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PubMed1988

Preliminary assessment of three new designs of prosthetic prehensors for upper limb amputees.

At present, upper-limb amputees have a basic choice of a hook or a hand for the prosthetic prehensor. In the USA about two-thirds of upper-limb amputees wear hooks and about one-third wear hands. Either of these options represents a compromise. The hook is more functional and the hand is more cosmetic. Some amputees solve the dilemma by having one of each and interchanging them as work and social situations dictate. However, they would prefer to have one acceptable prehensor, and they want one which is functional, is attractive, and does not necessarily have to look like a hand. In an attempt to meet the desires of upper-limb amputees, three prosthetic prehensors or "terminal devices" have been designed and developed into models. This article describes the preliminary assessment of these new designs.

Amputees↗

PubMed1993

Walking speed of normal subjects and amputees: aspects of validity of gait analysis.

This study investigated some aspects of the validity of walking speed recording in 15 normal subjects, 16 trans-femoral amputees and 8 knee disarticulation amputees. The variability and test-retest reliability of walking speed and the influence of simultaneous recording of EMG and goniometry on comfortable and fast walking speeds were studied. The variability between sessions was mainly determined by the variance within each session. The variance of speed within sessions while walking with fast speed, was higher when walking without equipment than when walking with equipment. The variances of speed within sessions of the normal subjects were higher than those for both amputee groups. The test-retest reliability, expressed by the intra-class correlation coefficient, was good: between 0.83 and 0.98. The speed when walking without equipment was significantly higher both in normal subjects and amputees than the speed when walking with equipment.

Adolescent↗

PubMed1993

Comparison of gait using a Multiflex foot versus a Quantum foot in knee disarticulation amputees.

The subjective responses and gait patterns of unilateral knee disarticulation amputees wearing prostheses fitted first with the Multiflex foot and then with the Quantum foot were studied. Nine amputees were included in the trial. A questionnaire asked the amputees about their preference for one of the feet. Gait analysis was performed measuring temporal parameters and goniometry of hips, knees and ankles in the sagittal and frontal planes. There was a slight preference for the Quantum foot. Preference seemed not to be related to physical characteristics of the amputees nor to gait parameters. There were no differences in gait as far as the temporal factors were concerned. The main differences in the range of motion of the joints were in the frontal plane: the eversion-inversion movement of the ankle and the adduction-abduction movement of the hip. During walking at comfortable speed with the Multiflex foot the ankle and hip range of motion averaged 2.1 and 3.1 degrees respectively, less than during walking with the Quantum foot.

Adult↗

PubMed1994

Energy expenditure of trans-tibial amputees during ambulation at self-selected pace.

The purpose of this investigation was two-fold: 1) to compare the metabolic cost (VO2), heart rate (HR), and self-selected speed of ambulation of trans-tibial amputees (TTAs) with those of non-amputee subjects; and 2) to determine whether a correlation exists between either stump length or prosthesis mass and the energy cost of ambulation at the self-selected ambulation pace of TTAs. Subjects were thirty-nine healthy male non-vascular TTAs between the ages of 22 and 75 years (mean +/- sd = 47 +/- 16). All had regularly used their prosthesis for longer than six months and were independent of assistive ambulation devices. Twenty-one healthy non-amputee males aged 27-47 years (31 +/- 6) served as controls. Subjects ambulated at a self-selected pace over an indoor course, with steady-state VO2, HR, and ambulation speed averaged across minutes seven, eight and nine of walking. Results showed that HR and VO2 for TTAs were 16% greater, and the ambulation pace 11% slower than the non-amputee controls. Significant correlations were not observed between stump length or prosthesis mass, and the energy cost of ambulation. However, when the TTA subject pool was stratified on the basis of long and short stump length, the former sustained significantly lower steady-state VO2 and HR than the latter while walking at comparable pace. These data indicate that stump length may influence the metabolic cost of ambulation in TTAs.

Adult↗

PubMed1994

A pilot study to test the influence of specific prosthetic features in preventing trans-tibial amputees from walking like able-bodied subjects.

The purpose of this pilot investigation was to develop a method to test the influence of specific prosthetic features in preventing trans-tibial amputees from walking like able-bodied subjects. An able-bodied subject was fitted with a patellar-tendon-bearing orthosis incorporating several features of an amputee's prosthesis. Kinetic, kinematic and metabolic data were collected as features were systematically removed from the orthosis. While wearing the orthosis the gait of the able-bodied subject closely simulated trans-tibial amputee gait kinematically, kinetically and metabolically. Although it was obvious that the various prosthetic features influenced the kinetics and kinematics of gait, they were difficult to quantify with only a single subject. However, the two features which appeared to have the largest influence in preventing trans-tibial amputees from walking like able-bodied subjects were patellar tendon loading and a solid ankle.

Adult↗

PubMed1995

The effect of prosthetic rehabilitation in lower limb amputees.

The objectives of this project were to ascertain whether, to date, the views concerning the determination of prosthetic candidacy have been optimal and whether the training methods applied have been effective and have resulted in constant use of the prosthesis after conclusion of the training programme. Secondly it was intended to set up guidelines for future budgeting as well as providing a reference framework for the process of rehabilitation. An inquiry based on questionnaires was the first phase in a quality assurance project carried out among 29 amputees trained in 1990 and 1991. The result of the inquiry was that rehabilitation using PTB prostheses for 19 trans-tibial amputations in 18 cases (one patient was a bilateral trans-tibial amputee) led to constant use of the prosthesis and that advanced age was no hindrance to constant use in this group. For 10 trans-femoral amputees the inquiry revealed that advanced age combined with problems of donning the prosthesis was a hindrance to constant use in two cases. It is concluded that there is a need for testing/developing new types of femoral prostheses. The patients' evaluation of the rehabilitation process and their prostheses stresses the need for communication between the team of professionals and the patients in the decision process concerning the provision of a prosthesis as well as the provision of complete information on the patients' future functional possibilities. Qualitative measurements must include the kind and number of medical complications and the social conditions of the amputee as well as tests of physical and mental resources.

Adult↗

PubMed1996

Use of an instrumented treadmill for real-time gait symmetry evaluation and feedback in normal and trans-tibial amputee subjects.

The purpose of this research was to evaluate a newly developed system for assessing and providing feedback of gait symmetry information in real time to subjects walking on a motorised treadmill (the CCF Treadmill). The advantages of the system are that it allows the rapid collection and comparison of temporal and kinetic parameters of gait for multiple successive strides, at a constant known speed, without forcing subjects to target their footsteps. Gait asymmetries of six normal (mean age 42.7 years) and six unilateral transtibial amputee subjects (mean age 41.7, and average 6.0 years using a prosthesis) were quantified. The amputee group was the reevaluated after receiving five minutes of training with each of three different types of real-time visual feedback (RTVF). Asymmetries in the measured parameters before feedback were 4.6 times greater in the amputee population than in the normal group, and were consistent with the finding of previous authors. Significant decreases in gait asymmetry were demonstrated for all forms of feedback after amputees received feedback training. Results, however, indicated that gait asymmetries for different variables are not necessarily related, and that more work needs to be done to identify those variables for which attaining a more symmetrical gait pattern is most beneficial. Further work also needs to be done to determine the long term effects of such RTVF training. The CCF Treadmill and RTVF were shown to be potentially useful tools both for defining rehabilitation targets and for quantifying patients' progress towards those goals.

Adult↗

PubMed1997

Static versus dynamic prosthetic weight bearing in elderly trans-tibial amputees.

The purpose of this study was to compare prosthetic weight-bearing tolerance in the standing position to the dynamic vertical ground reaction forces (VGRF) experienced during walking in elderly dysvascular trans-tibial amputees. Ten unilateral trans-tibial amputees attending an amputee clinic (mean age = 67 +/- 6.5 years) were selected as subjects. Selection criteria were the level of amputation, age, medical fitness to participate and informed consent. Each participant completed five trials of standing (static) weight bearing measurement followed by 10 walking (dynamic) trials on a 10m level walkway, five trials for each limb, Static weight bearing (SWB) was measured using standard bathroom scales. Dynamic weight bearing (DWB) was measured during gait using a Kistler multichannel force platform. T-tests for dependent means indicated that the forces borne in prosthetic single limb stance (mean = 0.97 +/- 0.03 times body weight (BW)) were significantly lower than the forces borne by the prosthetic limb during the first peak (weight acceptance) VGRF (mean = 1.08 +/- 0.08 BW; t = -4.999; p = 0.001) and significantly higher than the midstance VGRF (mean = 0.82 +/- 0.07 BW; t = 5.401; p < 0.001). However, there was no significant difference between SWB and the second peak (push-off) VGRF generated by the prosthetic limb during walking (mean = 0.96 +/- 0.03 BW). It was concluded that clinical gait training may utilise SWB as a guide to an amputees' prosthetic weight bearing tolerance and requirements during walking.

Aged↗

PubMed1975

Performance of bk amputees using ptb prostheses.

A below-knee amputee is generally known to achieve a close-to-normal performance level, with the patellar-tendon-bearing method of stump fitting. This was confirmed by an ergonomic investigation on ten below-knee amputees, fitted with PTB prostheses. The test group subjects were given two static tests, two dynamic tests and one exercise tolerance test, during which their oxygen consumptions, pulmonary ventilations, energy expenditures and peak heart rates were measured. The performance of the test subjects were compared with that of a control group consisting of sixteen normal, healthy, individuals. The percentage increases in the values of the biomechanical parameters of the test subjects, over those of the control group, were found to be justified and thus natural to the below-knee amputee-PTB prosthesis system. The ergonomic study has not yielded information regarding the biomechanical efficacy of the PTB prosthesis, but it has also shown that the amputees fitted with such prostheses can take up, without any undue extra effort and metabolic cost, industrial occupations of the moderately heavy kind.

Adolescent↗

PubMedDate not supplied

Effect of endurance training program based on anaerobic threshold (AT) for lower limb amputees.

We have already reported that the one-leg cycling test driven by the subject's sound leg as the exercise load test is effective in measuring the anaerobic threshold (AT) of unilateral lower limb amputees. The aim of this research is to investigate whether or not endurance training based on each subject's AT gained from the one-leg cycling test is useful in improving the physical fitness of lower limb amputees. The test subjects were all unilateral transfemoral amputees comprising a group of 14 undertaking endurance training and a control group of 10. The form of endurance training is driving an ergometer with the sound limb only in the same way as the load test. The training program was designed so that the subjects would exercise at a target heart rate corresponding to AT point for 30 minutes per day, 3-5 days each week for 6 weeks. After the training periods, in the training subjects the AT and maximum oxygen uptake (__O2max) increased significantly. The rate of increase averaged 36.5%, 26.0%, respectively, compared to their levels before the training. On the contrary, no changes occurred in the control subjects. These results suggest that our chosen training program based on each subject's AT is effective in improving the physical fitness of lower limb amputees.

Adult↗

PubMed1991

Rehabilitation of the elderly amputee.

A rehabilitation service based in a department of geriatric medicine and dealing exclusively with amputees aged 65 years or over, is described. Provision of prostheses has been expedited, and the multi-disciplinary approach of the department has been beneficial in rehabilitation especially of the amputee with multiple pathology. The experience of the first 146 patients with an average age of 74.1 years is reviewed. Discharge home was achieved in 77.6% of the patients provided with a prosthesis and in a small multi-centre study of the post discharge status of 20 elderly amputees it was found that over 90% used their prosthesis regularly and the great majority were independent in the activities of daily living. Although BKA (Below knee amputation) is preferable to AKA (Above knee amputation), the functional benefit in this age group is not always as significant as traditional attitudes would suggest whereas a failed BKA has serious consequences in terms of psychological impact, morbidity and length of hospital stay. In order to minimise the number of BKA's requiring revision or re-amputation every effort should be made to ensure that the initial procedure is carried out by a surgeon with experience of amputation in this age group. Limb provision is cost effective and the frequent difficulty with regard to the financing of prostheses for elderly amputees is counter-productive.

Aged↗

PubMed1987

Ergometer modification for combined arm-leg use by lower extremity amputees in cardiovascular testing and training.

A commercial arm-leg ergometer was adapted so that combined bilateral arm-single leg work could be performed by unilateral lower extremity amputees from their own wheelchairs. Three middle-aged to elderly unilateral amputees performed progressive discontinuous bilateral arm crank and combined bilateral arm-single leg cycle exercise tests on the same air-braked ergometer adapted for either form of ergometry. Select amputees may achieve greater peak oxygen uptakes (VO2), power outputs (PO), and heart rates (HR) during combined bilateral arm-single leg cycle testing versus bilateral arm crank testing. Following 14 weeks of combined arm-leg training on the modified ergometer, a 73-year-old above-knee amputee demonstrated peak VO2 and PO increases of 25% (+3.8 mL X kg-1 X min-1) and 33% (+25W) respectively. Combined arm-leg ergometry as described herein may activate the largest available muscle mass and elicit the greatest oxygen uptake during exercise testing. In addition this exercise modality may simultaneously condition the arms and leg, providing functional gains in both wheelchair propulsion and prosthetic ambulation.

Amputees↗

PubMed1984

Two methods for estimating body surface area in adult amputees.

Two methods for estimating body surface area (BSA) in adult amputees were developed. BSA in sq m was determined in 42 healthy, nonamputee men and women by summing the surface areas of individual body parts obtained using geometric measurements (BSAmeas) and by an equation using height and weight (BSAcalc). Linear regression analysis was used to determine correlations between BSAmeas and BSAcalc and between BSAmeas and surface-area measurements of individual body parts (SApart). The percentages of total BSA contributed by individual body parts in each subject were determined by the ratio of SApart to BSAmeas, and these percentages were compared with the corresponding percentages for body parts using the "Rule of Nines." BSAcalc and BSAmeas were significantly correlated, as were SApart and BSAmeas. Regression analysis of SApart versus BSAmeas yielded an equation for each measured body part that allowed calculation of SApart without direct measurement. SApart expressed as a percentage of total BSA differed from the percentage of BSA used in the "Rule of Nines" by a mean of 12.4-32% depending on the body part. Two methods of estimating BSA in amputees were proposed based on deduction of the surface area of the amputated part (calculated from the regression equation for SApart or as a percentage of total BSA) from total BSAcalc in adult amputees. The two methods developed in this study for estimating BSA may be useful in determining drug dosages in adult amputees and may provide more accurate information in burn therapy. Further studies are needed to validate the clinical application of these methods.

Adult↗

PubMed1982

Below-knee amputee running gait.

The running ability of ten unilateral below-knee amputees was examined by analyzing the temporal and length characteristics of their running strides and the angular displacement patterns of their intact and prosthetic limbs. Six of the individuals tested were able to run and in several cases their locomotor patterns were similar to those of non-amputees. The running gait of three of the amputee runners, however, did contain one particular undesirable element namely an excessively straight residual knee during at least a portion of support on the prosthesis. Although several explanations could be postulated to account for this tendency, we believe that it could be eliminated with training and possible prosthetic modification. Results of the study, while attesting to the fact that many lower extremity amputees can run, also suggested directions in which research efforts can and are being focused to facilitate their running performance.

Adult↗

PubMed1980

Infant amputees: early growth and care.

Limb-deficient children are more like their physically normal peers than like children with other kinds of physical differences or adult amputees. The therapist working with these children should foster their normal development, and be guided by the child's needs and interests when intervention is necessary. Children who have functional upper extremities can and should lead virtually normal lives. Those who have severe upper limb deficiencies may always be dependent on others for help in certain activities. Prosthetic restoration usually, but not alway, effective in improving the amputee's functional abilities. Prostheses are not actual replacements for real limbs, but usually restore considerable function to the amputee. The amputee is the best judge of whether prosthetic restoration is beneficial to him. In working with limb-deficient children, the author has discovered that for them, less (treatment) is more. The author would also suggest that the practice of minimal intervention has more applications in rehabilitation medicine, and desrves further exploration.

Amputees↗

PubMed1995

Knee joint proprioception in below-knee amputees.

This study determined knee joint proprioception in below-knee amputees using two methods of measurement of knee joint proprioception. The threshold for detection of passive motion and the ability to reproduce specific limb positions were recorded in nine below-knee amputees. A significant difference was observed between the prosthetic and sound limbs in the amputees in the threshold of detection test. The large angles (5 degrees to 25 degrees) involved in position reproduction tests may have provided cues through the cuff suspension. Different strategies are used by below-knee amputees to discern large and small movements of the knee.

Aged↗

PubMed1993

Geriatric amputee rehabilitation.

Comprehensive rehabilitation of the amputee should be more than the provision of a prosthetic device. This is especially true for the geriatric amputee, whose needs are greater because of comorbidity, fragile social supports, and limited resources. This article reviews demographic information as well as preventive, preoperative, and immediate postoperative care of the amputee. Phantom sensation and pain and their management are addressed. Prosthetic components selection and the rehabilitation in different environments are considered, as is the care of the bilateral amputee and the patient with dual disability.

Aged↗

PubMed2004

The strategies to regulate and to modulate the propulsive forces during gait initiation in lower limb amputees.

We used the framework of motor program adaptability to examine how unilateral above-knee (AK) or below-knee (BK) amputee subjects organize the global and local biomechanical processes of generation of the propulsive forces during gait initiation to overcome the segmental and neuro-muscular asymmetry. The organization of the global biomechanical process refers to the kinematics behavior of the couple center of foot pressure (CoP) and center of mass (CoM); the organization of the local biomechanical process refers to the propulsive forces generated by the prosthetic or intact limb during the anticipatory postural adjustment phase and the step execution phase. Specifically, we examined: i) the strategy to regulate the progression velocity, i.e., to maintain it comparably when the leading limb changed from the prosthetic limb to the intact limb; and ii) the strategy to modulate the progression velocity, i.e., to increase it when gait was initiated with the prosthetic limb vs. intact limb. The kinematics of the CoM and CoP in the amputees showed the same global biomechanical organization that is typically observed in able-bodied subjects, i.e., the production of the forward disequilibrium torque was obtained by a backward shift of the CoP, followed by a forward acceleration of the CoM. However, gait initiation was achieved by using a different local strategy depending on which limb was used to initiate the step. For the regulation of the CoM progression velocity, when the gait was initiated with the intact limb, the slope of the progression velocity during the anticipatory postural adjustment phase (APA) was steeper and lasted longer, the step execution duration was shorter, and the variation of the CoM speed was lower. In other words, to regulate the speed of progression, the amputee subjects controlled the spatial and temporal parameters of the propulsive forces. In the modulation of the CoM progression velocity, when the gait was initiated with the intact limb, the amputees controlled only the intensity of the propulsive forces during both the APA and step execution phases. In contrast, when the gait was initiated with the prosthetic limb, the modulation resulted mainly from the propulsive forces generated during the step execution phase. These different strategies are discussed in terms of the subject's capacity to adapt the motor program for gait initiation to new constraints.

Adaptation, Physiological↗