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At least 19 recordsLinked to original sources
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↗
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↗
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↗
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↗
PubMed1985

Gait analysis in amputees.

There are marked differences from normal in both AK and BK gait. Forward velocity of walking is significantly lower in the amputee and is lower in the AK than in the BK subjects. Traumatic AK amputees ambulate with time-distance parameters of velocity, cadence, stride length and gait cycle which are all two standard deviations below normal. The same parameters for the traumatic BK amputee are only one standard deviation below normal. The symmetry of walking seen in the normal subject is not present in the lower extremity amputee. Measurements of single limb support times and motion analysis of the lower extremities as well as of the head, arms and trunk bear this out. This asymmetry of motion increases the excursion of the center of mass during each cycle and thereby increases the energy cost of ambulation. Energy cost of amputee gait often places the dysvascular AK amputee at his limits and strains other amputees severely. Further research is necessary to enable amputees to approach the walking capabilities of normal people.

Adult↗
PubMed1978

Functional capabilities of lower extremity amputees.

One hundred thirty-four lower extremity amputees were evaluated from six months to 12 years postamputation by means of retrospective questionnaires. Patient population was similar to that of the "Amputee Census" in terms of sex, amputation level and cause of amputation. Information was gathered on activities generally considered essential for daily living, vocation and recreation, living arrangements and adjustments therein, as well as feedback on the patients' beliefs concerning what rehabilitation personnel should be doing to improve amputees' lifestyle. The relationship of functional outcome to age, amputation level, and cause of amputation was also evaluated. Results showed that most amputees did not resume a completely normal lifestyle and many modifications were made. The most popular recreational activities were fishing and swimming. Activities that amputees found most difficult were running and walking long distances. Patients requested better communication between professional staff and themselves. Below-knee amputees were significantly more independent than above-knee and bilateral amputees, but the differences between above-knee and bilateral amputees were statistically insignificant. Tumor patients did better than the other three etiologic groups. As age increased, functional independence decreased.

Activities of Daily Living↗
PubMed1983

Functional comparison of upper extremity amputees using myoelectric and conventional prostheses.

Upper extremity amputees were tested on a standardized series of tasks using a myoelectric hand, a conventional prosthesis (cable-controlled hook), and their normal hand (unilateral amputees only). They answered also a questionnaire on activities of daily living (ADL) and provided other prosthetic information. Amputees who had been fitted only with a conventional prosthesis, and used their prosthesis regularly, tended to wear the prosthesis more hours per day (14 hours) than amputees fitted with a myoelectric hand (9.6 hours), some of whom continued to use a conventional prosthesis for some jobs. However, the amputees with myoelectric prostheses had a greater functional range of motion (ROM) than those with a conventional prosthesis, and many regular wearers of a myoelectric prosthesis had long since rejected a conventional prosthesis. Amputees took about 2.5 times as long to complete the tasks tested with a conventional prosthesis and about five times as long with a myoelectric prosthesis than with their normal hand. Despite the slower function, more than 60% of below-elbow (B-E) amputees accepted the myoelectric prosthesis in preference to a conventional prosthesis, which they had all been fitted with previously. Others preferred to continue using a conventional prosthesis to which they had become accustomed (13%) or no prosthesis (26%). The combination of function, ROM, and cosmetic appearance of a myoelectric prosthesis is preferred by most B-E amputees, despite its slower performance at the present time.

Activities of Daily Living↗
PubMed1995

Prosthetic gait of unilateral transfemoral amputees: a kinematic study.

OBJECTIVE: The prosthetic gait of unilateral transfemoral amputees. DESIGN: Case series. SETTING: Laboratory of Gait Analysis (GIGA-system of K-lab) in the Department of Rehabilitation of a university hospital. PATIENTS: Eleven men with transfemoral amputation (mean age 35.7 years) participated. The amputation was performed at least 2 years ago and was caused by trauma or osteosarcoma. MAIN OUTCOME MEASURES: Stride parameters as well as the patterns of motion of the trunk, hip, and knee joint. RESULTS: The amputees walked with a 29% lower vcomf than normal subjects. The amputees compensate the vrapid with their stride length rather than with their step rate. The amputees showed an asymmetrical walking pattern; the amputees stood a little longer on their intact leg than on their prosthetic leg. Four amputees showed an extreme lateral bending of the trunk toward the prosthetic side during the stance phase of the prosthetic leg. The rebound of the hip at the amputated side at heel strike was very small or absent. The intact knee was flexed at heel strike and remained in a flexed position during the entire stance phase. CONCLUSIONS: The amount of asymmetry of the walking pattern is related to the stump length. The amputees with highly atrophied hip-stabilizing muscles walked with an extreme lateral bending of the trunk toward the prosthetic side. There is no correlation between stride width and lateral bending of the trunk. Amputees with a short and medium stump length showed a fast transition from hip extension to hip flexion.

Adult↗
PubMed1985

A review of employment patterns of industrial amputees--factors influencing rehabilitation.

More than 1,000 industrial amputees at the Ontario Workers' Compensation Board were reviewed. The study investigated the current employment status of amputees and the factors that influenced successful return to work post-amputation. The data obtained from a mailed questionnaire was analysed by the Statistical Analysis System. The results revealed that 89% of amputees returned to work after an amputation. The average follow-up post-amputation was 14 years with a range of one to 64 years. At the time of review the current employment status of amputees was as follows: 51% full time employed, 5% part-time employed, 25% retired and 8% unemployed. The remainder were engaged in a vocational activity, still recovering or were not seeking work. The data revealed that amputees typically changed jobs when returning to the work force. Amputees returned to jobs that were less physically demanding, but required greater intellectual skills in occupations such as clerical and service industries. Factors including prosthetic use, vocational services, and a younger age at the time of amputation were identified as being positively associated with a return to work. Those factors that were negatively related to successful employment included stump and phantom limb pain and multiple limb amputations. The study concluded that the majority of the amputees reviewed were successful in returning to work. The authors suggest that amputees benefit from treatment programmes that include medical, prosthetic and vocational services.

Accidents, Occupational↗
PubMed1983

Ambulation levels of bilateral lower-extremity amputees. Analysis of one hundred and three cases.

One hundred and three bilateral lower-extremity amputees were evaluated to determine their eventual ambulation level. Of thirty-eight bilateral above-the-knee amputees, two with traumatic amputation were prosthetically rehabilitated, while none of the thirty-five with dysvascular amputation were so rehabilitated. Twenty-two of the dysvascular above-the-knee amputees were wheelchair ambulators and thirteen were bedridden. Prosthetic rehabilitation has been successful for traumatic bilateral above-the-knee amputees but has never been successful for our dysvascular bilateral above-the-knee amputees. The goal for dysvascular bilateral above-the-knee amputees is wheelchair ambulation. Of twenty-one patients with combinations of above-the-knee and below-the-knee amputations, five were prosthetically rehabilitated, including four dysvascular amputees; ten were wheelchair ambulators; and six were bedridden. Of forty-four patients with bilateral below-the-knee amputation, thirty-five were prosthetically rehabilitated and the remaining nine were wheelchair ambulators. Since the success rate for prosthetic rehabilitation is higher for amputees with combination above-the-knee and below-the-knee amputation than for those with bilateral above-the-knee amputation, and again increases for those with bilateral below-the-knee amputation, the significance of preserving the knee joint, even a single knee, cannot be overemphasized.

Activities of Daily Living↗
PubMed1995

Insulin resistance and autonomic function in traumatic lower limb amputees.

This study examined plasma insulin response to oral glucose load and autonomic nervous system activity in male lower limb amputees (n = 52) aged 50-65 years, compared to matched controls (n = 53). The groups had similar body mass index, blood pressure and plasma lipid levels. The amputees had higher mean fasting plasma insulin levels (18.4 +/- 9.7 (SD) versus 13.7 +/- 5.1 mU/l, p = 0.005) and during an oral glucose tolerance test (OGTT) (1 h levels 88.1 +/- 45.3 versus 62.1 +/- 42.7, p = 0.016) with similar plasma glucose levels, indicating insulin resistance. At baseline with the subjects supine, there were no group differences in low- or high-frequency power of heart rate variability or in plasma levels of norepinephrine (NE) or epinephrine (EPI). In response to orthostasis, the groups had similarly increased plasma NE levels. During the OGTT, amputees had significantly larger increments in low-frequency power than did controls (2.2 +/- 1.3 versus 1.6 +/- 0.9 (beats/min)2 respectively, p < 0.01) and plasma NE levels increased significantly in amputees (1595 +/- 849 versus 1941 +/- 986 pM, p = 0.0008) but not in controls. At 1 h after glucose administration, plasma EPI levels were decreased significantly from baseline in both groups; at both 1 and 2 h after glucose administration, plasma EPI levels were higher in the amputees than controls. Amputees appear to have a combination of enhanced sympathoneural responsiveness and attenuated suppression of adrenomedullary secretion during glucose challenge. As catecholamines antagonize insulin effects, one possible explanation for insulin resistance in amputees is hyperglycaemia-induced sympathoneural activation and a failure of hyperglycaemia to decrease adrenomedullary secretion.

Aged↗
PubMed1993

Amputee population in the Kingdom of Saudi Arabia.

A 14 year retrospective study was conducted of 3210 amputees who attended during the period 1977-1990 at Riyadh Medical Rehabilitation Centre (RMRC), the first and the largest rehabilitation centre in the Kingdom of Saudi Arabia. The mean age was 30.5 years, male slightly older than female. The mean age of the lower limb amputees was 32.6 and of the upper limb amputees 21.8 years. An overall predominance of male to female with a ratio of 6.1:1 was observed. Males outnumbered females by 5 to 1 in the upper limb and 6.3 to 1 in lower limb amputees. The ratio of lower limb to upper limb and multiple limb amputees was 15:3.7:1. Trauma was the leading cause of upper limb amputations (86.9%). In the lower limb, although trauma (52.9%) was the prominent cause, 35.9% was due to disease. Major specific causes of trauma were road traffic accidents, machine accidents, and falls from height. The most common site of unilateral amputations was trans-tibial (45.2%), followed by trans-femoral (21.6%), trans-radial (7.6%), partial hand (4.8%), and trans-humeral (4.7%). Comparison with other studies shows a higher mean age and fewer trans-tibial amputees than in Australia and other Western countries, while studies in Asia show greater similarities to the present investigation as regards trauma and disease incidence which occur in similar patterns. These patterns of amputee population indicate the demand for prosthetic service and provide guidelines for future development.

Adolescent↗