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PubMed1998

Mass and mass distribution of below-knee prostheses: effect on gait efficacy and self-selected walking speed.

OBJECTIVE: To study mass and mass distribution effect on function of below-knee prostheses. DESIGN: Design modifications were done to produce proximal center of mass location versus distal center of mass location variations, and prosthesis weight was modified from 42% to 70% of normal limb weight. Work across joints of affected and unaffected extremities was compared to assess the ability of the prosthesis to substitute for function loss. SETTING: University biomechanics laboratory. PARTICIPANTS: Fifteen volunteers with below-knee amputations, residual limb length greater than 8.3 cm, but excluding Syme amputations. INTERVENTIONS: Patients walked with all configurations at self-selected walking speeds and 120 m/min. MAIN OUTCOME MEASURES: Self-selected walking speed and metabolic efficiency. Work across the joints of affected and unaffected sides was compared. RESULTS: Proximal center of mass location produced a more efficient gait. Weight change from 42% to 70% of normal had no significant effect. Mechanical studies show that the prosthesis is a relatively poor substitute for the normal limb; most work is done by the nonamputated side. Particularly, the prosthesis failed to produce effective forward impulses on the body, resulting from push-off and deceleration of the swing leg. CONCLUSIONS: For a proximal center of mass, lightweight distal components (e.g., feet) should be used; it is questionable whether further expenditure to develop ultralightweight prostheses would be cost effective for level walking.

Adolescent↗

PubMed1975

What influence does age have on rehabilitation of amputees?

A study of 194 male lower extremity amputees, with an average age of 56.8 years, showed that vascular disease is the most common cause of limb loss at all ages. Increasing age was correlated with an increasing incidence of bilateral amputation and arteriosclerotic and pulmonary problems, lower goals and levels of achievement, increased mortality during therapy, fewer amputees who were able to return home, an increased number of aids (cane, crutches, wheelchair), and a longer rehabilitation period. Many patients over age 65 required nearly a year of rehabilitation to achieve maximum benefit.

Adult↗

PubMed1976

An index of healing in below-knee amputation: leg blood pressure by Doppler ultrasound.

Preoperative Doppler ultrasonic assessment of below-knee (BK) arterial signals and systolic blood pressures was performed on 50 patients undergoing 53 BK amputations for advanced ischemia. No patient was excluded from initial BK amputation unless gangrene at that level or severe joint contracture was present. Failure of healing of the BK amputation occurred in all five limbs with an undetectable Doppler arterial signal (and thus pressure) below the knee. Failure of amputation occurred in four of 16 limbs with detectable arterial signals and BK pressures less than 70 mm. Hg. Healing occurred in all 32 limbs with BK pressures greater than 70 mm. Hg. The differences in healing between these three groups are highly significant (p less than 0.005). This study suggests that Doppler ultrasonic assessment of BK arterial signals and pressures may be a simple hemodynamic correlate of healing of a BK amputation. Absence of a detectable arterial signal below the knee may be an indication for initial above-knee (AK) amputation in advanced ischemia.

Amputation, Surgical↗

PubMed1981

General considerations in managing upper limb amputations.

Amputation is an unpleasant affair, generating a very negative aura that must be consciously combated. It requires the same careful consideration, planning, and technical skills required by any reparative hand surgery. For optimal care, the surgeon needs not only to be comprehensively trained in hand surgery but also to be knowledgeable about prosthetic possibilities and to appreciate the psychological impact on the patient. Thoughtful and concerned management can do much to reduce the loss in a global sense, and the only measure of success is how well the patient is reintegrated into normal life.

Amputation, Surgical↗

PubMed1977

Transmedullary amputation and resection of metastases in combined therapy of osteosarcoma.

The eradication of microfoci of metastatic osteosarcoma by adjuvant chemotherapy permits the surgeon to take a more conservative approach to amputation and to more aggressively resect metastases. In a series of 59 children with osteosarcoma of an extremity, transmedullary amputation carried no greater risk of stump recurrence than either disarticulation or amputation above the joint. We attribute this to careful selection of the level of amputation by use of preoperative bone scans, intraoperative frozen sections of bone stump and intensive postoperative adjuvant chemotherapy. Immediate application of a prosthetic limb has enhanced the physical and emotional rehabilitation of these patients. Resections of pulmonary metastases in 12 patients who were receiving adjuvant chemotherapy has resulted in a median tumor-free survival of 17 mo, with 3 patients still alive without disease for 13, 25, and 72 mo. A more aggressive approach to the resection of pulmonary metastases may substantially improve current rates of tumor-free survival.

Adolescent↗

PubMed1981

Carbon fibre reinforced plastic applied to prosthetics and orthotics.

This paper describes the work carried out at the Rehabilitation Engineering Unit, Chailey Heritage Hospital, in applying carbon fibre reinforced plastic CFRP to prosthetics and orthotics. The prosthetic application relates to the construction of the Chailey Harness which was used to mount externally powered, upper limb prostheses to the torso of limb deficient children damaged by the drug Thalidomide. The application to orthotics was limited to Hip-Knee-Ankle-Orthoses (HKAO) as worn by severely handicapped children with spina bifida and led to the development of a shapable CFRP/aluminium alloy hybrid composite bar. The construction of the composite, its properties and the assembly and performance of the first orthoses are described. Some of the practical problems experienced with the use of carbon fibre reinforced plastic are identified.

Abnormalities, Drug-Induced↗

PubMed2000

Rehabilitation considerations of prosthetic fittings for Kaposi's sarcoma amputees.

PURPOSE: We report on cutaneous limb manifestations of Kaposi's sarcoma and the secondary infection of these lesions that necessitated five lower-limb amputations. METHOD: The cases are briefly described and prosthetic adaptations in respect to pressure, traction and sweating on the skin are considered. RESULTS: All four patients ambulated initially; one lady died, the double amputee stopped walking owing to the excessive physical demand, and two patients ambulate freely. CONCLUSION: Special considerations to the cutaneous/prosthesis interface are necessary in order to provide these patients with optimal ambulatory ability.

Aged↗

PubMed1991

Prosthetic management of children with limb deficiencies.

Children with amputations present challenging management problems. Surgical management, prosthetic fitting options, and training regimens have progressed substantially over the past several decades. Clinicians should be familiar with the available technological options to provide children with amputations the best possible care. The plethora of small components available for lower- and upper-limb prostheses indicates the desirability of managing juvenile patients in an interdisciplinary, specialized clinical setting where the advantages and disadvantages of prosthetic options can be related to the particular needs and wishes of each young client and the client's family. Although prostheses are not anatomical avatars, careful appliance prescription and training, coordinated with the child's growth and developmental changes, can optimize the benefits the child derives from the prosthesis.

Adolescent↗

PubMed1995

Prevention of impairment in leprosy; results from a collaborative project in China.

OBJECTIVE: to evaluate programs of prevention and treatment of impairments due to leprosy in 8 geographical areas in the People's Republic of China. DESIGN: follow up of cohorts of leprosy patients receiving a range of different interventions. SETTING: 8 different geographical areas in China, varying in urban and rural characteristics from 6 provinces and 2 municipalities. SUBJECTS: leprosy patients who were receiving or had completed a course of antileprosy chemotherapy. INTERVENTIONS: a range of interventions, including steroids, self-care training, adapted footwear, surgery and provision of prostheses. MAIN OUTCOME MEASURES: changes in eye, hand and foot impairments between baseline assessment and assessment at 2 years. RESULTS: 232 out of 3571 patients assessed monthly over 2 years developed acute neuritis and, in most areas, were promptly and adequately treated. Regular self care of eyes was established in 238 out of 313 patients with lagophthalmos and was associated with reduction in the prevalence of conjunctivitis. Regular self care of hands was established in 730 out of 1010 patients with neurological impairment of the hand; this was associated with a reduction (80%) in hand cracks and wounds. Regular self care of feet was established in 745 out of 1094 patients with neurological impairment of the feet; this was associated with a 83% reduction in patients with cracks and a 33% reduction in patients with sole wounds. A footwear program was established in all 8 areas providing footwear to 4698 patients over the 2-year period; this was associated with a reduction of 61% and 21% in patients with cracks and wounds, respectively. Management of complicated sole wounds in 256 patients resulted in 69% of these patients being free of sole wounds at 2 years. Targets for reconstructive surgery and amputations were not fully attained, but lower limb prostheses were provided for 306 patients. CONCLUSIONS: leprosy is a chronic disease characterized by peripheral neuropathies which can result in increasing secondary impairments and disabilities. The emphasis, in countries such as China where the chemotherapy programs have been effectively implemented, is shifting to prevention and treatment of impairments. This innovative program in China has successfully demonstrated that it is possible to prevent and reverse impairments due to leprosy.

Artificial Limbs↗

PubMed2006

Progressive upper limb prosthetics.

The field of upper extremity prosthetics is a constantly changing arena as researchers and prosthetists strive to bridge the gap between prosthetic reality and upper limb physiology. With the further development of implantable neurologic sensing devices and targeted muscle innervation (discussed elsewhere in this issue), the challenge of limited input to control vast outputs promises to become a historical footnote in the future annals of upper limb prosthetics. Soon multidextrous terminal devices, such as that found in the iLimb system(Touch EMAS, Inc., Edinburgh, UK), will be a clinical reality (Fig. 22). Successful prosthetic care depends on good communication and cooperation among the surgeon, the amputee, the rehabilitation team, and the scientists harnessing the power of technology to solve real-life challenges. If the progress to date is any indication, amputees of the future will find their dreams limited only by their imagination.

Amputation, Surgical↗

PubMed1992

Weight distribution of below-knee amputee and able-bodied children during standing.

The purpose of this investigation was to compare weight distributions of a relatively large number of below-knee (BK) amputee and able-bodied children during two different standing positions. Twenty-one BK amputees and 200 able-bodied children volunteered as subjects for this investigation. Each child stood on a pressure plate and three sets of trial data were collected. One set of trial data was collected with both feet together on the pressure plate and two were collected with feet placed 20cm apart. The total force applied by each foot to the pressure plate was normalised by dividing by subject weight to yield foot force to body weight ratios. Data were separated into forefoot and rearfoot areas, force for the forefoot area was then calculated and normalised by dividing by total foot force to yield forefoot to whole-foot force ratios. Ratios for the two foot placement conditions and for non-prosthetic, prosthetic, dominant, and non-dominant feet were compared using paired t-tests (p < 0.05). Results indicated that: 1) BK amputee children placed more weight on their non-prosthetic limb than their prosthetic limb, yet this was not different from able-bodied children in respect of weight distribution between dominant and non-dominant limbs; 2) approximately 90% of the load on the prosthetic foot was placed on the forefoot; and 3) the load on the non-prosthetic foot was evenly distributed between the forefoot and rearfoot like that of able-bodied children. It was concluded that except for substantially more weight on the forefoot of the prosthetic leg BK amputee children stood in the same way as able-bodied children.

Adolescent↗

PubMed1989

[Prosthetic management of amputees].

The prosthesis of a lower limb amputee usually consists of a socket custom made out of wood, glass fiber, reinforced resin or other plastic material. This is also true for modern flexible sockets. Individually selected components depending on the amputee's level of activities, such as hip, knee and ankle joints, torsion adapter and different prosthetic feet, are produced by the orthopaedic industries. Function, however, depends significantly on the quality of the stump-created by the surgeon. Even a skilled prosthetist cannot improve the stump.

Amputation, Surgical↗

PubMed1977

Elderly patients with lower extremity amputations: three-year study in a rehabilitation setting.

Of the 112 mostly elderly patients with lower extremity amputations who were initially evaluated for this study, 86 were discharged as independent prosthetic ambulators after completion of both phases of a two-phase prosthetic rehabilitation program with a team approach. In four years of outpatient follow-up of the 86 patients who completed phase II, 14 died and contact was lost with 6. Sixty-six remain prosthetic ambulators. Six others who had unilateral amputations underwent amputation of the other limb; the initial procedure was above knee in one and below knee in five. All of the patients included in the study were originally referred to the Helen Hayes Hospital with a multitude of problems. The majority had emotional, social and financial difficulties, as well as medical problems. Many of the patients had undergone multiple surgical procedures prior to the first amputation. Psychological problems, particularly depression, were often severe in that group of patients.

Aged↗

PubMed2006

Skin problems in an amputee clinic.

OBJECTIVE: To document the type and frequency of individual residual limb skin problems among patients using a lower extremity prosthesis, including the suggested etiology and management of each type of skin problem. DESIGN: This is a 6-yr retrospective chart review of skin lesions diagnosed in patients examined in an outpatient amputee clinic at a regional, referral rehabilitation hospital in Ottawa, Canada. Skin lesions were included if they were on a lower extremity residual limb for a patient who functionally used a prosthesis. Descriptive statistics were used to analyze data. RESULTS: A total of 528 skin problems were documented in 337 lower extremity residual limbs. Ulcers, irritations, inclusion cysts, calluses, and verrucous hyperplasia were the five most common skin problems representing 79.5% of all documented skin disorders. CONCLUSIONS: This study demonstrated that a wide variety of dermatologic conditions occurred frequently in the lower extremity amputee who functionally used a prosthesis. Five types of skin problems accounted for nearly 80% of the skin lesions identified. Future studies are required to evaluate prevention and management of the most frequent skin problems.

Adult↗

PubMed1988

Mobility after amputation for failed knee replacement.

Management of the failed total knee replacement is a formidable problem. In a 13-year period, 24 patients with above knee amputation following unsuccessful knee replacement were referred for prosthetic limb fitting. Adequate data was available for 23 patients. At review (or at the time of death), an average of 48.6 months after amputation, only seven of the 23 patients were regular daily walkers, although 10 patients had managed to walk for more than two years; 20 of the 23 used a wheelchair for some part of the day and 12 were confined to a wheelchair.

Activities of Daily Living↗

PubMed1992

Running gait impulse asymmetries in below-knee amputees.

In running, large gait asymmetry is expected due to the inability of the foot prosthesis to comply with the kinematic demands and produce a powerful plantarflexion moment. In this work, interlimb asymmetry in below-knee (BK) amputee running gait was assessed for one rigid and three flexible keel prostheses, using vertical and anteroposterior ground reaction forces and respective impulses. Nine BK amputees and 6 controls participated in this study. The running speed was monitored by two light sensitive detectors while the ground reaction forces were measured with a Kistler force plate. Between the prosthetic side and the sound limb the impulse indicator showed greater asymmetry than the force. Interlimb asymmetry was very much present in all types of prosthesis tested but is less pronounced in the flexible keel prostheses. In the latter, the asymmetry may be associated with the force-time history modulation rather than its magnitude alone. Generally, the impulses better describe interlimb asymmetry and the forces allow a greater discrimination between prosthetic foot types.

Adolescent↗

PubMed1986

Osteogenic sarcoma.

Guarded optimism could be clearly stated for the treatment of osteogenic sarcoma. Improved methods of diagnosis and staging have been made possible by the computed tomography (CT) scan and other new modalities. The advent of pre- and postoperative chemotherapy has significantly enhanced survival rates that are now approaching 85%. Improved concepts of en bloc resection and better reconstructive techniques suggest that limb salvage procedures are not only possible but can provide excellent functional results in the context of muscle loss. Continued work must be directed toward improving the reconstructive techniques to provide implants with permanence, particularly for young patients and to clearly define the indications for such procedures. Patients presenting with thoracic lesions, although difficult to treat, can expect a 30%--45% long-term survival following repetitive thoracotomies.

Adolescent↗

PubMed1987

Amputation in the diabetic: ten years experience in a district general hospital.

Over a period of 10 years, 149 amputations were performed for lower limb ischaemia in 119 diabetic patients. Thirty patients required amputation of the second limb. Ninety per cent of the patients were over the age of 60 years. Sixty four ischaemic limbs were treated by primary local amputation or debridement--29 healed successfully, 30 proceeded to a higher amputation. The incidence of multiple local operations was high. A below knee amputation was performed in 56 limbs--7 failed to heal and required a more proximal amputation. Seventy five patients in the series have died; 58 of these survived less than 3 years from their first amputation. The hospital stay for all patients was long; for an unsuccessful local amputation the average stay was 109 days. Conservative management with the Scotchcast boot has been shown to be satisfactory. This must be compared with the significant costs to the patient of early operative intervention.

Adult↗