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PubMed2005

Automated estimation of initial and terminal contact timing using accelerometers; development and validation in transtibial amputees and controls.

The aim of this study was to develop and validate an automated accelerometry-based system for estimating initial contact (IC) and terminal contact (TC) timing information from walking patterns of healthy control subjects and transtibial amputees that can be used in daily life with minimal interference of researchers. Subjects were instrumented with two uniaxial accelerometers just below the knee while synchronized ground reaction force (GRF) recordings were used as reference measurements. An automated multiphase algorithm was developed to estimate the time of IC and TC in the acceleration signals of five healthy subjects and two transtibial amputees walking at different walking speeds. The accuracy of the detection algorithm in ten control subjects and eight transtibial amputees indicated mean errors ranging between 0.013 and 0.034 s for the TC and IC timing, with 95 % confidence interval of the individual step errors ranging between -0.062 and 0.115 s. Correlation coefficients between the estimated stance phase duration and GRF data were 0.98 and 0.97 for controls and amputees, respectively. We concluded that IC and TC can be accurately and easily measured using this system in both healthy subjects and transtibial amputees walking at different walking speeds. The system can be used in clinical situations or gait labs as well as during daily life.

Acceleration↗
PubMedDate not supplied

Body mass index in amputees.

Whereas estimates of percent deviation of body weight from ideal (F delta weight) are corrected for amputation, those of body mass index (BMI) are not, creating discrepancies in evaluating obesity. A correction of the BMI formula for amputation is proposed. The formula for BMI was corrected for amputation mathematically. The mathematical model predicts that the uncorrected BMI formula underestimates body fat in unilateral amputees and overestimates body fat in subjects with bilateral amputations at the same length of the legs. F delta weight and corrected and uncorrected BMI estimates were computed in 15 subjects with unilateral leg amputation and in 8 subjects with multiple amputations. BMI estimates were as follows: in unilateral amputees, corrected 24.1 +/- 4.1 kg/m2, uncorrected 22.2 +/- 3.9 kg/m2 (p < .001); and in multiple amputees, corrected 21.6 +/- 2.4 kg/m2, uncorrected 32.6 +/- 11.8 kg/m2 (p = .043). Linear regressions of F delta weight obtained from standard nutrition assessment on F delta weight computed from uncorrected and corrected BMI values were as follows: in unilateral amputees, uncorrected F delta weight = -0.079 + 0.932 x actual F delta weight, r = .974, p < .01, and corrected F delta weight = 0.002 + 1.005 x actual F delta weight, r = .997, p < .01; in multiple amputees, uncorrected F delta weight = 0.528 + 1.930 x actual F delta weight, r = .607, p is not significant, and corrected F delta weight = -0.010 + 0.920 x actual F delta weight, r = .936, p < .01.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

Somatosensation, circulation and stance balance in elderly dysvascular transtibial amputees.

OBJECTIVE: To establish the relationship between poor lower limb somatosensory and circulatory status with standing balance, falls history, age and mobility level in dysvascular transtibial amputees (TTAs). DESIGN: Within-subjects evaluation of somatosensation, circulation and stance balance measures in dysvascular transtibial amputees. SETTING: Physiotherapy department of a tertiary metropolitan hospital in Australia. PARTICIPANTS: Twenty-two community-dwelling unilateral dysvascular transtibial amputee volunteers, aged between 54 and 86 recruited from a metropolitan hospital outpatient amputee clinic. MAIN OUTCOME MEASURES: Lower limb vibration sense, light touch sensation and circulatory status were related to centre of pressure excursion during quiet stance, dynamic balance measures of forward and lateral reach distance, and demographic information such as falls history and mobility level. RESULTS: Overall, poor somatosensory status was associated with poor stance balance. There was an association between poor vibration and circulation and increased centre of pressure excursion in quiet stance and reduced reach distance, whereas poor light touch was linked with even weight-bearing in quiet stance. Poor vibration sense was associated with a history of frequent falls. CONCLUSIONS: Compromised lower limb somatosensation and circulation was linked with poor balance and a history of frequent falls in the elderly dysvascular amputee population.

Accidental Falls↗
PubMed2003

The influence of prosthetic foot alignment on trans-tibial amputee gait.

An optimally aligned prosthesis, as accomplished by the subjective judgment of the prosthetist, guarantees the best quality of gait. Yet, amputees can adapt to a large variety of geometrical configurations of the prosthetic components. Different external rotation angles of the foot in trans-tibial (TT) prostheses were investigated. The study tried to identify (a) the relationship between foot angle and other gait parameters and (b) the compensating pattern of the amputees to excessive external rotation of the foot. Eight (8) TT amputees, fitted with an identical type of prosthesis, were investigated during ambulation. The prosthetic foot was externally rotated as follows: optimal angle (10.94 x degrees +/- 5.21 degrees), optimal angle plus another 18 degrees, and optimal angle plus another 36 degrees. Analysis of gait was performed with the aid of an electronic walkway. Speed of gait, stance and swing time, and foot angle were monitored in 4 runs for each of the three foot angles. Speed of gait remained almost constant in the three tests. Stance and swing time, as well as step length, significantly changed when 36 degrees were added to the optimal foot angle. This foot position significantly influenced inter-legs time difference and symmetry between the legs. During ambulation, prosthetic foot external rotation was decreased by internal rotation of the limb at the hip joint level. It is concluded that TT amputees can maintain an efficient speed of gait even when the prosthetic foot is malpositioned in excessive external rotation. Although such a malalignment significantly influences other gait parameters during walking, amputees are able to adapt themselves by internal rotation of the hip joint in the amputated leg.

Adult↗
PubMed1984

A 24 year survey of amputees in Hong Kong.

A 24-year retrospective study of amputees was conducted at the Prosthetic and Orthotic Unit of the Kowloon Rehabilitation Centre, the first and largest rehabilitation centre in Hong Kong. A review was made of 1821 patients and a rising trend of amputee population was demonstrated probably related to the population growth. The ratio of lower limb to upper limb amputees was 1.83 to 1. The mean age of the amputees was 39 years. The commonest cause of upper limb amputation was trauma (89%) and of lower limb amputation was infection (35%). Vascular diseases were not as common in Chinese as in Caucasian communities. These patterns of amputee population indicate the demand for prosthetic service and provide guide-lines for future development.

Adolescent↗
PubMed1994

Benchmark data for elderly, vascular trans-tibial amputees after rehabilitation.

Benchmark data for lower limb amputees is often limited to young subjects who have had their amputations as the result of trauma. The majority of trans-tibial amputees rehabilitated are, however, elderly vascular amputees who may have different gait characteristics than their younger counterparts. Without biomechanical analyses to provide such benchmark data for this group it is not possible to compare the effects of different rehabilitation programmes, gait training regimens, or prosthetic devices. Twenty elderly vascular trans-tibial amputees rehabilitated at The Queen Elizabeth Centre, Ballarat, Australia and at least six months post-amputation were measured in respect of kinetic and kinematic parameters, and relationships between gait speed, consistency, and function were demonstrated. Further, an unexplained vertical ground reaction force pattern was demonstrated in faster, more functional amputees.

Aged↗
PubMed1996

Clinical rehabilitation of the amputee: a retrospective study.

The aim of this study was to determine the rehabilitation outcome of lower limb amputee patients after clinical rehabilitation. Altogether 183 amputee patients admitted for clinical rehabilitation in the years 1987-1991 were reviewed by retrospective analysis of medical record data. Three groups of amputee patients were identified by reason for amputation. The vascular group: (N = 132), mean age 67 years, mean admission time 119 days, 85% prosthetic fitting. The oncology group (N = 15), mean age 55 years, mean admission time 77 days, 60% prosthetic fitting. The traumatic amputee group: (N = 14), mean age 41 years, mean stay 134 days and 100% prosthetic fitting. Some 22 patients were bilateral amputees and were assessed separately. The most important reasons for not fitting a prosthesis were oncological metastases, stump and wound healing problems. After rehabilitation 86% of all patients could be discharged home. These results are more favourable than those seen in previous studies.

Adolescent↗
PubMed1996

Outcome of fitting an ICEROSS prosthesis: views of trans-tibial amputees.

A report of the outcome of fitting ICEROSS prostheses to trans-tibial amputees from a subregional amputee rehabilitation centre is presented. This work has mainly concentrated on obtaining patients' own views to judge advantages and disadvantages of ICEROSS compared to their previous patellar-tendon-bearing (PTB) prostheses. Sixty-nine patients were entered for this study, but the results of the study are based on 54 patients who responded. Fifteen patients (27.7%) had rejected their ICEROSS prosthesis at the time of the study. Provision of ICEROSS prostheses did not improve indoor and outdoor walking abilities in terms of distance or use of other walking aids, nor were they more comfortable to wear. An increase in sweating in the first 3 months of wearing ICEROSS was significant, but settled afterwards. The amputees considered that the rate of stump skin breakdown with ICEROSS compared to their PTB prostheses was significantly less. Walking up and down stairs was more comfortable and in general overall rating of ICEROSS prostheses they were scored significantly higher by the amputees themselves. It is concluded that appropriate patient selection is vital and in certain cases ICEROSS will provide considerable benefits to the amputees.

Activities of Daily Living↗
PubMed1998

Three measures of functional outcome for lower limb amputees: a retrospective review.

Outcome measures are becoming increasingly important in health care. Functional outcome measures are of particular importance for lower limb amputees since much of the rehabilitation process is concerned with increasing mobility and personal independence. The Scottish Physiotherapy Amputee Research Group (SPARG) has used three measures of functional outcome: the Barthel Index, Russek's classification and the Locomotor Index. The review reported here involves 938 patients having a primary amputation at the transtibial or transfemoral level between October 1992 and July 1997. Differences in function due to age and level of amputation are well known clinically and the measures were compared by looking at their ability to detect these differences. The Barthel Index lacked sensitivity because of ceiling effects and should not be considered as a suitable functional outcome measure for amputee patients. Russek's classification does detect significant differences but requires a large number of patients making it unsuitable for single hospital investigations. The Locomotor Index demonstrates significant differences due to age and amputation level despite fewer patients being assessed by this measure during the period covered by this paper. The range of the Locomotor Index can be extended to cover more active amputees by considering its 'advanced activities' subscale separately. The Locomotor Index is a promising measure and should be considered by rehabilitation teams looking for a valid, reliable and sensitive functional outcome measure for use with lower limb amputees.

Aged↗
PubMed2006

Heterotopic ossification in the residual limbs of traumatic and combat-related amputees.

Reports on the occurrence and treatment of heterotopic ossification in amputees are rare. Heterotopic ossification in the residual limbs of amputees may cause pain and skin breakdown and complicate or prevent optimal prosthetic fitting and utilization. Basic science research has shed light on the cellular and molecular basis for this disease process, but many questions remain unanswered. The recent experience of the military amputee centers with traumatic and combat-related amputations has demonstrated a surprisingly high prevalence of heterotopic ossification in residual limbs. Primary prophylactic regimens, such as nonsteroidal anti-inflammatory drugs and local irradiation, which have proved to be effective in preventing and limiting heterotopic ossification in other patient populations, have not been studied in amputees and generally are not feasible in the setting of acute traumatic amputation. When nonsurgical measures such as activity and repeated prosthetic modifications fail to provide relief, surgical excision has provided good early clinical results, with low rates of recurrence and acceptable complication rates in military amputees.

Amputation Stumps↗
PubMed2001

Comparative study of osteoarthritis of the contralateral knee joint of male amputees who do and do not play volleyball.

OBJECTIVE: To assess the prevalence of osteoarthritis (OA) of the contralateral knee of men with traumatic amputation who do and do not participate in regular, vigorous physical activity. METHODS: Three groups of patients were assessed. Group 1 consisted of 8 male amputee volleyball players. Group 2 consisted of 24 male amputees who do not play volleyball, and Group 3 was made up of 24 healthy controls matched by age and weight to Group 2. The prevalence of contralateral knee OA in Groups 1 and 2 was assessed by questionnaire, physical examination, and radiographs, and was compared with findings for Group 3. RESULTS: The rate of OA in all amputees (Groups 1 and 2 together) was 65.6%, which was significantly higher than among the controls (p < 0.05). The most common findings among the amputees were patellar and medial osteophytosis of the tibiofemoral joint, with a tendency to medial narrowing of the tibiofemoral joint space. CONCLUSION: Traumatic amputees have a higher prevalence of OA in the knee of the nonamputated leg than matched healthy controls.

Adult↗
PubMed1985

Energy expenditure and cardiac response in above-knee amputees while using prostheses with open and locked knee mechanisms.

The difference in physiological responses to ambulation effort, of above-knee (AK) amputees, using a prosthesis with open or locked knee mechanism was investigated at the Orthopaedic Rehabilitation Department of the Loewenstein Hospital. Of seventeen patients who were examined, fourteen were vascular patients over the age of fifty, and three were young traumatic amputees. Subjects performed an unrestrained walking test, using their prosthesis with an open-knee, and then with a locked knee joint mechanism. Heart rate and walking speed were measured, while oxygen consumption was evaluated only in the young patients. Results show that the use of a locked-knee joint resulted in a lower increase in heart rate in both groups. Comfortable walking velocity, as chosen by the subject himself, was higher with a locked-knee joint in the aged group and with an open-knee joint in the younger amputees. Oxygen consumption as measured for the younger patients was higher with an open-knee joint. In conclusion, a locked knee is recommended for the older amputees as it enables a higher walking velocity and lower effort. The preference of an open-knee in the young amputees is due to their better physical condition which enables a higher walking speed although energy expenditure and heart rate are higher.

Adult↗
PubMed1985

Prosthetic rehabilitation of geriatric amputee patients: a follow-up study.

During a four-year period, 116 lower extremity amputee patients older than 65 years were evaluated and treated by our department. Fifty-nine patients with below-knee (BK) amputations, 22 with above-knee (AK) amputations, and 15 with bilateral amputations were fitted with prostheses and trained in their use. A follow-up study on all patients was done at an average of 22 months after they had completed their training program but not earlier than after 6 months. Of all BK amputees who had been fitted with a prosthesis, 73% were using it fulltime and as their main mode of locomotion; 25% were using it part of the time. The results were less favorable for AK and for bilateral amputee patients: 50% of AK amputees and 33% of the bilateral amputees had become fulltime users of their prostheses. Age alone was not a major determining factor in success or failure of prosthetic rehabilitation. Failures usually were due to concurrent medical disease or mental deterioration. The study indicates that the effort and expense of fitting and training geriatric patients with prostheses may be well worthwhile.

Age Factors↗
PubMed1983

Evaluation of problems and needs of veteran lower-limb amputees in the San Francisco Bay Area during the period 1977-1980.

From 1977 through 1980, 251 veterans from the San Francisco Bay Area received permanent lower-extremity prostheses at the two local Veterans Administration hospitals. For a survey, 213 of the 251 were contacted and 179 of them (84%) responded to written or telephone questionnaires concerning their prosthetic problems and complaints and their recommendations regarding prosthetic care. Seventy-four percent of the patients were traumatic amputees and 23 percent were dysvascular amputees. Eighty-six percent of the traumatic amputees said they wore their limbs all day, compared with only 51 percent of the dysvascular group. Seventy-one percent of traumatic and 43 percent of dysvascular amputees engaged in some form of recreational activity. There was a high incidence of complaints of pain in the residual limb: 55 percent among the dysvascular group and 44 percent among the traumatic group. Half of the patients had socket problems. Fifty-four of the 178 patients received a physical examination, a prosthetic evaluation, and a gait analysis. Among this group, 59 percent of the below-knee prostheses and 78 percent of the above-knee prostheses had inadequate socket fitting. Improper shaping of socket margins was the most frequently observed deficiency. Moreover, 41 percent of below-knee and 22 percent of above-knee amputees had mechanical skin irritation or skin breakdown in the examined residual limbs. Faulty suspension and alignment in addition to improper socket fit and construction contributed to this problem. Excessive stiffness of SACH foot heel cushions was the most common prosthetic foot problem and contributed to gait abnormalities.

Activities of Daily Living↗
PubMed1980

Recreational activities of lower extremity amputees: a survey.

This study summarizes a detailed questionnaire evaluation of recreational activities participated in by 100 persons with lower extremity amputations. Additional information was obtained from prosthetists and physical therapists. Approximately 60% of the respondents are active in sports. Younger persons of either sex, who have had amputations for congenital deformities or trauma, are most active. Level of amputation does not appear to be a determining factor as to whether amputees participated or not. The most common recreational activities are fishing and swimming. Sports causing the amputee most discomfort are hunting and jogging. The ability to run and jump is the most difficult to achieve. Reasons for non-participation are pain, embarrassment, insufficient training and lack of organized sports programs for the disabled. Fear of further injury or an overprotective family are not inhibiting factors, nor is cost of the prosthesis. Only a few people wear specifically designed recreational prostheses, and only one-third of the amputees believe that their prosthetist is knowledgeable about recreational prostheses, while 40% feel the prosthetist discouraged their own ideas about prosthetic innovations. Therapists also proved inadequate in their knowledge and efforts at preparing the amputee for recreation. The amputees indicate a need for improved prosthetic design, and believe that insufficient information, both verbal and written, was given to them.

Adult↗
PubMed1980

Arterial occlusive disease in amputee patients: assessment with the Doppler ultrasound flowmeter and correlation with rehabilitation.

The vascular status of 14 below-knee (BK) amputee patients and 12 above-knee (AK) amputee patients who had undergone amputation for arterial occlusive disease was assessed with the Doppler ultrasound technique. Ten healthy subjects were investigated as a control group. The ankle-arm pressure index in the sound leg and thigh-arm pressure index in the stump were classified in 4 grades. Rehabilitation was graded according to the amputee patients' ability to use their prostheses. The vascular condition of the BK amputees was generally better than that of the AK amputees. The vascular condition of the stump in both groups was better than that of the sound leg. A good correlation was found between prosthetic rehabilitation and the vascular condition of the sound leg, but not with that of the stump. It is suggested that amputation removes the most severely affected part of the lower extremity and the so-called sound leg thus becomes the restricting factor in rehabilitation.

Aged↗
PubMed1997

Anticipatory postural adjustments during standing in below-the-knee amputees.

OBJECTIVE: We studied the role of adaptive changes within the central nervous system in anticipatory postural adjustments seen in unilateral below-the-knee amputees. DESIGN: Changes in electromyographic and mechanical variables were compared during standardized tasks performed by standing subjects. BACKGROUND: Anticipatory postural adjustments represent an important mechanism of postural control which was expected to be changed in amputees because of both mechanical and secondary, neurological reasons. METHODS: Six patients after a below-the-knee amputation and six control subjects stood on a force platform and performed fast bilateral shoulder movements and also dropped or caught a load from (into) extended hands. Anticipatory changes in the background activity of postural muscles were analysed. RESULTS: In amputees, there were cases of marked asymmetry in anticipatory changes of the background muscle activity which were larger on the intact side of the body but were commonly small or absent on the side of the amputation. This asymmetry could lead to larger mediolateral forces and displacements of the centre of pressure. CONCLUSIONS: We suggest that asymmetrical patterns of anticipatory postural adjustments reflect central adaptive changes secondary to the amputation. Rehabilitation approaches would benefit from understanding and taking advantage of the adaptive changes within the central nervous system. RELEVANCE: We demonstrated asymmetries in patterns of anticipatory postural adjustments during voluntary arm movements and load manipulations by standing unilateral amputees. This finding is of potential importance for rehabilitation of amputees and their prosthetic training.

Journal Article↗
PubMed1998

The 3-D motion of the centre of gravity of the human body during level walking. II. Lower limb amputees.

OBJECTIVE: To analyse the motion of the centre of gravity (CG) of the body during gait in unilateral lower limb amputees with good kinematic patterns. DESIGN: Three transtibial (below-knee, BK) and four transfemoral (above-knee, AK) amputees were required to perform successive walks over a 2.4 m long force plate, at freely chosen cadence and speed. BACKGROUND: In previous studies it has been shown that in unilateral lower limb amputee gait, the motion of the CG can be more asymmetric than might be suspected from kinematic analysis. METHODS: The mechanical energy changes of the CG due to its motion in the vertical, forward and lateral direction were measured. Gait speed ranged 0.75-1.32 m s(-1) in the different subjects. This allowed calculation of (a) the positive work done by muscles to maintain the motion of the CG with respect to the ground ('external' work, W(ext)) and (b) the amount of the pendulum-like, energy-saving transfer between gravitational potential energy and kinetic energy of the CG during each step (percent recovery, R). Step length and vertical displacement of the CG were also measured. RESULTS: The recorded variables were kept within the normal limits, calculated in a previous work, when an average was made of the steps performed on the prosthetic (P) and on the normal (N) limb. Asymmetries were found, however, between the P and the N step. In BK amputees, the P step R was 5% greater and W(ext) was 21% lower than in the N step; in AK amputees, in the P step R was 54% greater and W(ext) was 66% lower than in the N step. Asymmetries were also found in the relative magnitude of the external work provided by each lower limb during the single stance as compared with the double stance: a marked deficit of work occurred at the P to N transition.

Journal Article↗