Symposium: Amputations and artificial limbs.
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Specific rehabilitation of patients with amputated lower limbs is first of all rehabilitation to walk with a prosthesis (artificial limb). After 20 years of practice of prosthetic early fitting for lower limbs amputees using practice prosthesis, the authors suggest that this technique is still up-to-date. The taking charge of amputated patients by a specialised team is an important element if one wants to achieve a good functional result. A rehabilitation milieu, where the new amputee is with a large number of patients with the same pathology, also constitutes a framework that is reassuring as well as stimulating and allows the patient to imagine the situation in which he/she can find himself/ herself a few weeks later.
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This paper provides evidence that limb-deficient subjects who wear artificial arms tend to overestimate the perceived length of their residual limb. It is proposed that this "perceptual error" may provide a useful and possibly more valid alternative to existing methods of determining prosthetic acceptance. The degree of overestimation is substantial for most subjects with amputations, and typically represents 20 percent of the length of the prosthetic arm. The effect is considerably reduced when the prosthetic limb is removed. Comparisons are made with normal-limbed subjects of various ages. For the most part, their errors are small and typically are underestimates of actual limb length. This research is compared with the work of Fraser (1984), who found similarities in reaching trajectories for normal and artificial arms. Further investigation is required to determine if this effect may serve as an index of adjustment to a prosthesis and, additionally, if prosthetics training programs might benefit from including techniques for enhancing perceptual adaptations to artificial limbs.
The use of silicone inner sockets, with or without the incorporation of shuttle locks, has greatly improved the function of artificial limbs. They cushion and protect the stump and provide a means for prosthetic suspension, allowing more comfortable use, especially in patients with ischaemic stumps. They also allow greater movement at the proximal joint.
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