb prostheses through the increasing use of technology. However the limited function exhibited by these devices remains rooted in their single degree of freedom format. Commercial myoelectric hand prostheses warrant high grip forces to ensure stable prehension due to a planar pincer movement. Hence precise and conscious effort is required on the part of the user to ensure optimum grip. Consumers have shown dissatisfaction with the status quo due to the excessive weight and poor function of existing artificial hands. Increasing the number of grasping patterns and improving the visual feedback from an object in the hand are cited as key objectives. This paper outlines the development of the six-axis Southampton-Remedi hand prosthesis that addresses these design issues by maintaining stable prehension with minimal grip force. Constraints such as modularity, anthropomorphism, and low weight and power consumption are factors that have been adhered to throughout the design process.
PURPOSE: To establish through gait analysis how changing the mass at the distal end of an in-house, custom-made trans-tibial dynamic elastic response prosthetic limb altered selected gait variables. Including; walking velocity, cadence, single support and hip power for a single amputee. METHOD: A before-after single-subject research design was used with two interventions. A 3-dimensional gait analysis was conducted to analyse the effect on selected gait variables. The mass and moment of inertia of the prosthesis were altered by inserting wedges of different materials. RESULTS: Altering the mass had little effect on the cadence, single support or the velocity. Both the affected and intact limb hip pull-off power at terminal stance was increased, although the effect was greater for the affected limb than for the intact limb. The affected limb hip power at initial contact did not alter in a manner directly related to the mass. CONCLUSIONS: Altering the mass had an inconsistent effect on the gait parameters tested. The subject volunteered that he preferred the prosthesis of the middle mass.
This paper (Part II of II) presents application of the technique described in Part I to functional assessment of two myoelectric elbow-prosthesis controllers: the controller implemented in the Boston Elbow, a state-of-the-art elbow prosthesis, and a proposed control scheme that, to a crude degree, mimics control of the intact elbow. Assessment of the controllers was achieved by evaluating an amputee subject's functional capability as he performed a constrained motion task with a prosthesis that implemented each control scheme. Evaluation of the amputee's capability was accomplished off line using sampled values of his myoelectric activity, his limb kinematics, and the interface forces at the constraint. Superior performance was observed with the proposed scheme. Namely, the subject exhibited better synergy among his elbow and shoulder muscles. Furthermore, when using the proposed controller, he exhibited some natural patterns of muscle coordination.
Stubby prostheses have been used in the habilitation of very small children with bilateral lower limb deficiencies, particularly bilateral above knee limb deficiencies. While we reported on "The Use of Stubbies For the Child with Bilateral Lower Limb Deficiencies" in 1973, the literature has very little except in relation to the geriatric amputee. We have continued since 1973 to use stubbies in the bilateral above knee limb deficient child, as well as in the child with an above knee/below knee combination, with great success in establishing early balance, followed within several months by the application of articulated prostheses with equal success in establishing independent walking without the use of crutches or walkers.
The authors analyze the treatment of 54 patients with 65 limb stumps resultant from injuries to the limbs in 41 patients shortly exposed to traumatic agents and in 13 patients after a prolonged crushing of the limb during the earthquake in Armenia. Amputations were carried out as primary surgical wound treatment followed by open healing of the wound. To prevent infections, 12 patients were treated with the use of a local gnotobiologic isolation, the rest by traditional methods with due consideration for the wound process. Local treatment of stump wounds in the patients with the crush syndrome involved some specific measures because of massive necroses and deep suppuration. For the early formation of functional stumps of the limbs, wound treatment was followed by reconstructive surgery by closing the stump wound defect with massive removed skin and subcutaneous fat flaps and subsequent active drainage of the wound. Postoperative treatment was aimed at improving the microcirculation in the skin grafts. The status of the stump soft tissues and bone was assessed over the course of treatment by limb scintigraphy with 99mTc-labeled pyrophosphate. Such investigation helps determine the optimal terms for reconstructive surgery and predict its outcome. Good results were achieved: 80.6% of patients were supplied with prostheses within 3-4 months after the injury.
For about 15 years, technical advances in prosthetic treatment have been the main factor in the increased performance of athletes with lower-limb amputation. For trans-tibial amputation, the prosthesis for sprinting is composed of a gel liner and a socket joined by a locking or virtual vacuum liner. Because of these dynamic properties, the carbon prosthetic foot equipped with tacks ensures outstanding performance. For trans-femoral amputation, a hydraulic swing and a stance control unit are added to the same prosthesis. In comparison with the able-bodied runner, athletes with amputation have smaller loading times in the prosthetic limb and larger ones in the sound limb. The length of the energy-storing prosthetic foot is determined by the "up-on-the-toes" running gait. The sprinting gait with trans-tibial amputation is almost symmetrical. The hip extensor effort is the main compensation of propulsion reduction with lower-limb amputation. With trans-femoral amputation, the lack of knee increases the asymmetry. The total prosthetic knee extension (early in late-swing phase and lasting during total stance phase) compensates with extension of both hips, especially the opposite one. The amputation and sound limb load transfer with lumbar hyperlordosis concern the pelvis, trunk and shoulders. Because of athletes with amputation, research in prosthetic treatment has progressed. The development of orthotics and prostheses for such athletes has benefited non-athletes with amputation.
This contribution describes a simple device designed to convey independent donning of a shuttle lock trans-tibial prosthesis for a multiple limb amputee. The device is made of a post with a shuttle lock mechanism at one end and a plate covered by rubber at the other end. This device enables correct positioning of the silicone liner and independent attachment to the prosthesis.
Based on records of 81 patients who used the LLM, and on questionnaire answers and comments from clinicians, the following can be concluded: 1. The LLM can be operated easily after a minimum of training. It does not break down with extended clinical use when handled properly. 2. The LLM manual provides sufficient information for proper operation and clinical use of the device. 3. The number of patients in a clinic who can benefit from LLM training can be predicted, if consideration is given to the type of facility and the size of the patient population and physical therapy staff. 4. The largest diagnostic group of patients who can benefit from LLM therapy are lower-limb amputees, followed by hemiplegic and orthopedic patients. 5. The general selection criteria outlined initially proved sufficient. A patient who is selected properly can be expected to respond to the feedback signal (i.e., make a weight-bearing adjustment) within the first or second session.
UNLABELLED: This self-directed learning module highlights common comorbidities found in people with amputations and their impact on functional outcome. 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 focuses on prosthetic considerations, functional outcome, and potential complications for a woman with the comorbidities of stroke and diabetes who experiences a dysvascular amputation. Formulation of the differential diagnosis, management of limb pain, and evaluation of the potential psychosocial issues arising after amputation are also discussed. OVERALL ARTICLE OBJECTIVE: To analyze common comorbidities of people with amputations and to delineate their impact on functional outcome.
OBJECTIVE: To explore the nature of the accommodations in running gait that persons with below-knee amputations make in response to the limb segment loss. PATIENTS: Two groups of volunteer subjects (n = 6 in each group). Individuals in one group had below-knee amputations; the second group had intact lower limbs. DESIGN: Individuals ran at two nominal speeds, 2.7 m/sec and 3.5 m/sec, over a flush-mounted force platform. Ground reaction force data were combined with simultaneously recorded and subsequently digitized video data of coordinate motion to calculate joint and segment motion and net joint moment data. RESULTS: The degree of left-to-right asymmetry for the amputee group was dependent on the variable of interest. There was symmetry in stride frequency and support moment and a marked asymmetry in ankle, knee, and hip moments. In response to increased running speed, both groups increased the amplitude of each joint moment. The nonamputee group appeared to increase the gain uniformly across the three joints, whereas the intact and prosthetic limbs were not uniformly increased. The temporal sequencing of the components for the intact and prosthetic limbs did not appear to differ from the nonamputee limb. This similarity in timing was unaffected by speed increases. CONCLUSION: There was no need to develop completely new patterns of joint moments; rather, it was sufficient to retune the current moment patterns to account for new segmental properties and thus retain the internal timing characteristics.
OBJECTIVES: To test the hypotheses that prosthesis-wearing people with lower-limb amputations, using 2-wheeled walkers (TWW) versus 4-footed walkers (FFW), (1) walk faster, (2) walk with fewer interruptions, (3) walk no less safely, and (4) prefer the TWW. DESIGN: Within-subject comparisons. SETTING: Rehabilitation center. PARTICIPANTS: Twenty prosthesis-wearing people with lower-limb amputations (13 men, 7 women) with a mean age +/- standard deviation of 69+/-13 years. Of the subjects, 11 had unilateral transfemoral amputations, 7 had unilateral transtibial amputations, and 2 had bilateral transtibial amputations. INTERVENTION: Participants were trained to use both walkers. MAIN OUTCOME MEASURES: Five-meter walking velocity, gait pattern, need for spotter intervention, foot position with respect to the base of support of the walker, and subject preference. RESULTS: Subjects walked 28.5% faster when using the TWW (P=.000). During gait cycles, 100% of subjects brought the FFW to a complete halt, whereas only 55%, particularly subjects with transfemoral amputations, halted the TWW (P=.008). There was no difference in the need for spotter intervention. Subjects with unilateral amputations placed their feet significantly more anteriorly within the walker base of support when using an FFW (P=.000). Fourteen subjects preferred the TWW, and 6 chose the FFW (not significant). CONCLUSION: The TWW allows prosthesis-wearing people with lower-limb amputations, especially those with transtibial amputations, to walk more quickly and with less interruption, but no less safely, than the FFW. The findings have implications for ambulation training and the prescription of ambulation aids.
We used a combined superior gluteal artery skin flap and latissimus dorsi musculocutaneous flap to repair a massive tissue defect of the upper limb. This combined flap has several advantages in that the length can be more than 60 cm, it can be used as an auxilliary muscle (latissimus dorsi) and it can also be used as a sensory flap. This combined flap is useful for covering massive skin defects.
PURPOSE: To provide in-depth case descriptions that illustrate the common themes in the research literature on psychological adjustment to a lower-extremity amputation as well as capture the uniqueness of each individual's response to this prevalent acquired disability. METHOD: Four cases were chosen based on the diversity of adjustment issues they represented. These case presentations were reconstructed from evaluations completed by the authors, all psychologists, as part of routine care on an inpatient rehabilitation service. Identifying information was changed to protect confidentiality. CONCLUSIONS: Taken together, these four cases serve to underscore the importance attending to common issues such as post-amputation depression and anxiety, body image, feelings of vulnerability, social support changes, grief, pre-amputation psychological issues and phantom limb pain and sensations. Psychological assessment and referrals for treatment should be included as part of the routine care provided to individuals with amputations, irrespective of the length of time that has passed since the amputation.
OBJECTIVE: To investigate the functional outcome of patients with proximal upper limb deficiency--acquired and congenital (elbow disarticulation, transhumeral, shoulder disarticulation and forequarter level). DESIGN: Cohort observational study. SUBJECTS: All proximal upper limb amputees and patients with congenital upper limb absence currently registered with the Sheffield Mobility and Specialised Rehabilitation Centre. METHODS: A self-administered postal questionnaire and medical records were used to collect data. The questionnaire obtained information about demographic details, dominancy of the amputated arm and independence and participation in activities of daily living (ADL), domestic and recreational activities. The prevalence of pain in the phantom limb and stump, and information regarding the remaining arm was also obtained. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate the psychological state of the subjects. RESULTS: Trauma was the commonest cause of proximal upper limb loss (71.25%). Transhumeral amputation was the predominant level (78.75%). Although 73.2% returned to work following amputation, 66.6% had to change job. Overall rejection rate of prosthesis was 33.75%. Twenty-five per cent of patients found the prosthesis beneficial for driving and a small proportion used the prosthesis for employment and recreational activities, but the vast majority used the prosthesis primarily for cosmesis. Pain in the phantom limb was reported in 60% of our patients but there was no significant correlation between this and depression. Symptoms of overuse injury in the nonamputated limb were higher than expected in the normal population. CONCLUSION: As many as 33.75% of patients with proximal upper limb deficiency rejected their prostheses and many who continue to wear them do not find them useful in ADL and employment, etc. It is vital that rehabilitation programmes should focus on both prosthetic and nonprosthetic training to achieve maximal independence.
Prosthetic manufacturers have marketed shock-absorbing pylons (SAPs) for attenuation of injurious loads from foot-ground contact. In this study, we compared a commonly prescribed SAP with a conventional rigid pylon, using a within-subject design (n = 15 unilateral transtibial amputees), to assess effect on gait mechanics, measure transmitted accelerations in situ, and determine functional outcomes using step counts and questionnaires. No differences were found across pylons for self-selected walking speed, prosthetic-side step length, prosthetic-side loading rate and decelerative peak of the vertical ground reaction force, peak pylon acceleration, step count per week, or questionnaire results that examined pylon performance and subjects' pain and fatigue levels. The only statistically significant finding was for the prosthetic-side knee angle at initial contact, where subjects displayed an average of 2.6 degrees more flexion with the rigid pylon than the SAP while walking at a controlled speed (p = 0.004); this result indicates that transtibial amputees are able to modulate the effective stiffness of their residual limb in response to changes in prosthetic component stiffness. The results from the laboratory, field, and subjective outcome measurements suggest that the SAP in this study is as effective as a rigid pylon for unilateral transtibial amputees.