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At least 1,225 records · Page 68Linked to original sources
PubMed2006

The effect of prosthesis alignment on the symmetry of gait in subjects with unilateral transtibial amputation.

A high degree of gait symmetry is characteristic of healthy gait. The aim of this study is to examine the symmetry of various gait parameters in subjects with unilateral trans-tibial amputation over a range of acceptable anteroposterior translational and tilt alignments, and further to examine if a consistent alignment of highest symmetry can be found. Acceptable alignments were determined by bench, static and dynamic testing on level and non-level surfaces. A total of 15 kinetic and kinematic parameters were then measured in the seven subjects participating in this study. Results indicate that some parameters show consistently higher symmetries, particularly the vertical ground reaction force parameters and the stance duration, step length and time to full knee flexion during the swing phase. Symmetries in other parameters such as knee flexion at loading response, acceleration impulse, and peak anteroposterior propulsive force seem to have little relevance in determining whether the gait pattern for that prosthetic alignment is acceptable or not. While analysis of the symmetry of more relevant gait parameters may assist the prosthetist in consistently and objectively identifying a most symmetrical alignment within the acceptable range, further clinical study is required before any conclusions can be drawn regarding evaluation of symmetry as a tool in defining any optimum alignment.

Adult↗
PubMed2006

Clinical application of carbon fibre reinforced plastic leg orthosis for polio survivors and its advantages and disadvantages.

A prospective study was carried out on the clinical application and features of a carbon fibre reinforced plastic leg orthosis (carbon orthosis) for polio survivors. The subjects comprised 9 polio survivors, and 11 carbon knee-ankle-foot orthoses (KAFOs) were prescribed, fabricated, and checked out at the authors' post-polio clinic. Walking was classified based on the functional ambulatory category, and the features of walking with a carbon orthosis were self-evaluated by using a visual analogue scale. The period from modelling a cast to completion was 55 +/- 25 days; the weight of a carbon KAFO was 27.8% lighter than that of the ordinary KAFO; the standard carbon KAFO was 50% more expensive than the ordinary KAFO. The carbon KAFO remained undamaged for at least 2 years. It improved the scores in the functional ambulation categories, but there was no difference between walking with an ordinary and with a carbon KAFO. The self-evaluation of walking with a carbon KAFO revealed that the subjects using a carbon KAFO were satisfied with their carbon KAFO. The carbon KAFO is lightweight, durable, slim and smart, and is positively indicated for polio survivors.

Braces↗
PubMed2006

Stump ulcers and continued prosthetic limb use.

Stump ulcers are common problems in amputees. Temporary discontinuation of prosthetic limb use is frequently employed to facilitate healing. Inevitably, this limits activity and may, for instance, prevent an amputee from going to work. A survey of clinical practice was carried out based on the premise that controlled continued prosthetic limb use in patients with stump ulcers will not adversely affect the ulcer nor prevent healing. The survey would also form a basis for developing future guidelines in the management of stump ulcers. All consecutive patients attending the Chapel Allerton Hospital prosthetic clinic between January 2003 and May 2004 with stump ulcers were recruited into the study. Primary outcome measures were changes in the surface area of the ulcers and in clinical photographs taken on 2 occasions 6 weeks apart. Some 102 patients with a mean age 60 years (range 18 - 88 years) were recruited. Eight patients who were established prosthetic limb users did not complete the study and were excluded from the analysis. Of the patients 52 were newly referred patients with delayed surgical wound healing while 42 were established prosthetic limb users for at least 1 year. Continued prosthetic limb was associated with a significant reduction in ulcer size (p < 0.05). Mean sizes of the ulcers at first and second observations were 3.30 cm2 (range 0.06 - 81) and 0.70 cm2 (range 0.00 - 13.00) respectively. The ulcers improved in 83 cases while two were unchanged. Deterioration was observed in nine cases. The current clinical practice is to allow most of the patients to commence or continue prosthetic limb wearing despite the presence of stump ulceration. This observational study found that, despite prosthetic use, 60 (64%) cases healed completely within the six-week study period and 23 (25%) ulcers reduced in size. The ulcers were unchanged in 2% of the cases. Deterioration was observed in nine (9%) cases. This survey suggests that the current practice of allowing patients to use their prostheses is safe. A clinical trial is now needed to establish whether this practice alters healing rate or has any other disadvantages for new or established amputees.

Adolescent↗
PubMed2006

Clinical field testing of vulcanized Jaipur rubber feet for trans-tibial amputees in low-income countries.

The purpose of this study was to check out the performance and durability of vulcanized Jaipur rubber feet in tropical areas of the developing world. Forty-one MUKTI and 40 NISHA feet were followed for 16 (8 - 17) months. The user compliance was high and nearly all were satisfied. Failure of the prosthetic foot with the need for exchange at the end of the study amounted to 27% (22/81), which is equivalent to a mixed series of rubber feet previously reported (Jensen et al. 2006b). Failures were mostly related to skin fracture and gliding between sponge rubber layers of the heel block.

Adult↗
PubMed2000

Trans-tibial amputee gait adaptations as a result of prosthetic inertial manipulation.

PURPOSE: To establish through gait analysis how changing the mass at the distal end of an in-house, custom-made trans-tibial dynamic elastic response prosthetic limb altered selected gait variables. Including; walking velocity, cadence, single support and hip power for a single amputee. METHOD: A before-after single-subject research design was used with two interventions. A 3-dimensional gait analysis was conducted to analyse the effect on selected gait variables. The mass and moment of inertia of the prosthesis were altered by inserting wedges of different materials. RESULTS: Altering the mass had little effect on the cadence, single support or the velocity. Both the affected and intact limb hip pull-off power at terminal stance was increased, although the effect was greater for the affected limb than for the intact limb. The affected limb hip power at initial contact did not alter in a manner directly related to the mass. CONCLUSIONS: Altering the mass had an inconsistent effect on the gait parameters tested. The subject volunteered that he preferred the prosthesis of the middle mass.

Adaptation, Physiological↗
PubMed2003

Better practical evaluation for lower limb amputees.

PURPOSE: To avoid wastage of prostheses and unfair selection methods for prosthetic prescription, we aimed to develop a practical assessment tool for amputees with doubtful potential, using refurbished second hand modular prostheses. METHOD: Thirty-seven primary amputees (33 transfemoral, 4 transtibial; 22 males, 15 females; median age 71 years, range 19-91) were considered to have doubtful potential for prosthetic use, due to single or multiple impairments. Amputees were assessed using custom-made socket and refurbished second-hand modular prostheses. Liability issues were fully covered. RESULTS: Two patients died before completing the assessment. Median duration of assessment was 4 weeks (range 1-31 weeks). Among the 35 amputees who completed the trial, 14 (38%) proceeded to final prosthesis successfully and 21 (58%) decided to abandon the prostheses. The main reasons for prostheses rejection identified by the team were: hip flexion deformity (4); frailty (4); bilateral amputations (4); COAD (6), stroke (4), stump pain (3) and contralateral leg problems (2) CONCLUSION: High prosthetic rejection rate was expected and confirmed in this group (58%), but considerable number did proceed to definitive prosthesis. The method is practical and fair for amputees of doubtful potential, with considerable cost saving.

Adult↗
PubMed2004

A picture of amputees and the prosthetic situation in Haiti.

PURPOSE: The purpose of this study is to present the situation of Haitian amputees and to outline some of the major barriers in Haiti that prevent people from receiving prosthetic treatment. METHOD: Interviews were conducted with amputees throughout Haiti using a 42-question questionnaire. Additionally, interviews were conducted with traditional healers, health care workers, and leaders of handicap associations. Each interview was manuscripted and the data were subsequently coded and analysed in the USA. RESULTS: There are three full-time prosthetic shops and two part-time prosthetic shops in Haiti, all of which are severely limited in the scope of services they are able to provide amputees due to insufficient supplies and inadequately trained personnel. Only 25% of the 164 amputees interviewed had ever had a prosthetic limb. Typically prosthetic treatment is inaccessible and unaffordable for amputees, which prevents many from seeking treatment. The most common cause of amputation in Haiti is infection, followed by motor vehicle accidents. CONCLUSION: There must be additional cooperation between Haitian patients, doctors, traditional healers, prosthetists, and government officials in order to provide more adequate prosthetic care. Prosthetic treatment in Haiti can be successful with cooperation of different entities, proper rehabilitation therapy, adequately trained personnel, and development of culturally appropriate limbs.

Adolescent↗
PubMedDate not supplied

A two-year longitudinal study of social support following amputation.

PURPOSE: (1) To describe one aspect of social support, social integration, longitudinally for 2 years following lower limb amputation and (2) to explore the impact of social support on depression, pain interference, life satisfaction, mobility, and occupational functioning. METHOD: Eighty-nine adults recruited from consecutive admissions to an orthopaedic surgery service completed telephone interviews 1, 6, 12 and 24 months following amputation surgery. Dependent variables included the Social Integration (SI) sub-scale of the Craig Handicap Assessment and Reporting Technique (CHART) and the Multidimensional Scale of Perceived Social Support (MSPSS). RESULTS: There was a high level of SI among most persons following lower limb amputations that was relatively unchanged in the 2 years following surgery. However, mean levels of SI were lower in this group compared to a sample without disabilities. MSPSS scores were highly variable, ranging from almost no support to the maximum amount of support. MSPSS was an important concurrent predictor of pain interference, life satisfaction, and mobility, controlling for demographic and amputation-related factors. Baseline MSPSS predicted mobility and occupational functioning 6 months post-amputation, controlling for demographic and amputation-related factors. CONCLUSIONS: Findings suggest that interventions aimed at improving the quality of social relationships after amputation may facilitate participation in activities.

Activities of Daily Living↗
PubMedDate not supplied

A prospective study examining balance confidence among individuals with lower limb amputation.

PURPOSE: In this study we assessed whether balance confidence scores changed over a 2-year follow up period, and identified predictors of balance confidence and predictors of change in balance confidence among lower limb amputees. METHOD: A prospective follow-up survey of 245 community living adults with unilateral below and above knee lower limb amputation who used their prosthetic limb daily was conducted. Balance confidence, assessed using the 16-item Activity-specific Balance Confidence (ABC) Scale, socio-demographic, health and amputation related variables were collected at baseline and 2 years later. RESULTS: ABC scores were similar at baseline (mean = 67.6; SD = 25.7) and follow up (mean = 68.0; SD = 25.8). Lower balance confidence scores at follow up were predicted by older age, being female, use of a mobility device, poor perceived health, increased symptoms of depression, having to concentrate while walking, and fear of falling (all p < 0.05). Predictors of change in balance confidence included gender and perceived health (all p < 0.05). CONCLUSION: Balance confidence appears to be a persistent problem in the amputee population. Health professionals are encouraged to consider balance confidence as a potentially important variable that may influence function in this clinically unique group of individuals. The identified predictor variables may be useful to clinicians in targeting individuals who require attention to improve balance confidence.

Activities of Daily Living↗
PubMedDate not supplied

Comparison of clinical test and questionnaires for the evaluation of upper limb prosthetic use in children.

PURPOSE: The aim of the present study was to find out if there was a correlation between an observational clinical test and a questionnaire for the evaluation of upper limb prosthetic use in children and to determine which one was better and easier to use in clinical practice. METHOD: Twenty children who were patients of the children's prosthetic clinic at the Rehabilitation Institute in Ljubljana, Slovenia, and had a functional prosthesis were included in the study. The age appropriate subtest of the University of New Brunswick Test of Prosthetic Function (the UNB test) was assessed by an occupational therapist. Parents completed either the Child Amputee Prosthetics Project-Functional Status Inventory for Preschool children (CAPP-FSIP) or the Child Amputee Prosthetics Project-Functional Status Inventory (CAPP-FSI), depending on which was appropriate for the child's age. Information was limited to the upper extremity items. RESULTS: We found a significant correlation between UNB spontaneity and skill score (r = 0.956, p = 0.000) and also between the parental CAPP score and UNB test (UNB spontaneity--CAPP activities r = 0.634, p = 0.003; UNB spontaneity--CAPP prosthetic use r = 0.542, p = 0.014, UNB skill--CAPP activities r = 0.559, p = 0.010, UNB skill--CAPP prosthetic use r = 0.597, p = 0.005). CONCLUSIONS: We concluded that both instruments can be used for assessing upper limb prosthetic use in children but neither is an optimal choice.

Activities of Daily Living↗
PubMedDate not supplied

Using the theory of planned behaviour to develop an assessment of attitudes and beliefs towards prosthetic use in amputees.

PURPOSE: To develop a questionnaire based on the theory of planned behaviour (TPB) to predict prosthetic use. METHOD: In part one, 31 amputees over 50 years of age with peripheral arterial disease completed attitude items containing 27 bipolar adjectives and open-ended questions on behavioural, normative and control beliefs relating to using the prosthesis. Academic, clinical and patient experts (n = 12) identified bipolar adjectives with best face validity. In part two, 15 amputees completed three behavioural format questions relating to prosthetic use and were asked to indicate the easiest to answer. RESULTS: Following the completion of the attitude items by the amputees and the expert panel review, 5 items remained (Cronbach's alpha = 0.87) with corrected item-total correlations ranging from 0.43 to 0.83. Modal behavioural beliefs concerned mobility (46.5%), independence (25.6%) and participation restrictions (16.3%), normative beliefs concerned family (33.3%), NHS staff (31.7%), friends (19.1%) and other patients (15.9%) and control beliefs concerned stairs (21.1%), slippery/rough surfaces (28.9%), disabled facilities (54.8%) and people helping (22.6%). In relation to part 2, an exact numerical report of hours and days of prosthetic use was found easiest to answer (73%). CONCLUSIONS: Based on this qualitative and quantitative development work, the questionnaire contains five attitude items, six behavioural, eight normative, eight control belief items and two self-report questions of the behaviour.

Aged↗
PubMed2005

Finite element models of total shoulder replacement: application of boundary conditions.

The widespread use of FEA within orthopaedics is often prohibited by the limits of available computational power, with simplifications to the model often necessary in order to permit solution. An example of this includes the use of osseous models that exclude muscular loading, and may consist of only a partial or truncated region of the anatomy. However, is it possible to make such simplifications without affecting the predictive quality of the model? This issue has been considered using the specific example of the total shoulder reconstruction, where the effects of including the entire osseous region and/or the muscle loadings, has been evaluated. The effect of including the muscle loadings and the entire osseous structure was seen to increase with distance from the articular surface of the glenoid prosthesis. Stresses in the cement mantle were reduced in the absence of either the entire scapula bone or the muscle loading. The study suggests that the use of a fully defined scapula (hard- and soft-tissue) is particularly important when investigating fixation, whilst less comprehensive models should be appropriate for studies of the prosthesis exclusively.

Adult↗
PubMedDate not supplied

The 'shape&roll' prosthetic foot: II. Field testing in El Salvador.

A field test was performed in El Salvador to evaluate the usefulness of the Shape&Roll prosthetic foot, a foot developed for low-income countries, involving 12 participants. Quantitative gait parameters were measured with a Direct Ultrasound Ranging System (DURS). Qualitative information was obtained from questionnaires administered before and after a three-week trial. The results indicate that the Shape&Roll foot widened the speed range of all participants. According to the questionnaires, the Shape&Roll foot eases walking, enabling participants to walk significantly longer distances. The participants rated its roll-over as very natural and smooth, resulting in a self-perceived reduced walking effort. Handling inclined and uneven surfaces was also rated superior to their current Solid Ankle Cushioned Heel (SACH)-like feet.

Adult↗
PubMed2005

Comparison of psychometric properties of the International Outcome Inventory for Hearing Aids (IOI-hA) in various studies.

The German translation of the International Outcome Inventory for Hearing Aids (IOI-HA) was used in a variety of studies including a retrospective mailing campaign and three field tests on recently launched hearing aids. The psychometric properties were compared with each other and with results of previous studies in the U.S.A, Wales, and the Netherlands. Like the English and the Dutch version, the German IOI-HA showed high internal consistency, and factor analyses as well as inter-item correlations indicated the existence of a two-dimensional scale. Furthermore, the IOI turned out to be a valid instrument for distinguishing satisfied and non-satisfied customers during the trial period of a hearing aid.

Acoustics↗
PubMed2006

Effects of applied contact force and volume control setting on output force levels of the BAHA Softband.

The BAHA Softband has been developed to provide a transcutaneous anchor for a BAHA until a child is a surgical candidate for the percutaneous BAHA implant. We tested the objective output force level of the BAHA Classic 300 and Compact connected to a Softband on an artificial mastoid to determine: (1) the effects of direct contact force on output force levels (dB); and (2) the required volume control setting to ensure audibility of speech (assuming an average adult reference equivalent threshold force level). Direct contact force was varied from 2 to 5 N in 1 N steps. Output force level increased with increasing contact force. However, the average increase was 3 dB or lower, suggesting that the contact force is of minor importance. Volume control setting appears to be of much greater importance. It is suggested that the volume setting of either device be set to at least 2.5 to ensure audibility of conversational speech. Data from normal-hearing adults with simulated conductive hearing losses are presented to validate this conclusion.

Adult↗
PubMed2006

The subjective evaluation of the expansion time constant in single-channel wide dynamic range compression hearing instruments.

The present study investigated the subjective evaluation of expansion time constants in single-channel wide dynamic range compression (WDRC) hearing instruments. Thirty participants utilized binaural WDRC hearing instruments for a two-week trial. Subjective evaluations were conducted by having each participant rate their satisfaction with the expansion time constant on a daily basis and by having each participant indicate their preferred expansion time constant following the completion of the two-week trial. Each change in expansion time constant significantly affected listener satisfaction; however, all time constants resulted in satisfactory performance. Of the users expressing a preference, 75% preferred fast-acting over slow-acting expansion. These findings suggest that dynamic expansion parameters play an important role in determining the effectiveness of the feature for a given listener.

Adult↗
PubMed2006

Clinical benefits and risks of bilateral amplification.

Clinicians are in the unique position of continually developing a foundation of evidence-based practice each time they evaluate a patient. This is true not only in the field of audiology, but also in all healthcare professions. Typically, evidence-based practice (EBP) is assimilated from a combination of a systematic review of current practices, practitioner experience, academic training and ongoing continuing education through review of journals, textbooks and attendance at meetings as well as informal discussions with colleagues. Clinicians are inundated with information from these sources, and they need to extract the necessary information and apply it to their specific patient population. Evidence-based practice as it applies to the non-medical treatment of hearing loss (with hearing aids) will be discussed. In addition, several studies based on clinical observations are presented for discussion.

Aged, 80 and over↗