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At least 19 recordsLinked to original sources
PubMed2002

The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee's ability to ambulate.

OBJECTIVES: To describe the development of the Amputee Mobility Predictor (AMP) instrument designed to measure ambulatory potential of lower-limb amputees with (AMPPRO) and without (AMPnoPRO) the use of a prosthesis, and to test its reliability and validity. DESIGN: Measurement study using known groups method and concurrence with existing measures. SETTING: Academic medical center. PARTICIPANTS: A convenience sample of 191 lower-limb amputee subjects who had completed prosthetic training, 24 in the reliability study (mean age +/- standard deviation, 68.3+/-17.9y, range, 28-99y) and 167 in the validity study (mean age, 54.8+/-18.6y; range, 18-100y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Intra- and interrater reliability; construct validity by known groups method; concurrent validity by comparisons with 6-minute walk test, Comorbidity Index, age, and time since amputation; predictive validity by comparison with 6-minute walk test after controlling for other factors. RESULTS: Interrater reliability was.99 for subjects tested with and without their prosthesis; intrarater reliability was.96 and.97. Both the AMPnoPRO (P<.0001) and the AMPPRO scores (P<.0001) distinguished among the 4 Medicare functional classification levels. The AMP correlated strongly with 6-minute walk scores (AMPnoPRO r=.69, P<.0001; AMPPRO r=.82, P<.0001) and the amputee activity survey (AMPnoPRO r=.67, P<.0001; AMPPRO r=.77, P<.0001), and negatively correlated with age (AMPnoPRO r=-.69, P<.0001; AMPPRO r=.56, P<.0001) and comorbidity (AMPnoPRO r=-.43, P<.0001; AMPPRO r=.38, P<.0001). CONCLUSION: The AMP with and without a prosthesis are reliable and valid measures for the assessment of functional ambulation in lower-limb amputee subjects.

Adolescent↗
PubMed2002

A post-discharge functional outcome measure for lower limb amputees: test-retest reliability with trans-tibial amputees.

There are approximately 700 lower limb amputations performed throughout Scotland each year. A national system of survey and analysis conducted by the Scottish Physiotherapy Amputee Research Group (SPARG) provides information on these patients up until discharge from hospital. However, there has been no method of collecting long-term functional and prosthetic use information following discharge. The Functional Measure for Amputees (FMA) has, therefore, been developed from the Prosthetic Profile of the Amputee (PPA) questionnaire, designed by Gauthier-Gagnon and colleagues in Canada (Grisé et al, 1993). Modifications to the PPA were carried out to make it more appropriate for the Scottish amputee population; these changes were approved by the original authors. The test-retest reliability of the 14-question FMA was assessed using a repeat postal questionnaire study. One hundred and thirty-three (133) from a possible 390 trans-tibial amputees were returned. Comparing sociodemographic and clinical variables between consenters and non-consenters showed no evidence to support sample bias. Continuous data items on the FMA analysed using an intraclass correlation coefficient showed ICC values of 0.74, 0.85, 0.96 and 0.64. Categorical data items analysed using percentage agreements showed reliability of over 70% for seven items, between 40% and 70% for three items and between 20% and 40% for the remaining three items. The FMA questionnaire was found to be reliable on the majority of its questions and moderately reliable on the remaining questions during successive follow-up postal administrations.

Aged↗
PubMed1979

An amputee visitor program as an adjunct to rehabilitation of the lower limb amputee.

Based on evaluation of the rehabilitative needs of patients who have had a leg amputated because of cancer, an amputee visitor program was developed. The visitor is a cancer amputee who has successfully completed rehabilitation. About 5 days after a patient's amputation, the visitor sees the patient, telling of personal experiences, answering the patient's questions, and showing the prosthesis. The visitor later evaluates the visit on a data collection sheet. From 1 to 6 months after the visit, the patient and, if possible, a relative are interviewed to determine their long-term reaction to the program. During a 30-month period, 65 new patients were seen and evaluated by two visitors. Sixty (92%) responded favorably to the visit. In follow-up interviews with 36 patients, 33 (92%) said the visit substantially improved their outlook. In summary, our data indicate that the amputee visitor contributes significantly to rehabilitation.

Amputation, Surgical↗
PubMed2002

Interface pressure and shear stress changes with amputee weight loss: case studies from two trans-tibial amputee subjects.

Interface pressures and shear stresses were measured at monthly intervals on two trans-tibial amputee subjects who lost more than 12% of their body weight over the course of the study. For one subject interface pressures and shear stresses during the weight-acceptance phase of gait decreased over the study interval at all 13 sites monitored, while the other subject experienced increased pressures distally but decreased pressures proximally. Subjects' stumps appeared to atrophy over the study interval, increasing distal end and patellar tendon loading, but not increasing interface shear stresses at other locations. Adding socks at the end of the study did not return interface pressures to first session values at all sites. It is expected that local stump shape changes occurred, causing a non-uniform change in interface stress patterns.

Amputees↗
PubMed1992

Foot pressure measurements in diabetic and nondiabetic amputees.

OBJECTIVE: Foot problems are common in the remaining foot of diabetic amputees. Because high foot pressures are associated with foot ulceration, we studied foot pressures of the remaining foot of diabetic and nondiabetic unilateral amputees. RESEARCH DESIGN AND METHODS: Four age-matched groups of 11 subjects were studied. The groups were comprised of diabetic subjects with previous major amputation, nondiabetic nonneuropathic amputees, diabetic nonamputee patients with similar peripheral nerve involvement as the diabetic amputees, and nondiabetic control subjects. Vibration perception threshold (VPT) was assessed by biothesiometry and foot pressures with an optical pedobarograph. RESULTS: Mean +/- SE VPT in the diabetic amputees was significantly higher than the nondiabetic amputees (40.2 +/- 3.7 vs. 17.7 +/- 2.8 V, P less than 0.002) and similar to diabetic nonamputees (43.4 +/- 3.3 V, NS). VPT was abnormal in 9 (82%) diabetic amputees, 2 (18%) nondiabetic amputees, and 10 (91%) nonamputee diabetic patients. The mean peak foot pressure in the diabetic amputees was higher compared with nondiabetic amputees (18.3 +/- 2.2 vs. 11.3 +/- 1.4 kg/cm2, P less than 0.05) and control subjects (10.0 +/- 1.5 kg/m2, P less than 0.01), but no difference existed with diabetic nonamputees. Abnormally high foot pressures (greater than 12.3 kg/cm2) were present in 8 (73%) diabetic amputees, 3 (27%) nondiabetic amputees, 8 (73%) diabetic nonamputees, and 4 (36%) healthy subjects. CONCLUSIONS: We conclude that high pressures are present under the remaining foot in diabetic amputees, and that these pressures are associated with diabetic neuropathy. Prosthetic usage does not increase the pressures under the remaining foot in nondiabetic amputees.

Aged↗
PubMed2000

Touch-down and take-off characteristics of the long jump performance of world level above- and below-knee amputee athletes.

The aims of this study were to establish the take-off characteristics of long jump performance of disabled amputee athletes, and to establish to what extent amputee athletes conform to a model of performance defined for elite able-bodied athletes. The jumps of 8 male below-knee (trans-tibial) and 8 male above-knee (trans-femoral) amputee athletes who competed in the finals of the long jump at the 1998 World Disabled Championships were recorded in the sagittal plane on video (50 Hz). Approach speed was measured using a laser Doppler system. The best jump for each athlete was digitized, and kinematic data from the key instants of touch-down (TD), maximum knee flexion (MKF) and take-off (TO) were obtained. Amputees demonstrated a lower approach speed and jumped less far than able-bodied athletes although below-knee amputees performed better than above-knee amputees. For each amputee group there was a significant (p < 0.05) linear relationship between approach speed and distance jumped. With the exception of their slower horizontal speed and greater negative vertical speed at touch-down, below-knee amputees demonstrated characteristics of technique that were similar to elite able-bodied long jumpers. Above-knee amputees at touchdown had a more upright trunk, smaller hip and knee angles and consequently a smaller leg angle. This was attributed to the difficulty of taking off on the last stride on the prosthetic limb. Consequently, above-knee amputees were less able to gain vertical velocity during the compression (TD-MKF) phase, but were able to compensate for this by using a greater hip range of motion during the extension (MKF-TO) phase. It was concluded that below-knee amputees displayed the same basic jumping technique as elite able-bodied long jumpers, but above-knee amputees did not. These findings have implications for the training and technical preparation of amputee long jumpers.

Amputees↗
PubMed1994

Volume of distribution and fractional clearance of urea in amputees on continuous ambulatory peritoneal dialysis.

OBJECTIVES: To demonstrate the effects of amputation on the estimates of urea volume of distribution (V) and KT/V urea in continuous ambulatory peritoneal dialysis (CAPD) patients and to present a method for correcting the errors created by the uncorrected anthropometric formulas estimating V. DESIGN: (1) A mathematical analysis of the error and the correction proposed was performed. (2) Urea kinetic modeling with uncorrected and corrected estimates utilizing both the Watson and the Hume anthropometric formulas was performed in amputees on CAPD. SETTING: Subjects were recruited from four dialysis units in one city: one Veterans Affairs unit, one university-affiliated unit, and two community units. PATIENTS: Fourteen amputees on CAPD:12 with unilateral leg amputation and 2 with bilateral leg amputation, at the same length of the leg, were studied. INTERVENTIONS: Urea kinetic studies were performed in 24-hour drained dialysate and urine specimens. MAIN OUTCOME MEASURES: Uncorrected and corrected estimates of V and KT/V urea were compared to each other and to the predictions of the mathematical model. Body weights corresponding to uncorrected and corrected V estimates were compared to the actual body weights. RESULTS: (1) The mathematical model predicts that uncorrected estimates by the anthropometric formulas will falsely characterize unilateral amputees as leaner than they are and bilateral amputees as more obese than they are. (2) In unilateral amputees studied with the Watson formulas, uncorrected V was 0.546 +/- 0.023 L/kg and corrected V was 0.520 +/- 0.023 L/kg (p < 0.001). Corresponding weekly KT/V urea values were 1.97 +/- 0.14 and 2.07 +/- 0.14, respectively (p < 0.001). Similar results were obtained with the Hume formulas. In bilateral leg amputees studied with the Watson formulas, uncorrected V was 0.479 +/- 0.022 L/kg and corrected V was 0.514 +/- 0.023 L/kg. Corresponding KT/V estimates were 2.11 +/- 0.45 and 1.96 +/- 0.14, respectively. The differences were even greater with the Hume formulas. Estimates of body weight calculated from corrected V values were equal to actual weight measurements, whereas those calculated from uncorrected V values were lower than actual body weight measurements in unilateral amputees, and much higher than actual body weight measurements in bilateral amputees. CONCLUSION: Uncorrected anthropometric estimates falsely characterize unilateral amputees as leaner than they actually are and bilateral amputees, amputated at the same leg length, as more obese than they actually are. Uncorrected KT/V estimates are, therefore, falsely low in unilateral amputees, and falsely high in bilateral amputees. The proposed correction of the anthropometric formulas provides estimates agreeing closely with dietary estimates of body composition. Further studies are needed to define the accuracy of the corrected formulas.

Aged↗
PubMed1990

The role of the contralateral limb in below-knee amputee gait.

Very little quantitative biomechanical research has been carried out evaluating issues relevant to prosthetic management. The literature available suggests that amputees may demonstrate an asymmetrical gait pattern. Furthermore, studies suggest that the forces occurring during amputee gait may be unequally distributed between the contralateral and prosthetic lower limbs. This study investigates the role of the contralateral limb in amputee gait by determining lower limb joint reaction forces and symmetry of motion in an amputee and non-amputee population. Seven adult below-knee amputees and four non-amputees participated in the study. Testing involved collection of kinematic coordinate data employing a WATSMART video system and ground reaction force data using a Kistler force plate. The degree of lower limb symmetry was determined using bilateral angle-angle diagrams and a chain encoding technique. Ankle, knee and hip joint reaction forces were estimated in order to evaluate the forces acting across the joints of the amputee's contralateral limb. The amputees demonstrated a lesser degree of lower limb symmetry than the non-amputees. This asymmetrical movement was attributed to the inherent variability of the actions of the prosthetic lower limb. The forces acting across the joints of the contralateral limb were not significantly higher than that of the non-amputee. This suggests that, providing the adult amputee has a good prosthetic fit, there will not be increased forces across the joints of the contralateral limb and consequently no predisposition for the long-term wearer to develop premature degenerative arthritis.

Adult↗
PubMed1992

Lower limb amputee survival.

A total of 1710 primary amputees have been studied over a 25 year period and their survival time has been calculated. These were all consecutive primary lower limb amputees admitted to the Dundee Limb Fitting Centre during the period 1965-1989. Overall, the median survival was 4 yr 9 mth for the below-knee amputee (1019 patients) and 4 yr 3 mth for the above-knee amputee (586 patients). The vascular related amputees had an overall median survival of 4 yr. In the two decades 1970-1979 and 1980-1989 there were significant differences between the survival time of the below-knee and above-knee amputee. The survival of the amputee has increased during the two decades from 3 yr 6 mth to 6 yr 6 mth (p greater than 0.001). For the first decade male above-knee and male below-knee amputee median survival was 3 yr 1 mth and 3 yr 11 mth respectively and for the second the survival was 5 yr 9 mth and 6 yr 11 mth for these levels of amputation. For 1970-1979 no significant differences were found between male and female peripheral vascular disease (PVD) and diabetes mellitus related amputee survival. For 1980-1989 significant differences were found between PVD related male above-knee amputees (3 yr 10 mth) and male below-knee amputees (6 yr 7 mth) (p greater than 0.01). Similar results were found for the female patients. Operative mortality was found to be 5% over the period 1975-1989 which compared favorably with previous studies.

Age Factors↗
PubMed1996

In-hospital mortality and disposition of diabetic amputees in The Netherlands.

The purpose of this study is to identify in-hospital mortality of diabetic amputees and the disposition of survivors in The Netherlands in 1991 and 1992. A database including all hospitalizations in The Netherlands was used. Amputees who died while in the hospital were analysed separately. Survivors were categorized according to different types of discharge: home, nursing home, rehabilitation facility, and other health care facilities. Overall 9.0% of diabetic amputees died while in hospital. The age-adjusted mortality incidence for the diabetic population was 36.3 per 1000 diabetic amputees (95% CI: 18.7-53.9) and 28.2 per 1,000 non-diabetic amputees (95% CI: 20.5-35.9). Non-diabetic amputees with PVD has proportionally more mortality than diabetic amputees with PVD (P < 0.01), diabetic amputees without PVD (P < 0.01), and non-diabetic amputees without PVD (P < 0.001). Using Cox regression analysis age (B(age) = 0.023, RR = 1.024) and the occurrence of multiple amputations during the hospitalization (Bmultiple = 0.325, RR = 1.383) were significant negative predictors for survival. As age and level of amputation increased, more diabetic and non-diabetic amputees were discharged to facilities other than home (P < 0.001).

Age Factors↗
PubMed1996

Stump length as related to atrophy and strength of the thigh muscles in trans-tibial amputees.

Stump length and the thigh muscles strength of the amputated limb are among the major factors influencing outcome of prosthetic rehabilitation of trans-tibial amputees. In the present study the authors evaluated and compared the strength of quadriceps and hamstrings muscles of both limbs in trans-tibial amputees, as measured by means of an electrical dynamometer. The obtained results showed that the thigh muscles of the sound limbs are significantly stronger than those of the amputated limbs (p < 0.01). The results obtained for amputees with shorter stumps were compared with those with longer stumps. In the group of amputees (n = 9) with a stump shorter than 15.1 cm, values of peak torque (in isokinetic contraction) and maximal average torque (in isometric contraction) were significantly (p < 0.5) weaker when compared to those (n = 9) with a stump longer than 15.1 cm. The results obtained for amputees with a higher rate of thigh muscle atrophy were compared to those with lesser atrophy. In the group of amputees where muscle atrophy was accompanied by decrease in thigh girth of over 5.9 cm, muscles strength did not significantly decrease (p < 0.5) as compared to amputees where thigh girth decrease was less than 5.9 cm. It is concluded that atrophy of the thigh muscles of trans-tibial amputees is accompanied with a significant decrease in strength. In amputees with a short stump, the short lever action provided by the stump interferes with the ability of the thigh muscles to control the prosthesis efficiently during daily activities such as standing and walking.

Activities of Daily Living↗
PubMedDate not supplied

Functional outcome and comorbidity indexes in the rehabilitation of the traumatic versus the vascular unilateral lower limb amputee.

This study compared the Functional Independence Measure (FIM) scores of traumatic (n=12) and vascular (n=12) unilateral lower limb amputees at admission and discharge from a rehabilitation facility. FIM scores that were measured were amputation FIM subscores and total FIM scores. Comorbidity indexes were developed to weight the stump condition and comorbidities seen in both groups. The vascular group was significantly (P<0.01) greater stump comorbidity, but there was no significant difference with respect to length of stay, medical comorbidity score, and amputation and total FIM scores both at admission and discharge between the two groups. Medical comorbidity was significantly (P<0.05) correlated with amputation and total FIM scores at discharge for traumatic amputees with r = -0.64 and r = -0.66, respectively. Stump comorbidity was significantly (P<0.05) correlated with total FIM at discharge with r = -0.64 for vascular amputees. Medical comorbidity was a good predictor of discharge FIM scores for traumatic amputees, whereas stump comorbidity predicted discharge FIM scores for vascular amputees, although not as well. In conclusion, inpatient traumatic amputees may be younger than vascular amputees, but traumatic amputees may not necessarily be healthier or do better functionally at discharge than vascular amputees.

Adult↗
PubMed1991

Factors influencing rehabilitation of arteriosclerotic lower limb amputees.

This survey considered 598 arteriosclerotic amputees over a period of 9 years: 267 below-knee; 81 Gritti-Stokes; 195 above-knee; and 55 double amputees. A walking ability index (WAI) ranging from 1 for a normal gait to 6 for inability to walk was determined for these amputees by clinical grading at 3, 6, 9, and 12 months after prosthesis fitting. Amputees with the below-knee operation had better WAI at 3 and more months than those with either Gritti-Stokes or above-knee operations. There was no statistical evidence for a difference between Gritti-Stokes and above-knee operations at any time of assessment of WAI. The 50-59 year-old age group had significantly better WAI at 6, 9, and 12 months than did the 60-69 or 70+ age group, but the 60-69 year-old group was not significantly different from the 70+ age group. On an average, the 78 amputees (14 percent) with ischemic heart disease had a poorer WAI at 6 and more months than did those without it; the 46 amputees (8 percent) with hemiplegia were worse at 12 months than those without hemiplegia; and the 15 amputees (11 percent) with bronchitis were worse at 12 months than those without bronchitis. Double amputees had poorer WAIs at 12 months than those of single amputees.

Age Factors↗