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PubMed2002

Postural sway and active balance performance in highly active lower-limb amputees.

OBJECTIVE: To determine the balance performance of active lower-limb amputees during quiet standing and under dynamic conditions. DESIGN: Center-of-pressure excursions during quiet standing and the standing balance performance on a single axis stabilimeter was assessed in six unilateral lower-limb amputees and six able-bodied controls. Stabilimeter trials were repeated with subjects standing so that pivoting occurred either in the anteroposterior or mediolateral direction or in the mediolateral direction but with vision occluded. RESULTS: Center-of-pressure excursions were significantly greater (P < 0.05) for amputees in both the mediolateral and anteroposterior directions. During all stabilimeter tests, amputees spent significantly less time in balance than able-bodied controls (P < 0.05), and this was attributed to a nonsignificant increase in the average time the stabilimeter spent in contact with the ground. Group differences in the average time of contact in the anteroposterior test condition were meaningful (effect size, 1.19). CONCLUSIONS: Amputees had poorer static and dynamic balance than able-bodied controls. Amputees had a greater problem controlling dynamic balance in the anteroposterior direction than the mediolateral direction. Findings highlight the importance of the ankle in maintaining balance in situations that involve body movements in the sagittal plane.

Adult↗

PubMedDate not supplied

Prospective diary study of nonpainful and painful phantom sensations in a preselected sample of child and adolescent amputees reporting phantom limbs.

OBJECTIVE: To prospectively study factors associated with the occurrence of phantom sensations and pains in a pre-selected sample of child and adolescent amputees reporting phantom limbs. DESIGN: Prospective diary study over 1 month. PARTICIPANTS: Fourteen child and adolescent amputees from 10-18 years of age who were missing a limb due to trauma (n = 12) or congenital limb deficiency (n = 2), and who had previously reported having phantom sensations and pain. MAIN OUTCOME MEASURE: Diary used to assess the occurrence of non-painful and painful phantom sensations. Items included age, sex, location and cause of amputation, past experience with stump pain and pre-amputation pain, and intensity, quality, duration, and triggers of the sensations and pains. RESULTS: Thirteen amputees reported having 104 incidents of non-painful phantom sensations with an average intensity of 4.17 (SD = 2.14) on a 0-10 rating scale. Fifty-three incidents of phantom pain with an average intensity of 6.43 (SD = 1.76) were recorded by 8 amputees. Both amputees with a congenital limb deficiency reported phantom phenomena. Girls reported more psychosocial triggers than did boys whereas boys were more likely than girls to report that they could not identify a trigger (P = 0.0001). Boys also reported a higher proportion of physical triggers than psychosocial triggers while there were no differences for girls (P = 0.0001). DISCUSSION: Child and adolescent amputees experience phantom sensations and pains on a regular basis over a 1-month period. Differences in triggers of phantom phenomena between boys and girls may be due to differences in activities, awareness, attribution, and willingness to report psychosocial triggers.

Adolescent↗

PubMed1986

Insulin as a potential factor influencing blood pressure in amputees.

War-injured, bilateral above-knee amputees are known to be at increased risk for cardiovascular mortality. To evaluate possible risk factors, we compared blood pressures and plasma glucose and insulin responses to orally administered glucose in 19 above-knee amputees from the Vietnam War (mean age, 36 +/- 1 years) with those of 12 age-matched unilateral below-elbow amputees. Body composition by densitometry and maximal oxygen consumption during arm or leg exercise were also determined. Nine of 19 leg amputees were hypertensive compared with one of 12 arm amputees. Their 3-hour average insulin responses were markedly increased (260 +/- 60 microU/ml) compared with those of normotensive leg (125 +/- 24 microU/ml) and arm amputees (101 +/- 20 microU/ml), and their mean body fat content (37.2%) also was elevated compared with that in both of these groups (23.2 and 22.6%, respectively). A unique finding was that both insulin response and body fat content were strongly and independently correlated with diastolic blood pressure (r = 0.55, p less than 0.01, and r = 0.62, p less than 0.01, respectively). We conclude that insulin may be a major factor in blood pressure regulation in the maturity-onset obesity that develops following traumatic leg amputation in young, healthy men.

Adult↗

PubMed2006

A biomechanical analysis of the long-jump technique of elite female amputee athletes.

PURPOSE: The purpose of this study was to investigate whether female lower-limb amputees conform to the established long-jump model and to compare the kinematics of the approach and take-off phases for elite female transfemoral and transtibial amputee long jumpers. METHODS: Eight female transfemoral and nine female transtibial amputee athletes were videotaped (sagittal plane movements at 50 Hz) from third-to-last step to take-off during the 2004 Paralympic Games long-jump finals. After digitizing and reconstruction of 2D coordinates, key variables were calculated at each stride and during contact with the take-off board. Additionally, approach speed during the run-up of each jump was recorded (100 Hz) using a laser Doppler device (LDM 300 C Sport, Jenoptik Laser, Jena, Germany). RESULTS: The transfemoral amputees had a consistently higher center of mass height on the last three steps before take-off than the transtibial amputees. However, at touch-down onto the take-off board, they lowered their center of mass excessively so that from touch-down to take-off, they were actually lower than the transtibial amputees. This resulted in a greater negative vertical velocity at touch-down and may have inversely affected their jump performance. CONCLUSION: Female transtibial athletes conformed to the long-jump model, although adaptations to this technique were displayed. Female transfemoral athletes, however, exhibited no relationship between take-off speed and distance jumped, which may be attributable to their excessive lowering of their center-of-mass height at touch-down onto the take-off board. It is recommended that coaches and athletes proceed with caution when trying to replicate techniques used by able-bodied athletes because adaptations to the constraints of a prosthesis should be considered.

Amputees↗

PubMed1995

Exercise performance of lower-extremity amputees.

A comparison of the literature quantifying the energy expended during ambulation of healthy individuals and those with amputation of the lower extremity is difficult as study parameters and methods are inconsistent. However, the energy cost of ambulation is greater for amputees than for nonamputees. Ascending level of amputation appears to be associated with increasing metabolic demand. There appears to be a difference in energy cost of ambulation following different surgical procedures. The literature regarding energy cost of ambulating with different lower-extremity prostheses is equivocal, with the exception of the contoured adducted trochanteric-controlled alignment method (CAT-CAM) socket for above-knee amputees and the new energy-storing (Proteor) foot for traumatic below-knee amputees, which may decrease energy expenditure during ambulation. Therefore, it is reasonable to recommend that energy cost of ambulation be considered when deciding on the most efficacious surgical procedure, and metabolic efficiency of gait be considered when selecting prostheses most suitable for lower-extremity amputees. Though limited research is currently available, it appears that training or physical conditioning for the lower-extremity amputee, particularly with cardiopulmonary or vascular insufficiency, may decrease the metabolic cost of ambulation. More research is needed regarding the benefits of aerobic exercise and the safest, most effective exercise regimens for reducing metabolic costs of ambulation in lower-extremity amputees.

Amputees↗

PubMed1983

A field evaluation of arm prostheses for unilateral amputees.

A post-clinical investigation has been carried out among 42 unilateral amputees who lost their hand due to an accident. The investigation was directed at two main topics of interest. Firstly the amputee, the problems he has to cope with, and the role the prosthesis plays in his life; and secondly the prosthesis, its use and its potential benefits and burdens. The group of amputees consisted of above-elbow and below-elbow amputees. Body powered as well as myoelectric prostheses were represented in the group. Most of the information was obtained during a two-day home visit where a semi-structured interview was conducted, and where a number of daily life activities were observed. The information thus obtained has led to a number of conclusions and recommendations with respect to the rehabilitation of this category of amputees, and with respect to the design criteria of prostheses for unilateral amputees.

Activities of Daily Living↗

PubMed1993

Consumer concerns and the functional value of prostheses to upper limb amputees.

This paper reports a study of 66 upper limb amputees in County Funen, Denmark who were visited in their homes by the author. The purpose of the study was to evaluate the consumer concerns about their prostheses and to see if these were related to cessation of prosthetic use. It was also intended to estimate functional levels of both prosthetic users and non-users. The number of amputees investigated corresponds to the annual number of persons becoming upper limb amputees in Denmark. There were 3 prosthetic systems in use, two active systems and one passive system. At review there was a group of 18 amputees which did not use a prosthesis at all. It appeared that active and partially active users are younger persons with a relatively short time-lapse since amputation. Passive users are older persons with a long time-lapse since amputation. Only 4 out of 18 prosthetic non-users stopped prosthetic use as a consequence of prosthetic problems or discomfort. Active prostheses had the highest number of consumer problems. Most problems were concerned with the socket, and for the body powered prostheses also with the suspension and control system. It was shown that an awareness of the amputee's working conditions is important at the fitting stage, especially the daily working situation. As a consequence strictly individual fitting is needed with attention being given to the manner in which the individual will use the prosthesis. This investigation clearly shows that active fitting is a worthy effort. In daily living the active users have a superior performance over the passive and non-users. It was observed that amputees despite many years of training still have problems with activities of daily living, particularly in relation to independent functions.

Activities of Daily Living↗

PubMed1994

Gait in male trans-tibial amputees: a comparative study with healthy subjects in relation to walking speed.

Walking speed, stance duration and ground reaction forces were studied with the use of a stable force platform (Kistler) in 24 male transtibial amputees and 12 healthy subjects matched for sex and age. The aim of the study was to compare the gait performance of two groups with unilateral trans-tibial amputations for either vascular disease or trauma and also to compare the results of the two groups with the results of a group of healthy subjects. Multiple linear regression analysis was used to compare the stance duration and the ground reaction forces in relation to walking speed. The vascular and traumatic amputees had significantly reduced walking speeds compared with the healthy subjects, 0.85 +/- 0.2 m/s and 0.99 +/- 0.2 m/s. respectively, as compared to 1.42 +/- 0.2 m/s. By comparing the vascular and traumatic amputees with the healthy subjects in relation to walking speed, it was shown that the gait performance of the vascular amputee differed from that of the traumatic amputee, a difference that was not caused by the reduced walking speed. The active forces during push off on both the healthy (p = 0.02) and the prosthetic leg (p = 0.003) in the trauma group were not found in the vascular group. This disparity could be an effect of the systemic disease. It may be argued that the results of this study contribute to the understanding of the reduced walking ability of the vascular amputee and should be borne in mind when planning rehabilitation.

Aged↗

PubMed1998

An audit of the quality of the stump and its relation to rehabilitation in lower limb amputees.

An audit was undertaken amongst the lower limb (adult) amputees, 60 unilateral transfemoral (TF) and 72 unilateral trans-tibial (TT), who attended a Disablement Services Centre (DSC) during a one year period, to determine whether amputees with better quality stumps (as assessed by a scoring system used at the Centre) achieve better outcome from prosthetic rehabilitation and whether there is any relation between the construction of the stumps and the grade of surgeons. At eighteen months (minimum follow up of six months) there were 31 (52%) TF and 54 (75%) TT amputees wearing prostheses. Some 44 amputees with Grade A stumps (score of 60 and over, out of a possible 100) needed 154 days to achieve the predicted mobility grade, 15 (34%) of them needed alteration of prosthesis, attended the Centre every 42 days and achieved the activity score of -25.7; 41 amputees with Grade B stumps (scores less than 60) needed 206 days to achieve the predicted mobility grade, 24 (58.5%) of them needed alteration of prosthesis, attended the Centre every 29 days and achieved the activity score of -39.1 (less active than Grade A). The trainee surgeons (registrars, staff grade surgeons and SHOs) produced 26 Grade A stumps out of 67 amputations (40%) and the Consultants and the Senior Registrars (senior team) produced 37 Grade A stumps out of 65 amputations (57%). However, only 36% of amputees were prescribed prostheses at their first attendance (60% Grade A, and 40% Grade B).

Amputation Stumps↗

PubMed2006

Functional outcomes of unilateral lower limb amputee soldiers in two districts of Sri Lanka.

The purpose of this study was to describe functional outcomes of unilateral lower limb amputee soldiers, in comparison to nonamputee male subjects, and to identify factors affecting functional outcomes. Selected lower limb amputee soldiers of the Sri Lanka Army (n = 461) and matched nonamputee male subjects (n = 461) were evaluated with the prevalidated self-administered version of Short-Form Health Survey-36. A majority were below-knee amputees (n = 413; 89.6%), and the mean age was 30.2 +/- 4.6 years. Short-Form Health Survey-36 health profile scores of amputees were significantly lower than those of nonamputees (p < 0.001). The differences in profiles were largest in scales sensitive to physical health. Higher levels of amputation and problems with the stump and sound leg were significantly associated with poor physical and mental health scores. Amputee soldiers' assessment of changes in health over the past year was significantly worse than that of nonamputees (p < 0.001). The study concluded that amputees have comparatively poor functional outcomes, which could be improved by modifying some associated factors.

Activities of Daily Living↗

PubMedDate not supplied

Temporary phantom limbs evoked by vestibular caloric stimulation in amputees.

OBJECTIVE: Relationships between the vestibular system and the body schema have been suggested but never demonstrated in amputees. We studied the effects of vestibular stimulation on body representation in amputees focusing on the phantom limb phenomenon. METHOD: Prospective study in 31 amputated subjects of one or several limbs before the age of 16 years. The amputees underwent a caloric vestibular stimulation test, ipsilateral (n = 31) and contralateral (n = 8) to the side of amputation. Amputees were asked to report their perceptions spontaneously and to answer open questions. Four types of perceptions were analyzed: normal phantom, deformed phantom, painful phantom, and no phantom, before, during, and after the vestibular stimulation test. Data were compared between the two groups for pre- and post-test perceptions (chi2 test). RESULTS: Vestibular caloric stimulation provoked temporary perception of a normal phantom limb in 16 of 17 amputees who previously did not experience phantoms. For 12 of 12 amputees who currently experienced deformed or painful phantom limbs, caloric stimulation led to temporary replacement of the abnormal phantom with a non-painful normal phantom. CONCLUSIONS: The phenomena observed: 1) throw light on assumed mechanisms controlling construction of static and dynamic engrams used to produce the body schema; 2) complete the neuromatrix theory proposed to explain the phantom limb phenomenon; and 3) suggest that the vestibular system triggers the procedure of reconstruction of the global body schema.

Adult↗

PubMed1990

Prostheses and the forward reach of sitting lower-limb amputees.

The hypothesis that prostheses improve the forward reach of sitting lower-limb amputees was tested. While sitting with only ischial support, ten unilateral below-knee (BK) amputees could reach farther when they wore their prostheses than when they did not, when reaching at 45 degrees toward or away from the side of the amputation, with mean differences (+/- 1 SD) of 10.7cm (+/- 6.9, p less than 0.0001) and 4.4cm (+/- 4.1, p less than 0.01), respectively. With ten unilateral above-knee (AK) amputees, the differences were not statistically significant. Seven bilateral amputees (mixed levels) were able to reach farther with their prostheses on than off, with mean differences of 41.2cm (+/- 9.5) and 31.5cm (+/- 7.9) for reaches at 0 degrees and 45 degrees, respectively (p less than 0.0001). With the prostheses off, their reach was significantly greater when their thighs were supported than when they were sitting with only ischial support. These findings suggest that (1) prostheses improve the anterolateral reach of unilateral BK amputees, and the straight forward and anterolateral reach of bilateral amputees; (2) when prostheses are not being worn, a sitting surface which provides support through the residual limbs improves forward reach; and (3) the design of AK prostheses should reflect the patient's needs, both standing and sitting.

Adult↗

PubMed1985

Assertiveness, anxiety, and interpersonal discomfort among amputees: implications for assertiveness training.

It has been suggested that the onset of physical disability may lead to deficits in assertiveness. Therefore, in the present study assertiveness, interpersonal discomfort, anxiety, and demographic variables were investigated among lower limb amputees. Amputees completed self-report measures and hospital visitors served as a control group. Multiple regression analyses identified age as a significant predictor variable for assertiveness among amputee subjects. Similarly, outpatient status was a significant predictor variable for discomfort in interpersonal situations. It was concluded that only selected amputees may require assertiveness training, and recommendations were made for further research. The findings support the screening of disabled subjects in future assertiveness research, especially with respect to age and outpatient status. Further investigations in amputee populations are needed to describe the incidence, nature, and duration of discomfort and anxiety as psychosocial responses to amputation. Additionally, future studies should include a measure of discomfort in interpersonal situations at serial time periods during amputees' rehabilitation to describe existing patterns over time.

Adult↗

PubMed1995

Energy cost during ambulation in transfemoral amputees: a knee joint with a mechanical swing phase control vs a knee joint with a pneumatic swing phase control.

The aim of the study was (i) to evaluate the preference of transfemoral amputees for a 4-bar linked knee joint with either a mechanical swing phase control or a pneumatic swing phase control, and (ii) to compare the energy expenditure in transfemoral amputees using a prosthesis with a mechanical swing phase control with that of the same amputees using a prosthesis with a pneumatic swing phase control. The study included 28 unilateral transfemoral amputees amputated for reasons other than chronic vascular disease. All patients had a prosthesis with a knee joint with mechanical swing phase control (the Otto Bock 3R20) before entering the study. The amputees changed their knee joint to one with pneumatic swing phase control (the Tehlin knee joint) at random either after the first or second assessment. The amputees were asked for their preference at the second and third assessments. The energy expenditure while walking at speeds of 2 and 3 km/h was measured at each assessment. After having tried both knee joints, 19 patients preferred the Tehlin knee, 6 patients preferred the Otto Bock 3R20, and 3 patients had no preference. The energy expenditure measurement showed that walking with the Tehlin knee required more energy than walking with Otto Bock 3R20. Because of the limited number of patients included in the study and the fact that a double-blind design was impossible to achieve, conclusions should be drawn with caution.

Adolescent↗

PubMedDate not supplied

The role of adrenergic mechanisms in the blood pressure regulation of leg-amputees.

An increased occurrence of hypertension has been reported among leg-amputees. In order to investigate whether leg amputation is followed by an elevation of sympathetic tone, possibly enhanced by continuous mechanical irritation of the amputation stump by wearing a prosthesis, blood pressure (BP), pulse-rate (PR) and plasma catecholamines (norepinephrine, NE, and epinephrine, E) were measured in six hypertensive leg-amputees during prosthesis walking as well as during irritation of the amputation stump by vacuum suction in the supine position. Six patients suffering from essential hypertension and six normotensive subjects served as control groups. Basal levels of plasma NE and E did not differ in the three investigated groups. Mechanical stump(limb) irritation as well as walking induced a rise of NE but not of E, accompanied by a rise of BP and PR in amputees as well as in the control subjects. Elevation of NE and BP was most accentuated in hypertensive amputees when walking with prosthesis. Within each investigated group there was a positive correlation between NE and mean arterial blood pressure (MAP), (p less than 0.001 in hypertensive amputees and non-amputees, p less than 0.05 in normotensives). We conclude that mechanical limb irritation induces a rise of BP by sympathetic nervous stimulation. Thus wearing of a vacuum-prosthesis may support a consistent rise in BP.

Adult↗

PubMed1991

Computer-aided design and manufacture of an above-knee amputee socket.

This paper describes the initial test results obtained from a newly developed computer-aided socket design (CASD) and manufacturing (CASM) process for above-knee amputees. Anthropometric measures taken from an amputee provided input information to a CASD system. Using these measurements, data from a reference shape library stored in the computer were selected and modified to create a unique socket shape reflecting the particular characteristics of the amputation stump. The resultant shape was produced as a 'primitive' test socket by a CASM process. Numerical shape data were then transferred to a CNC milling machine to construct a negative cast, from which the primitive socket was produced by a vacuum-forming procedure. The resultant primitive socket shape was fitted and the amputee was able to load the socket without discomfort. Some shape discrepancies were identified and the shape data were modified interactively by the CASD system to create a final socket shape. The final socket shape was manufactured and worn by the amputee during a 35 min walking trial. Subjective evaluation was that the socket provided comfort and control comparable with that of the conventional socket, and proved to be acceptable to the amputee. This was followed by a 2-month home trial which was also successful. The CASD socket shapes were compared numerically in area, shape and volume with data taken from the original socket worn by the amputee, a new socket made by conventional methods and a topographic model of the amputation stump. The final CASD socket shape compared favourably with that of a socket manufactured by conventional methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Anthropometry↗

PubMed2002

Energy expenditure and biomechanical characteristics of lower limb amputee gait: the influence of prosthetic alignment and different prosthetic components.

In this study, the influence of different prosthetic alignments and components on oxygen consumption and the important biomechanical characteristics of the normal gait pattern of leg amputees was investigated. With 15 transtibial and 12 transfemoral amputees, the oxygen consumption during walking on a treadmill was analyzed and biomechanical parameters during walking on even ground at a self-selected speed were defined. The amputation of all patients was caused by trauma. Variations of the prosthetic alignment affect the energy consumption of transfemoral amputees more significantly than that of transtibial amputees. Comparison of different prosthetic feet worn by transtibial amputees did not show significant differences regarding metabolic parameters. Compared with conventional hydraulic knee controls, the oxygen consumption of transfemoral amputees provided with an electronically controlled hydraulic knee joint is reduced. All investigated variations can be clearly characterized by the sagittal moments acting on the joints of the prosthetic limb during gait.

Adolescent↗

PubMed2003

The SIGAM mobility grades: a new population-specific measure for lower limb amputees.

PURPOSE: To develop a valid measure of lower limb amputee mobility suitable for routine clinical use, including monitoring change. METHODS: The Special Interest Group in Amputee Medicine (SIGAM) described a single-item scale comprising six clinical grades (A-F) of amputee mobility. A self-report questionnaire was developed and algorithm designed to facilitate grade assignment. Reproducibility of the questionnaire and grades were assessed in 62 amputees. Concurrent validity and sensitivity to change were investigated using the timed walking test (TWT). The mobility construct was examined in 200 amputees, using item response theory, by co-calibration with the Rivermead Mobility Index (RMI) on the same patients. RESULTS: Patients included 144 males and 66 females, aged 13-90. Intraclass correlation coefficients and reproducibility kappa values were satisfactory. Observers agreed 100% in using the algorithm. TWT improved as SIGAM grade increased. Examination of psychometric properties revealed the SIGAM item fitted within the RMI mobility matrix. Average measures for the six grades were ordered correctly. There was no local dependency or differential item functioning for clinically relevant patient subgroups. The SIGAM scale showed an effect size of 10.66. CONCLUSIONS: The SIGAM mobility grades represent a novel, valid, clinically useful measure of amputee mobility which is also sensitive to change.

Activities of Daily Living↗