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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↗

PubMed2006

Prosthetic intervention effects on activity of lower-extremity amputees.

OBJECTIVE: To investigate the effect of prosthetic interventions on the functional mobility of lower-extremity amputees. DESIGN: Crossover with repeated measures. SETTING: Household and community environment. PARTICIPANTS: Twelve transtibial and 5 transfemoral amputees. INTERVENTIONS: For transtibial amputees, shock-absorbing versus rigid pylons. For transfemoral amputees, C-Leg versus Mauch SNS knees. MAIN OUTCOME MEASURES: Daily activity level (step count) and duration (minutes of activity). RESULTS: Pylon type had no effect on the daily activity level or duration of transtibial amputees. Knee type had no effect on the daily activity level or duration of transfemoral amputees. Transtibial amputees were more active on weekdays (3079+/-1515 steps/d) than weekends (2386+/-1225 steps/d) (P=.007). In general, lower-extremity amputees perform numerous short-duration bouts of activity (1-2 min) consisting of fewer than 17 steps/min, but activities of more than 15 minutes in duration were relatively rare (<1 per day). CONCLUSIONS: Intervention had no effect on amputee activity level and duration. Higher weekday activity levels of transtibial amputees suggest their vocational activities are more demanding than recreational activities. The fitting, alignment, and design of prosthetic components should be optimized for 1 to 2 minute bouts of activity consisting of only a few dozen steps.

Adult↗

PubMed2006

Functional outcome after major lower extremity amputation: a survey on lower extremity amputees.

The post-operatve course of amputees is poorly documented. This cross-sectional survey was unertaken to determine functional outcomes of 213 patients who had undergone either a below-knee or above-knee amputation from 2000 to 2002 in a state-hospital setting. The study comprises a self-constructed questionnaire and interview conducted by phone. Of the 213 amputees, 41 out of 61 documented telephone numbers of the patients were useful for contact. Only 30 amputees were available for the study as the remaining 11 had passed away. Included in the questionnaire was the modified Barthel Index, a measurement to assess the amputees' ability to carry out activities of daily living (ADL). It contains ten questions pertaining to ADL with a total score of 20 points. Two-thirds of the respondents (67%) use their prosthesis for less than six hours per day. The Barthel Index of 30 patients ranged from 9-20 (mean 17.7). However, the mean Barthel Index in those with and without prosthesis was 18.4 and 15.2 respectively, but this difference was not significant. Half of the respondents were unable to maintain their pre-amputation jobs, while the remaining 50% were still able to work. Forty seven percent of amputees took less than a year to return to their activities, while 33% took between one to two years. Regarding the adequacy of preamputation information provided by the doctors, 73% amputees responded in the affirmative, while 27% felt otherwise. Amputees were still facing substantial disabilities following major amputation of the lower limb. Although 80% of respondents surveyed own prosthesis, the full use of prosthesis is suboptimal due to prosthetic-related problems. Most amputees had a good functional outcome based on the modified Barthel Index. Some amputees were unhappy as they felt that they were insufficiently informed regarding post-amputation expectation prior to the amputation. Despite good support from family, the community support for amputees is still lacking.

Activities of Daily Living↗

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↗

PubMed2006

Environmental barriers experienced by amputees: the Craig Hospital Inventory of Environmental Factors-Short Form.

OBJECTIVES: To describe the prevalence of perceived environmental barriers in a population of amputees; to compare and contrast those barriers reported by amputees with reported barriers of a sample of disabled and nondisabled persons; and to identify the correlates of barriers among amputees. DESIGN: Cross-sectional survey. SETTING: A community sample who were interviewed by telephone. PARTICIPANTS: A stratified sample by etiology of 914 community-dwelling persons with limb loss. INTERVENTION: Telephone interview. MAIN OUTCOME MEASURES: Frequency (never, less than monthly, monthly, weekly, daily) and magnitude (little problem, big problem) of perceived environmental barriers in 5 domains as measured by the Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF), characteristics of the amputation, prosthetic use, and sociodemographic characteristics of the amputee. RESULTS: The majority (87%) of persons surveyed reported barriers in 1 or more areas with 57% reporting barriers in 4 or more of the 5 domains (policies, physical/structural, work/school, attitudes/support, and services/assistance subscales). Mean frequency-magnitude scores were lower for amputees with cancer-related amputation across all subscales, while traumatic amputees reported the greatest perceived barriers, except in the area of services/assistance. Across all domains, poverty level and comorbidity were significant predictors of significant barriers (CHIEF-SF score >/=3; range, 0-8). When compared with a general population sample of disabled and nondisabled Americans, amputees were more likely to perceive barrier in all areas except work/school. CONCLUSIONS: Perceived environmental barriers among persons with limb loss are highly prevalent. Reduction of environmental barriers may lead to reduction of disability and improvement of overall quality of life for amputees.

Adult↗

PubMed1997

Upper limb traumatic amputees. Review of prosthetic use.

The prosthetic status of the traumatic upper limb amputees was reviewed. Fifty-five upper limb amputees were reviewed using a detailed questionnaire, telephone or clinic review and by case note study. Twenty-three patients were traumatic amputees and 32 were congenital amputees. The amputees' function, prosthetic use and satisfaction were evaluated and this formed the basis of a scoring system. The traumatic group were less satisfied with their prosthesis and their functional ability was poorer, especially in the use of the myoelectric prosthesis. Traumatic amputees were their prosthesis for an average of 6.5 hours per day compared to 9.3 hours in the atraumatic group. None of the traumatic amputees fitted after 12 weeks returned to gainful employment. Early prosthetic fitting, rehabilitation and post-traumatic counselling are advocated in upper limb traumatic amputees in order to achieve an optimum prosthetic benefit for the patient.

Adolescent↗

PubMed2005

Chronic low back pain in traumatic lower limb amputees.

OBJECTIVE: To ascertain the prevalence of back pain amongst traumatic lower limb amputees attending a regional rehabilitation centre and to determine the possible causes of back pain. DESIGN: All traumatic lower limb amputees given a semi-structured questionnaire to complete and a comparative subgroup of amputees with back pain and without back pain underwent physical examination, gait analysis, magnetic resonance scanning (MRI) and gait/standing stability analysis. SETTING: A subregional amputee rehabilitation centre. RESULTS: Transfemoral amputees were more likely to suffer from back pain (81 %) than transtibial amputees (62%) (p<0.05) and of those suffering from severe back pain, 89% and 81% also suffered from severe pain in the phantom limb and severe stump pain respectively. In two comparative subgroups of amputees there was no significant difference between back pain and pain-free groups except those with pain were more likely to have a body mass index (BMI) ratio above 50% of the recommended ratio. No difference in degeneration or disc disease between the groups on MR scans was found. Impact ground reaction forces during walking, irrespective of limb, were significantly greater (p < 0.05) in the pain-free group than in the pain group, as was walking speed. Gait asymmetry measures were similar in both groups. Centre of pressure displacement measures during standing were greater in the pain group than in the pain-free group. CONCLUSIONS: Low back pain in amputees is a significant problem equal to that of pain in the phantom limb and a biomechanical (myofascial) rather than a degenerative aetiology is suggested.

Adolescent↗

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↗

PubMed2005

The gait initiation process in unilateral lower-limb amputees when stepping up and stepping down to a new level.

BACKGROUND: Unilateral lower-limb amputees lead with their intact limb when stepping up and with their prosthesis when stepping down; the gait initiation process for the different stepping directions has not previously been investigated. METHODS: Ten unilateral amputees (5 transfemoral and 5 transtibial) and 8 able-bodied controls performed single steps up and single steps down to a new level (73 and 219 mm). Duration, a-p and m-l centre of mass and centre of pressure peak displacements and centre of mass peak velocity of the anticipatory postural adjustment and step execution phase were evaluated for each stepping direction by analysing data collected using a Vicon 3D motion analysis system. FINDINGS: There were significant differences (in the phase duration, peak a-p and m-l centre of pressure displacement and peak a-p and m-l centre of mass velocity at heel-off and at foot-contact) between both amputee sub-groups and controls (P<0.05), but not between amputee sub-groups. These group differences were mainly a result of amputees adopting a different gait initiation strategy for each stepping direction. INTERPRETATION: Findings indicate the gait initiation process utilised by lower-limb amputees was dependent on the direction of stepping and more particularly by which limb the amputee led with; this suggests that the balance and postural control of gait initiation is not governed by a fixed motor program, and thus that becoming an amputee will require time and training to develop alternative neuromuscular control and coordination strategies. These findings should be considered when developing training/rehabilitation programs.

Adult↗

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↗

PubMed2003

Social integration of juvenile amputees: comparison with a general population.

The objective was to assess the social integration of juvenile amputees according to marital status, schooling and occupation, and to compare it with the population of Asturias, Spain. A retrospective study was carried out of the juvenile amputees registered from 1976 to 1999 at the Prosthetics Unit of the Asturias Central Hospital (n=281 amputees). The proportion of single women amongst the amputees was greater than in the population of Asturias (p<0.05). Amongst the male amputees, relative to the general population, there was a larger proportion of the group with primary studies (p<0.001) and a smaller proportion with secondary studies (p<0.001). At the higher level (university) there were no differences, either in men or in women. As regards occupation, amongst the amputees a larger number was found who were retired or unemployed (p<0.05 and p<0.001). In conclusion, juvenile amputees do not show differences compared to the general population with regard to their attendance at a higher or university level of education. However, if their social integration is considered through occupation, male amputees show a greater proportion of unemployment, which is a clear reflection of their handicap.

Adolescent↗

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↗