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PubMed2000

Factors conditioning the return to work of upper limb amputees in Asturias, Spain.

Reintegration into a social and work environment, as the final objective rehabilitation therapy, is one of the greatest challenges faced in this speciality. The aim of this study was to analyse the reintegration into the workforce of 43 upperlimb amputees in Asturias, Spain (1,100,000 inhabitants) whose amputations were as a result of accidents at work. For this purpose various factors related to their return to work were studied. The most important factor was the year in which the amputation was carried out, since reintegration was more likely to occur in those amputees whose accident at work took place before the 1980s.

Accidents, Occupational↗

PubMed1998

An evaluation of the use made of cosmetic and functional prostheses by unilateral upper limb amputees.

There is currently a distinction drawn between a prosthesis considered to be provided for purely cosmetic reasons and a functional prosthesis provided to enable the amputee to achieve basic hand function. Using video analysis the study reported in this paper demonstrates that for non-manipulative actions cosmetic prostheses are actively used in the performance of everyday tasks as frequently as functional prostheses. The study provides evidence for a cosmetic prosthesis to be presented to an amputee as a realistic initial prosthesis and not as the option of last resort if a functional prosthesis is rejected. It is also recommended that training is provided in the use of cosmetic prostheses in two-handed tasks.

Adolescent↗

PubMed2005

[Inertial effects on interface pressure between prosthetic socket and residual limb].

A quantitative understanding of interface pressure distribution between prosthetic socket and residual limb is fundamental for an optimal design of prosthesis. Most of traditional finite element (FE) models were static. In this paper a 3-D nonlinear finite element model was developed according to the data of one transtibial amputee. The interface pressures at residual limb were predicted, and the effect of inertial loads was investigated quantitatively. The results show that interface pressures were mainly distributed at patella tendon, lateral tibia, media tibia and popliteal depression regions. Interface pressure had the similar double-peaked waveform in stance phase. The average difference in interface pressure between the two cases with and without consideration of inertial loads was 8.4% in stance phase, while it was up to 20.1% in swing phase with considerably different change trend. It is found that inertial effects during walking can not be ignored.

Artificial Limbs↗

PubMed1986

Evaluating the Contourhook--help or hindrance?

A new Contourhook terminal device was introduced to the Central Development Unit (CDU) in Australia through the therapist attending the exhibit at the ISPO World Congress, London, September, 1983. Ten upper limb amputees, who were experienced prosthetic users were selected for the evaluation. The patients were asked to attend the CDU to perform selected activities; 7 activities were designed to simulate hand prehension and 17 were bimanual activities of daily living. The activities were performed using the conventional split hook terminal device. The same activities were repeated using the Contourhook terminal device. Performances and patients' comments were recorded. In general the Contourhook was found to compare unfavourably with conventional terminal devices, aspects of the brochure were misleading and all patients preferred their previously worn terminal device.

Adolescent↗

PubMed2001

[Classification and mechanisms of body perceptions in the amputees].

OBJECTIVE: Amputees can experience several types of physical illusions and phantom limb phenomenon. The objective was to establish a synthetic classification of theses perceptions. METHOD: Prospective study in 75 amputees (group 1: amputation (n = 60), group 2: congenital defect). The subjects were asked first to report their perceptions spontaneously and then to detail the perception, if exist, of the missing limb: form recognition, posture, movement, reminiscence of a lost limb. RESULTS: Different types of perception were described besides the perception of the real state : normal, deformed or commemorative phantom limb and illusion of a normal body. DISCUSSION: Whatever the model (i.e.: neuro-matrix) which support the construction of the scheme and the body image, the representations related to identified perceptions, use various innate, autobiographic and identity frames of references as well as instantaneous peripheral information, treated by reorganized cerebral structures. Each type of perception is related to a particular representation pattern. CONCLUSION: This approach, in accordance with the literature, offers a better understanding of the differences between amelic and amputated subjects and of their perception of any prosthetic equipment.

Amputees↗

PubMed1998

Major replantation versus revision amputation and prosthetic fitting in the upper extremity: a late functional outcomes study.

The functional outcomes of amputated arms that were either replanted or had a prosthesis were compared. In addition, factors that influenced the functional outcome of replants were evaluated. The Carroll test was used to evaluate functional capacity of 22 successful upper extremity replantations at or proximal to the wrist as well as 22 amputees (at similar levels) fitted with a variety of prosthetic devices. The outcome was excellent or good in 8 (36%) replanted limbs. This proportion was statistically higher than those grades in the prosthetic group. When the groups were more closely matched (adults with below elbow injuries), the replantation group had 6 (50%) good or excellent outcomes and the prosthetic group had none. An analysis of covariance of the replantations demonstrated a statistical association between a better outcome in younger patients with more distal injuries. This study indicates that replantation produces superior functional results compared with amputation and a prosthesis.

Adolescent↗

PubMedDate not supplied

Mechanical performance of inflatable inserts used in limb prosthetics.

Inflatable insert products used to overcome residual limb shrinkage were evaluated in a bench test environment under compressive loading conditions. Pressure-loss tests under static loading demonstrated that after inserts were inflated to 43.4 to 45.6 kPa, insert pressures reduced from 0.09%/min to 1.36%/min in the first 5 min and from 0.00%/min to 0.27%/min in the subsequent 55 min. As inserts were inflated, they demonstrated at least two phases in their pressure versus thickness curves: A relatively low-slope portion (Phase I) was followed by a high-slope portion (Phase II). The transition from Phase I to Phase II occurred at more than a 12-mm thickness, a thickness greater than that considered acceptable for practical clinical use (10 mm). This result suggests that in a socket, stress to resist insert expansion is taken by the residual limb and socket more than by the insert itself. Cyclic-loading tests under constrained thickness conditions demonstrated that local stiffness was more sensitive to insert pressure than to constraint spacing (insert thickness). The static and dynamic test results help to explain why some users claim that inserts do not provide equal and consistent support unless inflated to a very high insert pressure. An insert that allowed adjustment of the location of the Phase I to Phase II transition point in the pressure versus thickness curve might help to overcome these limitations.

Amputation, Surgical↗

PubMed1988

[Surgical treatment of bone tumors in children].

In the treatment of high grade malignant tumours of the extremities limb-preserving surgery plays an increasing role. This kind of surgery may pose special problems for children, when one or two epiphyses must be sacrificed. Especially when one performs this kind of operation in a very young child, an unacceptable leg length discrepancy may arise at the end of growth. In this article the different possibilities of reconstruction after resection of a bone tumour and the consequences for growth, are discussed. Special attention is drawn to the role of the rotation plasty in comparison to other forms of reconstruction after resection of a tumour around the knee.

Artificial Limbs↗

PubMed1984

Limb salvage and rotationplasty for osteosarcoma in children.

Limb salvage was previously described for patients with osteogenic sarcoma who had resectable lesions. In the very young child the usual methods of reconstruction are not applicable due to the resulting major leg-length inequality. One solution is to resect the lesion in accordance with good cancer surgery guidelines and then perform a rotationplasty of the Van Nes type. The ankle then functions as a knee joint, and the final result is a below-knee amputation rather than a high above-knee amputation. Functional results in two patients were remarkably good.

Amputation, Surgical↗

PubMed1982

Afferent sensory feedback for lower extremity prosthesis.

Electrical stimulation has been applied to sciatic nerves of patients to achieve sensory feedback after lower limb amputation for periods of up to six years. Patients used the sensory feedback device daily. Pain, infection and electrode displacement have not been problems. The immediate postoperative benefits are that pain is minimized after amputation and stump healing is improved. Furthermore, the stimulus affords the patient increased confidence when walking due to renewed awareness of the center of gravity. Improved ability to function in the dark and when walking up and down stairways makes the application of sciatic nerve stimulation after amputation very rewarding.

Amputation, Surgical↗

PubMedDate not supplied

Successful rehabilitation following amputation of dominant versus nondominant extremities.

In a study of 154 lower extremity amputees who received prostheses, those patients who lost a left lower extremity tended to make better progress in rehabilitation than those who required a prosthesis for the right leg. Eighty-three percent of the amputations were performed for vascular disease with no right-left difference. Heart disease played a greater role as a factor in limiting rehabilitation in those with left limb loss. Goals set and attained for loss of the left leg were higher than those for loss of the right leg. Left leg amputees can navigate more frequently without aids than can the right leg amputees. The use of a cane made both groups equal in rehabilitation time. Patients with a loss of the left leg attained maximum benefits of rehabilitation sooner than their colleagues with a loss of the right leg. Differences were nearly 2.3 weeks when the median was 22 weeks.

Adult↗

PubMed2004

Clinical field follow-up of high density polyethylene (HDPE)-Jaipur prosthetic technology for trans-femoral amputees.

The purpose of this study was to examine the outcome of the application of the high density polyethylene (HDPE)-Jaipur prosthetic construction in fitting trans-femoral amputees in a number of projects throughout the developing world. Projects in Honduras, Uganda and India were included. One hundred and fifty eight (158) patients had been provided with the HDPE-Jaipur prosthesis and of these 72 were seen for a clinical and technical follow-up after a median of 32 months. More than half the amputees seen had amputation due to trauma and the remainder due to disease. Fabrication and fitting in the three projects was carried out by individuals who had undertaken a three week training course provided by Bhagwan Mahaveer Viklang Sahayata Samiti limb centre in Jaipur. The individuals involved had limited background training in prosthetics. Craftsmanship and fit were assessed as being poor in 86% of cases. Failure requiring replacement of components was observed in 50% of cases. There was low patient satisfaction (58%) and patient compliance (65%). The outcome was considered unsatisfactory both technically and clinically. This was a reflection of the inadequacies of the prosthetic construction, particularly the knee joint, and the inadequate training of those involved in fitting and fabrication of the devices.

Adolescent↗

PubMed1998

Newly designed computer controlled knee-ankle-foot orthosis (Intelligent Orthosis).

The authors have developed a knee-ankle-foot orthosis with a joint unit that controls knee movements using a microcomputer (Intelligent Orthosis). The Intelligent Orthosis was applied to normal subjects and patients, and gait analysis was performed. In the gait cycle, the ratio of the stance phase to the swing phase was less in gait with the knee locked using a knee-ankle-foot orthosis than in gait without an orthosis or gait with the knee controlled by a microcomputer. The ratio of the stance phase to the swing phase between controlled gait and normal gait was similar. For normal subjects the activity of the tibialis anterior was markedly increased from the heel-off phase to the swing phase in locked gait. The muscle activities of the lower limb were lower in controlled gait than in locked gait. The ground reaction force in locked gait showed spikes immediately after heel-contact in the vertical component, and unusual patterns were observed at heel-contact in the sagittal and lateral component. Therefore, compared to locked gait, gait with the Intelligent Orthosis is smooth and close to normal gait from the viewpoint of biomechanics. Even in patients with muscle weakness of the quadriceps, control of the knee joint using the Intelligent Orthosis resulted in a more smooth gait with low muscle discharge.

Adult↗

PubMedDate not supplied

Psychosocial adjustment to lower-limb amputation: a review.

PURPOSE: To review the existing literature on the social and psychological challenges faced by people with an amputation and to provide a detailed analysis of the literature examining psychological adjustment to these challenges across time. METHOD: Existing papers on psychological adjustment to amputation were analysed according to their results, methodology, and conclusions. RESULTS: Although depression and anxiety are relatively high up to 2 years post-amputation, they appear to decline thereafter to general population norms. However, social discomfort and body-image anxiety have also been found among some people with amputations, and these have been associated with increased activity restriction, depression, and anxiety. Factors associated with positive adjustment to limb loss include greater time since amputation, more social support, greater satisfaction with the prosthesis, active coping attempts, an optimistic personality disposition, a lower level of amputation in the case of lower limbs, and lower levels of phantom limb pain and stump pain. CONCLUSION: The majority of studies on adjustment to amputation are cross-sectional in design and have used noncomparable measures. Furthermore, they have neglected to study many important areas of rehabilitation, including immediate reaction to amputation, adjustment during and shortly after the rehabilitation period, and development of a changed sense of self and identity. In order to address these concerns, more longitudinal and qualitative research is called for. We end by outlining the components of a descriptive phased model of the rehabilitation process.

Activities of Daily Living↗

PubMed1999

Transtibial amputations.

The transtibial amputation is one of the most frequently performed major limb amputations in the United States. The long posterior flap technique has become the most frequently recommended technique; however, the surgeon performing amputations needs to be comfortable with the alternative techniques as well. Situations occasionally do arise where the sagittal or skew techniques may be more applicable. With careful surgery and soft tissue handling, wound healing can be expected in the majority of patients. Aggressive rehabilitation is possible in many patients, and with good prosthetic intervention, return to ambulation at or near the preoperative level of function can be expected in most patients.

Activities of Daily Living↗

PubMed1996

Interface mechanics in lower-limb external prosthetics: a review of finite element models.

The distribution of mechanical stress at the interface between a residual limb and prosthetic socket is an important design consideration in lower-limb prosthetics. Stresses must be distributed so that the amputee is stable and comfortable, while avoiding trauma to the tissues of the residual limb. Numerical estimation of the stresses at the interface through finite element (FE) modeling can potentially provide researchers and prosthetists with a tool to aid in the design of the prosthetic socket. This review addresses FE modeling of interface stresses in lower-limb external prosthetics. The modeling methodologies adopted by analysts are described. Verification of FE estimates of interface stress against experimental data by different analysts is presented and the likely sources of error discussed. While the performance of the models is encouraging, there are definite limitations to all of them, necessitating further improvements. Parametric analysis of the sensitivity of interface stress to model parameters provides a tool to identify model weaknesses and to suggest possible refinements. Parametric analyses by different analysts are also presented and potential refinements discussed. Finally, directions for future work in prosthetic FE modeling are suggested.

Amputees↗

PubMed1997

The influence of bandage characteristics and inter-individual application variations on underneath bandage pressures.

INTRODUCTION:: Cohesive bandages are applied to the legs of racehorses and horses with limb injuries for protection (prevention of abrasion) and support (reduction of movement at the fetlock joint). The support capacity of all commercially available bandages has been questioned. Consequently, the protection aspect of bandaging and the negative side effects, which can be caused by bandaging (eg pressure induced ischemia with subsequent necrosis), were emphasized. High pressures underneath bandages were shown to cause reduced blood flow. Pressures underneath certain types of bandages were shown to be higher than under others. It is unclear if these differences were due to differences in material characteristics between the bandage types or caused by differences in application by the trainers. The purpose of this study was to determine (a) if differences between different types of bandages are observed if these are applied similarly and (b) if earlier observed differences in pressures underneath bandages are reproducible when wrapped by different trainers. METHODS AND MATERIAL:: (a) A wrapping machine for the application of bandages to an artificial joint (simulating the human knee joint) was designed and built. The machine allows to wrap bandages with adjustable, constant tension under well defined wrapping angles in order to simulate a wrapping technique similar to the wrapping by trainers. The artificial joint is equipped with two pressure sensors (Parotec, Germany). After bandage application, the artificial joint was placed in a specially designed testing machine and cycled through 200 cycles from 0 degrees to 90 degrees of flexion at a frequency of 0.5 Hz. Pressure data were collected at a frequency of 20 Hz. The force required to unwind the bandage from its core was measured with a material testing machine. Five samples each of four different 4" wide cohesive bandages were tested: 'E': high modulus latex, 'V': low mod. latex, 'C': low mod. latex, 'F': medium mod. laminate non-latex. All bandages were applied at manufacturer suggested tensions (50% intercept length). (b) Fifth-three trainers from the Kentucky Horse Center (Lexington, KY) and the Payson Park Training Facility (Indiantown, FL) volunteered for the study. They applied their favoured brand and a type 'F' bandage to an artificial horse limb. Underneath bandage pressures were collected using a pressure mat (Mikro Emed, Novel GmbH, Germany) placed over the fetlock joint. RESULTS AND DISCUSSION:: (a) Maximum pressures during maximum flexion underneath the type 'E' bandage (5.7+/-0.4 N/cm(2)) were significantly higher than for all other bandages (no difference between other bandages, range 3.5+/-0.6 to 4.0+/-0.4 N/cm). The unwinding force for the type 'F' bandage was significantly lower (10.1+/-5.5N) than for all other bandages (range 22.7+/-11.3 to 42.3+/-15.1N). (b) Trainers applied the type 'E' bandage significantly tighter than the other bandages (18.7+/-3.7 N/cm(2) vs a range of 7.5+/-5.4 to 10.4+/-6.1 N/cm(2)); a tendency was observed that the type 'F' bandage was applied looser than the type 'V' bandage. The results of part (b) of this study are consistent with the earlier study. Based on the results of part (a) of this study it can be speculated that (I) The high pressures underneath the type 'E' bandage are clearly due to its material characteristics, and (II) The differences between the other bandages are not caused by material characteristics but probably by the differences in unwinding force. If the unwinding force is higher than the force required to extend the bandage to 50% intercept length, trainers will probably wrap tighter as suggested and desired.

Journal Article↗

PubMed1998

Slow rehabilitation of a traumatic lower limb amputee.

A 65-year-old male (GM) was referred to the physiotherapy department of the regional limb fitting centre for outpatient rehabilitation following a right transfemoral amputation five weeks previously. He had been knocked down by a bus and suffered a crush injury to the right leg resulting in a stable fracture to the right pubic ramus, a fractured skull and orbital bone. Immediately following admission to the local district general hospital, his right leg was amputated at the transfemoral level. He was nursed post-operatively in ITU for three days and was ventilated during this time. GM was then transferred to the general orthopaedic ward. He received physiotherapy throughout his hospital stay by ward-based physiotherapists--not experts in amputee management but with access to specialist advice. Early physiotherapy was primarily concerned with respiratory care and maintenance of limb mobility and function in bed. Gentle, active stump exercises were commenced on the first post-operative day. GM sat out of bed on the sixth day and stood with the support of two people on the eighth day. His wound was healing well and treatment in the physiotherapy gym began the same day. Use of the pneumatic post-amputation mobility aid (PPAM aid) (Redhead, 1983; Marks, 1996) was started on day nine. However, progress with this early walking aid (EWA) was slow and GM achieved independent walking using parallel bars on the eighteenth post-operative day.

Aged↗