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PubMed2005

The gait initiation process in unilateral lower-limb amputees when stepping up and stepping down to a new level.

BACKGROUND: Unilateral lower-limb amputees lead with their intact limb when stepping up and with their prosthesis when stepping down; the gait initiation process for the different stepping directions has not previously been investigated. METHODS: Ten unilateral amputees (5 transfemoral and 5 transtibial) and 8 able-bodied controls performed single steps up and single steps down to a new level (73 and 219 mm). Duration, a-p and m-l centre of mass and centre of pressure peak displacements and centre of mass peak velocity of the anticipatory postural adjustment and step execution phase were evaluated for each stepping direction by analysing data collected using a Vicon 3D motion analysis system. FINDINGS: There were significant differences (in the phase duration, peak a-p and m-l centre of pressure displacement and peak a-p and m-l centre of mass velocity at heel-off and at foot-contact) between both amputee sub-groups and controls (P<0.05), but not between amputee sub-groups. These group differences were mainly a result of amputees adopting a different gait initiation strategy for each stepping direction. INTERPRETATION: Findings indicate the gait initiation process utilised by lower-limb amputees was dependent on the direction of stepping and more particularly by which limb the amputee led with; this suggests that the balance and postural control of gait initiation is not governed by a fixed motor program, and thus that becoming an amputee will require time and training to develop alternative neuromuscular control and coordination strategies. These findings should be considered when developing training/rehabilitation programs.

Adult↗

PubMed2000

Performance of persons with juvenile-onset amputation in driving motor vehicles.

OBJECTIVE: To study the driving of motor vehicles by persons with juvenile-onset amputation and to compare the percentage of drivers among them with that found in the general population. DESIGN: A follow-up study of subjects who were younger than 18 years of age at amputation and who underwent one-sided amputation, covering the period 1976 to 1996. SETTING: The Prosthesis Service of the Asturias Central Hospital, Spain. SUBJECTS: A total of 236 juvenile amputee patients. RESULTS: The percentage of women with amputations who drive is lower than that of their male counterparts (p<.05). The percentage of drivers with upper limb amputations is greater than that of drivers with amputation of the lower limb (p<.05). Motor vehicle adaptations were used more frequently by people with upper limb amputations (p<.05). The ability to drive was not affected by the etiology or the side of amputation, or by the use of a prosthesis. The level of amputation affected driving ability in cases of amputation of the lower limb, but not in those of amputation of the upper limb. CONCLUSION: The percentage of persons with juvenile-onset amputation who drive (47.4%) is similar to that found in the general population (40.8%), and the use of a prosthesis does not have any influence on the capacity to drive a car--89.2% of drivers and 93.5% of nondrivers used a prosthesis.

Adult↗

PubMed1978

Measurement of prosthetic alignment.

An essential part of alignment description is the position and orientation of the socket relative to the rest of the limb. Repeatable measurements of these parameters is hindered by the non-geometrical shape of the socket. A unique axis system has already been defined to enable such measurements to be carried out. The method however, employs an iterative technique and is time consuming. A simple device to facilitate these measurements has been developed and is reported.

Amputation Stumps↗

PubMedDate not supplied

Wound healing in orthopaedic procedures for Klippel-Trenaunay syndrome.

Klippel-Trenaunay syndrome is a triad of cutaneous hemangiomas, varicose veins, and hypertrophy of soft tissue and bone; when combined with arteriovenous fistulas, the syndrome is known as Klippel-Trenaunay-Weber syndrome. Orthopaedic surgical management of localized limb-length discrepancy or hypertrophy in these conditions is frequently indicated, especially in the lower limb. Forty orthopaedic procedures in 21 patients were retrospectively reviewed. Nine (22.5%) wound complications were identified in this study group. All the complications were associated with transverse amputations. All required significant further treatment and extension of hospital stay. Wound complications should be anticipated in patients with Klippel-Trenaunay syndrome having orthopaedic surgical procedures, especially terminal amputations.

Amputation, Surgical↗

PubMed1984

Immediate, early, and late postsurgical management of upper-limb amputation.

This series is composed of 47 patients who underwent immediate, early, or late postoperative prosthetic fitting after upper-limb amputation. The purpose of this review was to analyze the impact of rapid postoperative fitting on upper-limb amputation, and to assess general prosthetic prescription and guidelines for upper-limb amputees. It would appear that in adult amputations there is a "Golden Period" of fitting for upper-limb prosthetic devices and this period appears to be within the first month after amputation. There appears to be no difference in ultimate prosthetic acceptance rate or use patterns as a function of the type of prosthesis initially provided. Based upon this combined review between the Tucson and Atlanta VA Medical Centers, the authors would suggest that all upper-limb amputees be fitted as rapidly as possible (within 30 days) with conventional prosthetic devices, and when they have shown motivation and skill in the use of conventional devices, then to re-evaluate them for appropriate externally powered prosthetic components.

Adolescent↗

PubMed2003

The influence of prosthetic foot alignment on trans-tibial amputee gait.

An optimally aligned prosthesis, as accomplished by the subjective judgment of the prosthetist, guarantees the best quality of gait. Yet, amputees can adapt to a large variety of geometrical configurations of the prosthetic components. Different external rotation angles of the foot in trans-tibial (TT) prostheses were investigated. The study tried to identify (a) the relationship between foot angle and other gait parameters and (b) the compensating pattern of the amputees to excessive external rotation of the foot. Eight (8) TT amputees, fitted with an identical type of prosthesis, were investigated during ambulation. The prosthetic foot was externally rotated as follows: optimal angle (10.94 x degrees +/- 5.21 degrees), optimal angle plus another 18 degrees, and optimal angle plus another 36 degrees. Analysis of gait was performed with the aid of an electronic walkway. Speed of gait, stance and swing time, and foot angle were monitored in 4 runs for each of the three foot angles. Speed of gait remained almost constant in the three tests. Stance and swing time, as well as step length, significantly changed when 36 degrees were added to the optimal foot angle. This foot position significantly influenced inter-legs time difference and symmetry between the legs. During ambulation, prosthetic foot external rotation was decreased by internal rotation of the limb at the hip joint level. It is concluded that TT amputees can maintain an efficient speed of gait even when the prosthetic foot is malpositioned in excessive external rotation. Although such a malalignment significantly influences other gait parameters during walking, amputees are able to adapt themselves by internal rotation of the hip joint in the amputated leg.

Adult↗

PubMed1996

Rehabilitation in limb deficiency. 3. The geriatric amputee.

This self-directed learning module highlights advances in the evaluation and management of the geriatric amputee. It is part of the chapter on rehabilitation in limb deficiency in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses the impact of aging and comorbid factors on the function of the geriatric amputee. Specific clinical examples are provided to illustrate management issues. Advances that are covered include prosthetic management and modifications for the elderly.

Age Factors↗

PubMed2003

Postural and movement adaptations by individuals with a unilateral below-knee amputation during gait initiation.

The present study examined the compensatory strategies adopted by individuals with a unilateral below-knee amputation (BKA) during gait initiation. Eleven individuals with a unilateral BKA and 11 able-bodied subjects initiated gait at three step length conditions (+0, +25 and +50% of preferred step length). A lead-limb condition was also introduced, such that all participants were required to initiate gait with both their left and right limbs. For all step length and lead-limb conditions, it was found that individuals with a unilateral BKA required more time to initiate gait, as compared with the able-bodied. This increase in movement duration was attributed to the stability and movement limitations of the prosthetic limb. On the other hand, by prolonging the task duration, these individuals were also able to employ a 'horizontal impulse' strategy, whereby they could create a similar magnitude of horizontal impulse as the able-bodied without the need to apply a large magnitude of peak antero-posterior (A-P) force.

Adaptation, Physiological↗

PubMed1988

Use and usefulness of lower limb prostheses.

This article concerns a study of the use and usefulness of lower limb prostheses. The method used is discussed: the combining of quantitative data gathered via structured questions with qualitative data about the experiences, wishes and opinions of the people most involved. Some of the results regarding the users, the use and usefulness of prostheses and the wishes of the users are mentioned. Recommendations based on the results are also mentioned.

Adaptation, Psychological↗

PubMed1994

Upper limb prosthetic use in Slovenia.

The article deals with the use of different types of upper limb prostheses in Slovenia. Four hundred and fourteen upper limb amputees were sent a questionnaire on the type of their prosthesis, its use and reasons for non-use, respectively. The replies were subject to statistical analysis. Most of the questioned upper limb amputees (70%) wear a prosthesis only for cosmesis. The use of a prosthesis depends on the level of upper limb amputation, loss of the dominant hand, and time from amputation. Prosthetic success appears to be unrelated to age at the time of amputation and the rehabilitation programme. The most frequent reason for not wearing a prosthesis is heat and consequent sweating of the stump. More than a third of amputees are dissatisfied with their prostheses.

Activities of Daily Living↗

PubMed2000

Below knee prosthetic socket designs and suspension systems.

The prosthetic socket must act as a customized connection between the residual limb's surrounding tissues and the prosthetic components. The socket must be designed to control weight bearing, suspension, and ambulation stability. When making a below-the-knee socket, the prosthetist attempts to maximize loading and minimize displacements, such as vertical, transverse, or rotational. This article discusses the engineering designs or shapes of the two basic forms of below-the-knee prosthetic sockets used today.

Artificial Limbs↗

PubMed1995

Surgical management of primary bone sarcomas.

Effective chemotherapy regimens have changed the nature and scope of surgical management of primary sarcomas of bone. Limb-salvage surgical procedures are performed in the majority of patients without a significantly increased risk of local tumor relapse. Advances in technology have expanded the options available for skeletal reconstruction. End-result analyses have helped refine the application of this technology to maximize function. Further advances are necessary to maintain function in the long term.

Adolescent↗

PubMed2007

Neural machine interfaces for controlling multifunctional powered upper-limb prostheses.

This article investigates various neural machine interfaces for voluntary control of externally powered upper-limb prostheses. Epidemiology of upper limb amputation, as well as prescription and follow-up studies of externally powered upper-limb prostheses are discussed. The use of electromyographic interfaces and peripheral nerve interfaces for prosthetic control, as well as brain machine interfaces suitable for prosthetic control, are examined in detail along with available clinical results. In addition, studies on interfaces using muscle acoustic and mechanical properties and the problem of interfacing sensory information to the nervous system are discussed.

Amputation, Surgical↗

PubMed1991

Limb-salvage surgery in the treatment of osteosarcoma in skeletally immature individuals.

Sacrifice of major growth plates during resection and fixed-length reconstruction of a limb in a skeletally immature child with osteosarcoma may result in a significant limb-length inequality as growth progresses. A limb-length discrepancy in the humerus may cause minor cosmetic problems but does not generally result in a significant functional deficit. In the lower extremity, tumors about the knee, including the distal femur and proximal tibia, usually present the dilemma of whether limb salvage by arthrodesis, osteoarticular allograft, or endoprosthetic replacement would result in a significant limb-length inequality and whether amputation of the extremity is a preferable procedure. The techniques of rotationplasty and an expandable endoprosthesis have been successfully used for treating skeletally immature patients with osteosarcoma of the distal femur. With regard to survival and function, the results obtained with these innovative methods are favorable compared with those of a high above-knee amputation.

Adolescent↗

PubMed1983

The early rehabilitation of lower limb amputees using a pneumatic walking aid.

A pneumatic walking training aid for amputees is described. It was developed by the late Biomechanical Research and Development Unit, Roehampton, from an original design by Professor Little in Australia. The walking aid has been used successfully on the majority of below-knee and through-knee patients rehabilitated in the Roehampton Walking Training School since 1976. There have been no complications that could be attributed to the use of the pneumatic walking aid.

Adult↗

PubMedDate not supplied

Chopart prosthesis and semirigid foot orthosis in traumatic forefoot amputation. Comparative gait analysis.

Gait was analyzed in seven otherwise healthy males at least 11 mo after they had recovered from a traumatic unilateral transmetatarsal amputation incurred during the course of their usual occupation. All seven were fitted with a semirigid foot orthosis. Four were also fitted with a Chopart prosthesis. Gait was evaluated with forceplate measurements of ground reaction force during free walking, by clinical observation of such ambulation on videotape, and by the subjective impression of the men as obtained by a questionnaire. In all men, with unmodified footwear, with the orthosis, and with the prosthesis, the forceplate data showed an abnormal pattern characterized by reduced stance duration and deficient forward propulsion on the amputated side. The abnormality and asymmetry of ground-reaction forces were less with greater preserved stump length and for a given stump length were with the above-ankle concept (Chopart) prosthesis than with the below-ankle concept. These features were recognized during the clinical analysis of all footwear, but there was an extra irregularity of weight progression noted with the fixed ankle of the Chopart prosthesis. The questionnaire reported stump problems to be the principal difficulty, and the follow-up revealed persistent attempts at surgical management including consideration of amputation at a higher level. It was concluded that the patient and the surgeons are likely to choose preservation of limb length over considerations of function during acute care and that the prosthetic concept best suited to deal with the resulting stump should emphasize unloading the distal part of the stump and smoothing out the impulsive force peak on the stump in late stance to minimize pain and to enhance ambulation capacity.

Adult↗

PubMed1993

[Rotation grafts].

Nowadays rotationplasty is well established as an acceptable procedure for limb salvage in patients who have a malignant tumor in the femur or tibia. The main indication is that it is the alternative to amputation. Rotationplasty should be used in very young children because of the growth-dependent complications that can be expected after tumor resection. The different types of rotationplasty, the operative technique, prosthetic care, and the results of 104 patients are shown.

Adolescent↗

PubMed2002

Are stance ankle plantar flexor muscles necessary to generate propulsive force during human gait initiation?

The study examined whether the generation of the forward propulsive force (PF) during gait initiation resulted mainly from the electromyogram activity of stance ankle plantar flexor muscles (APF) which 'push' on the ground as is generally claimed in the literature. Six unilateral above-knee amputees performed a specific gait initiation protocol, i.e. they were asked to walk as fast as possible from an upright posture. Data from a force platform were collected and processed to obtain gait parameters (centre of mass (CoM) acceleration, anteroposterior (A/P) progression velocity, step length, etc.). The results showed that the A/P CoM velocity at the time of foot-off differed depending on the state of the lower limb (sound or prosthetic limb) performing the step. However, the A/P velocity of the CoM reached at the time of foot contact was similar whatever the state of the lower limb initiating the gait. Thus, the absence of ankle and knee muscles did not affect the velocity of body progression, i.e. the generation of the PF in gait initiation. Furthermore, the comparable slopes of the A/P velocity between the stance sound limb and the stance prosthetic limb suggest that the organization of the motor synergy underlying the production of the PF remained the same and did not directly involve the APF. However, other mechanisms could explain PF generation. PF could be generated by the swing leg oscillation, by the trunk movement, or by other mechanisms such as the energy transfer and the exchange of gravity potential energy into kinetic energy.

Adult↗