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PubMed2000

[Causes and correction of abnormal gait patterns due to prosthesis in above-knee amputees].

Abnormal gait patterns cause an increase in the energy cost of walking in above-knee amputees. Disturbances of the walking pattern are often caused both by the amputated patient himself and by incorrect prosthetic fitting. The early detection and correction of causative factors is of great importance for successful rehabilitation of these amputees. During the follow-up examinations the prosthesis must be inspected for a correct fitting and individually appropriate knee stabilizing components. Prior to any corrective measures it must be excluded that the artificial limb has been put on incorrectly by the amputee himself.

Amputees↗
PubMed2000

A study of technical changes to lower limb prostheses after initial fitting.

There is little published material in recent years about the use of lower limb prostheses in an elderly amputee population. In this study the authors were interested in the technical changes to lower limb prostheses after a first limb fitting procedure in a post-rehabilitation population in The Netherlands. The process of fitting a prosthesis and the technical changes to the artificial limb in the first year afterwards are studied.

Aged↗
PubMed2002

Evaluating a written emotional disclosure homework intervention for lower-limb amputees.

OBJECTIVE: To evaluate the Pennebaker Emotional Disclosure paradigm with lower-limb amputee patients in terms of compliance and efficacy. DESIGN: Repeated measures. SETTING: Home based. PARTICIPANTS: Low compliance, both with the initial mailed request (28%) and the subsequent writing task (48%), resulted in 23 lower-limb amputees who had been fitted with a prosthesis participating. INTERVENTIONS: Patients completed a 15-minute writing task, 6 times, over 2 weeks, with initial baseline and 2-month follow-up assessments. MAIN OUTCOME MEASURES: Cognitive processing, well-being, adjustment to an artificial limb, pain, and prosthetic use. RESULTS: Stronger emotional disclosure was associated with significant reductions in psychologic and physical aspects of amputees' satisfaction with their prosthesis, some of which were mediated by positive changes in affect immediately after the writing tasks. CONCLUSIONS: Our results failed to support previous findings with nonclinical samples; in fact, our results contradicted previous findings. We therefore caution that written emotional disclosure may be contraindicated with lower-limb amputee patients.

Amputees↗
PubMed2006

A study of the physical rehabilitation and psychological state of patients who sustained limb loss as a result of terrorist activity in Northern Ireland 1969-2003.

OBJECTIVE: To benchmark the psychological state and physical rehabilitation of patients who have sustained limb loss as a result of terrorist activity in Northern Ireland and to determine their satisfaction with the period of primary prosthetic rehabilitation and the artificial limb. METHOD: All patients who sustained limb loss as a result of the Troubles and were referred to our rehabilitation centre were sent a questionnaire. The main outcome measures were the SIGAM mobility grades, the General Health Questionnaire (GHQ12) and three screening questions for Post Traumatic Stress Disorder (PTSD). RESULTS: Out of a 66% response rate, 52 (69%) patients felt that the period of primary prosthetic rehabilitation was adequate; 32 (54%) lower limb amputees graded themselves SIGAM C or D; 45 (60%) patients stated that they were still having significant stump pain. Significant stump pain was associated with poorer mobility. Nine (56%) upper limb amputees used their prosthetic limb in a functional way; 33 (44%) patients showed "psychiatric caseness" on the GHQ 12 and 50 (67%) had symptoms of PTSD. CONCLUSIONS: Most patients felt that the period of physical rehabilitation had been adequate; those who did not were more likely to be having ongoing psychological problems. A high percentage of patients continue to have psychological problems and stump pain.

Adolescent↗
PubMed1989

How successful is below-knee amputation for injury?

This study analyses how successfully young adults rehabilitate after below-knee amputation for injury. Twenty-five patients referred to Bristol Artificial Limb and Appliance Centre and aged under 45 years at the time of amputation were investigated 2-12 years after operation by a review of their records, a questionnaire and, in a few cases, by interview. Most did extremely well. All without serious disabilities were able to work, most requiring little or no sick leave because of their amputations. Prostheses were worn by 84 per cent of patients for more than 13 h a day and only 32 per cent had left them off for more than 4 days in the previous 12 months. One mile could be walked by 72 per cent, nearly all (84 per cent) drove cars, and the majority could use public transport with relative ease. Of the patients 84 per cent regarded themselves as only slightly or not at all disabled. However, it takes about 1 year to reach this satisfactory 'present state' and 72 per cent remain troubled by phantom limb or stump pain.

Activities of Daily Living↗
PubMed1983

A modified Gritti-Stokes amputation: its place in the management of peripheral vascular disease.

A modified technique for performing the Gritti-Stokes amputation is described and the results obtained in 247 cases are presented. The mortality rate was 9.3% and healing occurred in 87% of survivors. Using this modified technique the frequently cited criticisms of non-union of the patella and painful stumps were not found to be major problems. The prosthetic problems of amputation at this level are discussed in relation to recent developments in the design of artificial limbs.

Adult↗
PubMed2001

Mobility of people with lower limb amputations: scales and questionnaires: a review.

OBJECTIVE AND DESIGN: A systematic literature review to compare mobility scales used for lower limb amputees. A literature search was carried out by computerized search of biomedical literature including Medline and Embase. The studies included were published between 1978 and 1998 and including the following keywords: amputation, artificial limbs, prosthesis, lower limb, activities of daily living, mobility. RESULTS: Thirty-five studies were identified; 19 had a measurement of separate levels of mobility comparable to each other. Sixteen studies used ordinal and ratio scales without separate levels of mobility. The widest range of measurement found was the scale from 'walking with prosthesis without a walking aid' to 'totally confined to bed'. The Stanmore Harold Wood mobility scale was published most frequently. None of the 35 studies presented give a continuous measurement of mobility. CONCLUSION: A multitude of measurement scales and questionnaires are available for differ in methods and measuring range. Measuring mobility by a scale has been shown to have limitations. Several authors did extensive research but they all measure only a number of aspects of mobility. Consensus about the measurement of mobility of lower limb amputees is not available in the recent literature.

Activities of Daily Living↗
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↗
PubMed1999

An epidemiological study of war amputees and the cost to society.

The purpose of this study was to assess the overall financial cost of the prosthetic care which war amputees have incurred since the injury occurred. Records of 98 war veteran amputees who had attended the Dundee Limb Fitting Centre were scrutinised, they revealed 52 survivors and 46 who had died by 1997 and represented all the records available at the time of the review. The number and nature of visits, the number of prosthetic limbs ordered were counted and using today's costs, the cost of these services calculated. The costs of stump socks, transport and social security payments were not included. The cost of the artificial limbs was calculated at Pound Sterling(GBP)69 million with the recognition that it is an underestimate and approximation. Despite this it shows that the cost, allowing for the underestimation, has been relatively insignificant in the total cost of a major war and the war machinery. The cost however to the individuals has been considerable with a substantial disability occurring at the prime of life resulting in a significant handicap. It is a continuing legacy that society is responsible for, as a direct result of armed conflict.

Amputees↗
PubMed1975

[Results in forearm prostheses (author's transl)].

A survey is given on 60 cases of forearm-amputationes, the properties of different prostheses are discussed. Based on questioning and experiences in changes of artificial limbs general conditions for limb fitting are worked out. Beside the function special attention was payed to the cosmetic results.

Amputation Stumps↗
PubMed2004

[Prosthetic possibilities after amputations in the upper extremities].

Whereas passive prostheses are fitted onto the patient after the amputation of an arm, hand or finger and are mostly cosmetic in function, active prostheses have much more potential. They can transform the movements of other body regions to movement in the artificial limb. Belts or harnesses, for example, effect the direct transfer of the power from the muscle to the prosthesis. The range of movement possible depends upon the level of the amputation, the length of the residual limb, the age of the patient, his body build and fitness. Myoelectrically controlled prostheses possess their own drive and power source. They control movement through the electrical action potentials of the residual limb muscles, which are detected, amplified and transmitted with help of electrodes.

Amputation, Surgical↗
PubMed1996

Rehabilitation in limb deficiency. 4. Limb amputation.

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on rehabilitation in limb deficiency in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article reviews the phases of amputation rehabilitation from preoperative stages to community reintegration and long-term follow-up. The various indications for artificial limb components for the upper and lower limb amputee and the expected functional levels based on level of amputation are discussed. New concepts of critical pathways are also introduced as guidelines in optimizing the rehabilitation of the amputee. The reader is directed to other relevant literature as well, in an attempt to enhance knowledge in this area of rehabilitation.

Activities of Daily Living↗
PubMed1987

Evaluation of introducing the team approach to the care of the amputee: the Dulwich study.

The effects of introducing the Team Approach to the management of the lower limb amputee has been assessed in a consecutive series of 233 patients over a five year period. During the first year, baseline data was collected and during the subsequent yearly phases the effects of introducing a physiotherapist co-ordinator, visiting prosthetist and medical officer from the local Artificial Limb and Appliance Centre (ALAC), and finally trained surgeons were studied. During the final phases of the study, the effects of changing team staff were monitored. The results have shown that only when the full Team Approach is adopted are the best results achieved, but that, once this approach is established, staff changes can be made without serious reductions in effectiveness. The study has shown that the team can reduce in-patient stay by 20 days; reduce the need for post-discharge physiotherapy by 94%; increase the proportion of patients discharged with a prosthesis more than fivefold and increase the effectiveness of long term rehabilitation threefold.

Amputation, Surgical↗
PubMed2000

Osseous overgrowth after post-traumatic amputation of the lower extremity in childhood.

Severe accidents in children may cause extreme destruction of the lower extremities. In some cases, there is no possibility to preserve the limbs. Initially, a weight-bearing stump cannot be achieved after amputation due to unstable local and soft tissue conditions. This critical situation is often complicated by one of the leading problems in the limb-deficient child - the development of osseous overgrowth. Bizarre overgrowth of the stump may lead to skin perforation, pressure ulcers, and difficulties with the prosthesis. Since 1993, we have been able to follow five pediatric and adolescent patients (2 years to 17 years old) with six post-traumatic amputations of the lower extremities. Four of these cases developed osseous overgrowth. One child treated with initial autologous stump-capping had excellent soft tissue conditions and no problems with the artificial limb. We also report on a case of bizarre and extensive new bone formation. We conclude that close follow-up visits after post-traumatic amputations in children are essential because of new bone formation which may endanger the soft tissue situation of the stump. Unfortunately, surgical revisions have to be performed quite often. To avoid several surgical corrections, an initial stump-capping with autologous material from the injured limb can be performed. Thus, the number of secondary procedures may be reduced drastically.

Adolescent↗
PubMed1977

The preformed socket and modular assembly for primary amputees.

A method is described by which an artificial limb can be fitted as soon as an above-knee or below-knee amputation wound is healed, by using preformed sockets which enable the prosthetist to fit the limb within the hour. The method has been found safe, and better than other methods previously described to facilitate the early mobilisation and rehabilitation of the amputee.

Amputation, Surgical↗
PubMed2005

The social meanings of prosthesis use.

The present research explores the social meanings surrounding the use of artificial limbs. Semi-structured email and face-to-face interviews were conducted with 35 prosthesis users, along with analysis of the posts made on an email discussion group for prosthesis users. This data was subject to an Interpretative Phenomenological Analysis. It is concluded that prosthesis use plays a social role in the lives of persons with limb loss/absence. The ability to conceal such use enabled participants to ward off social stigmatisation that in turn enabled their social integration and the reduction of emotional problems surrounding such disability.

Adolescent↗
PubMed1992

Rehabilitation of lower limb amputees and some implications for surgical management.

Aspects of peri-operative management, amputation level and rehabilitation of the lower limb amputee are reported in the context of a review of a rehabilitation service for amputees which includes an integrated prosthetic service. Two hundred admissions were reviewed and some complex cases described. It is concluded that: a very close liaison between the surgeon and the rehabilitation team (ideally with preoperative consultation) is in the patient's best interests; any person previously walking (or a potential walker) should be considered for a trial of prosthetic walking; an integrated prosthetic service enhances the efficiency of the rehabilitation service; and that modification of the current Artificial Limb Scheme to allow manufacture of first definitive limbs in prosthetic rehabilitation units would further enhance service to patients.

Adaptation, Psychological↗