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At least 1,333 records · Page 74Linked to original sources

PubMed2000

Gait analysis and energy consumption of below-knee amputees wearing three different prosthetic feet.

This study scientifically measures the dynamic gait characteristics and energy consumption of 16 male below-knee amputees, eight vascular and eight traumatic, while wearing solid ankle cushion heel (SACH), single axis and multiple axis prosthetic feet via six-camera motion analysis, metabolic measurement cart and heavy-duty treadmill. Subjective results are additionally determined via questionnaire after testing. Motion analysis showed statistically significant differences at P<0.05 between the SACH, single axis and multiple axis foot in the velocity, cadence, stride length and single limb stance. Significant differences were found in energy consumption between the traumatic and vascular groups, and significant changes in walking under different speeds and different inclines. Results provide quantitative and qualitative information about the dynamic performance of the various feet, which can be helpful in prescribing the optimal prosthetic foot for individual amputees.

Adult↗

PubMed2003

Psoriasis and the effect of prosthetic fitting.

This contribution presents the case histories of two patients who underwent limb amputation. One patient suffered from psoriasis prior to the surgery and the second developed psoriatic lesions post surgery. Both patients were provided with a prosthesis and despite the multiple cutaneous complications of the psoriasis both patients ambulate. It was expected that Koebner's phenomenon would create hardships but to date this has not happened.

Adult↗

PubMed2000

Biomechanical adaptations of transtibial amputee sprinting in athletes using dedicated prostheses.

OBJECTIVE: To determine the biomechanical adaptations of the prosthetic and sound limbs in two of the world's best transtibial amputee athletes whilst sprinting. DESIGN: Case study design, repeated measures. BACKGROUND: Using dedicated sprint prostheses transtibial amputees have run the 100 m in a little over 11 s. Lower-limb biomechanics when using such prostheses have not previously been investigated. METHODS: Moments, muscle powers and the mechanical work done at the joints of the prosthetic and sound limbs were calculated as subjects performed repeated maximal sprint trials using a Sprint Flex or Cheetah prosthesis. RESULTS: An increased hip extension moment on the prosthetic limb, with an accompanying increase in the amount of concentric work done, was the most notable adaptation in Subject 1 using either prosthesis. In Subject 2, an increased extension moment at the residual knee, and an accompanying increase in the amount of total work done, was the most notable adaptation using either prosthesis. This later adaptation was also evident in Subject 1 when using his Sprint Flex prosthesis. CONCLUSIONS: Increased hip work on the prosthetic limb has previously been shown to be the major compensatory mechanism that allow transtibial amputees to run. The increased work found at the residual knee, suggests that the two amputee sprinters used an additional compensatory mechanism. RELEVANCE: These findings provide an insight into the biomechanical adaptations that allow a transtibial amputee to attain the speeds achieved when sprinting.

Adaptation, Physiological↗

PubMed2002

Prosthetic rehabilitation of amputees aged over 90 is usually successful.

Prosthetic rehabilitation and prosthetic limb use in patients over 90 years of age have not been studied in detail. This study reports two concurrent successful cases and a review of registered patients aged over 90. Satisfactory outcomes often occur in this population and such patients should be referred for prosthetic rehabilitation, regardless of advanced age.

Aged↗

PubMed1999

Suspension systems for prostheses.

The appropriate suspension system results in a safe and well functioning lower extremity prosthesis. Residual limb length, joint ligament stability, and limb volume determine suspension methods as does activity level, dexterity, success of previous suspension, and cosmetic requirements. The supracondylar suspension cuff, prosthetic sleeves, and gel liners with locking mechanisms generally are indicated for the average to long transtibial amputation level. Short limbs are better fitted with supracondylar and suprapatellar suspension. Waist belts generally are indicated for patients with new amputations or those with vascular compromise. Suction suspension is the most desirable form of transfemoral suspension and is recommended for most standard to long residual limbs. Roll on silicone liners with or without locking pins and the hyperbaric sock offer the patient systems that are easier to don yet still provide unencumbered suspension. The total elastic suspension belt offers excellent auxiliary suspension and can be applied to the prosthesis by the patient. Multiple factors and patient preference should be considered when prescribing suspension systems for lower extremity prostheses.

Artificial Limbs↗

PubMed1981

Congenital limb deficiencies.

In the last 25 years great advances have been made in the management of children with congenital limb deficiency. An understanding of the embryology and development is essential for careful planning and management of these children. It is important to have an internationally accepted classification so that the results of treatment can be compared. In this paper, the international classification of congenital limb deficiency is described. Unfortunately, this is still not widely used by the orthopaedic surgeons. It is hoped that more orthopaedic surgeons will use this classification in future so that we have a common denomination for comparison. Transverse limb deficiency both in the upper and lower limbs can be managed satisfactorily with the aid of prosthesis. Longitudinal limb deficiency which often requires careful planning and judicious use of reconstructive procedure can improve the function considerably. However, some of these children often go through multiple operations and end up with a useless limb. The need for surgical reconstruction is to improve the child's function and this must always be kept in mind. Last but not least the psychological problems both with the child and the parents is of paramount importance. A judicious and sympathetic approach by the orthopaedic surgeons will go a long way in making success or failure of the whole treatment programme.

Artificial Limbs↗

PubMed1995

The VA-Cyberware lower limb prosthetics-orthotics optical laser digitizer.

Characterization of the residual limbs and limb segments of patients for prosthesis and orthosis design has principally been a subjective process, highly dependent upon the skill, level of training, and experience of the prosthetist/orthotist involved. Even with the application of computer-aided design (CAD) and computer-aided manufacturing (CAM) technologies in prosthetics and orthotics, residual limb/limb segment characterization has remained substantially subjective and dependent upon prosthetist/orthotist skill, training, and experience. To eliminate the variations and errors that frequently occur because of this dependence, and to further quantify the patient measurement process, rehabilitation engineering researchers at the New York Department of Veterans Affairs Medical Center developed an optical laser digitizer for quantitative characterization of patients' residual limbs'/limb segments' spatial geometry and surface topography. The optical digitizer developed is described, and results of laboratory and clinical tests with the digitizer are presented. Examples showing the capability of the digitizer to accurately, rapidly, repeatably, and consistently capture the contours over the entire surfaces of the residual limbs of patients with below-knee (BK) and above-knee (AK) amputation, the lower limbs of orthotics patients, and the feet and ankles of pedorthics patients, are given. In addition, results of a comparative clinical study of optical digitization and standard prosthetics CAD plaster wrap cast electromechanical digitization of the residual limbs of subjects with BK and AK amputation are presented. The enhanced accuracy, repeatability, and consistency afforded by optical digitization are shown. Finally, areas for refinement of the optical digitizer's design, identified in the project's laboratory and clinical tests, are discussed.

Amputation Stumps↗

PubMed1978

[Reconstructive-restorative operations of the skin after amputation of the limbs].

Up to 70% of cases admitted for primary prosthetics after amputation of the extremities suffer from some defects aod diseases of the stumps requiring surgical treatment. The experience of the Leningrad Scientific Research Institute of Prosthetics with 593 reconstructive-restorative operations on the stumps of the extremities allows to define indications for skin plasty on the stumps and to assess the advantages and drawbacks of different methods.

Adult↗

PubMed2005

Changes in interface pressures and shear stresses over time on trans-tibial amputee subjects ambulating with prosthetic limbs: comparison of diurnal and six-month differences.

For trans-tibial amputees maintenance over time of a quality fit of the prosthesis to the residual limb is an important clinical challenge. The purpose of this research was to compare diurnal and long-term (5 weeks to 6 months) interface stress changes as well as variance in the change in cross-sectional area down the length of the residual limb. If long-term changes were simply accentuated diurnal fluctuations then this result would suggest similar treatment methods should be used for both conditions. Interface pressures and shear stresses at 13 sites and residual limb shape were measured on eight trans-tibial amputee subjects using patellar-tendon-bearing prostheses. Data were collected at diurnal intervals (within the same day at least 5 h apart) as well as at long-term intervals (5, 10, 15, 20, and 25 weeks apart). Absolute diurnal interface stress changes were not significantly different from those at 5-weeks intervals but were significantly smaller than those at 15, 20, and 25-weeks intervals. Mean interface stress changes increased significantly (p<0.05) for increased session-to-session intervals. Variance of the change in cross-sectional area down the length of the residual limb was significantly smaller for diurnal intervals than for 6-months intervals, indicating that long-term changes were more localized than diurnal changes. These results indicate that long-term changes are not simply accentuated diurnal fluctuations, suggesting that different treatment methods should be used to treat each condition.

Adaptation, Physiological↗

PubMedDate not supplied

[Prosthesis edge nodule and verrucous hyperplasia in leg amputees].

Dermatologic problems in leg amputees mainly result from their specific prosthetic supply. As this relationship is not well documented in the German language literature, we try to illustrate important pathophysiologic aspects of lower and upper limb prostheses in two highly characteristic dermatoses, epidermoid cysts and verrucous hyperplasia (papillomatosis cutis lymphostatica). Their management includes improvements in prostheses' workmanship and conceptional changes (e.g. CAT-CAM-technique). Interdisciplinar diagnostic and therapeutic efforts particularly between orthopedic surgeons, prosthetists and dermatologists should prevent immobility of the amputee at an early stage.

Adult↗

PubMed1996

A finite element analysis of the load transfer between an above-knee residual limb and its prosthetic socket--roles of interface friction and distal-end boundary conditions.

A nonlinear finite element model was developed to investigate the manner of the load transfer between the above-knee residual limb and its prosthetic socket. The model was two-dimensional (2-D) with consideration of nonlinear boundary conditions and large deformation. Interface elements were used to simulate the friction/slip conditions between skin and the socket. Different distal-end conditions, including air cushion distal-end loading, were simulated to explore their influences on the load transfer.

Amputation Stumps↗

PubMed1995

Congenital limb anomalies and amputees Tayside, Scotland 1965-1994.

The purpose of this study was to review the 68 patients who had been referred to Dundee Limb Fitting Centre during the period 1965-1994, with a congenital anomaly of a major limb requiring prosthetic replacement. A profile of the incidence of congenital anomalies, amputation levels and prosthetic fitting was obtained. During the period only 68 cases with 80 congenital anomalies were referred. During these 29 years, 20 cases required surgical amputation and overall 35 surgical procedures were performed in these cases, only 3 were in the upper limb. The incidence of upper and lower limb deficiency was similar. The patients represented a small proportion (1.6%) of the patients who were reported to have congenital anomalies. Figures indicated that about 8% of all live/still births have some form of anomaly. Prosthetic fitting and use was successful in all 68 cases but long term life follow-up is necessary to ensure continued prosthetic use.

Amputees↗

PubMed1997

Weight bearing and velocity in trans-tibial and trans-femoral amputees.

The purpose of this study was to review the clinical utility of static weight bearing (SWB) and maximal self-selected ambulatory velocity as objective quantifiable measures in an outpatient lower limb prosthetic clinic. Seventy-three (n = 73) consecutive trans-tibial (TTA) and trans-femoral amputees (TFA) attending an outpatient prosthetic clinic were studied. Prosthetic weight bearing was measured on a bathroom scale (mass in kg), normalised to body mass then expressed as a percentage and labelled static weight bearing (SWB). Maximum safe self-selected ambulatory velocity over a 10 metre level walkway (m/s) was measured with a stopwatch. The SWB mean for the TTA group was 94.93% range 77-100%) and 88.36% for the TFA group (range 43-100%). The mean ambulatory velocity was 1.70 m/s (range 0.07-5.75) for the TTA group and 0.78 m/s (range 0.10-1.54) for the TFA group. A statistically significant relationship (p < 0.05) was found between SWB and ambulatory velocity in trans-tibial and trans-femoral amputees in this study. A ceiling effect was noted in the trans-tibial group with 42% achieving 100% SWB through their prosthetic limb so it was concluded that ambulatory velocity was the more sensitive measure in established trans-tibial prosthetic limb users. SWB may be the more appropriate quantifiable measure for use in established trans-femoral prosthesis users. Prosthetic training programmes would benefit from the objective measurement of SWB. Once optimal SWB was achieved, ambulatory velocity would be the more sensitive measure of prosthetic use.

Adolescent↗

PubMed2000

Transfemoral socket design and suspension options.

The transfemoral socket is the interface between the patient's residual limb and the remaining prosthesis. Whether the patient uses a technologically advanced knee mechanism and foot or a single axis, constant friction knee and solid ankle cushioned heel, no other prosthetic component is as crucial in assuring a comfortable and well-functioning prosthesis as the socket. This article discusses the rationale of quadrilateral and ischial containment socket designs and reviews suspension options.

Artificial Limbs↗

PubMed2001

Acquired limb deficiencies. 1. Acquired limb deficiencies in children and young adults.

UNLABELLED: This self-directed learning module highlights prosthetic treatment considerations and challenges in children and young adults. 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. This article specifically focuses on prosthetic considerations for a child experiencing a mutilating traumatic amputation, examines the rationale for limb salvage versus surgical amputation for malignant bone tumors, discusses the unique management options available for patients undergoing hip disarticulation due to a tumor, and highlights the complications associated with amputations resulting from trauma and malignancies. OVERALL ARTICLE OBJECTIVE: To summarize prosthetic treatment considerations and challenges in children and young adults.

Adolescent↗

PubMed1987

A pulsed Doppler ultrasonic system for making noninvasive measurements of the mechanical properties of soft tissue.

In response to the need for a more precise means of predicting the interaction of a prosthetic socket with an amputee's residual limb, a gated Doppler ultrasonic motion sensing system was devised for making noninvasive measurements of the elastic modulus of soft tissue in vivo. Ultrasound was chosen for its ability to indicate the viscoelastic behavior of biological materials without damaging tissue. The system consists of a holding jig to support the limb being tested, a tissue vibrator, and an ultrasonic transducer to monitor the motion of the tissue. The ultrasonic transducer is controlled by an external computer to control the depth at which the sensor is measuring tissue displacement. This ultrasonic measuring technique provides as much information as more conventional techniques, but with more convenience and fewer restrictions.

Artificial Limbs↗

PubMed1984

Nerve entrapment syndromes in the upper extremity contralateral to amputation.

Five cases are reported of upper extremity amputation with no metabolic disease. Patients experienced pain, paresthesia and weakness in the intact extremity associated with electrophysiologic evidence of entrapment neuropathies. All patients did heavy manual work, and all had carpal tunnel syndrome. One patient also had cubital tunnel syndrome and compression of the medial cord of the brachial plexus in the axilla, and another patient had cubital tunnel syndrome and axillary neuropathy. Surgery did not relieve symptoms of carpal tunnel and cubital tunnel syndromes for prosthesis users until the figure-8 harness was changed. Patients who did not use a prosthesis felt relief of symptoms following surgical release. Possible mechanisms which produce nerve entrapment syndromes in patients with upper extremity amputations are use of one limb for heavy manual work over prolonged periods, direct compression of neural structures from the axilla loop of a figure-8 harness, and compression of neural structures in the axilla resulting in entrapment at a distal site. Changing the figure-8 harness should be considered prior to surgical decompression for patients who have upper extremity amputations with entrapment syndromes.

Adult↗

PubMed1994

Rheumatoid nodules on amputation stumps: report of three cases.

We describe three patients, all of them lower limb amputees who also had seropositive, nodular rheumatoid arthritis. In each case, rheumatoid nodules developed on the amputation stump, causing difficulties with prosthesis fit and comfort and impairment of ambulation. Nodules were successfully excised in two cases and the prosthesis modified in the third. The patients were able to resume walking or transferring with their prostheses.

Aged↗