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At least 199 records · Page 11Linked to original sources
PubMed1995

[Endothoracic anesthesia for artificial anus formation in rabbits].

We succeeded in maintaining anesthesia for artificial anus formation in rabbits using a new anesthetic technique of endothoracic anesthesia. The drug injection through a catheter, which was inserted into the endothoracic fascia at the level of the 11th thoracic vertebra, caused an unilateral anesthesia from the chest down to the lower limb. Artificial anus formation was possible by this endothoracic anesthesia with a help of medetomidine and nitrous oxide.

Anesthesia, Local↗
PubMed2004

[Long-term treatment of phantom- and stump pain with Botulinum toxin type A over 12 months. A first clinical observation].

Recently we were able to describe the successful treatment of phantom pain and stump pain with botulinum toxin A in a first pilot study. This case report over a 1-year period now demonstrates that long-term treatment for this indication is possible. We injected 4 x 25 IU of botulinum toxin A (Botox) into trigger points of the stump muscles of a lower limb amputee who suffered from severe phantom and stump pain. With four injections performed every 3 months, the patient became almost completely pain-free, and his intrathecal morphine therapy could be reduced to 40% of the initial dose. Intrathecal clonidine was eliminated completely, as were the oral analgesics. A surgical treatment suggested for the stump pain was no longer necessary, and we suppose that botulinum toxin can also improve the tolerance of artificial limbs in cases of stump pain.

Amputation, Surgical↗
PubMed1998

Victims of war. Surgical principles must not be forgotten (again)!

Severe injuries to the limbs are common in wars and natural disasters, and most of them occur in developing countries with weak health-care systems. The International Committee of the Red Cross (ICRC) has gained a vast amount of experience in treating the war-wounded in this context. Basic principles for wound management, safe and simple methods for fracture-holding and amputation techniques adapted to missile and explosive injuries have proven successful. More than 81,000 amputees have been fitted with artificial limbs in ICRC workshops since 1979, but the needs are far greater. In an attempt to limit the effects of war, the ICRC promotes compliance with international humanitarian law, supports preventive activities such as the campaign to ban anti-personnel landmines, and strives to raise awareness of the implications of fast-developing weapon technologies.

Amputation, Traumatic↗
PubMed2001

Non-traumatic lower limb older amputees: a database survey from a geriatric centre.

PURPOSE: The purpose of this survey was to examine the characteristic of a geriatric population admitted for amputation of a lower limb and to explore some of the factors that may affect the course of their hospital stay. METHOD: The study took place in the geriatric division of a tertiary general hospital and included a close geriatric-orthopaedic liaison. Two-hundred and forty-one patients were included in the final analysis. RESULTS: Many above knee amputations were performed, which correlated with advanced age. Rates of in hospital mortality and systemic complications were 16% and 19%, respectively. Thirty-three percent of the patients were discharged back home, and only 6% were supplied with an artificial limb. The general condition of most patients remained poor. CONCLUSION: We conclude that despite a team approach to the care of the geriatric amputee a poor functional result was obtained. By encouraging earlier referrals from the community it is postulated that a reduction in the costly provision of antibiotics would be beneficial and that perhaps lower levels of amputation could be performed thereby enhancing the possibilities for ambulation.

Age Distribution↗
PubMed2005

Outcome after disarticulation of the hip for sarcomas.

AIMS: To review the oncological and functional outcome in 80 patients who underwent disarticulation of the hip as part of their treatment. METHODS: Eighty patients had disarticulation, of whom 46 had a bone sarcoma and 34 a soft tissue sarcoma. In 42 patients the operation was done as the first definitive surgical procedure for that patient. In 38 patients the disarticulation followed local recurrence after unsuccessful limb salvage, three of these patients had palliative amputations already having metastatic disease. All patients had adjuvant therapy when appropriate. RESULTS: The overall survival of the patients following the amputation was 56% at 1 year, 39% at 2 years, 27% at 5 years and 21% at 10 years. The 5-year survival of patients having the amputation as a primary procedure was 32%, for those with local recurrence it was 25% whilst for those with a palliative amputation it was nil. Local recurrence developed in 10 patients following the amputation, and was related to close margins of excision; all of these patients subsequently died. Function was on the whole poor, with only one surviving patient regularly using an artificial limb. CONCLUSION: Disarticulation of the hip remains a disabling procedure usually carried out for high grade sarcomas with extensive involvement of bone and soft tissues in the thigh. Long term survival is possible if wide margins of excision can be achieved.

Adolescent↗
PubMed1987

A prospective randomized comparison of healing in Gritti-Stokes and through-knee amputations.

Twenty-two patients with a median age of 79 years had 24 amputations about knee joint level. The patients were randomised to undergo either Gritti-Stokes or through-knee amputations. In two-thirds of limbs transcutaneous oxygen was less than 4.65 KPa (35 mmHg) or there were no audible Doppler signals at the ankle, indicating that a below-knee amputation would have been at risk of failing to heal, and in the remainder an amputation at the knee joint was considered the preferable site for a variety of reasons. Nine of 12 (75%) Gritti-Stokes amputations underwent uncomplicated primary healing compared with only 2 of 12 (17%) through-knee procedures (P = 0.04). Two through-knee amputations required revision to above the knee (17%) while all Gritti-Stokes amputations healed. Three patients in each group became mobile on a prosthesis, the remainder being bilateral amputees or unable to manage an artificial limb.

Aged↗
PubMed1992

Success rates for rehabilitation of vascular amputees: implications for preoperative assessment and amputation level.

All lower limb amputations performed during 1986 and 1988 in eight hospitals in the south-east region were assessed. Of 440 amputations for vascular disease, 193 were above-knee, 193 below-knee, 15 Gritti-Stokes, 15 through-knee and 24 bilateral. Of the 440 patients, 75 died in hospital, 113 were considered unsuitable for a prosthesis and 252 (57 per cent) were referred for prostheses. Rehabilitation questionnaires were sent to 179 patients (41 per cent), as a further 54 had died and 19 had become known non-wearers before the study commenced. The response rate was 81 per cent; 102 patients completed the questionnaire, 21 were reported dead, and 22 were non-wearers. Of a maximum rehabilitation score of 12, 52 patients scored 6 or more (consistent with mobility on their artificial limb around the home), and 21 scored 9 or more (a standard accepted as successful rehabilitation). It is concluded that 10-15 per cent of amputees achieve mobility around the home on their prosthesis. Only 5 per cent, however, rehabilitate well and become independent of their wheelchair. When amputation is inevitable, more consideration should be given to surgery that optimizes wheelchair rehabilitation.

Aged↗
PubMed2005

Skew flap technique in trans-tibial amputation.

The long posterior flap technique is an established technique for trans-tibial amputation in ischaemic limbs. Despite its success, it has a few drawbacks. It may be time-consuming and requires considerable planning, and at times the dog-ears cannot be avoided. The suture line passes over the distal end of the stump, which is usually a problem during prosthetic use. The skew flap technique retains the advantages of the long posterior flap technique and eliminates the difficulties of prosthetic fitting. The equal skin flaps are skewed so that the flaps become anteromedial and posterolateral, whereas the calf muscle flap remains long underneath the skewed skin flaps. The posterior muscles are brought anteriorly covering the cut ends of the bones and are buried in between the tibia and its anterior periosteum, by suturing their margins with the periosteum. The skew flap procedure was perceived in 1980 and was started at the Artificial Limb Centre, Pune in 1983 by the author. This procedure underwent many changes during the initial 5 years and by the end of April 1992, 85 trans-tibial amputations were performed using this technique. A 9-year follow-up of these patients, who had been using prostheses with ease and without any discomfort or problem, had been exceptionally good. Encouraged by the results, this technique is now being practised as routinely. By March 1998, a total of 125 such trans-tibial amputations had been performed in 119 patients, with excellent results.

Adolescent↗
PubMed2002

Military lower extremity amputee rehabilitation.

The role of the military has changed over the past eight decades. Although the threat of global warfare still exists, the military of today faces new challenges as a peacekeeper in countries under turmoil. Despite these changes, the fear of bodily injury, such as limb loss and even the possibility of death, are real concerns for our active duty personnel. The military physician must be aware of the appropriate surgical, rehabilitative, and psychosocial needs of the lower extremity traumatic amputee. The physical medicine and rehabilitation specialist is a physician particularly suited to provide direction for and to oversee the overall care of the amputee's condition. An amputee center providing a multidisciplinary team approach has worked well for the military during war and peacetimes. The physical medicine and rehabilitation inpatient service at WRAMC continues the tradition and philosophy of the military amputee centers dating back to WWI. By growing with the fast-paced technologic advances in prosthetic devices, yet keeping true to the fundamentals of prosthetic prescription and design, physical medicine and rehabilitation in the military has remained at the forefront of amputee rehabilitation. Patient satisfaction with the rehabilitation process and his or her new artificial limb remain priorities whether the goal is to return to active duty or to resume an active lifestyle in the civilian world.

Amputation, Surgical↗
PubMed2004

Artificial kinesthetic systems for telerehabilitation.

Artificial sensory motor systems are now under development in a truly wearable form using an innovative technology based on electroactive polymers. The integration of electroactive polymeric materials into wearable garments endorses them with strain sensing and mechanical actuation properties. The methodology underlying the design of haptic garments has necessarily to rely on knowledge of biological perceptual and motor processes which is, however, scattered and fragmented. Notwithstanding, the combined use of new polymeric electroactive materials in the form of fibers and fabrics with emerging concepts of biomimetic nature in sensor data analysis, pseudomuscular actuator control and biomechanical design may not only provide new avenues toward the realization of truly wearable kinesthetic and haptic interfaces, but also clues and instruments to better comprehend human manipulative and gestual functions. In this talk the conception, early stage implementation and preliminary testing of a fabric-based wearable interface endowed with spatially redundant strain sensing and distributed actuation are illustrated with reference to a wearable upper limb artificial kinesthesia system, intended to be used in telerehabilitation of post stroke patient.

Clothing↗
PubMed1990

Study of the effects of motor unit recruitment and firing statistics on the signal-to-noise ratio of a myoelectric control channel.

An important measure of the performance of a myoelectric control channel for powered artificial limbs is the myoelectric signal processor output signal-to-noise ratio (SNR). The signal and noise in this context are, respectively, the mean and variance of the estimate of some signal parameter to be used for control purposes. These quantities are determined by the signal processor, motor unit recruitment and motor unit firing statistics. The paper investigates, through analytical, simulation and experimental work, the role and significance of recruitment and firing statistics in channel performance. Equations are derived which express, for the single and multi-unit cases, channel SNR as a function of the number of active units, firing rates, action potential amplitude variation and action potential moments. A computer-simulated myoelectric signal is generated in which these variables can be controlled and SNR measured. The simulation results are compared with the theoretical and found to agree very well. Limited experiments with wire intramuscular electrodes and surface electrodes are performed to measure in vivo SNR from the biceps brachii muscle. The results of the experiments agree well with those of the simulation and theoretical work. The significance of this work is that it provides insight into the roles of important physiological parameters in myoelectric channel performance. It will also provide data necessary for the development of SNR enhancement techniques.

Electricity↗
PubMed2005

Replacing the patient: the fiction of prosthetics in medical practice.

The invention of computer simulations used for practicing surgical maneuvers in a video game-like format has an ancestry in the artificial limbs of history and is reflected, grotesquely, in Edgar Allan Poe's short story, "The Man That Was Used Up" (1850). The nineteenth century worked to ensure that the incomplete body did indeed retain a sense of self by creating prostheses to mimic corporeal wholeness. Our present-day technology seems intent on doing precisely the opposite, deliberately fragmenting the body and challenging our understanding of the body and the prosthetic.

Computer Simulation↗
PubMed1988

Biomechanical highlights--the personal miscellany of a decade.

Developments of the past decade, primarily in biomechanics, are characterized through personal recollections. Topics covered include pressure treatment of hypertrophic scars, laser eradication of tattoos, amputation stump and artificial limb interactions, elbow arthoplasty, disability rehabilitation and training for sports performance, functional electrical stimulation and joint goniometry. The review is prefaced by comments on the present day context and resource environment of bioengineering research and ends by discussing the anticipated advent of health maintenance oriented community care as the activity of first priority for the future.

Biomechanical Phenomena↗
PubMed1993

Motion measurement with high-speed video.

A new kinematic measurement system based on a high-speed video system, combined with a computer-assisted evaluation for the analysis of gait patterns, is described. The system allows both a reviewable visual assessment in slow motion (up to 1000 frames s-1 as well as automatic measurement of the kinematics of body segments. Specially developed software, which uses a pattern search algorithm and an additional subpixel correction, results in a deviation of less than 0.1% (without considering the lens nonlinearity). For most cases the recognition and tracking of temporarily concealed markers is also achieved. The results of the computer-assisted high-speed video analysis are being applied in rehabilitation programmes to increase the objectivity of standard movements, e.g. gait analysis of people with artificial limbs.

Algorithms↗
PubMed1991

The selection of amputation level: an approach using decision analysis.

The choice of level for a major amputation of the leg depends upon the careful balancing of the advantages of preserving the knee joint against the risks of failure to heal and subsequent revision of the amputation stump. A study has been carried out to measure the values that health care professionals put upon different levels of disability resulting from amputation. The results show that the reduction of quality of life is thought to be 5-10% and 10-20%, respectively, for ambulation upon a below-knee and above-knee prosthesis and about 50% for failure to mobilise on an artificial limb. These utilities have been incorporated into a decision analysis to determine the optimum strategy for evaluation of amputation level, with other probabilities obtained from published data. The results demonstrate the advantage of attempting to preserve the knee joint, even if the chance of primary healing is as low as 20%. Tests of likely healing are most useful if the sensitivity is high, with specificity being less important, and the advantages may be outweighed by the costs of false negatives if sensitivity is below 90%. Sensitivity analysis shows that these findings remain valid over a wide range of possible values. Further research is required to gain more accurate information on which to base decisions, but on current evidence a policy of below-knee amputation in all cases of clinical doubt may be preferable to the use of currently available tests.

Amputation, Surgical↗
PubMed1982

An unusual injury of the cervical spine caused by a fork lift.

A case of very unusual aetiology is reported. A severe traumatic injury of the cervical spine was associated with a suspended bilateral phrenic nerve paralysis, with limited sensory involvement, and weakness of the muscles of the right upper limb. The neurological status was otherwise normal, apart from slight weakness of the left upper limb. Artificial ventilation was necessary. Respiratory recovery was slow. The neural aetiology is discussed in relation to spinal cord and/or root involvement.

Accidents, Occupational↗
PubMed2003

The association of rehabilitation and war.

PURPOSE: To examine the assumed association of war and the development of rehabilitation through a review of the pertinent literature. METHODS: Search in the Medline databases from 1942-2002 for papers that described the impact of war on rehabilitation services and their practice, and the study of the relevant identified reports. The following search terms were used: history of rehabilitation, medicine and war, rehabilitation and war, rehabilitation of war casualties. RESULTS: In WWI physical and occupational therapy became adjuncts in the treatment of military orthopaedic casualties, artificial limb services were set-up and workshops and factories for vocational rehabilitation were created. During WWII further developments occurred, mainly in the field of amputation of limbs and spinal cord injuries. Additional advances took place in all armed conflicts after WWII, particularly in the field of brain injury. CONCLUSION: The literature review indicates that the assumed association of rehabilitation and war is correct. Rehabilitation services have developed partly in association with war and the experience of rehabilitating war casualties supplied valuable principles and practices to rehabilitation medicine enriching the specialty and contributing to the health care systems of the involved countries.

Asia↗