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PubMed1994

Rehabilitation outcome 5 years after 100 lower-limb amputations.

Received wisdom commends a policy of maximizing the ratio of below-knee to above-knee amputations in patients with end-stage arterial disease. After adoption of this policy, the long-term outcome of 100 consecutive lower-limb amputations in 96 patients was monitored by annual review for 5 years. The ratio of primary below-knee to above-knee amputations was 2:1, with 9 per cent of below-knee amputations undergoing revision to a higher level. At 2 years after amputation only 26 per cent of patients were successfully walking out of doors, while 40 per cent had died. By 5 years 67 per cent were dead and only 9 per cent continued to walk out of doors with an artificial limb, although a further 8 per cent continued to use the limb within the confines of their own homes. In a previous audit of 193 amputations performed during the 3.5 years to December 1984, stump healing was a problem in 45 per cent of primary below-knee amputations, compared with 25 per cent in the present study. Although the below- to above-knee ratio in 1984 was only 1:2, the overall rehabilitation rate, as determined by the proportion of patients able to walk at 2 years, was 34 per cent. It is concluded that increasing the proportion of below-knee amputations from one-third to two-thirds of lower-limb amputations for occlusive arterial disease does not improve effective rehabilitation rates. Received wisdom on the desirability of a high below- to above-knee ratio may be wrong.

Age Factors↗

PubMed1999

[Hand transplantation and implantation of nerve chips. New developments within hand surgery].

Injuries and diseases of the hand naturally have an enormous impact on hand function and on quality of life, both occupational and social. The majority of hand-injury patients are under 30 years of age. Hand surgery, an established specialty in Sweden since 1969, is of great importance in terms of clinical developments, education and research. In the coming decade, scientific and clinical advances are to be expected in several fields such as nerve injuries including brachial plexus lesion, microsurgery, flexor tendon injuries and tendon transfer. Bioimplant research and new advances at the biotechnological interface will yield new options in nerve reconstruction, microchip implants in the nervous system, and the restoration of muscle-tendon function following injury. Artificial limbs with advanced motor and sensory functions will be important future aids in the rehabilitation of amputees. Transplantation of human hands is another promising reconstructive procedure which may open up new perspectives in the coming millennium.

Amputation, Surgical↗

PubMed2000

[Hand transplantation and implantation of nerve chips. New developments within hand surgery].

Amputation, Surgical↗

PubMedDate not supplied

The Jaipur limb and foot.

In the 12 years which have elapsed since the United Nations declared 1981 to be the Year of the Disabled, the number of amputees world-wide has risen alarmingly, continuing the pattern of the past 40 years, which have seen innumerable conflicts, large and small, with ever-increasing and indiscriminate use of 'improved' antipersonnel mines which have been sown in enormous numbers in rural areas. Even after fighting has ceased--as in Vietnam, which currently has some 200,000 amputees--fresh injuries are caused daily, often to children, by the long-delayed detonation of these weapons. Much of the research and development in prosthetics since World War II has concentrated on producing artificial limbs suitable for an affluent and industrialized society. These, being made from the most modern materials and incorporating the latest technology, are of necessity expensive even for affluent Americans or Europeans and quite out of reach for the 80 per cent of the world's amputees who live in the developing world and for the vast majority of whom these splendid prostheses may be entirely inappropriate. This article describes a foot and leg specifically designed to fit in with the customs and practices of just such people.

Amputation, Traumatic↗

PubMed1985

Energy cost during gait in osteosarcoma patients after resection and knee replacement and after above-the-knee amputation.

We determined the energy cost during gait by measuring the oxygen consumption of twenty-six patients after treatment for osteosarcoma about the knee. Fourteen had had an en bloc resection of the distal end of the femur and proximal end of the tibia followed by segmental replacement with a custom-made knee prosthesis and twelve had had an above-the-knee amputation followed by fitting with an artificial limb. Comparisons of free-walking velocity, oxygen consumption per meter traveled, and per cent of maximum aerobic capacity used during walking demonstrated that patients with resection and prosthetic knee replacement had a lower energy cost during gait.

Adolescent↗

PubMed1982

[Disarticulation of the knee. Surgical technic--prosthesis fitting].

The authors describe a modified technique for knee joint disarticulation surgery. Their approach provides two flaps, one medial and one lateral, which result in a posterior, longitudinal scar that remains outside the contact areas of the prosthesis. They abrade the lateral and posterior aspect of each condyle, peeling out the articular cartilage and re-covering the condyles with the joint capsule. This technique allows a satisfactory stability in prosthetic rotation, and improves the appearance of the artificial limb. For post-operative rehabilitation the authors use a tridimensional alignment jig and a prosthetic ankle with three degrees of freedom: flexion-extension, lateral-medial motion and rotation, making easier the swing phase while maintaining the obvious advantages of a pilon-type prosthesis.

Amputation, Surgical↗

PubMedDate not supplied

[Importance of rehabilitation in the evaluation of personal injury].

The paper distinguishes between rehabilitation and the conferring of ability, limiting the application of rehabilitation methods to recovery of disablement due to trauma or disease. This can be achieved with the collaboration of specialists in the various branches of medicine; microsurgery, orthopaedics, physiotherapy, together with socio-psycho-biological aids. The Artificial Limb Center of the National Institute for Insurance against Occupational Diseases (INAIL) located at Vigorso di Budrio (Bologna) has been particularly successful in designing myoelectric and modular prostheses for patients who have undergone amputation of limbs, thus achieving functional, social and occupational rehabilitation. The concept of functional and anatomical disablement and personal injury on a forensic medicine basis is illustrated, as applicable in criminal and civil law, insurance and social security. Rehabilitation plays an important rôle since it reduces personal injury on a social and occupational level.

Amputees↗

PubMed1999

Prosthetic options for below knee amputations after osteomyelitis and nonunion of the tibia.

Below the knee amputation after trauma is an appropriate option for many patients with recalcitrant infection and nonunion of the tibia. Patients who have had transtibial amputations have lower energy expenditure, heart rate, and oxygen cost when ambulating with their prostheses than when using a three-point gait with crutches without their artificial limb. Innovative prosthetists have improved each of the five essential components of the limb amputated below the knee: socket, insert, shaft and pylon, foot and ankle assembly, and suspension system. Prosthetists are integral members of the patient's healthcare team. Their recommendations and direct patient care are essential to optimizing the functional ability of patients who have had amputations.

Amputation, Surgical↗

PubMed1989

A five-year review of referrals for prosthetic treatment in England, Wales and Northern Ireland, 1981-85.

Patients undergoing amputation and who are considered to be suitable for an artificial leg are referred to the Disablement Services Centres (formerly called the Artificial Limb and Appliance Centres). This article reviews the referrals to the 23 centres in England, Wales and Northern Ireland over the five-year period 1981-85. The results show that there has been a decrease in the number of both upper and lower limb referrals and a 4% increase in the primary cause of amputation, arteriosclerosis. Centres that are the busiest, those seeing the greatest and fewest number of arteriosclerosis and diabetic referrals and those being referred the largest numbers of above, below and knee level amputations are identified.

Amputation, Surgical↗

PubMed1986

Changing pattern of lower limb amputation for vascular disease.

In 1980 a review of lower limb amputation over a 3.5 year period between 1974 and 1978 was reported from our centre. More recently 193 amputations were performed for peripheral vascular disease over a similar 3.5 year period, representing an increase of 33 per cent in the amputation rate during the last 6 years. This cannot be explained by the increasing age of the population alone. Fewer below-knee amputations (BKA) (33.0 per cent) and more Gritti-Strokes amputations (GSA) (32.0 per cent) were performed and the overall incidence of re-amputation for stump breakdown was 13.5 per cent. Twenty-eight per cent of below-knee amputation stumps required re-amputation at higher levels, but when successful were associated with a 75 per cent incidence of rehabilitation with an artificial limb. Eight per cent of GSA stumps required re-amputation and were associated with a twenty-eight per cent incidence of successful rehabilitation. Thirty-seven per cent of patients had undergone reconstructive vascular surgery before amputation. Of the 26 patients requiring re-amputation 58 per cent had undergone arterial reconstruction in an attempt to salvage the limb (chi 2 = 5.65, P less than 0.02) and in 26.9 per cent of cases this was performed within the week before amputation. We feel that injudicious attempts at arterial reconstruction, when amputation appears inevitable, may adversely affect the subsequent level of amputation and jeopardize rehabilitation.

Age Factors↗

PubMed1985

Living with an amputation: the helper.

One hundred and nine key helpers were interviewed in connection with a study of the psychosocial implications of amputation. They were found to carry formidable burdens. Social isolation was a major problem which increased over time and was associated with diminished capacity to express needs. The respondents discussed emotional problems readily. Social workers had little sustained contact with helpers: welfare agencies had intervened mainly to provide practical help. The Artificial Limb Centre did not routinely see helpers or communicate with General Practitioners. A more realistic approach to the support of those who implement community care policies is advocated, with particular reference to the need for respite care to be provided in the domestic setting. The dangers of the exploitation of women as carers are highlighted.

Adaptation, Psychological↗

PubMed1983

[Quantitative analysis of lateral force of floor reactions in normal and above-knee prosthetic gait].

Analysis of the lateral force of floor reactions has only been reported with reference to the vertical and fore- and-aft force because of large individual variations and great differences between the right and left limb of the same individual on the normal pattern of the force curve. In this study, the lateral force in normal and above-knee prosthetic gait was evaluated by calculating the total impulse during stance phase duration as well as by characteristic points of the force curve. The sensitivity of the electronic unit connected to the Kistler 's force plate was enhanced four times. The following results were obtained: In normal gait, the lateral stability during stance phase was shown by the lateral force which was proved to be a regulative element for rhythmical forward movement of the center of gravity of the body. The lateral stability in above-knee prosthetic gait was evaluated not only by the characteristic pattern of the force curve, but also by a decreased difference of the impulse of lateral force between the natural and artificial limb. The initial adduction angle of above-knee prostheses was determined by such a definition of the lateral force. Five degrees proved to be the most appropriate angle, as has been generally accepted. The lateral force of floor reaction can be definitely measured by a quantitative analysis of the total impulse during stance phase duration.

Adult↗

PubMed1977

A percutaneous implant using a porous metal surface coating for adhesion to bone and a velour covering for soft tissue attachment: results of trials in pigs.

A percutaneous implant for the attachment of an artificial limb has been designed and tested in 14 pigs. Firm fixation to bone was achieved with the porous-surface layered metal intramedullary stem design in some cases. Dacron velour was used at the soft tissue interface. Evidence of soft tissue ingrowth was seen. However, the velour was unable to maintain adequate epithelial adhesion to form an anatomical seal and a barrier to bacteria.

Animals↗

PubMed1990

Feedback in myoelectric prostheses.

This article briefly reviews the history of the use of feedback in artificial limbs. It suggests that researchers have concentrated unduly upon the use of feedback to control prehensile force or joint angle and advocates a broader perspective. In that context, the article presents a comprehensive view of the need for feedback in myoelectric prostheses. The difficulties of designing transducers to meet the stringent demands of prosthetics applications are considered, and problems inherent in several alternatives are identified. Various means of conveying feedback information to the amputee are reviewed in some detail. The concept of feedback in control systems is introduced in the context of closed-loop control of a prosthesis. The surprisingly good performance of skilled users of myoelectric prostheses is noteworthy implying that the distinction between sensory and proprioceptive feedback may be somewhat artificial. By integrating these two feedback types a satisfactory feedback system may become an attainable goal.

Artificial Limbs↗

PubMed2000

A preliminary functional brain study on amputees.

The purpose of this study was to verify whether brain activation could be used to modulate the movements of an artificial limb. This approach was begun 20 years ago with the fitting of prostheses immediately following lower-limb amputations. We studied 9 unilateral amputees and 9 control participants using functional MRI, electroneuromyography, gait laboratory, and neuropsychological assessments. The results demonstrated that brain activation is analogous when participants in the control group are asked to mentally move a foot, compared with amputees who are asked to move a nonexistent foot. The brain has not been damaged and maintains its areas of command. This can be applied in rehabilitation.

Adolescent↗

PubMed2000

[A method for real-time pickup action signal].

Generally, each single action is picked up from successive action EMG signal by hand. Then this colleced signal is discriminated after getting its features. But doing by this way is obviously difficult to meet requirements of the myoelectric artificial limb. So this paper presents an easy method from the myoelectric energy point of view. The action signal segments and no-action signal segments are picked up from colleced EMG signal. Thus it is convenient for the relevant follow-up processing, and avoids dealing with no-action signal data. Therefore it is of useful and practical significance for multifunction myoelectric control of prostheses. In this paper, it has been proved that this method is feasible by using it to pick up actual effective action signal.

Algorithms↗

PubMed1982

Ankle-knee synchronous knee lock mechanism: a revision.

An ankle-knee synchronous mechanism in a new endoskeletal above-knee (A-K) prosthesis has been designed and a preliminary clinical study has been conducted. A revision of the knee mechanism which is mainly focused on the basis of reducing the energy cost of the prosthetic wearer has been developed. It provides multiple position of the knee lock. It also provides anterior placement of the knee joint and a synchronous motion with the ankle joint. It enables the prosthetic wearer to minimize the effect of hip extensor contraction, to stabilize the knee, and maximize the sense of security and to balance the body over the artificial limb through the stance phase of gait. It permits the amputees to assume various body postures which enable them to perform daily activities. A new concept for alignment of A-K prosthesis is accomplished by using a weight bearing line instead of a trochanter and ankle (TKA) line, especially for the short A-K amputees. Deletion of the inertia control mechanism becomes possible by simply inserting a bumper in the knee to prevent terminal impact at swing phase and a built in coil spring acts as a knee extension aid.

Ankle Joint↗

PubMed2000

Controlling an artificial arm with foot movements.

A history of prosthesis control techniques is outlined. An alternative approach to hand and arm prosthesis control is proposed, and a working-prototype model is described. Commercial artificial limbs have function limited by a small number of user-interface control channels, and they are awkward to operate because joints are turned on and off in a serial fashion and not in parallel. Because of natural anatomic and physiologic similarities between the upper and lower extremities, the foot and leg is an ideal control interface. A stocking laced with multiple sensors can provide input on multiple joint positions, and this information used to control homologous movements in a prosthetic upper extremity. One significant advantage of this form of control is simultaneous activation of multiple joints.

Amputation, Surgical↗