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PubMed1990

A function of the talocalcaneal joint during running support.

This study explored the possible function of the talocalcaneal joint during running support to minimize frontal plane rotation of the leg and thereby protect the knee from excessive frontal plane motions. The lower limb was modeled as two rigid segments representing the foot and the leg. The results indicated that for extreme ground-foot angles the talocalaneal joint was able to maintain the knee in a stable position in the frontal plane. It was concluded that the joint may function to minimize frontal plane rotation of the leg and thereby protect the knee from excessive frontal plane motions. The relevance of this function for a below-the-knee-amputee patient lies in the potential for improved prosthetic design.

Ankle Joint↗

PubMed2004

Interlimb symmetry of traumatic unilateral transtibial amputees wearing two different prosthetic feet in the early rehabilitation stage.

This study evaluated the SACH and the Greissinger Plus prosthetic feet, in terms of the symmetry provided between the lower limbs, in the case of unilateral transtibial amputees 16.3 weeks from the time of limb fitting and 38.9 weeks from surgery. Sagittal plane gait analysis was carried out for nine right-limb traumatic amputees. In all examined cases, the spatial and temporal parameters measured were significantly improved. When the symmetry indexes of the same parameters calculated with three different methods were considered, significant improvement was observed for the hip and ankle ranges of motion and the stance phase period. However, no significant differences were found for the symmetry indexes of the knee range of motion, cadence, and walking speed. In addition, for most spatial parameters, the statistical significance varied considerably among the three methods used for the analysis of symmetry.

Amputation, Traumatic↗

PubMed1985

Active plantar-flexion above-knee prosthesis: concept and preliminary design.

Lower limb prostheses produced so far do not replace the function of the musculature, which provides the necessary amount and the proper distribution of energy to the ambulatory mechanism. Provision of external power to lower limb prostheses has been hindered by the fact that the large amount of energy needed at a lower limb necessitates the use of external power sources of unacceptably high mass and volume. Self energized mechanisms offer a promising alternative to the problem. Normally a large part of energy output during locomotion appears at the ankle joint. It seems therefore desirable to develop an above-knee prosthesis featuring active plantar-flexion at the ankle. Energy may be offered by a self energized system. The system, described here, accumulates energy during the passive movements of the knee and ankle joints and stores it for later use at the ankle.

Ankle Joint↗

PubMed1990

The Edinburgh-ORLAU prosthetic system to provide reciprocal locomotion in children and adults with complete transverse lower limb deficiency.

A novel prosthetic system to provide reciprocal locomotion in children and adults with complete transverse lower limb deficiency is described. This is based on the hip joints from the ORLAU ParaWalker, a system with a proven record of success in the orthotic management of paraplegic patients. The fitting of the prototype system to an eight year old girl is described. This experience shows that the orthotic principles of the ParaWalker, which provides reciprocal locomotion for the paraplegic, is equally applicable to the prosthetic situation. Developments are therefore continuing to improve the design and to enable further fittings.

Artificial Limbs↗

PubMed1983

Prosthetic fitting in lower limb amputees.

A series of 320 patients with lower limb amputations was analyzed. Among patients admitted from home the risk of death in hospital, was 24 per cent (28/119) following AK amputation, as compared to 14 per cent (6/43) after TK amputation and 12 per cent (12/103) after BK amputation. Successful prosthetic fitting was achieved in 41 per cent (43/91) after AK amputation, 75 per cent (28/37) after TK amputation and 70 per cent (64/91) after BK amputation, including the 21 per cent (45/219) of patients discharged to a nursing home.

Adult↗

PubMed1998

Experimental development of a sensory control system for an upper limb myoelectric prosthesis with cosmetic covering.

A sensory control system based on the force-sensing resistor (FSR) for an upper limb prosthesis has been designed for application to a commercial prosthetic hand of proven reliability. In particular, FSR sensors have been used to control the strength of the grip on objects. Moreover, the problem of the object possibly slipping from the grip has been addressed by a system based on an optical sensor for detecting movement. Tests on different everyday objects have shown the feasibility of the above approach, given the constraints of the limited dimensions of the prosthesis and the presence of a cosmetic glove.

Arm↗

PubMed2001

Clinical results of an investigation of paediatric upper limb myoelectric prosthesis fitting at the Quebec Rehabilitation Institute.

This study was designed to investigate the satisfaction level of young users of myoelectric prostheses who received an upper limb myoelectric prosthesis, to assess their dropout rate and to identify which factors influence the use or non-use of the upper limb myoelectric prosthesis in the eastern part of Quebec (Canada). The users were fitted between 1990 and 1999 at the Quebec Rehabilitation Institute, a major rehabilitation centre located in the province of Quebec. This rehabilitation centre provides cutting-edge expertise not only for the eastern part of Quebec, but also across the entire province, because it is one of only two highly specialised centres serving all of Quebec. A literature review was completed to compile the results obtained in other rehabilitation centres and to identify factors influencing the use or non-use of paediatric upper limb myoelectric prostheses. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) was used in order to assess the degree to which the children were satisfied with their prostheses. Eighteen (18) children were fitted and trained to use an upper limb myoelectric prosthesis. A total of 10 children and parents agreed to participate. Some 80% of participants said that they were satisfied with their prostheses. A dropout rate of 53% for the overall group (participants and non-participants) seems high compared with that of other studies. Recommendations linked to factors identified in the literature are made. The authors conclude that a multidisciplinary team and structured training and follow-up can improve the clinical results pertaining to all the factors proposed in the literature.

Adolescent↗

PubMed2005

A comparative evaluation of oxygen consumption and gait pattern in amputees using Intelligent Prostheses and conventionally damped knee swing-phase control.

OBJECTIVE: To compare the gait of amputees wearing conventionally damped pneumatic swing-phase control knees and microchip-controlled Intelligent Prostheses. DESIGN: Crossover trial. SETTING: An amputee rehabilitation centre in a teaching hospital. PARTICIPANTS: Ten established unilateral transfemoral prosthetic users were asked to participate in the trial; all agreed. INTERVENTIONS: The amputees were assessed wearing pneumatic swing-phase control knees and then with the Intelligent Prosthesis. MAIN OUTCOME MEASURES: Oxygen consumption while walking at different speeds on a treadmill, video-recording of gait assessed by a panel and temporal-spatial parameters of gait whilst walking at slow, fast or normal speeds in a gait laboratory. RESULTS: Mean oxygen cost for all subjects at 0.69 m/s was 0.33 ml/kg.m with the conventional limb and 0.30 ml/kg.m with the Intelligent Prosthesis (p = 0.01). At 1.25 m/s the mean oxygen cost for the conventional limb was 0.24 ml/kg.m and for the Intelligent Prosthesis was 0.22 ml/kg.m (not significant). The ANOVA analysis showed that oxygen cost was similar at normal walking speeds but increased more at lower speeds for the pneumatic swing-phase control leg compared to the Intelligent Prosthesis (p < 0.02). There were no significant differences in subjective gait evaluation or temporal and spatial gait parameters. CONCLUSION: At lower speeds oxygen cost was lower with the Intelligent Prosthesis. Gait analysis detected no significant changes between the two legs.

Adult↗

PubMed2005

Dermatologic conditions associated with use of a lower-extremity prosthesis.

OBJECTIVES: To document the frequency of skin problems among lower-limb prosthesis users and to assess for factors associated with skin problems among patients using a prosthesis. DESIGN: Six-year retrospective chart review. SETTING: An outpatient amputee clinic at a regional, referral rehabilitation hospital in Canada. PARTICIPANTS: Seven hundred forty-five subjects with a total of 828 lower-extremity amputations participated. Subjects were included if they had a lower-extremity amputation and used a prosthesis for ambulation or transfers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The presence or absence of a skin problem. Descriptive and nonparametric statistics were used to analyze data. RESULTS: Three hundred thirty-seven residual limbs (40.7%) had at least 1 skin problem. Adjusted odds ratios showed that amputation level, being employed, type of walking aid, and absence of peripheral vascular disease (as a comorbidity) were independently associated with the presence of at least 1 skin problem ( P <.05). CONCLUSIONS; Dermatologic conditions are a frequent complication for the lower-extremity amputee who uses a prosthesis. The results suggest that more active amputees have an increased risk for developing skin problems. Further study in this area is warranted.

Aged↗

PubMed1976

Lower limb amputation in a general hospital: a comparative review.

This paper presents the results of a recent review of lower limb amputations carried out in a general hospital, and compares them with those of previous study of similar amputations. Particular attention is paid to the type of amputation-below-knee, through-knee or above-knee--and the associated morbidity, mortality and rehabilitation prospects. There is a need for an active approach to the problems of amputation with emphasis on preoperative preparation of the patient, the operation itself and rehabilitation follow-up in an amputation clinic.

Activities of Daily Living↗

PubMedDate not supplied

[A surgical method in the complex treatment of metastatic bone tumors].

The article deals with the results of operations applied in the system of complex treatment of 83 patients (86 operations) with metastases of malignant tumours in the skeletal bones. Fourteen patient had carcinoma of the lung, 23--carcinoma of the breast, 28--carcinoma of the kidney, 8--carcinoma of the thyroid gland, and 10 patients had other malignant tumors. Operative interventions in the form of resection of the articular end or total removal of a tubular bone with endoprosthesis in affection of a long tubular bone and its pathological fracture or the threat of such fracture were substantiated. In the presence of special indications, osteosynthesis of the pathological fracture or amputation (exarticulation) of the limb may be undertaken. Laminectomy is indicated in metastatic lesion of the spine with the development of neurological disorders. Four (5%) patients died in the postoperative period. Average survival in the group of patients was 35 months, in the separate groups it was as follows: lung carcinoma metastases--9 months, kidney carcinoma metastases--31 months, thyroid carcinoma metastases--37 months, breast carcinoma metastases--40 months, metastases of other forms of malignant tumors--30 months. Longest survival--7.5 years. Average value of life quality according to Karnovsky was 30% before operation and 67% after it.

Amputation, Surgical↗

PubMed1991

The influence of limb alignment on the gait of above-knee amputees.

Biomechanical gait tests on above-knee amputees were conducted in which the alignment of the prosthesis was changed systematically. An eight-segment biomechanical model of the above-knee amputee was developed to analyse and present the three-dimensional kinematic and kinetic data obtained. The effects of alignment changes on the above-knee amputees' gait were studied in terms of the angular displacements of the lower limbs, ground reactions and intersegmental moments. It was found that following the alignment changes the angular displacement at the hip joint on the prosthetic side showed compensatory actions by the amputee. The ground reaction force was sensitive to alignment changes, and in particular, the changes in the characteristics of the fore-aft component of the ground force could be related to the alignment changes. The antero-posterior intersegmental moments at the prosthetic ankle and knee joints were evidently influenced by alignment.

Amputation Stumps↗

PubMed1988

[En-bloc resection with immediate reconstruction of malignant tumor of the humerus--report of 9 patients].

From March 1966 to June 1985, 9 patients with humerus malignant tumor were treated by en-bloc resection and immediate reconstruction. There were 5 males and 4 females. The ages ranged from 18 to 74 with an average of 38.3 years. These 9 lesions were diagnosed by pathology as malignant giant cell tumor of the bone (2), chondrosarcoma (2), reticulum cell sarcoma (1), osteoblastoma (osteosarcomatous) (1), osteogenic sarcoma (1) and metastatic cancer (1) clear cell cancer and 1 thyroid cancer), located either in the upper or lower end of the humerus. Cutting margin was 4-7 cm from the tumor. The length of resected humerus was 10-18 cm. Simple excision without reconstruction was done only in 1 patient. The bone defect after resection was reconstructed with autogenous fibular graft in 3 patients, replantation of the limb in 2, one of whom was added with prosthesis for reconstruction of the elbow function, humerus prosthesis in 2 and elbow prosthesis in 1. All the patients were followed. Only two had died and 7 are still alive without evidence of disease. The longest survival was 20.5 years and the shortest, 18 months with an average of 10.1 years. The causes of death (1 osteoblastoma and 1 osteogenic sarcoma) were recurrence and lung metastasis. The indication, extent of excision and causes of recurrence are discussed.

Adenocarcinoma↗

PubMed1996

Rehabilitation of lower limb traumatic amputees: the Sandy Gall Afghanistan Appeal's experience.

Physical rehabilitation after lower limb traumatic amputation due to acts of war has not yet been investigated. It has been shown that patients suffering non-war injuries rehabilitate well. This study shows that despite the difficult circumstances and limited resources available in an area of conflict, good rehabilitation of war victims is possible. However, economic rehabilitation is worse than that seen in non-war populations. Given that this type of injury is very common in war zones worldwide, this failure of economic rehabilitation may represent a major healthcare issue.

Adolescent↗

PubMed2002

Neurovascular calcaneo-cutaneus pedicle graft for stump capping in congenital pseudarthrosis of the tibia: preliminary report of a new technique.

The operative treatment of congenital pseudarthrosis of the tibia, especially when associated with neurofibromatosis type I (Recklinghausen's disease), often leads to failure. Frequently, regardless of the type of deformity, multiple operative procedures end in the amputation of the affected limb. Soft tissue coverage of the amputation stump may confront the surgeon with new problems. Secondary perforation of the soft tissue envelope of the stump owing to terminal overgrowth is not a rare complication. A new technique of stump capping is demonstrated in a 10-year-old boy and a 14-year old girl, both with congenital pseudarthrosis of the tibia of the right leg and neurofibromatosis. During this procedure, a radical resection of the pseudarthrotic tissue is performed although all neurovascular structures supplying the calcaneus are carefully maintained (Arteria, vena et nervus tibialis posterior et peronealis). Subsequently, the tibia and fibula are inserted into the calcaneus. This construct is stabilized with two crossed Kirschner wires. Afterwards, the skin of the lower limb and the hindfoot are sutured together covering the neurovascular bundles, which are arranged in a loop-like fashion. The documented active range of motion was similar to that of the unaffected knee joint. Twelve weeks after operation in both patients, full weight bearing was achieved with a lower-leg prosthesis. This new procedure leads to a durable, full weight-bearing stump with complete sensitive innervation without the risk of future soft tissue perforation caused by the growing bone. The stump fits with an end-bearing lower-leg prosthesis.

Adolescent↗

PubMed2003

[The 3D finite element stress analysis of transtibial monolimb].

In this study, a 3D model of a transtibial monolimb and residual limb was constructed. The stresses on all nodes of the model under the simulus of the load at the Mid-Stance were computed through 3D finite element analysis (FEA). The stress distribution on the internal and external surfaces of the model was obtained. The results indicate that the stresses on socket are lower than those on prosthetic shank; high stress regions are located on the underneath of prosthetic shank and the border section of socket and prosthetic shank. These data will be useful for CAD\CAM system of monolimb designing.

Artificial Limbs↗

PubMed1989

Performance assessment of the Terry Fox jogging prosthesis for above-knee amputees.

The Terry Fox jogging (TFJ) prosthesis was developed at Chedoke-McMaster Hospital to alleviate the asymmetric jogging pattern experienced by above-knee amputees when attempting to jog with conventional walking prostheses. This prosthesis features a spring-loaded, telescoping shank designed to eliminate any vaulting action and control the trunk motion during stance. The spring is intended to attenuate the impact forces and release its stored energy at push-off to provide momentum transfer to the jogger. This prosthesis was comprehensively assessed in the gait laboratory, by evaluating the kinematics, energy and power flow patterns of an above-knee amputee jogger wearing the TFJ prosthesis. Included in the assessment is the ability of the prosthesis to satisfy a set of relevant design criteria that have been established from non-amputee jogging patterns. An increased swing phase time for the prosthetic limb and the need to have the knee hyperextended throughout the stance phase contributed to an asymmetric jogging style. The telescoping action did lower the amputee's centre of mass, thereby reducing the vaulting effect. However, the spring only imparted a lifting action to the jogger and the ground reaction forces were double those of a non-amputee jogger. These findings clearly indicate a need to redesign the TFJ prosthesis and are being incorporated in the design of a new physiological jogging prosthesis.

Adult↗

PubMed1998

Finite element modelling of a residual lower-limb in a prosthetic socket: a survey of the development in the first decade.

A review is presented of the existing finite element models developed from 1987 to 1996 for the biomechanics of lower-limb prostheses. Finite element analysis can be a useful tool in investigating the mechanical interaction between the residual limb and its prosthetic socket, and in computer-aided design and computer-aided manufacturing of prosthetic sockets. Various assumptions and simplifications are made in these models to simplify the actual problem with complex geometry, material properties, boundary and interfacial conditions, as well as loading situations. The analyses can provide the information on the stress distribution at the stump/socket interface and within the residual limb tissues. More recently, nonlinear models have been developed taking into consideration the process of socket rectifications, the slip/friction conditions and material large deformation. The models so far developed have provided some basic understanding of the biomechanics. Comparison of the predictions of these models with experimental measurements indicated that the predicted stresses were within the ranges measured, although one-to-one correspondence was difficult to achieve. Further research is still required in order to improve these models to obtain higher precision in the results taking into account nonlinear and dynamic effects.

Artificial Limbs↗