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At least 1,423 records · Page 79Linked to original sources

PubMed1997

Role of Gritti-Stokes amputation in peripheral vascular disease.

The perigenicula lower limb amputations performed for peripheral vascular disease in Nottingham between April 1987 and September 1992 were reviewed. Of the 434 amputations, 173 were below-knee amputations (BKA), 144 Gritti-Stokes amputations (GSA) and 117 above-knee amputations (AKA). The 30-day mortality was significantly greater for AKA patients than either GSA or BKA patients. There was no difference in mortality within 30 days of amputation between GSA and BKA. Re-amputation rate to a more proximal level was significantly higher in BKA compared with GSA. Mobility after prosthetic rehabilitation was assessed using the Stanmore grading. A greater number of patients achieved mobility grade III and above in the GSA and BKA groups when compared with the AKA group, but there was no significant difference between GSA and BKA groups. At follow-up, a median of 23 months after amputation, there was a tendency for more patients to have given up using their limb prosthesis in the GSA group than either the BKA or AKA groups. However, there remained no significant difference between the BKA and GSA groups in the numbers of patients who remained successfully rehabilitated to Stanmore grade III or above. When a BKA is not possible, GSA offers a better prospect for rehabilitation compared with AKA in patients with occlusive arterial disease.

Adult↗

PubMedDate not supplied

[Changes in technological orthopedics--function and esthetics].

A few famous historical examples of prosthetic and orthotic treatments of the upper and lower limbs are studied from the point of view of their function and aesthetics. For a long period the main emphasis was put on function. Since Ambroise Paré (1510-1590) aesthetics has been taken increasingly into consideration. In order to satisfy the growing functional and aesthetic expectations of our patients a close collaboration between physician and craftsman is essential. A hundred years ago Albert Hoffa (1859-1907) insisted that mechanical workshops be set up in Orthopaedic University Clinics. His demands are as actual as ever.

Artificial Limbs↗

PubMed2004

[Famous cases for amputation].

After a short historical survey 14 cases of celebrated personalities one woman and 13 men, with the grave handicap of amputation are represented. The causes of the lost limbs, once of the nose, were battle injuries (guns) or accidents. In many cases the protheseology followed the amputation, dependent on the technological level of the day. Often medical providing was bad and terrible. The introduction of anaesthesia changed the amputation technique. During different periods from renaissance to the first half of the twentieth century remarkable fates happened. Heroes as the emperor Friedrich III., the knight Goetz von Berlichingen, well known by the spectacle of Goethe, the scientist Tycho Brahe, the merchant and skipper Peter Stuyvesant, the military men Duke Christian II. of Braunschweig-Lueneburg-Wolfenbuettel, William Bayly, Admiral Lord Nelson and Earl Claus Stauffenberg, the actress Sarah Bernhard, the squadron leader of RAF Douglas R. S. Bader and other gave an excellent example for fulfilled life despite handicap. With their artificial legs, arms or hands they rode, fought, shoot, made sports etc.

Amputation, Surgical↗

PubMed2001

Consequences of non-vascular trans-femoral amputation: a survey of quality of life, prosthetic use and problems.

Individuals with unilateral trans-femoral amputations due to non-vascular causes were studied in a mailed survey designed to investigate health-related quality of life (HRQL), prosthetic use and problems. The Swedish SF-36 Health Survey and a structured questionnaire designed for trans-femoral amputees were used. The series consisted of 97 subjects (60 men, 37 women), aged 20 to 69 years with a mean of 22 years since the amputation. Trauma was the cause of amputation in 55%, tumour in 35% and other causes in 10%. Ninety-two (92) subjects (95%) had a prosthesis and 80 (82%) used it daily. General HRQL was significantly lower than Swedish age- and gender-matched norms in all dimensions as measured by SF-36. Most frequently reported problems that had led to reduction in quality of life were heat/sweating in the prosthetic socket (72%), sores/skin irritation from the socket (62%), inability to walk in woods and fields (61%) and inability to walk quickly (59%). Close to half were troubled by stump pain (51%), phantom limb pain (48%), back pain (47%) and pain in the other leg (46%). One fourth considered themselves to have a poor or extremely poor overall situation. Transfemoral amputation, due to non-vascular causes, has an evident impact on quality of life and there are considerable problems related to the amputation and the prosthesis. Efforts to improve the physical and the psychological well-being for this group, with a long life expectancy, are needed.

Activities of Daily Living↗

PubMed1976

Total joint replacement in extremities with below-knee amputations.

Patients with knee and hip joint diseases or fractures in a limb with a distal portion amputated were successfully treated with total joint arthroplasties. Two patients with below-knee amputations recieved total joint replacements. One underwent a total hip arthroplasty and the other had a total knee arthryplasty on the side of the amputation. Physical therapy was modified minimally for the two patients in comparison to other patients with total joint replacements. Prosthetic changes were required in both cases. With new prostheses, both patients were able to return to work.

Adult↗

PubMed1995

Conventional 4-bar linkage knee mechanisms: a strength-weakness analysis.

The purpose of this article is to inform clinicians of the relevant knowledge gained from research in the field of prosthetics. From a biomechanical point of view, clinicians need relevant knowledge in order to properly prescribe a lower limb prosthesis, including prosthetic components. In this context, and due to the lack of data regarding their utility, a strength-weakness analysis of 8 types of 4-bar linkage knee mechanisms has been carried out. Free-moving knees are intrinsically stable in the stance phase of walking when the O degrees center of rotation is behind the femur head to heel line. This was found in 5 of the 8 knees. Furthermore, bending the knee at toe-off requires force. The hip-flexion-torque required is smaller when the O degrees center of rotation is closer to the femur head to toe line and is dependent on the measure of axial load. Comparatively, however, much energy is usually still necessary. This can be improved. The maximal axial residual limb load, the maximal hip-moment, and the energy required are, on investigation of the knees, approximately the same in relation to the walking speed during the swing phase of gait. Friction influences the swing characteristics of the prosthetic lower limb considerably. In this context, little is yet known about swing phase knee control units. The present 4-bar linkage knees-with-lock are a derivation of the free-moving knees. Their movement characteristics, and often heavy construction, are of no relevance when walking with a fixed knee. In proportion, much energy is required. Therefore, there is a demand for a simple knee mechanism that moves freely during the swing phase, locks at the beginning of the stance phase, and unlocks at the end of it.

Artificial Limbs↗

PubMed1997

Interface pressures and shear stresses at thirteen socket sites on two persons with transtibial amputation.

Residual limb/prosthetic socket interface pressures and shear stresses were measured at 13 sites on two subjects with unilateral transtibial amputation (TTA) using total-contact patellar-tendon-bearing prostheses. Maximal interface stresses during stance phase for each of 13 transducer sites were determined, then means for all steps calculated. Maximal pressure and resultant shear stress during stance phase were shown at anterior distal or mid-limb sites and the maxima occurred during the first 50% of stance phase. Anterior medial and lateral proximal sites showed their greatest pressure during the second 50%. At lateral mid-limb and popliteal fossa sites, resultant shear stress directions suggest that soft tissue was displaced toward the socket brim during weight-bearing. Results also suggest that skin across the distal tibial crest was in tension at the times of the first and second peaks in the shank axial force-time curve in all sessions. Significant difference (p < 0.05) in maximal stresses between sessions conducted > 3 weeks apart were apparent for both subjects.

Adult↗

PubMed1999

In vivo indentation of lower extremity limb soft tissues.

In vivo rate-controlled indentation tests were conducted on the soft tissues of the residual limbs of five individuals with trans-tibial amputation and the right calf of five nonamputees. Force relaxation trials were also conducted. The cyclic indentation tests indicated that the bulk soft tissue response to compressive load is nonlinear and rate-dependent. Inter- and intrasubject stiffness variations were observed. The force relaxation studies indicated that approximately 55-95% relaxation may occur, with equilibration typically occurring in less than 60 s. Most of this relaxation (35-80%) occurred within 5 s after loading.

Adult↗

PubMed1996

Statistical analysis of amputations and trends in Korea.

Epidemiological research on amputees is being continued extensively world wide, but there are different epidemiologic reports from country to country. This study undertakes an epidemiologic report of the medical records of amputees in Korea which has developed very rapidly, when compared with other countries. This study included 4258 amputees who either had an amputation and/or received prosthetic training at Yonsei University College of Medicine, Severance Hospital from January 1970 to June 1994. The most common cause of amputation was trauma (66.7%), and the second most common cause was peripheral vascular disease. While amputations due to infection or trauma were the most common in the 1950's, amputations due to peripheral vascular disease have gradually increased until they now make up 23.5% of all amputations in the 1990's. Lower limb amputation, more common than upper limb amputation, accounted for 68.7% of all amputation. Multiple amputation accounted for 9.3% of all amputations, and the occurrence rate of multiple amputation was relatively higher in cases of burn injuries, train accidents, frostbite, and Buerger's disease than in cases brought about by other causes. The various amputation causes change according to the circumstances of the times, as can be seen in this study.

Adolescent↗

PubMed1996

Predicting prosthetic rehabilitation outcome in lower limb amputee patients with the functional independence measure.

OBJECTIVE: To determine the value of the Functional Independence Measure (FIM) score as a prognostic indicator for prosthetic use in the lower limb amputee patient. DESIGN: Cohort study of 41 patients with lower limb amputations. SETTING: University hospital rehabilitation unit. MAIN OUTCOME MEASURES: FIM motor subscore and Houghton Scale for prosthetic use. RESULTS: FIM score on admission did not correlate with prosthetic use as measured by the Houghton Scale; however, FIM motor subscore at discharge did. CONCLUSION: The admission FIM score is not useful in predicting successful prosthetic rehabilitation in lower extremity amputee patients. Only the motor subscore at discharge correlates with the use of prosthesis.

Activities of Daily Living↗

PubMed1992

Functional benefit of an adaptive myoelectric prosthetic hand compared to a conventional myoelectric hand.

Eight patients with a traumatic unilateral upper limb amputation, who used conventional myoelectric prostheses, were also fitted with a commercially available myoelectric prosthetic hand with an adaptive grip, in order to compare the functional benefit of the two types of prostheses. Comparisons were made regarding width of grip, force of grip, scores in a standardised grip function test and prosthesis preference. The conventional prosthesis showed significantly better results regarding these parameters. The adaptive hand does not appear to be fully developed for practical use in prosthetic rehabilitation.

Adaptation, Physiological↗

PubMed1999

The use of self organizing maps to evaluate myoelectric signals.

This paper presents a study of the use and accuracy of self-organizing maps (SOM) in classifying myoelectric signal properties. Myoelectric signals were obtained and classified for four upper-limb movements (elbow flexion, elbow extension, wrist pronation and wrist supination) and their force category. This was done for isolated actions as well as for multiple action sequences. The success of the developed SOM ranged from 92%-97% when determining the motion, from 81%-87% in determining the force category, and from 59%-96% in determining sequences of motions. These successes are encouraging for the continued development of this technique for use in controlling real-time complex motions in prosthetic devices.

Action Potentials↗

PubMed1994

[Indications for replantation of lower limbs after their traumatic amputation at the shin level].

From analysis of the results of replantation of 37 lower limbs at the level of the leg, which were amputated as the result of injury in 33 patients, the authors determine the tactical approach to the choice of indications for replantation. The authors believe that replantation at the level of the leg is always indicated in children if it is executable technically and the patient's somatic status presents no general contraindications. In other cases the formation of a stump and subsequent prosthetics should be considered more advisable.

Adolescent↗

PubMed1990

[Problems and techniques of functional rehabilitation of upper limb stump].

The authors discuss problems and techniques of rehabilitation in subjects who have undergone upper limb amputation, as well as the requirements for good application of a prosthesis. Various types of prostheses are described: passive ones, those moved by the body and externally operated ones. The amputee undergoes three stages of rehabilitation: a general preparatory phase for maintenance of good joint function and muscle efficiency; a phase of specific rehabilitation with the help of electromyometry and an electronic training device for the use of the prosthesis, and finally individual and group exercises in laboratories with special facilities.

Amputation Stumps↗

PubMed1998

Sensory changes in adults with unilateral transtibial amputation.

The purpose of this study was to describe the sensory changes in adults with unilateral transtibial amputation (TTA), as any loss of sensation may have significant impact on the successful use of a prosthesis. Sensory modalities of light touch, deep pressure, vibration, and superficial pain (pinprick) were examined on the residual and contralateral limbs of 16 veterans with TTA. Six Subjects demonstrated normal sensation on the contralateral limb and impaired sensation of superficial pain, vibration, and/or light touch on the residual limb. Superficial pain was the most frequently impaired sensation, and vibration and superficial pain sensation appeared to be age-dependent, with increased impairment observed in the elderly. Deep pressure sensation was intact in all subjects. These preliminary data suggest that although neither the amputation nor the prosthetic rehabilitation resulted in impaired deep pressure sensation, these two factors contributed to minimal impairment of light touch and vibration, and significant impairment of the superficial pain sensation.

Adult↗

PubMed1988

Traumatic amputation of the upper limb: the use of body-powered prostheses and employment consequences.

Forty three patients with unilateral traumatic amputations were reviewed as to the use of prostheses and employment consequences of the amputation. Seventeen of 19 below-elbow amputees, and 12 of 24 above-elbow amputees used their prostheses. Non-users compared to users of prostheses were characterized by: 1) Higher level of amputation 2) Non-dominant arm amputation and 3) Younger age at the time of amputation. However non-users usually did well on the labour market for various reasons.

Adult↗

PubMed2005

Prosthetic management of the partial foot amputee.

Partial foot amputations provide advantages and challenges to the patient confronting loss of limb and the rehabilitation team. The partial foot amputation offers the potential for retention of plantar load-bearing tissues that are capable of tolerating the forces involved in weight bearing; this can allow the patient to ambulate with or without a prosthesis. Because of the complexity of the foot-ankle complex and the multiple types of partial foot amputations encountered, choosing the appropriate prosthesis can be challenging. This article explains some of the rationale and common options available for the different levels of amputation.

Amputation, Surgical↗

PubMed1999

Dimensional change in muscle as a control signal for powered upper limb prostheses: a pilot study.

The vast majority of externally powered prostheses are controlled from the myoelectric signal, measured at the skin surface using socket-located electrodes. This signal has been well researched and sophisticated signal processing methods developed. Nevertheless, the inherent properties of the signal, such as its broad bandwidth and low voltage amplitude, make its use less than straightforward in the control of low frequency activity such as powered prosthetic hand movement. This paper reports on a pilot study of an alternative, a signal derived from dimensional change in muscle. A new socket-located sensor was designed to measure dimensional change in muscle, the linearised output of which is termed the myokinemetric (MK) signal. This was used in a series of tasks aimed at investigating the potential for its use in upper-limb prosthesis control. Six amputee subjects were tested, of whom one was a regular user of the myoelectric hand, one had some experience, and four had little or no previous experience of controlling devices using their residual limb. Data is presented on the problems of shift in signal range with time and socket donning and doffing and on the ability of subjects to control the amplitude of the signal. The results show that subjects were able to control the magnitude of the MK signal to a significant degree, with typical errors averaging 0.1-0.3 mm, around 10% of the signal range. The principal problem encountered was the shift in signal with time and socket donning and doffing.

Adult↗