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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↗
PubMed2004

P300-amplitudes in upper limb amputees with and without phantom limb pain in a visual oddball paradigm.

The aim of the study was to investigate to what extent cortical hyper-reactivity to visual stimuli is present in upper limb amputees. Five amputees with phantom limb pain (PLP), five amputees without PLP (Non-PLP) and 10 healthy controls (HC) were investigated using a visual oddball paradigm. Two hundred visual stimuli were presented with target stimuli occurring at a probability of 25% and standard stimuli at a probability of 75%. Event-related potentials were recorded from nine scalp positions (F3, F4, Fz, C3, C4, Cz, P3, P4, Pz). The PLP-patients had significantly higher P300-amplitudes to both types of stimuli compared to the non-PLP-patients. The HC were not significantly different from both amputee groups. P300-amplitude to targets at frontal sites in the hemisphere contralateral to the amputation was higher in the PLP patients. P300-latencies to target stimuli differed only at frontal sites with PLP-patients showing significantly longer latencies than non-PLP-patients. To standard stimuli, however, they showed significantly shorter latencies at central and parietal scalp positions. The HC had significantly shorter latencies than both amputee groups. The size of the P300-amplitude was positively correlated with the intensity of PLP. These findings suggest a higher magnitude of non-specific cortical excitability in amputees with PLP and a reduced excitability in amputees without PLP. This extends previous findings of differences in cortical excitability in PLP and non-PLP patients in the sensorimotor domain.

Adult↗
PubMed1998

Increased cardiovascular disease mortality rates in traumatic lower limb amputees.

We evaluated the 24-year mortality rates of male traumatic lower limb amputees (n = 201) of the Israeli army, wounded between 1948 and 1974 compared with a cohort sample representing the general population (n = 1,832). Mortality rates were significantly higher (21.9% vs 12.1%, p <0.001) in amputees than in controls. Cardiovascular disease (CVD) mortality was the main cause for this difference. The prevalence of selected risk factors for CVD was determined in 101 surviving amputees (aged 50 to 65 years) and a sample of the controls (n = 96) matched by age and ethnic origin. Amputees had higher plasma insulin levels (during fasting and in response to oral glucose loading) and increased blood coagulation activity. No differences were found in rates of current symptoms of ischemic heart disease or of cerebrovascular disease, obesity, hypertension, altered plasma lipoprotein profile, impaired physical activity, smoking, or nutritional habits. Traumatic lower limb amputees had increased mortality rates due to CVD. Surviving amputees had hyperinsulinemia, increased coagulability, and increased sympathetic and parasympathetic responses (described previously). These established CVD risk factors may explain the excess mortality due to CVD in traumatic amputees.

Aged↗
PubMedDate not supplied

A survey of the satisfaction of upper limb amputees with their prostheses, their lifestyles, and their abilities.

Seventy Australian upper limb amputees responded to a detailed postal questionnaire asking how often they wore their prostheses and their level of satisfaction with both their prostheses and their functional abilities. Fifty-six percent of amputees wore their limbs "once in a while" or "never." Prostheses were most often worn "all the time" for work and social activities. The amount of time amputees wore their prostheses was moderately associated with their level of satisfaction with their prostheses. The association between the amount of time amputees wore their prostheses and their level of satisfaction with their functional abilities was very low. Their prostheses were rated as "fair" or "not acceptable" by 64% of amputees. Sweating was rated as "not acceptable" by 55%. This may well be a significant contributing factor to the low prosthetic use. The amputees who did not wear prostheses did not have any greater satisfaction with their ability to do the tasks they want to do than the amputees who wore prostheses.

Adult↗
PubMed2002

A preliminary examination of the relationship between employment, pain and disability in an amputee population.

PURPOSE: To examine amputees' use of health, social and voluntary services and to assess the perceived benefit of such use. Additionally, to examine the degree and type of changes made in occupational status in relation to both pain and prosthetic limb use following amputation. METHOD: A survey methodology was employed to examine the services used by amputees and their experiences of occupational change. A response rate of 62% resulted in 315 amputees completing the study. The study sample was drawn from patient records at three artificial limb and appliance centres in the central belt of Scotland. RESULTS: Overall the data suggest that few amputees make use of the available services for general amputation-related problems. Even fewer services were utilized for phantom limb pain or for other pain problems. Moreover, of those services that were used, very few were reported as being helpful. Amputation had severe consequences in terms of employment with 75% of the sample in employment prior to the amputation and only 43.5% remaining following amputation. Additionally, of those who did remain in employment there were a number of changes from pre- to post-amputation occupational classification. Employment status was related to the intensity of phantom limb pain, and daily prosthetic limb use with unemployed amputees reporting higher levels of pain and lower levels of prosthesis use. CONCLUSIONS: The study demonstrates the need for further research to determine whether the results obtained regarding occupational changes following amputation result pain, disability, amputees' attitudes towards themselves in relation to work, or to employers' attitudes and beliefs about their capabilities. Further research is also required to determine why so few amputees make use of available services and why, even when they are used, such services are not perceived as being helpful. Finally, there is a need to clarify the relationship between the extent of daily prostheses use, the experience of phantom limb pain and employment status.

Adult↗
PubMed2002

Physical fitness of lower limb amputees.

OBJECTIVE: To investigate the cardiorespiratory endurance of the physical fitness of amputees and able-bodied subjects of the same ages and to demonstrate deterioration of the physical fitness of the amputees. DESIGN: The test subjects were 31 amputees. Eighteen able-bodied persons served as controls. The incremental exercise test was performed to evaluate physical fitness. Sixteen of 31 amputees underwent endurance training by using a cycle ergometer driven by the intact leg, and their physical fitness was evaluated after completion of the endurance training program. RESULTS: The Vo2max, anaerobic threshold, and maximum workload for the amputees were significantly lower than those of the able-bodied group. The equivalent values for the endurance training group before exercise treatment were 18.0, 12.1, and 63.9, respectively. After exercise treatment, these values significantly increased, and there was no significant difference from the able-bodied subjects. CONCLUSIONS: This study showed that the physical fitness of amputees was clearly lower than that of the able-bodied subjects and that the amputees were able to recover from a poorly conditioned status after endurance training.

Adult↗
PubMed1998

Segment velocities in normal and transtibial amputees: prosthetic design implications.

Dynamic elastic response foot and ankle prostheses (Seattle-Lite, Flex Foot, etc.) used by transtibial amputees feature substantial design improvements over conventional designs (SACH, Single Axis, etc.). Despite this progress, transtibial amputees continue to expend greater energy than normals. Increased residual limb EMG data and altered gait patterns suggest that impaired mobility may be the cause of overactive muscles in early stance. Prosthetic mobility was therefore quantified by measuring foot, shank and thigh velocities in nine transtibial amputees, wearing three different foot designs: Single Axis (SA), Seattle Lite (SL) and Flex Foot (FF). The magnitude, timing and rate of segment velocities for each prosthetic design, characterizing early stance mobility, were compared with corresponding measures in normal, nonamputee (NA) controls using Dunnett's test. Regardless of foot type, transtibial (TT) amputees walked slower than non amputee controls (63.3-65.8 m/min versus 78.5 m/min, p < 0.05) and their stride length was shorter (1.21-1.26 m versus 1.41 m, p < 0.01). In early stance, peak foot and shank velocities were lower (p < 0.01) for both the SL and FF while only shank velocity was lower (p < 0.01) with the SA compared to NA controls. Significant delays in the timing of early stance events such as peak shank velocity, peak ankle plantarflexion and peak knee flexion compromised shank and knee stability in TT amputees. Foot and shank mobility was uncontrolled with the SA design while ankle mobility was restricted by the FF and SL feet. In NA controls on the other hand, appropriate timing and rate of segment velocity changes preserved dynamic stability and forward progression in early stance. This was evidenced by rapid decreases in foot and shank velocity as the thigh velocity increased during weight acceptance. Future prosthetic designs should provide TT amputees with improved ankle mobility that attempt to capture the dynamic characteristics of a normal articulation between the foot and shank segments during the early stance weight acceptance period.

Amputation, Surgical↗
PubMedDate not supplied

Influence of terrain on metabolic and temporal gait characteristics of unilateral transtibial amputees.

The difficulties confronted by amputees during overground walking are rarely investigated. In this study, we evaluated, in real-world situations, the influence of ground surface on walking in young, active amputees by measuring temporal and spatial gait parameters (free walking speed [FWS], step length [SL], step rate), energy expenditure (EE) (e.g., oxygen uptake, oxygen cost [O(2)C]), and Rating of Perceived Exertion (RPE). Ten active transtibial amputees and ten nondisabled control subjects walked at self-selected speeds on three types of ground surface (asphalt, mown lawn, and high grass). No significant differences were observed between the two groups on asphalt and mown lawn. Differences between nondisabled subjects and amputees occurred for FWS (p = 0.03) and O(2)C (p = 0.04) on asphalt and mown lawn and for all variables in high grass. When amputees (even though very active) were exposed to a particularly difficult environment, their FWS decreased (p = 0.008) and their EE and RPE increased (p = 0.005) compared with nondisabled subjects. In high grass, both groups reduced their self-selected speeds (-15% for control subjects and -16% for amputees). Control subjects reduced their velocity by reducing both SL (-8.7%) and cadence (-7.1%), whereas amputees reduced their velocity by reducing SL (-17%) only.

Adult↗
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↗
PubMed1996

Isokinetic and isometric strength of the thigh muscles in below-knee amputees.

OBJECTIVE: The strength of the quadriceps and hamstring muscles of the amputated limb in below-knee amputees was evaluated. DESIGN: A descriptive study based on clinical measurements of muscle strength. BACKGROUND: The residual limb of below-knee amputees is less active in daily functions. As a result, atrophy of the thigh muscles in the affected limb is a common finding. Quality of standing and gait performances depend on the strength of these muscles, which activate the knee of the amputated limb. METHODS: Isokinetic concentric and eccentric, as well as isometric, strength of thigh muscles was measured by means of a dynamometer. Parameters of peak torque and maximal average torque of the quadriceps and hamstring muscles were considered. RESULTS: Significant decreases (P < 0.01) in strength of the quadriceps and hamstrings were observed in the amputated limb. Thigh muscle strength in amputees over 7 years was not significantly weaker when compared with amputees where amputation had been performed more recently. CONCLUSIONS: In below-knee amputees, the thigh muscle strength of the amputated limb decreases significantly during the first years after amputation. RELEVANCE: In so far as the ultimate goal in rehabilitation of amputees is to return the patient to an acceptable level of function, it is recommended that the amputee should be trained and encouraged in self-strengthening exercises for the thigh muscles of the amputated limb.

Journal Article↗
PubMed2000

Amputees in Limburg: incidence, morbidity and mortality, prosthetic supply, care utilisation and functional level after one year.

OBJECTIVES: To describe for the province of Limburg, the Netherlands, the incidence of lower limb amputation (LLA), the demographic characteristics of the amputees, reason and level of amputation, care the amputees receive, prosthetic supply and functional level after one year. DESIGN: A prospective descriptive cohort study. METHODS: Anonymized data on all amputees in all nine hospitals were collected during 1994. Follow-up was one year. RESULTS: 191 major lower limb amputations in 164 patients. Incidence was 17.1 per 100,000. Amputation levels: 77 trans-tibial, 52 transfemoral and 43 knee disarticulation. Twenty (20) patients died during hospitalisation. Eighty-seven (87) amputees gave permission for followup, 60 could be actually followed. Twenty-two (22) patients received in-patient rehabilitation, 16 primary day-care, 21 went to a nursing home and one went home without rehabilitation. The mean duration of rehabilitation was 35 weeks. In 53 patients a functional prosthesis was indicated. Forty-three (43) of these patients walked with the prosthesis after one year, 7 of whom more than 500 metres. Nineteen (19) amputees performed the Get Up and Go Test (GUGT) safely. Amputees on average have a low level of functioning, as indicated by SIP68 and Barthel Index Scores. The ability to walk is closely related to this daily function and quality of life. CONCLUSION: After one year the majority of amputees have low walking skills and the walking distance is limited. They are often ADL-dependent and their amputation greatly limits their daily function.

Activities of Daily Living↗
PubMed2004

The effect of prosthetic torsional stiffness on the golf swing kinematics of a left and a right-sided trans-tibial amputee.

The golf swing is a biomechanically complex movement requiring three-dimensional movements at the ankle joint complex (AJC), the hips and shoulders. Trans-tibial amputees lose the natural AJC movements as many prostheses do not allow three dimensional foot movements. Torsion devices have been developed and incorporated into prostheses to facilitate internal and external transverse plane rotations. These devices can help amputees to compensate for the loss of movement and to reduce shearing stresses at the stump-socket interface. The primary aim of the present study was to investigate the effects of three torsion devices on body rotations during the golf swing. Two trans-tibial amputees (one right-sided and one left-sided) were analysed using three-dimensional video analysis at address (ADR), the top of the backswing (TBS) and at the end of the follow-through (EFT). The participants played shots with a 3-wood under three different prosthetic conditions (two with a torsion device set to different stiffness values, and one with no torsion device). The results showed that the torsion device served to improve the hip and shoulder rotations of the left-side amputee without increasing perceived stress at the stump. The torsion device had minimal effect on the hip and shoulder rotations of the right-side amputee, although perceived stress was reduced. The difference in results between the right-sided and left-sided amputees was due to the different requirements of each foot during the golf swing. The main problem faced by the right-side amputee was a loss of the sagittal plane movement of ankle joint plantarflexion at EFT, rather than the transverse plane movement.

Adult↗
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↗
PubMed1999

Analyses of prosthetic episodes in trans-tibial amputees.

The prosthetic episodes, i.e. actual processes of provision, identifying number of prostheses, their maintenance, repairs and replacements were analysed for 104 trans-tibial amputees aged 16 and over, over a 10 year period. The purpose of this investigation was to identify how frequently a new prosthesis is actually required for this group of amputees and what are their maintenance requirements. Variations of requirement between the amputee groups of aged 16-60 and over 60 years are also addressed. In the 10 years period of the study the amputees needed an average of 5.04 new prostheses, 6.25 refits, 2.28 major repairs and 17.04 day repairs. The younger amputees, i.e. below the age of 60 years, required significantly more new prostheses (p=0.003), more refit of sockets (p=0.0012) and more day repairs (p=0.01). Traumatic amputees below the age of 60 years needed significantly more day repairs compared to the non-traumatic amputees in the older age group (p=0.003).

Adolescent↗
PubMed1994

The gait of unilateral transfemoral amputees.

The aim of this study was to describe the gait of persons with a unilateral transfemoral amputation by means of a questionnaire, gait analysis and measurement of energy expenditure, and to find correlations among the variables studied. The study included 29 transfemoral amputees amputated for other reasons than a chronic vascular disease. The patients were assessed using the following methods: 1) A questionnaire rating the walking distance and walking difficulty in different circumstances. 2) Gait analysis measuring temporal variables and goniometry of hips and knees. 3) Measurement of energy expenditure during sitting and walking. Scores on the questionnaire showed a correlation with socket design, a negative correlation with age and energy expenditure, and a positive correlation with fast speed. The gait of transfemoral amputees was asymmetrical as far as temporal variables were concerned, and for most amputees also for the range of motion of hip and knee. The walking speed of the amputees was lower than that of non-amputees and showed a positive correlation with hip extension-flexion range of motion and a negative correlation with age and stride time. The energy expenditure of the amputees during ambulation was higher than that of non-amputees, and seemed to correlate with residual limb length and the hip abduction-adduction range of motion.

Adolescent↗
PubMed1998

Cortical reorganization and phantom phenomena in congenital and traumatic upper-extremity amputees.

The relationship between phantom limb phenomena and cortical reorganization was examined in five subjects with congenital absence of an upper limb and nine traumatic amputees. Neuromagnetic source imaging revealed minimal reorganization of primary somatosensory cortex in the congenital amputees (M=0.69 cm, SD 0.24) and the traumatic amputees without phantom limb pain (M=0.27 cm, SD 0.25); the amputees with phantom limb pain showed massive cortical reorganization (M=2.22 cm, SD 0.78). Phantom limb pain and nonpainful phantom limb phenomena were absent in the congenital amputees. Whereas phantom limb pain was positively related to cortical reorganization (r=0.87), nonpainful phantom phenomena were not significantly correlated with cortical reorganization (r=0.34). Sensory discrimination was normal and mislocalization (referral of stimulation-induced sensation to a phantom limb) was absent in the congenital amputees. The role of peripheral and central factors in the understanding of phantom limb pain and phantom limb phenomena is discussed in view of these findings.

Adult↗
PubMed2005

The prevalence of knee pain and symptomatic knee osteoarthritis among veteran traumatic amputees and nonamputees.

OBJECTIVE: To determine whether amputees have an increased risk of knee pain or symptomatic osteoarthritis (OA) compared with nonamputees. DESIGN: Retrospective cohort study. SETTING: Veterans Administration Patient Treatment and Outpatient Care files. PARTICIPANTS: All male unilateral (transtibial or transfemoral) traumatic amputee patients and a random sample of male nonamputees. Patients were excluded if they were younger than 40 years, had sustained a significant injury to their knee(s), or had a rheumatic disease. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The prevalence of knee pain and symptomatic knee OA. RESULTS: The age and average weight-adjusted prevalence ratio of knee pain among transtibial amputees, compared with nonamputees, was 1.3 (95% confidence interval [CI], 0.7-2.1) for the knee of the intact limb and 0.2 (95% CI, .05-0.7) for the knee of the amputated limb. The standardized prevalence ratio of knee pain in the intact limb and symptomatic OA among transfemoral amputees, compared with nonamputees, was 3.3 (95% CI, 1.5-6.3) and 1.3 (95% CI, 0.2-4.8), respectively. CONCLUSIONS: Stresses on the contralateral knee of amputees may contribute to secondary disability. Possible explanations include gait abnormalities, increased physiologic loads on the knee of the intact limb, and the hopping and stumbling behavior common in many younger amputees.

Adult↗
PubMed2006

Does having a computerized prosthetic knee influence cognitive performance during amputee walking?

OBJECTIVE: To compare objective cognitive performance and perception of cognitive burden during walking tasks using 2 different prosthetic knees: a computerized hydraulic knee (Otto Bock C-leg) and a noncomputerized hydraulic knee (Ossur Mauch SNS). DESIGN: Two-group crossover trial, with participants randomly assigned to order of prosthesis. Participants completed assessments under 2 conditions, a self-selected speed walk and a controlled speed walk, on 2 separate occasions (precrossover, postcrossover). SETTING: Veterans Health Administration hospital. PARTICIPANTS: Eight transfemoral amputees. INTERVENTION: Computerized versus noncomputerized prosthetic knee. MAIN OUTCOME MEASURES: Objective cognitive performance measures included verbal fluency (Controlled Oral Word Association Test, Category Test), attention and working memory (serial subtraction), and walking speed during cognitive tasks. Measures of perceived cognitive burden included subjective attentional requirements of walking and cognitive tasks and subjective general cognitive burden of prosthesis. RESULTS: There were no significant differences in objective cognitive performance on any task between prostheses, nor did walking speed vary by prosthesis during the free-speed walk. Participants reported that walking required less attention while wearing the C-leg and that the C-leg was less of a cognitive burden than the noncomputerized prosthesis. CONCLUSIONS: In nondemanding walking conditions with experienced amputees, participants reported that the more costly C-leg required less cognitive attention than the noncomputerized knee. However, this subjective experience did not translate to improved performance on neuropsychologic screening instruments or on walking speed. Noncomputerized prostheses may be adequate for a majority of amputees, and further research is needed to identify particular groups of amputees (ie, new amputees, amputees with complex physical or cognitive demands) who may benefit from computerized prostheses.

Adult↗