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Sample records for amputees

  1. Rehabilitation of lower limb amputees

    OpenAIRE

    KOVAČ, IDA; KAUZLARIĆ, NEVEN; ŽIVKOVIĆ, OGNJEN; MUŽIĆ, VEDRANA; ABRAMOVIĆ, MARINA; VULETIĆ, ZORAN; VUKIĆ, TAMARA; IŠTVANOVIĆ, NEVEN; LIVAKOVIĆ, BRANKO

    2015-01-01

    Rehabilitation of amputees represents a complex process during the course of which an amputee receives professional aid and support, so as to adapt to the use of prosthesis, i.e. an artificial supplement for the lost body part. The process aims at achieving an independent performance of the amputee in all areas of everyday life and as high quality of life as possible. The rehabilitation encompasses not only the pre-amputation, postoperative, pre-prosthetic and prosthetic stage, within which a...

  2. Obstacle crossing in lower limb amputees

    NARCIS (Netherlands)

    Vrieling, A.H.; van Keeken, H.G.; Schoppen, Tanneke; Otten, Egbert; Halbertsma, J.P.; Hof, A.L.; Postema, K.

    2007-01-01

    Objective: To study limitations in function and adjustment strategies in lower limb amputees during obstacle crossing. Design: Observational cohort study. Subjects: Transfemoral and transtibial amputees and able-bodied control subjects. Methods: In a motion analysis laboratory unimpeded and obstacle

  3. Gait termination in lower limb amputees

    NARCIS (Netherlands)

    Vrieling, A. H.; van Keeken, H. G.; Schoppen, T.; Otten, E.; Halbertsma, J. P. K.; Hof, A. L.; Postema, K.

    Objective: To study the limitations in function and adjustment strategies of lower limb amputees in gait termination. Design: Observational cohort study. Setting: University Medical Centre. Participants: Unilateral transfemoral and transtibial amputees, and able-bodied control subjects. Main outcome

  4. The Winter Park Amputee Ski Teaching System.

    Science.gov (United States)

    O'Leary, Hal

    The three track method of teaching amputees to ski is presented in the illustrated manual. Problems unique to amputee skiers--care of hands, conditioning, care of stump, fatigue, excessive standing, wind, and balance--are discussed in terms of their implications to the amputee skier and practical solutions in attempting to solve them. Specific…

  5. Bariatric amputee: A growing problem?

    Science.gov (United States)

    Kulkarni, Jai; Hannett, Dominic P; Purcell, Steven

    2015-06-01

    This study reviewed prevalence of patients with lower limb amputations with above normal weight profile, with body mass index over 25, in seven disablement services centres managing their amputee rehabilitation in the United Kingdom. To review two clinical standards of practice in amputee rehabilitation. Ambulant lower limb amputees should have their body weight recorded on an electronic information system, with identification of cohort with body weight >100 kg. Lower limb amputees to be provided with suitable weight-rated prosthesis. Observational study of clinical practice. Data were collected from the Clinical Information Management Systems. Inclusion criteria--subjects were ambulant prosthetic users with some prosthetic intervention in the last 5 years and had at least one lower limb amputation. In 96% of patients, the weight record profile was maintained. In addition, 86% were under 100 kg, which is the most common weight limit of prosthetic componentry. Of 15,204 amputation levels, there were 1830 transfemoral and transtibial sites in users with body weight over 100 kg. In 60 cases, the prosthetic limb build was rated to be below the user body weight. In 96% of our patients, body weight was documented, and in 97%, the prosthetic limb builds were within stated body weight limits, but this may not be the case in all the other disablement services centres in the United Kingdom. Also, the incidence of obesity in the United Kingdom is a growing problem, and the health issues associated with obesity are further compounded in the amputee population. Prosthetic componentry has distinct weight limits which must be considered during prescription. As people with amputation approach the limits of specific components, clinicians are faced with the challenge of continued provision in a safe and suitable manner. This article reviews the amputee population and the current national profile to consider trends in provision and the incidence of these challenges. © The

  6. Amputee rehabilitation and preprosthetic care.

    Science.gov (United States)

    Klarich, Julie; Brueckner, Inger

    2014-02-01

    This article reviews occupational therapy treatment and physical therapy treatment during preprosthetic training for upper and lower extremity amputees. Review of preoperative intervention, preparing the residual limb for the prosthesis, instruction in techniques, and adaptive equipment for activities of daily living, as well as suggestions for return to vocational and avocational activities are addressed. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Comparison of transtibial amputee and non-amputee biomechanics during a common turning task.

    Science.gov (United States)

    Segal, Ava D; Orendurff, Michael S; Czerniecki, Joseph M; Schoen, Jason; Klute, Glenn K

    2011-01-01

    The biomechanics of amputee turning gait has been minimally studied, in spite of its integral relationship with the more complex gait required for household or community ambulation. This study compares the biomechanics of unilateral transtibial amputees and non-amputees completing a common turning task. Full body gait analysis was completed for subjects walking at comparable self-selected speeds around a 1m radius circular path. Peak internal and external rotation moments of the hip, knee and ankle, mediolateral ground reaction impulse (ML GRI), peak effective limb length, and stride length were compared across conditions (non-amputee, amputee prosthetic limb, amputee sound limb). Amputees showed decreased internal rotation moments at the prosthetic limb hip and knee compared to non-amputees, perhaps as a protective mechanism to minimize stress on the residual limb. There was also an increase in amputee sound limb hip external rotation moment in early stance compared to non-amputees, which may be a compensation for the decrease in prosthetic limb internal rotation moment during late stance of the prior step. ML GRI was decreased for the amputee inside limb compared to non-amputee, possibly to minimize the body's acceleration in the direction of the turn. Amputees also exhibited a shorter inside limb stride length compared to non-amputees. Both decreased ML GRI and stride length indicate a COM that is more centered over the base of support, which may minimize the risk of falling. Finally, a longer effective limb length was found for the amputee inside limb turning, possibly due to excessive trunk shift. Published by Elsevier B.V.

  8. Golf hand prosthesis performance of transradial amputees.

    Science.gov (United States)

    Carey, Stephanie L; Wernke, Matthew M; Lura, Derek J; Kahle, Jason T; Dubey, Rajiv V; Highsmith, M Jason

    2015-06-01

    Typical upper limb prostheses may limit sports participation; therefore, specialized terminal devices are often needed. The purpose of this study was to evaluate the ability of transradial amputees to play golf using a specialized terminal device. Club head speed, X-factor, and elbow motion of two individuals with transradial amputations using an Eagle Golf terminal device were compared to a non-amputee during a golf swing. Measurements were collected pre/post training with various stances and grips. Both prosthesis users preferred a right-handed stance initially; however, after training, one preferred a left-handed stance. The amputees had slower club head speeds and a lower X-factor compared to the non-amputee golfer, but increased their individual elbow motion on the prosthetic side after training. Amputees enjoyed using the device, and it may provide kinematic benefits indicated by the increase in elbow flexion on the prosthetic side. The transradial amputees were able to swing a golf club with sufficient repetition, form, and velocity to play golf recreationally. Increased elbow flexion on the prosthetic side suggests a potential benefit from using the Eagle Golf terminal device. Participating in recreational sports can increase amputees' health and quality of life. © The International Society for Prosthetics and Orthotics 2014.

  9. Arterial Stiffness in Lower Limb Amputees

    Directory of Open Access Journals (Sweden)

    Pedro Magalhães

    2011-01-01

    Full Text Available Background A high carotid-femoral pulse wave velocity (PWV has been related to increased cardiovascular morbidity and mortality, but has not been previously evaluated in amputees. The aim of this study was to compare PWV between amputees and nonamputees. Methods In this cross-sectional study, data were collected from 60 male lower limb amputees and 86 male age-matched nonamputees. PWV was measured noninvasively using a Complior ® device. All participants underwent laboratory investigations and anthropometry. The difference in PWV between amputee and nonamputees was estimated. Multivariate regression was used to adjust for differences between the groups as a result of potential confounders. Results PWV was higher in amputees than in nonamputees (10.8 ± 1.9 m/sec versus 9.9 ± 1.8 m/sec, P = 0.008, respectively. This difference remained even after adjusting for confounding factors. Conclusion A higher PWV was demonstrated in lower limb amputees. Routine assessment of PWV may contribute to cardiovascular risk stratification in amputees.

  10. Arterial Stiffness in Lower Limb Amputees

    Science.gov (United States)

    Magalhães, Pedro; Capingana, Daniel P.; Silva, Amílcar B.T.; Capunge, Inês R.; Gonçalves, Mauer A.A.

    2011-01-01

    Background: A high carotid-femoral pulse wave velocity (PWV) has been related to increased cardiovascular morbidity and mortality, but has not been previously evaluated in amputees. The aim of this study was to compare PWV between amputees and nonamputees. Methods: In this cross-sectional study, data were collected from 60 male lower limb amputees and 86 male age-matched nonamputees. PWV was measured noninvasively using a Complior® device. All participants underwent laboratory investigations and anthropometry. The difference in PWV between amputee and nonamputees was estimated. Multivariate regression was used to adjust for differences between the groups as a result of potential confounders. Results: PWV was higher in amputees than in nonamputees (10.8 ± 1.9 m/sec versus 9.9 ± 1.8 m/sec, P = 0.008, respectively). This difference remained even after adjusting for confounding factors. Conclusion: A higher PWV was demonstrated in lower limb amputees. Routine assessment of PWV may contribute to cardiovascular risk stratification in amputees. PMID:22084616

  11. Transtibial amputee joint motion has increased attractor divergence during walking compared to non-amputee gait

    OpenAIRE

    Wurdeman, Shane R.; Myers, Sara A.; Stergiou, Nicholas

    2012-01-01

    The amputation and subsequent prosthetic rehabilitation of a lower leg affects gait. Dynamical systems theory would predict the use of a prosthetic device should alter the functional attractor dynamics to which the system self-organizes. Therefore, the purpose of this study was to compare the largest Lyapunov exponent (a nonlinear tool for assessing attractor dynamics) for amputee gait compared to healthy non-amputee individuals. Fourteen unilateral, transtibial amputees and fourteen healthy,...

  12. Sprint Start Kinetics of Amputee and Non-Amputee Sprinters.

    Directory of Open Access Journals (Sweden)

    Steffen Willwacher

    Full Text Available The purpose of this study was to explore the relationship between the forces applied to the starting blocks and the start performances (SPs of amputee sprinters (ASs and non-amputee sprinters (NASs. SPs of 154 male and female NASs (100-m personal records [PRs], 9.58-14.00 s and 7 male ASs (3 unilateral above knee, 3 unilateral below knee, 1 bilateral below knee; 100 m PRs, 11.70-12.70 s with running specific prostheses (RSPs were analysed during full-effort sprint starts using instrumented starting blocks that measured the applied forces in 3D. Using the NAS dataset and a combination of factor analysis and multiple regression techniques, we explored the relationship between force characteristics and SP (quantified by normalized average horizontal block power. Start kinetics were subsequently compared between ASs and NASs who were matched based on their absolute 100 m PR and their 100 m PR relative to the world record in their starting class. In NASs, 86% of the variance in SP was shared with five latent factors on which measured parameters related to force application to the rear and front blocks and the respective push-off directions in the sagittal plane of motion were loaded. Mediolateral force application had little influence on SP. The SP of ASs was significantly reduced compared to that of NASs matched on the basis of relative 100-m PR (-33.8%; d = 2.11, p < 0.001, while a non-significant performance reduction was observed when absolute 100-m PRs were used (-17.7%; d = 0.79, p = 0.09. These results are at least partially explained by the fact that force application to the rear block was clearly impaired in the affected legs of ASs.

  13. Sprint Start Kinetics of Amputee and Non-Amputee Sprinters.

    Science.gov (United States)

    Willwacher, Steffen; Herrmann, Volker; Heinrich, Kai; Funken, Johannes; Strutzenberger, Gerda; Goldmann, Jan-Peter; Braunstein, Björn; Brazil, Adam; Irwin, Gareth; Potthast, Wolfgang; Brüggemann, Gert-Peter

    2016-01-01

    The purpose of this study was to explore the relationship between the forces applied to the starting blocks and the start performances (SPs) of amputee sprinters (ASs) and non-amputee sprinters (NASs). SPs of 154 male and female NASs (100-m personal records [PRs], 9.58-14.00 s) and 7 male ASs (3 unilateral above knee, 3 unilateral below knee, 1 bilateral below knee; 100 m PRs, 11.70-12.70 s) with running specific prostheses (RSPs) were analysed during full-effort sprint starts using instrumented starting blocks that measured the applied forces in 3D. Using the NAS dataset and a combination of factor analysis and multiple regression techniques, we explored the relationship between force characteristics and SP (quantified by normalized average horizontal block power). Start kinetics were subsequently compared between ASs and NASs who were matched based on their absolute 100 m PR and their 100 m PR relative to the world record in their starting class. In NASs, 86% of the variance in SP was shared with five latent factors on which measured parameters related to force application to the rear and front blocks and the respective push-off directions in the sagittal plane of motion were loaded. Mediolateral force application had little influence on SP. The SP of ASs was significantly reduced compared to that of NASs matched on the basis of relative 100-m PR (-33.8%; d = 2.11, p < 0.001), while a non-significant performance reduction was observed when absolute 100-m PRs were used (-17.7%; d = 0.79, p = 0.09). These results are at least partially explained by the fact that force application to the rear block was clearly impaired in the affected legs of ASs.

  14. Assessment of Self-Esteem and Satisfaction in Amputee Children

    Science.gov (United States)

    Spencer, C. D.; And Others

    1977-01-01

    The study involving six single and multiple amputee children (10 to 14 years old) was conducted to provide information on how situations affect the self esteem of amputee children, how situations affect satisfaction with their prostheses, and the relationship between amputee self esteem and their satisfaction with their prosthetic device.…

  15. Lower limb prosthesis utilisation by elderly amputees.

    Science.gov (United States)

    Bilodeau, S; Hébert, R; Desrosiers, J

    2000-08-01

    The goal of prosthetic rehabilitation is to compensate for the loss of a limb by amputation by, in the case of a lower limb, encouraging walking, and to achieve the same level of autonomy as prior to the amputation. However, because of difficulties walking, elderly amputees may use their prosthesis to a greater or lesser degree or simply stop using it during the rehabilitation period. The objective of this research was to study factors such as physical and mental health, rehabilitation, physical independence and satisfaction with the prosthesis to understand why amputees use their prosthesis or not. The sample was composed of 65 unilateral vascular amputees 60 years old or over living at home. The information was collected from medical records, by telephone interview and by mail questionnaire. Prosthesis use was measured by a questionnaire on amputee activities developed by Day (1981). Eighty-one per cent (81%) of the subjects wore their prosthesis every day and 89% of this group wore it 6 hours or more per day. Less use of the prosthesis was significantly related to age, female gender, possession of a wheelchair, level of physical disability, cognitive impairment, poorer self-perceived health and the amputee's dissatisfaction. A multiple regression analysis showed that satisfaction, not possessing a wheelchair and cognitive integrity explained 46% of the variance in prosthesis use.

  16. Transtibial amputee joint motion has increased attractor divergence during walking compared to non-amputee gait.

    Science.gov (United States)

    Wurdeman, Shane R; Myers, Sara A; Stergiou, Nicholas

    2013-04-01

    The amputation and subsequent prosthetic rehabilitation of a lower leg affects gait. Dynamical systems theory would predict the use of a prosthetic device should alter the functional attractor dynamics to which the system self-organizes. Therefore, the purpose of this study was to compare the largest Lyapunov exponent (a nonlinear tool for assessing attractor dynamics) for amputee gait compared to healthy non-amputee individuals. Fourteen unilateral, transtibial amputees and fourteen healthy, non-amputee individuals ambulated on a treadmill at preferred, self-selected walking speed. Our results showed that the sound hip (p = 0.013), sound knee (p = 0.05), and prosthetic ankle (p = 0.023) have significantly greater largest Lyapunov exponents than healthy non-amputees. Furthermore, the prosthetic ankle has a significantly greater (p = 0.0.17) largest Lyapunov exponent than the sound leg ankle. These findings indicate attractor states for amputee gait with increased divergence. The increased attractor divergence seems to coincide with decreased ability for motor control between the natural rhythms of the individual and those of the prosthetic device. Future work should consider the impact of different prostheses and rehabilitation on the attractor dynamics.

  17. Energy costs and performance of transfemoral amputees and non-amputees during walking and running: A pilot study.

    Science.gov (United States)

    Mengelkoch, Larry J; Kahle, Jason T; Highsmith, M Jason

    2017-10-01

    Limited information is available concerning the effects of prosthetic foot components on energy costs and ambulatory performance for transfemoral amputees. Compare energy costs (VO 2 ; gait economy) and ambulatory performance (self-selected walking speeds, self-selected running speeds, peak running speeds) differences during walking and running for transfemoral amputees and matched, non-amputee runners. Repeated measures. Transfemoral amputees were accommodated and tested with three prosthetic feet: conventional foot, solid-ankle cushioned heel (SACH); energy storing and return foot, Renegade; and running-specific energy storing and return foot, Nitro. During walking, VO 2 was similar between transfemoral amputees but was increased compared to controls. Self-selected walking speeds were slower for SACH compared to Renegade and Nitro. For transfemoral amputees, gait economy was decreased and self-selected walking speeds were slower compared to controls. During fixed running speeds, transfemoral amputees ran using Nitro, and VO 2 was greater compared to controls. Transfemoral amputees ran at self-selected running speeds using Renegade and Nitro. Self-selected running speeds were slower for Renegade compared to Nitro. For transfemoral amputees, gait economy was decreased and self-selected running speeds were slower compared to controls. VO 2 peak was similar between transfemoral amputees and controls, but controls achieved greater peak running speeds and % grade. Energy costs were greater and ambulatory performance was lower for transfemoral amputees compared to matched, non-amputee controls for all prosthetic foot conditions. Clinical relevance Both types of energy storing and return feet may improve walking performance for transfemoral amputees by providing faster self-selected walking speeds. For transfemoral amputees interested in performing vigorous running (exercise and running competition), clinicians should recommend a running-specific energy storing and

  18. Computer-Aided Socket Design For Amputees

    Science.gov (United States)

    Novicov, Aleksey; Foort, James

    1983-07-01

    The fitting of sockets and artificial legs to amputees' stumps is a difficult and lengthy process that can take numerous trials. It has been proposed that most amputees can be fitted with a standard socket shape with minimal changes to the socket. To perform this task, a procedure is being developed at the Medical Engineering Resource Unit for computer aided socket design for amputees. An interactive PASCAL program, operating on a microcomputer, will prompt the operator (or prosthetist) by asking him to determine the condition of the stump. While the operator is inputing this information into the computer, together with a few critical anatomical measurements, a standard socket shape, viewed on the video monitor, will begin to change. Throughout the "shape fitting" procedure, the operator will have the ability to modify the socket shape on the screen with the use of a light pen. It will also be possible to view various cross-sections and different perspectives. The shape fitting procedure continues until a suitable socket shape is designed. Future efforts will focus on transferring the computer designed socket into a physical socket. The overall goal is to provide amputees with a better fit in less time and to objectify socket fitting so that new prosthetists may be easily taught.

  19. Amputee football in practice and research

    Directory of Open Access Journals (Sweden)

    Kasińska Zofia

    2016-12-01

    Full Text Available Introduction: Sport for people with disabilities has interested scientists for a long time. However, there is a scarcity of research on the subject of amputee football – football adapted to individuals after amputations. The aim of the study was to describe this sport and to review research carried out in this field so far.

  20. Social integration of juvenile amputees: comparison with a general population.

    Science.gov (United States)

    Fernández, A; Revilla, C; Su, I-Ting; García, M

    2003-04-01

    The objective was to assess the social integration of juvenile amputees according to marital status, schooling and occupation, and to compare it with the population of Asturias, Spain. A retrospective study was carried out of the juvenile amputees registered from 1976 to 1999 at the Prosthetics Unit of the Asturias Central Hospital (n=281 amputees). The proportion of single women amongst the amputees was greater than in the population of Asturias (punemployed (pjuvenile amputees do not show differences compared to the general population with regard to their attendance at a higher or university level of education. However, if their social integration is considered through occupation, male amputees show a greater proportion of unemployment, which is a clear reflection of their handicap.

  1. Muscle Synergy Analysis in Transtibial Amputee during Ramp Ascending Activity

    OpenAIRE

    Mehryar, P; Shourijeh, MS; Maqbool, HF; Torabi, M; Dehghani-Sanij, AA

    2016-01-01

    In developed countries, the highest number of amputees are elderly with transtibial amputation. Walking on inclined surfaces is difficult for amputees due to loss of muscle volume and strength thereby transtibial amputees (TA) rely on the intact limb to maintain stability. The aim of this study was to use the concatenated non-negative matrix factorization (CNMF) technique to calculate muscle synergy components and compare the difference in muscle synergies and their associated activation prof...

  2. Amputee care education in physical medicine and rehabilitation residency programs.

    Science.gov (United States)

    Elias, Joseph Abraham; Morgenroth, David Crespi

    2013-02-01

    The aim of this study was to assess amputee care-related educational offerings and barriers to further educational opportunities in United States physical medicine and rehabilitation residency programs. A two-part survey was distributed to all United States physical medicine and rehabilitation residency program directors. Part 1 assessed the use of educational tools in amputee education. Part 2 assessed the potential barriers to amputee care-related education. Sixty-nine percent of the program directors responded. Seventy-five percent or more of the programs that responded have didactic lectures; grand rounds; reading lists; self-assessment exam review; gait analysis training; training with prosthetists; faculty with amputee expertise; and amputee care during inpatient, outpatient, and consult rotations. Less than 25% of the programs use intranet resources. No more than 14% of the programs said any one factor was a major barrier. However, some of the most prominent major barriers were limited faculty number, finances, and patient volume. The factors many of the programs considered somewhat of a barrier included lack of national standardized resources for curriculum, resident time, and faculty time. This study identified the most commonly used amputee educational opportunities and methods in physical medicine and rehabilitation residencies as well as the barriers to furthering resident amputee education. Developing Web-based resources on amputee care and increasing awareness of physiatrists as perioperative consultants could improve resident amputee education and have important implications toward optimizing care of individuals with amputation.

  3. Differences in whole-body angular momentum between below-knee amputees and non-amputees across walking speeds.

    Science.gov (United States)

    Silverman, A K; Neptune, R R

    2011-02-03

    Unilateral, below-knee amputees have an increased risk of falling compared to non-amputees. The regulation of whole-body angular momentum is important for preventing falls, but little is known about how amputees regulate angular momentum during walking. This study analyzed three-dimensional, whole-body angular momentum at four walking speeds in 12 amputees and 10 non-amputees. The range of angular momentum in all planes significantly decreased with increasing walking speed for both groups. However, the range of frontal-plane angular momentum was greater in amputees compared to non-amputees at the first three walking speeds. This range was correlated with a reduced second vertical ground reaction force peak in both the intact and residual legs. In the sagittal plane, the amputee range of angular momentum in the first half of the residual leg gait cycle was significantly larger than in the non-amputees at the three highest speeds. In the second half of the gait cycle, the range of sagittal-plane angular momentum was significantly smaller in amputees compared to the non-amputees at all speeds. Correlation analyses suggested that the greater range of angular momentum in the first half of the amputee gait cycle is associated with reduced residual leg braking and that the smaller range of angular momentum in the second half of the gait cycle is associated with reduced residual leg propulsion. Thus, reducing residual leg braking appears to be a compensatory mechanism to help regulate sagittal-plane angular momentum over the gait cycle, but may lead to an increased risk of falling. Copyright © 2010 Elsevier Ltd. All rights reserved.

  4. Management of the multiple limb amputee.

    Science.gov (United States)

    Davidson, J H; Jones, L E; Cornet, J; Cittarelli, T

    2002-09-10

    Multiple limb amputations involving at least one upper extremity are very uncommon. The amputation of both an upper and lower limb is even more uncommon. Due to the rarity of these amputations therapists are uncertain regarding the most appropriate treatment methods. While the majority of the protocols used for single limb amputations are appropriate for these multiple limb amputees, there are differences. Loss of multiple limbs creates a problem of overheating for the individual. Loss of an arm and leg results in difficulty donning the prostheses and difficulty using crutches and parallel bars during mobilization. A review is given of 16 multiple limb amputees seen in our rehabilitation centre in the last 15 years. Return to work was seen in one third and was not related to the number of the amputations. A higher proportion of these multiple limb amputations occur through alcoholism or attempted suicide behaviour than occurs with either single upper limb amputations or lower limb amputations. This existing behaviour can create a management problem for the rehabilitation team during rehabilitation. Guidelines as to appropriate prosthetic and preprosthetic care are provided to assist the practitioner who has the acute and long term care of these patients. All multiple limb amputees should be referred to a specialized rehabilitation centre to discuss prosthetic options and long term rehabilitation requirements. This paper does not discuss bilateral lower limb amputations when not combined with an upper limb amputation.

  5. FUNCTIONAL OUTCOME OF REHABILITATED BILATERAL LOWER-LIMB AMPUTEES

    NARCIS (Netherlands)

    DEFRETES, A; BOONSTRA, AM; VOS, LDW

    The functional outcome of rehabilitated bilateral lower limb amputees was studied. The study included 31 amputees who were admitted during 1980-1990 to a rehabilitation centre in the north of the Netherlands. The clinical notes made during the patients' admission were studied to obtain information

  6. Controlling propulsive forces in gait initiation in transfemoral amputees

    NARCIS (Netherlands)

    van Keeken, Helco G.; Vrieling, Aline H.; Hof, At L.; Halbertsma, Jan P. K.; Schoppen, Tanneke; Postema, Klaas; Otten, Bert

    During prosthetic gait initiation, transfemoral (TF) amputees control the spatial and temporal parameters that modulate the propulsive forces, the positions of the center of pressure (CoP), and the center of mass (CoM). Whether their sound leg or the prosthetic leg is leading, the TF amputees reach

  7. Muscle synergy analysis in transtibial amputee during ramp ascending activity.

    Science.gov (United States)

    Mehryar, P; Shourijeh, M S; Maqbool, H F; Torabi, M; Dehghani-Sanij, A A

    2016-08-01

    In developed countries, the highest number of amputees are elderly with transtibial amputation. Walking on inclined surfaces is difficult for amputees due to loss of muscle volume and strength thereby transtibial amputees (TA) rely on the intact limb to maintain stability. The aim of this study was to use the concatenated non-negative matrix factorization (CNMF) technique to calculate muscle synergy components and compare the difference in muscle synergies and their associated activation profiles in the healthy and amputee groups during ramp ascending (RA) activity. Healthy subjects' dominant leg and amputee's intact leg (IL) were considered for recording surface electromyography (sEMG). The muscle synergies comparison showed a reasonable correlation between the healthy and amputee groups. This suggests the central nervous system (CNS) activates the same group of muscles synergistically. However, the activation coefficient profile (C) results indicated statistically significant difference (p amputee groups. The difference exhibited in activation profiles of amputee's IL could be due to the instability of the prosthetic leg during the GC which resulted in alteration of the IL muscles activations. This information will be useful in rehabilitation and in the future development of prosthetic devices by using the IL muscles information to control the prostheses.

  8. Clinical rehabilitation of the amputee : A retrospective study

    NARCIS (Netherlands)

    Rommers, GM; Vos, LDW; Groothoff, JW; Eisma, WH

    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

  9. Uphill and downhill walking in unilateral lower limb amputees

    NARCIS (Netherlands)

    Vrieling, A. H.; van Keeken, H. G.; Schoppen, T.; Otten, E.; Halbertsma, J. P. K.; Hof, A. L.; Postema, K.

    Objective: To study adjustment strategies in unilateral amputees in uphill and downhill walking. Design: observational cohort study. Subjects: Seven transfemoral, 12 transtibial unilateral amputees and 10 able-bodied subjects. Methods: In a motion analysis laboratory the subjects walked over a level

  10. Factors affecting stair-ascent patterns in unilateral transfemoral amputees.

    Science.gov (United States)

    Hobara, Hiroaki; Kobayashi, Yoshiyuki; Tominaga, Shuichi; Nakamura, Takashi; Yamasaki, Nobuya; Ogata, Toru

    2013-06-01

    Patterns and ease of stair ambulation influence amputees' level of satisfaction with their rehabilitation, confidence level, and motivation for continued rehabilitation, demonstrating the importance of stair-ascent data for rehabilitation. However, little is known about the determinants of stair-ascent patterns in unilateral transfemoral amputees. To investigate the factors affecting stair-ascent patterns in transfemoral amputees. Cross-sectional survey. Stair-ascent patterns were evaluated using the Stair Assessment Index. We collected Stair Assessment Index data as well as demographic and clinical data (sex, age, height, mass, amputation side, reason for amputation, time since amputation, and residual limb length) from 25 transfemoral amputees. Statistical analyses revealed that age was negatively correlated and time since amputation was positively correlated with Stair Assessment Index. In contrast, height, body mass, and residual limb lengths were not correlated with Stair Assessment Index. The results of this study suggest that in unilateral transfemoral amputee, (1) both age and time since amputation could affect stair-climbing patterns and (2) residual limb length should not be a limiting factor for stair climbing if the transfemoral amputee has a certain minimum residual limb length. Rehabilitation teams should carefully consider nonmodifiable predisposing factors such as age and time since amputation. However, they may be able to carry on stair-ascent rehabilitation for transfemoral amputees disregarding residual limb length (depending on the length).

  11. Evaluation of rehabilitated bilateral lower limb amputees - an Indian study.

    Science.gov (United States)

    Paul, Rajesh; Masilamani, Suhas; Dwyer, Amitabh J

    2012-01-01

    This study assessed activities of daily living (ADL) and ambulation of rehabilitated bilateral lower limb amputees with relation to their level of amputation in an Indian setting. This retrospective study of 25 subjects comprised 12 bilateral Trans-femoral (TF) amputees, 8 bilateral Trans-tibial (TT) amputees and 5 a combination of ipsilateral Trans-femoral and contralateral Trans-tibial amputation. All subjects were contacted by post/telephone, were physically examined and assessed at the Orthopaedic clinic at a mean follow-up of 6.6 years. Physical rehabilitation was evaluated using ADL score and by grading the level of ambulation. ADL scores showed no significant difference according to level of amputation (p > 0.05), but the scores of prosthetic users were significantly higher than non-prosthetic users (p = 0.002). Only 11/25 amputees became prosthetic ambulators and most (50%, 6/12) were TF amputees. All prosthetically rehabilitated subjects were mobilising with their prostheses at follow-up and graded as unlimited or limited community ambulators. Though it is well documented that the potential for successful rehabilitation is best for bilateral TT amputees, given the subjects' economic constraints, higher prosthesis rehabilitation among bilateral TF amputees indicates that successful rehabilitation is possible in most subjects irrespective of the level of amputation.

  12. Prosthetic rehabilitation of the upper limb amputee

    Directory of Open Access Journals (Sweden)

    Bernard O′Keeffe

    2011-01-01

    Full Text Available The loss of all or part of the arm is a catastrophic event for a patient and a significant challenge to rehabilitation professionals and prosthetic engineers. The large, upper extremity amputee population in India has, historically, been poorly served, with most having no access to support or being provided with ineffective prostheses. In recent years, the arrival of organisations like Otto Bock has made high quality service standards and devices accessible to more amputees. This review attempts to provide surgeons and other medical professionals with an overview of the multidisciplinary, multistage rehabilitation process and the solution options available. With worldwide upper extremity prosthesis rejection rates at significant levels, the review also describes some of the factors which influence the outcome. This is particularly relevant in the Indian context where the service can involve high cost investments. It is the responsibility of all contributing professionals to guide vulnerable patients through the process and try to maximise the benefit that can be obtained within the resources available.

  13. Neural activation differences in amputees during imitation of intact versus amputee movements.

    Science.gov (United States)

    Cusack, William F; Cope, Michael; Nathanson, Sheryl; Pirouz, Nikta; Kistenberg, Robert; Wheaton, Lewis A

    2012-01-01

    The mirror neuron system (MNS) has been attributed with increased activation in motor-related cortical areas upon viewing of another's actions. Recent work suggests that limb movements that are similar and dissimilar in appearance to that of the viewer equivalently activate the MNS. It is unclear if this result can be observed in the action encoding areas in amputees who use prosthetic devices. Intact subjects and upper extremity amputee prosthesis users were recruited to view video demonstrations of tools being used by an intact actor and a prosthetic device user. All subjects pantomimed the movements seen in the video while recording electroencephalography (EEG). Intact subjects showed equivalent left parietofrontal activity during imitation planning after watching the intact or prosthetic arm. Likewise, when prosthesis users imitated prosthesis demonstrations, typical left parietofrontal activation was observed. When prosthesis users imitated intact actors, an additional pattern was revealed which showed greater activity in right parietal and occipital regions that are associated with the mentalizing system. This change may be required for prosthesis users to plan imitation movements in which the limb states between the observed and the observer do not match. The finding that prosthesis users imitating other prosthesis users showed typical left parietofrontal activation suggests that these subjects engage normal planning related activity when they are able to imitate a limb matching their own. This result has significant implications on rehabilitation, as standard therapy involves training with an intact occupational therapist, which could necessitate atypical planning mechanisms in amputees when learning to use their prosthesis.

  14. Leg stiffness and sprint ability in amputee sprinters.

    Science.gov (United States)

    Hobara, Hiroaki; Tominaga, Shuichi; Umezawa, Shingo; Iwashita, Koudai; Okino, Atsuo; Saito, Taku; Usui, Fumio; Ogata, Toru

    2012-09-01

    Understanding leg stiffness (K (leg)) in amputee sprinters is important for the evaluation of their sprint ability and development of running-specific prostheses (RSP). To investigate K (leg) during hopping in amputee sprinters. Cross-sectional study. Seven transtibial (TT) and seven transfemoral (TF) amputee sprinters, as well as seven non-active able-bodied subjects, performed one-legged hopping matching metronome beats at 2.2 Hz. Amputees hopped on their sound limb whereas able-bodied (AB) subjects hopped on their dominant limb. Using a spring-mass model, K (leg) was calculated from the subjects' body mass, ground contact and flight times. Both TT and TF sprinters demonstrated significantly higher K (leg) than AB subjects. K (leg) during hopping on the sound leg significantly correlated with personal records attained in a 100-m sprint in both TT (r = -0.757) and TF sprinters (r = -0.855). The results of the present study suggest that amputee sprinters have a greater K (leg) during hopping than inactive non-amputees, and that their sprint ability can be predicted from the K (leg) during hopping at 2.2 Hz on the sound limb.

  15. A cross-sectional study of post-amputation pain in upper and lower limb amputees, experience of a tertiary referral amputee clinic.

    Science.gov (United States)

    Davidson, Judith H; Khor, Kok E; Jones, Lorraine E

    2010-01-01

    To determine the pain characteristics and health-related quality of life (HR-QOL) of upper and lower limb amputees. Amputees attending the Prince of Wales Prosthetic Clinics in 2006 were administered a questionnaire survey of their pain experiences, Short form McGill pain questionnaire, Short Form 36 (SF 36) and Pain Self-Efficacy Questionnaire (PSEQ). Of the 17 who were upper limb amputees (including the two multiple limb amputees), only 1 was pain free and of the 39 who were lower limb amputees 14 were pain free. Upper limb amputees experienced significantly greater proportion, frequency and severity of post-amputation pain than lower limb amputees. The presence of significant pre-operative pain did not correlate with the development of persistent post-amputation pain. In quality of life measures, the amputees experienced a better physical function, role physical and confidence in performance of activities than chronic pain patients attending the pain clinic. Lower limb amputees fared better than upper limb amputees in terms of bodily pain, social function and mental health. However, the amputee groups have a reduced health status in almost all domains compared to the aged matched Australian population norm. The study suggests that upper limb amputees are significantly more likely to suffer post-amputation pain which is more frequent, longer lasting and more severe in intensity when compared to lower limb amputees. This is accompanied by reduced HR-QOL especially that related to bodily pain, social function and mental health. The overall health status of amputees are also significantly lower compared to the Australian population norm.

  16. The utility of hand transplantation in hand amputee patients.

    Science.gov (United States)

    Alolabi, Noor; Chuback, Jennifer; Grad, Sharon; Thoma, Achilles

    2015-01-01

    To measure the desirable health outcome, termed utility, and the expected quality-adjusted life years (QALYs) gained with hand composite tissue allotransplantation (CTA) using hand amputee patients and the general public. Using the standard gamble (SG) and time trade-off (TTO) techniques, utilities were obtained from 30 general public participants and 12 amputee patients. The health utility and net QALYs gained or lost with transplantation were computed. A sensitivity analysis was conducted to account for the effects of lifelong immunosuppression on the life expectancy of transplant recipients. Higher scores represent greater utility. Hand amputation mean health utility as measured by the SG and TTO methods, respectively, was 0.72 and 0.80 for the general public and 0.69 and 0.70 for hand amputees. In comparison, hand CTA mean health utility was 0.74 and 0.82 for the general public and 0.83 and 0.86 for amputees. Hand CTA imparted an expected gain of 0.9 QALYs (SG and TTO) in the general public and 7.0 (TTO) and 7.8 (SG) QALYs in hand amputees. A loss of at least 1.7 QALYs was demonstrated when decreasing the life expectancy in the sensitivity analysis in the hand amputee group. Hand amputee patients did not show a preference toward hand CTA with its inherent risks. With this procedure being increasingly adopted worldwide, the benefits must be carefully weighed against the risks of lifelong immunosuppressive therapy. This study does not show clear benefit to advocate hand CTA. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  17. Neural activation differences in amputees during imitation of intact versus amputee movements

    Directory of Open Access Journals (Sweden)

    William F Cusack

    2012-06-01

    Full Text Available The mirror neuron system has been attributed with increased activation in motor-related cortical areas upon viewing of another’s actions. Recent work suggests that limb movements that are similar and dissimilar in appearance to that of the viewer equivalently activate the mirror neuron system. It is unclear if this result can be observed in the action encoding areas in amputees who use prosthetic devices. Intact subjects and upper extremity amputee prosthesis users were recruited to view video demonstrations of tools being used by an intact actor and a prosthetic device user. All subjects were asked to pantomime the movements seen in the video while recording electroencephalography. Intact subjects showed equivalent left parietofrontal activity during imitation after watching the intact or prosthetic arm. Likewise, when prosthesis users imitated prosthesis demonstrations, typical left parietofrontal activation was observed during planning. When prosthesis users imitated intact actors, a new pattern was revealed which showed greater bilateral parietal and occipital activity during movement planning (p<0.001. This change may be required for prosthesis users to imitate movements in which the limb states between the observed and the observer do not match. The finding that prosthesis users imitating other prosthesis users showed typical left parietofrontal activation suggests that these subjects engage normal planning related activity when they are able to imitate a limb matching their own. This result has significant implications on rehabilitation, as standard therapy involves training with an intact occupational therapist, which could necessitate atypical planning mechanisms in amputees when learning to use their prosthesis.

  18. COMPARISON OF GAIT USING A MULTIFLEX FOOT VERSUS A QUANTUM FOOT IN KNEE DISARTICULATION AMPUTEES

    NARCIS (Netherlands)

    BOONSTRA, AM; FIDLER, [No Value; SPITS, GMA; HOF, AL; Tuil, P.

    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

  19. Amputee Virtual Environment Support Space—A vision for virtual military amputee support

    OpenAIRE

    Ashley Fisher, MA; Doug Thompson

    2010-01-01

    The war in Iraq is the largest and longest sustained combat operation by the U.S. military since the Vietnam war. An estimated nearly 2 million U.S. military personnel have been deployed for Operation Iraqi Freedom and Operation Enduring Freedom [1]. Dr. Chuck Scoville, Col. Ret., Chief of Amputee Patient Care at Walter Reed Army Medical Center, stated that as of November 2009, 937 war fighters have suffered an amputation as a result of a battle injury. The successful recovery from a traumati...

  20. Hand Grip Strength Vs. Sprint Effectiveness in Amputee Soccer Players.

    Science.gov (United States)

    Wieczorek, Marta; Wiliński, Wojciech; Struzik, Artur; Rokita, Andrzej

    2015-11-22

    Amputee soccer is one of the types of soccer designed for the disabled, especially those who have undergone amputations, as well as those with extremity dysfunction. The objective of the study was to find the relationship between hand grip strength and sprint time in amputee soccer players. Thirteen field amputee soccer players participated in the study. A SAEHAN hydraulic hand dynamometer manufactured by Jamar was used for hand grip strength measurements. The sprint running test was conducted over a distance of 30 m. The Fusion Smart Speed System was employed for running time measurements. No statistically significant relationships were found between hand grip strength of the left or right hand, and sprint times over 1, 5, 10, 15, 20, 25 and 30 m. Analysis of the running velocity curve of the subjects showed an interesting profile characterized by a 15 meter-long acceleration phase and a significant velocity increase over a distance of 20 - 25 m. The study suggests that there is no relationship between hand grip strength and sprint effectiveness in amputee soccer players. The specificity of locomotion with the use of elbow crutches among elite Polish amputee soccer players probably accounts for the profile of the sprint velocity curve. Extension of the acceleration phase in the sprint run and a velocity increase in the subsequent part of the run were observed.

  1. Hand Grip Strength Vs. Sprint Effectiveness in Amputee Soccer Players

    Directory of Open Access Journals (Sweden)

    Wieczorek Marta

    2015-12-01

    Full Text Available Amputee soccer is one of the types of soccer designed for the disabled, especially those who have undergone amputations, as well as those with extremity dysfunction. The objective of the study was to find the relationship between hand grip strength and sprint time in amputee soccer players. Thirteen field amputee soccer players participated in the study. A SAEHAN hydraulic hand dynamometer manufactured by Jamar was used for hand grip strength measurements. The sprint running test was conducted over a distance of 30 m. The Fusion Smart Speed System was employed for running time measurements. No statistically significant relationships were found between hand grip strength of the left or right hand, and sprint times over 1, 5, 10, 15, 20, 25 and 30 m. Analysis of the running velocity curve of the subjects showed an interesting profile characterized by a 15 meter-long acceleration phase and a significant velocity increase over a distance of 20 – 25 m. The study suggests that there is no relationship between hand grip strength and sprint effectiveness in amputee soccer players. The specificity of locomotion with the use of elbow crutches among elite Polish amputee soccer players probably accounts for the profile of the sprint velocity curve. Extension of the acceleration phase in the sprint run and a velocity increase in the subsequent part of the run were observed.

  2. Factors Associated with Prosthetic Looseness in Lower Limb Amputees.

    Science.gov (United States)

    Phonghanyudh, Thong; Sutpasanon, Taweesak; Hathaiareerug, Chanasak; Devakula, M L Buddhibongsa; Kumnerddee, Wipoo

    2015-12-01

    To determine the factors associated with prosthetic looseness in lower limb amputees in Sisaket province. The present was a cross-sectional descriptive study. Subjects were lower limb amputees who previously obtained prostheses and required prosthetic replacements at the mobile prosthetic laboratory unit under the Prostheses Foundation of H.R.H. the Princess Mother at Khun Han Hospital, Sisaket province, in February 2013. Data including participant characteristics, prosthetic looseness data, and various variables were collected by direct semi-structured interview. Energy expenditures in physical activities were measured using the Thai version of the short format international physical activity questionnaire. Data between participants with and without prosthetic looseness were compared to determine prosthetic loosening associated factors. Among 101 participants enrolled, 33 (32.7%) had prosthetic looseness with average onset of 1.76 ± 1.67 years. Diabetes mellitus was the only significant factor associated with prosthetic looseness from both univariate and multivariate analyses (HR = 7.05, p = 0.002 and HR = 5.93, p = 0.007 respectively). Among the lower limb amputees in Sisaket province, diabetes mellitus was the only factor associated with prosthetic looseness. Therefore, diabetic screening should be supplemented in lower limb amputee assessment protocol. In addition, we recommend that amputees with diabetes mellitus should receive prosthesis check out at approximately

  3. Kinetic and kinematic compensations in amputee vertical jumping.

    Science.gov (United States)

    Schoeman, Marlene; Diss, Ceri E; Strike, Siobhan C

    2012-08-01

    A unilateral transtibial amputation causes a disruption to the musculoskeletal system, which results in asymmetrical biomechanics. The current study aimed to assess the movement asymmetry and compensations that occur as a consequence of an amputation when performing a countermovement vertical jump. Six unilateral transtibial amputees and 10 able-bodied (AB) participants completed 10 maximal vertical jumps, and the highest jump was analyzed further. Three-dimensional lower limb kinematics and normalized (body mass) kinetic variables were quantified for the intact and prosthetic sides. Symmetry was assessed through the symmetry index (SI) for each individual and statistically using the Mann-Whitney U test between the intact and prosthetic sides for the amputee group. A descriptive analysis between the amputee and AB participants was conducted to explore the mechanisms of amputee jumping. The amputee jump height ranged from 0.09 to 0.24 m. In the countermovement, all ankle variables were asymmetrical (SI > 10%) and statistically different (p amputees. At the knee and hip, there was no statistical difference between the intact and prosthetic sides range of motion, although there was evidence of individual asymmetry. The knees remained more extended compared with the AB participants to prevent collapse. In propulsion, the prosthesis did not contribute to the work done and the ankle variables were asymmetrical (p < .05). The knee and hip variables were not statistically different between the intact and prosthetic sides, although there was evidence of functional asymmetry and the contribution tended to be greater on the intact compared with the prosthetic side. The lack of kinetic involvement of the prosthetic ankle and both knees due to the limitation of the prosthesis and the altered musculoskeletal mechanics of the joints were the reason for the reduced height jumped.

  4. Prosthetic options available for the diabetic lower limb amputee.

    Science.gov (United States)

    Chitragari, Gautham; Mahler, David B; Sumpio, Brandon J; Blume, Peter A; Sumpio, Bauer E

    2014-01-01

    Although the rate of lower limb amputation in patients with diabetes is decreasing, amputation still remains a major complication of diabetes. Prosthetics have been long used to help amputees ambulate. The last decade has seen many advances in prostheses with the enhanced understanding of the mechanics of ambulation and improved use of technology. This review describes the different types of prosthetic options available for below knee, ankle, and foot amputees, emphasizing the latest advances in prosthetic design. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Over rough and smooth : Amputee gait on an irregular surface

    NARCIS (Netherlands)

    Curtze, Carolin; Hof, At L.; Postema, Klaas; Otten, Bert

    When negotiating irregular surfaces, the control of dynamic stability is challenged. In this study, we compared the adjustments in stepping behaviour and arm-swing of 18 unilateral transtibial amputees and 17 able-bodied participants when walking on flat and irregular surfaces. Experimental findings

  6. Reintegration of traumatic lower limb amputees into the society

    African Journals Online (AJOL)

    underwent successful physical rehabilitation. Vocational rehabilitation was less successful. However, factors ... All patients had a prosthesis and used it the whole day or most of the day. By their own assessment,. 13,2% felt ... eported that 96% of below knee amputees. :turned to the work force an average of 10. ~onths after ...

  7. Reintegration of traumatic lower limb amputees into the society ...

    African Journals Online (AJOL)

    Seventy eight percent (78%) of respondents were completely independent at work, 92.4% felt there was no constraint to their mobility and two thirds of patients were satisfied with their adjustment. Traumatic amputees underwent successful physical rehabilitation. Vocational rehabilitation was less successful. However ...

  8. Attitudes regarding lower extremity allotransplantation among lower extremity amputees.

    Science.gov (United States)

    Carty, Matthew J; Duclos, Antoine; Talbot, Simon G; Tullius, Stefan G; Pribaz, Julian J; Pomahac, Bohdan

    2014-12-01

    Lower limb allotransplantation is garnering increasing attention in the vascularized composite allotransplantation community as a potential treatment modality for those suffering from lower limb amputations. Little is known, however, about the level of interest among lower limb amputees regarding this procedure. An online survey regarding lower limb allotransplantation was designed in conjunction with and distributed by the Amputee Coalition to lower limb amputees in the United States. Responses from the survey were blinded, tabulated, and analyzed for significance using chi-square or Fisher's exact test. A total of 770 respondents completed the online survey. Forty-three percent of respondents stated they would be interested in being evaluated for lower limb transplantation, 36 percent declined, and 21 percent were uncertain. Those respondents who expressed an interest in allotransplantation tended to be significantly younger, better educated, more recently amputated, and less satisfied with prosthetic outcomes than those who were not interested. The most important criterion for transplantation to be considered a success by respondents was restoration of meaningful knee/ankle joint function, followed by restoration of limb sensibility. If immunosuppression were not required, 32 percent of those who initially declined and 88 percent of those who were uncertain would choose to undergo evaluation for lower limb allotransplantation. A significant proportion of lower limb amputees would be interested in undergoing evaluation for lower limb allotransplantation.

  9. Preserved grip selection planning in chronic unilateral upper extremity amputees

    Science.gov (United States)

    Frey, Scott H.

    2016-01-01

    Upper limb amputees receive no proprioceptive or visual sensory feedback about their absent hand. In this study, we asked whether chronic amputees nevertheless retain the ability to accurately plan gripping movements. Fourteen patients and matched controls performed two grip selection tasks: overt grip selection (OGS), in which they used their intact hand to grasp an object that appeared in different orientations using the most natural (under- or overhand) precision grip, and prospective grip selection (PGS), in which they selected the most natural grip for either hand without moving. We evaluated planning accuracy by comparing concordance between grip preferences expressed in PGS vs. OGS for the intact hand and PGS vs. the inverse of OGS responses for the affected hand. Overall, amputees showed no deficits in the accuracy of grip selection planning based on either hand and a consistent preference for less awkward hand postures. We found no evidence for a speed-accuracy tradeoff. Furthermore, selection accuracy did not depend on phantom mobility, phantom limb pain, time since amputation, or the residual limb’s shoulder posture. Our findings demonstrate that unilateral upper limb amputees retain the ability to plan movements based on the biomechanics of their affected hand even many years after limb loss. This unimpaired representation may stem from persistent higher-level activity-independent internal representations or may be sustained by sensory feedback from the intact hand. PMID:21863261

  10. Skin problems in lower limb amputees : A systematic review

    NARCIS (Netherlands)

    Meulenbelt, HEJ; Dijkstra, PU; Jonkman, MF; Geertzen, JHB

    Purpose. Skin problems of the stump in lower limb amputees are relative common in daily rehabilitation practice, possibly impeding prosthetic use. This impediment may have great impact in daily life. Our objective was to review literature systematically concerning incidence and prevalence of skin

  11. Strength, Pain, Function in OIF/OEF Amputees: A Nurse-Managed Program

    Science.gov (United States)

    2014-03-25

    Rehabilitation Program (n=23) or standard Amputee Protocol (n=22). Analysis: Linear mixed models compared the outcomes of both groups after 3, 6, 9 and 12... Amputee rehabilitation protocol. The aims were to compare the two groups on: knee muscle strength; functional performance (mobility), QOL; and...NMES Rehabilitation Program (n=23) or standard Amputee Protocol (n=22). Analysis: Linear mixed models compared the outcomes of both groups after

  12. Energy expenditure of transfemoral amputees during floor and treadmill walking with different speeds.

    Science.gov (United States)

    Starholm, Inger Marie; Mirtaheri, Peyman; Kapetanovic, Nihad; Versto, Tarjei; Skyttemyr, Gjermund; Westby, Fredrik Tobias; Gjovaag, Terje

    2016-06-01

    Walking energy expenditure, calculated as the percent utilization of the maximal aerobic capacity, is little investigated in transfemoral amputees. Compare the energy expenditure of healthy participants (control participants) and transfemoral amputees walking with their respective preferred walking speeds on the treadmill (TPWS) and floor (FPWS). Randomized cross-over study. Oxygen uptake (VO2) was measured when walking with the FPWS and TPWS. VO2max was measured by an incremental treadmill test. Mean ± standard deviation VO2max of the transfemoral amputees and control participants were 30.6 ± 8.7 and 49.0 ± 14.4 mL kg(-1) min(-1), respectively (p amputees and control participants was 0.89 ± 0.2 and 1.33 ± 0.3 m s(-1), respectively (p amputees and control participants was 1.22 ± 0.2 and 1.52 ± 0.1 m s(-1), respectively (p amputees and control participants was 54% and 31% of VO2max, respectively (p amputees and control participants was 42% and 29% of the VO2max, respectively (p amputees than the control participants, regardless of walking surface. There are minimal differences in energy expenditure between treadmill and floor walking for the control participants but large differences for the transfemoral amputees. During walking, the transfemoral amputees expend a larger percentage of their maximal aerobic capacity than healthy participants. With a low VO2max, ordinary activities, such as walking, become physically more challenging for the transfemoral amputees than the control participants, and this may, in turn, have a negative effect on the walking range of the transfemoral amputees. © The International Society for Prosthetics and Orthotics 2015.

  13. Lower-limb amputee recovery response to an imposed error in mediolateral foot placement.

    Science.gov (United States)

    Segal, Ava D; Klute, Glenn K

    2014-09-22

    Despite walking with a wider step width, amputees remain 20% more likely to fall than non-amputees. Since mediolateral (ML) balance is critical for ambulation and contingent on ML foot placement, we used a ML disturbance to perturb walking balance and explore the influence of prosthetic foot stiffness on balance recovery. Ten transtibial amputees were fit with two commonly prescribed prosthetic feet with differing stiffness characteristics; 12 non-amputees also participated. A perturbation device that released an air burst just before heel strike imposed a repeatable medial or lateral disturbance in foot placement. After a medial disturbance, the first recovery step width was narrowed (pprosthetic limb (-103%), the sound limb (-51%) and non-amputees (-41%) and more than twice as variable. The ML inclination angle remained reduced (-109%) for the prosthetic limb, while the sound limb and non-amputees approached undisturbed levels (pprosthetic medial disturbance versus two steps for the sound limb and for non-amputees. After a lateral disturbance, the first recovery step was widened for the prosthetic limb (+82%), sound limb (+75%), and wider than non-amputees (+51%; pProsthetic feet with different stiffness properties did not have a significant effect. In conclusion, amputee balance was particularly challenged by medial disturbances to the prosthetic limb implying a need for improved interventions that address these balance deficits. Published by Elsevier Ltd.

  14. Evaluation Of Gait Symmetry In Amputees Who Use Below Knee Prosthesis With Dynamic Foot

    Directory of Open Access Journals (Sweden)

    Yasin Yurt

    2012-06-01

    Full Text Available Purpose: To assess inter limb symmetry while walking in unilateral transtibial amputees which use dynamic foot. Method: Gait velocity, cadence, step length, stance percentages and ambulation index results of amputees (n=20 were recorded. Comparison was made with control group. (n=21 Results: Gait velocity, cadence and ambulation index results were greater for control group. Cases had longer stance time on their intact limb than amputated side. Stance time difference between limbs were higher for amputee group than control group. Conclusion: Amputees had higher stance percentage on their intact limb than sound limb with regard to healthy people.

  15. The relationship between lumbar spine kinematics during gait and low-back pain in transfemoral amputees.

    Science.gov (United States)

    Morgenroth, David C; Orendurff, Michael S; Shakir, Ali; Segal, Ava; Shofer, Jane; Czerniecki, Joseph M

    2010-08-01

    Low-back pain is an important cause of secondary disability in transfemoral amputees. The primary aim of our study is to assess the differences in lumbar spine kinematics during gait between transfemoral amputees with and without low-back pain. Lumbar spine kinematics in three planes were measured when the subjects walked in a motion analysis laboratory. Nine transfemoral amputees with low-back pain, eight transfemoral amputees without low-back pain, and six healthy, nonamputee subjects participated. The Amputee Pain and Amputee No Pain groups were essentially the same in terms of all demographic and potentially confounding variable measures. Transfemoral amputees with low-back pain showed greater transverse plane rotational excursion in their lumbar spine during walking when compared with transfemoral amputees without low-back pain (P = 0.029; effect size = 1.03). There were no significant differences in sagittal or coronal plane lumbar spine excursions during walking between these two groups. Although our study design does not allow for proving causation, increased transverse plane rotation has been associated with intervertebral disc degeneration, suggesting that increased transverse plane rotation secondary to walking with a prosthetic limb may be a causative factor in the etiology of low-back pain in transfemoral amputees. Identifying differences in lumbar motion can lead to potential preventative and therapeutic intervention strategies.

  16. Managing the upper extremity amputee: a protocol for success.

    Science.gov (United States)

    Smurr, Lisa M; Gulick, Kristin; Yancosek, Kathleen; Ganz, Oren

    2008-01-01

    Since the beginning of Operation Enduring Freedom and Operation Iraqi Freedom, over 541 clients with major limb amputations have been seen in the Military Healthcare System. As a result of the nature and severity of injuries and the prevalence of concomitant injuries seen in this population, amputee care has become a specialized type of rehabilitative care at Walter Reed and Brooke Army Medical Centers. To streamline and accommodate the needs of clients with upper extremity limb loss, a five-phased upper extremity amputee protocol of care was developed. The five phases of the protocol include acute management; preprosthetic training; basic prosthetic training; advanced prosthetic training; and discharge planning. For the readers ease, these phases will be presented in the following categories: acute care, subacute care, and long-term rehabilitation needs. Furthermore, this article seeks to offer insight into the ideal treatment of an individual with upper extremity limb loss based on experience and collective expertise of the authoring therapists.

  17. Spirituality and quality of life in limb amputees.

    Science.gov (United States)

    Peirano, Amanda H; Franz, Randall W

    2012-03-01

    Limb amputation is a life-changing event that signifies long-term physical, social, psychological, and environmental change. Spiritual well-being in patients plays a significant role in coping and may affect outcomes of patients with limb loss. The objective of this study was to describe the role of spirituality in individuals with limb amputation and to determine whether spirituality is related to the quality of life (QOL) in this sample. Study participants were recruited through prosthetists, physicians, amputee support groups, the Amputee Coalition of America, and amputee listserv discussion groups in the United States and Canada. Participants completed questionnaires containing measures of satisfaction with life, general health, mobility, and social integration. A quantitative descriptive research design was used to examine the relationships between existential spirituality (belief that one's life is meaningful or has purpose) and religious spirituality and QOL among individuals with limb amputation. A prospective study of 108 patients with a history of limb amputation was performed. The study population consisted of 66.3% males and 33.7% females. Most patients were Caucasian (96.2%). Of the 108 participants, 86 (79.6%) were 41 years of age or older with a mean of 18 years since amputation. The most frequent cause of amputation was trauma (55.6%) and the most common location of amputation was below-the-knee (49.1%). Existential spirituality, female gender, and age above 50 years related to higher QOL in patients with a history of limb amputation. The findings of this research confirmed that amputees use spirituality to cope with limb amputation. Existential spirituality was a significant predictor of satisfaction with life, general health, and social integration.

  18. Biomechanical parameters of gait among transtibial amputees: a review

    Directory of Open Access Journals (Sweden)

    Alex Sandra Oliveira de Cerqueira Soares

    Full Text Available Rehabilitation for lower-limb amputees needs to focus on restoration of daily functions and independent locomotion. As gait is reestablished, reorganization of the motor pattern takes place in order to optimize the functions of the locomotor system. Biomechanics is a field of study that enables understanding of this reorganization. From such knowledge, appropriate strategies for recovering the autonomy of the means of locomotion can be established. Thus, this paper had the aim of reviewing the current status of the biomechanics of locomotion among unilateral transtibial amputees. To achieve this aim, papers written in English or Portuguese and published up to 2005 were selected from the Cochrane Library, PubMed, Scientific Electronic Library Online (SciELO, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs and Dedalus databases. In cases of transtibial amputation, the absence of plantar flexors negatively affects locomotion. Increased absorption and energy generation by the muscles that control the hip joint of the amputated leg can be considered to be the main compensatory strategy developed by unilateral transtibial amputees during gait. Factors associated with the characteristics of the amputation, prosthesis and experimental protocol used directly influence the results.

  19. Rehabilitation outcome of post-acute lower limb geriatric amputees.

    Science.gov (United States)

    Hershkovitz, Avital; Dudkiewicz, Israel; Brill, Shai

    2013-02-01

    To characterize the lower-limb elderly amputee patients admitted to a post-acute rehabilitation program, assess their 1-year survival rate, estimate rate of prosthetic fit and report rate and factors associated with 1-year post-discharge prosthetic use. A cohort study performed in a post-acute rehabilitation department. Patients were evaluated by the Functional Independence Measure (FIM), motor FIM (mFIM), rate of prosthesis fit, length of stay (LOS), 1-year survival rate and long-term prosthetic use. One-hundred and seventeen lower limb elderly amputee patients consecutively admitted from January 2004 to June 2010 were enrolled in the study. Mean age was 74.7 ± 8.1; 56 patients (47.9%) had transtibial amputation (TTA); 46 (39.3%) transfemoral amputation (TFA) and 15 (12.8%) bilateral amputation. The main cause for amputation was diabetic foot (60.7%). Fifty-four (46.2%) patients died during first year post-admission. Twenty-seven patients (23.1%) were fitted with a prosthesis. When the bilateral amputees were considered separately, the rate of prosthetic fit among unilateral amputees was 24.5% (25/102) whereas among bilateral amputees it was 20% (3/15). Patients with prosthesis rehabilitation had a higher rate of TTA (p = 0.027), better metabolic status (p rehabilitation. Twenty patients were contacted 1 year later: eight (40.0%) reported continuous functional prosthesis use, eight - partial prosthesis use and four (20%) did not use the prosthesis at all. The patient group with 1-year post-discharge prosthesis use had a significantly higher rate of TTA (p = 0.032), lower rate of congestive heart failure (CHF) (p = 0.014) and higher score changes on the FIM and mFIM (p = 0.043). Rehabilitation efforts should best be targeted depending on need. Rehabilitation professionals should make an educated estimate of outcomes at the beginning of rehabilitation based on the characteristics of the patients (level of amputation and functional level on admission).

  20. Wearable Vibrotactile Biofeedback Device Allowing Identification of Different Floor Conditions for Lower-Limb Amputees.

    Science.gov (United States)

    Wan, Anson H; Wong, Duo W; Ma, Christina Z; Zhang, Ming; Lee, Winson C

    2016-07-01

    To evaluate a newly developed biofeedback device enabling lower-limb amputees to identify various floor conditions. Self-control with repeated measures (with and without the biofeedback device) within the amputee group, and group control comparing between amputee and nonamputee groups. University locomotion laboratory. Five lower-limb amputees and 8 nonamputees (N=13). A wearable biofeedback device, which identified different floor conditions by analyzing the force patterns under the prosthetic feet and provided vibration cues in response to different floor conditions, was provided to the amputees. The subjects stepped on a foam platform concealing a small object or no object at 1 of the 4 locations of the foot sole. Subjects were asked whether there was a small object under their feet and the location of the object if it existed. The test was repeated with 4 different object types and 4 object locations. The success rate of floor identification was evaluated. Without the biofeedback device, nonamputee subjects (76.56%) identified floor conditions better than amputees (22.5%) significantly (Pdevice, the amputees significantly improved (Pdevice, amputees significantly improved their abilities in identifying different floor conditions. Future attempts could configure the device to allow it to provide warning signals in response to fall-inducing conditions. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. Determinants of Skin Problems of the Stump in Lower-Limb Amputees

    NARCIS (Netherlands)

    Meulenbelt, Henk E.; Geertzen, Jan H.; Jonkman, Marcel F.; Dijkstra, Pieter U.

    Objective: To identify determinants of skin problems in lower-limb amputees. Design: Survey, using a questionnaire. Setting: Not applicable. Participants: Lower-limb amputees (N=2039) who either obtained their prosthesis through the Orthopedische Instrument Makerij (a group of orthopedic workshops

  2. Participation in sports by lower limb amputees in the Province of Drenthe, The Netherlands

    NARCIS (Netherlands)

    Kars, Cojanne; Geertzen, Jan H. B.; Pepping, Gert-Jan; Dekker, Rienk; Hofman, M.

    2009-01-01

    The numbers of lower limb amputees participating in recreational activity date back more than 25 years Previous studies have shown that 60% of lower limb amputees participated in recreational activities, including sports To date, research in The Netherlands into sports participation of this specific

  3. Detection of the onset of gait initiation using kinematic sensors and EMG in transfemoral amputees

    NARCIS (Netherlands)

    Wentink, E.C.; Schut, V.G.H.; Prinsen, E.C.; Prinsen, Erik Christiaan; Rietman, Johan Swanik; Veltink, Petrus H.

    In this study we determined if detection of the onset of gait initiation in transfemoral amputees can be useful for voluntary control of upper leg prostheses. From six transfemoral amputees inertial sensor data and EMG were measured at the prosthetic leg during gait initiation. First, initial

  4. Quality of life and functionality after lower limb amputations: comparison between uni- vs. bilateral amputee patients.

    Science.gov (United States)

    Akarsu, Selim; Tekin, Levent; Safaz, Ismail; Göktepe, Ahmet Salim; Yazicioğlu, Kamil

    2013-02-01

    It is difficult for the lower limb amputee patients to adapt to their new lifestyles. To compare the life quality and functionality of patients with bilateral vs. unilateral lower extremity amputations. Cross-sectional study. Fifteen bilateral and 15 unilateral lower extremity amputee patients were enrolled. Demographics, cause and level of amputations, frequency and duration of prosthesis use were evaluated. SF-36, Satisfaction with Prosthesis Questionnaire (SAT-PRO), Amputee Body Image Scale. (ABIS), Houghton Scale (HS), six-minute walk test (6MWT), and 10-metre walk test (10 MWT) were performed. Physical function, physical and emotional role scores of SF-36 were significantly lower in the bilateral amputee group in comparison with the unilateral group. SAT-PRO and ABIS total scores were similar between the groups. There was a positive correlation between the frequency of prosthetic use and SF-36 subgroups (except pain). The unilateral amputee group had significantly better scores than the bilateral amputee group in terms of HS, 6MWT and 10 MWT. Physical capacity of bilateral lower extremity amputee patients is lower than the unilateral amputee patients; satisfaction with prosthesis and body image are not related with the amputation level; and the life quality and satisfaction with prostheses are increased in parallel with the use of the prostheses. Clinical relevance Although differences exist between the groups, in terms of quality of life and functionality, patients can reach an acceptable life standard with good rehabilitation and a suitable prosthesis.

  5. Skin problems in lower limb amputees : an overview by case reports

    NARCIS (Netherlands)

    Meulenbelt, H.E.J.; Geertzen, J.H.B.; Dijkstra, Pieter; Jonkman, M.F.

    The stump in lower limb amputees is prone to skin problems because it is exposed to several unnatural conditions (shear and stress forces and increased humidity) when a prosthesis is used. This study reviews the literature on case reports of lower limb amputees with skin problems on the stump. In

  6. Job adjustments, job satisfaction and health experience in upper and lower limb amputees

    NARCIS (Netherlands)

    van der Sluis, Corry K.; Hartman, Paul P.; Schoppen, Tanneke; Dijkstra, Pieter U.

    2009-01-01

    Objectives: To explore job adjustments, job satisfaction, and health experience among employees with an upper limb amputation and to compare the results with those of lower limb amputees and control subjects. Methods: Amputees were recruited from data files of a large European University Medical

  7. Balance recovery after an evoked forward fall in unilateral transtibial amputees

    NARCIS (Netherlands)

    Curtze, Carolin; Hof, At L.; Otten, Bert; Postema, Klaas

    Falls are a common and potentially dangerous event, especially in amputees. In this study, we compared the mechanisms of balance recovery of 17 unilateral transtibial amputees and 17 matched able-bodied controls after being released from a forward-inclined orientation of 10%. Kinematic analysis

  8. The energy cost for the step-to-step transition in amputee walking

    NARCIS (Netherlands)

    Houdijk, J.H.P.; Pollman, E.; Groenewold, M.; Wiggerts, H.; Polomski, W.

    2009-01-01

    The purpose of this study was to investigate whether the increased energy cost of amputee gait could be accounted for by an increase in the mechanical work dissipated during the step-to-step transition in walking. Eleven transtibial amputees (AMP) and 11 age-matched controls (CO) walked at both

  9. Three-dimensional knee joint contact forces during walking in unilateral transtibial amputees.

    Science.gov (United States)

    Silverman, Anne K; Neptune, Richard R

    2014-08-22

    Individuals with unilateral transtibial amputations have greater prevalence of osteoarthritis in the intact knee joint relative to the residual leg and non-amputees, but the cause of this greater prevalence is unclear. The purpose of this study was to compare knee joint contact forces and the muscles contributing to these forces between amputees and non-amputees during walking using forward dynamics simulations. We predicted that the intact knee contact forces would be higher than those of the residual leg and non-amputees. In the axial and mediolateral directions, the intact and non-amputee legs had greater peak tibio-femoral contact forces and impulses relative to the residual leg. The peak axial contact force was greater in the intact leg relative to the non-amputee leg, but the stance phase impulse was greater in the non-amputee leg. The vasti and hamstrings muscles in early stance and gastrocnemius in late stance were the largest contributors to the joint contact forces in the non-amputee and intact legs. Through dynamic coupling, the soleus and gluteus medius also had large contributions, even though they do not span the knee joint. In the residual leg, the prosthesis had large contributions to the joint forces, similar to the soleus in the intact and non-amputee legs. These results identify the muscles that contribute to knee joint contact forces during transtibial amputee walking and suggest that the peak knee contact forces may be more important than the knee contact impulses in explaining the high prevalence of intact leg osteoarthritis. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Advanced rehabilitation techniques for the multi-limb amputee.

    Science.gov (United States)

    Harvey, Zach T; Loomis, Gregory A; Mitsch, Sarah; Murphy, Ian C; Griffin, Sarah C; Potter, Benjamin K; Pasquina, Paul

    2012-01-01

    Advances in combat casualty care have contributed to unprecedented survival rates of battlefield injuries, challenging the field of rehabilitation to help injured service members achieve maximal functional recovery and independence. Nowhere is this better illustrated than in the care of the multiple-limb amputee. Specialized medical, surgical, and rehabilitative interventions are needed to optimize the care of this unique patient population. This article describes lessons learned at Walter Reed National Military Medical Center Bethesda in providing advanced therapy and prosthetics for combat casualties, but provides guidelines for all providers involved in the care of individuals with amputation.

  11. Estimation of the forces generated by the thigh muscles for transtibial amputee gait.

    Science.gov (United States)

    Voinescu, M; Soares, D P; Natal Jorge, R M; Davidescu, A; Machado, L J

    2012-04-05

    The forces generated by the muscles with origin on the human femur play a major role in transtibial amputee gait, as they are the most effective of the means that the body can use for propulsion. By estimating the forces generated by the thigh muscles of transtibial amputees, and comparing them to the forces generated by the thigh muscles of normal subjects, it is possible to better estimate the energy output needed from prosthetic devices. The purpose of this paper is to obtain the forces generated by the thigh muscles of transtibial amputees and compare these with forces obtained from the same muscles in the case of normal subjects. Two transtibial amputees and four normal subjects similar in size to the amputees were investigated. Level ground walking was chosen as the movement to be studied, since it is a common activity that most amputees engage in. Inverse dynamics and a muscle recruitment algorithm (developed by AnyBody Technology(®)) were used for generating the muscle activation patterns and for computing the muscle forces. The muscle forces were estimated as two sums: one for all posterior muscles and one for the anterior muscles, based on the position of the muscles of the thigh relative to the frontal plane of the human body. The results showed that a significantly higher force is generated by the posterior muscles of the amputees during walking, leading to a general increase of the metabolic cost necessary for one step. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Comparison of muscles activity of abled bodied and amputee subjects for around shoulder movement.

    Science.gov (United States)

    Kaur, Amanpreet; Agarwal, Ravinder; Kumar, Amod

    2016-05-12

    Worldwide, about 56% of the amputees are upper limb amputees. This research deals a method with two-channel surface electromyogram (SEMG) signal recorded from around shoulder to estimate the changes in muscle activity in non-amputee and the residual limb of trans humeral amputees with different movements of arm. Identification of different muscles activity of near shoulder amputee and non-amputee persons. SEMG signal were acquired during three distinct exercises from three-selected muscles location around shoulder. The participants were asked to move their dominant arm from an assigned position to record their muscles activity recorded with change in position. Results shows the muscles activity in scalene is more than the other muscles like pectoralis and infraspinatus with the same shoulder motion. In addition, STFT (Short-Time Fourier Transform) spectrogram with window length of 256 samples at maximum of 512 frequency bins using hamming window has used to identify the signal for the maximum muscles activity with best resolution in spectrum plot. The results suggest that one can use this analysis for making a suitable device for around shoulder prosthetic users based on muscles activation of amputee persons.

  13. 3D intersegmental knee loading in below-knee amputees across steady-state walking speeds.

    Science.gov (United States)

    Fey, Nicholas P; Neptune, Richard R

    2012-05-01

    Unilateral below-knee amputees often develop comorbidities that include knee joint disorders (e.g., intact leg knee osteoarthritis), with the mechanisms leading to these comorbidities being poorly understood. Mechanical knee loading of non-amputees has been associated with joint disorders and shown to be influenced by walking speed. However, the relationships between amputee knee loading and speed have not been identified. This study examined three-dimensional mechanical knee loading of amputees across a wide range of steady-state walking speeds. Fourteen amputees and 10 non-amputee control subjects were analyzed at four overground walking speeds. At each speed, intersegmental joint moment and force impulses (i.e., time-integrals over the stance phase) were compared between the control, intact and residual knees using repeated-measures ANOVAs. There were no differences in joint force impulses between the intact and control knees. The intact knee abduction moment impulse was lower than the non-amputees at 0.6 and 0.9 m/s. The intact knee flexion moment impulses at 0.6, 1.2 and 1.5m/s and knee external rotation moment impulses at all speeds were greater than the residual knee. The residual knee extension moment and posterior force impulses were insensitive to speed increases, while these quantities increased in intact and control knees. These results suggest the intact knees of asymptomatic and relatively new amputees are not overloaded during walking compared to non-amputees. Increased knee loads may develop in response to prolonged prosthesis usage or joint disorder onset. Further study is needed to determine if the identified bilateral loading asymmetries across speeds lead to diminished knee joint health. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Kinematic gait adaptations in unilateral transtibial amputees during rehabilitation.

    Science.gov (United States)

    Barnett, Cleveland; Vanicek, Natalie; Polman, Remco; Hancock, Amanda; Brown, Barbara; Smith, Lynne; Chetter, Ian

    2009-06-01

    Physiotherapists routinely prescribe the use of two different early walking aids (EWAs) to individuals who have recently undergone unilateral transtibial amputation. No research to date has investigated the kinematic gait patterns of transtibial amputees walking with an EWA during early rehabilitation. The aim of the current RCT study was to compare gait patterns when walking with two different EWAs and whether either EWA provided patients with greater gait benefits. Patients were randomly assigned into one of two EWA groups, one group using the Amputee Mobility Aid and another using the Pneumatic Post-Amputation Aid, prior to receiving their functional prosthesis. A 3D motion capture system recorded kinematic data from their first steps up to discharge from rehabilitation. Walking velocity increased significantly (p rehabilitation. Control of the prosthetic knee improved during rehabilitation in both groups. A lack of conclusive differences between EWAs was noted at discharge from rehabilitation. Both groups displayed changes in gait patterns in different gait measures during rehabilitation. However, these changes were not the same for both groups. Gait adaptations occurred soon after walking with a functional prosthesis. The results from this study would suggest that neither EWA was more beneficial for gait retraining during rehabilitation.

  15. Clinicians' perspectives on decision making in lower limb amputee rehabilitation.

    Science.gov (United States)

    Sansam, Kate; O'Connor, Rory J; Neumann, Vera; Bhakta, Bipin

    2014-05-01

    Decision making within amputee rehabilitation includes the assessment of whether a patient is suitable for a prosthesis and if so, what components to provide. This study seeks to increase understanding about clinicians' perspectives on what factors influence these decisions. One-to-one semi-structured interviews were completed with 23 experienced clinicians at their place of work at 4 UK amputee rehabilitation centres. Thematic analysis using a theoretical, semantic approach was used to identify key themes from the data. Four key themes were identified: estimating outcome; difficulties predicting outcome; patient choice and barriers to prescribing. There was variation in the importance placed on each theme between individual clinicians and services, with factors such as budget and risk aversion acting as barriers to prescribing. Only one of the 4 centres used formal prescribing guidelines. The results highlight the difficulties clinicians experience in estimating outcome and suggest inequity of prosthetic provision in the UK, with variation in the provision of high cost items. The development of national prescription guidelines is suggested to improve equality of prosthetic provision.

  16. A Powered Prosthetic Intervention for Bilateral Transfemoral Amputees

    Science.gov (United States)

    Lawson, Brian E.; Ruhe, Brian; Shultz, Amanda; Goldfarb, Michael

    2014-01-01

    This paper presents the design and validation of a control system for a pair of powered knee and ankle prostheses to be used as a prosthetic intervention for bilateral transfemoral amputees. The control system leverages communication between the prostheses for enhanced awareness and stability, along with power generation at the knee and ankle joints to better restore biomechanical functionality in level ground walking. The control methodology employed is a combination of an impedance-based framework for weight-bearing portions of gait and a trajectory-based approach for the non-weight-bearing portions. The control system was implemented on a pair of self-contained powered knee and ankle prostheses, and the ability of the prostheses and control approach to provide walking functionality was assessed in a set of experimental trials with a bilateral transfemoral amputee subject. Specifically, experimental data from these trials indicate that the powered prostheses and bilateral control architecture provide gait kinematics that reproduce healthy gait kinematics to a greater extent than the subject’s daily-use passive prostheses. PMID:25014950

  17. The development and validation of a novel outcome measure to quantify mobility in the dysvascular lower extremity amputee: the amputee single item mobility measure

    Science.gov (United States)

    Norvell, Daniel C; Williams, Rhonda M; Turner, Aaron P; Czerniecki, Joseph M

    2016-01-01

    Objective: This study describes the development and psychometric evaluation of a novel patient-reported single-item mobility measure. Design: Prospective cohort study. Setting: Four Veteran’s Administration Medical Centers. Subjects: Individuals undergoing their first major unilateral lower extremity amputation; 198 met inclusion criteria; of these, 113 (57%) enrolled. Interventions: None. Main measures: The Amputee Single Item Mobility Measure, a single item measure with scores ranging from 0 to 6, was developed by an expert panel, and concurrently administered with the Locomotor Capabilities Index-5 (LCI-5) and other outcome measures at six weeks, four months, and 12 months post-amputation. Criterion and construct validity, responsiveness, and floor/ceiling effects were evaluated. Responsiveness was assessed using the standardized response mean. Results: The overall mean 12-month Amputee Single Item Mobility Measure score was 3.39 ±1.4. Scores for transmetatarsal, transtibial, and transfemoral amputees were 4.2 (±1.3), 3.2 (±1.5), and 2.9 (±1.1), respectively. Amputee Single Item Mobility Measure scores demonstrated “large” and statistically significant correlations with the LCI-5 scores at six weeks (r = 0.72), four months (r = 0.81), and 12 months (r = 0.86). At four months and 12 months, the correlation between Amputee Single Item Mobility Measure scores and hours of prosthetic use were r = 0.69 and r = 0.66, respectively, and between Amputee Single Item Mobility Measure scores and Trinity Amputation and Prosthesis Experience Scales functional restriction scores were r = 0.45 and r = 0.67, respectively. Amputee Single Item Mobility Measure scores increased significantly from six weeks to 12 months post-amputation. Minimal floor/ceiling effects were demonstrated. Conclusions: In the unilateral dysvascular amputee, the Amputee Single Item Mobility Measure has strong criterion and construct validity, excellent

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

    Science.gov (United States)

    Boonstra, A M; Fidler, V; Eisma, W H

    1993-08-01

    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.

  19. Ultrasonographic assessment of the quadriceps muscle and femoral cartilage in transtibial amputees using different prostheses.

    Science.gov (United States)

    Şahin Onat, Şule; Malas, Fevziye Ünsal; Öztürk, Gökhan Tuna; Akkaya, Nuray; Kara, Murat; Özçakar, Levent

    2016-08-01

    In patients with lower limb amputations, gait alteration, increased loading on the intact extremity, and use of prosthesis may lead to joint degeneration. To explore the effects of prosthesis type on quadriceps muscle and distal femoral cartilage thicknesses in transtibial amputees. A cross-sectional study. A total of 38 below-knee amputees were enrolled in the study, of which 13 patients were using vacuum system type prosthesis and 25 patients were using silicon liner pin system prosthesis. Patients' femoral cartilage and quadriceps muscle thickness measurements were performed using musculoskeletal ultrasound. When compared with the intact sides, cartilage and rectus femoris, vastus intermedius, and vastus medialis muscle thickness values were significantly decreased on the amputee sides (all p vacuum system type prosthesis to prevent possible knee osteoarthritis due to cartilage thinning in adult transtibial amputees. © The International Society for Prosthetics and Orthotics 2015.

  20. Isometric hip muscle strength in posttraumatic below-knee amputees

    Directory of Open Access Journals (Sweden)

    Jandrić Slavica

    2007-01-01

    Full Text Available Background/Aim. Traumas and war injuries, next to chronic occlusive artery disease and diabetes mellitus-derived complications, are the most frequent cause of the lower limbs amputation. They affect mostly younger population that need a higher level of activities as compared with the elderly. Medical rehabilitation is very significant for the muscle performance improvement in this population providing their social reintegration. The aim of this study was to investigate the effect of below-knee amputation on the hip isometric muscle strength and effect of rehabilitation on improvement of hip muscle strength in below-knee amputees, secondary to war wounding. Methods. Forty below-knee amputees (after war wounding, average age 35.6±10.6 years, that were included in primary rehabilitation program with prosthetics, were examined. Objective parameters were used to evaluate therapeutical effects. Isometric muscle strength of hip flexors, extensors, abductors and adductors was measured by dynamometer and expressed in Newton (N at admission, control and discharge for each patient. Average length of the treatment was 51 ± 34.1 days. Results. For isometric hip flexors (t = - 1.99346, p < 0.05, extensors (t = -4.629073, p < 0.001, abductors (t = -4.9408, p < 0.001 and adductors (t = -2.00228, p < 0.05, muscle strength was significantly less on the amputated than on nonamputated side. The highest differences in muscle strength between amputated and nonamputated limbs were noted for hip abductors (26.6% and extensors (23.3%. There was significant improvement of mean values of strength for all examined hip muscles after rehabilitation and prosthetics for both legs in comparison to beginning of the therapy. The hip abductor on the amputated side was for 19.4% weaker after rehabilitation in comparison to the nonamputated limb. Conclusion. Decreases of isometric muscle strength in all examined hip muscles were observed, more in the amputated limb. Rehabilitation

  1. Perspiration Thresholds and Secure Suspension for Lower Limb Amputees in Demanding Environments

    Science.gov (United States)

    2016-10-01

    amputees in demanding environments.” U. S. Army Medical Research and Material Command, Clinical and Rehabilitative Medicine Research Program , Socket ...Limb Amputees in Demanding Environments 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER Glenn K. Klute, PhD 5e. TASK...Health Care System (VAPSHCS) site, fabricating custom, moisture-wicking textile sock with a proximal elastomeric seal, fabricating prosthetic sockets

  2. Secure Microprocessor-Controlled Prosthetic Leg for Elderly Amputees: Preliminary Results

    OpenAIRE

    Krut, S.; Coste, Ch. Azevedo; Chabloz, P.

    2011-01-01

    We introduce a new prosthetic leg design, adapted to elderly trans-femoral amputees. Technical progress in prosthesis design mainly concerns active individuals. An important number of elderly amputees are not very mobile, tire easily, present reduced muscle strength, and have difficulties managing their balance. Therefore, the needs and characteristics of this specific population are very different from those of younger ones and the prosthetic solutions are not adapted. Our artificial knee ha...

  3. Muscle activation patterns during walking from transtibial amputees recorded within the residual limb-prosthetic interface.

    Science.gov (United States)

    Huang, Stephanie; Ferris, Daniel P

    2012-08-10

    Powered lower limb prostheses could be more functional if they had access to feedforward control signals from the user's nervous system. Myoelectric signals are one potential control source. The purpose of this study was to determine if muscle activation signals could be recorded from residual lower limb muscles within the prosthetic socket-limb interface during walking. We recorded surface electromyography from three lower leg muscles (tibilias anterior, gastrocnemius medial head, gastrocnemius lateral head) and four upper leg muscles (vastus lateralis, rectus femoris, biceps femoris, and gluteus medius) of 12 unilateral transtibial amputee subjects and 12 non-amputee subjects during treadmill walking at 0.7, 1.0, 1.3, and 1.6 m/s. Muscle signals were recorded from the amputated leg of amputee subjects and the right leg of control subjects. For amputee subjects, lower leg muscle signals were recorded from within the limb-socket interface and from muscles above the knee. We quantified differences in the muscle activation profile between amputee and control groups during treadmill walking using cross-correlation analyses. We also assessed the step-to-step inter-subject variability of these profiles by calculating variance-to-signal ratios. We found that amputee subjects demonstrated reliable muscle recruitment signals from residual lower leg muscles recorded within the prosthetic socket during walking, which were locked to particular phases of the gait cycle. However, muscle activation profile variability was higher for amputee subjects than for control subjects. Robotic lower limb prostheses could use myoelectric signals recorded from surface electrodes within the socket-limb interface to derive feedforward commands from the amputee's nervous system.

  4. Assessment of aerobic capacity and walking economy of unilateral transfemoral amputees.

    Science.gov (United States)

    Gjovaag, Terje; Starholm, Inger M; Mirtaheri, Peyman; Hegge, Fride W; Skjetne, Katrine

    2014-04-01

    Studies of the maximal oxygen uptake (VO(2max)) of transfemoral amputees have mostly used protocols that activate a relatively small muscle mass. Consequently, transfemoral amputee VO(2max) may be systematically underestimated, and the validity of these test protocols is questionable. (1) Investigate validity and reliability of a VO(2max) walking protocol and (2) compare the VO(2max) of a transfemoral amputee group with a group of matching controls. (1) Randomized crossover study: walking versus running VO(2max) for the control group and (2) case-control study: transfemoral amputees versus control group VO(2max). Twelve transfemoral amputees and control participants performed a walking VO(2max) test with increasing treadmill inclinations to voluntary exhaustion. The control group also completed a running ("gold-standard") VO(2max) test. Mean (standard deviation) control group VO(2max) following walking and running was similar, that is, 2.99 (0.6) L min(-1) and 3.09 (0.7) L min(-1), respectively. Mean (standard deviation) transfemoral amputee walking VO(2max) was 2.14 (0.8) L min(-1) (compared to CON; p amputees was 40% lower compared to control group. Reliability of the walking protocol is comparable to other walking protocols. Clinical relevance The design, alignment, and materials of prostheses are important for effective ambulation. Cardio-respiratory fitness is, however, also important in this regard, and a low fitness may compromise health and independent living. Hence, transfemoral amputees with low physical fitness should engage in regular physical activity to improve health, gait capacity, and independency.

  5. Intracortical inhibition is modulated by phase of prosthetic rehabilitation in transtibial amputees

    Science.gov (United States)

    Hordacre, Brenton; Bradnam, Lynley V.; Barr, Christopher; Patritti, Benjamin L.; Crotty, Maria

    2015-01-01

    Reorganization of primary motor cortex (M1) is well-described in long-term lower limb amputees. In contrast cortical reorganization during the rehabilitation period after amputation is poorly understood. Thirteen transtibial amputees and 13 gender matched control participants of similar age were recruited. Transcranial magnetic stimulation was used to assess corticomotor and intracortical excitability of M1 bilaterally. Neurophysiological assessments were conducted at admission, prosthetic casting, first walk and discharge. Gait variability at discharge was assessed as a functional measure. Compared to controls, amputees had reduced short-latency intracortical inhibition (SICI) for the ipsilateral M1 at admission (p = 0.01). Analysis across rehabilitation revealed SICI was reduced for the contralateral M1 at first walk compared to discharge (p = 0.003). For the ipsilateral M1 both short and long-latency intracortical inhibition were reduced at admission (p rehabilitating amputees. A dichotomous relationship between reduced intracortical inhibition for each M1 and gait function was observed at different times. Intracortical inhibition may be an appropriate cortical biomarker of gait function in lower limb amputees during rehabilitation, but requires further investigation. Understanding M1 intracortical excitability of amputees undertaking prosthetic rehabilitation provides insight into brain reorganization in the sub-acute post-amputation period and may guide future studies seeking to improve rehabilitation outcomes. PMID:26042015

  6. [Function of prosthesis components in lower limb amputees with bone-anchored percutaneous implants : Biomechanical aspects].

    Science.gov (United States)

    Blumentritt, S

    2017-05-01

    Bone anchorage of an artificial limb has been proven to be an alternative intervention for amputees when prosthesis use is seriously reduced because of stump problems. Little is known about how prosthesis components interact with bone and joints and which potential the optimum use provides with respect to quality of treatment of leg amputees. Does osseointegration influence the motor activity of residual limbs differently compared with socket prostheses? How should prosthesis components be aligned? What type of prosthetic knee joints should be preferred in transfemoral amputees? Transfer of biomechanical knowledge of socket prosthetics to bone-anchored prostheses. Pilot studies with a limited number of amputees. Force transmission at the interface between the prosthesis and residual limb stump is completely different for osseointegrated fixation and socket design; however, the number of muscles available for control remains unchanged. Because the iliotibial tract is missing, bending moments of the femur are expected to be greater. Prosthetic alignment is very critical for gait pattern and the basic rules seem to be the same as for socket design. The foot position determines the knee function for below-knee amputees. The position of the femur influences the gait pattern of above-knee amputees. The lowest risk of falls and best functional properties are shown by microprocessor controlled knee joints. Osseointegrated leg prostheses have some biomechanical advantages over the socket design. Since rehabilitation quality is clearly affected the prosthetic alignment has to be done carefully and precisely. As a rule microprocessor controlled knee joints are indicated.

  7. Step Frequency and Step Length of 200-m Sprint in Able-bodied and Amputee Sprinters.

    Science.gov (United States)

    Hobara, H; Sano, Y; Kobayashi, Y; Heldoorn, T A; Mochimaru, M

    2016-02-01

    The goal of this study was to examine the hypothesis that the difference in the 200-m sprint performance of amputee and able-bodied sprinters is due to a shorter step length rather than a lower step frequency. Men's elite-level 200-m races with a total of 16 able-bodied, 13 unilateral transtibial, 5 bilateral transtibial, and 16 unilateral transfemoral amputee sprinters were analyzed from publicly available internet broadcasts. For each run, the average forward velocity, step frequency, and step length over the entire 200-m distance were analyzed for each sprinter. The average forward velocity of able-bodied sprinters was faster than that of the other 3 groups, but there was no significant difference in average step frequency between able-bodied and transtibial amputee sprinters. However, the average step length of able-bodied sprinters was significantly longer than that of the transtibial amputee sprinters. In contrast, the step frequency and step length of transfemoral amputees were significantly lower and shorter than those of the other 3 groups. These results suggest that the differences in 200-m sprint performance between able-bodied and amputee sprinters are dependent on amputation level. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Integration of surface electromyographic sensors with the transfemoral amputee socket: a comparison of four differing configurations.

    Science.gov (United States)

    Hefferman, Gerald M; Zhang, Fan; Nunnery, Michael J; Huang, He

    2015-04-01

    In recent years, there has been an increased interest in recording high-quality electromyographic signals from within the sockets of lower-limb amputees. However, successful recording presents major challenges to both researchers and clinicians. This article details and compares four prototypical integrated socket-sensor designs used to record electromyographic signals from within the sockets of transfemoral amputees. Four prototypical socket-sensor configurations were constructed and tested on a single transfemoral amputee asked to perform sitting/standing, stair ascent/descent, and level ground walking. The number of large-amplitude motion artifacts generated using each prototype was quantified, the amount of skin irritation documented, and the comfort level of each assembly subjectively assessed by the amputee subject. Of the four configurations tested, the combination of a suction socket with integrated wireless surface electrodes generated the lowest number of large-amplitude motion artifacts, the least visible skin irritation, and was judged to be most comfortable by the amputee subject. The collection of high-quality electromyographic signals from an amputee's residual limb while maximizing patient comfort holds substantial potential to enhance neuromuscular clinical assessment and as a method of intuitive control of powered lower-limb prostheses. © The International Society for Prosthetics and Orthotics 2014.

  9. The Effect of Prosthetic Socket Interface Design on Socket Comfort, Residual Limb Health, and Function for the Transfemoral Amputee

    Science.gov (United States)

    2016-10-01

    for the Transfemoral Amputee PRINCIPAL INVESTIGATOR: M. Jason Highsmith CONTRACTING ORGANIZATION: University of South Florida Tampa, FL 33620 REPORT...and Function for the Transfemoral Amputee 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Highsmith, M. Jason 5d...There are two alternative interface designs for the military and veteran above knee amputee that could provide answers to issues germane to above

  10. Tactile display on the remaining hand for unilateral hand amputees

    Directory of Open Access Journals (Sweden)

    Li Tao

    2016-09-01

    Full Text Available Human rely profoundly on tactile feedback from fingertips to interact with the environment, whereas most hand prostheses used in clinics provide no tactile feedback. In this study we demonstrate the feasibility to use a tactile display glove that can be worn by a unilateral hand amputee on the remaining healthy hand to display tactile feedback from a hand prosthesis. The main benefit is that users could easily distinguish the feedback for each finger, even without training. The claimed advantage is supported by preliminary tests with healthy subjects. This approach may lead to the development of effective and affordable tactile display devices that provide tactile feedback for individual fingertip of hand prostheses.

  11. Bodies completed: on the physical rehabilitation of lower limb amputees.

    Science.gov (United States)

    Hoffman, Michal

    2013-05-01

    This ethnographic study, based on empirical work carried out in an Israeli rehabilitation hospital, discusses the physical rehabilitation of lower limb amputees, during which body normalcy is re-constructed. Throughout the process, physiotherapists serve as social agents who teach pragmatic and discursive practices to manage the body as well as the prosthesis in the re-cultivation of body techniques. The findings, portraying four spheres of meaning, show that the mere use of prosthesis is insufficient since it stigmatizes the body as absent a limb. To avoid such stigmatization, the staff teach compensatory and discursive skills which enable incorporation of the prosthesis in body techniques while referring to it as a biological leg. Constructed as a 'social organ', the device is gradually transformed from an extension to an integral part of the body. Disability and its remedies, thereby concealed, facilitate able-bodied performance. Paradoxically, the prosthesis, though meant to benefit patients, induces pain and discomfort, a fact that challenges the acceptance of its conventionality as a medical aid for amputees. Yet, physical rehabilitation by means of prosthetics remains one of the many medical practices in Israel that ensure a disability-free society, together with the promotion of rights to accessibility and anti-discrimination regulation. The study contributes to the theoretical debate regarding the relationship between the biological and the social in disability studies. The findings indicate the need to encompass the cultural and the corporeal when exploring disability. The ethnography of disability, I suggest, should be viewed as a juncture of socio-cultural perceptions of the body, embedded in its own corporeal constraints.

  12. Hyperbaric oxygenation accelerates prosthetic rehabilitation of lower limb amputees.

    Science.gov (United States)

    Igor, Simanic; Mirko, Teofilovski; Dalibor, Paspalj; Milutin, Radotic; Dusica, Djordjevic; Vladimir, Zivkovic; Vladimir, Jakovljevic

    2013-01-01

    The purpose of the study was to assess the effects of hyperbaric oxygen (HBO2) therapy on prosthetic rehabilitation of patients with unilateral lower limb amputation. Narang's scale,the Locomotor Capabilities Index and the two-minute walk test were used to assess functional abilities of amputees on the admission and on discharge from hospital. We also kept records of some clinical parameters whose improvement enables better mobility of patients: thigh and lower leg girth, strength of amputation stump, existence of amputation stump contracture, existence of some other complications on amputation stump, blood oxygenation and pulse palpation. Our results show that hyperbaric oxygenation accelerates prosthetic rehabilitation of lower limb amputees. HBO2-treated patients were discharged from the hospital faster than the controls (hospitalized for 133.2 +/- 54.87 days vs. 158.36 +/- 53.05 days), they had improved arterial Hb saturation (97.40 +/- 3.51% vs. 94.74 +/- 3.28 %) and pulse palpability (pulse palpable in 27 vs. 18 subjects), less complications of the amputation stump (complications present in 24 vs. 30 subjects), greater healthy leg thigh girth (50.75 +/- 3.96 cm vs. 48.90 +/- 2.59 cm), stronger amputation stump (mark 3.90 +/- 0.54 vs. 3.33 +/- 0.47) and better functional abilities as measured by adapted Narang's scale (category 3.43 +/- 1.30 vs. 4.10 +/- 1.12) and locomotor capabilities index (score 38.06 +/- 10.90 vs. 33.16 +/- 8.80). These findings highlight the increasing validity of this procedure after limb amputation, which should be confirmed by further research in multicenter studies involving a larger number of respondents.

  13. Kinetic asymmetry in transfemoral amputees while performing sit to stand and stand to sit movements.

    Science.gov (United States)

    Highsmith, M Jason; Kahle, Jason T; Carey, Stephanie L; Lura, Derek J; Dubey, Rajiv V; Csavina, Kristine R; Quillen, William S

    2011-05-01

    Transitional movements are a determinant of functional independence and have limited study in amputees. Microprocessor prosthetic knees' abilities to assist transfemoral amputees with sitting and standing have not been studied. Through cross-sectional study, 21 transfemoral amputees, divided into 3 groups of 7 by knee type (power knee, C-leg, Mauch SNS) and 7 non-amputee controls (n=28) performed sit to stand and stand to sit while kinematic and kinetic data were recorded. Transfemoral amputees can stand (1.6-2.0s) and sit (2.1-2.8s) at rates comparable to controls (1.6s). Controls' ground reaction force (GRF) and knee moment production was knee moments. For stand to sit, amputees' asymmetry for GRF ranged from 32 to 60% and 84 to 114% for knee moments. Hip moment asymmetry for sit to stand was less for control (21%) and power knee (34%) groups than that produced by the Mauch SNS (59%) group. For stand to sit, hip moment production for the Mauch SNS (47%) and C-leg groups (71%) were more asymmetric than controls (19%). In the majority of cases transfemoral amputees do not load their prosthesis extensively for standing up or sitting down. Therefore, this transitional movement is currently a one-legged task, which increases stress on the sound limb. Generally, the prosthetic knees studied did not produce a significant knee moment in either task. Although most differences between knee groups were not statistically significant, differences may be clinically meaningful on an individual basis. Published by Elsevier B.V.

  14. The effects of laterality on obstacle crossing performance in unilateral trans-tibial amputees.

    Science.gov (United States)

    De Asha, Alan R; Buckley, John G

    2015-05-01

    Unilateral trans-tibial amputees have bilaterally reduced toe clearance, and an increased risk of foot contact, while crossing obstacles compared to the able-bodied. While the able-bodied tend to lead with a 'preferred' limb it is equivocal whether amputees prefer to lead with the intact or prosthetic limb. This study determined the effects of laterality, compared to side of amputation, on amputees' obstacle crossing performance. To help understand why laterality could affect performance we also assessed knee proprioception for both limbs. Foot placement and toe clearance parameters were recorded while nine amputees crossed obstacles of varying heights leading with both their intact and prosthetic limbs. Joint-position sense was also assessed. Participants self-reported which limb was their preferred (dominant) limb. There were no significant differences in foot placements or toe clearance variability across lead-limb conditions. There were no significant differences in toe clearance between intact and prosthetic lead-limbs (p=0.28) but toe clearance was significantly higher when amputees led with their preferred compared to non-preferred limb (p=0.025). There was no difference in joint-position sense between the intact and residual knees (p=0.34) but joint-position sense tended to be more accurate for the preferred, compared to non-preferred limb (p=0.08). Findings suggest that, despite the mechanical constraints imposed by use of a prosthesis, laterality may be as important in lower-limb amputees as it is in the able bodied. This suggests that amputees should be encouraged to cross obstacles leading with their preferred limb. Copyright © 2015. Published by Elsevier Ltd.

  15. Muscle activation patterns during walking from transtibial amputees recorded within the residual limb-prosthetic interface

    Science.gov (United States)

    2012-01-01

    Background Powered lower limb prostheses could be more functional if they had access to feedforward control signals from the user’s nervous system. Myoelectric signals are one potential control source. The purpose of this study was to determine if muscle activation signals could be recorded from residual lower limb muscles within the prosthetic socket-limb interface during walking. Methods We recorded surface electromyography from three lower leg muscles (tibilias anterior, gastrocnemius medial head, gastrocnemius lateral head) and four upper leg muscles (vastus lateralis, rectus femoris, biceps femoris, and gluteus medius) of 12 unilateral transtibial amputee subjects and 12 non-amputee subjects during treadmill walking at 0.7, 1.0, 1.3, and 1.6 m/s. Muscle signals were recorded from the amputated leg of amputee subjects and the right leg of control subjects. For amputee subjects, lower leg muscle signals were recorded from within the limb-socket interface and from muscles above the knee. We quantified differences in the muscle activation profile between amputee and control groups during treadmill walking using cross-correlation analyses. We also assessed the step-to-step inter-subject variability of these profiles by calculating variance-to-signal ratios. Results We found that amputee subjects demonstrated reliable muscle recruitment signals from residual lower leg muscles recorded within the prosthetic socket during walking, which were locked to particular phases of the gait cycle. However, muscle activation profile variability was higher for amputee subjects than for control subjects. Conclusion Robotic lower limb prostheses could use myoelectric signals recorded from surface electrodes within the socket-limb interface to derive feedforward commands from the amputee’s nervous system. PMID:22882763

  16. Muscle and prosthesis contributions to amputee walking mechanics: a modeling study.

    Science.gov (United States)

    Silverman, Anne K; Neptune, Richard R

    2012-08-31

    Unilateral, below-knee amputees have altered gait mechanics, which can significantly affect their mobility. Below-knee amputees lose the functional use of the ankle muscles, which are critical during walking to provide body support, forward propulsion, leg-swing initiation and mediolateral balance. Thus, either muscles must compensate or the prosthesis must provide the functional tasks normally provided by the ankle muscles. Three-dimensional (3D) forward dynamics simulations of amputee and non-amputee walking were generated to identify muscle and prosthesis contributions to amputee walking mechanics, including the subtasks of body support, forward propulsion, leg-swing initiation and mediolateral balance. Results showed that the prosthesis provided body support in the absence of the ankle muscles. The prosthesis contributed to braking from early to mid-stance and propulsion in late stance. The prosthesis also functioned like the uniarticular soleus muscle by transferring energy from the residual leg to the trunk to provide trunk propulsion. The residual-leg vasti and rectus femoris reduced their contributions to braking in early stance, which mitigated braking from the prosthesis during this period. The prosthesis did not replace the function of the gastrocnemius, which normally generates energy to the leg to initiate swing. As a result, lower overall energy was delivered to the residual leg. The prosthesis also acted to accelerate the body laterally in the absence of the ankle muscles. These results provide further insight into muscle and prosthesis function in below-knee amputee walking and can help guide rehabilitation methods and device designs to improve amputee mobility. Copyright © 2012 Elsevier Ltd. All rights reserved.

  17. Muscle activation patterns during walking from transtibial amputees recorded within the residual limb-prosthetic interface

    Directory of Open Access Journals (Sweden)

    Huang Stephanie

    2012-08-01

    Full Text Available Abstract Background Powered lower limb prostheses could be more functional if they had access to feedforward control signals from the user’s nervous system. Myoelectric signals are one potential control source. The purpose of this study was to determine if muscle activation signals could be recorded from residual lower limb muscles within the prosthetic socket-limb interface during walking. Methods We recorded surface electromyography from three lower leg muscles (tibilias anterior, gastrocnemius medial head, gastrocnemius lateral head and four upper leg muscles (vastus lateralis, rectus femoris, biceps femoris, and gluteus medius of 12 unilateral transtibial amputee subjects and 12 non-amputee subjects during treadmill walking at 0.7, 1.0, 1.3, and 1.6 m/s. Muscle signals were recorded from the amputated leg of amputee subjects and the right leg of control subjects. For amputee subjects, lower leg muscle signals were recorded from within the limb-socket interface and from muscles above the knee. We quantified differences in the muscle activation profile between amputee and control groups during treadmill walking using cross-correlation analyses. We also assessed the step-to-step inter-subject variability of these profiles by calculating variance-to-signal ratios. Results We found that amputee subjects demonstrated reliable muscle recruitment signals from residual lower leg muscles recorded within the prosthetic socket during walking, which were locked to particular phases of the gait cycle. However, muscle activation profile variability was higher for amputee subjects than for control subjects. Conclusion Robotic lower limb prostheses could use myoelectric signals recorded from surface electrodes within the socket-limb interface to derive feedforward commands from the amputee’s nervous system.

  18. Normative Spatiotemporal Parameters During 100-m Sprints in Amputee Sprinters Using Running-Specific Prostheses.

    Science.gov (United States)

    Hobara, Hiroaki; Potthast, Wolfgang; Müller, Ralf; Kobayashi, Yoshiyuki; Heldoorn, Thijs A; Mochimaru, Masaaki

    2016-02-01

    The aim of this study was to develop a normative sample of step frequency and step length during maximal sprinting in amputee sprinters. We analyzed elite-level 100-m races of 255 amputees and 93 able-bodied sprinters, both men and women, from publicly-available Internet broadcasts. For each sprinter's run, the average forward velocity, step frequency, and step length over the 100-m distance were analyzed by using the official record and number of steps in each race. The average forward velocity was greatest in able-bodied sprinters (10.04 ± 0.17 m/s), followed by bilateral transtibial (8.77 ± 0.27 m/s), unilateral transtibial (8.65 ± 0.30 m/s), and transfemoral amputee sprinters (7.65 ± 0.38 m/s) in men. Differences in velocity among 4 groups were associated with step length (able-bodied vs transtibial amputees) or both step frequency and step length (able-bodied vs transfemoral amputees). Although we also found that the velocity was greatest in able-bodied sprinters (9.10 ± 0.14 m/s), followed by unilateral transtibial (7.08 ± 0.26 m/s), bilateral transtibial (7.06 ± 0.48 m/s), and transfemoral amputee sprinters (5.92 ± 0.33 m/s) in women, the differences in the velocity among the groups were associated with both step frequency and step length. Current results suggest that spatiotemporal parameters during a 100-m race of amputee sprinters is varied by amputation levels and sex.

  19. Female combat amputees have higher rates of posttraumatic stress disorder disability.

    Science.gov (United States)

    Rivera, Jessica C; Krueger, Chad A; Johnson, Anthony E

    2015-01-01

    The civilian trauma literature suggests that the sexes differ in physical and mental health outcomes following traumatic injury. In order to determine if the reaction to combat injury is different between the sexes in a specific war wounded population, service members with amputations, we examined the disability profiles of male and female amputees. All US combatants who sustained a major extremity amputation between October 2001 and July 2011 were examined for demographic and injury information from the Department of Defense Trauma Registry and for disability outcomes in the service specific Physical Evaluation Boards. The proportions of women versus men with various disabling conditions were compared using Fisher's Exact Test and the mean disability ratings for each condition were compared using student's t tests. Among 1,107 amputees, 21 were female. There was no difference in the average age, military rank, or Injury Severity Score between the sexes. While the most common military occupation of male amputees was infantry service, the most common occupation for the female amputee was military police. The overall disability ratings between females and males were not different (82% for females, 75% for males). Female amputees had more frequent disability from posttraumatic stress disorder (PTSD, 8/21 [38%] vs 168/818 [17%]). Disability ratings from PTSD tended to also be higher in women. Outside of variable occupational descriptions, both male and female amputees were exposed to explosions resulting in their injuries. Consistent with many civilian trauma and veterans' population studies, female amputees have higher frequencies of disability from PTSD. These results support the need for additional effort and attention directed towards optimizing physical and mental fitness following deployment in order to reduce disability and promote return to duty. Because certain conditions, such as PTSD, may be more or less common in men versus women veterans, postdeployment

  20. Vacuum level effects on knee contact force for unilateral transtibial amputees with elevated vacuum suspension.

    Science.gov (United States)

    Xu, Hang; Greenland, Kasey; Bloswick, Donald; Zhao, Jie; Merryweather, Andrew

    2017-05-24

    The elevated vacuum suspension system (EVSS) has demonstrated unique health benefits for amputees, but the effect of vacuum pressure values on knee contact force (KCF) is still unclear. The objective of this study was to investigate the effect of vacuum levels on KCF for unilateral transtibial amputees (UTA) using the EVSS. Three-dimensional gait was modeled for 9 UTA with five vacuum levels (0-20inHg [67.73kPa], 5inHg [16.93kPa] increments) and 9 non-amputees based on kinematic and ground reaction force data. The results showed that the vacuum level effects were significant for peak axial KCF, which had a relatively large value at 0 and 20inHg (67.73kPa). The intact limb exhibited a comparable peak axial KCF to the non-amputees at 15inHg (50.79kPa). At moderate vacuum levels (5inHg [16.93kPa] to 15inHg [50.79kPa]), co-contraction of quadriceps and hamstrings at peak axial KCF was similar for the intact limb, but was smaller for the residual limb comparing with the non-amputees. The intact limb showed a similar magnitude of quadriceps and hamstrings force at 15inHg (50.79kPa) to the non-amputees, but the muscle coordination patterns varied between the residual and intact limbs. These findings indicate that a proper vacuum level may partially compensate for the lack of ankle plantarflexor and reduce the knee loading. Of the tested vacuum levels, 15inHg (50.79kPa) appears most favorable, although additional analyses with more amputees are suggested to confirm these results prior to establishing clinical guidelines. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Is hip muscle strength the key to walking as a bilateral amputee, whatever the level of the amputations?

    Science.gov (United States)

    Visser, Jma; McCarthy, I; Marks, L; Davis, R C

    2011-12-01

    Little data have been reported on the factors that are important in bilateral amputee walking ability especially the role of hip strength. Observational, case-control study where participants were evaluated at a single point in time. The aim of this study was to investigate the factors involved in bilateral amputee walking ability by assessment of walking speed, perceived exertion, exercise intensity, physiological cost index (PCI) and hip muscle strength. For a group of 10 bilateral amputees, with different levels of amputation, and a non-pathological reference group, walking ability was assessed using the two-minute walk test. Hip muscle strength was assessed using isokinetic strength tests. Bilateral amputees were found to have slower walking speeds and increased PCI of walking which were correlated to higher levels of amputation. Peak hip torques were reduced in the amputees, which was only significant for concentric extension torque (p = 0.029), and approaching significance for concentric flexion (p = 0.061) and abduction (p = 0.057). Bilateral amputee peak hip strength suggested a positive trend with increasing walking ability. Bilateral amputee walking ability was reduced and mainly related to level of amputation. The role of hip strength in bilateral amputee walking ability requires further investigation.

  2. Robotic touch shifts perception of embodiment to a prosthesis in targeted reinnervation amputees

    Science.gov (United States)

    Kim, Keehoon; Colgate, James Edward; Peshkin, Michael A.; Kuiken, Todd A.

    2011-01-01

    Existing prosthetic limbs do not provide amputees with cutaneous feedback. Tactile feedback is essential to intuitive control of a prosthetic limb and it is now clear that the sense of body self-identification is also linked to cutaneous touch. Here we have created an artificial sense of touch for a prosthetic limb by coupling a pressure sensor on the hand through a robotic stimulator to surgically redirected cutaneous sensory nerves (targeted reinnervation) that once served the lost limb. We hypothesize that providing physiologically relevant cutaneous touch feedback may help an amputee incorporate an artificial limb into his or her self image. To investigate this we used a robotic touch interface coupled with a prosthetic limb and tested it with two targeted reinnervation amputees in a series of experiments fashioned after the Rubber Hand Illusion. Results from both subjective (self-reported) and objective (physiological) measures of embodiment (questionnaires, psychophysical temporal order judgements and residual limb temperature measurements) indicate that returning physiologically appropriate cutaneous feedback from a prosthetic limb drives a perceptual shift towards embodiment of the device for these amputees. Measurements provide evidence that the illusion created is vivid. We suggest that this may help amputees to more effectively incorporate an artificial limb into their self image, providing the possibility that a prosthesis becomes not only a tool, but also an integrated body part. PMID:21252109

  3. A Survey on Activities of Daily Living and Occupations of Upper Extremity Amputees

    Science.gov (United States)

    Jang, Chul Ho; Yang, Hea Eun; Lee, Seon Yeong; Kwon, Ji Won; Yun, Bong Duck; Choi, Jae Yung; Kim, Seon Nyeo; Jeong, Hae Won

    2011-01-01

    Objective To assess prosthetic use by upper extremity amputees, and their difficulties with prostheses in activities of daily living and occupations. Method This study is based on a survey of 307 subjects, who were using prostheses manufactured in the Center of Prosthetics and Orthotics. The survey questionnaire included items about general demographic characteristics, side and level of amputation, type of prosthesis and its use, and difficulties in the activities of daily living, employment and driving. Results The most common type of prosthesis was the cosmetic hand type (80.2%). There were no statistically significant correlations between satisfaction with prosthesis and the amputation level or type of prosthesis. The most common difficulties in daily living activities experienced by amputees were lacing shoes, removing bottle-tops with a bottle opener, and using scissors. Only 7.3% of amputees received rehabilitation services. Less than half of the amputees (44.7%) used their prostheses for eight or more hours a day, and 76.9% used their prostheses for regular or irregular cosmetic purposes. After amputation, most of the respondents (69.0%) became unemployed or changed workplaces. Conclusion In our study, respondents preferred cosmetic usage to functional usage. Only 30.0% of respondents reported satisfaction with their prostheses. Many of the amputees had difficulties in complex tasks and either changed jobs or became unemployed. Clerical workers were the occupation group, which was most likely to return to work. The development of a more functional prosthetic hand and additional rehabilitation services are required. PMID:22506221

  4. The relative contributions of the prosthetic and sound limb to balance control in unilateral transtibial amputees.

    Science.gov (United States)

    Curtze, Carolin; Hof, At L; Postema, Klaas; Otten, Bert

    2012-06-01

    In unilateral transtibial amputees maintenance of standing balance is compromised due to the lack of active ankle control in the prosthetic limb. The purpose of this study is to disentangle the contribution of the prosthetic and sound limb to balance control following waist-pull perturbations. We compared the contribution of the hip and ankle joints to balance control of 15 unilateral transtibial amputees and 13 able-bodied controls after been externally perturbed through release of a pulling force. Perturbations were applied in four different directions. Outcome measure was the proportion of joint moment integrated over time generated by the hip and ankle joints in order to restore static stability after perturbation. Analyses revealed that perturbations in backward/forward direction were recovered mainly by the ankle strategy. The amputees compensated for the absence of active ankle control in the prosthetic limb by increasing the ankle moment in the sound limb. Interestingly, the passive properties of the prosthetic foot contributed to balance control, which has important implications for prosthetic fitting and standing stability in lower limb amputees. Amputees and controls resisted perturbations in medio-lateral direction by generating the necessary hip moments. Finally, these findings are discussed with respect to prosthetic design and rehabilitation processes. Copyright © 2012 Elsevier B.V. All rights reserved.

  5. Bilateral lower limb amputee rehabilitation. A retrospective review.

    Science.gov (United States)

    Torres, M. M.; Esquenazi, A.

    1991-01-01

    We retrospectively reviewed 61 cases of bilateral lower limb amputations in patients admitted to a regional amputee rehabilitation program. Of the 61 cases, 41 were analyzed as to functional outcome on discharge, at 1 month, and at 3 months; 20 were not included owing to transfers to acute care or loss to follow-up. There were 41 men and 20 women, the average age was 61.5 years, and 47 patients (77%) were discharged to home. There were 25 bilateral below-knee, 14 above-knee and below-knee, 12 bilateral above-knee, 5 below-knee and partial-foot, 3 above-knee and partial-foot, and 2 bilateral partial-foot amputations. The average length of stay for all levels was 24.2 days. Most of the patients at the time of discharge achieved a level of limited household walking with the exception of those with bilateral above-knee amputations. A significant improvement in function was noted for all patients at 3-month follow-up, with most patients achieving household ambulation level, but 10 remained independent at wheelchair level for mobility. Images PMID:1866955

  6. [The use of occupational therapy in upper limb amputees].

    Science.gov (United States)

    Moscato, T A; Orlandini, D

    2010-01-01

    Since pre-history until modern times, the ever more refined use of the hand has been fundamental to the progress of mankind. The list of functions of this incredible part of the body would fill several pages and show its fundamental importance in all our actions; in fact, there is very little that humans do that does not involve the use of the hands. The hand offers points for unlimited dissertation and is the executive organ par excellence, carrying out directly or participating in almost all our actions; it is an organ for communication and an instrument of well-being as well as being the main site of one of the five senses: touch. On this background, attention will be focused on the importance that the hand plays in daily life and, particularly, on the difficulties inevitably faced by people who are forced to live without a hand, even if replaced by an orthopaedic prosthesis. This is the sense of occupational therapy in the context of upper limb amputees.

  7. Pirogoff amputation for a bilateral traumatic lower-extremity amputee: indication and technique.

    Science.gov (United States)

    Ipaktchi, Kyros; Seidl, Adam; Banegas, Rodrigo; Hak, David; Mauffrey, Cyril

    2014-06-01

    Although only a small portion of all lower-extremity amputations in the United States are of traumatic origin, almost half of all living amputees have sustained traumatic amputations. This particular epidemiology is explained by the younger age, and thus longer life expectancy, of traumatic amputees. In this group especially, restoration and lifelong maintenance of ambulation and mobility is essential. The authors present the case of a bilateral traumatic lower-leg amputee whose management included a Pirogoff amputation. Although this amputation technique is not widely used, the authors believe it greatly facilitated stump and soft tissue management in this case and allowed for improved mobility. The indication for and technique of Pirogoff amputation are described, and a brief overview of amputation techniques in the foot is provided. Copyright 2014, SLACK Incorporated.

  8. Use of prostheses in lower limb amputee patients due to peripheral arterial disease.

    Science.gov (United States)

    Chamlian, Therezinha Rosane

    2014-01-01

    To evaluate the indication of prosthesis during rehabilitation and the maintenance of their use or abandonment rate after discharge, as well as mortality of lower limb amputees due to peripheral arterial disease. A retrospective and cross-sectional study carried out with lower limb amputee patients, at transfemoral and transtibial levels, due to vascular conditions. The sample was composed of 310 patients (205 men, 105 women, mean age 61.8 years), transfemoral (142) and transtibial (150) levels, unilateral or bilateral (18). A total of 217 were fitted with prosthesis and 93 did not. Nonparametric statistical tests with equality of two proportions, 95% confidence interval and p value amputees, due to vascular conditions, during rehabilitation is high. However, maintenance of prosthesis is not frequent after discharge. Early and high mortality is observed mainly among diabetic patients.

  9. A wearable skin stretch haptic feedback device: Towards improving balance control in lower limb amputees.

    Science.gov (United States)

    Husman, M A B; Maqbool, H F; Awad, M I; Abouhossein, A; Dehghani-Sanij, A A

    2016-08-01

    Haptic feedback to lower limb amputees is essential to maximize the functionality of a prosthetic device by providing information to the user about the interaction with the environment and the position of the prostheses in space. Severed sensory pathway and the absence of connection between the prosthesis and the Central Nervous System (CNS) after lower limb amputation reduces balance control, increases visual dependency and increases risk of falls among amputees. This work describes the design of a wearable haptic feedback device for lower limb amputees using lateral skin-stretch modality intended to serve as a feedback cue during ambulation. A feedback scheme was proposed based on gait event detection for possible real-time postural adjustment. Preliminary perceptual test with healthy subjects in static condition was carried out and the results indicated over 98% accuracy in determining stimuli location around the upper leg region, suggesting good perceptibility of the delivered stimuli.

  10. Profile of match performance and heart rate response in Japanese amputee soccer.

    Science.gov (United States)

    Maehana, Hirofumi; Miyamoto, Aya; Koshiyama, Kenichi; Tanaka Yanagiya, Toshio; Yoshimura, Masafumi

    2017-05-05

    The purpose of this study was to profile the match performance and heart rate response in Japanese amputee soccer. Twelve amputee soccer players participated in this study. Match data were collected 20 samples in 4 matches. Match performances data such as total distance, high-intensity running (HIR: ≥13km·h-1) were collected using a global positioning systems technology. Heart rate (HR) was recorded using short-range radio telemetry. In addition, the rating of perceived exertion (RPE) was assessed immediately using Borg's original after the first half and the second half. This study showed that the distance covered over the 50 minutes of the match was 2984.2±56.1m, and it was significantly shorter in the second half than the first half (p<0.05). The distance covered by HIR was 205.3±100.5m, and there was no significant difference between the first half and the second half. Moreover, the mean HR during match was 176.8±7.9beats·min-1, which corresponded to 96.3% of HRmax. RPE was a high value of more 15 in both of the first half and the second half. This study was the first to evaluate competitive performance during matches in amputee soccer. Results of this study indicated that the exercise intensity was high in amputee soccer. It would be considered that causes were amputee soccer own rules and exercise style. These findings would serve as the reference when advance the future studies of amputee soccer.

  11. Iodine-Starch test for assessment of hyperhidrosis in amputees, evaluation of different methods of application.

    Science.gov (United States)

    Hansen, Colby; Wayment, Ben; Klein, Stephanie; Godfrey, Bradeigh

    2017-08-21

    Hyperhidrosis is a common problem for amputees. The iodine-starch test is frequently used to assess hyperhidrosis, but a method for its application has not been described for amputees. We performed an unblinded comparison of the iodine-starch test using various methods to protect the prosthesis in 10 prosthetic limb users with hyperhidrosis. Plastic wrap produced a diffuse pattern of sweating in 70% of subjects. Forty percent had complaints about this method, and 50% experienced leakage of iodine stain onto prosthetic liners. The prosthetic sheath produced a focal or multifocal reaction in 100% of subjects after 10 min of ambulation. Eighty percent had minor leakage onto the liner, and complaints were noted in 10%. The proportion that experienced diffuse sweating was significantly higher in the plastic wrap condition (p = 0.016; difference in proportions = 70%; 95% confidence interval = 32-100%). The prosthetic sock was tested in four subjects and all had at least mild complaints; three had minor leakage onto the liner. Repeated complaints and lack of stain prevention led to discontinuation with this method. Of the three methods, the sheath produces a focal or multifocal reaction after 10 min of ambulation and tends to cause less subject complaints. It should be the preferred method to apply the iodine-starch test to amputees. Implications for rehabilitation Hyperhidrosis is a common problem in amputees which negatively affects quality of life. The iodine-starch test is commonly used to guide treatment decisions for hyperhidrosis, but a preferred method for applying it in amputees has not been described. This study describes different methods for applying the iodine-starch test. A prosthetic sheath covering should be the preferred method for the iodine-starch test in amputees.

  12. Intracortical inhibition is modulated by phase of prosthetic rehabilitation in transtibial amputees

    Directory of Open Access Journals (Sweden)

    Brenton eHordacre

    2015-05-01

    Full Text Available Reorganisation of primary motor cortex (M1 is well described in long-term lower limb amputees. In contrast cortical reorganisation during the rehabilitation period after amputation is poorly understood. Thirteen transtibial amputees and thirteen gender matched control participants of similar age were recruited. Transcranial magnetic stimulation was used to assess corticomotor and intracortical excitability of M1 bilaterally. Neurophysiological assessments were conducted at admission, prosthetic casting, first walk and discharge. Gait variability at discharge was assessed as a functional measure. Compared to controls, amputees had reduced short-latency intracortical inhibition for the ipsilateral M1 at admission (p=0.01. Analysis across rehabilitation revealed short-latency intracortical inhibition was reduced for the contralateral M1 at first walk compared to discharge (p=0.003. For the ipsilateral M1 both short and long-latency intracortical inhibition were reduced at admission (p<0.05 and prosthetic casting (p<0.02. Analysis of the neurophysiology and gait function revealed several interesting relationships. For the contralateral M1, reduced inhibition at admission (p=0.04 and first walk (p=0.05 was associated with better gait function. For the ipsilateral M1, reduced inhibition at discharge (p=0.05 was associated with poor gait function. This study characterised intracortical excitability in rehabilitating amputees. A dichotomous relationship between reduced intracortical inhibition for each M1 and gait function was observed at different times. Intracortical inhibition may be an appropriate cortical biomarker of gait function in lower limb amputees during rehabilitation, but requires further investigation. Understanding M1 intracortical excitability of amputees undertaking prosthetic rehabilitation provides insight into brain reorganisation in the sub-acute post amputation period and may guide future studies seeking to improve rehabilitation

  13. The effects of a controlled energy storage and return prototype prosthetic foot on transtibial amputee ambulation

    Science.gov (United States)

    Segal, Ava D.; Zelik, Karl E.; Klute, Glenn K.; Morgenroth, David C.; Hahn, Michael E.; Orendurff, Michael S.; Adamczyk, Peter G.; Collins, Steven H.; Kuo, Arthur D.; Czerniecki, Joseph M.

    2015-01-01

    The lack of functional ankle musculature in lower limb amputees contributes to the reduced prosthetic ankle push-off, compensations at other joints and more energetically costly gait commonly observed in comparison to non-amputees. A variety of energy storing and return prosthetic feet have been developed to address these issues but have not been shown to sufficiently improve amputee biomechanics and energetic cost, perhaps because the timing and magnitude of energy return is not controlled. The goal of this study was to examine how a prototype microprocessor-controlled prosthetic foot designed to store some of the energy during loading and return it during push-off affects amputee gait. Unilateral transtibial amputees wore the Controlled Energy Storage and Return prosthetic foot (CESR), a conventional foot (CONV), and their previously prescribed foot (PRES) in random order. Three-dimensional gait analysis and net oxygen consumption were collected as participants walked at constant speed. The CESR foot demonstrated increased energy storage during early stance, increased prosthetic foot peak push-off power and work, increased prosthetic limb center of mass (COM) push-off work and decreased intact limb COM collision work compared to CONV and PRES. The biological contribution of the positive COM work for CESR was reduced compared to CONV and PRES. However, the net metabolic cost for CESR did not change compared to CONV and increased compared to PRES, which may partially reflect the greater weight, lack of individualized size and stiffness and relatively less familiarity for CESR and CONV. Controlled energy storage and return enhanced prosthetic push-off, but requires further design modifications to improve amputee walking economy. PMID:22100728

  14. The effects of a controlled energy storage and return prototype prosthetic foot on transtibial amputee ambulation.

    Science.gov (United States)

    Segal, Ava D; Zelik, Karl E; Klute, Glenn K; Morgenroth, David C; Hahn, Michael E; Orendurff, Michael S; Adamczyk, Peter G; Collins, Steven H; Kuo, Arthur D; Czerniecki, Joseph M

    2012-08-01

    The lack of functional ankle musculature in lower limb amputees contributes to the reduced prosthetic ankle push-off, compensations at other joints and more energetically costly gait commonly observed in comparison to non-amputees. A variety of energy storing and return prosthetic feet have been developed to address these issues but have not been shown to sufficiently improve amputee biomechanics and energetic cost, perhaps because the timing and magnitude of energy return is not controlled. The goal of this study was to examine how a prototype microprocessor-controlled prosthetic foot designed to store some of the energy during loading and return it during push-off affects amputee gait. Unilateral transtibial amputees wore the Controlled Energy Storage and Return prosthetic foot (CESR), a conventional foot (CONV), and their previously prescribed foot (PRES) in random order. Three-dimensional gait analysis and net oxygen consumption were collected as participants walked at constant speed. The CESR foot demonstrated increased energy storage during early stance, increased prosthetic foot peak push-off power and work, increased prosthetic limb center of mass (COM) push-off work and decreased intact limb COM collision work compared to CONV and PRES. The biological contribution of the positive COM work for CESR was reduced compared to CONV and PRES. However, the net metabolic cost for CESR did not change compared to CONV and increased compared to PRES, which may partially reflect the greater weight, lack of individualized size and stiffness and relatively less familiarity for CESR and CONV. Controlled energy storage and return enhanced prosthetic push-off, but requires further design modifications to improve amputee walking economy. Published by Elsevier B.V.

  15. Kinematics of gait using bionic and hydraulic knee joints in transfemoral amputees

    OpenAIRE

    Jaroslav Uchytil; Daniel Jandačka; Roman Farana; David Zahradník; Jiri Rosicky; Miroslav Janura

    2017-01-01

    Background: The development of new technologies has led to further improvements in prosthetic knee joints. Objective: The aim of this study was to compare angle parameters in knee and hip joints during the gait of transfemoral amputees and to determine the effect of the type of knee joint used on their symmetry. The study also compared pelvic movements in transfemoral amputees using different types of knee joints. Method: Eleven patients (5 female, 6 male, mean age 39.2 ± 10....

  16. Functional and Mental Health Status of United Kingdom Military Amputees Postrehabilitation.

    Science.gov (United States)

    Ladlow, Peter; Phillip, Rhodri; Etherington, John; Coppack, Russell; Bilzon, James; McGuigan, M Polly; Bennett, Alexander N

    2015-11-01

    To evaluate the functional and mental health status of severely injured traumatic amputees from the United Kingdom military at the completion of their rehabilitation pathway and to compare these data with the published normative data. Retrospective independent group comparison of descriptive rehabilitation data recorded postrehabilitation. A military complex trauma rehabilitation center. Amputees (N=65; mean age, 29±6 y) were evaluated at the completion of their rehabilitation pathway; of these, 54 were operationally (combat) injured (23 unilateral, 23 bilateral, 8 triple) and 11 nonoperationally injured (all unilateral). Continuous ∼4-week inpatient, physician-led, interdisciplinary rehabilitation followed by ∼4-weeks of patient-led, home-based rehabilitation. The New Injury Severity Score at the point of injury was used as the baseline reference. The 6-minute walk test, Amputee Mobility Predictor with Prosthesis, Special Interest Group in Amputee Medicine, Defence Medical Rehabilitation Centre mobility and activity of daily living scores as well as depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder Scale-7), mental health support, and pain scores were recorded at discharge and compared with the published normative data. The mean New Injury Severity Score was 40±15. After 34±14 months of rehabilitation, amputees achieved a mean 6-minute walk distance of 489±117 m compared with age-matched normative distances of 459 to 738 m. The 2 unilateral groups walked (544 m) significantly further (P>.05) than did the bilateral amputee (445±104 m) and triple amputee (387±99 m) groups. All groups demonstrated mean functional mobility scores consistent with scores of either active adults or community ambulators with limb loss. In total, 85% could walk/run independently and 95% could walk and perform activities of daily living independently with an aid/adaptation. No significant difference in mental health outcome was reported between the

  17. Evaluation of disabilities and activities of daily living of war-related bilateral lower extremity amputees.

    Science.gov (United States)

    Ebrahimzadeh, Mohammad H; Moradi, Ali; Bozorgnia, Shahram; Hallaj-Moghaddam, Mohammad

    2016-02-01

    Long-term consequences and the activities of daily living of bilateral lower limb amputation are not well documented. The aims of our study were to identify the long-term effects of bilateral lower extremity amputations on daily activities and understand how these amputees cope with their mobility assistive devices. Cross-sectional study. A total of 291 veterans with war bilateral lower limb amputations accepted to participate in a cross-sectional study. The average of follow-up was 25.4 years. A total of 152 amputees (54%) were involved in sports averagely 6.7 h per week. Bilateral amputees walk 10 m by the average of 15 ± 33 s, and they could walk continuously with their prosthesis 315 ± 295 m. They wore their prosthesis 6.8 ± 1.7 days per week and 7.9 ± 8.1 h per day. Of these, 6.7% of bilateral lower limb amputees needed help to wear their prosthesis; 88.3% of amputees used assistant device for walking. According to this survey, 73 (42%) prostheses in right limb were appropriate, 95 (54.6%) needed to be replaced, and 6 (3.4) needed to be fixed. On the left side, it was 76 (42%), 92 (52.0%), and 9 (5.1%), respectively. A total of 203 (74.9%) amputees reported limitations in at least one domain of the activities of daily living. The most common single item that affected the patients was ascending and descending stairs by the score of 66% of normal population. Veterans with bilateral lower limb amputations suffering from vast categories of daily problems. This study and its results confirm that bilateral lower limb amputees have major progressive disabilities in daily activities and their social performance. This should attract the attention of amputees' administrative organizations, social workers, health-care providers and caregiver providers. © The International Society for Prosthetics and Orthotics 2014.

  18. The quantification of game-induced muscle fatigue in amputee soccer players.

    Science.gov (United States)

    Simim, Mário A; Bradley, Paul S; da Silva, Bruno V; Mendes, Edmar L; de Mello, Marco T; Marocolo, Moacir; da Mota, Gustavo R

    2017-06-01

    This study quantified the degree of game-induced muscular fatigue in amputee soccer players. Thirty-three male amputee soccer players performed muscular tests (Push Up Test [PUT], Countermovement Jump Test [CMJ] and medicine-ball throw [MBT]) before and after a competitive match. Five players served as a control group. The rating of perceived exertion was recorded after each battery. Control group demonstrated no differences between the two testing batteries (P>0.05, effect size [ES]: 0.1-0.4). However, match group illustrated markedly lower performances for PUT (-17%, Pamputee soccer matches causes impairments in muscular performance and this could be different to able-bodied players.

  19. Rehabilitation of the older lower limb amputee: a brief review.

    Science.gov (United States)

    Cutson, T M; Bongiorni, D R

    1996-11-01

    To review outcomes, over the last 25 to 30 years, of prosthetic rehabilitation in the older patient with a major lower limb amputation. Literature review of articles and reports about lower limb amputation, using key words elderly amputee rehabilitation, and lower limb amputation, through a computerized Medline Search. Age alone should not determine prosthetic rehabilitation. Comorbidities and general health are important determinants. The more proximal the amputation, the more energy is demanded from the cardiovascular and pulmonary systems for prosthetic gait. Changes in surgical technique and revascularization procedures have allowed preservation of the knee, which decreases energy demands and allows more older patients a chance to undergo rehabilitation for ambulation. Although the ratio of below knee (transtibial) amputations to above knee (transfemoral) amputations has increased, overall postsurgical mortality (10-30%), long term survival (40-50%@2 years, 30-40%@5 years), and risk of loss of the contralateral leg (15-20%@2 years) has not changed significantly since the 1960s. Despite the lack of improvement in survival as a result of the systemic vascular disease, the older patient can benefit from rehabilitation efforts with goals of prosthetic ambulation or simply cosmesis. The shortened longevity emphasizes the need for timely rehabilitation to enhance the quality of the remaining years. The geriatrician can add to the presurgical care and preprosthetic phase of rehabilitation by attention to the problems common to the older patient, i.e., multiple comorbidities, polypharmacy, immobility, and depression. Postoperatively, early mobilization is crucial to avoid the deleterious effects of immobility in the older person. Further investigations into the psychosocial issues and cost benefits of limb loss and prosthetic rehabilitation are needed. In addition, comparison of the various rehabilitation protocols and the impact of cardiac resting before

  20. Lower-limb amputee ankle and hip kinetic response to an imposed error in mediolateral foot placement.

    Science.gov (United States)

    Segal, Ava D; Shofer, Jane B; Klute, Glenn K

    2015-11-26

    Maintaining balance while walking is challenging for lower limb amputees. The effect of prosthetic foot stiffness on recovery kinetics from an error in foot placement may inform prescription practice and lead to new interventions designed to improve balance. Ten unilateral transtibial amputees were fit with two prosthetic feet with different stiffness properties in random order. After a 3-week acclimation period, they returned to the lab for testing before switching feet. Twelve non-amputees also participated in a single data collection. While walking on an instrumented treadmill, we imposed a repeatable, unexpected medial or lateral disturbance in foot placement by releasing a burst of air at the ankle just before heel strike. Three-dimensional motion capture, ground reaction force and center of pressure (COP) data were collected for two steps prior, the disturbed step and three steps after the disturbance. During undisturbed walking, coronal ankle impulse was lower by 42% for amputees wearing a stiff compared to a compliant foot (p=0.017); however, across steps, both prosthetic recovery patterns were similar compared to the sound limb and non-amputees. Peak coronal hip moment was 15-20% lower for both foot types during undisturbed walking (p<0.001), with less change in response to the medial disturbance (p<0.001) compared to the sound limb and non-amputees. Amputee prosthetic COP excursion was unaffected by the disturbance (2.4% change) compared to the sound limb (59% change; p<0.001) and non-amputees (55% change; p<0.001). These findings imply that a prosthetic foot-ankle system able to contribute to ankle kinetics may improve walking balance among amputees. Published by Elsevier Ltd.

  1. Adaptation to random and systematic errors: Comparison of amputee and non-amputee control interfaces with varying levels of process noise

    Science.gov (United States)

    Kording, Konrad P.; Hargrove, Levi J.; Sensinger, Jonathon W.

    2017-01-01

    The objective of this study was to understand how people adapt to errors when using a myoelectric control interface. We compared adaptation across 1) non-amputee subjects using joint angle, joint torque, and myoelectric control interfaces, and 2) amputee subjects using myoelectric control interfaces with residual and intact limbs (five total control interface conditions). We measured trial-by-trial adaptation to self-generated errors and random perturbations during a virtual, single degree-of-freedom task with two levels of feedback uncertainty, and evaluated adaptation by fitting a hierarchical Kalman filter model. We have two main results. First, adaptation to random perturbations was similar across all control interfaces, whereas adaptation to self-generated errors differed. These patterns matched predictions of our model, which was fit to each control interface by changing the process noise parameter that represented system variability. Second, in amputee subjects, we found similar adaptation rates and error levels between residual and intact limbs. These results link prosthesis control to broader areas of motor learning and adaptation and provide a useful model of adaptation with myoelectric control. The model of adaptation will help us understand and solve prosthesis control challenges, such as providing additional sensory feedback. PMID:28301512

  2. Adaptation to random and systematic errors: Comparison of amputee and non-amputee control interfaces with varying levels of process noise.

    Directory of Open Access Journals (Sweden)

    Reva E Johnson

    Full Text Available The objective of this study was to understand how people adapt to errors when using a myoelectric control interface. We compared adaptation across 1 non-amputee subjects using joint angle, joint torque, and myoelectric control interfaces, and 2 amputee subjects using myoelectric control interfaces with residual and intact limbs (five total control interface conditions. We measured trial-by-trial adaptation to self-generated errors and random perturbations during a virtual, single degree-of-freedom task with two levels of feedback uncertainty, and evaluated adaptation by fitting a hierarchical Kalman filter model. We have two main results. First, adaptation to random perturbations was similar across all control interfaces, whereas adaptation to self-generated errors differed. These patterns matched predictions of our model, which was fit to each control interface by changing the process noise parameter that represented system variability. Second, in amputee subjects, we found similar adaptation rates and error levels between residual and intact limbs. These results link prosthesis control to broader areas of motor learning and adaptation and provide a useful model of adaptation with myoelectric control. The model of adaptation will help us understand and solve prosthesis control challenges, such as providing additional sensory feedback.

  3. Adaptation to random and systematic errors: Comparison of amputee and non-amputee control interfaces with varying levels of process noise.

    Science.gov (United States)

    Johnson, Reva E; Kording, Konrad P; Hargrove, Levi J; Sensinger, Jonathon W

    2017-01-01

    The objective of this study was to understand how people adapt to errors when using a myoelectric control interface. We compared adaptation across 1) non-amputee subjects using joint angle, joint torque, and myoelectric control interfaces, and 2) amputee subjects using myoelectric control interfaces with residual and intact limbs (five total control interface conditions). We measured trial-by-trial adaptation to self-generated errors and random perturbations during a virtual, single degree-of-freedom task with two levels of feedback uncertainty, and evaluated adaptation by fitting a hierarchical Kalman filter model. We have two main results. First, adaptation to random perturbations was similar across all control interfaces, whereas adaptation to self-generated errors differed. These patterns matched predictions of our model, which was fit to each control interface by changing the process noise parameter that represented system variability. Second, in amputee subjects, we found similar adaptation rates and error levels between residual and intact limbs. These results link prosthesis control to broader areas of motor learning and adaptation and provide a useful model of adaptation with myoelectric control. The model of adaptation will help us understand and solve prosthesis control challenges, such as providing additional sensory feedback.

  4. Mirror therapy in lower limb amputees. A look beyond primary motor cortex reorganization

    Energy Technology Data Exchange (ETDEWEB)

    Seidel, S.; Essmeister, M.; Sycha, T.; Auff, E. [Vienna Medical Univ. (Austria). Dept. of Neurology; Kasprian, G.; Furtner, J.; Schoepf, V.; Prayer, D. [Vienna Medical Univ. (Austria). Dept. of Neuroradiology

    2011-11-15

    Phantom pain in upper limb amputees is associated with the extent of reorganization in the primary sensorimotor cortex. Mirror visual feedback therapy has been shown to improve phantom pain. We investigated the extent of cortical reorganization in lower limb amputees and changes in neural activity induced by mirror therapy. Eight lower limb amputees underwent 12 sessions of MVFT and functional magnetic resonance imaging (fMRI) of the brain before the first and after the last MVFT session. FMRI sessions consisted of two runs in which subjects were instructed to perform repetitive movement of the healthy and phantom ankle. Before MVFT, the mean phantom pain intensity was 4.6 {+-} 3.1 on a visual analog scale and decreased to 1.8 {+-} 1.7 (p = 0.04). We did not observe a consistent pattern of cortical activation in primary sensorimotor areas during phantom limb movements. Following MVFT, increased activity was obtained in the right orbitofrontal cortex during phantom ankle movements. Comparison of cortical activity during movements of the phantom ankle and the intact ankle showed significantly higher activity in the left inferior frontal cortex (pars triangularis). These results question the known association between phantom pain and primary sensorimotor reorganization and propose reorganizational changes involving multiple cortical areas in lower limb amputees. Finally, reduction of phantom pain after mirror visual feedback therapy was associated with increased prefrontal cortical activity during phantom ankle movements. (orig.)

  5. Hip prosthesis in sitting posture for bilateral transfemoral amputee after burn injury: a case report.

    Science.gov (United States)

    Shimizu, Yukiyo; Mutsuzaki, Hirotaka; Maezawa, Takayuki; Idei, Yuji; Takao, Kazuya; Takeuchi, Ryoko; Onishi, Shinzo; Hada, Yasushi; Yamazaki, Masashi; Wadano, Yasuyoshi

    2017-10-01

    To overcome the challenges of rehabilitation of bilateral transfemoral amputees, we developed a novel "hip prosthesis in the sitting posture." Case Description and Methods: A 64-year-old male bilateral transfemoral amputee was transferred for rehabilitation 4 months following a burn injury. His wounds remained unhealed for 20 months; thus, he was unable to participate in standing training with the standard prosthetic sockets. Hip prosthesis in the sitting posture has very little friction between the sockets and residual limbs, which facilitated our patient to begin standing and walking exercises. Findings and Outcomes: The patient's refractory wounds healed 1 month after initiating exercises using hip prosthesis in the sitting posture, and he could begin rehabilitation with the standard prostheses. Hip prosthesis in the sitting posture enabled a bilateral transfemoral amputee with unhealed residual limbs to stand, walk, and begin balance training. Hip prosthesis in the sitting posture is an effective temporary prosthesis to prevent disuse until wounds are healed and to continue rehabilitation with standard prostheses. Clinical relevance Hip prosthesis in the sitting posture is useful for bilateral transfemoral amputees with unhealed residual limbs after burn injuries to prevent disuse and maintain motivation for walking.

  6. Foot clearance strategy for step-over-step stair climbing in transfemoral amputees.

    Science.gov (United States)

    Hobara, Hiroaki; Kobayashi, Yoshiyuki; Nakamura, Takashi; Yamasaki, Nobuya; Ogata, Toru

    2014-08-01

    Stair ascent is a particularly challenging task for transfemoral amputees. The aim of this clinical note was to describe the kinematic features of foot clearance in transfemoral amputee who can ascend stairs using a step-over-step strategy. The marker trajectories of the first metatarsophalangeal joint (Mt1) and clearance height were measured in two transfemoral amputees who could (TF1) and could not (TF2) climb stairs using a step-over-step strategy. The Mt1 marker trajectories of the TF1 moved backward in the early swing phase, and the trajectory followed an off-centered parabolic arc to achieve a similar clearance height as able-bodied subjects. TF2 could not climb the stairs without tripping in each step. An effective compensatory strategy to avoid tripping during stair climbing may be to use the hip joint for a backward extension and rapid flexion of the prosthetic leg during the early swing phase. The foot clearance strategy in transfemoral amputees who can climb stairs using a step-over-step strategy will help us better understand adaptive prosthetic control and thus develop more effective gait rehabilitation programs. © The International Society for Prosthetics and Orthotics 2013.

  7. Rehabilitation of the older vascular amputee: a review of the literature.

    Science.gov (United States)

    Fleury, Aisling M; Salih, Salih A; Peel, Nancye M

    2013-04-01

    The aim was to review the literature on factors affecting prosthetic rehabilitation of older vascular lower extremity amputees. A search of the literature was carried out using the MEDLINE, EMBASE and CINAHL databases up to September 2010. Only original English language articles were accepted. Relevant studies were reviewed and selected based on prespecified inclusion criteria namely: age more than 65 years; vascular cause for the amputation; amputation level of below knee, through-the-knee or above knee; and discussed factors affecting rehabilitation. Age alone is not an absolute contraindication to prosthetic limb prescription; however, it does influence the potential success of gait retraining. Other factors influencing prosthetic fitting and use include comorbidities, premorbid function, level of amputation, status of the remaining limb and patient motivation. Prosthetic gait retraining is not possible in every older dysvascular amputee; however, almost all amputees will benefit from a rehabilitation program to increase independence in transfers and learn wheelchair skills. The MESH key words were: "aged" "diabetes complications" "peripheral vascular diseases" "amputees" "amputation" "rehabilitation" and "artificial limbs". © 2012 Japan Geriatrics Society.

  8. Mechanisms of Gait Asymmetry Due to Push-off Deficiency in Unilateral Amputees

    Science.gov (United States)

    Adamczyk, Peter Gabriel; Kuo, Arthur D.

    2015-01-01

    Unilateral lower-limb amputees exhibit asymmetry in many gait features, such as ground force, step time, step length, and joint mechanics. Although these asymmetries result from weak prosthetic-side push-off, there is no proven mechanistic explanation of how that impairment propagates to the rest of the body. We used a simple dynamic walking model to explore possible consequences of a unilateral impairment similar to that of a transtibial amputee. The model compensates for reduced push-off work from one leg by performing more work elsewhere, for example during the middle of stance by either or both legs. The model predicts several gait abnormalities, including slower forward velocity of the body center-of-mass (COM) during intact-side stance, greater energy dissipation in the intact side, and more positive work overall. We tested these predictions with data from unilateral transtibial amputees (N = 11) and non-amputee control subjects (N = 10) walking on an instrumented treadmill. We observed several predicted asymmetries, including forward velocity during stance phases and energy dissipation from the two limbs, as well as greater work overall. Secondary adaptations, such as to reduce discomfort, may exacerbate asymmetry, but these simple principles suggest that some asymmetry may be unavoidable in cases of unilateral limb loss. PMID:25222950

  9. Evaluation of functionality in acquired and congenital upper extremity child amputees.

    Science.gov (United States)

    Korkmaz, Mustafa; Erbahçeci, Fatih; Ulger, Ozlem; Topuz, Semra

    2012-01-01

    The aim of this study was to evaluate the functional level of children with congenital and acquired upper limb loss after a rehabilitation program. This study included a total of 40 children, aged 8 to 17 years with upper limb loss. Children were divided into two groups; congenital amputees (n=20) and acquired amputees (n=20). The children underwent prosthetic fitting, prosthetic training and rehabilitation. The Child Amputee Prosthetics Project - Functional Status Inventory (CAPP-FSI) and Prosthetic Upper Extremity Functional Index (PUFI) were used at the initial visit to the prosthetic unit without prosthesis, 3 weeks after the prosthetic training and 6 months after discharge with and without prosthesis. The results with and without the prosthesis were compared between the acquired and congenital amputee groups. There were significant differences in all tests performed at the baseline, at the 3rd week, and at the 6th month without prosthesis and at the 3rd week and at the 6th month with prosthesis (pamputees. Functionality may improve based on these factors.

  10. Adjustments to amputation and an artificial limb in lower limb amputees.

    Science.gov (United States)

    Sinha, Richa; van den Heuvel, Wim J A; Arokiasamy, Perianayagam

    2014-04-01

    Positive adjustments to amputation and an artificial limb play important roles in the rehabilitation process. To study the different facets of adjustments to amputation and an artificial limb in lower limb amputees and to assess the possible role of different background and amputation-related factors that could potentially influence these adjustments. Cross-sectional. Adult unilateral and non-congenital lower limb amputees (n = 368) met the inclusion/exclusion criteria. Face-to-face interviews were conducted using structured questionnaires including patient's background, amputation and the Trinity Amputation and Prosthesis Experience Scales. Amputees were on average satisfied with the functioning of the prosthesis, moderately psychosocially adjusted and not restricted in performing functional and social activities, except for athletic activities. Age, employment, daily use of prosthesis and assistive device use were the most important factors associated with adjustments to amputation and prosthesis, followed by gender, co-morbidity and amputation level. Evaluation of employment status and measures to curb unemployment through vocational rehabilitation and providing assistance for placement should be intrinsic to the rehabilitation programme. Future studies are envisaged to understand the underlying factors determining the extent of daily use of prosthesis and the reasons for the use of assistive devices by the amputees. Clinical relevance Proper appraisal and measures to alleviate employment and co-morbidity, related issues, routine evaluation of daily use of prosthesis and providing appropriate gait training might facilitate immediate and long-term adjustment.

  11. Innovative Use of Thighplasty to Improve Prosthesis Fit and Function in a Transfemoral Amputee

    Directory of Open Access Journals (Sweden)

    Todd A. Kuiken, MD, PhD

    2018-01-01

    Conclusions:. This study demonstrates the potential of using a routine plastic surgery procedure to modify the intrinsic properties of the limb and to improve functional outcomes in overweight or obese transfemoral amputees. This technique is a potentially attractive option compared with multiple reiterations of sockets, which can be time-consuming and costly.

  12. Gait analysis of transfemoral amputee patients using prostheses with two different knee joints

    NARCIS (Netherlands)

    Boonstra, AM; Schrama, JM; Eisma, WH; Hof, AL; Fidler, EV

    Objective: To evaluate the gait of transfemoral amputee patients using a prosthesis with a 4-bar linkage knee joint with either a mechanical swing phase control (Otto Beck 3R20) or a pneumatic swing phase control (Tehlin knee). Design: Randomized cross-over trial. Setting: Rehabilitation Department

  13. Study on Gait Efficiency and Energy Cost of Below Knee Amputees After Therapeutic Practices

    Directory of Open Access Journals (Sweden)

    Durbadal Biswas

    2011-04-01

    Full Text Available An earlier research advocated that a below knee amputee (BK with conventional trans-tibial prosthesis attains higher gait efficiency at lower energy cost with therapeutic practices of proper time and co-ordination in compare to normal subjects of similar physical parameters and quality of life. The present study focused on comparative analysis of energy cost and gait efficiency between a group of below knee amputees and a control group (normal subjects without amputation to indicate the consistency of the earlier findings. The subjects were selected with similar physical parameters and quality of life. Oxygen Uptake (VO2 and Heart Rate (HR were measured by Cosmed® k4 b2 analyzer system. Gait efficiency (p < 0.0001 was found higher with lower energy cost for BK amputees after therapeutic practices than control group. The therapeutic activities contributed to efficient gait pattern for amputees ensuring proper time and co-ordination with balance in consistence to the earlier research.

  14. Piezoelectric Bimorphs’ Characteristics as In-Socket Sensors for Transfemoral Amputees

    Directory of Open Access Journals (Sweden)

    Amr M. El-Sayed

    2014-12-01

    Full Text Available Alternative sensory systems for the development of prosthetic knees are being increasingly highlighted nowadays, due to the rapid advancements in the field of lower limb prosthetics. This study presents the use of piezoelectric bimorphs as in-socket sensors for transfemoral amputees. An Instron machine was used in the calibration procedure and the corresponding output data were further analyzed to determine the static and dynamic characteristics of the piezoelectric bimorph. The piezoelectric bimorph showed appropriate static operating range, repeatability, hysteresis, and frequency response for application in lower prosthesis, with a force range of 0–100 N. To further validate this finding, an experiment was conducted with a single transfemoral amputee subject to measure the stump/socket pressure using the piezoelectric bimorph embedded inside the socket. The results showed that a maximum interface pressure of about 27 kPa occurred at the anterior proximal site compared to the anterior distal and posterior sites, consistent with values published in other studies. This paper highlighted the capacity of piezoelectric bimorphs to perform as in-socket sensors for transfemoral amputees. However, further experiments are recommended to be conducted with different amputees with different socket types.

  15. The relative contributions of the prosthetic and sound limb to balance control in unilateral transtibial amputees

    NARCIS (Netherlands)

    Curtze, C.; Hof, A.L.; Postema, K.; Otten, Bert

    In unilateral transtibial amputees maintenance of standing balance is compromised due to the lack of active ankle control in the prosthetic limb. The purpose of this study is to disentangle the contribution of the prosthetic and sound limb to balance control following waist-pull perturbations. We

  16. WALKING SPEED OF NORMAL SUBJECTS AND AMPUTEES - ASPECTS OF VALIDITY OF GAIT ANALYSIS

    NARCIS (Netherlands)

    BOONSTRA, AM; FIDLER, [No Value; EISMA, WH

    This study investigated some aspects of the validity of walking speed recording in 15 normal subjects. 16 trans-femoral empathics 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

  17. Early treatment of trans-tibial amputees: retrospective analysis of early fitting and elastic bandaging

    NARCIS (Netherlands)

    van Velzen, A.D.; Nederhand, Marcus Johannes; Emmelot, C.H.; IJzerman, Maarten Joost

    2005-01-01

    This study investigates the effects of early fitting in trans-tibial amputees. The assumption is that compared to elastic bandaging, the use of a rigid dressing in early fitting will result in quicker wound healing and earlier ambulation. A retrospective file search was carried out in three

  18. Kinetic and Kinematic Differences in a Golf Swing in One and Both Lower Limb Amputees

    Directory of Open Access Journals (Sweden)

    Stastny Petr

    2015-12-01

    Full Text Available Amputee golfers need to cope with the absence of sole proprioception, a decreased range of swing motion and other factors which should be recognized for training purposes. The aim of this study was to determine the kinetic and kinematic differences in the golf swing in one leg and two legs amputees. The participants consisted of two males and one female at a professional or amateur level with a different degree of disability. Each participant was taped by 3D markers and performed five golf swings with the iron 6. The intraclass correlation coefficient (ICC did not vary between individuals in kinematics, however, it was low in kinetic variables of two leg amputees. The Kendal rank correlation showed a significant relationship between the level of amputation and a large number of kinetic and kinematic variables such as X factor, O factor, S factor and individual body angles. The fluency and similarity of the golf swing did not depend on the level of amputation. One lower limb amputation did not seem to increase movement variability contrary to two lower limb amputation. The most variable parameter was a weight-shift in all golfers. The takeaway and horizontal force angle depended on the level of amputation rather than individual technique, thus, their modification by training may be difficult. Estimation of golf swing „mistakes“ in amputees in respect to the leading arm in an early follow or late follow position appeared to be useless.

  19. Does long-distance walking improve or deteriorate walking stability of transtibial amputees?

    Science.gov (United States)

    Wong, Duo Wai-Chi; Lam, Wing Kai; Yeung, L F; Lee, Winson C C

    2015-10-01

    Falls are common in transtibial amputees which are linked to their poor stability. While amputees are encouraged to walk more, they are more vulnerable to fatigue which leads to even poorer walking stability. The objective of this study was to evaluate the dynamic stability of amputees after long-distance walking. Six male unilateral transtibial amputees (age: 53 (SD: 8.8); height: 170cm (SD: 3.4); weight: 75kg (SD: 4.7)) performed two sessions (30minutes each) of treadmill walking, separated by a short period of gait tests. Gait tests were performed before the walking (baseline) and after each session of treadmill walking. Gait parameters and their variability across repeated steps at each of the three conditions were computed. There were no significant differences in walking speed, step length, stance time, time of occurrence, and magnitude of peak angular velocities of the knee and hip joint (P>0.05). However, variability of knee and hip angular velocity after 30-minute walking was significantly higher than the baseline (Pamputees to restore their walking stability after further continuous walking. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Sciatic nerve block performed with nerve stimulation technique in an amputee a case study

    DEFF Research Database (Denmark)

    Heiring, C.; Kristensen, Billy

    2008-01-01

    We present a case of a sciatic nerve block performed with the nerve stimulation technique. This technique is normally not used in amputees because detection of a motor response to an electrical stimulation is impossible. In our patient the stimulation provoked a phantom sensation of movement...

  1. Piezoelectric Bimorphs' Characteristics as In-Socket Sensors for Transfemoral Amputees

    Science.gov (United States)

    El-Sayed, Amr M.; Hamzaid, Nur Azah; Osman, Noor Azuan Abu

    2014-01-01

    Alternative sensory systems for the development of prosthetic knees are being increasingly highlighted nowadays, due to the rapid advancements in the field of lower limb prosthetics. This study presents the use of piezoelectric bimorphs as in-socket sensors for transfemoral amputees. An Instron machine was used in the calibration procedure and the corresponding output data were further analyzed to determine the static and dynamic characteristics of the piezoelectric bimorph. The piezoelectric bimorph showed appropriate static operating range, repeatability, hysteresis, and frequency response for application in lower prosthesis, with a force range of 0–100 N. To further validate this finding, an experiment was conducted with a single transfemoral amputee subject to measure the stump/socket pressure using the piezoelectric bimorph embedded inside the socket. The results showed that a maximum interface pressure of about 27 kPa occurred at the anterior proximal site compared to the anterior distal and posterior sites, consistent with values published in other studies. This paper highlighted the capacity of piezoelectric bimorphs to perform as in-socket sensors for transfemoral amputees. However, further experiments are recommended to be conducted with different amputees with different socket types. PMID:25513823

  2. Mirror therapy in lower limb amputees. A look beyond primary motor cortex reorganization

    International Nuclear Information System (INIS)

    Seidel, S.; Essmeister, M.; Sycha, T.; Auff, E.; Kasprian, G.; Furtner, J.; Schoepf, V.; Prayer, D.

    2011-01-01

    Phantom pain in upper limb amputees is associated with the extent of reorganization in the primary sensorimotor cortex. Mirror visual feedback therapy has been shown to improve phantom pain. We investigated the extent of cortical reorganization in lower limb amputees and changes in neural activity induced by mirror therapy. Eight lower limb amputees underwent 12 sessions of MVFT and functional magnetic resonance imaging (fMRI) of the brain before the first and after the last MVFT session. FMRI sessions consisted of two runs in which subjects were instructed to perform repetitive movement of the healthy and phantom ankle. Before MVFT, the mean phantom pain intensity was 4.6 ± 3.1 on a visual analog scale and decreased to 1.8 ± 1.7 (p = 0.04). We did not observe a consistent pattern of cortical activation in primary sensorimotor areas during phantom limb movements. Following MVFT, increased activity was obtained in the right orbitofrontal cortex during phantom ankle movements. Comparison of cortical activity during movements of the phantom ankle and the intact ankle showed significantly higher activity in the left inferior frontal cortex (pars triangularis). These results question the known association between phantom pain and primary sensorimotor reorganization and propose reorganizational changes involving multiple cortical areas in lower limb amputees. Finally, reduction of phantom pain after mirror visual feedback therapy was associated with increased prefrontal cortical activity during phantom ankle movements. (orig.)

  3. Glasgow Coma Scores, Early Opioids, and Posttraumatic Stress Disorder Among Combat Amputees

    Science.gov (United States)

    2014-04-01

    Center, 2011). Patients with severe brain or spinal injury leading to paralysis were excluded. Of the 857 combat amputees injured through 2008, we...included postconcussion syndrome, pain, and sleep disorders. Data Analysis Sample sizes for analyses of data varied by the level of care at which

  4. Pain, functional status, social function and conditions of habitation in elderly unilaterally lower limb amputees

    Directory of Open Access Journals (Sweden)

    Đurović Aleksandar

    2007-01-01

    Full Text Available Background/Aim. Few authors are involved in home rehabilitation of amputees or their reintegration into the community. It has been remarked that there is a discontinuity between the phases of the amputee rehabilitation in Serbia. The aim of the study was to establish pain characteristics and functional status of amputees two months after the amputation and to determine their social function and the conditions of their habitation. Methods. This prospective observation study involved 38 elderly amputees with unilateral lower limb amputations. The patients were tested at the hospital on discharge and at their homes two months after the amputation. Pain intensity and functional status were measured by a visual analogue scale (VAS and by Functional Independence Measure (FIM. The patients’ social function was assessed using the Social Dysfunction Rating Scale (SDRS and conditions of their habitation by the self-created Scale of Conditions of Habitation (SCH. In statistic analysis we used the Student t test, χ2 test and Analysis of variance (ANOVA. Results. The majority of patients (63% underwent below knee amputation caused by diabetes (89%. A significant number of patients (84%, χ2 = 17.78; p < 0.01 was not visited by a physiotherapist nor an occupational therapist during two months at home. In this period, the majority of the amputees (68% had phantom pain or residual limb pain (21%. Two months after amputation the pain intensity was significantly lower (VAS = 4.07±2.19; 2.34±1.41; p < 0.001, and the functional status significantly better than on discharge (FIM = 75.13±16.52; 87.87±16.48; p < 0.001. The amputees had the average level of social dysfunction (SDRS = 62.00±11.68 and conditions of habitation (SCH = 7.81±1.97. Conclusion. A total 38 elderly amputees with unilateral lower limb amputations achieved significant functional improvement and reduction of pain, in spite of their social dysfunction, the absence of socio-medical support

  5. Understanding adaptive gait in lower-limb amputees: insights from multivariate analyses

    Science.gov (United States)

    2013-01-01

    Background In this paper we use multivariate statistical techniques to gain insights into how adaptive gait involving obstacle crossing is regulated in lower-limb amputees compared to able-bodied controls, with the aim of identifying underlying characteristics that differ between the two groups and consequently highlighting gait deficits in the amputees. Methods Eight unilateral trans-tibial amputees and twelve able-bodied controls completed adaptive gait trials involving negotiating various height obstacles; with amputees leading with their prosthetic limb. Spatiotemporal variables that are regularly used to quantify how gait is adapted when crossing obstacles were determined and subsequently analysed using multivariate statistical techniques. Results and discussion There were fundamental differences in the adaptive gait between the two groups. Compared to controls, amputees had a reduced approach velocity, reduced foot placement distance before and after the obstacle and reduced foot clearance over it, and reduced lead-limb knee flexion during the step following crossing. Logistic regression analysis highlighted the variables that best distinguished between the gait of the two groups and multiple regression analysis (with approach velocity as a controlling factor) helped identify what gait adaptations were driving the differences seen in these variables. Getting closer to the obstacle before crossing it appeared to be a strategy to ensure the heel of the lead-limb foot passed over the obstacle prior to the foot being lowered to the ground. Despite adopting such a heel clearance strategy, the lead-foot was positioned closer to the obstacle following crossing, which was likely a result of a desire to attain a limb/foot angle and orientation at instant of landing that minimised loads on the residuum (as evidenced by the reduced lead-limb knee flexion during the step following crossing). These changes in foot placement meant the foot was in a different part of swing

  6. Apparent motion perception in lower limb amputees with phantom sensations: "obstacle shunning" and "obstacle tolerance".

    Science.gov (United States)

    Saetta, Gianluca; Grond, Ilva; Brugger, Peter; Lenggenhager, Bigna; Tsay, Anthony J; Giummarra, Melita J

    2018-03-21

    Phantom limbs are the phenomenal persistence of postural and sensorimotor features of an amputated limb. Although immaterial, their characteristics can be modulated by the presence of physical matter. For instance, the phantom may disappear when its phenomenal space is invaded by objects ("obstacle shunning"). Alternatively, "obstacle tolerance" occurs when the phantom is not limited by the law of impenetrability and co-exists with physical objects. Here we examined the link between this under-investigated aspect of phantom limbs and apparent motion perception. The illusion of apparent motion of human limbs involves the perception that a limb moves through or around an object, depending on the stimulus onset asynchrony (SOA) for the two images. Participants included 12 unilateral lower limb amputees matched for obstacle shunning (n = 6) and obstacle tolerance (n = 6) experiences, and 14 non-amputees. Using multilevel linear models, we replicated robust biases for short perceived trajectories for short SOA (moving through the object), and long trajectories (circumventing the object) for long SOAs in both groups. Importantly, however, amputees with obstacle shunning perceived leg stimuli to predominantly move through the object, whereas amputees with obstacle tolerance perceived leg stimuli to predominantly move around the object. That is, in people who experience obstacle shunning, apparent motion perception of lower limbs was not constrained to the laws of impenetrability (as the phantom disappears when invaded by objects), and legs can therefore move through physical objects. Amputees who experience obstacle tolerance, however, had stronger solidity constraints for lower limb apparent motion, perhaps because they must avoid co-location of the phantom with physical objects. Phantom limb experience does, therefore, appear to be modulated by intuitive physics, but not in the same way for everyone. This may have important implications for limb experience post

  7. Locomotor Adaptation by Transtibial Amputees Walking With an Experimental Powered Prosthesis Under Continuous Myoelectric Control.

    Science.gov (United States)

    Huang, Stephanie; Wensman, Jeffrey P; Ferris, Daniel P

    2016-05-01

    Lower limb amputees can use electrical activity from their residual muscles for myoelectric control of a powered prosthesis. The most common approach for myoelectric control is a finite state controller that identifies behavioral states and discrete changes in motor tasks. An alternative approach to state-based myoelectric control is continuous proportional myoelectric control where ongoing electrical activity has a proportional relationship to the prosthetic joint torque or power. To test the potential of continuous proportional myoelectric control for powered lower limb prostheses, we recruited five unilateral transtibial amputees to walk on a treadmill with an experimental powered prosthesis. Subjects walked using the powered prosthesis with and without visual feedback of their control signal in real time. Amputee subjects were able to adapt their residual muscle activation patterns to alter prosthetic ankle mechanics when we provided visual feedback of their myoelectric control signal in real time. During walking with visual feedback, subjects significantly increased their peak prosthetic ankle power ( p = 0.02, ANOVA) and positive work ( p = 0.02, ANOVA) during gait above their prescribed prosthesis values. However, without visual feedback, the subjects did not increase their peak ankle power during push off. These results show that amputee users were able to volitionally alter their prosthesis mechanics during walking, but only when given an explicit goal for their residual muscle motor commands. Future studies that examine the motor and learning capabilities of lower limb amputees using their residual muscles for continuous proportional myoelectric control are needed to determine the viability of integrating continuous high-level control with existing finite state prosthetic controllers.

  8. Postural responses to dynamic perturbations in amputee fallers versus nonfallers: a comparative study with able-bodied subjects.

    Science.gov (United States)

    Vanicek, Natalie; Strike, Siobhan; McNaughton, Lars; Polman, Remco

    2009-06-01

    To quantify postural responses in amputee fallers versus nonfallers by using computerized dynamic posturography. All participants completed standard protocols on the Sensory Organization Test (SOT) and Motor Control Test (MCT) of the NeuroCom Equitest. Human performance laboratory in a university in the United Kingdom. Transtibial amputees (n=9) and able-bodied subjects (n=9) (all categorized into fallers and nonfallers according to their falls history in the previous 9 mo). Not applicable. Equilibrium and strategy scores on the SOT. Postural response latency and weight distribution on the MCT. Equilibrium scores were highest when somatosensory information was accurate, but there were no differences between the groups. Strategy scores were lower when visual cues and somatosensory information were inaccurate, and the fallers and nonfallers used a combination of ankle and hip strategies to prevent a loss of balance. The amputee nonfallers indicated they had a greater reliance on visual input even when it was inaccurate compared with the amputee fallers, whereas the control fallers used the hip strategy significantly more compared with the control nonfallers (SOT condition 6: 56+/-22 vs 72+/-10, P=.01). Weight distribution symmetry showed that the amputee nonfallers bore significantly more weight through their intact limb compared with the amputee fallers during backward and forward translations (Pamputees or distinguish between community-dwelling control fallers and nonfallers. Amputee and control fallers can prevent a fall during challenging static and dynamic conditions by adapting their neuromuscular responses. The results from this study have important implications for amputee gait rehabilitation, falls prevention, and treatment programs.

  9. Use of an Activity Monitor and GPS Device to Assess Community Activity and Participation in Transtibial Amputees

    Science.gov (United States)

    Hordacre, Brenton; Barr, Christopher; Crotty, Maria

    2014-01-01

    This study characterized measures of community activity and participation of transtibial amputees based on combined data from separate accelerometer and GPS devices. The relationship between community activity and participation and standard clinical measures was assessed. Forty-seven participants were recruited (78% male, mean age 60.5 years). Participants wore the accelerometer and GPS devices for seven consecutive days. Data were linked to assess community activity (community based step counts) and community participation (number of community visits). Community activity and participation were compared across amputee K-level groups. Forty-six participants completed the study. On average each participant completed 16,645 (standard deviation (SD) 13,274) community steps and 16 (SD 10.9) community visits over seven days. There were differences between K-level groups for measures of community activity (F(2,45) = 9.4, p amputees demonstrating lower levels of community activity and participation than K3 and K4 amputees. There was no significant difference between K3 and K4 for community activity (p = 0.28) or participation (p = 0.43). This study demonstrated methodology to link accelerometer and GPS data to assess community activity and participation in a group of transtibial amputees. Differences in K-levels do not appear to accurately reflect actual community activity or participation in higher functioning transtibial amputees. PMID:24670721

  10. Use of an Activity Monitor and GPS Device to Assess Community Activity and Participation in Transtibial Amputees

    Directory of Open Access Journals (Sweden)

    Brenton Hordacre

    2014-03-01

    Full Text Available This study characterized measures of community activity and participation of transtibial amputees based on combined data from separate accelerometer and GPS devices. The relationship between community activity and participation and standard clinical measures was assessed. Forty-seven participants were recruited (78% male, mean age 60.5 years. Participants wore the accelerometer and GPS devices for seven consecutive days. Data were linked to assess community activity (community based step counts and community participation (number of community visits. Community activity and participation were compared across amputee K-level groups. Forty-six participants completed the study. On average each participant completed 16,645 (standard deviation (SD 13,274 community steps and 16 (SD 10.9 community visits over seven days. There were differences between K-level groups for measures of community activity (F(2,45 = 9.4, p < 0.001 and participation (F(2,45 = 6.9, p = 0.002 with lower functioning K1/2 amputees demonstrating lower levels of community activity and participation than K3 and K4 amputees. There was no significant difference between K3 and K4 for community activity (p = 0.28 or participation (p = 0.43. This study demonstrated methodology to link accelerometer and GPS data to assess community activity and participation in a group of transtibial amputees. Differences in K-levels do not appear to accurately reflect actual community activity or participation in higher functioning transtibial amputees.

  11. Use of an activity monitor and GPS device to assess community activity and participation in transtibial amputees.

    Science.gov (United States)

    Hordacre, Brenton; Barr, Christopher; Crotty, Maria

    2014-03-25

    This study characterized measures of community activity and participation of transtibial amputees based on combined data from separate accelerometer and GPS devices. The relationship between community activity and participation and standard clinical measures was assessed. Forty-seven participants were recruited (78% male, mean age 60.5 years). Participants wore the accelerometer and GPS devices for seven consecutive days. Data were linked to assess community activity (community based step counts) and community participation (number of community visits). Community activity and participation were compared across amputee K-level groups. Forty-six participants completed the study. On average each participant completed 16,645 (standard deviation (SD) 13,274) community steps and 16 (SD 10.9) community visits over seven days. There were differences between K-level groups for measures of community activity (F(2,45) = 9.4, p amputees demonstrating lower levels of community activity and participation than K3 and K4 amputees. There was no significant difference between K3 and K4 for community activity (p = 0.28) or participation (p = 0.43). This study demonstrated methodology to link accelerometer and GPS data to assess community activity and participation in a group of transtibial amputees. Differences in K-levels do not appear to accurately reflect actual community activity or participation in higher functioning transtibial amputees.

  12. An event-related potential study on the time course of mental rotation in upper-limb amputees.

    Science.gov (United States)

    Lyu, Yuanyuan; Guo, Xiaoli; Bekrater-Bodmann, Robin; Flor, Herta; Tong, Shanbao

    2017-05-01

    Mental rotation of body parts involves sequential cognitive processes, including visual processing, categorization and the mental rotation process itself. However, how these processes are affected by the amputation of a limb is still unclear. Twenty-five right upper-limb amputees and the same number of matched healthy controls participated in a hand mental rotation task. Thirty-two-channel electroencephalography (EEG) was recorded and the event-related potentials (ERPs) were analyzed. In the early visual processing phase, amputees and controls showed a similar P100. During the categorization phase, the amputees exhibited a decreased N200 compared with controls, and the decline was positively correlated with the time since amputation. In the mental rotation phase, controls had a larger ERP for the right upright hand than for the left upright hand, while amputees had a larger ERP for the left (intact) upright hand than for the right (affected) upright hand. Early visual processing was not affected by limb amputation. However, the perceptual salience of hand pictures decreased and the intact hand gained more significance in the amputees. Event-related potentials had the capability of showing the differences in categorization and mental rotation phases between amputees and controls. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  13. Improving Functional Outcomes for Vascular Amputees Through Use of Mirror Therapy and Elimination of the Effects of Electromagnetic Fields.

    Science.gov (United States)

    Houston, Helen; Dickerson, Anne E

    2016-01-01

    The objective of this pilot study was to investigate the effectiveness of combining an amputee limb cover to eliminate the effects of electromagnetic fields (i.e., pain) and a Mirror Therapy exercise program to improve functional outcomes for vascular amputees. A cross-sectional repeated-measures design was used with 14 participants with either acute amputations or surgery at least 8 to 24 months previously. The 4-week intervention included the use of an amputee limb cover and mirror therapy exercises each day. The outcome measures were activities of daily living interference (e.g., self-care, walking, car transfer, low chair transfer, sleep), and well-being (e.g., satisfaction, mood, quality of life) at three times (pre- and posttreatment and maintenance). Participants with acute amputations made significant improvements in the areas of self-care, walking, car transfer, sleep, mood, and quality of life, while the subacute participants improved significantly in sleep and satisfaction. A reduction in the time required before prosthetic fitting decreased from 12 weeks to 8 weeks for acute amputees and an improvement in wearing tolerance from 0-2 to 8-12 hours for the subacute amputees were unexpected results suggesting the combined intervention may improves the extent to which amputees can increase participation in their activities of everyday living.

  14. Transfemoral amputee recovery strategies following trips to their sound and prosthesis sides throughout swing phase.

    Science.gov (United States)

    Shirota, Camila; Simon, Ann M; Kuiken, Todd A

    2015-09-09

    Recovering from trips is challenging for transfemoral amputees, and attempts often result in falls. Better understanding of the effects of the sensory-motor deficits brought by amputation and the functional limitations of prosthetic devices could help guide therapy and fall prevention mechanisms in prostheses. However, how transfemoral amputees attempt to recover from trips on the sound and prosthesis sides throughout swing phase is poorly understood. We tripped eight able-bodied subjects and eight unilateral transfemoral amputees wearing their prescribed prostheses. The protocol consisted of six repetitions of 6 and 4 points throughout swing phase, respectively. We compared recovery strategies in able-bodied, sound side and prosthesis side limbs. The number of kinematic recovery strategies used, when they were used throughout swing phase, and kinematic characteristics (tripped limb joint angles, bilateral trochanter height and time from foot arrest to foot strike) of each strategy were compared across limb groups. Non-parametric statistical tests with corrections for post-hoc tests were used. Amputees used the same recovery strategies as able-bodied subjects on both sound and prosthesis sides, although not all subjects used all strategies. Compared to able-bodied subjects, amputees used delayed-lowering strategies less often from 30-60 % of swing phase on the sound side, and from 45-60 % of swing phase on the prosthesis side. Within-strategy kinematic differences occurred across limbs; however, these differences were not consistent across all strategies. Amputee-specific recovery strategies-that are not used by control subjects-occurred following trips on both the sound and prosthesis sides in mid- to late swing. Collectively, these results suggest that sensory input from the distal tripped leg is not necessary to trigger able-bodied trip recovery strategies. In addition, the differences between sound and prosthesis side recoveries indicate that the ability of the

  15. Incidence and morbidity of concomitant spine fractures in combat-related amputees.

    Science.gov (United States)

    Bevevino, Adam J; Lehman, Ronald A; Tintle, Scott M; Kang, Daniel G; Dworak, Theodora C; Potter, Benjamin K

    2014-04-01

    High-energy blasts are the most frequent cause of combat-related amputations in Operations Iraqi and Enduring Freedom (OIF/OEF). The nondiscriminating effects of this mechanism often result in both appendicular and axial skeletal injuries. Despite this recognized coincident injury pattern, the incidence and consequence of spine fractures in trauma-related combat amputees are unknown. This study sought to determine the incidence and morbidity of the associated spine fractures on patients with traumatic lower extremity amputation sustained during OIF/OEF. Retrospective case control. Two hundred twenty-six combat-related lower extremity amputees presenting to a single institution and injured between 2003 and 2008 were included for analysis. Physiologic and functional outcome measures were used to determine the influence of spine fractures on combat amputees. Physiologic measures included intensive care unit (ICU) admission rates, injury severity score (ISS), rate of narcotic/neuropathic pain use, and heterotopic ossification (HO) rates. Functional outcome measures included return-to-duty rates and ambulatory status at final follow-up. Data from 300 consecutive combat-related lower extremity amputations were retrospectively reviewed and grouped. Group 1 consisted of amputees with associated spine fractures, and Group 2 consisted of amputees without spine fractures. The results of the two groups were compared with regard to initial presentation and final functional outcomes. A total of 226 patients sustained 300 lower extremity amputations secondary to combat-related injuries, the most common mechanism being an improvised explosive device. Twenty-nine of these patients had a spine fracture (13%). Group 1 had a higher ISS than Group 2 (30 vs. 19, pamputees is 13%. The results suggest that combat-related amputees with spine fractures are more likely to sustain severe injuries to other body systems, as indicated by the significantly higher ISS and rates of ICU admission

  16. Bilateral below-knee amputee 107 years old and still wearing artificial limbs.

    Science.gov (United States)

    Saadah, E S

    1988-08-01

    It is not often that a person over 100 years old is able to walk on artificial limbs and maintain their mobility and independence after going through bilateral below-knee amputation. This case note is about a 107 year old lady with bilateral below-knee amputation, who is perhaps the oldest surviving bilateral below-knee amputee in the British Isles, if not in the World. There does not appear to be any reference in the literature to a bilateral below-knee amputee of 100 years old plus, who is still alive and wearing his or her artificial limbs. The nearest is of a 91 year old lady with bilateral below-knee amputation and wearing artificial limbs, reported by Gerhardt et al, 1986.

  17. Dalayed referral of lower limb amputees for rehabilitation; an audit study

    International Nuclear Information System (INIS)

    Raza, M.A.; Fahim, M.; Gill, Z.A.; Waheed, A.

    2014-01-01

    determine the causes of delayed referral of lower limb amputees for rehabilitation. Study Design: Descriptive study. Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine Rawalpindi, from April 2012 to July 2012. Patient and Methods: Thirty two patient cases of lower limb amputation were included. They were referred cases to AFIRM from operational areas and CMHs all over Pakistan for provision of prosthesis and rehabilitation. Results: A total of 32 lower limbamputees' male patients with mean age 29 years were included in the study. Transtibial level was the most common amputation 19(57.6 %). Improvised Explosive Device (IED) was the most common mode of injury 19(57.6 %). 34.37 % patients were delayed due to leave granted to them at local set ups before referral to AFIRM for rehabilitation. Conclusion: Delayed referral for rehabilitation has poor impact on rehabilitation of an amputee. (author)

  18. Physiologically Relevant Prosthetic Limb Movement Feedback for Upper and Lower Extremity Amputees

    Science.gov (United States)

    2016-10-01

    Extremity Amputees 5b. GRANT NUMBER W81XWH-15-1-0575 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER Paul Marasco*, Jacqueline Hebert, Alex...most effectively influence motor control. We are developing novel socket designs (EMG and Suspension Focused Design, and Vibration Tactor Focused...the context of optimal foraging theory. 4) Gait perturbation analysis. In order to develop devices that have clinical applicability prosthetic socket

  19. Mobile Gait Analysis System for Lower Limb Amputee High-Level Activity Rehabilitation

    Science.gov (United States)

    2013-09-01

    regarding the presentation of clinically meaningful data to users . Additional data collection and prosthesis adjustment sessions are necessary to bridge the... prosthesis is also an iterative and ongoing process which means multiple gait lab analyses are needed to get the best results . It also requires patient...the performance of lower leg prosthesis and the overall 15 quality of life of amputee. To further evaluate the effectiveness of the analysis system

  20. Ultrasound Findings of Young and Traumatic Amputees With Lower Extremity Residual Limb Pain in Turkey.

    Science.gov (United States)

    Aydemir, Koray; Demir, Yasin; Güzelküçük, Ümüt; Tezel, Kutay; Yilmaz, Bilge

    2017-08-01

    The current study was designed to document clinical and ultrasound (US) findings of patients with residual limb pain (RLP) after amputation and to investigate the relationship between these findings. A chart review was performed to identify demographic and clinical data including the age (current and at the time of injury), time since amputation, gender, reason for amputation, affected limb number, side and level of limb loss, and ultrasonographic findings of young and traumatic amputees with RLP. The study included a total of 147 patients. Inflammation and neuroma were the leading pathologies in 20-29 years and 30-39 years age groups, respectively. Inflammation/edema were detected significantly more in patients with amputation (P = 0.001). Neuroma was found at a significantly high rate in patients at 1-5 years (P = 0.029) and infection/abscess was more common in patients at >5 years since amputation (P = 0.051). The percentage of neuromas in below-the-knee amputees was significantly higher than in non-below-the-knee amputees (45.8% vs. 28.6%). Neuroma formation was detected in 50% of the patients with land mine-related amputation and at 27% in patients with amputation secondary to other traumatic reasons. Regression analysis showed below-the-knee-level amputation to be an associated factor for US abnormality. The leading US findings were inflammation/edema, neuroma, and infection/abscess in traumatic amputees with RLP. The US findings might be different in patients according to the time since amputation. Patient with land mine-related amputations may have different US findings.

  1. A prosthesis-specific multi-link segment model of lower-limb amputee sprinting.

    Science.gov (United States)

    Rigney, Stacey M; Simmons, Anne; Kark, Lauren

    2016-10-03

    Lower-limb amputees commonly utilize non-articulating energy storage and return (ESAR) prostheses for high impact activities such as sprinting. Despite these prostheses lacking an articulating ankle joint, amputee gait analysis conventionally features a two-link segment model of the prosthetic foot. This paper investigated the effects of the selected link segment model׳s marker-set and geometry on a unilateral amputee sprinter׳s calculated lower-limb kinematics, kinetics and energetics. A total of five lower-limb models of the Ottobock ® 1E90 Sprinter were developed, including two conventional shank-foot models that each used a different version of the Plug-in-Gait (PiG) marker-set to test the effect of prosthesis ankle marker location. Two Hybrid prosthesis-specific models were then developed, also using the PiG marker-sets, with the anatomical shank and foot replaced by prosthesis-specific geometry separated into two segments. Finally, a Multi-link segment (MLS) model was developed, consisting of six segments for the prosthesis as defined by a custom marker-set. All full-body musculoskeletal models were tested using four trials of experimental marker trajectories within OpenSim 3.2 (Stanford, California, USA) to find the affected and unaffected hip, knee and ankle kinematics, kinetics and energetics. The geometry of the selected lower-limb prosthesis model was found to significantly affect all variables on the affected leg (p prosthesis-specific spatial, inertial and elastic properties from full-body models significantly affects the calculated amputee gait characteristics, and we therefore recommend the implementation of a MLS model. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Longitudinal kinematic and kinetic adaptations to obstacle crossing in recent lower limb amputees.

    Science.gov (United States)

    Barnett, Cleveland T; Polman, Remco C J; Vanicek, Natalie

    2014-12-01

    Obstacle crossing is an important activity of daily living, necessary to avoid tripping or falling, although it is not fully understood how transtibial amputees adapt to performing this activity of daily living following discharge from rehabilitation. The objective of this study was to investigate the longitudinal adaptations in obstacle crossing in transtibial amputees post-discharge from rehabilitation. Longitudinal repeated measures. Seven unilateral transtibial amputees crossed an obstacle 0.1m high positioned along a walkway while kinematic and kinetic data were recorded at 1, 3 and 6 months post-discharge. At 6 months post-discharge, walking velocity had increased (0.17 m.s(-1)) with most participants self-selecting an intact lead limb preference. During swing phase, peak knee flexion (p = 0.03) and peak knee power absorption (K4; p = 0.01) were greater with an intact versus affected lead limb preference. Having crossed the obstacle, intact limb peak ankle power generation in pre-swing (A2; p = 0.01) and knee power absorption (K3; p = 0.05) during stance phase were greater when compared to the affected limb. Obstacle crossing improved, although a greater reliance on intact limb function was highlighted. Results suggested that further improvements to locomotor performance may be obtained by increasing affected limb knee range of motion and concentric and eccentric strength of the knee extensors and flexors. The novel objective data from this study establish an understanding of how recent transtibial amputees adapt to performing obstacle crossing following discharge from rehabilitation. This allows for evidence-based clinical interventions to be developed, aimed at optimising biomechanical function, thus improving overall locomotor performance and perhaps subsequent quality of life. © The International Society for Prosthetics and Orthotics 2013.

  3. Kinematic differences exist between transtibial amputee fallers and non-fallers during downwards step transitioning.

    Science.gov (United States)

    Vanicek, Natalie; Strike, Siobhán C; Polman, Remco

    2015-08-01

    Stair negotiation is biomechanically more challenging than level gait. There are few biomechanical assessments of transtibial amputees descending stairs and none specifically related to falls. Stair descent may elicit more differences than level gait in amputees with and without a previous falls history. The aim of this study was to compare the gait kinematics of fallers and non-fallers during downwards step transitioning in transtibial amputees. Cross-sectional study. Six fallers and five non-fallers completed step transition trials on a three-step staircase at their self-selected pace. Nine participants exhibited a clear preference to lead with the affected limb, while two had no preference. Four participants self-selected a step-to rather than a reciprocal stair descent strategy. The fallers who used a reciprocal strategy walked 44% more quickly than the non-fallers. To compensate for the lack of active plantar flexion of the prosthetic foot, exaggerated range of motion occurred proximally at the pelvis during swing. The step-to group was more reliant on the handrails than the reciprocal group and walked more slowly. As anticipated, the fallers walked faster than the non-fallers despite employing the more difficult 'roll-over' technique. Handrail use could help to improve dynamic control during downwards step transitions. Transtibial amputees are advised to descend steps using external support, such as handrails, for enhanced dynamic control. Hip abductor and knee extensor eccentric strength should be improved through targeted exercise. Prosthetic socket fit should be checked to allow adequate knee range of motion on the affected side. © The International Society for Prosthetics and Orthotics 2014.

  4. Lower-limb amputee rehabilitation in Australia: analysis of a national data set 2004-10.

    Science.gov (United States)

    Hordacre, Brenton G; Stevermuer, Tara; Simmonds, Frances; Crotty, Maria; Eagar, Kathy

    2013-02-01

    Examine demographics, clinical characteristics and rehabilitation outcomes of lower-limb amputees, using the Australasian Rehabilitation Outcomes Centre (AROC) database. Lower-limb amputee rehabilitation separations between 2004 and 2010 were identified using AROC impairment codes 5.3-5.7.(1) Analysis was conducted by year, impairment code, Australian National Sub-acute and Non-Acute Patient (AN-SNAP) classification (S2-224, Functional Independence Measure (FIM) motor(Mot) score 72-91; S2-225, FIM (Mot) score 14-71) and states of Australia. Mean length of stay (LOS) for all lower-limb amputee episodes was 36.1 days (95% confidence interval (CI): 35.4-36.9). Majority of episodes were unilateral below knee (63.6%), males (71.8%) with a mean age of 67.9 years (95% CI: 67.6-68.3). Year-on-year analysis revealed a trend for increasing LOS and decreasing age. Analysis by impairment code demonstrated no significant difference in rehabilitation outcomes. Analysis by AN-SNAP found that LOS was 16.2 days longer for S2-225 than for S2-224 (95% CI: 14.7-17.8, Prehabilitation services across states. Although amputees represented a comparatively small proportion of all rehabilitation episodes in Australia, their LOS was significant. Unlike many other rehabilitation conditions, there was no evidence of decreasing LOS over time. AN-SNAP classes were effective in distinguishing rehabilitation outcomes, and could potentially be used more effectively in planning rehabilitation programs.

  5. Configuring a Powered Knee and Ankle Prosthesis for Transfemoral Amputees within Five Specific Ambulation Modes

    Science.gov (United States)

    Simon, Ann M.; Ingraham, Kimberly A.; Fey, Nicholas P.; Finucane, Suzanne B.; Lipschutz, Robert D.; Young, Aaron J.; Hargrove, Levi J.

    2014-01-01

    Lower limb prostheses that can generate net positive mechanical work may restore more ambulation modes to amputees. However, configuration of these devices imposes an additional burden on clinicians relative to conventional prostheses; devices for transfemoral amputees that require configuration of both a knee and an ankle joint are especially challenging. In this paper, we present an approach to configuring such powered devices. We developed modified intrinsic control strategies—which mimic the behavior of biological joints, depend on instantaneous loads within the prosthesis, or set impedance based on values from previous states, as well as a set of starting configuration parameters. We developed tables that include a list of desired clinical gait kinematics and the parameter modifications necessary to alter them. Our approach was implemented for a powered knee and ankle prosthesis in five ambulation modes (level-ground walking, ramp ascent/descent, and stair ascent/descent). The strategies and set of starting configuration parameters were developed using data from three individuals with unilateral transfemoral amputations who had previous experience using the device; this approach was then tested on three novice unilateral transfemoral amputees. Only 17% of the total number of parameters (i.e., 24 of the 140) had to be independently adjusted for each novice user to achieve all five ambulation modes and the initial accommodation period (i.e., time to configure the device for all modes) was reduced by 56%, to 5 hours or less. This approach and subsequent reduction in configuration time may help translate powered prostheses into a viable clinical option where amputees can more quickly appreciate the benefits such devices can provide. PMID:24914674

  6. Immersive VR in Phantom Limb Pain Therapy of Amputee Patients Due to Critical Limb Ischemia

    Directory of Open Access Journals (Sweden)

    Zanfir Ana-Maria

    2017-09-01

    Full Text Available Introduction: Phantom limb pain (PLP occurs in approximately 75% of patients who undergo limb amputation. In identifying the etiopathogenic mechanisms, multidisciplinary approaches are increasingly important in explaining the causality based on neurological and psychological factors. PLP has many negative effects on the amputee's physical and mental integrity, which is why a variety of treatments have been conceived, whose effectiveness is rather limited.

  7. Static Standing Trunk Sway Assessment in Amputees – Effects of Sub-Threshold Stimulation

    Directory of Open Access Journals (Sweden)

    L. Ming-Yih

    2007-01-01

    Full Text Available Sub-threshold electrical stimulation can enhance the sensitivity of the human somatosensory system to improve the balance control capability of elderly was shown in recent rehabilitation articles. The purpose of this study was to evaluate the postural sway of trans-tibial amputees when performing single leg quiet standing on firm surface. Four unilateral trans-tibial amputees who consecutively wore prosthetics over 2 years were recruited in this study. Subjects performed single leg quiet standing trails with sub-threshold electrical stimulation applied at the quadriceps muscle during the trails. Spatial co-ordinates for the determination kinematic data (sway distance of the center of mass (COM on second sacral (S2 were collected using an ultrasound-based Zebris CMS-HS system. The single leg quiet standing test is measure considered to assess postural steadiness in a static position by a spatial measurement. The common notion is that a better postural steadiness, i.e. less postural sway, allows for longer time single leg quiet standing. However, there is lack of evidence how postural steadiness during single leg quiet standing changes over time. In this article, we hypothesized that the static balance of single leg quiet standing could be improved for providing proprioceptive neuromuscular facilitation using sub-sensory stimulation in amputees. To test this hypothesis, a computerized sub-threshold low-level electrical stimulation device was developed and proposed for clinical study. Experimental results show that reduction in all of the postural sway indices (constant time sway length, max sway distance and average sway distance and increase in single leg support time index during single leg quiet standing by applying sub-sensory stimulation. The single leg quiet standing test findings suggest that sub-threshold electrical stimulation rehabilitation strategies may be effective in improving static balance performance for amputees.

  8. Return to Duty Rate of Amputee Soldiers in the Current Conflicts in Afghanistan and Iraq

    Science.gov (United States)

    2010-06-01

    6 If an amputee soldier wishes to remain on active duty, he or she must demonstrate a higher level of function with a prosthesis and have the...elbow disartic- ulation), below elbow, wrist disarticulation (includes hand proximal to the metacarpals), above knee (includes hip dis- articulation...94% of senior enlisted and senior officers returned to duty after total hip replacement. Senior enlisted personnel usually have more time in service

  9. Studying Upper-Limb Amputee Prosthesis Use to Inform Device Design

    Science.gov (United States)

    2017-10-01

    comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to...Myoelectric Control Symposium, (MEC) Website(s) or other Internet site(s) Recruitment Page 11 https://www.facebook.com/YaleGrabLab/ Technologies...prosthesis use during daily living by upper-limb amputees • Develop task-related prosthesis usage /non- usage statistics • Examine compensatory motions

  10. Vacuum level effects on gait characteristics for unilateral transtibial amputees with elevated vacuum suspension.

    Science.gov (United States)

    Xu, Hang; Greenland, Kasey; Bloswick, Donald; Zhao, Jie; Merryweather, Andrew

    2017-03-01

    The elevated vacuum suspension system has demonstrated unique health benefits for amputees, but the effect of vacuum pressure values on gait characteristics is still unclear. The purpose of this study was to investigate the effects of elevated vacuum levels on temporal parameters, kinematics and kinetics for unilateral transtibial amputees. Three-dimensional gait analysis was conducted in 9 unilateral transtibial amputees walking at a controlled speed with five vacuum levels ranging from 0 to 20inHg, and also in 9 able-bodied subjects walking at self-preferred speed. Repeated ANOVA and Dunnett's t-test were performed to determine the effect of vacuum level and limb for within subject and between groups. The effect of vacuum level significantly affected peak hip external rotation and external knee adduction moment. Maximum braking and propulsive ground reaction forces generally increased for the residual limb and decreased for the intact limb with increasing vacuum. Additionally, the intact limb experienced an increased loading due to gait asymmetry for several variables. There was no systematic vacuum level effect on gait. Higher vacuum levels, such as 15 and 20inHg, were more comfortable and provided some relief to the intact limb, but may also increase the risk of osteoarthritis of the residual limb due to the increased peak external hip and knee adduction moments. Very low vacuum should be avoided because of the negative effects on gait symmetry. A moderate vacuum level at 15inHg is suggested for unilateral transtibial amputees with elevated vacuum suspension. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Choosing best components for an amputee: a methodology for the best decision-making

    OpenAIRE

    Matos, José Pedro; Tomás, Mª Teresa

    2016-01-01

    Introduction - The harmony between the stump and the prosthesis is critical to allow it to fulfill its function enabling an efficient gait. A well fitted socket, with an efficient and comfortable suspension, allows the amputee to continue their daily living activities, maintaining the stump functional, making this correlation between socket and suspension very important in the functionality of the prosthesis, mobility and overall satisfaction with the device. Of our knowledge, the quantitativ...

  12. Secure Microprocessor-Controlled Prosthetic Leg for Elderly Amputees: Preliminary Results

    Directory of Open Access Journals (Sweden)

    S. Krut

    2011-01-01

    Full Text Available We introduce a new prosthetic leg design, adapted to elderly trans-femoral amputees. Technical progress in prosthesis design mainly concerns active individuals. An important number of elderly amputees are not very mobile, tire easily, present reduced muscle strength, and have difficulties managing their balance. Therefore, the needs and characteristics of this specific population are very different from those of younger ones and the prosthetic solutions are not adapted. Our artificial knee has been designed to fulfill the specific requirements of this population in terms of capabilities, transfer assistance, security, intuitiveness, simplicity of use, and types of physical activity to be performed. We particularly focused our efforts on ensuring safe and secure stand-to-sit transfers. We developed an approach to control the different states of the prosthetic joint (blocked, free, resistant, associated with different physical activities. Amputee posture and motion are observed through a single multi-axis force sensor embedded in the prosthesis. The patient behaves naturally, while the controller analyses his movements in order to detect his intention to sit down. The detection algorithm is based on a reference pattern, calibrated individually, to which the sensor data are compared, and submitted to a set of tests allowing the discrimination of the intention to sit down from other activities. Preliminary validation of the system has been performed in order to verify the applicability of the prosthesis to different tasks: walking, standing, sitting down, standing up, picking up an object from a chair, slope and stair climbing.

  13. Gait asymmetry of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees.

    Science.gov (United States)

    Kaufman, Kenton R; Frittoli, Serena; Frigo, Carlo A

    2012-06-01

    Amputees walk with an asymmetrical gait, which may lead to future musculoskeletal degenerative changes. The purpose of this study was to compare the gait asymmetry of active transfemoral amputees while using a passive mechanical knee joint or a microprocessor-controlled knee joint. Objective 3D gait measurements were obtained in 15 subjects (12 men and 3 women; age 42, range 26-57). Research participants were longtime users of a mechanical prosthesis (mean 20 years, range 3-36 years). Joint symmetry was calculated using a novel method that includes the entire waveform throughout the gait cycle. There was no significant difference in hip, knee and ankle kinematics symmetry when using the different knee prostheses. In contrast, the results demonstrated a significant improvement in lower extremity joint kinetics symmetry when using the microprocessor-controlled knee. Use of the microprocessor-controlled knee joint resulted in improved gait symmetry. These improvements may lead to a reduction in the degenerative musculoskeletal changes often experienced by amputees. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Anthropometric profile and physical performance characteristic of the Brazilian amputee football (soccer team

    Directory of Open Access Journals (Sweden)

    Mário A. M. Simim

    2013-09-01

    Full Text Available Amputee football is a variation of conventional soccer in which athletes with lower limb amputation and one athelete with upper limb amputation (the goalkeeper participate. The objective of this study was to investigate the anthropometric and physical characteristics of amputee football athletes and to verify differences between heart rate peak (HRpeak and equations for predicting maximum heart rate (HRmax. Twelve amputee soccer players from the Brazilian team participated in this study. The body mass, height and body composition were measured. The physical tests used were: the 20 m running test, the T-square test and the Yo Yo intermitent recovery test - level 1 (YYIRT1. The percentage of fat was significantly different between midfielders and defenders. No significant differences were found between positions in the physical tests. The HRpeak was significantly lower than all of HRmax prediction equations tested. We conclude that the indicators of physical performance did not differ significantly between the different tactics roles of players, and that, after intermittent maximum effort, the cardiac response was lower when compared with the investigated HRmax prediction equations.

  15. Physical activity and quality of life of amputees in southern Brazil.

    Science.gov (United States)

    da Silva, Rudney; Rizzo, Julia Ghazel; Gutierres Filho, Paulo José Barbosa; Ramos, Valmor; Deans, Sarah

    2011-12-01

    Physical activity is a positive component of human health. Its effects are associated with improvement in physical, psychological and social aspects of quality of life. Physical activity is therefore an important factor in the rehabilitation of amputees. To analyse the relationship between physical activity and quality of life for amputees in southern Brazil. Descriptive, cross-sectional design with nonrandomized sample. A total of 40 questionnaire instruments were distributed to subjects who met the inclusion criteria, with a response rate of 55% (22 individuals, n = 15 males, n = 7 females). Outcome measurements were obtained through the International Physical Activity Questionnaire and World Health Organization Quality of Life-Bref. The sample was characterized by physically active adult male prosthetic users with positive quality of life, and amputation below the right knee caused by mechanical trauma related to traffic accidents with motorcycles. Significant correlations were identified between all domains of quality of life and between level of physical activity and psychological quality of life. No correlation was identified between gender and quality of life variables or physical activity levels. This study showed that in very active amputees of both genders, level of physical activity is not associated with quality of life except for the psychological domain.

  16. The effect of amputation level and age on outcome: an analysis of 135 amputees.

    Science.gov (United States)

    Yilmaz, Murat; Gulabi, Deniz; Kaya, Ibrahim; Bayram, Erhan; Cecen, Gultekin Sitki

    2016-01-01

    In this retrospective study, the impact of age, amputation level and the cause of amputation were examined using the Hospital Anxiety and Depression Scale (HADS) and Medicare K scores of amputees with unilateral lower-limb amputation. In total, 135 patients with unilateral transfemoral (TF) or (TT) transtibial amputations were examined. All data were collected using questionnaires that were either self-administered or administered during an interview. The HADS was developed as a self-reporting questionnaire to detect adverse anxiety and depressive status. K code is used to describe the functional abilities of amputees. The mean age at the time of surgery was 52.79 ± 13.08 years. The mean time since amputation was 59.20 ± 24.41 months for TT, and 60.89 ± 22.09 months for TF amputation. The HADS-A scores of the transfemoral amputation group were determined as significantly high compared to those of the transtibial group (p traumatic transfemoral amputation. Therefore, adequate psychiatric evaluation and rehabilitation should be applied to all amputees, especially in cases of young, traumatic, transfemoral amputations. Level 3, retrospective comparative cohort study.

  17. Leg stiffness during sprinting in transfemoral amputees with running-specific prosthesis.

    Science.gov (United States)

    Sano, Yoko; Makimoto, Atsushi; Hashizume, Satoru; Murai, Akihiko; Kobayashi, Yoshiyuki; Takemura, Hiroshi; Hobara, Hiroaki

    2017-07-01

    Carbon fiber running-specific prostheses are designed to reproduce the spring-like stepping behavior of individuals similar to springs loaded by the entire body mass (i.e. spring-mass model). The aim of this study was to test whether leg stiffness would be modulated differently between intact and prosthetic legs in transfemoral amputees wearing RSP during sprinting. Eight unilateral transfemoral amputees performed maximum sprinting along an indoor overground runway. Leg stiffness was calculated from kinetic and kinematic data in intact and prosthetic legs. The results showed that leg stiffness was for the prosthetic limb approximately 12% decreased compared to the intact limb. Although there was no difference in leg compression between the legs, maximal vertical ground reaction force was significantly greater in the intact leg than in the prosthetic one. These results indicate that asymmetric modulation of leg stiffness in transfemoral amputees with running-specific prostheses is mainly associated with asymmetric ground reaction force. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Feasibility study of transtibial amputee walking using a powered prosthetic foot.

    Science.gov (United States)

    Grimmer, Martin; Holgate, Matthew; Ward, Jeffrey; Boehler, Alexander; Seyfarth, Andre

    2017-07-01

    Passive prosthetic feet are not able to provide non-amputee kinematics and kinetics for the ankle joint. Persons with amputations show reduced interlimb symmetry, slower walking speeds, and increased walking effort. To improve ankle range of motion and push off, various powered prosthetic feet were introduced. This feasibility study analyzed if predefined motor reference trajectories can be used to achieve non-amputee ankle biomechanics during walking with the powered prosthetic foot, Walk-Run Ankle. Trajectories were calculated using the desired ankle angle and ankle moment based spring deflection at a given spring stiffness. Model assumptions of the motor-spring interaction were well reflected in the experiment. The powered foot was able to improve range of motion, peak ankle power, average positive ankle power, peak ankle moment, and positive moment onset compared to a passive usage of the foot. Furthermore, symmetry improvements were identified for step length and duty factor. Further studies with an increased number of subjects are needed to show if the approach is also valid for other amputees. Using this method as a base, trajectories can be further individualized using human in the loop optimization targeting a reduction of user effort, improved stability, or gait symmetry.

  19. Comparison of muscle activity patterns of transfemoral amputees and control subjects during walking

    Science.gov (United States)

    2013-01-01

    Background Only few studies have looked at electromyography (EMG) during prosthetic gait. Differences in EMG between normal and prosthetic gait for stance and swing phase were never separately analyzed. These differences can give valuable information if and how muscle activity changes in prosthetic gait. Methods In this study EMG activity during gait of the upper leg muscles of six transfemoral amputees, measured inside their own socket, was compared to that of five controls. On and off timings for stance and swing phase were determined together with the level of co-activity and inter-subject variability. Results and conclusions Gait phase changes in amputees mainly consisted of an increased double support phase preceding the prosthetic stance phase. For the subsequent (pre) swing phase the main differences were found in muscle activity patterns of the prosthetic limb, more muscles were active during this phase and/or with prolonged duration. The overall inter-subject variability was larger in amputees compared to controls. PMID:23914785

  20. Portable haptic device for lower limb amputee gait feedback: Assessing static and dynamic perceptibility.

    Science.gov (United States)

    Husman, M A B; Maqbool, H F; Awad, M I; Dehghani-Sanij, A A

    2017-07-01

    Loss of joints and severed sensory pathway cause reduced mobility capabilities in lower limb amputees. Although prosthetic devices attempt to restore normal mobility functions, lack of awareness and control of limb placement increase the risk of falling and causing amputee to have high level of visual dependency. Haptic feedback can serve as a cue for gait events during ambulation thus providing sense of awareness of the limb position. This paper presents a wireless wearable skin stretch haptic device to be fitted around the thigh region. The movement profile of the device was characterized and a preliminary work with able-bodied participants and an above-knee amputee to assess the ability of users to perceive the delivered stimuli during static and dynamic mode is reported. Perceptibility was found to be increasing with stretch magnitude. It was observed that a higher magnitude of stretch was needed for the stimuli to be accurately perceived during walking in comparison to static standing, most likely due to the intense movement of the muscle and increased motor skills demand during walking activity.

  1. Technology Efficacy in Active Prosthetic Knees for Transfemoral Amputees: A Quantitative Evaluation

    Science.gov (United States)

    El-Sayed, Amr M.; Abu Osman, Noor Azuan

    2014-01-01

    Several studies have presented technological ensembles of active knee systems for transfemoral prosthesis. Other studies have examined the amputees' gait performance while wearing a specific active prosthesis. This paper combined both insights, that is, a technical examination of the components used, with an evaluation of how these improved the gait of respective users. This study aims to offer a quantitative understanding of the potential enhancement derived from strategic integration of core elements in developing an effective device. The study systematically discussed the current technology in active transfemoral prosthesis with respect to its functional walking performance amongst above-knee amputee users, to evaluate the system's efficacy in producing close-to-normal user performance. The performances of its actuator, sensory system, and control technique that are incorporated in each reported system were evaluated separately and numerical comparisons were conducted based on the percentage of amputees' gait deviation from normal gait profile points. The results identified particular components that contributed closest to normal gait parameters. However, the conclusion is limitedly extendable due to the small number of studies. Thus, more clinical validation of the active prosthetic knee technology is needed to better understand the extent of contribution of each component to the most functional development. PMID:25110727

  2. Falls in a Young Active Amputee Population: A Frequent Cause of Rehospitalization?

    Science.gov (United States)

    Felcher, Shaun M; Stinner, Daniel J; Krueger, Chad A; Wilken, Jason M; Gajewski, Donald A; Hsu, Joseph R

    2015-10-01

    Falls occur in up to 50% of amputees within a single year of their operation and up to 40% of these falls result in injury. However, there is a lack of data evaluating falls in a young, active amputee population despite an estimated 58% of persons living with an amputation being under the age of 65. The authors evaluated an amputee population (n = 393) with a mean age of 25.53 years. Overall incidence, prevalence, fall characteristics, and risk factors were calculated for falls resulting in rehospitalization. An incidence of 1.92 per 1,000 person years with a prevalence of 2.04% was found with 87.5% occurring within the first 6 months following definitive amputation. Of the patients rehospitalized, 75% required at least 1 surgical procedure. Infectious complications had the most significant morbidity requiring a mean of 5 operative procedures. Those that delayed evaluation (mean = 13 days) vs. those that presented 0 to 1 day from a fall were significantly more at risk of an infectious complication (p = 0.03). This study is the first to report such a relationship, and emphasizes the need for at-risk patients to seek early medical attention as this may minimize the risk of infection and obviate the need for surgical intervention. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  3. Spatiotemporal Variables of Able-bodied and Amputee Sprinters in Men's 100-m Sprint.

    Science.gov (United States)

    Hobara, H; Kobayashi, Y; Mochimaru, M

    2015-06-01

    The difference in world records set by able-bodied sprinters and amputee sprinters in the men's 100-m sprint is still approximately 1 s (as of 28 March 2014). Theoretically, forward velocity in a 100-m sprint is the product of step frequency and step length. The goal of this study was to examine the hypothesis that differences in the sprint performance of able-bodied and amputee sprinters would be due to a shorter step length rather than lower step frequency. Men's elite-level 100-m races with a total of 36 able-bodied, 25 unilateral and 17 bilateral amputee sprinters were analyzed from the publicly available internet broadcasts of 11 races. For each run of each sprinter, the average forward velocity, step frequency and step length over the whole 100-m distance were analyzed. The average forward velocity of able-bodied sprinters was faster than that of the other 2 groups, but there was no significant difference in average step frequency among the 3 groups. However, the average step length of able-bodied sprinters was significantly longer than that of the other 2 groups. These results suggest that the differences in sprint performance between 2 groups would be due to a shorter step length rather than lower step frequency. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Phantom movements from physiologically inappropriate muscles: A case study with a high transhumeral amputee.

    Science.gov (United States)

    Gade, Julie; Hugosdottir, Rosa; Kamavuako, Ernest N

    2015-08-01

    Individuals with high-level amputation have a great need for functional prostheses because of their vast functional deficits. Conventional techniques are considered inappropriate for high-level amputees due to the lack of physiologically appropriate muscles. This study investigates how accurate phantom movements (PMs) can be classified from physiologically inappropriate muscles. The study involves a case study of a 42-year-old transhumeral amputee. Suitable PMs and best electrode configuration were identified using the sequential forward selection method and brute-force technique. Using linear discriminant analysis, the best PMs (elbow extension/flexion, wrist supination/pronation) and rest were classified with error ranging from 3% to 0.18% when using 3 to 8 EMG channels respectively. A completion rate of 93 % was obtained during a targeted achievement control test in a virtual reality environment. This case indicates that a proximal transhumeral amputee can generate muscle activation patterns related to distinct PMs; and these PMs can be decoded from physiologically inappropriate muscles.

  5. Magnetic resonance spectroscopy of current hand amputees reveals evidence for neuronal-level changes in former sensorimotor cortex.

    Science.gov (United States)

    Cirstea, Carmen M; Choi, In-Young; Lee, Phil; Peng, Huiling; Kaufman, Christina L; Frey, Scott H

    2017-04-01

    Deafferentation is accompanied by large-scale functional reorganization of maps in the primary sensory and motor areas of the hemisphere contralateral to injury. Animal models of deafferentation suggest a variety of cellular-level changes including depression of neuronal metabolism and even neuronal death. Whether similar neuronal changes contribute to patterns of reorganization within the contralateral sensorimotor cortex of chronic human amputees is uncertain. We used functional MRI-guided proton magnetic resonance spectroscopy to test the hypothesis that unilateral deafferentation is associated with lower levels of N -acetylaspartate (NAA, a putative marker of neuronal integrity) in the sensorimotor hand territory located contralateral to the missing hand in chronic amputees ( n = 19) compared with the analogous hand territory of age- and sex-matched healthy controls ( n = 28). We also tested whether former amputees [i.e., recipients of replanted ( n = 3) or transplanted ( n = 2) hands] exhibit NAA levels that are indistinguishable from controls, possible evidence for reversal of the effects of deafferentation. As predicted, relative to controls, current amputees exhibited lower levels of NAA that were negatively and significantly correlated with the time after amputation. Contrary to our prediction, NAA levels in both replanted and transplanted patients fell within the range of the current amputees. We suggest that lower levels of NAA in current amputees reflects altered neuronal integrity consequent to chronic deafferentation. Thus local changes in NAA levels may provide a means of assessing neuroplastic changes in deafferented cortex. Results from former amputees suggest that these changes may not be readily reversible through reafferentation. NEW & NOTEWORTHY This study is the first to use functional magnetic resonance-guided magnetic resonance spectroscopy to examine neurochemical mechanisms underlying functional reorganization in the primary somatosensory

  6. Co-contraction patterns of trans-tibial amputee ankle and knee musculature during gait

    Science.gov (United States)

    2012-01-01

    Background Myoelectric control of upper extremity powered prostheses has been used clinically for many years, however this approach has not been fully developed for lower extremity prosthetic devices. With the advent of powered lower extremity prosthetic components, the potential role of myoelectric control systems is of increasing importance. An understanding of muscle activation patterns and their relationship to functional ambulation is a vital step in the future development of myoelectric control. Unusual knee muscle co-contractions have been reported in both limbs of trans-tibial amputees. It is currently unknown what differences exist in co-contraction between trans-tibial amputees and controls. This study compares the activation and co-contraction patterns of the ankle and knee musculature of trans-tibial amputees (intact and residual limbs), and able-bodied control subjects during three speeds of gait. It was hypothesized that residual limbs would have greater ankle muscle co-contraction than intact and able-bodied control limbs and that knee muscle co-contraction would be different among all limbs. Lastly it was hypothesized that the extent of muscle co-contraction would increase with walking speed. Methods Nine unilateral traumatic trans-tibial amputees and five matched controls participated. Surface electromyography recorded activation from the Tibialis Anterior, Medial Gastrocnemius, Vastus Lateralis and Biceps Femoris of the residual, intact and control limbs. A series of filters were applied to the signal to obtain a linear envelope of the activation patterns. A co-contraction area (ratio of the integrated agonist and antagonist activity) was calculated during specific phases of gait. Results Co-contraction of the ankle muscles was greater in the residual limb than in the intact and control limbs during all phases of gait. Knee muscle co-contraction was greater in the residual limb than in the control limb during all phases of gait. Conclusion Co

  7. Co-contraction patterns of trans-tibial amputee ankle and knee musculature during gait

    Directory of Open Access Journals (Sweden)

    Seyedali Mahyo

    2012-05-01

    Full Text Available Abstract Background Myoelectric control of upper extremity powered prostheses has been used clinically for many years, however this approach has not been fully developed for lower extremity prosthetic devices. With the advent of powered lower extremity prosthetic components, the potential role of myoelectric control systems is of increasing importance. An understanding of muscle activation patterns and their relationship to functional ambulation is a vital step in the future development of myoelectric control. Unusual knee muscle co-contractions have been reported in both limbs of trans-tibial amputees. It is currently unknown what differences exist in co-contraction between trans-tibial amputees and controls. This study compares the activation and co-contraction patterns of the ankle and knee musculature of trans-tibial amputees (intact and residual limbs, and able-bodied control subjects during three speeds of gait. It was hypothesized that residual limbs would have greater ankle muscle co-contraction than intact and able-bodied control limbs and that knee muscle co-contraction would be different among all limbs. Lastly it was hypothesized that the extent of muscle co-contraction would increase with walking speed. Methods Nine unilateral traumatic trans-tibial amputees and five matched controls participated. Surface electromyography recorded activation from the Tibialis Anterior, Medial Gastrocnemius, Vastus Lateralis and Biceps Femoris of the residual, intact and control limbs. A series of filters were applied to the signal to obtain a linear envelope of the activation patterns. A co-contraction area (ratio of the integrated agonist and antagonist activity was calculated during specific phases of gait. Results Co-contraction of the ankle muscles was greater in the residual limb than in the intact and control limbs during all phases of gait. Knee muscle co-contraction was greater in the residual limb than in the control limb during all phases

  8. Implant survival, adverse events, and bone remodeling of osseointegrated percutaneous implants for transhumeral amputees.

    Science.gov (United States)

    Tsikandylakis, Georgios; Berlin, Örjan; Brånemark, Rickard

    2014-10-01

    Osseointegrated percutaneous implants provide direct anchorage of the limb prosthesis to the residual limb. These implants have been used for the rehabilitation of transhumeral amputees in Sweden since 1995 using a two-stage surgical approach with a 6-month interval between the stages, but results on implant survival, adverse events, and radiologic signs of osseointegration and adaptive bone remodeling in transhumeral amputees treated with this method are still lacking. This study reports on 2- and 5-year implant survival, adverse events, and radiologic signs of osseointegration and bone remodeling in transhumeral amputees treated with osseointegrated prostheses. Between 1995 and 2010, we performed 18 primary osseointegrated percutaneous implants and two implant revisions in 18 transhumeral amputees; of those, 16 patients were available for followup at a minimum of 2 years (median, 8 years; range, 2-19 years). These include all transhumeral amputees who have received osseointegrated prostheses and represented approximately 20% of the all transhumeral amputees we evaluated for potential osseointegration during that time; general indications for this approach included transhumeral amputation resulting from trauma or tumor, inability to wear or severe problems wearing a conventional socket prosthesis, eg, very short residual limb, and compliant patients. Medical charts and plain radiographs were retrospectively evaluated. The 2- and 5-year implant survival rates were 83% and 80%, respectively. Two primary and one revised implant failed and were removed because of early loosening. A fourth implant was partially removed because of ipsilateral shoulder osteoarthritis and subsequent arthrodesis. The most common adverse event was superficial infection of the skin penetration site (15 infections in five patients) followed by skin reactions of the skin penetration site (eight), incomplete fracture at the first surgery (eight), defective bony canal at the second surgery

  9. The capability of fiber Bragg grating sensors to measure amputees' trans-tibial stump/socket interface pressures.

    Science.gov (United States)

    Al-Fakih, Ebrahim A; Osman, Noor Azuan Abu; Eshraghi, Arezoo; Adikan, Faisal Rafiq Mahamd

    2013-08-12

    This study presents the first investigation into the capability of fiber Bragg grating (FBG) sensors to measure interface pressure between the stump and the prosthetic sockets of a trans-tibial amputee. FBG element(s) were recoated with and embedded in a thin layer of epoxy material to form a sensing pad, which was in turn embedded in a silicone polymer material to form a pressure sensor. The sensor was tested in real time by inserting a heavy-duty balloon into the socket and inflating it by using an air compressor. This test was conducted to examine the sensitivity and repeatability of the sensor when subjected to pressure from the stump of the trans-tibial amputee and to mimic the actual environment of the amputee's Patellar Tendon (PT) bar. The sensor exhibited a sensitivity of 127 pm/N and a maximum FSO hysteresis of around ~0.09 in real-time operation. Very good reliability was achieved when the sensor was utilized for in situ measurements. This study may lead to smart FBG-based amputee stump/socket structures for pressure monitoring in amputee socket systems, which will result in better-designed prosthetic sockets that ensure improved patient satisfaction.

  10. EMG-based simultaneous and proportional estimation of wrist/hand kinematics in uni-lateral trans-radial amputees

    Science.gov (United States)

    2012-01-01

    We propose a method for estimating wrist kinematics during dynamic wrist contractions from multi-channel surface electromyography (EMG). The algorithm extracts features from the surface EMG and uses dedicated multi-layer perceptron networks to estimate individual joint angles of the 3 degrees of freedom (DoFs) of the wrist. The method was designed with the aim of proportional and simultaneous control of multiple DoFs of active prostheses by unilateral amputees. Therefore, the proposed approach was tested in both unilateral transradial amputees and in intact-limbed control subjects. It was shown that the joint angles at the 3 DoFs of amputees can be estimated from surface EMG recordings , during mirrored bi-lateral contractions that simultaneously and proportionally articulated the 3 DoFs. The estimation accuracies of amputee subjects with long stumps were 62.5% ± 8.50% across all 3 DoFs, while accuracies of the intact-limbed control subjects were 72.0% ± 8.29%. The estimation results from intact-limbed subjects were consistent with earlier studies. The results from the current study demonstrated the feasibility of the proposed myoelectric control approach to provide a more intuitive myoelectric control strategy for unilateral transradial amputees. PMID:22742707

  11. EMG-based simultaneous and proportional estimation of wrist/hand kinematics in uni-lateral trans-radial amputees

    Directory of Open Access Journals (Sweden)

    Jiang Ning

    2012-06-01

    Full Text Available Abstract We propose a method for estimating wrist kinematics during dynamic wrist contractions from multi-channel surface electromyography (EMG. The algorithm extracts features from the surface EMG and uses dedicated multi-layer perceptron networks to estimate individual joint angles of the 3 degrees of freedom (DoFs of the wrist. The method was designed with the aim of proportional and simultaneous control of multiple DoFs of active prostheses by unilateral amputees. Therefore, the proposed approach was tested in both unilateral transradial amputees and in intact-limbed control subjects. It was shown that the joint angles at the 3 DoFs of amputees can be estimated from surface EMG recordings , during mirrored bi-lateral contractions that simultaneously and proportionally articulated the 3 DoFs. The estimation accuracies of amputee subjects with long stumps were 62.5% ± 8.50% across all 3 DoFs, while accuracies of the intact-limbed control subjects were 72.0% ± 8.29%. The estimation results from intact-limbed subjects were consistent with earlier studies. The results from the current study demonstrated the feasibility of the proposed myoelectric control approach to provide a more intuitive myoelectric control strategy for unilateral transradial amputees.

  12. Metabolic energy expenditure of ambulation in lower extremity amputees: what have we learned and what are the next steps?

    Science.gov (United States)

    Czerniecki, Joseph M; Morgenroth, David C

    2017-01-01

    Amputation results in reduced mobility and contributes to reduced quality of life. The increased metabolic cost of ambulation has been suggested as an important contributor to reduced mobility in this population. Current research on the metabolic energy expenditure of ambulation will be critically reviewed from the perspectives of ecological validity of the research methods and the relative contribution to functional improvement in amputees. Recommendations will be made regarding possible future directions for research and their potential clinical utility. Narrative review. The methods used to quantify metabolic energy expenditure of amputee ambulation do not emulate typical mobility conditions that amputees experience. Amputee mobility is characterized by short bouts of activity with starting, stopping and changes of direction. This is opposed to the typical metabolic testing protocol that requires at least 5 min of steady state linear walking on a treadmill. These studies, therefore, have limitations in ecological validity and therefore limitations in the extent to which they accurately reflect the effect of amputation level, amputation etiology and prosthetic components on energy consumption during walking. Further, the broader perspective on outcomes after dysvascular amputation and sports participation limitations, raises questions about the relative importance of improving metabolic costs and its potential effect on improving mobility in amputees. The greatest potential clinical impact of future research requires methods with improved ecological validity, and the ability to translate metabolic energy expenditure outcomes into functional terms that are meaningful to both clinicians and patients. Implications for Rehabilitation The search for objective measurements to define the effects of amputation on outcome and the consequences of prosthetic components on mobility has focused in part on the use of study designs incorporating metabolic measurement. However

  13. Bioelectric Analyses of an Osseointegrated Intelligent Implant Design System for Amputees

    Science.gov (United States)

    Isaacson, Brad M.; Stinstra, Jeroen G.; MacLeod, Rob S.; Webster, Joseph B.; Beck, James P.; Bloebaum, Roy D.

    2009-01-01

    The projected number of American amputees is expected to rise to 3.6 million by 2050. Many of these individuals depend on artificial limbs to perform routine activities, but prosthetic suspensions using traditional socket technology can prove to be cumbersome and uncomfortable for a person with limb loss. Moreover, for those with high proximal amputations, limited residual limb length may prevent exoprosthesis attachment all together. Osseointegrated implant technology is a novel operative procedure which allows firm skeletal attachment between the host bone and an implant. Preliminary results in European amputees with osseointegrated implants have shown improved clinical outcomes by allowing direct transfer of loads to the bone-implant interface. Despite the apparent advantages of osseointegration over socket technology, the current rehabilitation procedures require long periods of restrictive load bearing prior which may be reduced with expedited skeletal attachment via electrical stimulation. The goal of the osseointegrated intelligent implant design (OIID) system is to make the implant part of an electrical system to accelerate skeletal attachment and help prevent periprosthetic infection. To determine optimal electrode size and placement, we initiated proof of concept with computational modeling of the electric fields and current densities that arise during electrical stimulation of amputee residual limbs. In order to provide insure patient safety, subjects with retrospective computed tomography scans were selected and three dimensional reconstructions were created using customized software programs to ensure anatomical accuracy (Seg3D and SCIRun) in an IRB and HIPAA approved study. These software packages supported the development of patient specific models and allowed for interactive manipulation of electrode position and size. Preliminary results indicate that electric fields and current densities can be generated at the implant interface to achieve the

  14. Epidemiologic data of trauma-related lower limb amputees: A single center 10-year experience.

    Science.gov (United States)

    Yaşar, Evren; Tok, Fatih; Kesikburun, Serdar; Ada, A Mustafa; Kelle, Bayram; Göktepe, A Salim; Yazıcıoğlu, Kamil; Tan, A Kenan

    2017-02-01

    The aim of this study is three fold: 1) to introduce epidemiologic data of patients with trauma-related amputations as a 10-year experience of a rehabitation center; 2) to determine comorbidities and secondary conditions of lower limb loss; 3) to determine the rehospitalization reasons for lower limb amputee patients. This retrospective study was conducted in a tertiary rehabilitation center in Turkey. Clinical and demographic data of amputees including sex, age, employment status, time since amputation, time after amputation to first hospitalization, length of hospitalization, how many times the patient was hospitalized, reason for hospitalization, stump complications, comorbid conditions, amputation level and K classifacation were documented. Three hundred ninetynine patients with a mean age of 23,48±6,04 (4-74) years were included in this study. Mean duration after amputation was 119,71±68,86months. Patients were 3,43±2,53 times hospitalized. Landmine explosion was the most common etiology of amputation with 370 patients (92.7%). Below knee amputation was the most common amputation level with 230 (50,77%) amputations. 399 patients were hospitalized 1369 times and the most common hospitalization reason were stump complications (356 times, 26,00%). Spur formation (202 times) was the most common stump complications. Pyscologic disorders were the most common comorbidity with 68 patient (37,56%). Patients with traumatic limb amputations are likely to experience several complications and comorbidities. Prevention of secondary conditions affecting those living with the loss of a limb is an important part of amputee rehabilitation and may prevent rehospitalization. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Feasibility testing of smart tablet questionnaires compared to paper questionnaires in an amputee rehabilitation clinic.

    Science.gov (United States)

    Payne, Michael; Janzen, Shannon; Earl, Eric; Deathe, Barry; Viana, Ricardo

    2017-08-01

    Capturing the variability that exists among patients attending an amputee clinic using standardized paper-based questionnaires is time-consuming and may not be practical for routine clinical use. Electronic questionnaires are a potential solution; however, the benefits are dependent on the feasibility and acceptance of this mode of data collection among patients. To determine the feasibility and patient preference/comfort in using a tablet-based questionnaire for data collection in an outpatient amputee rehabilitation clinic compared to a traditional paper-based questionnaire. Observational study. In all, 48 patients with major extremity amputations completed both tablet and paper questionnaires related to their amputation and prosthetic use. Both trials were timed; patients then completed a semi-structured questionnaire about their experience. In all, 20.5% of patients needed hands-on assistance completing the paper questionnaire compared to 20.8% for the tablet. The majority of participants (52.1%) indicated a preference for the tablet questionnaire; 64.6% of patients felt the tablet collected a more complete and accurate representation of their status and needs. In all, 70.8% of participants described themselves as comfortable using the tablet. Despite comorbidities, patients with amputations demonstrated excellent acceptance of the electronic tablet-based questionnaire. Tablet questionnaires have significant potential advantages over paper questionnaires and should be further explored. Clinical relevance A custom electronic questionnaire was found to be beneficial for routine clinic use and was well received by patients in an amputee rehabilitation clinic. Development of such questionnaires can provide an efficient mechanism to collect meaningful data that can be used for individual patient care and program quality improvement initiatives.

  16. Predicting mobility outcome in lower limb amputees with motor ability tests used in early rehabilitation.

    Science.gov (United States)

    Spaan, Matthijs H; Vrieling, Aline H; van de Berg, Pim; Dijkstra, Pieter U; van Keeken, Helco G

    2017-04-01

    Retrospective cohort study. Persons with a lower limb amputation can regain mobility using a prosthetic device. For fast and adequate prescription of prosthetic components, it is necessary to predict the mobility outcome early in rehabilitation. Currently, prosthetic prescription is primarily based on empirical knowledge of rehabilitation professionals. In this study, we explored motor ability tests, to be completed without a prosthetic device, which have predictive value for mobility outcome at the end of rehabilitation. For this study, data of 82 patients with a lower limb amputation were included. The Single-limb standing balance test (Balance test), the Lower-Extremity Motor Coordination Test and the Amputee Mobility Predictor Assessment Tool (AMPnoPRO) were used as measures for motor ability. Mobility outcome was measured using the Timed Up and Go Test, the Two-Minute Walking Test and K levels were used. The explained variance of the Balance test, the Lower-Extremity Motor Coordination Test and the AMPnoPRO was, respectively, 0.603, 0.534 and 0.649 on the Two-Minute Walking Test (linear regression); 0.597, 0.431 and 0.624 on the Timed Up and Go Test (linear regression); and 0.432, 0.420 and 0.526 on the K levels (logistic regression). The AMPnoPRO predicted mobility outcome statistically (largest amount of explained variance). Clinical relevance This study explored the possibility of statistically predicting mobility outcome in lower limb amputees at the end of rehabilitation, using motor ability tests conducted in early rehabilitation. This study suggests the use of the AMPnoPRO to predict mobility outcome in lower limb amputees.

  17. Compensatory Changes Accompanying Chronic Forced Use of the Nondominant Hand by Unilateral Amputees

    Science.gov (United States)

    2014-01-01

    Amputation of the dominant hand forces patients to use the nondominant hand exclusively, including for tasks (e.g., writing and drawing) that were formerly the sole domain of the dominant hand. The behavioral and neurological effects of this chronic forced use of the nondominant hand remain largely unknown. Yet, these effects may shed light on the potential to compensate for degradation or loss of dominant hand function, as well as the mechanisms that support motor learning under conditions of very long-term training. We used a novel precision drawing task and fMRI to investigate 8 adult human amputees with chronic (mean 33 years) unilateral dominant (right) hand absence, and right-handed matched controls (8 for fMRI, 19 for behavior). Amputees' precision drawing performances with their left hands reached levels of smoothness (associated with left hemisphere control), acceleration time (associated with right hemisphere control), and speed equivalent to controls' right hands, whereas accuracy maintained a level comparable with controls' left hands. This compensation is supported by an experience-dependent shift from heavy reliance on the dorsodorsal parietofrontal pathway (feedback control) to the ventrodorsal pathway and prefrontal regions involved in the cognitive control of goal-directed actions. Relative to controls, amputees also showed increased activity within the former cortical sensorimotor hand territory in the left (ipsilateral) hemisphere. These data demonstrate that, with chronic and exclusive forced use, the speed and quality of nondominant hand precision endpoint control in drawing can achieve levels nearly comparable with the dominant hand. PMID:24599461

  18. Changes to transtibial amputee gait with a weighted backpack on multiple surfaces.

    Science.gov (United States)

    Doyle, Sean S; Lemaire, Edward D; Besemann, Markus; Dudek, Nancy L

    2015-12-01

    Modern prosthetic technology and rehabilitation practices have enabled people with lower extremity amputations to participate in almost all occupations and physical activities. Carrying backpack loads can be an essential component for many of these jobs and activities; however, amputee gait with backpack loads is poorly understood. This knowledge gap must be addressed in order to further improve an individual's quality of living through changes in rehabilitation programs and prosthesis development. Ten male, unilateral, K4-level (ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels), transtibial amputees completed ten walking trials at a self-selected pace on simulated uneven ground, ramp ascent, and ramp descent. Five trials were with a 24.5 kg backpack load and five trials without. Temporal-spatial parameters and kinematic peak values for the ankle, knee, hip, pelvis, and trunk were collected and analyzed for differences between backpack conditions. Each surface had novel findings not found on the other surfaces. However differences in temporal-spatial parameters were congruent with the literature on able bodied individuals. Pelvis and trunk angular velocities decreased with the backpack. Hip flexion on both limbs increased during weight acceptance while wearing the backpack, a common adaptation seen in able-bodied individuals on level ground. A 24.5 kg backpack load can be accommodated by transtibial amputees at the K4 functional level. Future studies on load carriage and gait training programs should include incline and descent due to the increased difficulty. Rehabilitation programs should verify hip and knee flexor strength and work to reduce intact limb reliance. Copyright © 2015. Published by Elsevier Ltd.

  19. [Preliminary analysis of serum enzymes indicators in childhood amputees due to earthquake resulting trauma].

    Science.gov (United States)

    Jiang, Xin; Liu, Lijun; Li, Hui

    2014-04-01

    To retrospectively analyze the serum enzymes in childhood amputees as a result of earthquake, and to discuss their clinical significance. From 150 children amputees who were victims of Sichuan Wenchuan earthquake in 2008 and Sichuan Lushan earthquake in 2013, 45 cases with complete records of serum enzymes examinations were reviewed retrospectively. They were divided into three groups: amputation group (n=6), fasciotomy decompression group (n=5), general trauma without injury to extremity group (n=34). Serum enzyme examination data were compared for statistical analysis to find the difference among groups. Ten children who were not victims of earthquake were selected from department of orthopaedics to serve as controls, and 20 adult amputees as a result of earthquake served as another control group. There were significant differences in injury severity scale (ISS) and the contents of all serum enzymes, including aspartate transaminase (AST), alanine aminotransferase (ALT), creatine kinase (CK), lactate dehydrogenase (LDH), and hydroxybutyrate dehydrogenase (HBDH), between the amputation group and other patients (FISS=15.474, PFCK=12.848, P<0.001; FLDH=13.126, P<0.001; FHBDH=13.186, P<0.001), and the difference in amputation group was even more significant. AST, LDH, HBDH in childhood amputees group were significantly higher than those in adult amputation group. The contents of ALT and CK were slightly increased. Serum enzyme contents were found to be significantly helpful for prediction of disease condition and prognosis. It was also found that CK was extremely helpful in assessing the degree of illness in patients with severe trauma, especially in patients complicated by severe soft tissue injury. In all the groups, of patients, it was found that CK rose from (129±62) U/L in non-earthquake induced trauma group to (44 208±39,788) U/L in earthquake amputation group, and it was thus increased more than 300 times. Its highest value even reached 117,513 U/L, which

  20. Sciatic nerve block performed with nerve stimulation technique in an amputee a case study

    DEFF Research Database (Denmark)

    Heiring, C.; Kristensen, Billy

    2008-01-01

    We present a case of a sciatic nerve block performed with the nerve stimulation technique. This technique is normally not used in amputees because detection of a motor response to an electrical stimulation is impossible. In our patient the stimulation provoked a phantom sensation of movement...... in the non-existing extremity. This sensation was verbally described by the patient and thus used as an alternative to visual identification of motor response. After surgery the patient was pain free. The technique thus presents an alternative method for anesthesia and perioperative pain management in a high...

  1. [Comparative study of the volume difference vs. healthy limb, morphological and population description in transfemoral amputees].

    Science.gov (United States)

    Mendoza-Cruz, Felipe; Rodríguez-Reyes, Gerardo; Galván Duque-Gastélum, Carlos; Alvarez-Camacho, Michelín

    2014-07-01

    Knowledge of the general characteristics and physical condition that keeps the transfemoral amputation stump to select and adapt appropriate type of prosthesis to restore a walking pattern amputee patient acceptable and useful design parameters set to propose new prosthetic systems. In this paper, the degree of difference between the volumes of the limb stump and healthy as well as morphological features occurred more frequently in the stumps of transfemoral amputees who were treated at the Laboratory of Orthotics and Prosthetics (LOP), Instituto Nacional de Rehabilitación (INR) in 2008. It captured all patients with unilateral transfemoral amputation left and right, over 18 years old, both sexes, use of hearing candidates were evaluated clinically and took three measurements of the circumferences at different wavelengths and the limb stump healthy, were calculated volumes of both sides using the mathematical model of the truncated cone and analyzed in three groups according to the level of amputation (proximal, middle and distal third). We obtained 49 patients, 39 men and 10 women, the difference stump volume compared to healthy limb volume per group were: 44.9% proximal third, middle third and distal 26.5%, 21.1%, the frequency of diagnostic data showed a stump right transfemoral amputees, due to metabolic, without use of prostheses, the most common morphological features indicate that the stump has a conical shape and size distal third, whose tissue is semi-flaccid consistency, the scar is not adhered to deep planes and shows a negative tinel, the mattress soft tissue is 2.15 ± 1.3 cm and physically presents a force level 4 in the clinical rating scale Daniels. The data are consistent with other studies comparing the percentage of the volume change with the percentages of reduced diameters transfemoral stump muscle, likewise agrees most amputees incidence of diabetes mellitus with other studies, cataloging it eat first cause amputation. The general description

  2. Reliability and construct validity of the Turkish version of the Trinity Amputation and Prosthetic Experience Scales (TAPES) in lower limb amputees.

    Science.gov (United States)

    Topuz, Semra; Ülger, Özlem; Yakut, Yavuz; Gül Şener, Fatma

    2011-06-01

    In Turkey there is no amputee-specific instrument to measure health-related quality of life in lower limb amputees. To evaluate the validity and reliability of a Turkish version of the Trinity Amputation and Prosthesis Experience Scales (TAPES). Outcome study to determine test-retest reliability and construct validity of the adapted Turkish version of the TAPES. After translation/retranslation of the TAPES, the Turkish version of the TAPES was applied to 47 amputees. A quality of life evaluation (Nottingham Health Profile), a satisfaction evaluation (Satisfaction with Prosthesis), and a functional assessment tool (Amputee Mobility Predictor) were also performed and analysed. On the basis of retesting, the Turkish version of the TAPES was observed to be reliable. The first domain of the Turkish version, which includes psychosocial adjustment, activity restriction and satisfaction with the prosthesis, was found to be valid. However, the validity of the second domain could not be analysed. The Turkish version of the multidimensional TAPES survey is valid and reliable in Turkish unilateral lower limb amputees and may be used in clinical situations to assess the needs of amputees. The Turkish version of the TAPES quality-of-life measurement tool for amputees is a valid instrument for assessing the effectiveness of rehabilitation and clinical applications.

  3. Energy expenditure and activity of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees.

    Science.gov (United States)

    Kaufman, Kenton R; Levine, James A; Brey, Robert H; McCrady, Shelly K; Padgett, Denny J; Joyner, Michael J

    2008-07-01

    To quantify the energy efficiency of locomotion and free-living physical activity energy expenditure of transfemoral amputees using a mechanical and microprocessor-controlled prosthetic knee. Repeated-measures design to evaluate comparative functional outcomes. Exercise physiology laboratory and community free-living environment. Subjects (N=15; 12 men, 3 women; age, 42+/-9 y; range, 26-57 y) with transfemoral amputation. Research participants were long-term users of a mechanical prosthesis (20+/-10 y as an amputee; range, 3-36 y). They were fitted with a microprocessor-controlled knee prosthesis and allowed to acclimate (mean time, 18+/-8 wk) before being retested. Objective measurements of energy efficiency and total daily energy expenditure were obtained. The Prosthetic Evaluation Questionnaire was used to gather subjective feedback from the participants. Subjects demonstrated significantly increased physical activity-related energy expenditure levels in the participant's free-living environment (P=.04) after wearing the microprocessor-controlled prosthetic knee joint. There was no significant difference in the energy efficiency of walking (P=.34). When using the microprocessor-controlled knee, the subjects expressed increased satisfaction in their daily lives (P=.02). People ambulating with a microprocessor-controlled knee significantly increased their physical activity during daily life, outside the laboratory setting, and expressed an increased quality of life.

  4. Two-dimensional myoelectric control of a robotic arm for upper limb amputees

    International Nuclear Information System (INIS)

    Lopez Celani, Natalia M; Soria, Carlos M; Orosco, Eugenio C; Di Sciascio, Fernando A; Valentinuzzi, Max E

    2007-01-01

    Rehabilitation engineering and medicine have become integral and significant parts of health care services, particularly and unfortunately in the last three or four decades, because of wars, terrorism and large number of car accidents. Amputees show a high rate of rejection to wear prosthetic devices, often because of lack of an adequate period of adaptation. A robotic arm may appear as a good preliminary stage. To test the hypothesis, myoelectric signals from two upper limb amputees and from four normal volunteers were fed, via adequate electronic conditioning and using MATLAB, to an industrial robotic arm. Proportional strength control was used for two degrees of freedom (x-y plane) by means of eight signal features of control (four traditional statistics plus energy, integral of the absolute value, Willison's amplitude, waveform length and envelope) for comparison purposes, and selecting the best of them as final reference. Patients easily accepted the system and learned in short time how to operate it. Results were encouraging so that valuable training, before prosthesis is implanted, appears as good feedback; besides, these patients can be hired as specialized operators in semi-automatized industry

  5. Body image and self-esteem in lower-limb amputees.

    Science.gov (United States)

    Holzer, Lukas A; Sevelda, Florian; Fraberger, Georg; Bluder, Olivia; Kickinger, Wolfgang; Holzer, Gerold

    2014-01-01

    Limb amputation is often an inevitable procedure in the advanced condition of various diseases and poses a dramatic impact on a patient's life. The aim of the present study is to analyze the impact of lower-limb amputations on aesthetic factors such as body image and self-esteem as well as quality of life (QoL). 298 patients (149 uni- or bilateral lower-limb amputees and 149 controls) were included in this cross-sectional study in three centers. Demographic data was collected and patients received a 118-item questionnaire including the Multidimensional Body-Self Relations Questionnaire (MBSRQ), the Rosenberg Self-esteem (RSE) scale and the SF-36 Health Survey (QoL). ANOVA and student's t-test were used for statistical analysis. Unilateral lower-limb amputees showed a significant lower MBSRQ score of 3.07±0.54 compared with 3.41±0.34 in controls (pbody image and QoL. Self-esteem seems to be an independent aspect, which is not affected by lower-limb amputation. However, self-esteem is influenced significantly by phantom pain sensation.

  6. Control Capabilities of Myoelectric Robotic Prostheses by Hand Amputees: A Scientific Research and Market Overview.

    Science.gov (United States)

    Atzori, Manfredo; Müller, Henning

    2015-01-01

    Hand amputation can dramatically affect the capabilities of a person. Cortical reorganization occurs in the brain, but the motor and somatosensorial cortex can interact with the remnant muscles of the missing hand even many years after the amputation, leading to the possibility to restore the capabilities of hand amputees through myoelectric prostheses. Myoelectric hand prostheses with many degrees of freedom are commercially available and recent advances in rehabilitation robotics suggest that their natural control can be performed in real life. The first commercial products exploiting pattern recognition to recognize the movements have recently been released, however the most common control systems are still usually unnatural and must be learned through long training. Dexterous and naturally controlled robotic prostheses can become reality in the everyday life of amputees but the path still requires many steps. This mini-review aims to improve the situation by giving an overview of the advancements in the commercial and scientific domains in order to outline the current and future chances in this field and to foster the integration between market and scientific research.

  7. Control Capabilities of Myoelectric Robotic Prostheses by Hand Amputees: A Scientific Research and Market Overview

    Directory of Open Access Journals (Sweden)

    Manfredo eAtzori

    2015-11-01

    Full Text Available Hand amputation can dramatically affect the capabilities of a person. Cortical reorganization occurs in the brain, but the motor and somatosensorial cortex can interact with the remnant muscles of the missing hand even many years after the amputation, leading to the possibility to restore the capabilities of hand amputees through myoelectric prostheses. Myoelectric hand prostheses with many degrees of freedom are commercially available and recent advances in rehabilitation robotics suggest that their natural control can be performed in real life. The first commercial products exploiting pattern recognition to recognize the movements have recently been released, however the most common control systems are still usually unnatural and must be learned through long training. Dexterous and naturally controlled robotic prostheses can become reality in the everyday life of amputees but the path still requires many steps. This mini-review aims to improve the situation by giving an overview of the advancements in the commercial and scientific domains in order to outline the current and future chances in this field and to foster the integration between market and scientific research.

  8. Functional changes in vascular amputee patients: evaluation by Barthel Index, PULSES profile and ESCROW scale.

    Science.gov (United States)

    O'Toole, D M; Goldberg, R T; Ryan, B

    1985-08-01

    This study evaluated the changes made by 60 peripheral vascular amputees from one month prior to admission to six months after attending a rehabilitation hospital. The Barthel index, PULSES profile, and ESCROW profile were used to measure functional status, social support, and rehabilitation progress. Statistical analysis consisted of t-tests to determine significant differences between the means of scores at varying intervals, and analysis of variance was added to determine interactions between amputation level, age, and sex as related to functional change. Amputees showed significant gains in Barthel scores from admission to discharge; this was attributed to rehabilitation intervention. They showed a significant decrease by the PULSES profile over the study period, indicating a decrease in independence from their premorbid function. Changes in ESCROW scores showed patients to have a greater need for social supports as they moved from admission to discharge. Age was a significant factor in mobility at discharge as measured by the Barthel index. As measured by the PULSES profile, men did better than women at six months follow-up. Unexpected results were that neither amputation level nor the presence or absence of diabetes mellitus had a significant impact on functional status as measured. The lack of significant differences by amputation level may be due to factors of age and sex, as well as to more depression in the below-knee group.

  9. The African disability scooter: efficiency testing in paediatric amputees in Malawi.

    Science.gov (United States)

    Beckles, Verona; McCahill, Jennifer L; Stebbins, Julie; Mkandawire, Nyengo; Church, John C T; Lavy, Chris

    2016-01-01

    The African Disability Scooter (ADS) was developed for lower limb amputees, to improve mobility and provide access to different terrains. The aim of this study was to test the efficiency of the ADS in Africa over different terrains. Eight subjects with a mean age of 12 years participated. Energy expenditure and speed were calculated over different terrains using the ADS, a prosthetic limb, and crutches. Repeated testing was completed on different days to assess learning effect. Speed was significantly faster with the ADS on a level surface compared to crutch walking. This difference was maintained when using the scooter on rough terrain. Oxygen cost was halved with the scooter on level ground compared to crutch walking. There were no significant differences in oxygen consumption or heart rate. There were significant differences in oxygen cost and speed between days using the scooter over level ground, suggesting the presence of a learning effect. This study demonstrates that the ADS is faster and more energy efficient than crutch walking in young individuals with amputations, and should be considered as an alternative to a prosthesis where this is not available. The presence of a learning effect suggests supervision and training is required when the scooter is first issued. Implications for Rehabilitation The African Disability Scooter: is faster than crutch walking in amputees; is more energy efficient than walking with crutches; supervised use is needed when learning to use the device; is a good alternative/adjunct for mobility.

  10. Trans-Tibial Amputee Gait Correction through Real-Time Visual Feedback

    Directory of Open Access Journals (Sweden)

    Seyyed Farhad Tabatabi Ghomshe

    2016-03-01

    Full Text Available Objective: The present paper reports on program of work undertaken to evaluate the effect of real time visual feedback on kinematics of prosthetic gait. Methods: A total of 6 below-knee male amputees were included in the study. Each individual underwent three trials of self-selected speed treadmill walking, in which real time visual feedback was provided from forward, backward, and lateral views, together with a control trial without any visual feedback. Kinematic reference values were captured via VICON motion analysis system, and one-minute slots of data sets were processed by its Workstation software (Plug in Gait, which were than statistically analyzed running Wilcoxon Signed-Rank Test. Results: Statistical analyses revealed significant differences in stance phase (Z=0.923, p=0.031 and stride length (Z=-1.807, p=0.043 between normal and affected sides in front visual feedback mode. Stance phase was generally extended on normal legs, and there appeared to be reductions in hip joint range of motion on affected limbs. Stride time followed relatively comparable patterns in both sides across all trials. Conclusion: The results suggest that providing visualization in the context of amputee gait rehabilitation may provide an effective way to help subjects correct gait patterns and thereby it may improve the outcome of rehabilitation.

  11. Adaptation to altered balance conditions in unilateral amputees due to atherosclerosis: a randomized controlled study

    Directory of Open Access Journals (Sweden)

    Bretz Éva

    2011-05-01

    Full Text Available Abstract Background Amputation impairs the ability to balance. We examined adaptation strategies in balance following dysvascularity-induced unilateral tibial amputation in skilled prosthetic users (SPU and first fitted amputees (FFA (N = 28. Methods Excursions of center of pressure (COP were determined during 20 s quiet standing using a stabilometry system with eyes-open on both legs or on the non-affected leg(s. Main measures: COP trajectories and time functions; distribution of reaction forces between the two legs; inclination angles obtained through second order regression analysis using stabilogram data. Results FFA vs SPU demonstrated 27.8% greater postural sway in bilateral stance (p = 0.0004. Postural sway area was smaller in FFA standing on the non-affected leg compared with SPU (p = 0.028. The slope of the regression line indicating postural stability was nearly identical in FFA and SPU and the direction of regression line was opposite for the left and right leg amputees. Conclusion Of the two adaptation strategies in balance, the first appears before amputation due to pain and fatigue in the affected leg. This strategy appears in the form of reduced postural sway while standing on the non-affected leg. The second adaptation occurs during rehabilitation and regular use of the prosthesis resulting in normal weightbearing associated with reduced postural sway on two legs and return to the normal postural stability on one leg.

  12. Two-dimensional myoelectric control of a robotic arm for upper limb amputees

    Science.gov (United States)

    López Celani, Natalia M.; Soria, Carlos M.; Orosco, Eugenio C.; di Sciascio, Fernando A.; Valentinuzzi, Max E.

    2007-11-01

    Rehabilitation engineering and medicine have become integral and significant parts of health care services, particularly and unfortunately in the last three or four decades, because of wars, terrorism and large number of car accidents. Amputees show a high rate of rejection to wear prosthetic devices, often because of lack of an adequate period of adaptation. A robotic arm may appear as a good preliminary stage. To test the hypothesis, myoelectric signals from two upper limb amputees and from four normal volunteers were fed, via adequate electronic conditioning and using MATLAB, to an industrial robotic arm. Proportional strength control was used for two degrees of freedom (x-y plane) by means of eight signal features of control (four traditional statistics plus energy, integral of the absolute value, Willison's amplitude, waveform length and envelope) for comparison purposes, and selecting the best of them as final reference. Patients easily accepted the system and learned in short time how to operate it. Results were encouraging so that valuable training, before prosthesis is implanted, appears as good feedback; besides, these patients can be hired as specialized operators in semi-automatized industry.

  13. Two-dimensional myoelectric control of a robotic arm for upper limb amputees

    Energy Technology Data Exchange (ETDEWEB)

    Lopez Celani, Natalia M [Gabinete de Tecnologia Medica (Argentina); Soria, Carlos M [Instituto de Automatica (INAUT), Universidad Nacional de San Juan (UNSJ), San Juan (Argentina); Orosco, Eugenio C [Gabinete de Tecnologia Medica (Argentina); Di Sciascio, Fernando A [Instituto de Automatica (INAUT), Universidad Nacional de San Juan (UNSJ), San Juan (Argentina); Valentinuzzi, Max E [Gabinete de Tecnologia Medica (Argentina)

    2007-11-15

    Rehabilitation engineering and medicine have become integral and significant parts of health care services, particularly and unfortunately in the last three or four decades, because of wars, terrorism and large number of car accidents. Amputees show a high rate of rejection to wear prosthetic devices, often because of lack of an adequate period of adaptation. A robotic arm may appear as a good preliminary stage. To test the hypothesis, myoelectric signals from two upper limb amputees and from four normal volunteers were fed, via adequate electronic conditioning and using MATLAB, to an industrial robotic arm. Proportional strength control was used for two degrees of freedom (x-y plane) by means of eight signal features of control (four traditional statistics plus energy, integral of the absolute value, Willison's amplitude, waveform length and envelope) for comparison purposes, and selecting the best of them as final reference. Patients easily accepted the system and learned in short time how to operate it. Results were encouraging so that valuable training, before prosthesis is implanted, appears as good feedback; besides, these patients can be hired as specialized operators in semi-automatized industry.

  14. Ground reaction force and electromyographic activity of transfemoral amputee gait: a case series

    Directory of Open Access Journals (Sweden)

    Alex Sandra Oliveira de Cerqueira

    2013-01-01

    Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2013v15n1p16 Ground reaction forces (GRF and electromyographic activity form a part of the descriptive data that characterise the biomechanics of gait. The research of these parameters is important in establishing gait training and understanding the impact of amputation and prosthetic components on movement during the act of walking. Therefore, this case series describes the GRF and electromyographic activity in the gait of transfemoral amputees. A force plate was used to measure GRF, and an electromyographic system monitored the vastus lateralis, biceps femoris, tibialis anterior, and gastrocnemius lateralis muscles of the non-amputated leg. The average vertical and anteroposterior GRF time-curves, average electromyographic activity, and descriptor variables were then analysed. We observed decreases in vertical and anteroposterior GRF magnitudes as well as in anteroposterior GRF descriptor variables during the propulsive phase in the amputated leg. There were increases in phasic muscle activity and co-activation in the non-amputated leg. We concluded that, during walking, the unilateral transfemoral amputees (who were analysed in this case series developed lower GRF in the amputated limb and a longer period of electromyographic activity in the non-amputated limb.

  15. Influence of gait training and prosthetic foot category on external work symmetry during unilateral transtibial amputee gait.

    Science.gov (United States)

    Agrawal, Vibhor; Gailey, Robert; O'Toole, Christopher; Gaunaurd, Ignacio; Finnieston, Adam

    2013-10-01

    Prosthetic foot prescription guidelines lack scientific evidence and are concurrent with an amputee's concurrent with an amputee's Medicare Functional Classification Level (K-Level) and categorization of prosthetic feet. To evaluate the influence of gait training and four categories of prosthetic feet (K1, K2, K3, and microprocessor ankle/foot) on Symmetry in External Work for K-Level-2 and K-Level-3 unilateral transtibial amputees. Randomized repeated-measures trial. Five K-Level-2 and five K-Level-3 subjects were tested in their existing prosthesis during Session 1 and again in Session 2, following 2 weeks of standardized gait training. In Sessions 3-6, subjects were tested using a study socket and one of four randomized test feet. There was an accommodation period of 10-14 days with each foot. Symmetry in External Work for positive and negative work was calculated at each session to determine symmetry of gait dynamics between limbs at self-selected walking speeds. K-Level-2 subjects had significantly higher negative work symmetry with the K3 foot, compared to K1/K2 feet. For both subject groups, gait training had a greater impact on positive work symmetry than test feet. Higher work symmetry is possible for K-Level-2 amputees who are trained to take advantage of K3 prosthetic feet designs. There exists a need for an objective determinant for categorizing and prescribing prosthetic feet.

  16. Assessment of Gait Symmetry in Transfemoral Amputees Using C-Leg Compared With 3R60 Prosthetic Knees

    DEFF Research Database (Denmark)

    Petersen, Andreas Overbeck; Comins, Jonathan David; Alkjaer, T

    2010-01-01

    The objective of the study was to investigate gait symmetry in transfemoral amputees using a hydraulic- and a microprocessor-controlled knee prosthesis. An A-B design with repeated measurements was chosen, and the measurements were carried out at a prosthetics/orthotics rehabilitation center. Nine...

  17. Variation in Results of Volume Measurements of Stumps of Lower-Limb Amputees : A Comparison of 4 Methods

    NARCIS (Netherlands)

    de Boer-Wilzing, Vera G.; Bolt, Arjen; Geertzen, Jan H.; Emmelot, Cornelis H.; Baars, Erwin C.; Dijkstra, Pieter U.

    de Boer-Wilzing VG, Bolt A, Geertzen JH, Emmelot CH, Baars EC, Dijkstra PU. Variation in results of volume measurements of stumps of lower-limb amputees: a comparison of 4 methods. Arch Phys Med Rehabil 2011;92:941-6. Objective: To analyze the reliability of 4 methods (water immersion,

  18. Sport prostheses and prosthetic adaptations for the upper and lower limb amputees : an overview of peer reviewed literature

    NARCIS (Netherlands)

    Bragaru, Mihai; Dekker, Rienk; Geertzen, Jan H. B.

    Background: Sport prostheses are used by both upper- and lower-limb amputees while participating in sports and other physical activities. Although the number of these devices has increased over the past decade, no overview of the peer reviewed literature describing them has been published

  19. Crowd-Sourced Amputee Gait Data: A Feasibility Study Using YouTube Videos of Unilateral Trans-Femoral Gait.

    Science.gov (United States)

    Gardiner, James; Gunarathne, Nuwan; Howard, David; Kenney, Laurence

    2016-01-01

    Collecting large datasets of amputee gait data is notoriously difficult. Additionally, collecting data on less prevalent amputations or on gait activities other than level walking and running on hard surfaces is rarely attempted. However, with the wealth of user-generated content on the Internet, the scope for collecting amputee gait data from alternative sources other than traditional gait labs is intriguing. Here we investigate the potential of YouTube videos to provide gait data on amputee walking. We use an example dataset of trans-femoral amputees level walking at self-selected speeds to collect temporal gait parameters and calculate gait asymmetry. We compare our YouTube data with typical literature values, and show that our methodology produces results that are highly comparable to data collected in a traditional manner. The similarity between the results of our novel methodology and literature values lends confidence to our technique. Nevertheless, clear challenges with the collection and interpretation of crowd-sourced gait data remain, including long term access to datasets, and a lack of validity and reliability studies in this area.

  20. Transradial Amputee Gesture Classification Using an Optimal Number of sEMG Sensors: An Approach Using ICA Clustering.

    Science.gov (United States)

    Naik, Ganesh R; Al-Timemy, Ali H; Nguyen, Hung T

    2016-08-01

    Surface electromyography (sEMG)-based pattern recognition studies have been widely used to improve the classification accuracy of upper limb gestures. Information extracted from multiple sensors of the sEMG recording sites can be used as inputs to control powered upper limb prostheses. However, usage of multiple EMG sensors on the prosthetic hand is not practical and makes it difficult for amputees due to electrode shift/movement, and often amputees feel discomfort in wearing sEMG sensor array. Instead, using fewer numbers of sensors would greatly improve the controllability of prosthetic devices and it would add dexterity and flexibility in their operation. In this paper, we propose a novel myoelectric control technique for identification of various gestures using the minimum number of sensors based on independent component analysis (ICA) and Icasso clustering. The proposed method is a model-based approach where a combination of source separation and Icasso clustering was utilized to improve the classification performance of independent finger movements for transradial amputee subjects. Two sEMG sensor combinations were investigated based on the muscle morphology and Icasso clustering and compared to Sequential Forward Selection (SFS) and greedy search algorithm. The performance of the proposed method has been validated with five transradial amputees, which reports a higher classification accuracy ( > 95%). The outcome of this study encourages possible extension of the proposed approach to real time prosthetic applications.

  1. Crowd-Sourced Amputee Gait Data: A Feasibility Study Using YouTube Videos of Unilateral Trans-Femoral Gait.

    Directory of Open Access Journals (Sweden)

    James Gardiner

    Full Text Available Collecting large datasets of amputee gait data is notoriously difficult. Additionally, collecting data on less prevalent amputations or on gait activities other than level walking and running on hard surfaces is rarely attempted. However, with the wealth of user-generated content on the Internet, the scope for collecting amputee gait data from alternative sources other than traditional gait labs is intriguing. Here we investigate the potential of YouTube videos to provide gait data on amputee walking. We use an example dataset of trans-femoral amputees level walking at self-selected speeds to collect temporal gait parameters and calculate gait asymmetry. We compare our YouTube data with typical literature values, and show that our methodology produces results that are highly comparable to data collected in a traditional manner. The similarity between the results of our novel methodology and literature values lends confidence to our technique. Nevertheless, clear challenges with the collection and interpretation of crowd-sourced gait data remain, including long term access to datasets, and a lack of validity and reliability studies in this area.

  2. Sports Adaptations for Unilateral and Bilateral Upper-Limb Amputees: Archery/Badminton/Baseball/Softball/Bowling/Golf/Table Tennis.

    Science.gov (United States)

    Cowart, Jim

    1979-01-01

    The booklet discusses sports adaptations for unilateral and bilateral upper limb amputees. Designs for adapted equipment are illustrated and information on adaptations are described for archery (including an archery release aid and a stationary bow holder); badminton (serving tray); baseball/softball (adaptations for catching, throwing, and…

  3. A comparison between the suction suspension system and the hypobaric Iceross Seal-In® X5 in transtibial amputees.

    Science.gov (United States)

    Brunelli, Stefano; Delussu, Anna Sofia; Paradisi, Francesco; Pellegrini, Roberto; Traballesi, Marco

    2013-12-01

    The two passive vacuum suspension systems currently available in total surface-bearing sockets are the hypobaric Iceross Seal-In(®) and the suction suspension system. The purpose of this study was to compare the effect of the hypobaric Iceross Seal-In(®) liner with that of the suction suspension system for quality of life, pistoning, and prosthesis efficiency in unilateral transtibial amputees. Single-group repeated measures. Ten amputees were enrolled. The pistoning test, used to compare vertical movement of the stump within the socket, and the energy cost of walking test were carried out when the amputees were wearing the suction suspension system and after 2, 5, and 7 weeks of Seal-In® X5 use. The Prosthesis Evaluation Questionnaire and the Houghton Scale Questionnaire of perceived mobility and quality of life with the prosthesis, and the Timed Up&Go Test and the Locomotor Capability Index for functional mobility were also administered at the beginning and end of the study. The hypobaric Iceross Seal-In® X5 led to significant pistoning reduction and improvement on the Houghton Scale Questionnaire and 3 of 9 domains of the Prosthesis Evaluation Questionnaire. No statistical changes were observed in functional mobility or the energy cost of walking tests. Replacing the suction suspension system with the hypobaric Iceross Seal-In® X5 improves quality of life in transtibial amputees.

  4. Construct Validity and Test-Retest Reliability of the Climbing Stairs Questionnaire in Lower-Limb Amputees

    NARCIS (Netherlands)

    de Laat, Fred A.; Rommers, Gerardus M.; Geertzen, Jan H.; Roorda, Leo D.

    de Laat FA, Rommers GM, Geertzen JH, Roorda LD. Construct validity and test-retest reliability of the Climbing Stairs Questionnaire in lower-limb amputees. Arch Phys Med Rehabil 2010;91:1396-401. Objective: To investigate the construct validity and test-retest reliability of the Climbing Stairs

  5. Establishing the Turkish version of the SIGAM mobility scale, and determining its validity and reliability in lower extremity amputees.

    Science.gov (United States)

    Yilmaz, Hülya; Gafuroğlu, Ümit; Ryall, Nicola; Yüksel, Selcen

    2018-02-01

    The aim of this study is to adapt the Special Interest Group in Amputee Medicine (SIGAM) mobility scale to Turkish, and to test its validity and reliability in lower extremity amputees. Adaptation of the scale into Turkish was performed by following the steps in American Association of Orthopedic Surgeons (AAOS) guideline. Turkish version of the scale was tested twice on 109 patients who had lower extremity amputations, at hours 0 and 72. The reliability of the Turkish version was tested for internal consistency and test-retest reliability. Structural validity was tested using the "scale validity" method. For this purpose, the scores of the Short Form-36 (SF-36), Functional Ambulation Scale (FAS), Get Up and Go Test, and Satisfaction with the Prosthesis Questionnaire (SATPRO) were calculated, and analyzed using Spearman's correlation test. Cronbach's alpha coefficient was 0.67 for the Turkish version of the SIGAM mobility scale. Cohen's kappa coefficients were between 0.224 and 0.999. Repeatability according to the results of the SIGAM mobility scale (grades A-F) was 0.822. We found significant and strong positive correlations of the SIGAM mobility scale results with the FAS, Get Up and Go Test, SATPRO, and all of the SF-36 subscales. In our study, the Turkish version of the SIGAM mobility scale was found as a reliable, valid, and easy to use scale in everyday practice for measuring mobility in lower extremity amputees. Implications for Rehabilitation Amputation is the surgical removal of a severely injured and nonfunctional extremity, at a level of one or more bones proximal to the body. Loss of a lower extremity is one of the most important conditions that cause functional disability. The Special Interest Group in Amputee Medicine (SIGAM) mobility scale contains 21 questions that evaluate the mobility of lower extremity amputees. Lack of a specific Turkish scale that evaluates rehabilitation results and mobility of lower extremity amputees, and determines their

  6. Combat amputees' health-related quality of life and psychological outcomes: A brief report from the wounded warrior recovery project.

    Science.gov (United States)

    Woodruff, Susan I; Galarneau, Michael R; Sack, Daniel I; McCabe, Cameron T; Dye, Judy L

    2017-03-01

    This study extends what is known about long-term health-related quality of life (HrQoL) and other psychosocial outcomes (i.e., depression, posttraumatic stress disorder [PTSD]) among US military combat amputees serving in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. A total of 63 combat amputees were identified from the Wounded Warrior Recovery Project, a study assessing long-term self-reported HrQoL and psychological outcomes among those wounded during military service. Another 477 service members from the Wounded Warrior Recovery Project were identified as a comparison group (i.e., nonamputees with moderate to severe extremity injuries). After adjusting for age, time since injury, overall injury severity, and traumatic brain injury, amputees had poorer functional HrQoL than those in the nonamputee comparison group overall and in the specific area related to performance of usual activities, and, to some degree, chronic and acute symptoms, and mobility/self-care. On the other hand, depression and PTSD symptoms were not different for the two groups. Results suggest that when assessed over 5 years postinjury, on average, amputees have unique physical and functional limitations, yet do not report greater depression or PTSD symptoms than others seriously injured in combat. It may be that state-of-the-art integrated amputee care that includes support networks and emphasis on adjustment and psychological health may increase successful coping and adjustment, at least to a level that is on par with other types of serious combat injury. Epidemiologic/prognostic study, level III.

  7. Dexterous hand gestures recognition based on low-density sEMG signals for upper-limb forearm amputees

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    John Jairo Villarejo Mayor

    2017-08-01

    Full Text Available Abstract Introduction Intuitive prosthesis control is one of the most important challenges in order to reduce the user effort in learning how to use an artificial hand. This work presents the development of a novel method for pattern recognition of sEMG signals able to discriminate, in a very accurate way, dexterous hand and fingers movements using a reduced number of electrodes, which implies more confidence and usability for amputees. Methods The system was evaluated for ten forearm amputees and the results were compared with the performance of able-bodied subjects. Multiple sEMG features based on fractal analysis (detrended fluctuation analysis and Higuchi’s fractal dimension combined with traditional magnitude-based features were analyzed. Genetic algorithms and sequential forward selection were used to select the best set of features. Support vector machine (SVM, K-nearest neighbors (KNN and linear discriminant analysis (LDA were analyzed to classify individual finger flexion, hand gestures and different grasps using four electrodes, performing contractions in a natural way to accomplish these tasks. Statistical significance was computed for all the methods using different set of features, for both groups of subjects (able-bodied and amputees. Results The results showed average accuracy up to 99.2% for able-bodied subjects and 98.94% for amputees using SVM, followed very closely by KNN. However, KNN also produces a good performance, as it has a lower computational complexity, which implies an advantage for real-time applications. Conclusion The results show that the method proposed is promising for accurately controlling dexterous prosthetic hands, providing more functionality and better acceptance for amputees.

  8. Demographics and discharge outcomes of dysvascular and non-vascular lower limb amputees at a subacute rehabilitation unit: a 7-year series.

    Science.gov (United States)

    Batten, Heather R; Kuys, Suzanne S; McPhail, Steven M; Varghese, Paulose N; Nitz, Jennifer C

    2015-02-01

    To examine personal and social demographics, and rehabilitation discharge outcomes of dysvascular and non-vascular lower limb amputees. In total, 425 lower limb amputation inpatient rehabilitation admissions (335 individuals) from 2005 to 2011 were examined. Admission and discharge descriptive statistics (frequency, percentages) were calculated and compared by aetiology. Participants were male (74%), aged 65 years (s.d. 14), born in Australia (72%), had predominantly dysvascular aetiology (80%) and a median length of stay 48 days (interquartile range (IQR): 25-76). Following amputation, 56% received prostheses for mobility, 21% (n = 89) changed residence and 28% (n = 116) required community services. Dysvascular amputees were older (mean 67 years, s.d. 12 vs 54 years, s.d. 16; P amputees worked before amputation (43% vs 11%; P amputees.

  9. Energy Cost and Gait Efficiency of Below-Knee Amputee and Normal Subject with Similar Physical Parameters & Quality of Life: A Comparative Case Study

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    Durbadal Biswas

    2010-10-01

    Full Text Available The study focused on the comparative analysis of energy cost and gait efficiency between a below knee (BK amputee and a reference subject (without amputation. It also attempted to indicate the specific feature responsible for a controlled gait with optimum energy cost for BK amputees. Selection criteria of the subjects were similar physical parameters and quality of life studied with WHOQOL-100 quality of life assessment. A Cosmed® k4 b2 Respiratory Analyzer system was used for the measurement of Oxygen Uptake (VO2, Energy Expenditure per minute (EE and Heart Rate (HR. Gait efficiency (p < 0.0002 was found higher for BK amputee than normal subject. The therapeutic activities and mainly walking rhythm contributed to improve the mobility & balance. This ensures the optimum time & co-ordination of movements and hence improves the gait efficiency for the BK amputee. Comparison with control group was performed to validate the data.

  10. The Effect of a Microprocessor Prosthetic Foot on Function and Quality of Life in Transtibial Amputees Who Are Limited Community Ambulators

    Science.gov (United States)

    2017-09-01

    to qualify for evaluation of Medicare Functional Classification Level (MFCL) using the Amputee Mobility Predictor-Prosthesis ( AMP -Pro). Five (15.6...Functional Classification Level (MFCL) using the Amputee Mobility Predictor-Prosthesis ( AMP -Pro). Five (15.6%) of those individuals (who comprised 7... AMP -Pro results to date are presented in Table 1 below. Table 1: VALOR Study Frequency of participant MFCL by K-Level evaluated using the AMP -Pro

  11. To Compare the Effect of Pre and Post Weight Bearing Anxiety, Depression in Conventional and Modular Prosthesis on Unilateral Transtibial Amputees

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    R. Raja

    2014-01-01

    Full Text Available Aims and Objectives: To compare the effect of anxiety and depression on unilateral trans tibial amputees those who are using conventional and modular patellar tendon bearing (PTB prosthesis with stump exercises. Material and Methods: A sample of 40 persons with below knee amputation who were trained to wear prosthesis were studied with an experimental comparative study design. Patients who were admitted at Kempegowda Institute of Medical Sciences and Research Centre, Bangalore, K. S. Hegde Medical Academy and Research Centre Mangalore, (N=150 who underwent unilateral transtibial, transfemoral and other amputations between August 2009 - December 2011. To find out peri and postoperative prosthetic fitting, anxiety and depression level of transtibial amputees who wear conventional and modular PTB prosthesis. 3 years of experimental comparative study reveals that the outcome measures of peri and post-operative anxiety and depression level while using conventional PTB prosthesis with stump exercises and modular PTB prosthesis with stump exercises on unilateral transtibial amputees. Results: The unilateral transtibial amputees who were trained with modular prosthesis along with stump exercises group patients anxiety and depression levels are reduced as compared to the unilateral transtibial amputees who were trained with conventional PTB prosthesis along with stump exercises. There is no significant difference seen in both the groups while giving stump exercises alone. Conclusion: The unilateral transtibial amputees who were trained with modular prosthesis along with stump exercises group, patient’s anxiety and depression levels are reduced drastically.

  12. Identification of the critical level of implantation of an osseointegrated prosthesis for above-knee amputees.

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    Andrango Castro, Elder Michael; Konvickova, Svatava; Daniel, Matej; Horak, Zdenek

    2017-11-01

    The aim of our study was to identify potential critical levels of implantation of an osseointegrated prosthesis for above-knee amputees. The implant used was the OPRA system. It was inserted in the femur at four different amputation heights, characterized by their residual limb ratios (0.299, 0.44, 0.58 and 0.73). The stress and strain distribution was evaluated in the bone-implant system during walking, considering a body mass of 100 kg. Considerably high stimulus (11,489 με) in the tissue near the tip was found at the highest implantation level. All models presented small non-physiologic stress values in the tissue around the implant. The results revealed that the implantation level has a decisive effect on bone-implant performance. Mainly, the analysis indicates adverse biomechanical conditions for implantations in very short residual limbs.

  13. An experimental and theoretical framework for manufacturing prosthetic sockets for transtibial amputees.

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    Faustini, Mario C; Neptune, Richard R; Crawford, Richard H; Rogers, William E; Bosker, Gordon

    2006-09-01

    Selective laser sintering (SLS) is a powerful manufacturing technology that does not require part-specific tooling or significant human intervention and provides the ability to easily generate parts with complex geometric designs. The present work focuses on developing a manufacturing framework using this technology to produce subject-specific transtibial amputee prosthetic sockets made of Duraform PA, which is a nylon-based material. The framework includes establishing an overall socket design (using the patellar-tendon bearing approach), performing a structural analysis using the finite element method (FEM) to ensure structural reliability during patient use, and validating the results by comparing the model output with experimental data. The validation included quantifying the failure conditions for the socket through a series of bending moment and compression tests. In the case study performed, the FEM results were within 3% of the experimental failure loads for the socket and were considered satisfactory.

  14. Relation of Stump Length with Various Gait Parameters in Trans-tibial Amputee

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    Koyel Majumdar

    2008-07-01

    Full Text Available The purpose of this paper is evaluating the impact of stump length of unilateral below knee amputees (BKA on different gait parameters. Nine unilateral BKA were chosen and divided into three groups comprising patients with short, medium, and long stump length. Each of them underwent gait analysis test by Computer Dynography (CDG system to measure the gait parameters. It was found that the ground reaction force is higher in the patients with medium stump length whereas the velocity, step length both for the prosthetic and sound limb and cadence were high in longer stump length. Statistical analysis shows a significant difference (p<0.05 between the gait parameters of BKA with medium and longer stump length. The patients with longer stump length were more efficient than medium and short stump patients as they consumed comparatively lesser energy while walking with self-selected velocity and conventional (Solid ankle cushioned heel SACH foot.

  15. Kinematics of gait using bionic and hydraulic knee joints in transfemoral amputees

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    Jaroslav Uchytil

    2017-10-01

    Full Text Available Background: The development of new technologies has led to further improvements in prosthetic knee joints. Objective: The aim of this study was to compare angle parameters in knee and hip joints during the gait of transfemoral amputees and to determine the effect of the type of knee joint used on their symmetry. The study also compared pelvic movements in transfemoral amputees using different types of knee joints. Method: Eleven patients (5 female, 6 male, mean age 39.2 ± 10.1 years, height 171.8 ± 9.5 cm, mass 71.5 ± 11.0 kg with a transfemoral amputation (5 used bionic knee, 6 used hydraulic knee participated in this study. The control group consisted of 10 individuals with no locomotion-related problems (2 female, 8 male. Results: Movement was more symmetrical in the hip joint for all monitored parameters in patients with bionic knee joints. Flexion at heel contact and maximum flexion in the swing phase in the knee joint were more symmetrical in the group with hydraulic knee joints; for all other parameters the group with bionic knee joints achieved better symmetry. The kinematics of pelvic movement in the patients using hydraulic knee joints differed from the control group in all monitored parameters. The greatest difference with excellent effect size (ES = 7.96 was found in pelvic tilt. Pelvic tilt was higher when using hydraulic knee joints. Conclusion:  In comparison with the mechanically passive knee joint, gait with the bionic knee joint evinced gait symmetry.

  16. Body image and self-esteem in lower-limb amputees.

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    Lukas A Holzer

    Full Text Available BACKGROUND: Limb amputation is often an inevitable procedure in the advanced condition of various diseases and poses a dramatic impact on a patient's life. The aim of the present study is to analyze the impact of lower-limb amputations on aesthetic factors such as body image and self-esteem as well as quality of life (QoL. METHODS: 298 patients (149 uni- or bilateral lower-limb amputees and 149 controls were included in this cross-sectional study in three centers. Demographic data was collected and patients received a 118-item questionnaire including the Multidimensional Body-Self Relations Questionnaire (MBSRQ, the Rosenberg Self-esteem (RSE scale and the SF-36 Health Survey (QoL. ANOVA and student's t-test were used for statistical analysis. RESULTS: Unilateral lower-limb amputees showed a significant lower MBSRQ score of 3.07±0.54 compared with 3.41±0.34 in controls (p<0.001 and a lower score in the RSE compared to controls (21.63±4.72 vs. 21.46±5.86. However, differences were not statistically significant (p = 0.36. Patients with phantom pain sensation had a significantly reduced RSE (p = 0.01. The SF-36 health survey was significantly lower in patients with lower-limb amputation compared to controls (42.17±14.47 vs. 64.05±12.39 (p<0.001. CONCLUSION: This study showed that lower-limb amputations significantly influence patients' body image and QoL. Self-esteem seems to be an independent aspect, which is not affected by lower-limb amputation. However, self-esteem is influenced significantly by phantom pain sensation.

  17. Development and evaluation of the activities measure for upper limb amputees.

    Science.gov (United States)

    Resnik, Linda; Adams, Laurel; Borgia, Matthew; Delikat, Jemy; Disla, Roxanne; Ebner, Christopher; Walters, Lisa Smurr

    2013-03-01

    (1) To develop a measure of activities for adults with upper limb amputation: the Activities Measure for Upper Limb Amputees (AM-ULA); and (2) to conduct initial psychometric evaluation of the measure. This was a cohort study where the prototype measure was administered twice within 1 week. Tests were videotaped and graded by 2 independent raters. Interrater reliability, test-retest reliability, internal consistency, and minimal detectable change were estimated. Known group validity was examined using analyses of variance comparing scores of transradial, transhumeral, and shoulder level amputees. Convergent validity was examined by correlating AM-ULA scores with dexterity tests and self-reported function. Hospital outpatient. Subjects (N=52) with upper limb amputation. Not applicable. Not applicable. Intraclass correlation coefficients (ICCs) for test-retest reliability were .88 to .91. ICCs for interrater reliability were .84 to .89. Cronbach alphas were .89 to .91. The minimal detectable change at the 90% confidence interval was 3.7 points. Subjects with more distal levels of limb loss had better scores than those with more proximal levels (P<.01). The AM-ULA was moderately correlated with most dexterity tests and self-reported function. The AM-ULA is a new measure of activity performance for adults with upper limb amputation that considers task completion, speed, movement quality, skillfulness of prosthetic use, and independence in its rating system. It has good interrater reliability, test-retest reliability, and demonstrated known group validity. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  18. Attachment of upper arm prostheses with a subcutaneous osseointegrated implant in transhumeral amputees.

    Science.gov (United States)

    Salminger, Stefan; Gradischar, Andreas; Skiera, Richard; Roche, Aidan D; Sturma, Agnes; Hofer, Christian; Aszmann, Oskar C

    2018-02-01

    The stump-socket interface is of utmost importance for prosthetic function in transhumeral amputees. Stability of this connection may be improved using a newly designed subcutaneous implant. The purpose was to determine the effect of the implant together with customized socket designs on the range of motion of the shoulder and the prosthetic function compared to conventional fitting. Case series. The range of motion was measured with scaled metrics and the prosthetic function evaluated with the Southampton Hand Assessment Procedure and the Box and Block Test. Maximal loading was measured in straight and 90° flexion of the elbow. The restriction of range of motion after conventional fitting was decreased from 42.55% ± 6.56% to 9.23% ± 14.89% in Patient I and from 62.18% ± 15.19% to 2.51% ± 2.49% in Patient II using the implant with customized sockets compared to range of motion without prosthesis. Both patients showed improved prosthetic function with the new system compared to conventional fitting. The presented subcutaneous humeral implant, together with customized socket designs without straps and harnesses to the contralateral shoulder, can maintain almost complete range of motion of the shoulder. This resulted in improved prosthetic function and comfort for the patient without constant risk of infection. Clinical relevance Discomfort and limited prosthetic function are the main reasons for abandonment especially in transhumeral amputees. Shoulder straps and harnesses within conventional socket designs may not only lead to pain and skin irritations at the contralateral shoulder but also limit the range of motion of the shoulder joint and therefore prosthetic function.

  19. A Randomized, Controlled Trial of Mirror Therapy for Upper Extremity Phantom Limb Pain in Male Amputees

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    Sacha B. Finn

    2017-07-01

    Full Text Available ObjectivePhantom limb pain (PLP is prevalent in patients post-amputation and is difficult to treat. We assessed the efficacy of mirror therapy in relieving PLP in unilateral, upper extremity male amputees.MethodsFifteen participants from Walter Reed and Brooke Army Medical Centers were randomly assigned to one of two groups: mirror therapy (n = 9 or control (n = 6, covered mirror or mental visualization therapy. Participants were asked to perform 15 min of their assigned therapy daily for 5 days/week for 4 weeks. The primary outcome was pain as measured using a 100-mm Visual Analog Scale.ResultsSubjects in the mirror therapy group had a significant decrease in pain scores, from a mean of 44.1 (SD = 17.0 to 27.5 (SD = 17.2 mm (p = 0.002. In addition, there was a significant decrease in daily time experiencing pain, from a mean of 1,022 (SD = 673 to 448 (SD = 565 minutes (p = 0.003. By contrast, the control group had neither diminished pain (p = 0.65 nor decreased overall time experiencing pain (p = 0.49. A pain decrement response seen by the 10th treatment session was predictive of final efficacy.ConclusionThese results confirm that mirror therapy is an effective therapy for PLP in unilateral, upper extremity male amputees, reducing both severity and duration of daily episodes.RegistrationNCT0030144 ClinicalTrials.gov.

  20. Double nerve intraneural interface implant on a human amputee for robotic hand control.

    Science.gov (United States)

    Rossini, Paolo M; Micera, Silvestro; Benvenuto, Antonella; Carpaneto, Jacopo; Cavallo, Giuseppe; Citi, Luca; Cipriani, Christian; Denaro, Luca; Denaro, Vincenzo; Di Pino, Giovanni; Ferreri, Florinda; Guglielmelli, Eugenio; Hoffmann, Klaus-Peter; Raspopovic, Stanisa; Rigosa, Jacopo; Rossini, Luca; Tombini, Mario; Dario, Paolo

    2010-05-01

    The principle underlying this project is that, despite nervous reorganization following upper limb amputation, original pathways and CNS relays partially maintain their function and can be exploited for interfacing prostheses. Aim of this study is to evaluate a novel peripheral intraneural multielectrode for multi-movement prosthesis control and for sensory feed-back, while assessing cortical reorganization following the re-acquired stream of data. Four intrafascicular longitudinal flexible multielectrodes (tf-LIFE4) were implanted in the median and ulnar nerves of an amputee; they reliably recorded output signals for 4 weeks. Artificial intelligence classifiers were used off-line to analyse LIFE signals recorded during three distinct hand movements under voluntary order. Real-time control of motor output was achieved for the three actions. When applied off-line artificial intelligence reached >85% real-time correct classification of trials. Moreover, different types of current stimulation were determined to allow reproducible and localized hand/fingers sensations. Cortical organization was observed via TMS in parallel with partial resolution of symptoms due to the phantom-limb syndrome (PLS). tf-LIFE4s recorded output signals in human nerves for 4 weeks, though the efficacy of sensory stimulation decayed after 10 days. Recording from a number of fibres permitted a high percentage of distinct actions to be classified correctly. Reversal of plastic changes and alleviation of PLS represent corollary findings of potential therapeutic benefit. This study represents a breakthrough in robotic hand use in amputees. Copyright 2010 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  1. The role of the environment in eliciting phantom-like sensations in non-amputees

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    Elizabeth eLewis

    2013-01-01

    Full Text Available Following the amputation of a limb, many amputees report that they can still vividly perceive its presence despite conscious knowledge that it is not physically there. However, our ability to probe the mental representation of this experience is limited by the intractable and often distressing pain associated with amputation. Here, we present a method for eliciting phantom-like experiences in non-amputees using a variation of the rubber hand illusion in which a finger has been removed from the rubber hand. An interpretative phenomenological analysis revealed that the structure of this experience shares a wide range of sensory attributes with subjective reports of phantom limb experience. For example, when the space where the ring finger should have been on the rubber hand was stroked, 93% of participants (i.e., 28/30 reported the vivid presence of a finger that they could not see and a total of 57% (16/28 of participants who felt that the finger was present reported one or more additional sensory qualities such as tingling or numbness (25%; 7/28 and alteration in the perceived size of the finger (50%; 14/28. These experiences indicate the adaptability of body experience and share some characteristics of the way that phantom limbs are described. Participants attributed changes to the shape and size of their ‘missing’ finger to the way in which the experimenter mimed stroking in the area occupied by the missing finger. This alteration of body perception is similar to the phenomenon of telescoping experienced by people with phantom limbs and suggests that our sense of embodiment not only depends on internal body representations but on perceptual information coming from peripersonal space.

  2. Real-time gait event detection for lower limb amputees using a single wearable sensor.

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    Maqbool, H F; Husman, M A B; Awad, M I; Abouhossein, A; Mehryar, P; Iqbal, N; Dehghani-Sanij, A A

    2016-08-01

    This paper presents a rule-based real-time gait event/phase detection system (R-GEDS) using a shank mounted inertial measurement unit (IMU) for lower limb amputees during the level ground walking. Development of the algorithm is based on the shank angular velocity in the sagittal plane and linear acceleration signal in the shank longitudinal direction. System performance was evaluated with four control subjects (CS) and one transfemoral amputee (TFA) and the results were validated with four FlexiForce footswitches (FSW). The results showed a data latency for initial contact (IC) and toe off (TO) within a range of ± 40 ms for both CS and TFA. A delay of about 3.7 ± 62 ms for a foot-flat start (FFS) and an early detection of -9.4 ± 66 ms for heel-off (HO) was found for CS. Prosthetic side showed an early detection of -105 ± 95 ms for FFS whereas intact side showed a delay of 141 ±73 ms for HO. The difference in the kinematics of the TFA and CS is one of the potential reasons for high variations in the time difference. Overall, detection accuracy was 99.78% for all the events in both groups. Based on the validated results, the proposed system can be used to accurately detect the temporal gait events in real-time that leads to the detection of gait phase system and therefore, can be utilized in gait analysis applications and the control of lower limb prostheses.

  3. A comprehensive musculoskeletal and peripheral nervous system assessment of war-related bilateral upper extremity amputees.

    Science.gov (United States)

    Allami, Mostafa; Mousavi, Batool; Masoumi, Mehdi; Modirian, Ehsan; Shojaei, Hadi; Mirsalimi, Fatemeh; Hosseini, Maryam; Pirouzi, Pirouz

    2016-01-01

    Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation. The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees (206 amputations) from the Iran-Iraq war were evaluated, and a detailed questionnaire was also administered. The most common level of amputation was the finger or wrist level (108, 52.4 %). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis (65, 31.6 %), rotator cuff injury (24, 11.7 %), bicipital tendonitis (69, 33.5 %), shoulder drop (42, 20.4 %) and muscle atrophy (19, 9.2 %). Peripheral nerve disorders included carpal tunnel syndrome in 13 (6.3 %) and unilateral brachial plexus injury in 1 (1 %). Fifty-three (51.5 %) were diagnosed with facet joint syndrome at the level of the cervical spine (the most frequent site). Using a prosthesis was reported by 65 (63.1 %), both left and right sides. The back was the most common site of pain (71.8 %). The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.

  4. Body Image and Self-Esteem in Lower-Limb Amputees

    Science.gov (United States)

    Holzer, Lukas A.; Sevelda, Florian; Fraberger, Georg; Bluder, Olivia; Kickinger, Wolfgang; Holzer, Gerold

    2014-01-01

    Background Limb amputation is often an inevitable procedure in the advanced condition of various diseases and poses a dramatic impact on a patient's life. The aim of the present study is to analyze the impact of lower-limb amputations on aesthetic factors such as body image and self-esteem as well as quality of life (QoL). Methods 298 patients (149 uni- or bilateral lower-limb amputees and 149 controls) were included in this cross-sectional study in three centers. Demographic data was collected and patients received a 118-item questionnaire including the Multidimensional Body-Self Relations Questionnaire (MBSRQ), the Rosenberg Self-esteem (RSE) scale and the SF-36 Health Survey (QoL). ANOVA and student's t-test were used for statistical analysis. Results Unilateral lower-limb amputees showed a significant lower MBSRQ score of 3.07±0.54 compared with 3.41±0.34 in controls (p<0.001) and a lower score in the RSE compared to controls (21.63±4.72 vs. 21.46±5.86). However, differences were not statistically significant (p = 0.36). Patients with phantom pain sensation had a significantly reduced RSE (p = 0.01). The SF-36 health survey was significantly lower in patients with lower-limb amputation compared to controls (42.17±14.47 vs. 64.05±12.39) (p<0.001). Conclusion This study showed that lower-limb amputations significantly influence patients' body image and QoL. Self-esteem seems to be an independent aspect, which is not affected by lower-limb amputation. However, self-esteem is influenced significantly by phantom pain sensation. PMID:24663958

  5. Transcranial direct current stimulation versus user training on improving online myoelectric control for amputees

    Science.gov (United States)

    Pan, Lizhi; Zhang, Dingguo; Jiang, Ning; Sheng, Xinjun; Zhu, Xiangyang

    2017-08-01

    Objective. Transcranial direct current stimulation (tDCS) and user training (UT) are two types of methods to improve myoelectric control performance for amputees. In this study, we compared the independent effect between tDCS and UT, and investigated the combined effect of tDCS and UT. Approach. An online paradigm of simultaneous and proportional control (SPC) based on electromyography (EMG) was adopted. The proposed experiments were conducted on six naïve unilateral trans-radial amputees. The subjects each received three types of 20 min interventions: active tDCS with motor training (tDCS  +  UT), active tDCS with quiet sitting (tDCS), and sham tDCS with motor training (UT). The interventions were applied at one week intervals in a randomized order. The subjects performed online control of a feedback arrow with two degrees of freedom (DoFs) to accomplish target reaching motor tasks in pre-sessions and post-sessions. We compared the performance, measured by completion rate, completion time, and efficiency coefficient, between pre-sessions and post-sessions. Main results. The results showed that the intervention tDCS  +  UT and tDCS significantly improved the online SPC performance (i.e. improved the completion rate; reduced the completion time; and improved the efficiency coefficient), while intervention UT did not significantly change the performance. The results also showed that the online SPC performance after intervention tDCS  +  UT and tDCS was not significantly different, but both were significantly better than that after intervention UT. Significance. tDCS could be an effective intervention to improve the online SPC performance in a short time.

  6. Evaluation of function, performance, and preference as transfemoral amputees transition from mechanical to microprocessor control of the prosthetic knee.

    Science.gov (United States)

    Hafner, Brian J; Willingham, Laura L; Buell, Noelle C; Allyn, Katheryn J; Smith, Douglas G

    2007-02-01

    To evaluate differences in function, performance, and preference between mechanical and microprocessor prosthetic knee control technologies. A-B-A-B reversal design. Home, community, and laboratory environments. Twenty-one unilateral, transfemoral amputees. Mechanical control prosthetic knee versus microprocessor control prosthetic knee (Otto Bock C-Leg). Stair rating, hill rating and time, obstacle course time, divided attention task accuracy and time, Amputee Mobility Predictor score, step activity, Prosthesis Evaluation Questionnaire score, Medical Outcomes Study 36-Item Short-Form Health Survey score, self-reported frequency of stumbles and falls, and self-reported concentration required for ambulation. Stair descent score, hill descent time, and hill sound-side step length showed significant (Pmicroprocessor knee. Subject satisfaction with the C-Leg was significantly (Pprosthesis. The study population showed improved performance when negotiating stairs and hills, reduced frequency of stumbling and falling, and a preference for the microprocessor control C-Leg as compared with the mechanical control prosthetic knee.

  7. Cerebral blood perfusion changes in amputees with myoelectric hands after rehabilitation: a SPECT computer-aided analysis.

    Science.gov (United States)

    Liu, Qiufang; Zheng, Xiujuan; Li, Panli; Xu, Lian; He, Longwen; Mei, Zhao; Zhu, Yinyan; Huang, Gang; Zhong, Chunlong; Song, Shaoli

    2016-08-31

    Rehabilitation, which is essential for amputees with myoelectric hands, can improve the quality of daily life by remodeling the neuron network. In our study, we aim to develop a cerebral blood perfusion (CBF) single-photon emission computed tomography computer-aided (SPECT-CA) detection scheme to automatically locate the brain's activated regions after rehabilitation. Five participants without forearms (three male, two female, mean age 51 ± 12.89 years, two missing the right side, and three missing the left side) were included in our study. In the clinical assessment, all of the participants received higher scores after training. The results of the SPM analysis indicated that CBF in the precentral gyrus, postcentral gyrus, frontal lobe, temporal lobe and cerebellum was significantly different among the five participants (P rehabilitation with high sensitivity and accuracy. This method has great potential for locating the remodeled neuron regions of amputees with myoelectric hands after rehabilitation.

  8. Improved comfort and function of arm prosthesis after implantation of a Humerus-T-Prosthesis in trans-humeral amputees.

    Science.gov (United States)

    Witsø, Eivind; Kristensen, Tomm; Benum, Pål; Sivertsen, Svein; Persen, Leif; Funderud, Are; Magne, Tordis; Aursand, Hans Petter; Aamodt, Arild

    2006-12-01

    The use of arm prosthesis in trans-humeral amputees is limited; due to the cone form of the amputation stump. A Humerus-T-Prosthesis was implanted in three patients to create artificial humerus condyles. Two of the patients were successfully rehabilitated with the application of a new type trans-humeral arm prosthesis. This arm prosthesis had a socket which is suspended and stabilized by the humerus and implant only. Traction and rotational stability were secured by adjustable pressure adaptation around the artificial condyles. The third patient developed a pressure wound over the lateral part of the artificial condyle that later healed. He also was subject to a new trauma with a fracture of the ipsilateral scapula and until now has had limited the use of his new arm prosthesis. It was concluded that this new concept for prosthesis fitting of trans-humeral amputees looks promising, but alternative designs of the implant should be tested.

  9. Effects of ladder parameters on asymmetric patterns of force exertion during below-knee amputees climbing ladders.

    Science.gov (United States)

    Li, Weidong; Li, Shiqi; Fu, Yan; Chen, Jacon

    2017-03-01

    Different from walking, ladder climbing requires four-limb coordination and more energy exertion for below-knee amputees (BKAs). We hypothesized that functional deficiency of a disabled limb shall be compensated by the other three intact limbs, showing an asymmetry pattern among limbs. Hand and foot forces of six below-knee amputees and six able-bodied people were collected. Hand, foot and hand/foot sum force variances between groups (non-BKA, intact side and prosthetic side) were carefully examined. Our hypothesis was validated that there is asymmetry between prosthetic and intact side. Results further showed that the ipsilateral hand of the prosthetic leg is stronger than the hand on the intact side, compensating weakness of the prosthetic leg. Effects of ladder rung separations and ladder slant on asymmetric force distribution of BKAs were evaluated, indicating that rung separation has a more significant interactive effect on hand/foot force of BKAs than ladder slant.

  10. Assessment of Gait Symmetry in Transfemoral Amputees Using C-Leg Compared With 3R60 Prosthetic Knees

    DEFF Research Database (Denmark)

    Petersen, Andreas Overbeck; Comins, Jonathan David; Alkjaer, T

    2010-01-01

    unilateral transfemoral C-Leg bearing amputees participated in the study, of whom five subjects completed the study. Three-dimensional inverse dynamic gait analysis was performed on each subject. Each subject was then fitted with a 3R60 prosthesis. After a 1-week acclimation period, gait analysis......The objective of the study was to investigate gait symmetry in transfemoral amputees using a hydraulic- and a microprocessor-controlled knee prosthesis. An A-B design with repeated measurements was chosen, and the measurements were carried out at a prosthetics/orthotics rehabilitation center. Nine...... C-Leg. The butterfly patterns differed remarkably across subjects, which indicates different gait strategies, but the gait patterns within subjects were not influenced by the type of prosthetic knee. In conclusion, none of the outcome measures investigated showed a significantly improved gait...

  11. Functional and Psychosocial Outcomes of Hand Transplantation Compared with Prosthetic Fitting in Below-Elbow Amputees: A Multicenter Cohort Study.

    Directory of Open Access Journals (Sweden)

    Stefan Salminger

    Full Text Available Hand-transplantation and improvements in the field of prostheses opened new frontiers in restoring hand function in below-elbow amputees. Both concepts aim at restoring reliable hand function, however, the indications, advantages and limitations for each treatment must be carefully considered depending on level and extent of amputation. Here we report our findings of a multi-center cohort study comparing hand function and quality-of-life of people with transplanted versus prosthetic hands.Hand function in amputees with either transplant or prostheses was tested with Action Research Arm Test (ARAT, Southampton Hand Assessment Procedure (SHAP and the Disabilities of the Arm, Shoulder and Hand measure (DASH. Quality-of-life was compared with the Short-Form 36 (SF-36.Transplanted patients (n = 5 achieved a mean ARAT score of 40.86 ± 8.07 and an average SHAP score of 75.00 ± 11.06. Prosthetic patients (n = 7 achieved a mean ARAT score of 39.00 ± 3.61 and an average SHAP score of 75.43 ± 10.81. There was no significant difference between transplanted and prosthetic hands in ARAT, SHAP or DASH. While quality-of-life metrics were equivocal for four scales of the SF-36, transplanted patients reported significantly higher scores in "role-physical" (p = 0.006, "vitality" (p = 0.008, "role-emotional" (p = 0.035 and "mental-health" (p = 0.003.The indications for hand transplantation or prosthetic fitting in below-elbow amputees require careful consideration. As functional outcomes were not significantly different between groups, patient's best interests and the route of least harm should guide treatment. Due to the immunosuppressive side-effects, the indication for allotransplantation must still be restrictive, the best being bilateral amputees.

  12. The benefits of using a vacuum-assisted socket system to improve balance and gait in elderly transtibial amputees.

    Science.gov (United States)

    Samitier, C Beatriz; Guirao, Lluis; Costea, Maria; Camós, Josep M; Pleguezuelos, Eulogio

    2016-02-01

    Lower limb amputation leads to impaired balance, ambulation, and transfers. Proper fit of the prosthesis is a determining factor for successful ambulation. Vacuum-assisted socket systems extract air from the socket, which decreases pistoning and probability of soft-tissue injuries and increases proprioception and socket comfort. To investigate the effect of vacuum-assisted socket system on transtibial amputees' performance-based and perceived balance, transfers, and gait. Quasi-experimental before-and-after study. Subjects were initially assessed using their prosthesis with the regular socket and re-evaluated 4 weeks after fitting including the vacuum-assisted socket system. We evaluated the mobility grade using Medicare Functional Classification Level, Berg Balance Scale, Four Square Step Test, Timed Up and Go Test, the 6-Min Walk Test, the Locomotor Capabilities Index, Satisfaction with Prosthesis (SAT-PRO questionnaire), and Houghton Scale. A total of 16 unilateral transtibial dysvascular amputees, mean age 65.12 (standard deviation = 10.15) years. Using the vacuum-assisted socket system, the patients significantly improved in balance, gait, and transfers: scores of the Berg Balance Scale increased from 45.75 (standard deviation = 6.91) to 49.06 (standard deviation = 5.62) (p gait, and transfers in over-50-year-old dysvascular transtibial amputees. This study gives more insight into the use of vacuum-assisted socket systems to improve elderly transtibial dysvascular amputees' functionality and decrease their risk of falls. The use of an additional distal valve in the socket should be considered in patients with a lower activity level. © The International Society for Prosthetics and Orthotics 2014.

  13. Longitudinal changes in transtibial amputee gait characteristics when negotiating a change in surface height during continuous gait.

    Science.gov (United States)

    Barnett, C T; Polman, R C J; Vanicek, N

    2014-08-01

    Negotiating a raised surface during continuous gait is an important activity of daily living and is a potentially hazardous task with regards to trips, falls and fall-related injury. However, it is not known how recent transtibial amputees adapt to performing stepping gait tasks in the 6-month period following discharge from rehabilitation. Recent transtibial amputees performed continuous gait trials, stepping onto and from a raised surface walkway representing the height of a street kerb, whilst kinematic and kinetic data were recorded at one, three and six months post-discharge from rehabilitation. Walking speed increased when stepping down (p=0.04) and was invariant across the study period when stepping up. At one month post-discharge, participants displayed an affected lead limb preference (90.8%) when stepping down and an intact lead limb preference (70.0%) when stepping up, although these lead limb preferences diminished over time. Participants spent more time in stance on the intact limb compared to the affected limb in both stepping down (trail limb) (p=0.01) and stepping up (lead and trail limbs) (p=0.05). Participants displayed significantly greater joint mobility and power bursts in the intact trail limb when stepping down and in the intact lead limb when stepping up. Transtibial amputees prefer to exploit intact limb function to a greater extent, although over time, the means by which this occurs changes which affects the initial lead limb preferences. The results from the current study enable future evidence-based therapeutic and prosthetic interventions to be designed that improve transtibial amputee stepping gait. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. BIOENERGETIC DIFFERENCES DURING WALKING AND RUNNING IN TRANSFEMORAL AMPUTEE RUNNERS USING ARTICULATING AND NON-ARTICULATING KNEE PROSTHESES

    OpenAIRE

    Highsmith, M. Jason; Kahle, Jason T.; Miro, Rebecca M.; Mengelkoch, Larry J.

    2016-01-01

    Transfemoral amputation (TFA) patients require considerably more energy to walk and run than non-amputees. The purpose of this study was to examine potential bioenergetic differences (oxygen uptake (VO2), heart rate (HR), and ratings of perceived exertion (RPE)) for TFA patients utilizing a conventional running prosthesis with an articulating knee mechanism versus a running prosthesis with a non-articulating knee joint. Four trained TFA runners (n = 4) were accommodated to and tested with bot...

  15. Efficacy of proprioceptive neuromuscular facilitation techniques versus traditional prosthetic training for improving ambulatory function in transtibial amputees

    OpenAIRE

    Pallavi Sahay, MPT; Santosh Kr. Prasad, MSc; Shahnawaz Anwer, MPT; P.K. Lenka, PhD; Ratnesh Kumar, MS

    2014-01-01

    The objective of this randomized controlled trial was to evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF) techniques in comparison to traditional prosthetic training (TPT) in improving ambulatory function in transtibial amputees. Thirty study participants (19 men and 11 women) with unilateral transtibial amputation participated in the study. They were randomly allocated to either the traditional training group (i.e., TPT) (n = 15) or the PNF training group (n = 15). Th...

  16. Split-belt adaptation and gait symmetry in transtibial amputees walking with a hybrid EMG controlled ankle-foot prosthesis.

    Science.gov (United States)

    Kannape, Oliver A; Herr, Hugh M

    2016-08-01

    Our ability to automatically adapt our walking pattern to the demands of our environment is central to maintaining a steady gait. Accordingly, a large effort is being made to extend and integrate this adaptability to lower-limb prostheses. To date, the main focus of this research has been on short term adaptation, such as in response to a terrain transition or a sudden change in the environment. However, long term adaptation and underlying sensorimotor learning processes are critical to optimizing walking patterns and predictively changing our gait when faced with continued perturbations. Furthermore, investigating these processes in lower-limb amputees may provide a unique window into the interplay between sensory driven adaptation and top-down cerebellar modulation of locomotor reflexes and may potentially help alleviate gait asymmetries. In the current exploratory study, we therefore investigated adaptation, sensorimotor learning, and gait symmetry in a group of transtibial amputees walking with a hybrid-EMG controlled powered prosthesis and matched controls (both groups N=3). Participants were asked to perform a split-belt walking trial during which the belt on the affected side ran at twice the speed of the contralateral belt (1.0m/s and 0.5m/s respectively). Adaptation, sensorimotor learning, and symmetry are compared to two baseline conditions. Initial results illustrate that the amputees were readily able to use the hybrid controller, modulated their EMG depending on treadmill speed, and successfully adapted their gait during split-belt walking. However, the temporal gait parameters suggest that amputees used a different adaptation technique and showed reduced sensorimotor learning, while gait symmetry was improved, in the short term, post-adaptation.

  17. Bottom-up and top-down processes in body representation: a study of brain-damaged and amputee patients.

    Science.gov (United States)

    Palermo, Liana; Di Vita, Antonella; Piccardi, Laura; Traballesi, Marco; Guariglia, Cecilia

    2014-09-01

    Body representation is a complex process involving different sources of top-down and bottom-up information. Processing the position and the relations among different body parts is necessary to build up a specific body representation, that is, the visuospatial body map (or topological map of the body). Here we aimed to investigate how the loss of peripheral or central information affects this representation by testing amputee and brain-damaged patients. Thirty-two unilateral brain-damaged patients (i.e., left-brain-damaged patients and right-brain-damaged patients who were or were not affected by personal neglect), 18 lower limb amputees and 15 healthy controls took part in the study. The topological body map was assessed by means of the "Frontal body-evocation subtest" (Daurat-Hmeljiak, Stambak, & Berges, 1978), in which participants have to put tiles (each representing a body part) on a small wooden board on which a head is depicted. Group statistical analysis showed that in amputee patients the loss of peripheral information about the right lower limb affects the ability to represent relations among different body parts as much as the loss of top-down information in brain-damaged patients with personal neglect. Single case analysis of brain-damaged patients without personal neglect showed that the topological map of the body was deficient in 1 right-brain-damaged and 2 left-brain-damaged patients. Studying amputee and brain-damaged patients together allowed us to highlight the importance of visuospatial information about one's own limbs and the role of both hemispheres (not only the left one) in creating an efficient topological body representation. (c) 2014 APA, all rights reserved.

  18. Optical fiber Bragg grating-instrumented silicone liner for interface pressure measurement within prosthetic sockets of lower-limb amputees

    Science.gov (United States)

    Al-Fakih, Ebrahim; Arifin, Nooranida; Pirouzi, Gholamhossein; Mahamd Adikan, Faisal Rafiq; Shasmin, Hanie Nadia; Abu Osman, Noor Azuan

    2017-08-01

    This paper presents a fiber Bragg grating (FBG)-instrumented prosthetic silicone liner that provides cushioning for the residual limb and can successfully measure interface pressures inside prosthetic sockets of lower-limb amputees in a simple and practical means of sensing. The liner is made of two silicone layers between which 12 FBG sensors were embedded at locations of clinical interest. The sensors were then calibrated using a custom calibration platform that mimics a real-life situation. Afterward, a custom gait simulating machine was built to test the liner performance during an amputee's simulated gait. To validate the findings, the results were compared to those obtained by the commonly used F-socket mats. As the statistical findings reveal, both pressure mapping methods measured the interface pressure in a consistent way, with no significant difference (P-values ≥0.05). This pressure mapping technique in the form of a prosthetic liner will allow prosthetics professionals to quickly and accurately create an overall picture of the interface pressure distribution inside sockets in research and clinical settings, thereby improving the socket fit and amputee's satisfaction.

  19. Stability and selectivity of a chronic, multi-contact cuff electrode for sensory stimulation in human amputees.

    Science.gov (United States)

    Tan, Daniel W; Schiefer, Matthew A; Keith, Michael W; Anderson, J Robert; Tyler, Dustin J

    2015-04-01

    Stability and selectivity are important when restoring long-term, functional sensory feedback in individuals with limb-loss. Our objective is to demonstrate a chronic, clinical neural stimulation system for providing selective sensory response in two upper-limb amputees. Multi-contact cuff electrodes were implanted in the median, ulnar, and radial nerves of the upper-limb. Nerve stimulation produced a selective sensory response on 19 of 20 contacts and 16 of 16 contacts in subjects 1 and 2, respectively. Stimulation elicited multiple, distinct percept areas on the phantom and residual limb. Consistent threshold, impedance, and percept areas have demonstrated that the neural interface is stable for the duration of this on-going, chronic study. We have achieved selective nerve response from multi-contact cuff electrodes by demonstrating characteristic percept areas and thresholds for each contact. Selective sensory response remains consistent in two upper-limb amputees for 1 and 2 years, the longest multi-contact sensory feedback system to date. Our approach demonstrates selectivity and stability can be achieved through an extraneural interface, which can provide sensory feedback to amputees.

  20. Tactile Myography: An Off-Line Assessment of Able-Bodied Subjects and One Upper-Limb Amputee

    Directory of Open Access Journals (Sweden)

    Claudio Castellini

    2018-03-01

    Full Text Available Human-machine interfaces to control prosthetic devices still suffer from scarce dexterity and low reliability; for this reason, the community of assistive robotics is exploring novel solutions to the problem of myocontrol. In this work, we present experimental results pointing in the direction that one such method, namely Tactile Myography (TMG, can improve the situation. In particular, we use a shape-conformable high-resolution tactile bracelet wrapped around the forearm/residual limb to discriminate several wrist and finger activations performed by able-bodied subjects and a trans-radial amputee. Several combinations of features/classifiers were tested to discriminate among the activations. The balanced accuracy obtained by the best classifier/feature combination was on average 89.15% (able-bodied subjects and 88.72% (amputated subject; when considering wrist activations only, the results were on average 98.44% for the able-bodied subjects and 98.72% for the amputee. The results obtained from the amputee were comparable to those obtained by the able-bodied subjects. This suggests that TMG is a viable technique for myoprosthetic control, either as a replacement of or as a companion to traditional surface electromyography.

  1. Application of virtual reality to the rehabilitation field to aid amputee rehabilitation: findings from a systematic review.

    Science.gov (United States)

    D'Angelo, M; Narayanan, S; Reynolds, D B; Kotowski, S; Page, S

    2010-01-01

    To determine the scope and use of virtual reality (VR) applications in the gait rehabilitation field and to review and characterise VR approaches for application in amputee rehabilitation. A state-of-the-art research analysis was completed to review different approaches of VR to the gait rehabilitation field. Systematic research using Medline, EBSCOhost and Science Direct (ISI Web of Knowledge) was conducted to analyse various VR rehabilitation methods, and we developed a framework to characterise different research findings. Framework for a research approach in the field of VR and rehabilitation was developed based on the literature review. On the basis of outcomes from gait rehabilitation using VR, trials for amputee rehabilitation using VR is warranted and an outline of this potential VR rehabilitation area was identified. Evidence supports the investigation of VR as applied to amputee rehabilitation based on general gait rehabilitation results. Research should be expanded to better understand the role and use of technology in community-based rehabilitation to enhance the quality of life of individuals.

  2. Going places: Does the two-minute walk test predict the six-minute walk test in lower extremity amputees?

    Science.gov (United States)

    Reid, Lauren; Thomson, Penny; Besemann, Markus; Dudek, Nancy

    2015-03-01

    Assessing a patient's ability to walk the distance required for community ambulation (at least 300 m) is important in amputee rehabilitation. During the 2-min walk test, most amputees cannot walk 300 m. Thus, the 6-min walk test may be preferred, but it has not been fully validated in this population. This study examined the convergent and discriminative validity of the 6-min walk test and assessed whether the 2-min test could predict the results of the 6-min test. A total of 86 patients with unilateral or bilateral amputations at the Syme, transtibial, knee disarticulation or transfemoral level completed the 6-min walk test, 2-min walk test, Timed Up and Go test, Locomotor Capabilities Index version 5, Houghton Scale of Prosthetic Use, and Activity-Specific Balance Confidence scale. The 6-min walk test correlated with the other tests (R = 0.57-0.95), demonstrating convergent validity. It demonstrated discriminative validity with respect to age, aetiology of amputation, and K-level (p amputee ambulation. However, the results suggest that it may not be necessary, since the 2-min walk test strongly predicts the 6-min walk test. Clinicians could therefore save time by using the shorter test.

  3. Conception, design and development of a low-cost intelligent prosthesis for one-sided transfemoral amputees

    Directory of Open Access Journals (Sweden)

    Wilson Carlos da Silva Júnior

    Full Text Available Introduction Modern transfemoral knee prostheses are designed to offer comfort and self-confidence to amputees. These prostheses are mainly based upon either a passive concept, with a damping system, or an active computational intelligent design to control knee motion during the swing phase. In Brazil, most lower extremity amputees are unable to afford modern prostheses due to their high cost. In this work, we present the conception, design and development of a low-cost intelligent prosthesis for one-sided transfemoral amputees. Methods The concept of the prosthesis is based on a control system with sensors for loads, which are installed on the amputee’s preserved leg and used as a mirror for the movement of the prosthesis. Mechanical strength analysis, using the Finite Element Method, electromechanical tests for the sensors and actuators and verification of data acquisition, signal conditioning and data transferring to the knee prosthesis were performed. Results The laboratory tests performed showed the feasibility of the proposed design. The electromechanical concept that was used enabled a controlled activation of the knee prosthesis by the two load cells located on the shoe sole of the preserved leg. Conclusions The electromechanical design concept and the resulting knee prosthesis show promising results concerning prosthesis activation during walking tests, thereby showing the feasibility of a reduced manufacturing cost compared to the modern prostheses available on the market.

  4. Predict the Medicare Functional Classification Level (K-level) using the Amputee Mobility Predictor in people with unilateral transfemoral and transtibial amputation: A pilot study.

    Science.gov (United States)

    Dillon, Michael P; Major, Matthew J; Kaluf, Brian; Balasanov, Yuri; Fatone, Stefania

    2018-04-01

    While Amputee Mobility Predictor scores differ between Medicare Functional Classification Levels (K-level), this does not demonstrate that the Amputee Mobility Predictor can accurately predict K-level. To determine how accurately K-level could be predicted using the Amputee Mobility Predictor in combination with patient characteristics for persons with transtibial and transfemoral amputation. Prediction. A cumulative odds ordinal logistic regression was built to determine the effect that the Amputee Mobility Predictor, in combination with patient characteristics, had on the odds of being assigned to a particular K-level in 198 people with transtibial or transfemoral amputation. For people assigned to the K2 or K3 level by their clinician, the Amputee Mobility Predictor predicted the clinician-assigned K-level more than 80% of the time. For people assigned to the K1 or K4 level by their clinician, the prediction of clinician-assigned K-level was less accurate. The odds of being in a higher K-level improved with younger age and transfemoral amputation. Ordinal logistic regression can be used to predict the odds of being assigned to a particular K-level using the Amputee Mobility Predictor and patient characteristics. This pilot study highlighted critical method design issues, such as potential predictor variables and sample size requirements for future prospective research. Clinical relevance This pilot study demonstrated that the odds of being assigned a particular K-level could be predicted using the Amputee Mobility Predictor score and patient characteristics. While the model seemed sufficiently accurate to predict clinician assignment to the K2 or K3 level, further work is needed in larger and more representative samples, particularly for people with low (K1) and high (K4) levels of mobility, to be confident in the model's predictive value prior to use in clinical practice.

  5. Standing on slopes - how current microprocessor-controlled prosthetic feet support transtibial and transfemoral amputees in an everyday task.

    Science.gov (United States)

    Ernst, Michael; Altenburg, Björn; Bellmann, Malte; Schmalz, Thomas

    2017-11-16

    Conventional prosthetic feet like energy storage and return feet provide only a limited range of ankle motion compared to human ones. In order to overcome the poor rotational adaptability, prosthetic manufacturers developed different prosthetic feet with an additional rotational joint and implemented active control in different states. It was the aim of the study to investigate to what extent these commercially available microprocessor-controlled prosthetic feet support a natural posture while standing on inclines and which concept is most beneficial for lower limb amputees. Four unilateral transtibial and four unilateral transfemoral amputees participated in the study. Each of the subjects wore five different microprocessor-controlled prosthetic feet in addition to their everyday feet. The subjects were asked to stand on slopes of different inclinations (level ground, upward slope of 10°, and downward slope of -10°). Vertical ground reaction forces, joint torques and joint angles in the sagittal plane were measured for both legs separately for the different situations and compared to a non-amputee reference group. Differences in the biomechanical parameters were observed between the different prosthetic feet and compared to the reference group for the investigated situations. They were most prominent while standing on a downward slope. For example, on the prosthetic side, the vertical ground reaction force is reduced by about 20%, and the torque about the knee acts to flex the joint for feet that are not capable of a full adaptation to the downward slope. In contrast, fully adaptable feet with an auto-adaptive dorsiflexion stop show no changes in vertical ground reaction forces and knee extending torques. A prosthetic foot that provides both, an auto-adaptive dorsiflexion stop and a sufficient range of motion for fully adapting to inclinations appears to be the key element in the prosthetic fitting for standing on inclinations in lower limb amputees. In such

  6. Psychological and Physical Health in Military Amputees During Rehabilitation: Secondary Analysis of a Randomized Controlled Trial.

    Science.gov (United States)

    Talbot, Laura A; Brede, Emily; Metter, E Jeffrey

    2017-05-01

    Service members who have experienced combat trauma with resulting amputation are at risk for compromised quality of life postamputation. Monitoring mental and physical health in amputees returning from the war is of paramount importance. This study examined changes in physical and mental health-related quality of life in service members following traumatic unilateral, transtibial amputation (TTA) during a 12-week period of rehabilitation before and after receiving a prosthesis. This study is a secondary analysis from a randomized controlled trial (RCT) of military service members starting Military Amputee Rehabilitation Program (MARP) following a traumatic TTA. The study examined change in SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores as two aspects of health-related quality of life. Forty-four injured service members, aged 19 to 46, were recruited into the RCT. Participants were randomized into 12 weeks of MARP plus home neuromuscular electrical stimulation therapy (n = 23) or MARP alone (N = 21) and compared at baseline, 6, and 12 weeks on: SF-36 PCS and MCS scores. Linear mixed models examined time and group differences and their interaction for the MCS and PCS scores. A multivariate mixed model tested whether MCS and PCS scores differed. For the combined rehabilitation cohort, MCS did not differ over 12 weeks (p = 0.27) with scores at week 0 of M = 56.7 (SD = 11.9) and at week 12 of M = 52.7 (SD = 11.4), similar to healthy controls (age = 25-34, M = 51.0, SD = 7.6). Scores did not differ between treatment groups (p = 0.28) with no group by time interaction (p = 0.34). The MCS significantly declined over time (p = 0.05) after adjustment for covariates. PCS improved over 12 weeks (p rehabilitation group with scores at week 0 of M = 34.0 (SD = 8.1) to M = 41.8 (SD = 8.4) at week 12, significantly lower than healthy controls (age = 25-34, M = 54.1, SD = 6.6). Scores did not differ between treatment groups (p = 0.89), and there was

  7. Exercise intervention for unilateral amputees with low back pain: study protocol for a randomised, controlled trial.

    Science.gov (United States)

    Wasser, Joseph G; Herman, Daniel C; Horodyski, MaryBeth; Zaremski, Jason L; Tripp, Brady; Page, Phillip; Vincent, Kevin R; Vincent, Heather K

    2017-12-29

    Atraumatic lower limb amputation is a life-changing event for approximately 185,000 persons in the United States each year. A unilateral amputation is associated with rapid changes to the musculoskeletal system including leg and back muscle atrophy, strength loss, gait asymmetries, differential mechanical joint loading and leg length discrepancies. Even with high-quality medical care and prostheses, amputees still develop secondary musculoskeletal conditions such as chronic low back pain (LBP). Resistance training interventions that focus on core stabilization, lumbar strength and dynamic stability during loading have strong potential to reduce LBP and address amputation-related changes to the musculoskeletal system. Home-based resistance exercise programs may be attractive to patients to minimize travel and financial burdens. This study will be a single-assessor-blinded, pre-post-test randomised controlled trial involving 40 men and women aged 18-60 years with traumatic, unilateral transtibial amputation. Participants will be randomised to a home-based, resistance exercise group (HBRX) or a wait-list control group (CON). The HBRX will consist of 12 weeks of elastic resistance band and bodyweight training to improve core and lumbopelvic strength. Participants will be monitored via Skype or Facetime on a weekly basis. The primary outcome will be pain severity (11-point Numerical Pain Rating Scale; NRS pain ). Secondary outcomes will include pain impact on quality of life (Medical Outcomes Short Form 36, Oswestry Disability Index and Roland Morris Disability Questionnaire), kinematics and kinetics of walking gait on an instrumented treadmill, muscle morphology (muscle thickness of multifidus, transversus abdominis, internal oblique), maximal muscle strength of key lumbar and core muscles, and daily step count. The study findings will determine whether a HBRX program can decrease pain severity and positively impact several physiological and mechanical factors that

  8. Multisession, noninvasive closed-loop neuroprosthetic control of grasping by upper limb amputees.

    Science.gov (United States)

    Agashe, H A; Paek, A Y; Contreras-Vidal, J L

    2016-01-01

    Upper limb amputation results in a severe reduction in the quality of life of affected individuals due to their inability to easily perform activities of daily living. Brain-machine interfaces (BMIs) that translate grasping intent from the brain's neural activity into prosthetic control may increase the level of natural control currently available in myoelectric prostheses. Current BMI techniques demonstrate accurate arm position and single degree-of-freedom grasp control but are invasive and require daily recalibration. In this study we tested if transradial amputees (A1 and A2) could control grasp preshaping in a prosthetic device using a noninvasive electroencephalography (EEG)-based closed-loop BMI system. Participants attempted to grasp presented objects by controlling two grasping synergies, in 12 sessions performed over 5 weeks. Prior to closed-loop control, the first six sessions included a decoder calibration phase using action observation by the participants; thereafter, the decoder was fixed to examine neuroprosthetic performance in the absence of decoder recalibration. Ability of participants to control the prosthetic was measured by the success rate of grasping; ie, the percentage of trials within a session in which presented objects were successfully grasped. Participant A1 maintained a steady success rate (63±3%) across sessions (significantly above chance [41±5%] for 11 sessions). Participant A2, who was under the influence of pharmacological treatment for depression, hormone imbalance, pain management (for phantom pain as well as shoulder joint inflammation), and drug dependence, achieved a success rate of 32±2% across sessions (significantly above chance [27±5%] in only two sessions). EEG signal quality was stable across sessions, but the decoders created during the first six sessions showed variation, indicating EEG features relevant to decoding at a smaller timescale (100ms) may not be stable. Overall, our results show that (a) an EEG

  9. ENERGY-COST DURING AMBULATION IN TRANSFEMORAL AMPUTEES - A KNEE-JOINT WITH A MECHANICAL SWING PHASE-CONTROL VS A KNEE-JOINT WITH A PNEUMATIC SWING PHASE-CONTROL

    NARCIS (Netherlands)

    BOONSTRA, AM; SCHRAMA, J; FIDLER, [No Value; EISMA, WH

    The aim of the study was (i) to evaluate the preference of transfemoral amputees for a 4-bar linked knee joint with either a mechanical swing phase control or a pneumatic swing phase control, and (ii) to compare the energy expenditure in transfemoral amputees using a prosthesis with a mechanical

  10. Relief of knee flexion contracture and gait improvement following adaptive training for an assist device in a transtibial amputee: A case study.

    Science.gov (United States)

    Kim, Sol-Bi; Ko, Chang-Yong; Son, Jinho; Kang, Sungjae; Ryu, Jeicheong; Mun, Museong

    2017-01-01

    Management of a knee contracture is important for regaining gait ability in transtibial amputees. However, there has been little study of prosthesis training for enhancing mobility and improving range of motion in cases of restricted knee extension. This study aimed to evaluate the effects of adaptive training for an assist device (ATAD) for a transtibial amputee with a knee flexion contracture (KFC). A male transtibial amputee with KFC performed 4 months of ATAD with a multidisciplinary team. During the ATAD, the passive range of motion (PROM) in the knee, amputee mobility predictor (AMP) assessment, center of pressure (COP) on a force plate-equipped treadmill, gait features determined by three-dimensional motion analysis, and Short-Form 36 Item Health Survey (SF-36) scores were evaluated. Following ATAD, PROM showed immediate improvement (135.6 ± 2.4° at baseline, 142.5 ± 1.7° at Step 1, 152.1 ± 1.8° at Step 2, 165.8 ± 1.9° at Step 3, and 166.0 ± 1.4° at Step 4); this was followed by an enhanced COP. Gradually, gait features also improved. Additionally, the AMP score (5 at baseline to 29 at Step 4) and K-level (K0 at baseline to K3 at Step 4) increased after ATAD. Along with these improvements, the SF-36 score also improved. ATAD could be beneficial for transtibial amputees by relieving knee contractures and improving gait.

  11. Changes in force production and stroke parameters of trained able-bodied and unilateral arm-amputee female swimmers during a 30 s tethered front-crawl swim.

    Science.gov (United States)

    Lee, Casey Jane; Sanders, Ross H; Payton, Carl J

    2014-01-01

    This study examined changes in the propulsive force and stroke parameters of arm-amputee and able-bodied swimmers during tethered swimming. Eighteen well-trained female swimmers (nine unilateral arm amputees and nine able-bodied) were videotaped performing maximal-effort 30 s front-crawl swims, while attached to a load cell mounted on a pool wall. Tether force, stroke rate, stroke phase durations and inter-arm angle were quantified. The able-bodied group produced significantly higher mean and maximum tether forces than the amputee group. The mean of the intra-cyclic force peaks was very similar for both groups. Mean and maximum tether force had significant negative associations with 100 m swim time, for both groups. Both groups exhibited a similar fatigue index (relative decrease in tether force) during the test, but the amputees had a significantly greater stroke rate decline. A significant positive association between stroke rate decline and fatigue index was obtained for the able-bodied group only. Inter-arm angle and relative phase durations did not change significantly during the test for either group, except the recovery phase duration of the arm amputees, which decreased significantly. This study's results can contribute to the development of a more evidence-based classification system for swimmers with a disability.

  12. Prosthesis rejection in acquired major upper-limb amputees: a population-based survey.

    Science.gov (United States)

    Østlie, Kristin; Lesjø, Ingrid Marie; Franklin, Rosemary Joy; Garfelt, Beate; Skjeldal, Ola Hunsbeth; Magnus, Per

    2012-07-01

    To estimate the rates of primary and secondary prosthesis rejection in acquired major upper-limb amputees (ULAs), to describe the most frequently reported reasons for rejection and to estimate the influence of background factors on the risk of rejection. Cross-sectional study analysing population-based questionnaire data (n = 224). Effects were analysed by logistic regression analyses and Cox regression analyses. Primary prosthesis rejection was found in 4.5% whereas 13.4% had discontinued prosthesis use. The main reasons reported for primary non-wear were a perceived lack of need and discrepancies between perceived need and the prostheses available. The main reasons reported for secondary prosthesis rejection were dissatisfaction with prosthetic comfort, function and control. Primary prosthesis rejection was more likely in ULAs amputated at high age and in ULAs with proximal amputations. Secondary prosthesis rejection was more likely in proximal ULAs and in women. Clinicians should be aware of the increased risk of rejection in proximal ULAs, elderly ULAs and in women. Emphasising individual needs will probably facilitate successful prosthetic fitting. Improved prosthesis quality and individualised prosthetic training may increase long-term prosthesis use. Further studies of the effect of prosthetic training and of the reasons for rejection of different prosthetic types are suggested.

  13. Promoting the health of amputees: an educational action called talking with the bedridden patient

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    Ruy Luiz Lorenzetti Branco

    2017-09-01

    Full Text Available Objective: The aim of the present study was to report the educational activity called ‘Talking with the Bedridden Patient’ based on five themes: Rehabilitation; Empowerment; Amputation; Uncertainties and Guidance. This research was conducted as part of the outreach project Multidisciplinary Rehabilitation of Amputees of the State University of Santa Catarina. The actions of the project at hospital level included: collection of notifications; conversation with bedridden patients; delivery of a kit with informative brochures and an elastic band for the bandaging of the stump; schedule for physical therapy assessment after hospital discharge in the outreach project. Method: This qualitative case study was performed with a person who had recently undergone a lower limb amputation in a public hospital in the city of São José/Santa Catarina. Results: This project proved to be efficient mainly to empower the patient for early onset of rehabilitation. Conclusion: We call attention to the importance of training hospital multidisciplinary teams involved in providing guidelines on fitting, return to work and clarification of general doubts taking into account the patient’s wishes and family support.

  14. Autobiographical memory and psychological distress in a sample of upper-limb amputees.

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    Martina Luchetti

    Full Text Available Amputation is a traumatic and life-changing event that can take years to adjust to. The present study (a examines psychological adjustment in a specific trauma-exposed sample, (b compares the phenomenology (e.g., vividness of amputation-related memories to more recent memories, and (c tests whether memory phenomenology is associated with psychological distress. A total of 24 upper-limb amputees recalled two autobiographical memories--an amputation-related memory and a recent memory--and rated the phenomenological qualities of each memory, including Vividness, Coherence, Emotional Intensity, Visual Perspective, and Distancing. Participants also completed self-rated measures of psychological distress and personality. The sample was generally well adjusted; participants showed no relevant symptoms of anxiety and depression, and personality scores were similar to the general population. There were no significant differences in phenomenology between the two types of memories recalled. Even though amputation-related memories were, on average, almost 20 years older than the recent memories, they retained their intense phenomenology. Despite the intensity of the memory, none of the phenomenological dimensions were associated with psychological distress. It is worth to further define which dimensions of phenomenology characterize memories of traumatic events, and their association with individuals' psychological reactions.

  15. Amputation effects on the underlying complexity within transtibial amputee ankle motion

    Energy Technology Data Exchange (ETDEWEB)

    Wurdeman, Shane R., E-mail: shanewurdeman@gmail.com [Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, Nebraska 68182 (United States); Advanced Prosthetics Center, Omaha, Nebraska 68134 (United States); Myers, Sara A. [Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, Nebraska 68182 (United States); Stergiou, Nicholas [Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, Nebraska 68182 (United States); College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska 68198 (United States)

    2014-03-15

    The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed “more appropriate” and the other “less appropriate” based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a “more appropriate” prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a “less appropriate” prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users.

  16. Motion Intention Analysis-Based Coordinated Control for Amputee-Prosthesis Interaction

    Directory of Open Access Journals (Sweden)

    Fei Wang

    2010-01-01

    Full Text Available To study amputee-prosthesis (AP interaction, a novel reconfigurable biped robot was designed and fabricated. In homogeneous configuration, two identical artificial legs (ALs were used to simulate the symmetrical lower limbs of a healthy person. Linear inverted pendulum model combining with ZMP stability criterion was used to generate the gait trajectories of ALs. To acquire interjoint coordination for healthy gait, rate gyroscopes were mounted on CoGs of thigh and shank of both legs. By employing principal component analysis, the measured angular velocities were processed and the motion synergy was obtained in the final. Then, one of two ALs was replaced by a bionic leg (BL, and the biped robot was changed into heterogeneous configuration to simulate the AP coupling system. To realize symmetrical stable walking, master/slave coordinated control strategy is proposed. According to information acquired by gyroscopes, BL recognized the motion intention of AL and reconstructed its kinematic variables based on interjoint coordination. By employing iterative learning control, gait tracking of BL to AL was archived. Real environment robot walking experiments validated the correctness and effectiveness of the proposed scheme.

  17. Inpatient rehabilitation challenges in a quadrimembral amputee after bilateral hand transplantation.

    Science.gov (United States)

    Lee, Jerome; Garcia, Angela M; Lee, W P Andrew; Munin, Michael C

    2011-08-01

    Bilateral forearm and hand transplantation poses unique challenges especially in the setting of bilateral lower limb amputations. A 57-yr-old man with bilateral transradial amputations and bilateral transtibial amputations after remote streptococcal sepsis was admitted for inpatient rehabilitation because of severe debilitation after forearm/hand transplantations. He required 6 wks of bed rest to allow the healing of the allografts but developed profound deconditioning. Because of weight-bearing precautions and other complications such as femoral neurapraxia, he required the use of body weight-support apparatus to ambulate with lower limb prostheses, keeping weight off the allografts. He progressed to walking 600 ft using a platform-wheeled walker at a modified independent level, to climbing four stairs with minimal assistance, and to being able to toss a small football using his right hand, indicating improved flexor function in this hand. Tacrolimus levels were maintained without clinical evidence of acute rejection. Through an individualized therapy regimen, careful monitoring of the allografts and dedicated support staff, rehabilitation training of a previous quadrimembral amputee after bilateral hand transplantations can be successful.

  18. Amputation effects on the underlying complexity within transtibial amputee ankle motion

    Science.gov (United States)

    Wurdeman, Shane R.; Myers, Sara A.; Stergiou, Nicholas

    2014-03-01

    The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed "more appropriate" and the other "less appropriate" based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a "more appropriate" prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a "less appropriate" prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users.

  19. Factors that predict walking ability with a prosthesis in lower limb amputees

    Directory of Open Access Journals (Sweden)

    Knežević Aleksandar

    2016-01-01

    Full Text Available Introduction. Identification of predictive factors for walking ability with a prosthesis, after lower limb amputation, is very important in order to define patient’s potentials and realistic rehabilitation goals, however challenging they are. Objective. The objective of this study was to investigate whether variables determined at the beginning of rehabilitation process are able to predict walking ability at the end of the treatment using support vector machines (SVMs. Methods. This research was designed as a retrospective clinical case series. The outcome was defined as three-leveled ambulation ability. SVMs were used for predicting model forming. Results. The study included 263 patients, average age 60.82 Ѓ} 9.27 years. In creating SVM models, eleven variables were included: age, gender, cause of amputation, amputation level, period from amputation to prosthetic rehabilitation, Functional Comorbidity Index (FCI, presence of diabetes, presence of a partner, restriction concerning hip or knee extension, residual limb hip extensor strength, and mobility at admission. Six SVM models were created with four, five, six, eight, 10, and 11 variables, respectively. Genetic algorithm was used as an optimization procedure in order to select the best variables for predicting the level of walking ability. The accuracy of these models ranged from 72.5% to 82.5%. Conclusion. By using SVM model with four variables (age, FCI, level of amputation, and mobility at admission we are able to predict the level of ambulation with a prosthesis in lower limb amputees with high accuracy.

  20. Real Time Hand Motion Reconstruction System for Trans-Humeral Amputees Using EEG and EMG

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    Jacobo Fernandez-Vargas

    2016-08-01

    Full Text Available Predicting a hand’s position using only biosignals is a complex problem that has not been completely solved. The only reliable solutions currently available require invasive surgery. The attempts using non-invasive technologies are rare, and usually have led to lower correlation values between the real and the reconstructed position than those required for real-world applications. In this study, we propose a solution for reconstructing the hand’s position in three dimensions using EEG and EMG to detect from the shoulder area. This approach would be valid for most trans-humeral amputees. In order to find the best solution, we tested four different architectures for the system based on artificial neural networks. Our results show that it is possible to reconstruct the hand’s motion trajectory with a correlation value up to 0.809 compared to a typical value in the literature of 0.6. We also demonstrated that both EEG and EMG contribute jointly to the motion reconstruction. Furthermore, we discovered that the system architectures do not change the results radically. In addition, our results suggest that different motions may have different brain activity patterns that could be detected through EEG. Finally, we suggest a method to study non-linear relations in the brain through the EEG signals, which may lead to a more accurate system.

  1. Evaluation of methods for calculating maximum allowable standing height in amputees competing in Paralympic athletics.

    Science.gov (United States)

    Connick, M J; Beckman, E; Ibusuki, T; Malone, L; Tweedy, S M

    2016-11-01

    The International Paralympic Committee has a maximum allowable standing height (MASH) rule that limits stature to a pre-trauma estimation. The MASH rule reduces the probability that bilateral lower limb amputees use disproportionately long prostheses in competition. Although there are several methods for estimating stature, the validity of these methods has not been compared. To identify the most appropriate method for the MASH rule, this study aimed to compare the criterion validity of estimations resulting from the current method, the Contini method, and four Canda methods (Canda-1, Canda-2, Canda-3, and Canda-4). Stature, ulna length, demispan, sitting height, thigh length, upper arm length, and forearm length measurements in 31 males and 30 females were used to calculate the respective estimation for each method. Results showed that Canda-1 (based on four anthropometric variables) produced the smallest error and best fitted the data in males and females. The current method was associated with the largest error of those tests because it increasingly overestimated height in people with smaller stature. The results suggest that the set of Canda equations provide a more valid MASH estimation in people with a range of upper limb and bilateral lower limb amputations compared with the current method. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Long-term follow-up of unilateral transfemoral amputees from the Vietnam war.

    Science.gov (United States)

    Dougherty, Paul J

    2003-04-01

    Despite their frequency, few reports exist concerning the initial and long-term consequences of battle-incurred unilateral transfemoral amputations. A retrospective cohort design was used to measure the long-term health of transfemoral battle amputees treated at a single hospital during the Vietnam War. Data collection consisted of medical record abstraction and a follow-up questionnaire that included the SF-36 Health Survey. Forty-six patients responded to the survey an average of 28 years after injury. Compared with the controls, patient responses to the SF-36 were significantly (p < 0.01) less in all categories except Mental Health and Vitality. Forty-three (93.5%) are or have been married. Forty-one (89.1%) are or have been employed an average of 20.1 years. Forty patients (87%) wore a prosthesis an average of 13.5 h/day. Although the patients do relatively well with employment and marriage stability, the low SF-36 scores suggest a significant disability.

  3. Bilateral Neck of Femur Fractures in a Bilateral Below-Knee Amputee: A Unique Case

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    Hannah R. Lancer

    2016-01-01

    Full Text Available According to the National Hip Fracture Database, over 64,000 patients were admitted with a hip fracture across England, Wales, and Northern Ireland in 2013, but very few are bilateral, and there are no current cases in the literature of bilateral neck of femur fractures in a patient with bilateral below-knee amputations. We present a case of a 69-year-old bilateral below-knee amputee male admitted to the emergency department with bilateral hip pain and radiological evidence of bilateral displaced neck of femur fractures. The patient subsequently underwent synchronous bilateral total hip replacements under general anaesthetic and an epidural and then went on to make a full recovery. He was discharged 27 days after arrival in hospital. Outpatient follow-up at 3 months has shown that the patient has returned to a similar level of preinjury function and is still able to carry out his daily activities with walking aids and bilateral leg prostheses.

  4. Amputation effects on the underlying complexity within transtibial amputee ankle motion

    International Nuclear Information System (INIS)

    Wurdeman, Shane R.; Myers, Sara A.; Stergiou, Nicholas

    2014-01-01

    The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed “more appropriate” and the other “less appropriate” based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a “more appropriate” prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a “less appropriate” prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users

  5. Gait Analysis of Transfemoral Amputees: Errors in Inverse Dynamics Are Substantial and Depend on Prosthetic Design.

    Science.gov (United States)

    Dumas, Raphael; Branemark, Rickard; Frossard, Laurent

    2017-06-01

    Quantitative assessments of prostheses performances rely more and more frequently on gait analysis focusing on prosthetic knee joint forces and moments computed by inverse dynamics. However, this method is prone to errors, as demonstrated in comparison with direct measurements of these forces and moments. The magnitude of errors reported in the literature seems to vary depending on prosthetic components. Therefore, the purposes of this study were (A) to quantify and compare the magnitude of errors in knee joint forces and moments obtained with inverse dynamics and direct measurements on ten participants with transfemoral amputation during walking and (B) to investigate if these errors can be characterised for different prosthetic knees. Knee joint forces and moments computed by inverse dynamics presented substantial errors, especially during the swing phase of gait. Indeed, the median errors in percentage of the moment magnitude were 4% and 26% in extension/flexion, 6% and 19% in adduction/abduction as well as 14% and 27% in internal/external rotation during stance and swing phase, respectively. Moreover, errors varied depending on the prosthetic limb fitted with mechanical or microprocessor-controlled knees. This study confirmed that inverse dynamics should be used cautiously while performing gait analysis of amputees. Alternatively, direct measurements of joint forces and moments could be relevant for mechanical characterising of components and alignments of prosthetic limbs.

  6. A comparison of trans-tibial amputee suction and vacuum socket conditions.

    Science.gov (United States)

    Board, W J; Street, G M; Caspers, C

    2001-12-01

    Daily volume loss of the stump leads to a poor fit of the prosthetic socket. A method of preventing this volume loss and maintaining a good fit was developed. A vacuum (-78 kPa) was drawn on the expulsion port of a total surface-bearing suction socket to hold the liner tightly against the socket. Stump volume of 10 trans-tibial amputees was measured prior to and immediately after a 30 minute walk with normal and vacuum socket conditions. Under the normal condition, the limb lost an average of 6.5% of its volume during the walk. In contrast, with the liner held tightly by vacuum, the limb gained an average of 3.7% in volume. It is believed that the difference observed between conditions resulted from a greater negative pressure developed during the swing phase of gait with the vacuum condition. X-rays revealed that the limb and tibia pistoned 4 mm and 7 mm less, respectively, under the vacuum condition. The combination of reduced pistoning and maintenance of volume is thought to account for the more symmetrical gait observed with the vacuum.

  7. Amputation effects on the underlying complexity within transtibial amputee ankle motion.

    Science.gov (United States)

    Wurdeman, Shane R; Myers, Sara A; Stergiou, Nicholas

    2014-03-01

    The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed "more appropriate" and the other "less appropriate" based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a "more appropriate" prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a "less appropriate" prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users.

  8. Medial-lateral centre of mass displacement and base of support are equally good predictors of metabolic cost in amputee walking.

    Science.gov (United States)

    Weinert-Aplin, R A; Twiste, M; Jarvis, H L; Bennett, A N; Baker, R J

    2017-01-01

    Amputees are known to walk with greater metabolic cost than able-bodied individuals and establishing predictors of metabolic cost from kinematic measures, such as centre of mass (CoM) motion, during walking are important from a rehabilitative perspective, as they can provide quantifiable measures to target during gait rehabilitation in amputees. While it is known that vertical CoM motion poorly predicts metabolic cost, CoM motion in the medial-lateral (ML) and anterior-posterior directions have not been investigated in the context of gait efficiency in the amputee population. Therefore, the aims of this study were to investigate the relationship between CoM motion in all three directions of motion, base of support and walking speed, and the metabolic cost of walking in both able-bodied individuals and different levels of lower limb amputee. 37 individuals were recruited to form groups of controls, unilateral above- and below-knee, and bilateral above-knee amputees respectively. Full-body optical motion and oxygen consumption data were collected during walking at a self-selected speed. CoM position was taken as the mass-weighted average of all body segments and compared to each individual's net non-dimensional metabolic cost. Base of support and ML CoM displacement were the strongest correlates to metabolic cost and the positive correlations suggest increased ML CoM displacement or Base of support will reduce walking efficiency. Rehabilitation protocols which indirectly reduce these indicators, rather than vertical CoM displacement will likely show improvements in amputee walking efficiency. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  9. Impact of anatomical placement of an accelerometer on prediction of physical activity energy expenditure in lower-limb amputees

    Science.gov (United States)

    Ladlow, Peter; Nightingale, Tom E.

    2017-01-01

    Purpose To assess the influence of the anatomical placement of a tri-axial accelerometer on the prediction of physical activity energy expenditure (PAEE) in traumatic lower-limb amputees during walking and to develop valid population-specific prediction algorithms. Methods Thirty participants, consisting of unilateral (n = 10), and bilateral (n = 10) amputees, and non-injured controls (n = 10) volunteered to complete eight activities; resting in a supine position, walking on a flat (0.48, 0.67, 0.89, 1.12, 1.34 m.s-1) and an inclined (3 and 5% gradient at 0.89 m.s-1) treadmill. During each task, expired gases were collected and an Actigraph GT3X+ accelerometer was worn on the right hip, left hip and lumbar spine. Linear regression analyses were conducted between outputs from each accelerometer site and criterion PAEE (indirect calorimetry). Mean bias ± 95% limits of agreement were calculated. Additional covariates were incorporated to assess whether they improved the prediction accuracy of regression models. Subsequent mean absolute error statistics were calculated for the derived models at all sites using a leave-one out cross-validation analysis. Results Predicted PAEE at each anatomical location was significantly (Pamputees using an ActiGraph GT3X+ accelerometer. Of the 3 anatomical locations considered, wearing the accelerometer on the side of the shortest residual limb provides the most accurate prediction of PAEE with the least error in unilateral and bilateral traumatic lower-limb amputees. PMID:28982199

  10. Prediction of Above-elbow Motions in Amputees, based on Electromyographic(EMG Signals, Using Nonlinear Autoregressive Exogenous (NARX Model

    Directory of Open Access Journals (Sweden)

    Ali Akbar Akbari

    2014-08-01

    Full Text Available Introduction In order to improve the quality of life of amputees, biomechatronic researchers and biomedical engineers have been trying to use a combination of various techniques to provide suitable rehabilitation systems. Diverse biomedical signals, acquired from a specialized organ or cell system, e.g., the nervous system, are the driving force for the whole system. Electromyography(EMG, as an experimental technique,is concerned with the development, recording, and analysis of myoelectric signals. EMG-based research is making progress in the development of simple, robust, user-friendly, and efficient interface devices for the amputees. Materials and Methods Prediction of muscular activity and motion patterns is a common, practical problem in prosthetic organs. Recurrent neural network (RNN models are not only applicable for the prediction of time series, but are also commonly used for the control of dynamical systems. The prediction can be assimilated to identification of a dynamic process. An architectural approach of RNN with embedded memory is Nonlinear Autoregressive Exogenous (NARX model, which seems to be suitable for dynamic system applications. Results Performance of NARX model is verified for several chaotic time series, which are applied as input for the neural network. The results showed that NARX has the potential to capture the model of nonlinear dynamic systems. The R-value and MSE are  and  , respectively. Conclusion  EMG signals of deltoid and pectoralis major muscles are the inputs of the NARX  network. It is possible to obtain EMG signals of muscles in other arm motions to predict the lost functions of the absent arm in above-elbow amputees, using NARX model.

  11. The Effect of Prosthetic Foot Push-off on Mechanical Loading Associated with Knee Osteoarthritis in Lower Extremity Amputees

    Science.gov (United States)

    Morgenroth, David C.; Segal, Ava D.; Zelik, Karl E.; Czerniecki, Joseph M.; Klute, Glenn K.; Adamczyk, Peter G.; Orendurff, Michael S.; Hahn, Michael E.; Collins, Steven H.; Kuo, Art D.

    2011-01-01

    Lower extremity amputation not only limits mobility, but also increases the risk of knee osteoarthritis of the intact limb. Dynamic walking models of non-amputees suggest that pushing-off from the trailing limb can reduce collision forces on the leading limb. These collision forces may determine the peak knee external adduction moment (EAM), which has been linked to the development of knee OA in the general population. We therefore hypothesized that greater prosthetic push-off would lead to reduced loading and knee EAM of the intact limb in unilateral transtibial amputees. Seven unilateral transtibial amputees were studied during gait under three prosthetic foot conditions that were intended to vary push-off. Prosthetic foot-ankle push-off work, intact limb knee EAM and ground reaction impulses for both limbs during step-to-step transition were measured. Overall, trailing limb prosthetic push-off work was negatively correlated with leading intact limb 1st peak knee EAM (slope = −0.72 +/− 0.22; p=0.011). Prosthetic push-off work and 1st peak intact knee EAM varied significantly with foot type. The prosthetic foot condition with the least push-off demonstrated the largest knee EAM, which was reduced by 26% with the prosthetic foot producing the most push-off. Trailing prosthetic limb push-off impulse was negatively correlated with leading intact limb loading impulse (slope = −0.34 +/− 0.14; p=.001), which may help explain how prosthetic limb push-off can affect intact limb loading. Prosthetic feet that perform more prosthetic push-off appear to be associated with a reduction in 1st peak intact knee EAM, and their use could potentially reduce the risk and burden of knee osteoarthritis in this population. PMID:21803584

  12. Pressure characteristics at the stump/socket interface in transtibial amputees using an adaptive prosthetic foot.

    Science.gov (United States)

    Wolf, Sebastian I; Alimusaj, Merkur; Fradet, Laetitia; Siegel, Johannes; Braatz, Frank

    2009-12-01

    The technological advances that have been made in developing highly functional prostheses are promising for very active patients but we do not yet know whether they cause an increase in biomechanical load along with possibly negative consequences for pressure conditions in the socket. Therefore, this study monitored the socket pressure at specific locations of the stump when using a microprocessor-controlled adaptive prosthetic ankle under different walking conditions. Twelve unilateral transtibial amputees between 43 and 59 years of age were provided with the Proprio-Foot (Ossur) and underwent an instrumented 3D gait analysis in level, stair, and incline walking, including synchronous data capturing of socket pressure. Peak pressures and pressure time integrals (PTI) at three different locations were compared for five walking conditions with and without using the device's ankle adaptation mode. Highest peak pressures of 2.4 k Pa/kg were found for incline ascent at the calf muscle as compared to 2.1 k Pa/kg in level walking with large inter-individual variance. In stair ascent a strong correlation was found between maximum knee moment and socket pressure. The most significant pressure changes relative to level walking were seen in ramp descent anteriorly towards the stump end, with PTI values being almost twice as high as those in level walking. Adapting the angle of the prosthesis on stairs and ramps modified the pressure data such that they were closer to those in level walking. Pressure at the stump depends on the knee moments involved in each walking condition. Adapting the prosthetic ankle angle is a valuable means of modifying joint kinetics and thereby the pressure distribution at the stump. However, large inter-individual differences in local pressures underline the importance of individual socket fitting.

  13. Psychophysical Evaluation of the Capability for Phantom Limb Movement in Forearm Amputees.

    Directory of Open Access Journals (Sweden)

    Noritaka Kawashima

    Full Text Available A phantom limb is the sensation that an amputated limb is still attached to the body and is moving together with other body parts. Phantom limb phenomenon is often described on the basis of the patient's subjective sense, for example as represented using a visual analog scale (VAS. The aim of this study was to propose a novel quantification method for behavioral aspect of phantom limb by psychophysics. Twelve unilateral forearm amputees were asked to perform phantom wrist motion with various motion frequencies (60, 80, 100, 120, 140, 160, 180, 200, 220, 240% of preferred speed. The attainment of phantom limb motion in each session was rated by the VAS ranging from 0 (hard to 10 (easy. The relationship between the VAS and motion frequency was mathematically fitted by quadric function, and the value of shift and the degree of steepness were obtained as evaluation variables for the phantom limb movement. In order to test whether the proposed method can reasonably quantify the characteristics of phantom limb motion, we compared the variables among three different phantom limb movement conditions: (1 unilateral (phantom only, (2 bimanual, and (3 bimanual wrist movement with mirror reflection-induced visual feedback (MVF. While VAS rating showed a larger extent of inter- and intra-subject variability, the relationship of the VAS in response to motion frequency could be fitted by quadric curve, and the obtained parameters based on quadric function well characterize task-dependent changes in phantom limb movement. The present results suggest the potential usefulness of psychophysical evaluation as a validate assessment tool of phantom limb condition.

  14. Contribution of each leg to the control of unperturbed bipedal stance in lower limb amputees: new insights using entropy.

    Directory of Open Access Journals (Sweden)

    Petra Hlavackova

    Full Text Available The present study was designed to assess the relative contribution of each leg to unperturbed bipedal posture in lower limb amputees. To achieve this goal, eight unilateral traumatic trans-femoral amputees (TFA were asked to stand as still as possible on a plantar pressure data acquisition system with their eyes closed. Four dependent variables were computed to describe the subject's postural behavior: (1 body weight distribution, (2 amplitude, (3 velocity and (4 regularity of centre of foot pressure (CoP trajectories under the amputated (A leg and the non-amputated (NA leg. Results showed a larger body weight distribution applied to the NA leg than to the A leg and a more regular CoP profiles (lower sample entropy values with greater amplitude and velocity under the NA leg than under the A leg. Taken together, these findings suggest that the NA leg and the A leg do not equally contribute to the control of unperturbed bipedal posture in TFA. The observation that TFA do actively control unperturbed bipedal posture with their NA leg could be viewed as an adaptive process to the loss of the lower leg afferents and efferents because of the unilateral lower-limb amputation. From a methodological point of view, these results demonstrate the suitability of computing bilateral CoP trajectories regularity for the assessment of lateralized postural control under pathological conditions.

  15. Assessing gait variability in transtibial amputee fallers based on spatial-temporal gait parameters normalized for walking speed.

    Science.gov (United States)

    Hordacre, Brenton G; Barr, Christopher; Patritti, Benjamin L; Crotty, Maria

    2015-06-01

    To determine whether normalizing spatial-temporal gait data for walking speed obtained from multiple walking trials leads to differences in gait variability parameters associated with a history of falling in people with transtibial amputations. Cross-sectional study. Rehabilitation center. People with unilateral transtibial amputations (N=45; mean age ± SD, 60.5±13.7y; 35 men [78%]) were recruited. Not applicable. Participants completed 10 consecutive walking trials using an instrumented walkway system. Primary gait parameters were walking speed and step-length, step-width, step-time, and swing-time variability. A retrospective 12-month fall history was obtained from participants. Sixteen amputees (36%) were classified as fallers. Variation in gait speed across the 10 walking trials was 2.9% (range, 1.1%-12.1%). Variability parameters of normalized gait data were significantly different from variability parameters of nonnormalized data (all Prehabilitation efforts of amputees with a fall history. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Analyzing at-home prosthesis use in unilateral upper-limb amputees to inform treatment & device design.

    Science.gov (United States)

    Spiers, Adam J; Resnik, Linda; Dollar, Aaron M

    2017-07-01

    New upper limb prosthetic devices are continuously being developed by a variety of industrial, academic, and hobbyist groups. Yet, little research has evaluated the long term use of currently available prostheses in daily life activities, beyond laboratory or survey studies. We seek to objectively measure how experienced unilateral upper limb prosthesis-users employ their prosthetic devices and unaffected limb for manipulation during everyday activities. In particular, our goal is to create a method for evaluating all types of amputee manipulation, including non-prehensile actions beyond conventional grasp functions, as well as to examine the relative use of both limbs in unilateral and bilateral cases. This study employs a head-mounted video camera to record participant's hands and arms as they complete unstructured domestic tasks within their own homes. A new 'Unilateral Prosthesis-User Manipulation Taxonomy' is presented based observations from 10 hours of recorded videos. The taxonomy addresses manipulation actions of the intact hand, prostheses, bilateral activities, and environmental feature-use (aiïordances). Our preliminary results involved tagging 23 minute segments of the full videos from 3 amputee participants using the taxonomy. This resulted in over 2,300 tag instances. Observations included that non-prehensile interactions outnumbered prehensile interactions in the affected limb for users with more distal amputation that allowed arm mobility.

  17. Improving the Robustness of Real-Time Myoelectric Pattern Recognition against Arm Position Changes in Transradial Amputees

    Directory of Open Access Journals (Sweden)

    Yanjuan Geng

    2017-01-01

    Full Text Available Previous studies have showed that arm position variations would significantly degrade the classification performance of myoelectric pattern-recognition-based prosthetic control, and the cascade classifier (CC and multiposition classifier (MPC have been proposed to minimize such degradation in offline scenarios. However, it remains unknown whether these proposed approaches could also perform well in the clinical use of a multifunctional prosthesis control. In this study, the online effect of arm position variation on motion identification was evaluated by using a motion-test environment (MTE developed to mimic the real-time control of myoelectric prostheses. The performance of different classifier configurations in reducing the impact of arm position variation was investigated using four real-time metrics based on dataset obtained from transradial amputees. The results of this study showed that, compared to the commonly used motion classification method, the CC and MPC configurations improved the real-time performance across seven classes of movements in five different arm positions (8.7% and 12.7% increments of motion completion rate, resp.. The results also indicated that high offline classification accuracy might not ensure good real-time performance under variable arm positions, which necessitated the investigation of the real-time control performance to gain proper insight on the clinical implementation of EMG-pattern-recognition-based controllers for limb amputees.

  18. Effect of swim speed on leg-to-arm coordination in unilateral arm amputee front crawl swimmers.

    Science.gov (United States)

    Osborough, Conor; Daly, Daniel; Payton, Carl

    2015-01-01

    The aim of this study was to examine the effect of swimming speed on leg-to-arm coordination in competitive unilateral arm amputee front crawl swimmers. Thirteen well-trained swimmers were videotaped underwater during three 25-m front crawl trials (400 m, 100 m and 50 m pace). The number, duration and timing of leg kicks in relation to arm stroke phases were identified by video analysis. Within the group, a six-beat kick was predominantly used (n = 10) although some swimmers used a four-beat (n = 2) or eight-beat kick (n = 1). Swimming speed had no significant effect on the relative duration of arm stroke and leg kick phases. At all speeds, arm stroke phases were significantly different (P kicking phases of both legs were not different. Consequently, leg-to-arm coordination was asymmetrical. The instant when the leg kicks ended on the affected side corresponded with particular positions of the unaffected arm, but not with the same positions of the affected arm. In conclusion, the ability to dissociate the movements of the arms from the legs demonstrates that, because of their physical impairment, unilateral arm amputee swimmers functionally adapt their motor organisation to swim front crawl.

  19. Understanding dynamic stability from pelvis accelerometer data and the relationship to balance and mobility in transtibial amputees.

    Science.gov (United States)

    Howcroft, Jennifer; Lemaire, Edward D; Kofman, Jonathan; Kendell, Cynthia

    2015-03-01

    This study investigated whether pelvis acceleration-derived parameters can differentiate between dynamic stability states for transtibial amputees during level (LG) and uneven ground (UG) walking. Correlations between these parameters and clinical balance and mobility measures were also investigated. A convenience sample of eleven individuals with unilateral transtibial amputation walked on LG and simulated UG while pelvis acceleration data were collected at 100Hz. Descriptive statistics, Fast Fourier Transform, ratio of even to odd harmonics, and maximum Lyapunov exponent measures were derived from acceleration data. Of the 26 pelvis acceleration measures, seven had a significant difference (p≤0.05) between LG and UG walking conditions. Seven distinct, stability-relevant measures appeared in at least one of the six regression models that correlated accelerometer-derived measures to Berg Balance Scale (BBS), Community Balance and Mobility Scale (CBMS), and Prosthesis Evaluation Questionnaire (PEQ) scores, explaining up to 100% of the variability in these measures. Of these seven measures, medial-lateral acceleration range was the most frequent model variable, appearing in four models. Anterior-posterior acceleration standard deviation and stride time appeared in three models. Pelvis acceleration-derived parameters were able to differentiate between LG and UG walking for transtibial amputees. UG walking provided the most relevant data for balance and mobility assessment. These results could translate to point of patient contact assessments using a wearable system such as a smartbelt or accelerometer-equipped smartphone. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Evaluation of postural steadiness in below-knee amputees when wearing different prosthetic feet during various sensory conditions using the Biodex® Stability System.

    Science.gov (United States)

    Arifin, Nooranida; Abu Osman, Noor Azuan; Ali, Sadeeq; Gholizadeh, Hossein; Wan Abas, Wan Abu Bakar

    2015-07-01

    In recent years, computerized posturography has become an essential tool in quantitative assessment of postural steadiness in the clinical settings. The purpose of this study was to explore the ability of the Biodex(®) Stability System (BSS) to quantify postural steadiness in below-knee amputees. A convenience sample of 10 below-knee amputees participated in the study. The overall (OSI), anterior-posterior (APSI) and medial-lateral (MLSI) stability indexes as well as the percentage of time spent in left and right quadrants and four concentric zones were measured under altered sensory conditions while standing with solid ankle cushion heel (SACH), single-axis (SA) and energy storage and release (ESAR) feet. Significant difference was found between sensory conditions in SACH and ESAR feet for OSI (SACH, p = 0.002; ESAR, p = 0.005), APSI (SACH, p = 0.036; ESAR, p = 0.003) and MLSI (SACH, p = 0.008; ESAR, p = 0.05) stability indexes. The percentage of time spent in Zone A (0°-5°) was significantly greater than the other three concentric zones (p amputees showed compromised postural steadiness when visual, proprioceptive or vestibular sensory input was altered. The findings highlight that the characteristics of postural stability in amputees can be clinically assessed by utilizing the outcomes produced by the BSS. © IMechE 2015.

  1. Regulation of step frequency in transtibial amputee endurance athletes using a running-specific prosthesis.

    Science.gov (United States)

    Oudenhoven, Laura M; Boes, Judith M; Hak, Laura; Faber, Gert S; Houdijk, Han

    2017-01-25

    Running specific prostheses (RSP) are designed to replicate the spring-like behaviour of the human leg during running, by incorporating a real physical spring in the prosthesis. Leg stiffness is an important parameter in running as it is strongly related to step frequency and running economy. To be able to select a prosthesis that contributes to the required leg stiffness of the athlete, it needs to be known to what extent the behaviour of the prosthetic leg during running is dominated by the stiffness of the prosthesis or whether it can be regulated by adaptations of the residual joints. The aim of this study was to investigate whether and how athletes with an RSP could regulate leg stiffness during distance running at different step frequencies. Seven endurance runners with an unilateral transtibial amputation performed five running trials on a treadmill at a fixed speed, while different step frequencies were imposed (preferred step frequency (PSF) and -15%, -7.5%, +7.5% and +15% of PSF). Among others, step time, ground contact time, flight time, leg stiffness and joint kinetics were measured for both legs. In the intact leg, increasing step frequency was accompanied by a decrease in both contact and flight time, while in the prosthetic leg contact time remained constant and only flight time decreased. In accordance, leg stiffness increased in the intact leg, but not in the prosthetic leg. Although a substantial contribution of the residual leg to total leg stiffness was observed, this contribution did not change considerably with changing step frequency. Amputee athletes do not seem to be able to alter prosthetic leg stiffness to regulate step frequency during running. This invariant behaviour indicates that RSP stiffness has a large effect on total leg stiffness and therefore can have an important influence on running performance. Nevertheless, since prosthetic leg stiffness was considerably lower than stiffness of the RSP, compliance of the residual leg should

  2. The effects of prosthetic foot type and visual alteration on postural steadiness in below-knee amputees.

    Science.gov (United States)

    Arifin, Nooranida; Abu Osman, Noor Azuan; Ali, Sadeeq; Wan Abas, Wan Abu Bakar

    2014-03-05

    Achieving independent upright posture has known to be one of the main goals in rehabilitation following lower limb amputation. The purpose of this study was to compare postural steadiness of below knee amputees with visual alterations while wearing three different prosthetic feet. Ten male below-knee amputees were instructed to stand quietly on the Biodex® balance platform while wearing solid ankle cushion heel (SACH), single axis (SA) and energy storage and release (ESAR) prosthetic foot under different visual input conditions (eyes-opened and eyes-closed). The overall stability index (OSI), anterior- posterior stability index (APSI), and medial-lateral stability index (MLSI) were computed. Perceived balance assessment of each foot was evaluated using Activities-specific Balance Confidence (ABC) score. The findings highlights that SACH showed lowest overall stability index (indicating less body sway) during eyes-opened (OSI: SACH = 1.09, SA = 1.58, ESAR = 1.59) and SA showed lowest overall stability index during eyes-closed (OSI: SACH = 2.52, SA = 2.30, ESAR = 2.76) condition. However, overall stability indexes between foot types did not differ significantly during eyes-opened or eyes-closed (p = 0.651). There was a trend of instability which occurred more in medial-lateral compared to anterior-posterior direction for all foot types, with significant result in ESAR foot(eyes-opened: MLSI = 1.59, APSI = 0.65, p = 0.034; eyes-closed: MLSI = 2.76, APSI = 1.80, p = 0.017, respectively). When comparing between visual conditions, stability score was significantly higher during eyes-closed compared to eyes-opened situations for SACH and ESAR foot (eyes-closed vs opened; SACH OSI: 3.43 vs 1.71, p = 0.018 and MLSI: 3.43 vs 1.71, p = 0.018; ESAR OSI: 3.58 vs 1.86, p = 0.043 and APSI: 1.80 vs 0.65, p = 0.027). The results of this study suggested postural steadiness in below-knee amputees was not affected by

  3. A combined kinematic and kinetic analysis at the residuum/socket interface of a knee-disarticulation amputee.

    Science.gov (United States)

    Tang, Jinghua; McGrath, Michael; Hale, Nick; Jiang, Liudi; Bader, Dan; Laszczak, Piotr; Moser, David; Zahedi, Saeed

    2017-11-01

    The bespoke interface between a lower limb residuum and a prosthetic socket is critical for an amputee's comfort and overall rehabilitation outcomes. Analysis of interface kinematics and kinetics is important to gain full understanding of the interface biomechanics, which could aid clinical socket fit, rehabilitation and amputee care. This pilot study aims to investigate the dynamic correlation between kinematic movement and kinetic stresses at the interface during walking tests on different terrains. One male, knee disarticulation amputee participated in the study. He was asked to walk on both a level surface and a 5° ramped surface. The movement between the residuum and the socket was evaluated by the angular and axial couplings, based on the outputs from a 3D motion capture system. The corresponding kinetic stresses at anterior-proximal (AP), posterior-proximal (PP) and anterior-distal (AD) locations of the residuum were measured, using individual stress sensors. Approximately 8° of angular coupling and up to 32 mm of axial coupling were measured when walking on different terrains. The direction of the angular coupling shows strong correlation with the pressure difference between the PP and AP sensors. Higher pressure was obtained at the PP location than the AP location during stance phase, associated with the direction of the angular coupling. A strong correlation between axial coupling length, L, and longitudinal shear was also evident at the PP and AD locations i.e. the shortening of L corresponds to the increase of shear in the proximal direction. Although different terrains did not affect these correlations in principle, interface kinematic and kinetic values suggested that gait changes can induce modifications to the interface biomechanics. It is envisaged that the reported techniques could be potentially used to provide combined kinematics and kinetics for the understanding of biomechanics at the residuum/socket interface, which may play an important

  4. Influence of functional task-oriented mental practice on the gait of transtibial amputees: a randomized, clinical trial.

    Science.gov (United States)

    Cunha, Rodrigo Gontijo; Da-Silva, Paulo José Guimarães; Dos Santos Couto Paz, Clarissa Cardoso; da Silva Ferreira, Ana Carolina; Tierra-Criollo, Carlos Julio

    2017-04-11

    Mental practice (MP) through motor imagery is a cognitive training strategy used to improve locomotor skills during rehabilitation programs. Recent works have used MP tasks to investigate the neurophysiology of human gait; however, its effect on functional performance has not been evaluated. In the present study, the influence of gait-oriented MP tasks on the rehabilitation process of gait in transtibial amputees was investigated by assessing the vertical (V), anterior-posterior (AP), and medio-lateral (ML) ground reaction forces (GRFs) and the time duration of the support phase of the prosthetic limb. Unilateral transtibial amputees, who were capable of performing motor imagination tasks (MIQ-RS score ≥4), were randomly divided into two groups: Group A (n = 10), who performed functional gait-oriented MP combined with gait training, and Group B (n = 5), who performed non-motor task MP. The MP intervention was performed in the first-person perspective for 40 min, 3 times/week, for 4 weeks. The GRF outcome measures were recorded by a force platform to evaluate gait performance during 4 distinct stages: at baseline (BL), 1 month before the MP session; Pre-MP, 1-3 days before the MP session; Post-MP, 1-3 days after the MP session; and follow-up (FU), 1 month after MP session. The gait variables were compared inter- and intra-group by applying the Mann-Whitney and Friedman tests (alpha = 0.05). All volunteers exhibited a homogenous gait pattern prior to MP intervention, with no gait improvement during the BL and Pre-MP stages. Only Group A showed significant improvements in gait performance after the intervention, with enhanced impact absorption, as indicated by decreased first V and AP peaks; propulsion capacity, indicated by increasing second V and AP peaks; and balance control of the prosthetic limb, indicated by decreasing ML peaks and increasing duration of support. This gait pattern persisted until the FU stage. MP combined with gait training

  5. A motion-classification strategy based on sEMG-EEG signal combination for upper-limb amputees.

    Science.gov (United States)

    Li, Xiangxin; Samuel, Oluwarotimi Williams; Zhang, Xu; Wang, Hui; Fang, Peng; Li, Guanglin

    2017-01-07

    Most of the modern motorized prostheses are controlled with the surface electromyography (sEMG) recorded on the residual muscles of amputated limbs. However, the residual muscles are usually limited, especially after above-elbow amputations, which would not provide enough sEMG for the control of prostheses with multiple degrees of freedom. Signal fusion is a possible approach to solve the problem of insufficient control commands, where some non-EMG signals are combined with sEMG signals to provide sufficient information for motion intension decoding. In this study, a motion-classification method that combines sEMG and electroencephalography (EEG) signals were proposed and investigated, in order to improve the control performance of upper-limb prostheses. Four transhumeral amputees without any form of neurological disease were recruited in the experiments. Five motion classes including hand-open, hand-close, wrist-pronation, wrist-supination, and no-movement were specified. During the motion performances, sEMG and EEG signals were simultaneously acquired from the skin surface and scalp of the amputees, respectively. The two types of signals were independently preprocessed and then combined as a parallel control input. Four time-domain features were extracted and fed into a classifier trained by the Linear Discriminant Analysis (LDA) algorithm for motion recognition. In addition, channel selections were performed by using the Sequential Forward Selection (SFS) algorithm to optimize the performance of the proposed method. The classification performance achieved by the fusion of sEMG and EEG signals was significantly better than that obtained by single signal source of either sEMG or EEG. An increment of more than 14% in classification accuracy was achieved when using a combination of 32-channel sEMG and 64-channel EEG. Furthermore, based on the SFS algorithm, two optimized electrode arrangements (10-channel sEMG + 10-channel EEG, 10-channel sEMG + 20-channel

  6. Reliability and construct validity of a new Danish translation of the Prosthesis Evaluation Questionnaire in a population of Danish amputees

    DEFF Research Database (Denmark)

    Christensen, Jan; Doherty, Patrick; Bjorner, Jakob Bue

    2017-01-01

    .85/0.72), Residual Limb Health (0.80/0.69), Well-Being (0.78/0.90), Utility (0.76/0.89), Frustration (0.74/0.90), Perceived Response (0.62/0.80), Ambulation (0.61/0.94), Sounds (0.51/0.65). Construct validity was supported in three out of four subscales evaluated. Conclusions: The subscales Social Burden, Appearance....... Estimates for standard error of measurement (SEM) were calculated based on reliability estimates. Construct validity was evaluated by testing using hypotheses testing. Results: Reliability estimates (ICC/Cronbach’s alpha) for the nine subscales were: Social Burden (0.85/0.76), Appearance (0......, Well-Being, Utility and Frustration had consistent high reliability, supporting their use in assessing the prosthesis related quality of life in lower limb amputees. Results were mixed on three other scales (Residual Limb Health, Perceived Response, and Ambulation), while one scale, Sounds, had...

  7. Kinematic and kinetic comparisons of transfemoral amputee gait using C-Leg and Mauch SNS prosthetic knees.

    Science.gov (United States)

    Segal, Ava D; Orendurff, Michael S; Klute, Glenn K; McDowell, Martin L; Pecoraro, Janice A; Shofer, Jane; Czerniecki, Joseph M

    2006-01-01

    The C-Leg (Otto Bock, Duderstadt, Germany) is a microprocessor-controlled prosthetic knee that may enhance amputee gait. This intrasubject randomized study compared the gait biomechanics of transfemoral amputees wearing the C-Leg with those wearing a common noncomputerized prosthesis, the Mauch SNS (Ossur, Reykjavik, Iceland). After subjects had a 3-month acclimation period with each prosthetic knee, typical gait biomechanical data were collected in a gait laboratory. At a controlled walking speed (CWS), peak swing phase knee-flexion angle decreased for the C-Leg group compared with the Mauch SNS group (55.2 degrees +/- 6.5 degrees vs 64.41 degrees +/- 5.8 degrees , respectively; p = 0.005); the C-Leg group was similar to control subjects' peak swing knee-flexion angle (56.0 degrees +/- 3.4 degrees ). Stance knee-flexion moment increased for the C-Leg group compared with the Mauch SNS group (0.142 +/- 0.05 vs 0.067 +/- 0.07 N"m, respectively; p = 0.01), but remained significantly reduced compared with control subjects (0.477 +/- 0.1 N"m). Prosthetic limb step length at CWS was less for the C-Leg group compared with the Mauch SNS group (0.66 +/- 0.04 vs 0.70 +/- 0.06 m, respectively; p = 0.005), which resulted in increased symmetry between limbs for the C-Leg group. Subjects also walked faster with the C-Leg versus the Mauch SNS (1.30 +/- 0.1 vs 1.21 +/- 0.1 m/s, respectively; p = 0.004). The C-Leg prosthetic limb vertical ground reaction force decreased compared with the Mauch SNS (96.3 +/- 4.7 vs 100.3 +/- 7.5 % body weight, respectively; p = 0.0092).

  8. Examination of Force Discrimination in Human Upper Limb Amputees With Reinnervated Limb Sensation Following Peripheral Nerve Transfer

    Science.gov (United States)

    Sensinger, Jonathon W.; Schultz, Aimee E.; Kuiken, Todd A.

    2011-01-01

    Artificial limbs allow amputees to manipulate objects, but the loss of a limb severs the sensory link between a subject and objects they touch. A novel surgical technique we term targeted reinnervation (TR) allows severed cutaneous nerves to reinnervate skin on a different portion of the body. This technique provides a physiologically appropriate portal to the sensory pathways of the missing limb through the reinnervated skin. This study quantified the ability of three amputee subjects who had undergone TR surgery on the chest (two subjects) and upper arm (one subject) to discriminate changes in graded force on their reinnervated skin over a range of 1–4 N using a stochastic staircase approach. These values were compared to those from sites on their intact contralateral skin and index fingers, and from the chests and index fingers of a control population (n = 10). Weber’s ratio (WR) was used to examine the subjects’ abilities to discriminate between a baseline force and subsequent forces of different magnitudes. WRs of 0.22, 0.25, and 0.12 were measured on the reinnervated skin of the three TR subjects, whereas WRs of 0.25,0.23, and 0.12 were measured on their contralateral skin. TR subjects did not have substantially different WRs on their reinnervated versus their contralateral normal side and did not appear to exhibit a trend towards impaired sensation. No significant difference was found between the WR of the chest and index finger of the control subjects, which ranged between 0.09 and 0.21. WR of reinnervated skin for TR subjects were within the 95% confidence interval of the control group. These data suggest that subjects with targeted reinnervation have unimpaired ability to discriminate gradations in force. PMID:19775983

  9. What Is the Magnitude and Long-term Economic Cost of Care of the British Military Afghanistan Amputee Cohort?

    Science.gov (United States)

    Edwards, D S; Phillip, Rhodri D; Bosanquet, Nick; Bull, Anthony M J; Clasper, Jon C

    2015-09-01

    Personal protection equipment, improved early medical care, and rapid extraction of the casualty have resulted in more injured service members who served in Afghanistan surviving after severe military trauma. Many of those who survive the initial trauma are faced with complex wounds such as multiple amputations. Although costs of care can be high, they have not been well quantified before. This is required to budget for the needs of the injured beyond their service in the armed forces. The purposes of this study were (1) to quantify and describe the extent and nature of traumatic amputations of British service personnel from Afghanistan; and (2) to calculate an estimate of the projected long-term cost of this cohort. A four-stage methodology was used: (1) systematic literature search of previous studies of amputee care cost; (2) retrospective analysis of the UK Joint Theatre Trauma and prosthetic database; (3) Markov economic algorithm for healthcare cost and sensitivity analysis of results; and (4) statistical cost comparison between our cohort and the identified literature. From 2003 to 2014, 265 casualties sustained 416 amputations. The average number of limbs lost per casualty was 1.6. The most common type of amputation was a transfemoral amputation (153 patients); the next most common amputation type was unilateral transtibial (143 patients). Using a Markov model of healthcare economics, it is estimated that the total 40-year cost of the UK Afghanistan lower limb amputee cohort is £288 million (USD 444 million); this figure estimates cost of trauma care, rehabilitation, and prosthetic costs. A sensitivity analysis on our model demonstrated a potential ± 6.19% variation in costs. The conflict in Afghanistan resulted in high numbers of complex injuries. Our findings suggest that a long-term facility to budget for veterans' health care is necessary. Estimates here should be taken as the start of a challenge to develop sustained rehabilitation and recovery

  10. A realistic implementation of ultrasound imaging as a human-machine interface for upper-limb amputees

    Directory of Open Access Journals (Sweden)

    David eSierra González

    2013-10-01

    Full Text Available In the past years, especially with the advent of multi-fingered hand prostheses, the rehabilitation robotics community has tried to improve the use of human-machine interfaces to reliably control mechanical artifacts with many degrees of freedom. Ideally, the control schema should be intuitive and reliable, and the calibration (training short and flexible.This work focuses on medical ultrasound imaging as such an interface. Medical ultrasound imaging is rich in information, fast, widespread, relatively cheap and provides high temporal/spatial resolution; moreover, it is harmless. We already showed that a linear relationship exists between ultrasound image features of the human forearm and the hand kinematic configuration; here we demonstrate that such a relationship also exists between similar features and fingertip forces. An experiment with 10 participants shows that a very fast data collection, namely of zero and maximum forces only and using no force sensors, suffices to train a system that predicts intermediate force values spanning a range of about 20N per finger with average errors in the range 10-15%.This training approach, in which the ground truth is limited to an 'on-off' visual stimulus, constitutes a realistic scenario and we claim that it could be equally used by intact subjects and amputees. The linearity of the relationship between images and forces is furthermore exploited to build an incremental learning system that works online and can be retrained on demand by the human subject. We expect this system to be able in principle to reconstruct an amputee's imaginary limb, and act as a sensible improvement of, e.g., mirror therapy, in the treatment of phantom-limb pain.

  11. Real-time, ultrasound-based control of a virtual hand by a trans-radial amputee.

    Science.gov (United States)

    Baker, Clayton A; Akhlaghi, Nima; Rangwala, Huzefa; Kosecka, Jana; Sikdar, Siddhartha

    2016-08-01

    Advancements in multiarticulate upper-limb prosthetics have outpaced the development of intuitive, non-invasive control mechanisms for implementing them. Surface electromyography is currently the most popular non-invasive control method, but presents a number of drawbacks including poor deep-muscle specificity. Previous research established the viability of ultrasound imaging as an alternative means of decoding movement intent, and demonstrated the ability to distinguish between complex grasps in able-bodied subjects via imaging of the anterior forearm musculature. In order to translate this work to clinical viability, able-bodied testing is insufficient. Amputation-induced changes in muscular geometry, dynamics, and imaging characteristics are all likely to influence the effectiveness of our existing techniques. In this work, we conducted preliminary trials with a transradial amputee participant to assess these effects, and potentially elucidate necessary refinements to our approach. Two trials were performed, the first using a set of three motion types, and the second using four. After a brief training period in each trial, the participant was able to control a virtual prosthetic hand in real-time; attempted grasps were successfully classified with a rate of 77% in trial 1, and 71% in trial 2. While the results are sub-optimal compared to our previous able-bodied testing, they are a promising step forward. More importantly, the data collected during these trials can provide valuable information for refining our image processing methods, especially via comparison to previously acquired data from able-bodied individuals. Ultimately, further work with amputees is a necessity for translation towards clinical application.

  12. Vacuum-assisted socket suspension compared with pin suspension for lower extremity amputees: effect on fit, activity, and limb volume.

    Science.gov (United States)

    Klute, Glenn K; Berge, Jocelyn S; Biggs, Wayne; Pongnumkul, Suporn; Popovic, Zoran; Curless, Brian

    2011-10-01

    To investigate the effect of a vacuum-assisted socket suspension system as compared with pin suspension on lower extremity amputees. Randomized crossover with 3-week acclimation. Household, community, and laboratory environments. Unilateral, transtibial amputees (N=20 enrolled, N=5 completed). (1) Total surface-bearing socket with a vacuum-assisted suspension system (VASS), and (2) modified patellar tendon-bearing socket with a pin lock suspension system. Activity level, residual limb volume before and after a 30-minute treadmill walk, residual limb pistoning, and Prosthesis Evaluation Questionnaire. Activity levels were significantly lower while wearing the vacuum-assisted socket suspension system than the pin suspension (P=.0056; 38,000 ± 9,000 steps per 2 wk vs 73,000 ± 18,000 steps per 2 wk, respectively). Residual limb pistoning was significantly less while wearing the vacuum-assisted socket suspension system than the pin suspension (P=.0021; 1 ± 3mm vs 6 ± 4mm, respectively). Treadmill walking had no effect on residual limb volume. In general, participants ranked their residual limb health higher, were less frustrated, and claimed it was easier to ambulate while wearing a pin suspension compared with the VASS. The VASS resulted in a better fitting socket as measured by limb movement relative to the prosthetic socket (pistoning), although the clinical relevance of the small but statistically significant difference is difficult to discern. Treadmill walking had no effect, suggesting that a skilled prosthetist can control for daily limb volume fluctuations by using conventional, nonvacuum systems. Participants took approximately half as many steps while wearing the VASS which, when coupled with their subjective responses, suggests a preference for the pin suspension system. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  13. Assessment of transfemoral amputees using a passive microprocessor-controlled knee versus an active powered microprocessor-controlled knee for level walking.

    Science.gov (United States)

    Creylman, Veerle; Knippels, Ingrid; Janssen, Paul; Biesbrouck, Evelyne; Lechler, Knut; Peeraer, Louis

    2016-12-19

    In transfemoral (TF) amputees, the forward propulsion of the prosthetic leg in swing has to be mainly carried out by hip muscles. With hip strength being the strongest predictor to ambulation ability, an active powered knee joint could have a positive influence, lowering hip loading and contributing to ambulation mobility. To assess this, gait of four TF amputees was measured for level walking, first while using a passive microprocessor-controlled prosthetic knee (P-MPK), subsequently while using an active powered microprocessor-controlled prosthetic knee (A-MPK). Furthermore, to assess long-term effects of the use of an A-MPK, a 4-weeks follow-up case study was performed. The kinetics and kinematics of the gait of four TF amputees were assessed while walking with subsequently the P-MPK and the A-MPK. For one amputee, a follow-up study was performed: he used the A-MPK for 4 weeks, his gait was measured weekly. The range of motion of the knee was higher on both the prosthetic and the sound leg in the A-MPK compared to the P-MPK. Maximum hip torque (HT) during early stance increased for the prosthetic leg and decreased for the sound leg with the A-MPK compared to the P-MPK. During late stance, the maximum HT decreased for the prosthetic leg. The difference between prosthetic and sound leg for HT disappeared when using the A-MPK. Also, an increase in stance phase duration was observed. The follow-up study showed an increase in confidence with the A-MPK over time. Results suggested that, partially due to an induced knee flexion during stance, HT can be diminished when walking with the A-MPK compared to the P-MPK. The single case follow-up study showed positive trends indicating that an adaptation time is beneficial for the A-MPK.

  14. Prosthesis use in adult acquired major upper-limb amputees: patterns of wear, prosthetic skills and the actual use of prostheses in activities of daily life.

    Science.gov (United States)

    Østlie, Kristin; Lesjø, Ingrid Marie; Franklin, Rosemary Joy; Garfelt, Beate; Skjeldal, Ola Hunsbeth; Magnus, Per

    2012-11-01

    To describe patterns of prosthesis wear and perceived prosthetic usefulness in adult acquired upper-limb amputees (ULAs). To describe prosthetic skills in activities of daily life (ADL) and the actual use of prostheses in the performance of ADL tasks. To estimate the influence of prosthetic skills on actual prosthesis use and the influence of background factors on prosthetic skills and actual prosthesis use. Cross-sectional study analysing population-based questionnaire data (n = 224) and data from interviews and clinical testing in a referred/convenience sample of prosthesis-wearing ULAs (n = 50). Effects were analysed using linear regression. 80.8% wore prostheses. 90.3% reported their most worn prosthesis as useful. Prosthetic usefulness profiles varied with prosthetic type. Despite demonstrating good prosthetic skills, the amputees reported actual prosthesis use in only about half of the ADL tasks performed in everyday life. In unilateral amputees, increased actual use was associated with sufficient prosthetic training and with the use of myoelectric vs cosmetic prostheses, regardless of amputation level. Prosthetic skills did not affect actual prosthesis use. No background factors showed significant effect on prosthetic skills. Most major ULAs wear prostheses. Individualised prosthetic training and fitting of myoelectric rather than passive prostheses may increase actual prosthesis use in ADL.

  15. Assessing the Relative Contributions of Active Ankle and Knee Assistance to the Walking Mechanics of Transfemoral Amputees Using a Powered Prosthesis

    Science.gov (United States)

    Simon, Ann M.; Hargrove, Levi J.

    2016-01-01

    Powered knee-ankle prostheses are capable of providing net-positive mechanical energy to amputees. Yet, there are limitless ways to deliver this energy throughout the gait cycle. It remains largely unknown how different combinations of active knee and ankle assistance affect the walking mechanics of transfemoral amputees. This study assessed the relative contributions of stance phase knee swing initiation, increasing ankle stiffness and powered plantarflexion as three unilateral transfemoral amputees walked overground at their self-selected walking speed. Five combinations of knee and ankle conditions were evaluated regarding the kinematics and kinetics of the amputated and intact legs using repeated measures analyses of variance. We found eliminating active knee swing initiation or powered plantarflexion was linked to increased compensations of the ipsilateral hip joint during the subsequent swing phase. The elimination of knee swing initiation or powered plantarflexion also led to reduced braking ground reaction forces of the amputated and intact legs, and influenced both sagittal and frontal plane loading of the intact knee joint. Gradually increasing prosthetic ankle stiffness influenced the shape of the prosthetic ankle plantarflexion moment, more closely mirroring the intact ankle moment. Increasing ankle stiffness also corresponded to increased prosthetic ankle power generation (despite a similar maximum stiffness value across conditions) and increased braking ground reaction forces of the amputated leg. These findings further our understanding of how to deliver assistance with powered knee-ankle prostheses and the compensations that occur when specific aspects of assistance are added/removed. PMID:26807889

  16. Energy flow analysis of amputee walking shows a proximally-directed transfer of energy in intact limbs, compared to a distally-directed transfer in prosthetic limbs at push-off.

    Science.gov (United States)

    Weinert-Aplin, R A; Howard, D; Twiste, M; Jarvis, H L; Bennett, A N; Baker, R J

    2017-01-01

    Reduced capacity and increased metabolic cost of walking occurs in amputees, despite advances in prosthetic componentry. Joint powers can quantify deficiencies in prosthetic gait, but do not reveal how energy is exchanged between limb segments. This study aimed to quantify these energy exchanges during amputee walking. Optical motion and forceplate data collected during walking at a self-selected speed for cohorts of 10 controls, 10 unilateral trans-tibial, 10 unilateral trans-femoral and 10 bilateral trans-femoral amputees were used to determine the energy exchanges between lower limb segments. At push-off, consistent thigh and shank segment powers were observed between amputee groups (1.12W/kg vs. 1.05W/kg for intact limbs and 0.97W/kg vs. 0.99W/kg for prosthetic limbs), and reduced prosthetic ankle power, particularly in trans-femoral amputees (3.12W/kg vs. 0.87W/kg). Proximally-directed energy exchange was observed in the intact limbs of amputees and controls, while prosthetic limbs displayed distally-directed energy exchanges at the knee and hip. This study used energy flow analysis to show a reversal in the direction in which energy is exchanged between prosthetic limb segments at push-off. This reversal was required to provide sufficient energy to propel the limb segments and is likely a direct result of the lack of push-off power at the prosthetic ankle, particularly in trans-femoral amputees, and leads to their increased metabolic cost of walking. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

  17. Safety and function of a prototype microprocessor-controlled knee prosthesis for low active transfemoral amputees switching from a mechanic knee prosthesis: a pilot study.

    Science.gov (United States)

    Hasenoehrl, Timothy; Schmalz, Thomas; Windhager, Reinhard; Domayer, Stephan; Dana, Sara; Ambrozy, Clemens; Palma, Stefano; Crevenna, Richard

    2018-02-01

    Aim of this pilot study was to assess safety and functioning of a microprocessor-controlled knee prosthesis (MPK) after a short familiarization time and no structured physical therapy. Five elderly, low-active transfemoral amputees who were fitted with a standard non-microprocessor controlled knee prosthesis (NMPK) performed a baseline measurement consisting of a 3 D gait analysis, functional tests and questionnaires. The first follow-up consisted of the same test procedure and was performed with the MPK after 4 to 6 weeks of familiarization. After being refitted to their standard NMPK again, the subjects undertook the second follow-up which consisted of solely questionnaires 4 weeks later. Questionnaires and functional tests showed an increase in the perception of safety. Moreover, gait analysis revealed more physiologic knee and hip extension/flexion patterns when using the MPK. Our results showed that although the Genium with Cenior-Leg ruleset-MPK (GCL-MPK) might help to improve several safety-related outcomes as well as gait biomechanics the functional potential of the GCL-MPK may have been limited without specific training and a sufficient acclimation period. Implications for Rehabilitation Elderly transfemoral amputees are often limited in their activity by safety issues as well as insufficient functioning regarding the non microprocessor-controlled knee prostheses (NMPK), thing that could be eliminated with the use of suitable microprocessor-controlled prostheses (MPK). The safety and functioning of a prototype MPK (GCL-MPK) specifically designed for the needs of older and low-active transfemoral amputees was assessed in this pilot study. The GCL-MPK showed indicators of increased safety and more natural walking patterns in older and low-active transfemoral amputees in comparison to the standard NMPK already after a short acclimatisation time and no structured physical therapy. Regarding functional performance it seems as if providing older and low

  18. Toward attenuating the impact of arm positions on electromyography pattern-recognition based motion classification in transradial amputees

    Science.gov (United States)

    2012-01-01

    Background Electromyography (EMG) pattern-recognition based control strategies for multifunctional myoelectric prosthesis systems have been studied commonly in a controlled laboratory setting. Before these myoelectric prosthesis systems are clinically viable, it will be necessary to assess the effect of some disparities between the ideal laboratory setting and practical use on the control performance. One important obstacle is the impact of arm position variation that causes the changes of EMG pattern when performing identical motions in different arm positions. This study aimed to investigate the impacts of arm position variation on EMG pattern-recognition based motion classification in upper-limb amputees and the solutions for reducing these impacts. Methods With five unilateral transradial (TR) amputees, the EMG signals and tri-axial accelerometer mechanomyography (ACC-MMG) signals were simultaneously collected from both amputated and intact arms when performing six classes of arm and hand movements in each of five arm positions that were considered in the study. The effect of the arm position changes was estimated in terms of motion classification error and compared between amputated and intact arms. Then the performance of three proposed methods in attenuating the impact of arm positions was evaluated. Results With EMG signals, the average intra-position and inter-position classification errors across all five arm positions and five subjects were around 7.3% and 29.9% from amputated arms, respectively, about 1.0% and 10% low in comparison with those from intact arms. While ACC-MMG signals could yield a similar intra-position classification error (9.9%) as EMG, they had much higher inter-position classification error with an average value of 81.1% over the arm positions and the subjects. When the EMG data from all five arm positions were involved in the training set, the average classification error reached a value of around 10.8% for amputated arms. Using a

  19. Toward attenuating the impact of arm positions on electromyography pattern-recognition based motion classification in transradial amputees.

    Science.gov (United States)

    Geng, Yanjuan; Zhou, Ping; Li, Guanglin

    2012-10-05

    Electromyography (EMG) pattern-recognition based control strategies for multifunctional myoelectric prosthesis systems have been studied commonly in a controlled laboratory setting. Before these myoelectric prosthesis systems are clinically viable, it will be necessary to assess the effect of some disparities between the ideal laboratory setting and practical use on the control performance. One important obstacle is the impact of arm position variation that causes the changes of EMG pattern when performing identical motions in different arm positions. This study aimed to investigate the impacts of arm position variation on EMG pattern-recognition based motion classification in upper-limb amputees and the solutions for reducing these impacts. With five unilateral transradial (TR) amputees, the EMG signals and tri-axial accelerometer mechanomyography (ACC-MMG) signals were simultaneously collected from both amputated and intact arms when performing six classes of arm and hand movements in each of five arm positions that were considered in the study. The effect of the arm position changes was estimated in terms of motion classification error and compared between amputated and intact arms. Then the performance of three proposed methods in attenuating the impact of arm positions was evaluated. With EMG signals, the average intra-position and inter-position classification errors across all five arm positions and five subjects were around 7.3% and 29.9% from amputated arms, respectively, about 1.0% and 10% low in comparison with those from intact arms. While ACC-MMG signals could yield a similar intra-position classification error (9.9%) as EMG, they had much higher inter-position classification error with an average value of 81.1% over the arm positions and the subjects. When the EMG data from all five arm positions were involved in the training set, the average classification error reached a value of around 10.8% for amputated arms. Using a two-stage cascade classifier

  20. Toward attenuating the impact of arm positions on electromyography pattern-recognition based motion classification in transradial amputees

    Directory of Open Access Journals (Sweden)

    Geng Yanjuan

    2012-10-01

    Full Text Available Abstract Background Electromyography (EMG pattern-recognition based control strategies for multifunctional myoelectric prosthesis systems have been studied commonly in a controlled laboratory setting. Before these myoelectric prosthesis systems are clinically viable, it will be necessary to assess the effect of some disparities between the ideal laboratory setting and practical use on the control performance. One important obstacle is the impact of arm position variation that causes the changes of EMG pattern when performing identical motions in different arm positions. This study aimed to investigate the impacts of arm position variation on EMG pattern-recognition based motion classification in upper-limb amputees and the solutions for reducing these impacts. Methods With five unilateral transradial (TR amputees, the EMG signals and tri-axial accelerometer mechanomyography (ACC-MMG signals were simultaneously collected from both amputated and intact arms when performing six classes of arm and hand movements in each of five arm positions that were considered in the study. The effect of the arm position changes was estimated in terms of motion classification error and compared between amputated and intact arms. Then the performance of three proposed methods in attenuating the impact of arm positions was evaluated. Results With EMG signals, the average intra-position and inter-position classification errors across all five arm positions and five subjects were around 7.3% and 29.9% from amputated arms, respectively, about 1.0% and 10% low in comparison with those from intact arms. While ACC-MMG signals could yield a similar intra-position classification error (9.9% as EMG, they had much higher inter-position classification error with an average value of 81.1% over the arm positions and the subjects. When the EMG data from all five arm positions were involved in the training set, the average classification error reached a value of around 10.8% for

  1. Impact of Powered Knee-Ankle Prosthesis on Low Back Muscle Mechanics in Transfemoral Amputees: A Case Series

    Directory of Open Access Journals (Sweden)

    Chandrasekaran Jayaraman

    2018-03-01

    Full Text Available Regular use of prostheses is critical for individuals with lower limb amputations to achieve everyday mobility, maintain physical and physiological health, and achieve a better quality of life. Use of prostheses is influenced by numerous factors, with prosthetic design playing a critical role in facilitating mobility for an amputee. Thus, prostheses design can either promote biomechanically efficient or inefficient gait behavior. In addition to increased energy expenditure, inefficient gait behavior can expose prosthetic user to an increased risk of secondary musculoskeletal injuries and may eventually lead to rejection of the prosthesis. Consequently, researchers have utilized the technological advancements in various fields to improve prosthetic devices and customize them for user specific needs. One evolving technology is powered prosthetic components. Presently, an active area in lower limb prosthetic research is the design of novel controllers and components in order to enable the users of such powered devices to be able to reproduce gait biomechanics that are similar in behavior to a healthy limb. In this case series, we studied the impact of using a powered knee-ankle prostheses (PKA on two transfemoral amputees who currently use advanced microprocessor controlled knee prostheses (MPK. We utilized outcomes pertaining to kinematics, kinetics, metabolics, and functional activities of daily living to compare the efficacy between the MPK and PKA devices. Our results suggests that the PKA allows the participants to walk with gait kinematics similar to normal gait patterns observed in a healthy limb. Additionally, it was observed that use of the PKA reduced the level of asymmetry in terms of mechanical loading and muscle activation, specifically in the low back spinae regions and lower extremity muscles. Further, the PKA allowed the participants to achieve a greater range of cadence than their predicate MPK, thus allowing them to safely

  2. Residual limb wounds or ulcers heal in transtibial amputees using an active suction socket system. A randomized controlled study.

    Science.gov (United States)

    Traballesi, M; Delussu, A S; Fusco, A; Iosa, M; Averna, T; Pellegrini, R; Brunelli, S

    2012-12-01

    The factors that determine successful rehabilitation after lower limb amputation have been widely investigated in the literature, but little attention has been paid to the type of prosthesis and clinical state of the residual limb, particularly the presence of open ulcers. The aim of this study was to investigate the effects of a vacuum-assisted socket system (VASS) in a sample of trans-tibial amputees with wounds or ulcers on the stump and to evaluate prosthesis use as a primary outcome. Secondary outcome measures were mobility with the prosthesis, pain associated with prosthesis use, and wound/ulcer healing. Randomized controlled study. Inpatient. Twenty dysvascular transtibial amputees suffering from ulcers due to prosthesis use or delayed wound healing post-amputation were enrolled. Participants were separated into two groups: the experimental group was trained to use a VASS prosthesis in the presence of open ulcers/wounds on the stump; and the control group was trained to use a standard suction socket system prosthesis following ulcers/wounds healing. At the end of the 12-week rehabilitation program, all VASS users were able to walk independently with their prosthesis as reflected by a median Locomotor Capability Index (LCI) value of 42, whereas only five participants in the control group were able to walk independently with a median LCI value of 21. At the two-month follow-up, the participants used their VASS prostheses for 62 hours a week (median; range: 0-91), which was significantly longer than the control group using the standard prosthesis for 5 hours per week (range: 0-56, p=0.003). At the six-month follow-up, the difference between VASS-users (80, range: 0-112 hours a weeks) and control-users (59, range: 0-91) was no longer significant (p=0.191). Despite more intense use of the prosthesis, pain and wound healing did not significantly differ between the two groups. These results showed that the VASS prosthesis allowed early fitting with prompt

  3. A study on the development and the deodorizing capability of metal-phthalocyanine processed stump socks for amputees.

    Science.gov (United States)

    Furukawa, H

    2000-04-01

    The socks which were treated with Metal-Phthalocyanine, a derivative of an artificial enzyme, were developed by the author and called Kobe Stump Socks(KSS). KSS was made of a cotton cloth that had undergone an ammonium salt cationization process and also a Metal-Phthalocyanine process. The study from a bacteriological view and the moisture absorption effect of KSS revealed that the mechanism of the deodorizing ability was bared on the decomposition function of Metal-Phthalocyanine, while the antibacterial function came from the cationization and also that the high water absorption speed and capacity further enhanced these two functions. In this report, the author studied the deodorizing capability of KSS. To measure the adherence of an odor substance, ammonia, a testing device that measured this adherence was used. As a result, the adherence of ammonia to KSS was more than three times that of an unprocessed cloth. KSS had been used as stump socks on the stumps of amputees who were using prosthetic limbs, and a snuff test on the difference of the odor strength inside the socket was done. Of 33 subjects, 32 recognized a deodorizing effect. From these facts, KSS was proven to dry and deodorize the limb surface with the moisture absorption effect and deodorizing capabilities due to the Metal-Phthalocyanine process. These characteristics were never recognized in other stump socks. These date mentioned above suggested that KSS was the best material to deodorize prosthetic limb sockets.

  4. Physical function, pain, quality of life and life satisfaction of amputees from the 2008 Sichuan earthquake: A prospective cohort study.

    Science.gov (United States)

    Li, Ling; Reinhardt, Jan D; Zhang, Xia; Pennycott, Andrew; Zhao, Zhengen; Zeng, Xianmen; Li, Jianan

    2015-05-01

    To examine the development and determinants of long-term outcomes for earthquake victims with amputations, including physical function, pain, quality of life and life satisfaction. Prospective cohort study with 2-3 measurement points. A total of 72 people who underwent amputations following the 2008 Sichuan Earthquake and resided in Mianzhu County, Sichuan Province, China were enrolled in the study. Of these, 27 people were lost to follow-up. Data on pain (visual analogue scale) and physical function (Barthel Index) were collected at 3 measurement points (2009, 2010 and 2012), and data on quality of life (Medical Outcomes Short-Form 36) and life satisfaction (Life Satisfaction Questionnaire-11) were collected at 2 measurement points (2010 and 2012). Data were analysed with mixed effects regression. Pain severity declined significantly and physical function increased by 2012. Quality of life and life satisfaction remained relatively stable between 2010 and 2012, while quality of life was significantly lower than reference values from the general population. Illiteracy and lower extremity amputations were associated with lower quality of life and life satisfaction in several domains. While amputees' functioning and pain were improved over time, quality of life and life satisfaction did not change. Illiterate earthquake survivors and those with lower extremity amputations are at particular risk of low quality of life and life satisfaction, and may require additional attention in future earthquake rehabilitation programs.

  5. An exploration of the experiences of wound healing in military traumatic amputees and its impact on their rehabilitation.

    Science.gov (United States)

    Neal, Phyllis K

    2015-12-01

    The aim of this study was to establish the effect that wounds had on the rehabilitation of traumatic amputees from the military patients' perspective. In particular it established which aspects of wound healing had the greatest impact in relation to living with a wound and the effect that military cohesion had on their recovery. The study was undertaken within the interpretivistic paradigm and followed an ethnographic design using semi-structured interviews. It contributes to the theoretical understanding of rehabilitation of the combat injured as no other study has been undertaken in this area in the UK. It captured the responses of this unique group as they reach the end of their journey through rehabilitation and detailed their reflections on the challenges they had faced and overcome. Analysis revealed that complications including infection, pain, foreign bodies and further surgery prevented the wounds from healing. The participants found this frustrating and they further highlighted time as an important factor in their journey. The military environment formed a culture in which patients learned from, and were supported by, each other. This was compared to a community of practice. In conclusion suggestions were made for practice, policy and education and further research in this area. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. The effects of mirror therapy on pain and motor control of phantom limb in amputees: A systematic review.

    Science.gov (United States)

    Barbin, J; Seetha, V; Casillas, J M; Paysant, J; Pérennou, D

    2016-09-01

    Phantom limb pain (PLP) is a major problem after limb amputation. Mirror therapy (MT) is a non-pharmacological treatment using representations of movement, the efficacy of which in reducing PLP remains to be clarified. Here, we present the first systematic review on MT efficacy in PLP and phantom limb movement (PLM) in amputees (lower or upper limb). A search on Medline, Cochrane Database and Embase, crossing the keywords "Phantom Limb" and "Mirror Therapy" found studies which were read and analyzed according the PRISMA statement. Twenty studies were selected, 12 on the subject of MT and PLP, 3 on MT and PLM, 5 on MT and both (PLP and PLM). Among these 20 studies, 5 were randomized controlled trials (163 patients), 6 prospective studies (55 patients), 9 case studies (40 patients) and methodologies were heterogeneous. Seventeen of the 18 studies reported the efficacy of MT on PLP, but with low levels of evidence. One randomized controlled trial did not show any significant effect of MT. As to the effect of MT on PLM, the 8 studies concerned reported effectiveness of MT: 4 with a low level of evidence and 4 with a high level of evidence. An alternative to visual illusion seems to be tactile or auditory stimulation. We cannot recommend MT as a first intention treatment in PLP. The level of evidence is insufficient. Further research is needed to assess the effect of MT on pain, prosthesis use, and body representation, and to standardize protocols. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  7. Hands-Off and Hands-On Casting Consistency of Amputee below Knee Sockets Using Magnetic Resonance Imaging

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Safari

    2013-01-01

    Full Text Available Residual limb shape capturing (Casting consistency has a great influence on the quality of socket fit. Magnetic Resonance Imaging was used to establish a reliable reference grid for intercast and intracast shape and volume consistency of two common casting methods, Hands-off and Hands-on. Residual limbs were cast for twelve people with a unilateral below knee amputation and scanned twice for each casting concept. Subsequently, all four volume images of each amputee were semiautomatically segmented and registered to a common coordinate system using the tibia and then the shape and volume differences were calculated. The results show that both casting methods have intra cast volume consistency and there is no significant volume difference between the two methods. Inter- and intracast mean volume differences were not clinically significant based on the volume of one sock criteria. Neither the Hands-off nor the Hands-on method resulted in a consistent residual limb shape as the coefficient of variation of shape differences was high. The resultant shape of the residual limb in the Hands-off casting was variable but the differences were not clinically significant. For the Hands-on casting, shape differences were equal to the maximum acceptable limit for a poor socket fit.

  8. Evaluation of a new geriatric foot versus the Solid Ankle Cushion Heel foot for low-activity amputees.

    Science.gov (United States)

    Bonnet, Xavier; Adde, Jean N; Blanchard, François; Gedouin-Toquet, Annick; Eveno, Dominique

    2015-04-01

    It is always a challenge to rehabilitate geriatric amputees to perform self-care skills at home with limited ambulation. A new geriatric foot (with a lower effective foot length) has been specifically designed to reduce residual limb stress and to ease the step completion. The aim of this study is to evaluate the benefit of a new geriatric foot versus a Solid Ankle Cushion Heel foot for low-activity persons with transtibial amputation. Crossover study. A total of 12 patients were included in this study. 2-min walking test, Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 questionnaire and pressure socket measurements. The geriatric foot allows for greater patient satisfaction. The maximal pressure was significantly lower in the proximal anterior stump area. No statistical differences were obtained from the 2-min walking test. A geriatric foot designed with a low effective foot length improves the satisfaction and reduces proximal anterior socket pressures for poor-performing persons with transtibial amputation. The development and evaluation of feet specifically designed for geriatric persons with transtibial amputation could improve their specific requirements and satisfaction. © The International Society for Prosthetics and Orthotics 2014.

  9. The Evaluation of Daily Life Activities after Application of an Osseointegrated Prosthesis Fixation in a Bilateral Transfemoral Amputee

    Science.gov (United States)

    Schalk, Stephanie A.F.; Jonkergouw, Niels; van der Meer, Fred; Swaan, Willem M.; Aschoff, Horst-H.; van der Wurff, Peter

    2015-01-01

    Abstract Individuals with a transfemoral amputation (TFA) may experience limitations in daily life due to reduced mobility and prosthesis-related problems. An osseointegrated prosthesis fixation (OPF) procedure in amputees might contribute to a solution for patients with short stumps or socket-related problems. To date, no study has specifically described the application of an OPF procedure in individuals with a TFA. This study evaluated the level of daily life activities of a 21-year old service member with a bilateral TFA and cerebral trauma. Due to a short stump length and coordination problems, an OPF procedure was deemed the most suitable option. The result of this procedure and the rehabilitation program showed an increased mobility and satisfaction as obtained by the assessment of life habits questionnaire (LIFE-H) and lower extremity functional scale. The participant was able to walk short distances and the Genium knee provided a stance position. Stair ambulation is impossible because of inadequate muscle capacity. In this specific case we conclude that the quality of life improved through the use of an OPF. However, OPF might not be the appropriate device for every individual with TFA, due to varying bone compositions, co-morbidities, and limited clinical experience and unknown long-term effects. PMID:26356693

  10. The impact a surgeon has on primary amputee prosthetic rehabilitation: A survey of residual lower limb quality.

    Science.gov (United States)

    Sooriakumaran, Sellaiah; Uden, Maggie; Mulroy, Sarah; Ewins, David; Collins, Thomas

    2018-02-01

    Substantial improvements have been perceived in surgical results following major lower limb amputation, but there remains observed variation in amputation quality for patients referred for prosthetic rehabilitation from different hospitals. To assess various elements that influence residual limb quality and evaluate their impact on progress through initial prosthetic rehabilitation and mobility outcome after rehabilitation. Clinical survey. A revised 10-item residual limb scoring system was used to survey a succession of 95 primary amputees with transtibial and transfemoral amputations (100 residual limbs) presenting for rehabilitation. The majority of residual limbs scored highly, supporting the perception of generally good amputation quality. There were significant differences in average residual limb scores between some hospitals. The overall scores showed weak or minimal correlation to progress through rehabilitation and mobility outcome but residual limbs scoring higher in seven of the items of the score showed significant advantages in key aspects of progress or mobility at discharge. There is need for continued collaboration between surgeons and rehabilitation centres to ensure consistent high standards. The revised residual limb score used in this survey needs further refinement for future use. Clinical relevance Residual limb quality is an important component influencing prosthetic rehabilitation. This survey of residual limbs at one Rehabilitation Centre suggests encouragingly good surgical results but highlights differences between hospitals. A particular issue is the need for effective collaboration between surgeons and prosthetic rehabilitation professionals to optimise residual limb preparation.

  11. Techniques for Interface Stress Measurements within Prosthetic Sockets of Transtibial Amputees: A Review of the Past 50 Years of Research

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    Ebrahim A. Al-Fakih

    2016-07-01

    Full Text Available The distribution of interface stresses between the residual limb and prosthetic socket of a transtibial amputee has been considered as a direct indicator of the socket quality fit and comfort. Therefore, researchers have been very interested in quantifying these interface stresses in order to evaluate the extent of any potential damage caused by the socket to the residual limb tissues. During the past 50 years a variety of measurement techniques have been employed in an effort to identify sites of excessive stresses which may lead to skin breakdown, compare stress distributions in various socket designs, and evaluate interface cushioning and suspension systems, among others. The outcomes of such measurement techniques have contributed to improving the design and fitting of transtibial sockets. This article aims to review the operating principles, advantages, and disadvantages of conventional and emerging techniques used for interface stress measurements inside transtibial sockets. It also reviews and discusses the evolution of different socket concepts and interface stress investigations conducted in the past five decades, providing valuable insights into the latest trends in socket designs and the crucial considerations for effective stress measurement tools that lead to a functional prosthetic socket.

  12. Prosthetic ankle push-off work reduces metabolic rate but not collision work in non-amputee walking

    Science.gov (United States)

    Caputo, Joshua M.; Collins, Steven H.

    2014-12-01

    Individuals with unilateral below-knee amputation expend more energy than non-amputees during walking and exhibit reduced push-off work and increased hip work in the affected limb. Simple dynamic models of walking suggest a possible solution, predicting that increasing prosthetic ankle push-off should decrease leading limb collision, thereby reducing overall energy requirements. We conducted a rigorous experimental test of this idea wherein ankle-foot prosthesis push-off work was incrementally varied in isolation from one-half to two-times normal levels while subjects with simulated amputation walked on a treadmill at 1.25 m.s-1. Increased prosthesis push-off significantly reduced metabolic energy expenditure, with a 14% reduction at maximum prosthesis work. In contrast to model predictions, however, collision losses were unchanged, while hip work during swing initiation was decreased. This suggests that powered ankle push-off reduces walking effort primarily through other mechanisms, such as assisting leg swing, which would be better understood using more complete neuromuscular models.

  13. Strategies for providing upper extremity amputees with tactile and hand position feedback--moving closer to the bionic arm.

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    Riso, R R

    1999-01-01

    A continuing challenge for prostheses developers is to replace the sensory function of the hand. This includes tactile sensitivity such as finger contact, grip force, object slippage, surface texture and temperature, as well as proprioceptive sense. One approach is sensory substitution whereby an intact sensory system such as vision, hearing or cutaneous sensation elsewhere on the body is used as an input channel for information related to the prosthesis. A second technique involves using electrical stimulation to deliver sensor derived information directly to the peripheral afferent nerves within the residual limb. Stimulation of the relevant afferent nerves can ultimately come closest to restoring the original sensory perceptions of the hand, and to this end, researchers have already demonstrated some degree of functionality of the transected sensory nerves in studies with amputee subjects. This paper provides an overview of different types of nerve interface components and the advantages and disadvantages of employing each of them in sensory feedback systems. Issues of sensory perception, neurophysiology and anatomy relevant to hand sensation and function are discussed with respect to the selection of the different types of nerve interfaces. The goal of this paper is to outline what can be accomplished for implementing sensation into artificial arms in the near term by applying what is present or presently attainable technology.

  14. Recommended number of strides for automatic assessment of gait symmetry and regularity in above-knee amputees by means of accelerometry and autocorrelation analysis

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    Tura Andrea

    2012-02-01

    Full Text Available Abstract Background Symmetry and regularity of gait are essential outcomes of gait retraining programs, especially in lower-limb amputees. This study aims presenting an algorithm to automatically compute symmetry and regularity indices, and assessing the minimum number of strides for appropriate evaluation of gait symmetry and regularity through autocorrelation of acceleration signals. Methods Ten transfemoral amputees (AMP and ten control subjects (CTRL were studied. Subjects wore an accelerometer and were asked to walk for 70 m at their natural speed (twice. Reference values of step and stride regularity indices (Ad1 and Ad2 were obtained by autocorrelation analysis of the vertical and antero-posterior acceleration signals, excluding initial and final strides. The Ad1 and Ad2 coefficients were then computed at different stages by analyzing increasing portions of the signals (considering both the signals cleaned by initial and final strides, and the whole signals. At each stage, the difference between Ad1 and Ad2 values and the corresponding reference values were compared with the minimum detectable difference, MDD, of the index. If that difference was less than MDD, it was assumed that the portion of signal used in the analysis was of sufficient length to allow reliable estimation of the autocorrelation coefficient. Results All Ad1 and Ad2 indices were lower in AMP than in CTRL (P Conclusions Without the need to identify and eliminate the phases of gait initiation and termination, twenty strides can provide a reasonable amount of information to reliably estimate gait regularity in transfemoral amputees.

  15. Effects of long-distance walking on socket-limb interface pressure, tactile sensitivity and subjective perceptions of trans-tibial amputees.

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    Yeung, L F; Leung, Aaron K L; Zhang, Ming; Lee, Winson C C

    2013-06-01

    Many trans-tibial amputees could not tolerate long-distance walking. Lack of walking could explain for the increased cardiovascular diseases mortality rate. This study investigated the effects of long-distance walking (LDW) on socket-limb interface pressure, tactile sensitivity of the residual limb, and subjective feedbacks, which potentially identified the difficulties in LDW. Five male unilateral trans-tibial amputees walked on a level treadmill for a total of one hour at comfortable speed. Tactile sensitivity of the residual limb and socket-limb interface pressure during over-ground walking were measured before and after the treadmill walking. Modified Prosthesis Evaluation Questionnaires were also administered. After the treadmill walking, the socket-limb interface pressure and the tactile sensitivity at the popliteal depression area were significantly reduced. This corresponds well with the questionnaire results showing that the level of discomfort and pain of the residual limb did not increase. The questionnaire revealed that there were significant increases in fatigue level at the sound-side plantar flexors, which could lead to impaired dynamic stability. Fatigue of sound-side plantar-flexor was the main difficulty faced by the five subjects when walking long-distances. This finding might imply the importance of refining prosthetic components and rehabilitation protocols in reducing the muscle fatigue. • After long-distance walking (LDW) of the trans-tibal amputee subjects, there were significant increases in fatigue level at the plantar flexors. These might explain the reduced walking stability as perceived by the subjects. • LDW did not produce any problems in residual-limb comfort and pain feeling. These were in line with the significant reductions of socket-limb interface pressure and the tactile sensitivity at the popliteal depression after LDW. • Refinements of prosthetic components and rehabilitation protocols should be attempted to reduce the

  16. Improved Weight-Bearing Symmetry for Transfemoral Amputees During Standing Up and Sitting Down With a Powered Knee-Ankle Prosthesis.

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    Simon, Ann M; Fey, Nicholas P; Ingraham, Kimberly A; Finucane, Suzanne B; Halsne, Elizabeth G; Hargrove, Levi J

    2016-07-01

    To test a new user-modulated control strategy that enables improved control of a powered knee-ankle prosthesis during sit-to-stand and stand-to-sit movements. Within-subject comparison study. Gait laboratory. Unilateral transfemoral amputees (N=7; 4 men, 3 women) capable of community ambulation. Subjects performed 10 repetitions of sit-to-stand and stand-to-sit with a powered knee-ankle prosthesis and with their prescribed passive prosthesis in a randomized order. With the powered prosthesis, knee and ankle power generation were controlled as a function of weight transferred onto the prosthesis. Vertical ground reaction force limb asymmetry and durations of movement were compared statistically (Wilcoxon signed-rank test, α=.05). For sit-to-stand, peak vertical ground reaction forces were significantly less asymmetric using the powered prosthesis (mean, 19.3%±11.8%) than the prescribed prosthesis (57.9%±13.5%; P=.018), where positive asymmetry values represented greater force through the intact limb. For stand-to-sit, peak vertical ground reaction forces were also significantly less asymmetric using the powered prosthesis (28.06%±11.6%) than the prescribed prosthesis (48.2%±16%; P=.028). Duration of movement was not significantly different between devices (sit-to-stand: P=.18; stand-to-sit: P=.063). Allowing transfemoral amputees more control over the timing and rate of knee and ankle power generation enabled users to stand up and sit down with their weight distributed more equally between their lower limbs. Increased weight bearing on the prosthetic limb may make such activities of daily living easier for transfemoral amputees. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  17. Post-amputation pain is associated with the recall of an impaired body representation in dreams-results from a nation-wide survey on limb amputees.

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    Robin Bekrater-Bodmann

    Full Text Available The experience of post-amputation pain such as phantom limb pain (PLP and residual limb pain (RLP, is a common consequence of limb amputation, and its presence has negative effects on a person's well-being. The continuity hypothesis of dreams suggests that the presence of such aversive experiences in the waking state should be reflected in dream content, with the recalled body representation reflecting a cognitive proxy of negative impact. In the present study, we epidemiologically assessed the presence of post-amputation pain and other amputation-related information as well as recalled body representation in dreams in a sample of 3,234 unilateral limb amputees. Data on the site and time of amputation, residual limb length, prosthesis use, lifetime prevalence of mental disorders, presence of post-amputation pain, and presence of non-painful phantom phenomena were included in logistic regression analyses using recalled body representation in dreams (impaired, intact, no memory as dependent variable. The effects of age, sex, and frequency of dream recall were controlled for. About 22% of the subjects indicated that they were not able to remember their body representation in dreams, another 24% of the amputees recalled themselves as always intact, and only a minority of less than 3% recalled themselves as always impaired. Almost 35% of the amputees dreamed of themselves in a mixed fashion. We found that lower-limb amputation as well as the presence of PLP and RLP was positively associated with the recall of an impaired body representation in dreams. The presence of non-painful phantom phenomena, however, had no influence. These results complement previous findings and indicate complex interactions of physical body appearance and mental body representation, probably modulated by distress in the waking state. The findings are discussed against the background of alterations in cognitive processes after amputation and hypotheses suggesting an innate

  18. Post-amputation pain is associated with the recall of an impaired body representation in dreams-results from a nation-wide survey on limb amputees.

    Science.gov (United States)

    Bekrater-Bodmann, Robin; Schredl, Michael; Diers, Martin; Reinhard, Iris; Foell, Jens; Trojan, Jörg; Fuchs, Xaver; Flor, Herta

    2015-01-01

    The experience of post-amputation pain such as phantom limb pain (PLP) and residual limb pain (RLP), is a common consequence of limb amputation, and its presence has negative effects on a person's well-being. The continuity hypothesis of dreams suggests that the presence of such aversive experiences in the waking state should be reflected in dream content, with the recalled body representation reflecting a cognitive proxy of negative impact. In the present study, we epidemiologically assessed the presence of post-amputation pain and other amputation-related information as well as recalled body representation in dreams in a sample of 3,234 unilateral limb amputees. Data on the site and time of amputation, residual limb length, prosthesis use, lifetime prevalence of mental disorders, presence of post-amputation pain, and presence of non-painful phantom phenomena were included in logistic regression analyses using recalled body representation in dreams (impaired, intact, no memory) as dependent variable. The effects of age, sex, and frequency of dream recall were controlled for. About 22% of the subjects indicated that they were not able to remember their body representation in dreams, another 24% of the amputees recalled themselves as always intact, and only a minority of less than 3% recalled themselves as always impaired. Almost 35% of the amputees dreamed of themselves in a mixed fashion. We found that lower-limb amputation as well as the presence of PLP and RLP was positively associated with the recall of an impaired body representation in dreams. The presence of non-painful phantom phenomena, however, had no influence. These results complement previous findings and indicate complex interactions of physical body appearance and mental body representation, probably modulated by distress in the waking state. The findings are discussed against the background of alterations in cognitive processes after amputation and hypotheses suggesting an innate body model.

  19. Post-Amputation Pain Is Associated with the Recall of an Impaired Body Representation in Dreams—Results from a Nation-Wide Survey on Limb Amputees

    Science.gov (United States)

    Bekrater-Bodmann, Robin; Schredl, Michael; Diers, Martin; Reinhard, Iris; Foell, Jens; Trojan, Jörg; Fuchs, Xaver; Flor, Herta

    2015-01-01

    The experience of post-amputation pain such as phantom limb pain (PLP) and residual limb pain (RLP), is a common consequence of limb amputation, and its presence has negative effects on a person’s well-being. The continuity hypothesis of dreams suggests that the presence of such aversive experiences in the waking state should be reflected in dream content, with the recalled body representation reflecting a cognitive proxy of negative impact. In the present study, we epidemiologically assessed the presence of post-amputation pain and other amputation-related information as well as recalled body representation in dreams in a sample of 3,234 unilateral limb amputees. Data on the site and time of amputation, residual limb length, prosthesis use, lifetime prevalence of mental disorders, presence of post-amputation pain, and presence of non-painful phantom phenomena were included in logistic regression analyses using recalled body representation in dreams (impaired, intact, no memory) as dependent variable. The effects of age, sex, and frequency of dream recall were controlled for. About 22% of the subjects indicated that they were not able to remember their body representation in dreams, another 24% of the amputees recalled themselves as always intact, and only a minority of less than 3% recalled themselves as always impaired. Almost 35% of the amputees dreamed of themselves in a mixed fashion. We found that lower-limb amputation as well as the presence of PLP and RLP was positively associated with the recall of an impaired body representation in dreams. The presence of non-painful phantom phenomena, however, had no influence. These results complement previous findings and indicate complex interactions of physical body appearance and mental body representation, probably modulated by distress in the waking state. The findings are discussed against the background of alterations in cognitive processes after amputation and hypotheses suggesting an innate body model. PMID

  20. The quality of life analysis of knee prosthesis with complete microprocessor control in trans-femoral amputees.

    Science.gov (United States)

    Saglam, Yavuz; Gulenc, Baris; Birisik, Fevzi; Ersen, Ali; Yilmaz Yalcinkaya, Ebru; Yazicioglu, Onder

    2017-12-01

    The aim of this study was to analyze the patient demographics, etiology of limb loss as well as reporting SF-36 scores for microprocessor prosthesis users in Turkish population. We reviewed 72 patients (61 male and 11 female; mean age: 37.7 ± 10.7) with uni-lateral, above knee amputation and a history of regular and microprocessor prosthesis use. All patients were called back for a last follow-up and they were asked to fill a self-administered general health status questionnaire (SF-36). According to the SF-36 results; physical component score (PCS) score was 46 ± 7.3 and mental components summary (MCS) score was 46.5 ± 9.1. These scores have statistical similarity with Turkish healthy controls, except SF (social functioning) sub-dimension. PCS score for women microprocessor users were significantly lower than men (43.3 vs. 48.7, p = 0.03), but MCS scores were similar in between genders (46 vs. 48.2, p = 0.13). Conventional prostheses usage time was positively correlated with physical function (PF) scores (r = 0.322, p = 0.010). Microprocessor prosthesis usage time was negatively correlated with role limitations due to emotional problem (RE) scores (r = -0,313, p = 0.009). The quality of life surveys were showed that the loss of an extremity have higher physical and psychological impact on women's physical scores. Overall, SF-36 results were similar in microprocessor using amputee's and Turkish normal controls. Level IV, therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  1. Bone Mineral Density Measurements Around Osseointegrated Implants: A Precision Study and Validation of Scan Protocol for Transfemoral Amputees.

    Science.gov (United States)

    Hansen, Rehne Lessmann; Langdahl, Bente Lomholt; Jørgensen, Peter Holmberg; Petersen, Klaus Kjær; Søballe, Kjeld; Stilling, Maiken

    Visual evaluation of bone changes around an osseointegration (OI) implant in femoral amputees examined on plain radiographs shows that periprosthetic bone resorption takes place during the first years after OI surgery, but the bone mineral density (BMD) change has not been previously quantified by dual-energy X-ray absorptiometry (DXA). Precision is vital when monitoring BMD changes around implants, and thus the aim of this study was to evaluate the precision and feasibility of a scan protocol for BMD measurements in proximity of OI implants. The proximal part of 2 human cadaveric femoral bones (specimens A and B) with OI implants were mounted in a positioning jig and DXA scans were repeated 5 times in increments of 5° from neutral (0°) to 20° flexion and rotation. BMD changes as a result of change in leg position were evaluated. Repeated patient examinations (n = 20) were conducted in a clinical setting and the precision error was calculated for each of 7 periprosthetic custom-made regions of interest (ROIs). The precision of cadaveric BMD measurements in neutral position was square standard deviation ranged from 0.031 g/cm 2 to 0.047 g/cm 2 and %CV ranged from 3.12% to 6.57% depending on ROI. Simulated hip flexion or rotation of the femur affected periprosthetic BMD measurements around OI implants in cadaveric femoral bones, which stresses the importance of a reproducible set-up during DXA scans to reduce measurement errors caused by variation in leg position. Adherence to the scan protocol with a relaxed position of the residual limb resulted in an acceptable short-term precision below 6.6%. Copyright © 2017 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  2. Contributions of knee swing initiation and ankle plantar flexion to the walking mechanics of amputees using a powered prosthesis.

    Science.gov (United States)

    Ingraham, Kimberly A; Fey, Nicholas P; Simon, Ann M; Hargrove, Levi J

    2014-01-01

    Recently developed powered prostheses are capable of producing near-physiological joint torque at the knee and/or ankle joints. Based on previous studies of biological joint impedance and the mechanics of able-bodied gait, an impedance-based controller has been developed for a powered knee and ankle prosthesis that integrates knee swing initiation and powered plantar flexion in late stance with increasing ankle stiffness throughout stance. In this study, five prosthesis configuration conditions were tested to investigate the individual contributions of each sub-strategy to the overall walking mechanics of four unilateral transfemoral amputees as they completed a clinical 10-m walk test using a powered knee and ankle prosthesis. The baseline condition featured constant ankle stiffness and no swing initiation or powered plantar flexion. The four remaining conditions featured knee swing initiation alone (SI) or in combination with powered plantar flexion (SI+PF), increasing ankle stiffness (SI+IK), or both (SI+PF+IK). Self-selected walking speed did not significantly change between conditions, although subjects tended to walk the slowest in the baseline condition compared to conditions with swing initiation. The addition of powered plantar flexion resulted in significantly higher ankle power generation in late stance irrespective of ankle stiffness. The inclusion of swing initiation resulted in a significantly more flexed knee at toe off and a significantly higher average extensor knee torque following toe off. Identifying individual contributions of intrinsic control strategies to prosthesis biomechanics could help inform the refinement of impedance-based prosthesis controllers and simplify future designs of prostheses and lower-limb assistive devices alike.

  3. A comparison of vacuum and KBM prosthetic fitting for unilateral transtibial amputees using the Gait Profile Score.

    Science.gov (United States)

    Kuntze Ferreira, Alana Elisabeth; Neves, Eduardo Borba

    2015-02-01

    The purpose of this study was to compare gait deviations between Kondylen Bettung Münster (KBM) and vacuum prosthetic fitting using the Gait Profile Score (GPS), the Movement Analysis Profile (MAP) and temporal-spatial parameters. Seventeen transtibial amputees that received their prosthesis from the Brazilian governmental health system participated in this study. Twelve of them used KBM prosthetic fitting on their prosthesis and five used vacuum prosthetic fitting. Kinematic and temporal-spatial parameters data were captured by a six-camera Motion Analysis system (Santa Rosa, CA). The results showed that the vacuum group walked faster than the KBM group but the differences in temporal-spatial parameters between them were not significant. The GPS for the intact limb (IL) and the overall GPS differentiated between the groups of prosthetic fitting. Hip flexion/extension and knee flexion/extension were higher in KBM group than in the vacuum group, although only knee flexion/extension for the intact limb revealed significant difference between the groups. In KBM group, the major deviations were in hip flexion/extension for both limbs, knee flexion/extension for both limbs and ankle dorsi/plantar flexion for the prosthetic limb. The vacuum group showed deviations especially in ankle dorsi/plantar flexion for both limbs, knee flexion/extension for the prosthetic limb and hip rotation for the prosthetic limb. Besides, the vacuum group was more symmetrical than the KBM group. This study concluded that subjects who used vacuum prosthetic fitting presented smaller gait deviations and a more symmetrical gait than those who used KBM prosthetic fitting. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. Comparison of different microprocessor controlled knee joints on the energy consumption during walking in trans-femoral amputees: intelligent knee prosthesis (IP) versus C-leg.

    Science.gov (United States)

    Chin, Takaaki; Machida, Katsuhiro; Sawamura, Seishi; Shiba, Ryouichi; Oyabu, Hiroko; Nagakura, Yuji; Takase, Izumi; Nakagawa, Akio

    2006-04-01

    The purpose of this study was to investigate the characteristic differences between the IP and C-Leg by making a comparative study of energy consumption and walking speeds in trans-femoral amputees. The subjects consisted of four persons with traumatic trans-femoral amputations aged 17 - 33 years who had been using the IP and were active in society. Fourteen able-bodied persons served as controls. First the energy consumption at walking speeds of 30, 50, 70, and 90 m/min was measured when using the IP. Then the knee joint was switched to the C-Leg. The same energy consumption measurement was taken once the subjects were accustomed to using the C-Leg. The most metabolically efficient walking speed was also determined. At a walking speed of 30 m/min using the IP and C-Leg, the oxygen rate (ml/kg/ min) was, on average, 42.5% and 33.3% higher (Pmicroprocessor controlled knee joints appeared to be valid alternative for improving walking performance of trans-femoral amputees.

  5. Biomechanics of ramp descent in unilateral trans-tibial amputees: Comparison of a microprocessor controlled foot with conventional ankle-foot mechanisms.

    Science.gov (United States)

    Struchkov, Vasily; Buckley, John G

    2016-02-01

    Walking down slopes and/or over uneven terrain is problematic for unilateral trans-tibial amputees. Accordingly, 'ankle' devices have been added to some dynamic-response feet. This study determined whether use of a microprocessor controlled passive-articulating hydraulic ankle-foot device improved the gait biomechanics of ramp descent in comparison to conventional ankle-foot mechanisms. Nine active unilateral trans-tibial amputees repeatedly walked down a 5° ramp, using a hydraulic ankle-foot with microprocessor active or inactive or using a comparable foot with rubber ball-joint (elastic) 'ankle' device. When inactive the hydraulic unit's resistances were those deemed to be optimum for level-ground walking, and when active, the plantar- and dorsi-flexion resistances switched to a ramp-descent mode. Residual limb kinematics, joints moments/powers and prosthetic foot power absorption/return were compared across ankle types using ANOVA. Foot-flat was attained fastest with the elastic foot and second fastest with the active hydraulic foot (Ptypes. The greater negative 'ankle' work done when using the active hydraulic compared to other two ankle types, explains why there was a corresponding reduction in flexion and negative work at the residual knee. These findings suggest that use of a microprocessor controlled hydraulic foot will reduce the biomechanical compensations used to walk down slopes. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. The Conventional Non-Articulated SACH or a Multiaxial Prosthetic Foot for Hypomobile Transtibial Amputees? A Clinical Comparison on Mobility, Balance, and Quality of Life

    Directory of Open Access Journals (Sweden)

    Francesco Paradisi

    2015-01-01

    Full Text Available The effects of a non-articulated SACH and a multiaxial foot-ankle mechanism on the performance of low-activity users are of great interest for practitioners in amputee rehabilitation. The aim of this study is to compare these two prosthetic feet and assess possible improvements introduced by the increased degrees of freedom provided by the multiaxial foot. For this purpose, a group of 20 hypomobile transtibial amputees (TTAs had their usual SACH replaced with a multiaxial foot. Participants’ functional mobility, involving ambulatory skills in overground level walking, ramps, and stairs, was evaluated by performing Six-Minute Walking Test (6MWT, Locomotor Capability Index-5 (LCI-5, Hill Assessment Index (HAI, and Stair Assessment Index (SAI. Balance performances were assessed using Berg Balance Scale (BBS and analysing upper body accelerations during gait. Moreover, the Prosthesis Evaluation Questionnaire (PEQ was performed to indicate the prosthesis-related quality of life. Results showed that participants walked faster using the multiaxial foot (p<0.05 maintaining the same upright gait stability. Significant improvements with the multiaxial foot were also observed in BBS, LCI-5, and SAI times and 4 of 9 subscales of the PEQ. Our findings demonstrate that a multiaxial foot represents a considerable alternative solution with respect to the conventional SACH in the prosthetic prescription for hypomobile TTAs.

  7. Dynamic input to determine hip joint moments, power and work on the prosthetic limb of transfemoral amputees: ground reaction vs knee reaction.

    Science.gov (United States)

    Frossard, Laurent; Cheze, Laurence; Dumas, Raphael

    2011-06-01

    Calculation of lower limb kinetics is limited by floor-mounted force-plates. Comparison of hip joint moments, power and mechanical work on the prosthetic limb of a transfemoral amputee calculated by inverse dynamics using either the ground reactions (force-plates) or knee reactions (transducer). Comparative analysis. Kinematics, ground reaction and knee reaction data were collected using a motion analysis system, two force-plates, and a multi-axial transducer mounted below the socket, respectively. The inverse dynamics using ground reaction underestimated the peaks of hip energy generation and absorption occurring at 63% and 76% of the gait cycle (GC) by 28% and 54%, respectively. This method also overestimated by 24% a phase of negative work at the hip (37%-56% GC), and underestimated the phases of positive (57%-72% GC) and negative (73%-98%GC) work at the hip by 11% and 58%, respectively. A transducer mounted within the prosthesis has the capacity to provide more realistic kinetics of the prosthetic limb because it enables assessment of multiple consecutive steps and a wide range of activities without the issue of foot placement on force-plates. The hip is the only joint an amputee controls directly to set the prosthesis in motion. Hip joint kinetics are associated with joint degeneration, low back pain, risk of falls, etc. Therefore, realistic assessment of hip kinetics over multiple gait cycles and a wide range of activities is essential.

  8. Cost utility analysis of knee prosthesis with complete microprocessor control (C-leg) compared with mechanical technology in trans-femoral amputees.

    Science.gov (United States)

    Gerzeli, Simone; Torbica, Aleksandra; Fattore, Giovanni

    2009-02-01

    The study determines the cost-utility of a unilateral electronic knee prosthesis (C-leg) compared to mechanical alternatives in trans-femoral amputees. For each type of prosthesis, 50 patients, treated in a major Italian centre, were enrolled. Quality adjusted life years (QALYs) were estimated from responses to EuroQol (EQ-5D). Healthcare and social costs were assessed for the estimated life cycle of the technologies (5 years). C-leg was associated with 0.09 more QALYs per patient per year (P = 0.007). For the 5-year period, the incremental cost-utility ratio of C-leg resulted in euro 35,971 per QALY from the healthcare system perspective. If non-healthcare costs and productivity losses are included, the two groups to have similar costs (euro 66,669 vs euro 66,927).

  9. Apparatus for monitoring load bearing rehabilitation exercises of a transfemoral amputee fitted with an osseointegrated fixation: a proof-of-concept study.

    Science.gov (United States)

    Frossard, Laurent; Gow, David Lee; Hagberg, Kerstin; Cairns, Nicola; Contoyannis, Bill; Gray, Steven; Brånemark, Richard; Pearcy, Mark

    2010-02-01

    The purpose of this proof-of-concept study was to determine the relevance of direct measurements to monitor the load applied on the osseointegrated fixation of transfemoral amputees during static load bearing exercises. The objectives were (A) to introduce an apparatus using a three-dimensional load transducer, (B) to present a range of derived information relevant to clinicians, (C) to report on the outcomes of a pilot study and (D) to compare the measurements from the transducer with those from the current method using a weighing scale. One transfemoral amputee fitted with an osseointegrated implant was asked to apply 10 kg, 20 kg, 40 kg and 80 kg on the fixation, using self-monitoring with the weighing scale. The loading was directly measured with a portable kinetic system including a six-channel transducer, external interface circuitry and a laptop. As the load prescribed increased from 10 kg to 80 kg, the forces and moments applied on and around the antero-posterior axis increased by four-fold anteriorly and 14-fold medially, respectively. The forces and moments applied on and around the medio-lateral axis increased by nine-fold laterally and 16-fold from anterior to posterior, respectively. The long axis of the fixation was overloaded and underloaded in 17% and 83% of the trials, respectively, by up to + or - 10%. This proof-of-concept study presents an apparatus that can be used by clinicians facing the challenge of improving basic knowledge on osseointegration, for the design of equipment for load bearing exercises and for rehabilitation programs. Copyright 2009 Elsevier B.V. All rights reserved.

  10. Inter-individual difference in the effect of mirror reflection-induced visual feedback on phantom limb awareness in forearm amputees.

    Directory of Open Access Journals (Sweden)

    Noritaka Kawashima

    Full Text Available OBJECTIVE: To test whether the phantom limb awareness could be altered by observing mirror reflection-induced visual feedback (MVF in unilateral forearm amputees. METHODS: Ten unilateral forearm amputees were asked to perform bilateral (intact and phantom synchronous wrist motions with and without MVF. During wrist motion, electromyographic activities in the extensor digitorum longus (EDL and flexor carpi radialis muscles (FCR were recorded with bipolar electrodes. Degree of wrist range of motion (ROM was also recorded by electrogoniometry attached to the wrist joint of intact side. Subjects were asked to answer the degree of attainment of phantom limb motion using a visual analog scale (VAS: ranging from 0 (hard to 10 (easy. RESULTS: VAS and ROM were significantly increased by utilizing MVF, and the extent of an enhancement of the VAS and wrist ROM was positively correlated (r = 0.72, p<0.05. Although FCR EMG activity also showed significant enhancement by MVF, this was not correlated with the changes of VAS and ROM. Interestingly, while we found negative correlation between EDL EMG activity and wrist ROM, MVF generally affected to be increasing both EDL EMG and ROM. CONCLUSIONS: Although there was larger extent of variability in the effect of MVF on phantom limb awareness, MVF has a potential to enhance phantom limb awareness, in case those who has a difficulty for the phantom limb motion. The present result suggests that the motor command to the missing limb can be re-activated by an appropriate therapeutic strategy such as mirror therapy.

  11. The effects of prosthetic ankle stiffness on ankle and knee kinematics, prosthetic limb loading, and net metabolic cost of trans-tibial amputee gait.

    Science.gov (United States)

    Major, Matthew J; Twiste, Martin; Kenney, Laurence P J; Howard, David

    2014-01-01

    Previous studies of commercially-available trans-tibial prosthetic components have been unable to provide clear insight into the relationships between prosthetic mechanical properties and user performance (i.e., gait quality and energy expenditure), the understanding of which is key to improving prosthesis design and prescription. Many of these studies have been limited by not characterising the mechanical properties of the tested prostheses and/or only considered level walking at self-selected speeds. The aim of this study was to conduct a systematic investigation of the effects of ankle rotational stiffness on trans-tibial amputee gait during various walking conditions reflective of those encountered during daily ambulation. Ankle and knee kinematics, prosthetic limb normal ground reaction forces, and net metabolic cost were measured in five traumatic unilateral trans-tibial amputees during treadmill walking on the level, a 5% incline and a 5% decline whilst using an experimental articulated prosthetic foot with four different rotational stiffness setups and without changes in alignment between conditions. Overall, lower dorsiflexion stiffness resulted in greater prosthetic side dorsiflexion motion and sound side knee flexion, reduced normal ground reaction force during the loading phase of prosthetic stance and reduced net metabolic cost. Few differences were observed with changes in plantarflexion stiffness, most likely due to the foot achieving early foot flat. Low dorsiflexion stiffness generally improved gait performance seemingly due to easier tibial progression during stance. However, observed differences were small, suggesting that a wider range of walking and stiffness conditions would be useful to fully explore these effects in future studies. © 2013.

  12. Performance enhancement of epoxy based sandwich composites using multiwalled carbon nanotubes for the application of sockets in trans-femoral amputees.

    Science.gov (United States)

    Arun, S; Kanagaraj, S

    2016-06-01

    A socket plays a vital role in giving the comfort to the amputees. However, the accumulation of heat inside the socket and its weight led to increase their metabolic cost. Hence, an attempt was made to increase the performance of the epoxy based sandwich composites to be used for the socket by reinforcing multiwalled carbon nanotubes (MWCNT), which was varied from 0.1 to 0.5wt%. It was homogeneously dispersed in epoxy to obtain the desired properties, where the enhancement of thermal conductivity, compressive strength and modulus of epoxy was observed to be 76.7%, 62.6% and 20.2%, respectively at 0.3wt% of MWCNT concentration beyond which the mechanical properties were found to be decreased. Hence, the epoxy, E-glass plain fabric, 2-10 layers of stockinet and 0.3wt% of MWCNT were used to prepare the sandwich composites. The flexural strength and thermal conductivity of 0.3wt% of MWCNT reinforced sandwich composites were found to be improved by 11.38±1.5% and 29.8±1.3% for the 4-10 layers and up to 10 layers of stockinet, respectively compared to unreinforced sandwich composites, which helped to reduce the weight of the socket and decrease the heat accumulation inside the socket. Thus, it is suggested to be explored for the application of socket in trans-femoral amputees to increase their comfort level by decreasing the metabolic cost. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. A pilot study comparing the cognitive demand of walking for transfemoral amputees using the Intelligent Prosthesis with that using conventionally damped knees.

    Science.gov (United States)

    Heller, B W; Datta, D; Howitt, J

    2000-10-01

    To compare the cognitive demand of walking when using a conventional prosthesis with that using a microprocessor-controlled prosthesis. Ten unilateral transfemoral amputees wearing conventional pneumatic swing phase control (conventional prosthesis) prostheses walked on a treadmill which enforced a pattern of constantly varying speeds. The subjects simultaneously performed a simple or a complex distracting task. Following a period of accustomization, the subjects performed the same test wearing a prosthesis with microprocessor control of swing phase damping (the Intelligent Prosthesis). The three-dimensional trajectory (sway) of a retroreflective marker attached to the forehead was measured by a video-based motion analysis system, and used as a measure of gait quality. The ratio of the sway for the complex task over the simple task (the 'automation index') was used as a measure of the degree of automation of gait. No significant differences were found in the automation index between the two devices. However, the total sway for the conventional prosthesis was significantly higher. Sway during the complex distracting task was significantly higher than during the simple task. The microprocessor-controlled prosthesis was not found to be less cognitively demanding than a conventional prosthesis.

  14. C-Leg® improves function and quality of life in an adolescent traumatic trans-femoral amputee: a case study.

    Science.gov (United States)

    Tofts, Louise J; Hamblin, Natasha

    2014-10-01

    (1) To demonstrate that a 13-year-old male can be successfully fitted with a C-Leg® microprocessor-controlled knee. (2) To use validated outcome measurement tools to assess change in mobility, physical function, fatigue and quality of life after fitting. A 13-year-old unilateral traumatic trans-femoral amputee was studied pre-C-Leg fitting and 2 weeks and 10 months post C-Leg fitting. The 6-Minute Walk Test improved by 33% from 360 to 480 m. PedsQL™ Multidimensional Fatigue Scale improved by 32% from 68 to 90, and PedsQL™ Quality of Life Scale improved 14 points, with minimal clinically important difference of 4.36 points. In this case, the provision of a microprocessor-controlled knee in the context of a new prosthesis with new socket system produced improvements for the patient in walking speed, fatigue and quality of life. This case report shows that n = 1 methodology can be used to demonstrate clinical improvement in an adolescent subject when using an intervention (C-Leg) which is not supported in this age group by published evidence. © The International Society for Prosthetics and Orthotics 2013.

  15. An investigation on effects of amputee's physiological parameters on maximum pressure developed at the prosthetic socket interface using artificial neural network.

    Science.gov (United States)

    Nayak, Chitresh; Singh, Amit; Chaudhary, Himanshu; Unune, Deepak Rajendra

    2017-10-23

    Technological advances in prosthetics have attracted the curiosity of researchers in monitoring design and developments of the sockets to sustain maximum pressure without any soft tissue damage, skin breakdown, and painful sores. Numerous studies have been reported in the area of pressure measurement at the limb/socket interface, though, the relation between amputee's physiological parameters and the pressure developed at the limb/socket interface is still not studied. Therefore, the purpose of this work is to investigate the effects of patient-specific physiological parameters viz. height, weight, and stump length on the pressure development at the transtibial prosthetic limb/socket interface. Initially, the pressure values at the limb/socket interface were clinically measured during stance and walking conditions for different patients using strain gauges placed at critical locations of the stump. The measured maximum pressure data related to patient's physiological parameters was used to develop an artificial neural network (ANN) model. The effects of physiological parameters on the pressure development at the limb/socket interface were examined using the ANN model. The analyzed results indicated that the weight and stump length significantly affects the maximum pressure values. The outcomes of this work could be an important platform for the design and development of patient-specific prosthetic socket which can endure the maximum pressure conditions at stance and ambulation conditions.

  16. Development of a prosthesis shoulder mechanism for upper limb amputees: application of an original design methodology to optimize functionality and wearability.

    Science.gov (United States)

    Troncossi, Marco; Borghi, Corrado; Chiossi, Marco; Davalli, Angelo; Parenti-Castelli, Vincenzo

    2009-05-01

    The application of a design methodology for the determination of the optimal prosthesis architecture for a given upper limb amputee is presented in this paper along with the discussion of its results. In particular, a novel procedure was used to provide the main guidelines for the design of an actuated shoulder articulation for externally powered prostheses. The topology and the geometry of the new articulation were determined as the optimal compromise between wearability (for the ease of use and the patient's comfort) and functionality of the device (in terms of mobility, velocity, payload, etc.). This choice was based on kinematic and kinetostatic analyses of different upper limb prosthesis models and on purpose-built indices that were set up to evaluate the models from different viewpoints. Only 12 of the 31 simulated prostheses proved a sufficient level of functionality: among these, the optimal solution was an articulation having two actuated revolute joints with orthogonal axes for the elevation of the upper arm in any vertical plane and a frictional joint for the passive adjustment of the humeral intra-extra rotation. A prototype of the mechanism is at the clinical test stage.

  17. Multi-body simulation of various falling scenarios for determining resulting loads at the prosthesis interface of transfemoral amputees with osseointegrated fixation.

    Science.gov (United States)

    Welke, Bastian; Schwarze, Michael; Hurschler, Christof; Calliess, Tilman; Seehaus, Frank

    2013-07-01

    Conventionally, transfemoral amputees are treated with a shaft prosthesis fitted over the residual limb. To improve the quality of life of such patients, in particular those with complications relating to conventional attachment (e.g., skin irritation, stump ulcers, and poor motor-control with short stumps), osseointegrated prosthesis fixation implants have been developed and implanted in a limited population of patients. To assess possible damage to the implant/prosthesis during falling scenarios, the loads in high-risk situations were estimated using a multi-body simulation of motion. Five falling scenarios were identified and performed by healthy volunteer wearing safety equipment. Kinematic data and ground reaction forces were captured as input for the inverse-dynamics-based simulations, from which the forces and moments at a typical implant-prosthesis interface location were computed. The estimated peak loads in all five scenarios were of a magnitude that could lead to bone fracture. The largest peak force observed was 3274 ± 519 N, with an associated resultant moment of 176 ± 55 Nm on the prosthesis-implant interface. A typical femur is prone to fracture under this load, thus illustrating the need for a safety-release element in osseointegrated prosthesis fixation. Copyright © 2013 Orthopaedic Research Society.

  18. The Evaluation of Daily Life Activities after Application of an Osseointegrated Prosthesis Fixation in a Bilateral Transfemoral Amputee: A Case Study.

    Science.gov (United States)

    Schalk, Stephanie A F; Jonkergouw, Niels; van der Meer, Fred; Swaan, Willem M; Aschoff, Horst-H; van der Wurff, Peter

    2015-09-01

    Individuals with a transfemoral amputation (TFA) may experience limitations in daily life due to reduced mobility and prosthesis-related problems. An osseointegrated prosthesis fixation (OPF) procedure in amputees might contribute to a solution for patients with short stumps or socket-related problems. To date, no study has specifically described the application of an OPF procedure in individuals with a TFA. This study evaluated the level of daily life activities of a 21-year old service member with a bilateral TFA and cerebral trauma. Due to a short stump length and coordination problems, an OPF procedure was deemed the most suitable option.The result of this procedure and the rehabilitation program showed an increased mobility and satisfaction as obtained by the assessment of life habits questionnaire (LIFE-H) and lower extremity functional scale. The participant was able to walk short distances and the Genium knee provided a stance position. Stair ambulation is impossible because of inadequate muscle capacity.In this specific case we conclude that the quality of life improved through the use of an OPF. However, OPF might not be the appropriate device for every individual with TFA, due to varying bone compositions, co-morbidities, and limited clinical experience and unknown long-term effects.

  19. Understanding responses to gait instability from plantar pressure measurement and the relationship to balance and mobility in lower-limb amputees.

    Science.gov (United States)

    Howcroft, Jennifer; Lemaire, Edward D; Kofman, Jonathan; Kendell, Cynthia

    2016-02-01

    Measuring responses to a more unstable walking environment at the point-of-care may reveal clinically relevant strategies, particularly for rehabilitation. This study determined if temporal measures, center of pressure-derived measures, and force impulse measures can quantify responses to surface instability and correlate with clinical balance and mobility measures. Thirty-one unilateral amputees, 11 transfemoral and 20 transtibial, walked on level and soft ground while wearing pressure-sensing insoles. Foot-strike and foot-off center of pressure, center of pressure path, temporal, and force impulse variables were derived from F-Scan pressure-sensing insoles. Significant differences (Pamputees. Center of pressure-derived parameters correlated with clinical measures of mobility and balance, explaining up to 84.0% of the variability. The number of posterior deviations per stride, mean CoP path velocity stride time, anterior-posterior center of pressure path coefficient of variation, percent double-support time, and percent stance were frequently related to clinical balance and mobility measures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Amputee locomotion: Frequency content of prosthetic vs. intact limb vertical ground reaction forces during running and the effects of filter cut-off frequency.

    Science.gov (United States)

    Kiernan, Dovin; Miller, Ross H; Baum, Brian S; Kwon, Hyun Joon; Shim, Jae Kun

    2017-07-26

    Compared to intact limbs, running-specific prostheses have high resonance non-biologic materials and lack active tissues to damp high frequencies. These differences may lead to ground reaction forces (GRFs) with high frequency content. If so, ubiquitously applying low-pass filters to prosthetic and intact limb GRFs may attenuate veridical high frequency content and mask important and ecologically valid data from prostheses. To explore differences in frequency content between prosthetic and intact limbs we divided signal power from transtibial unilateral amputees and controls running at 2.5, 3.0, and 3.5m/s into Low (25Hz) frequency bandwidths. Faster speeds tended to reduce the proportion of signal power in the Low bandwidth while increasing it in the High and Non-biologic bandwidths. Further, prostheses had lower proportions of signal power at the High frequency bandwidth but greater proportions at the Non-biologic bandwidth. To evaluate whether these differences in frequency content interact with filter cut-offs and alter results, we filtered GRFs with cut-offs from 1 to 100Hz and calculated vertical impact peak (VIP). Changing cut-off had inconsistent effects on VIP across speeds and limbs: Faster speeds had significantly larger changes in VIP per change in cut-off while, compared to controls, prosthetic limbs had significantly smaller changes in VIP per change in cut-off. These findings reveal differences in GRF frequency content between prosthetic and intact limbs and suggest that a cut-off frequency that is appropriate for one limb or speed may be inappropriate for another. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Ground reaction force and electromyographic activity of transfemoral amputee gait: a case series http://dx.doi.org/10.5007/1980-0037.2013v15n1p16

    Directory of Open Access Journals (Sweden)

    Alberto Carlos Amadio

    2013-01-01

    Full Text Available Ground reaction forces (GRF and electromyographic activity form a part of the descriptive data that characterise the biomechanics of gait. The research of these parameters is important in establishing gait training and understanding the impact of amputation and prosthetic components on movement during the act of walking. Therefore, this case series describes the GRF and electromyographic activity in the gait of transfemoral amputees. A force plate was used to measure GRF, and an electromyographic system monitored the vastus lateralis, biceps femoris, tibialis anterior, and gastrocnemius lateralis muscles of the non-amputated leg. The average vertical and anteroposterior GRF time-curves, average electromyographic activity, and descriptor variables were then analysed. We observed decreases in vertical and anteroposterior GRF magnitudes as well as in anteroposterior GRF descriptor variables during the propulsive phase in the amputated leg. There were increases in phasic muscle activity and co-activation in the non-amputated leg. We concluded that, during walking, the unilateral transfemoral amputees (who were analysed in this case series developed lower GRF in the amputated limb and a longer period of electromyographic activity in the non-amputated limb.

  2. The effects of walking speed on minimum toe clearance and on the temporal relationship between minimum clearance and peak swing-foot velocity in unilateral trans-tibial amputees.

    Science.gov (United States)

    De Asha, Alan R; Buckley, John G

    2015-04-01

    Minimum toe clearance is a critical gait event because it coincides with peak forward velocity of the swing foot, and thus, there is an increased risk of tripping and falling. Trans-tibial amputees have increased risk of tripping compared to able-bodied individuals. Assessment of toe clearance during gait is thus clinically relevant. In able-bodied gait, minimum toe clearance increases with faster walking speeds, and it is widely reported that there is synchronicity between when peak swing-foot velocity and minimum toe clearance occur. There are no such studies involving lower-limb amputees. To determine the effects of walking speed on minimum toe clearance and on the temporal relationship between clearance and peak swing-foot velocity in unilateral trans-tibial amputees. Cross-sectional. A total of 10 trans-tibial participants walked at slow, customary and fast speeds. Minimum toe clearance and the timings of minimum toe clearance and peak swing-foot velocity were determined and compared between intact and prosthetic sides. Minimum toe clearance was reduced on the prosthetic side and, unlike on the intact side, did not increase with walking speed increase. Peak swing-foot velocity consistently occurred (~0.014 s) after point of minimum toe clearance on both limbs across all walking speeds, but there was no significant difference in the toe-ground clearance between the two events. The absence of speed related increases in minimum toe clearance on the prosthetic side suggests that speed related modulation of toe clearance for an intact limb typically occurs at the swing-limb ankle. The temporal consistency between peak foot velocity and minimum toe clearance on each limb suggests that swing-phase inter-segmental coordination is unaffected by trans-tibial amputation. The lack of increase in minimum toe clearance on the prosthetic side at higher walking speeds may potentially increase risk of tripping. Findings indicate that determining the instant of peak swing

  3. Uso da prótese e retorno ao trabalho em amputados por acidentes de transporte Use of prosthesis and return to work by amputees involved in traffic accidents

    Directory of Open Access Journals (Sweden)

    Lílian de Fátima Dornelas

    2010-01-01

    Full Text Available OBJETIVO: Verificar o uso de prótese de membro inferior e o retorno ao trabalho em amputados por acidentes de transporte (AT. MÉTODO: Estudo de série de casos por meio de uma entrevista, com amputados por AT, cadastrados no período de dezembro de 2002 a dezembro de 2004, após a alta da reabilitação na AACD/MG. A amostra foi composta por 26 amputados, 22 homens e quatro mulheres, com média de idade de 37,7 anos. Quinze amputações eram transfemorais e 11 transtibiais. Dezoito (69,2% pessoas tinham grau de instrução fundamental. RESULTADOS: Todos os amputados receberam a prótese e 16 (61,5% deles, relataram utilizá-la para passeio. Todos os indivíduos permaneceram afastados do trabalho após o acidente, sendo que 16 (66,7% afastaram pelo INSS, seis (25% aposentaram por invalidez e dois (8,3% por idade. Cinco das pessoas afastadas pelo INSS retornaram ao trabalho e três aposentadas por invalidez e uma por idade, declararam que praticam atividade para suplementar à aposentadoria. CONCLUSÃO: O uso da prótese é comumente para passeio e é baixa a taxa de retorno ao trabalho após a reabilitação.. O baixo nível de instrução e qualificação podem ter sido responsáveis por estes resultados.OBJECTIVE: To detect the use of a prosthetic leg and the return to work in amputees by traffic accidents (TA. METHOD: A case series by means of an interview with AT amputees who were registered between December 2002 and December 2004, after discharge from rehabilitation at the AACD/MG. The sample consisted of 26 amputees, 22 men and four women, mean age of 37.7 years. Fifteen amputations were above the knee and 11 below the knee. Eighteen (69.2% people had completed elementary education. RESULTS: All amputees received prostheses and 16 (61.5% of them reported using it for walking. All subjects remained off work after the accident, and 16 (66.7% remained off work by utilizing the INSS, six (25% retired due to disability and two (8.3% retired

  4. Análise do impacto mecânico nas próteses de um sujeito bi-amputado durante a marcha Mechanic impact analysis in the prostheses of a bilateral lower-limb amputee during the gait

    Directory of Open Access Journals (Sweden)

    Thessaly Puel de Oliveira

    2011-03-01

    Full Text Available Observa-se o aumento do uso da acelerometria (medida de impactos na aplicação clínica, especialmente para estudos da marcha acoplando-se os acelerômetros na tíbia. Entretanto, não se tem observado estudos sobre os efeitos dessas vibrações no sistema locomotor de usuários de prótese do membro inferior. O objetivo deste estudo foi medir a quantidade de impacto durante a marcha de um sujeito amputado bilateral transtibial. As coletas foram realizadas durante a marcha do sujeito caminhando a 4 km/h em uma distância de 8 metros com dois acelerômetros piezoelétricos uniaxiais fixados em dois locais distintos da prótese: inicialmente nos encaixes das próteses e posteriormente fixou-se nas hastes metálicas. Utilizou-se estatística descritiva exploratória com Anova One-Way e Post Hoc de Tukey. Constatou-se diferenças significativas com o teste Anova One-Way entre as 10 aquisições em cada local de fixação do acelerômetro. Através do Post Hoc de Tukey observou-se maiores picos de aceleração no encaixe esquerdo (p LATELY We can experience the increasing use of accelerometers (Shock measurements in clinical applications, especially in gait studies attaching the accelerometers in the subjects tibia to impact appraisal. However, there are few studies about the effect of those vibrations in the locomotor system of lower limb prosthetic users. The objective of this study was to measure the amount of vibration during the gait in two different spots in both prostheses of bilateral below-knee amputee. For the acquisition we use a gait speed of 4km/h through 8 meters walk with two uniaxial piezoelectric accelerometers set at two different sites of the prostheses. First, the accelerometers were fixed in both prostheses sockets and later they were fixed in the prostheses pylons. We used descriptive statistics exploratory Anova one-way and post hoc Tukey. The One-way Anova test showed significant differences comparing the accelerometer

  5. Caracterização nutricional de jogadores de elite de futebol de amputados Caracterización nutricional de jugadores de elite de futbol de amputados Nutritional characterization of elite amputee soccer players

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    Ainá Innocencio da Silva Gomes

    2005-02-01

    amputados no es conocido por el público en general. Este deporte requiere un aumento en la demanda metabólica y, com la amputación de miembros inferiores, el gasto energético de la caminata y la corrida puede aumentar considerablemente. Luego, el aspecto nutricional tiene un papel importante en el desempeño deportivo y en la calidad de vida de estos atletas. El objetivo del presente estudio fué evaluar el estado nutricional de cuatro jugadores de futbol de amputados, con edades entre los 21 y 33 años, participantes de la Seleción Brasilera de Futbol de Amputados. El consumo alimenticio fué evaluado a través del registro alimenticio de 6 dias para energia, macronutrientes, fibras alimentarias y micronutrientes. La avaliación antropométrica consistió en las medidas de estatura, peso, pliuegues cutáneos y circunferencias que permitieron evaluar el estado nutricional. Los análisis bioquímicos realizados fueron: hemoglobina, hematocrito, ferritina y transferrina para verificar el estado nutricional de hierro; urea, albúmina y creatinina para caracterizar el perfil protéico y el colesterol total y fracciones de triglicerídeos para evaluar el perfil lipídico. Los resultados mostraron que los atletas presentaban grandes variaciones en cuanto al consumo energético (2179 a 4294 kcal y de macronutrientes. Los atletas presentaron consumo lipídico de 25 a 30% do VET, protéico de 1,8 a 3,9 g/kg/dia y un bajo percentual de carbohidratos (48 a 54% de VET y baja ingesta de vitamina E. La evaluación bioquímica demostró que no existía anemia ferropénica, con las reservas protéicas adecuadas y el perfil lipídico dentro de la faja de normalidad. Se concluye que los futbolistas amputados necesitan de orientacion nutricional, para corregir hábitos alimenticios observados en el periodo pre-competitivo y para propiciar un mejor desempeño atletico.Although soccer is a popular sport in Brazil, the amputee soccer is not known by the public in general. This sport

  6. Amputees and sports : a systematic review

    NARCIS (Netherlands)

    Bragaru, Mihail; Dekker, Rienk; Geertzen, Jan H. B.; Dijkstra, Pieter U.

    2011-01-01

    Amputation of a limb may have a negative impact on the psychological and physical well-being, mobility and social life of individuals with limb amputations. Participation in sports and/or regular physical activity has a positive effect on the above mentioned areas in able-bodied individuals. Data

  7. Amputees and sports: a systematic review.

    Science.gov (United States)

    Bragaru, Mihail; Dekker, Rienk; Geertzen, Jan H B; Dijkstra, Pieter U

    2011-09-01

    Amputation of a limb may have a negative impact on the psychological and physical well-being, mobility and social life of individuals with limb amputations. Participation in sports and/or regular physical activity has a positive effect on the above mentioned areas in able-bodied individuals. Data concerning participation in sports or regular physical activity together with its benefits and risks for individuals with limb amputations are scarce. No systematic review exists that addresses a wide range of outcomes such as biomechanics, cardiopulmonary function, psychology, sport participation and sport injuries. Therefore, the aim of this article is to systematically review the literature about individuals with limb amputations and sport participation. MEDLINE (PubMed), EMBASE, CINAHL® and SportDiscus® were searched without time or language restrictions using free text words and MeSH terms. The last search date was 31 March 2010. Books, internet sites and references of included papers were checked for papers relevant to the topic under review. Papers were included if the research topic concerned sports and a minimum of ten individuals with limb amputations were part of the study population. Papers were excluded if they included individuals with amputations of body parts other than upper or lower limbs or more distal than the wrist or ankle, or if they consisted of case reports, narrative reviews, books, notes or letters to the editor. Title, abstract and full-text assessments were performed by two independent observers following a list of preset criteria. Of the 3689 papers originally identified, 47 were included in the review. Most of the included studies were older than 10 years and had cross-sectional designs. Study participants were generally younger and often had more traumatic amputations than the general population of individuals with limb amputations. Heterogeneity in population characteristics, intervention types and main outcomes made data pooling impossible. In general, sports were associated with a beneficial effect on the cardiopulmonary system, psychological well-being, social reintegration and physical functioning. Younger individuals with unilateral transtibial amputations achieve better athletic performance and encounter fewer problems when participating in sports compared with older individuals with bilateral transfemoral amputations. Regardless of their amputation level, individuals with limb amputations participate in a wide range of recreational activities. The majority of them were not aware of the sport facilities in their area and were not informed about available recreational activities. Sport prosthetic devices were used mostly by competitive athletes. For football, the injury rate and pattern of the players with an amputation were similar to those of able-bodied players. Individuals with limb amputations appear to benefit both physically and psychologically from participation in sports and/or regular physical activity. Therefore, sports should be included in rehabilitation programmes, and individuals with limb amputations should be encouraged to pursue a physically active life following hospital discharge.

  8. Sustainment and Advancement of Amputee Care

    Science.gov (United States)

    2015-04-08

    important aids to recovery, ambulation, and reduction of back pain. Thus, strengthening exercises are initiated as soon as they are tolerated. Aerobic ...military careers, future under-employment, as well as post-traumatic stress disorder (PTSD), severely altered body image, and low self - esteem ...capabilities are significantly enhanced and facilitated by the BADER Consortium, the Consortium must be self -sustainable by September 2016, as it was

  9. Prosthetic management of the partial foot amputee.

    Science.gov (United States)

    Yonclas, Peter P; O'donnell, Casey J

    2005-07-01

    Partial foot amputations provide advantages and challenges to the patient confronting loss of limb and the rehabilitation team. The partial foot amputation offers the potential for retention of plantar load-bearing tissues that are capable of tolerating the forces involved in weight bearing; this can allow the patient to ambulate with or without a prosthesis. Because of the complexity of the foot-ankle complex and the multiple types of partial foot amputations encountered, choosing the appropriate prosthesis can be challenging. This article explains some of the rationale and common options available for the different levels of amputation.

  10. Dočasná symetrie zdravých a protetických končetin během chůze osoby s transtibiální amputací s různým protetickým zařazením Temporal symmetry of sound and prosthetic limbs during transtibial amputee gait with various prosthetic alignment

    Directory of Open Access Journals (Sweden)

    Miroslav Janura

    2007-01-01

    reduced. In the course of the biomechanical investigation of gait in subjects with various afflictions, the symmetry of lower limb loading is also the object of research. A certain number of biomechanical studies are focussed on the kinematic and dynamic variables of the gait cycle in subjects with transtibial amputation (Bateni & Olney, 2002; Thomas et al., 2000; Perry, 2004. An interesting problem is the evaluation of gait symmetry between a transtibial amputee and groups of healthy persons (Winter & Sienko, 1988; Dingwell, Davis, & Frazier, 1996. Miff et al. (2005 compared temporal symmetries in a healthy group with the values in a transtibial amputee group during gait initiation and termination. Nolan et al. (2003 took an interest in changes in gait symmetry influenced by gait speed in transtibial and transfemoral amputees in comparison with a healthy group. The interlimb gait symmetry of transtibial amputees wearing two different prosthetic feet in the early rehabilitation stage was investigated by Marinakis (2004. Full symmetry in one's gait is not always desirable. The human system, with its major structural asymmetries in the neuromuscular skeletal system (one limb has been amputated cannot perform optimally when the gait is symmetrical (Winter & Sienko, 1988. Non symmetrical gait performance, with constraints of its residual system and the mechanics of its prosthesis, is better in this case. For persons who have undergone amputation, asymmetrical gait may be the instrument which protects the stump of the disabled limb. We can say that gait asymmetry would be a relevant measure for investigating the gait characteristics of amputees and establishing their propensity for future joint pain and degeneration (Nolan et al., 2003. For amputee gait, the choice of a suitable prosthesis is very important. The influence of a prosthetic foot on gait variables in a group of these subjects was observed by Gitter et al. (1991. Efficiency of performance of the gait cycle is also

  11. Voice Recognition Interface in the Rehabilitation of Combat Amputees

    National Research Council Canada - National Science Library

    Lenhart, Martha; Yancosek, Kathleen E

    2004-01-01

    The goal of this pilot study is to assess the impact of training on voice recognition software as part of the rehabilitation process that Military patients with amputation, or peripheral nerve loss...

  12. Psycho-social correlates of adjustment in adult amputees | Ajala ...

    African Journals Online (AJOL)

    Data collection was done by using structured questionnaire which contained the locus of control, self-concept, social support and coping scales. Multiple Regressions was used to test the independent and joint influence of these factors on adjustment. The result revealed significant influence of self-concept (t = 0.07, â = 0.03 ...

  13. A kneeless leg prothesis for the elderly amputee, advanced version.

    Science.gov (United States)

    Seliktar, R; Kenedi, R M

    1976-01-01

    The work described in this paper is part of a development and evaluation program, the aim of which was to bring a telescopic kneeless leg prosthesis to a reliable, commercially viable, and easily manufacturable stage. It is considered that these aims have been almost achieved, as the prosthesis appears to improve the gait characteristics significantly, compared with its first prototypes and compared with the conventional National Health Service (N.H.S.) above-knee prostheses. The clinical evaluation was carried out with three patients and its results were found satisfactory. The specific advantages of this prosthesis compared with the conventional prostheses are: improved proprioception and stability, and improvements of certain kinematic characteristics. The paper describes briefly the modified version of the prosthesis an the investigations undertaken, and also discusses the results obtained.

  14. Localizing and Assessing Amputee Pain with Intense Focused Ultrasound

    Science.gov (United States)

    2016-10-01

    transfemoral), and 18-75 years of age. Exclusion criteria were: current pressure ulcers , rashes, or open skin over residual limb, history of skin...generating tissue and may therefore prevent unnecessary surgical interventions . Instead, iFU may help clinicians to more readily attend to central...scar tissue at the end of cut nerves that then applies pressure to the nerve ending. In addition, traditional amputation surgery almost always produces

  15. Spirituality and Quality of Life in Limb Amputees

    OpenAIRE

    Peirano, Amanda H.; Franz, Randall W.

    2012-01-01

    Limb amputation is a life-changing event that signifies long-term physical, social, psychological, and environmental change. Spiritual well-being in patients plays a significant role in coping and may affect outcomes of patients with limb loss. The objective of this study was to describe the role of spirituality in individuals with limb amputation and to determine whether spirituality is related to the quality of life (QOL) in this sample. Study participants were recruited through prosthetist...

  16. Prosthetic Frequently Asked Questions for the New Amputee

    Science.gov (United States)

    ... A prosthesis is basically an extension of your body. A standard prosthesis is made of conventional component parts that create ... limb to attain a proper, sound shape. Learn body positioning and strengthening to ... FOR A PROSTHESIS AND IT FEELS COMFORTABLE, WHAT HAPPENS NEXT? You ...

  17. Body image and prosthesis satisfaction in the lower limb amputee.

    OpenAIRE

    Murray, Craig; Fox, Jezz

    2002-01-01

    Purpose: This study examines the relationship between prosthesis satisfaction and body image in lower limb prosthesis users, and the gendered variations within these relationships. Method: A total of 44 valid responses were obtained to an Internet survey regarding prosthesis satisfaction, body image, and phantom pain. Spearman Rho correlations were calculated for these three domains. Results: Moderate to high negative correlations were observed between Body Image Disturbance and Prosthesis Sa...

  18. Geriatric rehabilitation of lower limb amputees: a multicenter study.

    Science.gov (United States)

    Eijk, Monica Spruit-van; van der Linde, Harmen; Buijck, Bianca I; Zuidema, Sytse U; Koopmans, Raymond T C M

    2012-01-01

    The aim of this study was to determine factors independently associated with successful rehabilitation of patients with lower limb amputation in skilled nursing facilities (SNFs). All patients admitted to one of the 11 participating SNFs were eligible. Multidisciplinary teams collected the data. Successful rehabilitation was defined as discharge to an independent living situation within 1 year after admission. Functional status at discharge, as measured with the Barthel index (BI), was a secondary outcome. Multivariate regression analyses were used to assess the independent contribution of each determinant to the two outcome measures. Of 55 eligible patients, 48 were included. Mean age was 75 years. Sixty-five percent rehabilitated successfully. Multivariate analyses showed that presence of diabetes mellitus (DM) (OR 23.87, CI 2.26-252.47) and premorbid BI (OR 1.37, CI 1.10-1.70) were the most important determinants of successful rehabilitation, whereas 78% of the variance of discharge BI was explained by premorbid BI, BI on admission, and 1-leg balance. The presence of DM and high premorbid BI were associated with discharge to an independent living situation within 1 year after admission. Premorbid BI, admission BI, and 1-leg balance were independently associated to discharge BI.

  19. Psycho-physiological training approach for amputee rehabilitation.

    Science.gov (United States)

    Dhal, Chandan; Wahi, Akshat

    2015-01-01

    Electromyography (EMG) signals are very noisy and difficult to acquire. Conventional techniques involve amplification and filtering through analog circuits, which makes the system very unstable. The surface EMG signals lie in the frequency range of 6Hz to 600Hz, and the dominant range is between the ranges from 20Hz to 150Hz. 1 Our project aimed to analyze an EMG signal effectively over its complete frequency range. To remove these defects, we designed what we think is an easy, effective, and reliable signal processing technique. We did spectrum analysis, so as to perform all the processing such as amplification, filtering, and thresholding on an Arduino Uno board, hence removing the need for analog amplifiers and filtering circuits, which have stability issues. The conversion of time domain to frequency domain of any signal gives a detailed data of the signal set. Our main aim is to use this useful data for an alternative methodology for rehabilitation called a psychophysiological approach to rehabilitation in prosthesis, which can reduce the cost of the myoelectric arm, as well as increase its efficiency. This method allows the user to gain control over their muscle sets in a less stressful environment. Further, we also have described how our approach is viable and can benefit the rehabilitation process. We used our DSP EMG signals to play an online game and showed how this approach can be used in rehabilitation.

  20. Occupational therapy protocol for amputees with targeted muscle reinnervation.

    Science.gov (United States)

    Stubblefield, Kathy A; Miller, Laura A; Lipschutz, Robert D; Kuiken, Todd A

    2009-01-01

    Targeted muscle reinnervation (TMR) is a surgical intervention to improve the control of myoelectric prostheses in high-level upper-limb amputation. This article briefly describes the procedure and presents the protocol for postoperative, preprosthetic care. We also recommend a guide to patient training using standard-of-care prosthetic devices controlled by up to four intuitive, independent, and isolated myoelectric signals. We discuss the advantages of this new control paradigm and methods for optimizing clinical outcomes for patients with high-level upper-limb amputations. This material is based on more than 6 years of experience treating patients with TMR in a research setting. Detailed results of this research are reported elsewhere.

  1. Proprioception in Above-the-Knee Amputees with Artificial Limbs

    Directory of Open Access Journals (Sweden)

    E. P. Latanioti

    2013-01-01

    Full Text Available Purpose. To evaluate the lower limb proprioceptive sensation in patients with femoral amputation who received an artificial joint. Materials and Methods. 22 patients (18 men, 4 women, 24–65 years old (mean: 42, who had undergone above-the-knee joint amputation and underwent evaluation of proprioception using joint reposition in a predetermined angle of 15° knee flexion. The measurements were applied using a conventional goniometer to both amputated and healthy knees. The last ones were used as internal control. All patients performed an active knee flexion from hyperextension to 15° in a closed kinetic chain in order to evaluate proprioceptive sensation of the knee joint using the joint position sense (JPS method during specific controllable circumstances very close to normal gait. Results. JPS at 15° flexion for the amputated knee was calculated to be equal to 13.91 (SD = ±4.74, and for the healthy side it was equal to 14.15 (SD = ±2.61. No statistically significant differences were detected between the amputated and the healthy limb (. Conclusions. The proprioceptive information of the stumps did not appear to be affected significantly after thigh amputation and application of artificial prosthesis when JPS at 15° was evaluated. It seems that these patients compensate the loss of the knee sensory receptors via alternative mechanisms.

  2. Surgical apgar score predicts early complication in transfemoral amputees

    DEFF Research Database (Denmark)

    Wied, Christian; Foss, Nicolai Bang; Kristensen, Morten T

    2016-01-01

    AIM: To assess whether the surgical apgar score (SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery. METHODS: This was a single-center, retrospective observational cohort study conducted between January 2013......) performed approximately 10 cm below the knee joint. All TTA procedures were performed with sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint, performed with anterior/posterior flaps. Trained residents or senior consultants performed...... to the author until after the calculation of SAS. The SAS results were arranged into four groups (SAS 0-4, SAS 5-6, SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk (SAS ≥ 7) and high-risk patients (SAS

  3. Improved Training Method for Rapid Rehabilitation of Amputees

    Science.gov (United States)

    2015-05-01

    increase trust in their prosthesis and reduce falls by using a novel training method. Deliverables included a quantitatively derived, deployment ready...training program effectiveness was done using a perturbation testing protocol in a Computer Assisted Rehabilitation Environment (CAREN, Motek Medical BV...centered information was also collected prior to and at the conclusion of the training. The Prosthesis Evaluation Questionnaire (PEQ-A) was used to

  4. Geriatric rehabilitation of lower limb amputees: a multicenter study.

    NARCIS (Netherlands)

    Eijk, M.S. van; Linde, H. van der; Buijck, B.I.; Zuidema, S.U.; Koopmans, R.T.C.M.

    2012-01-01

    PURPOSE: The aim of this study was to determine factors independently associated with successful rehabilitation of patients with lower limb amputation in skilled nursing facilities (SNFs). METHODS: All patients admitted to one of the 11 participating SNFs were eligible. Multidisciplinary teams

  5. [Amputee rehabilitation: taking charge, functional assessment and goal setting].

    Science.gov (United States)

    Damiani, Carlo

    2015-01-01

    Patients with lower limb amputations need the help of a multi-professional care team. There is no single professional who encompasses the skills required by patients who generally present multiple pathologies: skills in the care of wounds which are often dehiscent, knowledge of prosthetics, considering the fast evolving technologies in the field, psychological skills, essential to help the patient face their somatic conditions and resultant changes in body image. The physiatrist manages a care team which must prioritise treatments and intervention methods, and define practicable objectives in both the short and long term. The article details the basic principles to be followed for each patient so as to not overlook any of the aspects which combine to create a process which is neither simple nor quick, and focuses on the first parts of the treatment, from admittance until the choice of the temporary prosthesis.

  6. Prosthetic reconstruction to restore function in transcarpal amputees.

    Science.gov (United States)

    Salminger, S; Roche, A D; Hruby, L A; Sturma, A; Riedl, O; Bergmeister, K D; Aszmann, O C

    2016-03-01

    Mutilated hands at the distal level may pose a challenge for reconstruction. Biological treatment options may require multiple surgical interventions and a long rehabilitation course with little hope of good functional outcome. Standard hand prostheses are also not an ideal solution, as they are too long and cumbersome for partial hand injuries. This paper outlines the functional outcomes of prosthetic reconstruction with devices customized for the transcarpal amputation levels. The functional outcome was evaluated with the Action Research Arm Test (ARAT), Southampton Hand Assessment Procedure (SHAP), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Functional evaluation was performed at least 12 months after final fitting. Psychological assessment was performed with the Short Form-36. The three patients achieved a mean ARAT score of 35.67 ± 0.58. The average SHAP score was 74 ± 7.81. The average DASH score was found to be 16.11 ± 12.03. The reconstructed hand achieved a score of 75.27 ± 8.16% in SHAP and 62.57 ± 1.02% in ARAT in relation to the healthy hand. All patients exhibited average physical and mental component summary scales in the Short Form-36. The majority of transcarpal amputations are seen in manual laborers due to work-related trauma. Returning to work is the main goal in such young and otherwise-healthy patients. As shown with this study, prosthetic fitting results in quick and reliable functional reconstruction. Therefore, this treatment should be considered as an option during the initial decision-making process of reconstructing difficult traumatic injuries of the hand. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. Gait and balance of transfemoral amputees using passive mechanical and microprocessor-controlled prosthetic knees.

    Science.gov (United States)

    Kaufman, K R; Levine, J A; Brey, R H; Iverson, B K; McCrady, S K; Padgett, D J; Joyner, M J

    2007-10-01

    Microprocessor-controlled knee joints appeared on the market a decade ago. These joints are more sophisticated and more expensive than mechanical ones. The literature is contradictory regarding changes in gait and balance when using these sophisticated devices. This study employed a crossover design to assess the comparative performance of a passive mechanical knee prosthesis compared to a microprocessor-controlled knee joint in 15 subjects with an above-knee amputation. Objective measurements of gait and balance were obtained. Subjects demonstrated significantly improved gait characteristics after receiving the microprocessor-controlled prosthetic knee joint (pknee to a flexed knee during loading response which resulted in a change from an internal knee flexor moment to a knee extensor moment. The participants' balance also improved (pmicroprocessor-controlled knee have significant improvements in gait and balance.

  8. Percutaneous osseointegrated prostheses for amputees: Limb compensation in a 12-month ovine model.

    Science.gov (United States)

    Shelton, Trevor J; Beck, J Peter; Bloebaum, Roy D; Bachus, Kent N

    2011-10-13

    Percutaneous osseointegrated prostheses are being investigated as an alternative strategy to attach prosthetic limbs to patients. Although the use of these implants has shown to be promising in clinical trials, the ability to maintain a skin seal around an osseointegrated implant interface is a major challenge to prevent superficial and deep periprosthetic infections. The specific aim of this study was to establish a translational load-bearing ovine model to assess postoperative limb compensation and gait symmetry following a percutaneous osseointegrated implant. We tested the following hypotheses: (1) the animals would return to pre-amputation limb loads within 12-months; (2) the animals would return to a symmetrical gait pattern (stride length and time in stance) within 12-months. The results demonstrated that one month following surgery, the sheep loaded their amputated limb to a mean value of nearly 80% of their pre-amputation loading condition; by 12-months, this mean had dropped to approximately 74%. There was no statistical differences between the symmetry of the amputated forelimb and the contralateral forelimb at any time point for the animals stride length or the time spent in the stance phase of their gait cycle. Thus, the data showed that while the animals maintained symmetric gait patterns, they did not return to full weight-bearing after 12-months. The results of this study showed that a large animal load-bearing model had a symmetric gait and was weight bearing for up to 12 months. While the current investigation utilizes an ovine model, the data show that osseointegrated implant technology with postoperative follow-up can help our human patients return to symmetric gait and maintain an active lifestyle, leading to an improvement in their quality of life following amputation. Published by Elsevier Ltd.

  9. Neglected foreign body in contralateral limb in a traumatic transfemoral amputee-radiographs can be misleading

    Directory of Open Access Journals (Sweden)

    Jaiswal Atin

    2013-02-01

    Full Text Available 【Abstract】Missed or neglected foreign bodies are not infrequent in surgical practice. This case report high-lights the fact that thorough clinical examination and de-tailed evaluation of trauma patients are very necessary so that any associated injuries or foreign bodies will not be missed and any unforeseen clinical or medico-legal compli-cations can be prevented. We present a case of a 35-year-old male patient who had traumatic transfemoral amputa-tion of the right lower limb with a clean laceration (size 2 cmx1 cm over the medial aspect of the left thigh. Radio-graphs suggested a single radioopaque foreign body which proved misleading, as during surgical removal multiple radi-olucent and radiopaque foreign bodies were discovered. Postoperative ultrasound was performed and showed no retained foreign bodies. A secondary closure of the right thigh amputation was done and patient was discharged. At the last follow-up, 9 months after injury, the patient had no complaints, and both the amputation stump and the wound over the left thigh were healthy. Thus in the cases of re-tained foreign bodies, in addition to thorough clinical ex-amination and radiography, ultrasonograpy should be supplemented. And if required, use of CT scan as well as MRI should be also considered. Key words: Foreign bodies; Radiography; Diagnos-tic errors; Ultrasonography

  10. Biomechanic and Energetic Effects of a Quasi-Passive Artificial Gastrocnemius on Transtibial Amputee Gait

    Directory of Open Access Journals (Sweden)

    Michael F. Eilenberg

    2018-01-01

    Full Text Available State-of-the-art transtibial prostheses provide only ankle joint actuation and thus do not provide the biarticular function of the amputated gastrocnemius muscle. We develop a prosthesis that actuates both knee and ankle joints and then evaluate the incremental effects of this prosthesis as compared to ankle actuation alone. The prosthesis employs a quasi-passive clutched-spring knee orthosis, approximating the largely isometric behavior of the biological gastrocnemius, and utilizes a commercial powered ankle-foot prosthesis for ankle joint functionality. Two participants with unilateral transtibial amputation walk with this prosthesis on an instrumented treadmill, while motion, force, and metabolic data are collected. Data are analyzed to determine differences between the biarticular condition with the activation of the knee orthosis and the monoarticular condition with the orthosis behaving as a free-joint. As hypothesized, the biarticular system is shown to reduce both affected-side knee and hip moment impulse and positive mechanical work in both participants during the late stance knee flexion phase of walking, compared to the monoarticular condition. The metabolic cost of walking is also reduced for both participants. These very preliminary results suggest that biarticular functionality may provide benefits beyond even those of the most advanced monoarticular prostheses.

  11. Control of lateral balance in walking - Experimental findings in normal subjects and above-knee amputees

    NARCIS (Netherlands)

    Hof, At L.; van Bockel, Renske M.; Schoppen, Tanneke; Postema, Klaas

    In walking the human body is never in balance. Most of the time the trunk is supported by one leg and the centre of mass (CoM) 'falls' to the contralateral side. In dynamical situations the velocity of the CoM should be acknowledged as well in the 'extrapolated centre of mass (XcoM). Centre of

  12. A Study of the Amputee Experience of Viewing Self in the Mirror.

    Science.gov (United States)

    Freysteinson, Wyona; Thomas, Lisa; Sebastian-Deutsch, Amy; Douglas, Denika; Melton, Danielle; Celia, Tania; Reeves, Kristin; Bowyer, Patricia

    To describe the trajectory of viewing self in a mirror after an ampu-tation and participants' perceptions of what health care professionals should know about mirrors. Hermeneutic phenomenologyMETHODS: Focus groups were conducted to collect the research data. The mirror experience had three key moments: decision, seeing, and consent. The trajectory of viewing self in a mirror had four key themes: mirror shock, mirror anguish, recognizing self, and acceptance: a new normal. Participants' recommendations for introducing the mirror after an amputation and using a mirror to avoid skin breakdown and infection, and correct gait and balance are described. This study provides a unique viewpoint into the world of those who have suffered amputation of a limb. Rehabilitation nurses and other health care professionals are encouraged through these participants to consider the effect and value of mirrors when caring for those who have had an amputation.

  13. Amputees by choice: body integrity identity disorder and the ethics of amputation.

    Science.gov (United States)

    Bayne, Tim; Levy, Neil

    2005-01-01

    Should surgeons be permitted to amputate healthy limbs if patients request such operations? We argue that if such patients are experiencing significant distress as a consequence of the rare psychological disorder named Body Integrity Identity Disorder (BIID), such operations might be permissible. We examine rival accounts of the origins of the desire for healthy limb amputations and argue that none are as plausible as the BIID hypothesis. We then turn to the moral arguments against such operations, and argue that on the evidence available, none is compelling. BIID sufferers meet reasonable standards for rationality and autonomy: so as long as no other effective treatment for their disorder is available, surgeons ought to be allowed to accede to their requests.

  14. ALGORITHM FOR THE PREDICTION OF THE REACTIVE FORCES DEVELOPED IN THE SOCKET OF TRANSFEMORAL AMPUTEES

    Directory of Open Access Journals (Sweden)

    JUAN FERNANDO RAMÍREZ

    2012-01-01

    Full Text Available Se presenta un algoritmo en Matlab 2010a basado en un modelo matemático para predecir los momentos y las fuerzas de reacción en un punto particular del socket vinculado al miembro inferior de un amputado transfemoral. El modelo tiene en cuenta las inercias desarrolladas durante el ciclo de la marcha. Se realiza una validación del modelo comparando los resultados con los datos obtenidos en un laboratorio de análisis de la marcha y se encuentra una buena correspondencia con los datos experimentales en las fases de apoyo y balanceo.

  15. Regulation of step frequency in transtibial amputee endurance athletes using a running-specific prosthesis

    NARCIS (Netherlands)

    Oudenhoven, Laura M.; Boes, Judith M.; Hak, Laura; Faber, Gert S.; Houdijk, Han

    2017-01-01

    Running specific prostheses (RSP) are designed to replicate the spring-like behaviour of the human leg during running, by incorporating a real physical spring in the prosthesis. Leg stiffness is an important parameter in running as it is strongly related to step frequency and running economy. To be

  16. Avoidable 30-day mortality analysis and failure to rescue in dysvascular lower extremity amputees

    DEFF Research Database (Denmark)

    Wied, Christian; Foss, Nicolai B; Tengberg, Peter T

    2018-01-01

    in LEA patients who followed an enhanced treatment program. Patients and methods - Medical charts of 195 primary LEA procedures were reviewed independently by 3 of the authors, and deaths during hospitalization following amputation were classified according to consensus. Results - 31 patients died within...... 30 days after surgery. 4 deaths were classified as "definitely unavoidable," 4 as "probably unavoidable," and 23 as "FTR." Patients who died had a higher incidence of sepsis, pneumonia, and acute myocardial infarction compared with those alive. A log binominal regression analysis adjusted for age......, sex, ASA score, diabetes, nursing home admission, transfemoral amputation (TFA), and BMI showed that the risk of 30-day mortality was increased for TFA (RR =2.3, 95% CI 1.1-4.8) and for patients with diabetes (RR =2.7, 95% CI 1.3-5.6). The FTR rate (patients with 30-day mortality/all patients...

  17. An electromyographic study of the hip muscles of transfemoral amputees in walking

    NARCIS (Netherlands)

    Jaegers, SMHJ; Arendzen, JH; deJongh, HJ

    The aim of this study was to obtain insight into the electromyographic activity of the hip muscles after transfemoral amputation and to determine whether the cleaved hip muscles are still functional in locomotion, The electromyographic activity of the superficial hip muscles of both legs was studied

  18. Validity of DynaPort GaitMonitor for assessment of spatiotemporal parameters in amputee gait

    NARCIS (Netherlands)

    Houdijk, Han; Appelman, Franka M.; van Velzen, Judith M.; van der Woude, Lucas H. V.; van Bennekom, Coen A. M.

    2008-01-01

    Accelerometry can be used to objectively assess the walking ability of people with a lower-limb prosthesis inside and outside the laboratory setting. In this study, the validity of the DynaPort GaitMonitor software (McRoberts, The Hague, the Netherlands) for assessing spatiotemporal parameters of

  19. Sound side joint contact forces in below knee amputee gait with an ESAR prosthetic foot.

    Science.gov (United States)

    Karimi, Mohammad Taghi; Salami, Firooz; Esrafilian, Amir; Heitzmann, Daniel W W; Alimusaj, Merkur; Putz, Cornelia; Wolf, Sebastian I

    2017-10-01

    The incidence of knee and hip joint osteoarthritis in subjects with below knee amputation (BK) appears significantly higher compared to unimpaired subjects, especially in the intact side. However, it is controversial if constant higher loads on the sound side are one of the major factors for an increased osteoarthritis (OA) incidence in subjects with BK, beside other risk factors, e.g. with respect to metabolism. The aim wasto investigate joint contact forces (JCF) calculated by a musculoskeletal model in the intact side and to compare it with those of unimpaired subjects and to further elucidate in how far increased knee JCF are associated with increased frontal plane knee moments. A group of seven subjects with BK amputation and a group of ten unimpaired subjects were recruited for this study. Gait data were measured by 3D motion capture and force plates. OpenSim software was applied to calculate JCF. Maximum joint angles, ground reaction forces, and moments as well as time distance parameters were determined and compared between groups showing no significant differences, with some JCF components of knee and hip even being slightly smaller in subjects with BK compared to the reference group. This positive finding may be due to the selected ESAR foot. However, other beneficial factors may also have influenced this positive result such as the general good health status of the subjects or the thorough and proper fitting and alignment of the prosthesis. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Mobile Gait Analysis System for Lower Limb Amputee High-Level Activity Rehabilitation

    Science.gov (United States)

    2012-09-01

    extremity trauma resulting in a unilateral transtibial amputation and may have contralateral limb injuries to include peripheral nerve injury, volumetric... Rehab . Res. and Dev. 2005:42 (2), 175-182. 11. Quesada PM, Pitkin M, Colvin J. Biomechanical Evaluation of a Prototype Foot/Ankle Prosthesis. IEEE...Trans. on Rehab . Eng. 2000:8(1), 156-159. 12. Buckley JG, ODriscoll D, Bennett SJ. Postural Sway and Active Balance Performance in Highly Active

  1. Effects of prosthetic limb prescription on 3-year mortality among lower extremity veteran amputees

    Science.gov (United States)

    Kurichi, Jibby E.; Kwong, Pui; Vogel, W. Bruce; Xie, Dawei; Ripley, Diane Cowper; Bates, Barbara E.

    2015-01-01

    Our objective was to determine the relationship between receipt of a prescription for a prosthetic limb and three-year mortality post-surgery among veterans with lower extremity amputation. We conducted a retrospective observational study that included 4,578 veterans hospitalized for lower extremity amputation and discharged in Fiscal Years 2003 and 2004. The outcome was time to all-cause mortality from the amputation surgical date up to the 3-year anniversary of the surgical date. There were 1,300 (28.4%) veterans with lower extremity amputations who received a prescription for a prosthetic limb within a year after the surgical amputation. About 46% (n=2086) died within three-years of the surgical anniversary. Among those who received a prescription for a prosthetic limb, only 25.2% died within 3 years of the surgical anniversary. After adjustment, veterans who received a prescription for a prosthetic limb were less likely to die after the surgery than veterans without a prescription with a hazard ratio of 0.68 (95% CI, 0.60-0.77). Findings demonstrated that veterans with lower extremity amputations who received a prescription for a prosthetic limb within a year after the surgical amputation were less likely to die within three years of the surgical amputation after controlling for patient-, treatment-, and facility-level characteristics. PMID:26348602

  2. Effect of take-off from prosthetic versus intact limb on transtibial amputee long jump technique.

    Science.gov (United States)

    Nolan, L; Patritti, Benjamin L; Simpson, Kathy J

    2012-09-01

    Increasing numbers of long jumpers with lower limb amputations choose to take off from their prosthetic limb. It is not yet known what difference in technique, if any, this requires, or which is more advantageous. To investigate kinematic differences in long jump technique in athletes with a unilateral transtibial ampution (TT) who take off from their prosthetic limb versus those who take off from their intact limb. Naturalistic, field-based, observational; independent group, nonparametric comparison. Two-dimensional sagittal plane kinematic analysis was performed on all athletes competing in the men's Paralympic TT long jump finals. Five athletes took off from their prosthetic limb (TO(prosth)) and five from their intact limb (TO(intact)). No differences were seen between the two groups in terms of jump distance, approach speed or vertical velocity at touch down. While in contact with the take-off board, the two groups gained a similar amount of vertical velocity. However, the TO(prosth) group appeared to conserve horizontal velocity by using the prosthesis as a 'springboard', minimizing the large hip and knee range of motion displayed by the TO(intact) group and athletes in previous studies. While differences in technique were observed, no difference was found for jump distance.

  3. Adaptation and prosthesis effects on stride-to-stride fluctuations in amputee gait.

    Directory of Open Access Journals (Sweden)

    Shane R Wurdeman

    Full Text Available Twenty-four individuals with transtibial amputation were recruited to a randomized, crossover design study to examine stride-to-stride fluctuations of lower limb joint flexion/extension time series using the largest Lyapunov exponent (λ. Each individual wore a "more appropriate" and a "less appropriate" prosthesis design based on the subject's previous functional classification for a three week adaptation period. Results showed decreased λ for the sound ankle compared to the prosthetic ankle (F1,23 = 13.897, p = 0.001 and a decreased λ for the "more appropriate" prosthesis (F1,23 = 4.849, p = 0.038. There was also a significant effect for the time point in the adaptation period (F2,46 = 3.164, p = 0.050. Through the adaptation period, a freezing and subsequent freeing of dynamic degrees of freedom was seen as the λ at the ankle decreased at the midpoint of the adaptation period compared to the initial prosthesis fitting (p = 0.032, but then increased at the end compared to the midpoint (p = 0.042. No differences were seen between the initial fitting and the end of the adaptation for λ (p = 0.577. It is concluded that the λ may be a feasible clinical tool for measuring prosthesis functionality and adaptation to a new prosthesis is a process through which the motor control develops mastery of redundant degrees of freedom present in the system.

  4. Controlling horizontal deceleration during gait termination in transfemoral amputees : Measurements and simulations

    NARCIS (Netherlands)

    van Keeken, Helco G.; Vrieling, Aline H.; Hof, At L.; Postema, Klaas; Otten, Bert

    In this study we investigated how leading limb angles combined with active ankle moments of a sound ankle or passive stiffness of a prosthetic ankle, influence the center of mass (CoM) velocity during the single limb support phase in gait termination. Also, we studied how the trailing limb velocity

  5. Predicting mobility outcome in lower limb amputees with motor ability tests used in early rehabilitation

    NARCIS (Netherlands)

    Spaan, Matthijs H; Vrieling, Aline H; van de Berg, Pim; Dijkstra, Pieter U; van Keeken, Helco G

    STUDY DESIGN: Retrospective cohort study. BACKGROUND: Persons with a lower limb amputation can regain mobility using a prosthetic device. For fast and adequate prescription of prosthetic components, it is necessary to predict the mobility outcome early in rehabilitation. Currently, prosthetic

  6. Development of Osseointegrated Implants for Soldier Amputees Following Orthopaedic Extremity Trauma

    Science.gov (United States)

    2008-08-01

    Jung (Leica) 2050 Microtome (Leica Microsystems Inc., Bannockburn, IL) with Accu-Edge® Low Profile Blades (Sakura Finetek U.S.A., Inc., Torrance, CA...119-30. 18. Matsuzaki K. Why and how are peptide-lipid interactions utilized for self- defense? Magainins and tachyplesins as archetypes . Biochim

  7. Is increased residual shank length a competitive advantage for elite transtibial amputee long jumpers?

    Science.gov (United States)

    Nolan, Lee; Patritti, Benjamin L; Stana, Laura; Tweedy, Sean M

    2011-07-01

    The purpose of this study was to evaluate the extent to which residual shank length affects long jump performance of elite athletes with a unilateral transtibial amputation. Sixteen elite, male, long jumpers with a transtibial amputation were videoed while competing in major championships (World Championships 1998, 2002 and Paralympic Games, 2004). The approach, take-off, and landing of each athlete's best jump was digitized to determine residual and intact shank lengths, jump distance, and horizontal and vertical velocity of center of mass at touchdown. Residual shank length ranged from 15 cm to 38 cm. There were weak, nonsignificant relationships between residual shank length and (a) distance jumped (r = 0.30), (b) horizontal velocity (r = 0.31), and vertical velocity (r = 0.05). Based on these results, residual shank length is not an important determinant of long jump performance, and it is therefore appropriate that all long jumpers with transtibial amputation compete in the same class. The relationship between residual shank length and key performance variables was stronger among athletes that jumped off their prosthetic leg (N = 5), and although this result must be interpreted cautiously, it indicates the need for further research.

  8. Use of the DEKA Arm for amputees with brachial plexus injury: A case series.

    Directory of Open Access Journals (Sweden)

    Linda Resnik

    Full Text Available Patients with upper limb amputation and brachial plexus injuries have high rates of prosthesis rejection. Study purpose is to describe experiences of subjects with transhumeral amputation and brachial plexus injury, who were fit with, and trained to use, a DEKA Arm.This was a mixed-methods study utilizing qualitative (e.g. interview, survey and quantitative data (e.g. self-report and performance measures. Subject 1, a current prosthesis user, had a shoulder arthrodesis. Subject 2, not a prosthesis user, had a subluxed shoulder. Both were trained in laboratory and participated in a trial of home use. Descriptive analyses of processes and outcomes were conducted.Subject 1 was fitted with the transhumeral configuration (HC DEKA Arm using a compression release stabilized socket. He had 12 hours of prosthetic training and participated in all home study activities. Subject 1 had improved dexterity and prosthetic satisfaction with the DEKA Arm and reported better quality of life (QOL at the end of participation. Subject 2 was fit with the shoulder configuration (SC DEKA Arm using a modified X-frame socket. He had 30 hours of training and participated in 3 weeks of home activities. He reported less functional disability at the end of training as compared to baseline, but encountered personal problems and exacerbation of PTSD symptoms and withdrew from home use portion at 3 weeks. Both subjects reported functional benefits from use, and expressed a desire to receive a DEKA Arm in the future.This paper reported on two different strategies for prosthetic fitting and their outcomes. The advantages and limitations of each approach were discussed.Use of both the HC and SC DEKA Arm for patients with TH amputation and brachial plexus injury was reported. Lessons learned may be instructive to clinicians considering prosthetic choices for future cases.

  9. Use of the DEKA Arm for amputees with brachial plexus injury: A case series.

    Science.gov (United States)

    Resnik, Linda; Fantini, Christopher; Latlief, Gail; Phillips, Samuel; Sasson, Nicole; Sepulveda, Eve

    2017-01-01

    Patients with upper limb amputation and brachial plexus injuries have high rates of prosthesis rejection. Study purpose is to describe experiences of subjects with transhumeral amputation and brachial plexus injury, who were fit with, and trained to use, a DEKA Arm. This was a mixed-methods study utilizing qualitative (e.g. interview, survey) and quantitative data (e.g. self-report and performance measures). Subject 1, a current prosthesis user, had a shoulder arthrodesis. Subject 2, not a prosthesis user, had a subluxed shoulder. Both were trained in laboratory and participated in a trial of home use. Descriptive analyses of processes and outcomes were conducted. Subject 1 was fitted with the transhumeral configuration (HC) DEKA Arm using a compression release stabilized socket. He had 12 hours of prosthetic training and participated in all home study activities. Subject 1 had improved dexterity and prosthetic satisfaction with the DEKA Arm and reported better quality of life (QOL) at the end of participation. Subject 2 was fit with the shoulder configuration (SC) DEKA Arm using a modified X-frame socket. He had 30 hours of training and participated in 3 weeks of home activities. He reported less functional disability at the end of training as compared to baseline, but encountered personal problems and exacerbation of PTSD symptoms and withdrew from home use portion at 3 weeks. Both subjects reported functional benefits from use, and expressed a desire to receive a DEKA Arm in the future. This paper reported on two different strategies for prosthetic fitting and their outcomes. The advantages and limitations of each approach were discussed. Use of both the HC and SC DEKA Arm for patients with TH amputation and brachial plexus injury was reported. Lessons learned may be instructive to clinicians considering prosthetic choices for future cases.

  10. Phantom pain and phantom sensations in upper limb amputees : an epidemiological study

    NARCIS (Netherlands)

    Kooijman, CM; Dijkstra, PU; Geertzen, JHB; Elzinga, A; van der Schans, CP

    Phantom pain in subjects with an amputated limb is a well-known problem. However, estimates of the prevalence of phantom pain differ considerably in the literature. Various factors associated with phantom pain have been described including pain before the amputation, gender, dominance, and time

  11. Glasgow Coma Scale Scores, Early Opioids, and 4-year Psychological Outcomes among Combat Amputees

    Science.gov (United States)

    2014-01-01

    Patients who died of wounds or survived with severe brain or spinal injuries leading to paralysis were excluded. Following these exclusions, we...psychological diagnoses included postconcussion syndrome, pain, sleep , and unspecified cognitive disorders. Data Analysis and Study Retention The... sleep disturbance in a department of vet- erans affairs outpatient rehabilitation setting. Am J Phys Med Rehabil. 2010;89(6):437–45. [PMID:20489391

  12. The quality of life analysis of knee prosthesis with complete microprocessor control in trans-femoral amputees

    OpenAIRE

    Yavuz Saglam; Baris Gulenc; Fevzi Birisik; Ali Ersen; Ebru Yilmaz Yalcinkaya; Onder Yazicioglu

    2017-01-01

    Objective: The aim of this study was to analyze the patient demographics, etiology of limb loss as well as reporting SF-36 scores for microprocessor prosthesis users in Turkish population. Methods: We reviewed 72 patients (61 male and 11 female; mean age: 37.7 ± 10.7) with uni-lateral, above knee amputation and a history of regular and microprocessor prosthesis use. All patients were called back for a last follow-up and they were asked to fill a self-administered general health status ques...

  13. Development and psychometric properties of the Basic Amputee Mobility Score for use in patients with a major lower extremity amputation

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Nielsen, Anni Østergaard; Topp, Ulla Madsen

    2018-01-01

    and agreement were examined in an additional sample of 30 patients. RESULTS: The 30-day mortality risk was reduced by 88% (HR = 0.12, 95% CI 0.02-0.68) for those out of bed (BAMS ≥2 points) at the first physiotherapy assessment, while BAMS scores improved between the first and the discharge assessment...... a large responsiveness, excellent interrater reliability and with a change of 1 point indicating a real change in performances. Geriatr Gerontol Int 2017; ••: ••-••....

  14. A Comparison of Health Outcomes for Combat Amputee and Limb Salvage Patients Injured in Iraq and Afghanistan Wars

    Science.gov (United States)

    2013-01-01

    Osteomyelitis 33a 33 47a 2 of 6 34 2 of 10 DVT and/or PE 16 42† 15 1 of 6 15 2 of 10 Cellulitis 25a 30 40a,c 1 of 6 20c 1 of 10 Septicemia 10a 15 4a 1 of 6 9 0...significantly increased ORs for any infection, osteomye- litis, and cellulitis relative to LS patients. They also had in- creased odds of mood

  15. Association Between Montreal Cognitive Assessment Scores and Measures of Functional Mobility in Lower Extremity Amputees After Inpatient Rehabilitation.

    Science.gov (United States)

    Frengopoulos, Courtney; Burley, Joshua; Viana, Ricardo; Payne, Michael W; Hunter, Susan W

    2017-03-01

    To determine whether scores on a cognitive measure are associated with walking endurance and functional mobility of individuals with transfemoral or transtibial amputations at discharge from inpatient prosthetic rehabilitation. Retrospective cohort study. Rehabilitation hospital. Consecutive admissions (N=176; mean age ± SD, 64.27±13.23y) with transfemoral or transtibial amputation that had data at admission and discharge from an inpatient prosthetic rehabilitation program. Not applicable. Cognitive status was assessed using the Montreal Cognitive Assessment (MoCA). The L Test and the 2-minute walk test (2MWT) were used to estimate functional mobility and walking endurance. The mean ± SD MoCA score was 24.05±4.09 (range, 6-30), and 56.3% of patients had scores rehabilitation on the basis of cognitive impairment alone. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Real-time subject-specific analyses of dynamic internal tissue loads in the residual limb of transtibial amputees.

    Science.gov (United States)

    Portnoy, Sigal; van Haare, Judith; Geers, Richard P J; Kristal, Anat; Siev-Ner, Itzhak; Seelen, Henk A M; Oomens, Cees W J; Gefen, Amit

    2010-05-01

    Transtibial amputation (TTA) prosthetic-users may risk the integrity of their residuum while trying to maintain everyday activities. Compression of the muscle flap between the truncated bones and the prosthetic socket may cause pressure ulcers and deep tissue injury (DTI). We hypothesize that mechanical stresses in the muscle flap are higher when walking over complex terrains than during plane gait, and so, the residuum could be at risk for DTI when walking over these terrains. Accordingly, we evaluated internal soft tissue stresses in the residuum at the vicinity of the tibia in 18 prosthetic-users (7 vascular, 11 traumatic). For this purpose, we developed a portable monitor that calculated subject-specific internal stresses in the residuum in real-time. Each subject was studied while walking on plane floor, grass, stairs and slope. We found that internal stresses were the highest while subjects descended a slope, during which internal peak and root mean square (RMS) stresses were approximately 40% and 50% greater than in plane gait, respectively. Peak and RMS stresses calculated while descending a slope were approximately 2 times higher for the sub-group of vascular subjects compared to traumatic, but were similar between the two sub-groups for other ambulation tasks. Overall, the present internal stress monitor is a practical tool for real-time evaluation of internal stresses in the residuum of TTA prosthetic-users in the clinical setting or outdoors. Pending integration of appropriate dynamic tissue injury thresholds, the device can be utilized for alerting to the danger of DTI.

  17. Effectiveness of Proprioceptive Neuromuscular Facilitation Techniques as Compared to Traditional Strength Training in Gait Training Among Transtibial Amputees.

    Science.gov (United States)

    Anjum, Hadeya; Amjad, Imran; Malik, Arshad Nawaz

    2016-06-01

    To determine the effects of proprioceptive neuromuscular facilitation (PNF) techniques as compared with the traditional prosthetic strength training (TPT), in improving ambulatory function in subjects with transtibial amputation. Randomized control trial. Artificial Limb Centre of Fauji Foundation Hospital, Rawalpindi, from July to December 2014. Patients with lower-limb amputation was selected through purposive sampling and randomly assigned into PNF group (n=31) and traditional group (n=32). The baseline and follow-up of 04 weeks treatment session was provided and measurement was noted through the locomotor capabilities index. The locomotor capabilities index abilities had significant difference in both groups. The mean index was 23.93 for PNF and 18.18 for TPT(p > 0.05), and the knee muscle strength was also significantly different (p > 0.05). There was no significant difference in gait parameters. Proprioceptive neuromuscular facilitation technique is better in improving the locomotor abilities and knee muscle strength as compared to traditional training. The basic gait parameters have same effect in both groups.

  18. The Effect of Prosthetic Socket Interface Design on Socket Comfort, Residual Limb Health, and Function for the Transfemoral Amputee

    Science.gov (United States)

    2017-10-01

    underway. What opportunities for training and professional development has the project provided? A Mechanical Engineering undergraduate student was...original copies of journal articles, reprints of manuscripts and abstracts, a curriculum vitae, patent applications, study questionnaires, and

  19. First-in-Man Demonstration of Fully Implanted Myoelectric Sensors for Control of an Advanced Electromechanical Arm by Transradial Amputees

    Science.gov (United States)

    Pasquina, Paul F.; Evangelista, Melissa; Carvalho, Antonio J.; Lockhart, Joseph; Griffin, Sarah; Nanos, George; McKay, Patricia; Hansen, Morten; Ipsen, Derek; Vandersea, James; Butkus, Josef; Miller, Matthew; Murphy, Ian; Hankin, David

    2014-01-01

    Background Advanced motorized prosthetic devices are currently controlled by EMG signals generated by residual muscles and recorded by surface electrodes on the skin. These surface recordings are often inconsistent and unreliable, leading to high prosthetic abandonment rates for individuals with upper limb amputation. Surface electrodes are limited because of poor skin contact, socket rotation, residual limb sweating, and their ability to only record signals from superficial muscles, whose function frequently does not relate to the intended prosthetic function. More sophisticated prosthetic devices require a stable and reliable interface between the user and robotic hand to improve upper limb prosthetic function. New Method Implantable Myoelectric Sensors (IMES®) are small electrodes intended to detect and wirelessly transmit EMG signals to an electromechanical prosthetic hand via an electromagnetic coil built into the prosthetic socket. This system is designed to simultaneously capture EMG signals from multiple residual limb muscles, allowing the natural control of multiple degrees of freedom simultaneously. Results We report the status of the first FDA-approved clinical trial of the IMES® System. This study is currently in progress, limiting reporting to only preliminary results. Comparison with Existing Methods Our first subject has reported the ability to accomplish a greater variety and complexity of tasks in his everyday life compared to what could be achieved with his previous myoelectric prosthesis. Conclusion The interim results of this study indicate the feasibility of utilizing IMES® technology to reliably sense and wirelessly transmit EMG signals from residual muscles to intuitively control a three degree-of-freedom prosthetic arm. PMID:25102286

  20. Fitting a bilateral transhumeral amputee with utensil prostheses and their functional assessment 10 years later: a case report.

    Science.gov (United States)

    Hung, Jen Wen; Wu, Yee Hwa

    2005-11-01

    Traumatic transhumeral amputations resulting from electric burn injury are uncommon and present a significant rehabilitation challenge. Compensating for loss of fine, coordinated function of the upper extremities with prostheses is difficult medically, technologically, psychologically, and socially. We followed up a patient with traumatic bilateral transhumeral amputation who was fitted with specially designed bilateral low-temperature utensil prostheses for 10 years. A bilateral utensil prosthesis consists of 2 thermoplastic sockets, an elastic harness, 2 utensil holders, and several different utensils. The characteristics of utensil prostheses are low cost, quick fabrication, and responsiveness to a patient's needs. Ten years after the patient's first prosthesis fitting, he still used these specially designed prostheses. By using these devices and his feet, the patient has regained independence in most activities of daily living and gained a new working skill.

  1. Dynamic Balance Control (DBC) in lower leg amputee subjects; contribution of the regulatory activity of the prosthesis side

    NARCIS (Netherlands)

    Nederhand, Marcus Johannes; van Asseldonk, Edwin H.F.; van der Kooij, Herman; Rietman, Johan Swanik

    2012-01-01

    Background Regaining effective postural control after lower limb amputation requires complex adaptation strategies in both the prosthesis side and the non-amputated side. The objective in this study is to determine the individual contribution of the ankle torques generated by both legs in balance

  2. Successful use of autogenous bone graft for the treatment of a radius-ulna nonunion in an amputee dog

    Directory of Open Access Journals (Sweden)

    B.W. Minto

    2015-08-01

    Full Text Available Fracture nonunions represent important complications in orthopedic surgeries. Nonunion repairs or bone defects are surgically challenging. Our aim was to describe a nonunion case, which was repaired with rapid bone recovery. An 8-month-old male mixed breed dog that has been previously operated was presented to the Veterinary Medical Teaching Hospital of São Paulo State University, with a right radius-ulna nonunion and an amputated contralateral forelimb. A cancellous bone graft was collected from a partially amputated limb, in order to correct the nonunion, and used in association with a locking plate. After four weeks, the bone graft had been incorporated into the original bone. Clinical union with good weight bearing was achieved after eight weeks.

  3. Künstliches feedback für oberschenkelamputierte; theoretische Analyse - Artificial feedback for transfemoral amputees : Theoretical analysis

    NARCIS (Netherlands)

    Pagel, A.K.; Oes, J.; Pfeifer, S.; Riener, R.; Vallery, H.

    2013-01-01

    Dieser Beitrag untersucht auf Basis von Modellen der menschlichen Wahrnehmung den Einfluss künstlichen sensorischen Feedbacks auf posturale Kontrolle und Gangsymmetrie von Oberschenkelamputierten. In der Standphase wird ein vereinfachtes, statisches neuromechanisches Modell verwendet, in der

  4. Does an intraneural interface short-term implant for robotic hand control modulate sensorimotor cortical integration? An EEG-TMS co-registration study on a human amputee.

    Science.gov (United States)

    Ferreri, F; Ponzo, D; Vollero, L; Guerra, A; Di Pino, G; Petrichella, S; Benvenuto, A; Tombini, M; Rossini, L; Denaro, L; Micera, S; Iannello, G; Guglielmelli, E; Denaro, V; Rossini, P M

    2014-01-01

    Following limb amputation, central and peripheral nervous system relays partially maintain their functions and can be exploited for interfacing prostheses. The aim of this study is to investigate, for the first time by means of an EEG-TMS co-registration study, whether and how direct bidirectional connection between brain and hand prosthesis impacts on sensorimotor cortical topography. Within an experimental protocol for robotic hand control, a 26 years-old, left-hand amputated male was selected to have implanted four intrafascicular electrodes (tf-LIFEs-4) in the median and ulnar nerves of the stump for 4 weeks. Before tf-LIFE-4s implant (T0) and after the training period, once electrodes have been removed (T1), experimental subject's cortico-cortical excitability, connectivity and plasticity were tested via a neuronavigated EEG-TMS experiment. The statistical analysis clearly demonstrated a significant modulation (with t-test p < 0.0001) of EEG activity between 30 and 100 ms post-stimulus for the stimulation of the right hemisphere. When studying individual latencies in that time range, a global amplitude modulation was found in most of the TMS-evoked potentials; particularly, the GEE analysis showed significant differences between T0 and T1 condition at 30 ms (p < 0.0404), 46 ms (p < 0.0001) and 60 ms (p < 0.007) latencies. Finally, also a clear local decrement in N46 amplitude over C4 was evident. No differences between conditions were observed for the stimulation of the left hemisphere. The results of this study confirm the hypothesis that bidirectional neural interface could redirect cortical areas -deprived of their original input/output functions- toward restorative neuroplasticity. This reorganization strongly involves bi-hemispheric networks and intracortical and transcortical modulation of GABAergic inhibition.

  5. Impact of stance phase microprocessor-controlled knee prosthesis on ramp negotiation and community walking function in K2 level transfemoral amputees.

    Science.gov (United States)

    Burnfield, Judith M; Eberly, Valerie J; Gronely, Joanne K; Perry, Jacquelin; Yule, William Jared; Mulroy, Sara J

    2012-03-01

    Microprocessor controlled prosthetic knees (MPK) offer opportunities for improved walking stability and function, but some devices' swing phase features may exceed needs of users with invariable cadence. One MPK offers computerized control of only stance (C-Leg Compact). To assess Medicare Functional Classification Level K2 walkers' ramp negotiation performance, function and balance while using a non-MPK (NMPK) compared to the C-Leg Compact. Crossover. Gait while ascending and descending a ramp (stride characteristics, kinematics, electromyography) and function were assessed in participant's existing NMPK and again in the C-Leg Compact following accommodation. Ramp ascent and descent were markedly faster in the C-Leg Compact compared to the NMPK (p ≤ 0.006), owing to increases in stride length (p ≤ 0.020) and cadence (p ≤ 0.020). Residual limb peak knee flexion and ankle dorsiflexion were significantly greater (12.9° and 4.9° more, respectively) during single limb support while using the C-Leg Compact to descend ramps. Electromyography (mean, peak) did not differ significantly between prosthesis. Function improved in the C-Leg Compact as evidenced by a significantly faster Timed Up and Go and higher functional questionnaire scores. Transfemoral K2 walkers exhibited significantly improved function and balance while using the stance-phase only MPK compared to their traditional NMPK.

  6. Social relationships in rehabilitation and their impact on positive outcomes among amputees with lower limb loss at Walter Reed National Military Medical Center

    Directory of Open Access Journals (Sweden)

    Seth Messinger

    2017-11-01

    Full Text Available Objective: To explore how the social context of the clinic influenced the way former patients with lower limb loss in the Military Advanced Training Center at Walter Reed National Military Medical Center evaluated their outcomes. Design: Cross-sectional phenomenological-based interviews and observations. Patients: Twenty individuals with lower limb amputation were recruited from a multidisciplinary military treatment programme for patients with lower-extremity traumatic limb-loss injured in Afghanistan or Iraq. Methods: Lightly structured interviews were conducted either in person or over the telephone with former patients and clinical care-providers. Where possible, observation was conducted in conjunction with the interviews. The research team used content analysis of the data, consistent with ethnographic methods. Results: Analysis of the therapeutic effect of social relationships developed in the clinical rehabilitation programme identified 3 areas of significance: enduring relationships with key care-providers, access to treatment team by patients, and peer support among patients. Conclusion: The social component of service delivery influences patients’ outcomes from clinical care. These results could be translated across healthcare settings to improve patient outcomes.

  7. Determination of Long Term Motor Control and Cutaneous Sensory Properties of a High Resolution Peripheral Nerve Interface Technology for Limb Amputees

    Science.gov (United States)

    2012-12-01

    CMOS integrated circuit (IC) function. Together with the multilayer passivations commonly in use for CMOS ICs, the SiC     overlayer should ensure...still be required.   Figure 2: Example of attempted micro- extrusion of ABS onto SiC/IrOx electrode array. Resolution of the 3D system allowed

  8. Single-stage osseointegrated reconstruction and rehabilitation of lower limb amputees: the Osseointegration Group of Australia Accelerated Protocol-2 (OGAAP-2) for a prospective cohort study.

    Science.gov (United States)

    Al Muderis, Munjed; Lu, William; Tetsworth, Kevin; Bosley, Belinda; Li, Jiao Jiao

    2017-03-22

    Lower limb amputations have detrimental influences on the quality of life, function and body image of the affected patients. Following amputation, prolonged rehabilitation is required for patients to be fitted with traditional socket prostheses, and many patients experience symptomatic socket-residuum interface problems which lead to reduced prosthetic use and quality of life. Osseointegration has recently emerged as a novel approach for the reconstruction of amputated limbs, which overcomes many of the socket-related problems by directly attaching the prosthesis to the skeletal residuum. To date, the vast majority of osseointegration procedures worldwide have been performed in 2 stages, which require at least 4 months and up to 18 months for the completion of reconstruction and rehabilitation from the time of the initial surgery. The current prospective cohort study evaluates the safety and efficacy of a single-stage osseointegration procedure performed under the Osseointegration Group of Australia Accelerated Protocol-2 (OGAAP-2), which dramatically reduces the time of recovery to ∼3-6 weeks. The inclusion criteria for osseointegrated reconstruction under the OGAAP-2 procedure are age over 18 years, unilateral transfemoral amputation and experiencing problems or difficulties in using socket prostheses. All patients receive osseointegrated implants which are press-fitted into the residual bone. Functional and quality-of-life outcome measures are recorded preoperatively and at defined postoperative follow-up intervals up to 2 years. Postoperative adverse events are also recorded. The preoperative and postoperative values are compared for each outcome measure, and the benefits and harms of the single-stage OGAAP-2 procedure will be compared with the results obtained using a previously employed 2-stage procedure. This study has received ethics approval from the University of Notre Dame, Sydney, Australia (014153S). The study outcomes will be disseminated by publications in peer-reviewed academic journals and presentations at relevant clinical and orthopaedic conferences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. Cortical representation of illusory body perception in healthy persons and amputees: implications for the understanding and treatment of phantom limb pain

    OpenAIRE

    Milde, Christopher

    2018-01-01

    A disturbed body perception is characteristic for various neurological and mental disorders and becomes particularly evident in phantom phenomena after limb amputation. Body illusions, such as mirror visual feedback (MVF) illusions, have been shown to be efficient in treating chronic pain and to be further related to a reversal of cortical reorganization. The present thesis aimed at identifying the neural circuitry of illusory body perception in healthy subjects and unilateral upper-limb ampu...

  10. Frontal plane pelvis and hip kinematics of transfemoral amputee gait. Effect of a prosthetic foot with active ankle dorsiflexion and individualized training - a case study.

    Science.gov (United States)

    Armannsdottir, Anna; Tranberg, Roy; Halldorsdottir, Gudfinna; Briem, Kristin

    2018-05-01

    Following a transfemoral amputation (TFA), numerous changes in movement patterns during gait can occur. Frontal plane hip and pelvis compensatory strategies are recognized among individuals with a TFA, some thought to aid in safe foot clearance during the swing phase of gait. The aim of this case study was to evaluate the effect of an active ankle dorsiflexion provided by a microprocessor-controlled prosthetic foot, as well as the effect of individualized training on these parameters. In this case study, a 42-year-old male underwent 3 D gait analysis. Data were captured for two conditions; with a microprocessor-controlled prosthetic foot with active/inactive ankle dorsiflexion, during two sessions; before and after 6 weeks of individualized training. The main outcomes analyzed were frontal plane pelvis and hip kinematics. Prior to training, pelvic lift decreased slightly, coupled with an increase in hip abduction, during gait with the active ankle dorsiflexion of a prosthetic foot, compared to inactive dorsiflexion. After the training period, the pelvic lift was further decreased and an increase in hip adduction was concurrently seen. The results of this case study indicate a positive effect of the active dorsiflexion of the prosthetic foot but highlight the need for specific training after prescription of a microprocessor prosthetic foot. Implications for rehabilitation Decreased compensatory changes seen in this case study indicate a positive effect of the active dorsiflexion of the prosthetic foot, especially after a 6-week training period. Individualized training should be aimed at helping the user utilizing the benefits of the active dorsiflexion of the microprocessor prosthetic foot, implementing exercises that improve gait quality, technical training for this specific foot, strength training and balance exercises.

  11. Mobility Analysis of AmpuTees (MAAT I): Quality of life and satisfaction are strongly related to mobility for patients with a lower limb prosthesis.

    Science.gov (United States)

    Wurdeman, Shane R; Stevens, Phillip M; Campbell, James H

    2017-10-01

    While rehabilitation professionals are historically trained to place emphasis on the restoration of mobility following lower limb amputation, changes in healthcare dynamics are placing an increased emphasis on the limb loss patient's quality of life and general satisfaction. Thus, the relationship between these constructs and mobility in the patient with lower limb loss warrants further investigation. To determine the relationship between mobility of the patient with lower limb loss and both (1) general (1) general satisfaction and (2) quality of life. Retrospective chart analysis. A retrospective chart review of the Prosthetic Limb Users Survey of Mobility and the Prosthesis Evaluation Questionnaire-Well-Being subsection. Pearson correlations were used to test relationships. Data from 509 patients with a lower limb prosthesis were included. Mobility was found to be positively correlated with quality of life ( r = 0.511, p mobility and both quality of life and general satisfaction. Thus, in the holistic care of a patient with lower limb loss, maximizing mobility would correlate with greater quality of life and general satisfaction. Clinical relevance There is growing emphasis on the quality of life and general satisfaction experienced by patients undergoing prosthetic rehabilitation. The results of this study underscore the importance of providing prosthetic rehabilitation that maximizes the patient's mobility, noting that these individuals also report greater quality of life and general satisfaction.

  12. Determining Clinically Relevant Changes in Community Walking Metrics to Be Tracked by the VA as Part of Routine Care in Lower Limb Amputee Veterans

    Science.gov (United States)

    2017-10-01

    PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER Modus Health, LLC 123 Second Ave South...by the VA as part of the new VA initiative. The metrics are the following: 1) functional level assessment, 2) peak performance index, 3) daily...for an upcoming abstract submission for a prosthetic conference or the Association of Academic Physiatrists annual conference. The other presented a

  13. Heterotopic Ossification in Combat Amputees from Afghanistan and Iraq wars: Five Case Histories and Results from a Small Series of Patients

    Science.gov (United States)

    2011-01-01

    DP. Lower extremity trauma: Trends in the management of soft-tissue reconstruc- tion of open tibia- fibula fractures . Plast Reconstr Surg. 2006; 117...team believed the medica- tions were appropriate because the patient had no other contraindications, such as healing fractures . One month postinjury...lower limbs had fractures near the ankles that required external fixa- tion. The patient had a lumbar plexopathy that compro- mised function of the

  14. The Design And Development Of Adjustable Prosthetic Device For A ...

    African Journals Online (AJOL)

    Using a six bar link knee mechanism an artificial adjustable leg is produced for an amputee. The prosthetic device when fitted to an amputee provided easy movement for the left leg amputee. It is produced using readily available materials involving aluminum, steel, polyethylene, leader, glue etc. the device has a special ...

  15. A System Approach to Navy Medical Education and Training. Appendix 39. Competency Curriculum for Physical Therapy Assistant.

    Science.gov (United States)

    1974-08-31

    Amputee Rehabilitation ...... . . . . . . . . 32 1. Preprosthetic Care . . . . . . . . . . . . 33 2...THERAPY ASSISTANT (PTA) COMPETENCY UNIT IV: AMPUTEE REHABILITATION This unit includes the following modules: Number Title 1 Preprosthetic Caree ...Training II ............ 37 32 lA ICompetency: PHYSICAL THERAPY ASSISTANT (PTA) Unit IV: Amputee Rehabilitation MODULE 1: PREPROSTHETIC CARE TASKS

  16. Characterisation and outcomes of upper extremity amputations.

    Science.gov (United States)

    Tennent, David J; Wenke, Joseph C; Rivera, Jessica C; Krueger, Chad A

    2014-06-01

    The purpose of this study is to characterise the injuries, outcomes, and disabling conditions of the isolated, combat-related upper extremity amputees in comparison to the isolated lower extremity amputees and the general amputee population. A retrospective study of all major extremity amputations sustained by the US military service members from 1 October 2001 to 30 July 2011 was conducted. Data from the Department of Defense Trauma Registry, the Armed Forces Health Longitudinal Technology Application, and the Physical Evaluation Board Liaison Offices were queried in order to obtain injury characteristics, demographic information, treatment characteristics, and disability outcome data. A total of 1315 service members who sustained 1631 amputations were identified; of these, 173 service members were identified as sustaining an isolated upper extremity amputation. Isolated upper extremity and isolated lower extremity amputees had similar Injury Severity Scores (21 vs. 20). There were significantly more non-battle-related upper extremity amputees than the analysed general amputation population (39% vs. 14%). Isolated upper extremity amputees had significantly greater combined disability rating (82.9% vs. 62.3%) and were more likely to receive a disability rating >80% (69% vs. 53%). No upper extremity amputees were found fit for duty; only 12 (8.3%) were allowed continuation on active duty; and significantly more upper extremity amputees were permanently retired than lower extremity amputees (82% vs. 74%). The most common non-upper extremity amputation-related disabling condition was post-traumatic stress disorder (PTSD) (17%). Upper extremity amputees were significantly more likely to have disability from PTSD, 13% vs. 8%, and loss of nerve function, 11% vs. 6%, than the general amputee population. Upper extremity amputees account for 14% of all amputees during the Operation Enduring Freedom and Operation Iraqi Freedom conflicts. These amputees have significant

  17. International Rehabilitation Network

    National Research Council Canada - National Science Library

    Smith, William

    2001-01-01

    The International Rehabilitation Network's goal is to improve the quality of services for land mine survivors and other amputee's through the dissemination of educational programs to rehabilitation professionals...

  18. Modular externally-powered system for limb prostheses

    Energy Technology Data Exchange (ETDEWEB)

    Seamone, W.; Hoshall, C.H.; Schmeisser, G.

    Many upper limb amputees especially those who have sustained high level amputations of injury to remaining portions of the body, are unable to use conventional prosthetic devices effectively. In an effort to help the more severely handicapped amputees and those who may for other reasons require capabilities that standard prostheses cannot provide, the Applied Physics Laboratory, in conjunction with the Johns Hopkins Medical Institutions, has developed a prosthetic system which is powered by rechargeable batteries. The amputee need supply only a control signal. This article describes the concept which is now being evaluated with the aid of amputee subjects, and discusses results obtained to data in field tests.

  19. Conocimientos, destrezas y conductas ante el cuidado de los pies en un grupo de amputados diabéticos Knowledge, abilities and behaviours in foot care in a group of diabetic amputees

    Directory of Open Access Journals (Sweden)

    Rolando Suárez Pérez

    2001-08-01

    Full Text Available Se conoce que el cuidado de los pies, uno de los mayores retos en la atención a personas diabéticas, no se enfoca adecuadamente en las consultas de rutina por lo cual se pierde la función preventiva de las complicaciones en miembros inferiores y su máxima manifestación: la amputación. Para lograr un acercamiento a este problema el trabajo tuvo como objetivo determinar la información y las orientaciones prácticas que tenía un grupo de pacientes diabéticos que sufrían una amputación en el momento del estudio. Se entrevistaron 105 diabéticos hospitalizados en las salas de Angiología de 2 hospitales generales. La entrevista se dirigió a recoger información que permitiera caracterizar el actual proceso de amputación y determinar la información y las orientaciones prácticas que sobre el cuidado de los pies en general y su proceso particular de amputación, habían recibido estas personas. Se encontró que el 62,5 % del grupo no revisaba periódicamente sus pies y el 42,4 % no identificó como peligrosas algunas prácticas caseras ante callosidades, cortado de uñas, etc. Solamente el 29,5 % pudo identificar 1 ó 2 cuidados prácticos de los pies. Se comprobó que no habían recibido información práctica al respecto y que en el 52,4 %, el inicio de la presente complicación fue por descuido, errores de conducta o ignorancia de cómo proceder. Se concluyó que una intervención educativa podría haber contribuido sustancialmente a reducir las amputacionesIt is known that foot care, one of the biggest challenges for diabetic persons care, is not adequately approached in regular appointments and that is why the function of preventing the occurrence of complications in lower limbs and its top manifestation, that is, amputation, is lost. To address this problem, the present paper was aimed at determining the information and practical orientations received by a group of diabetic patients suffering from amputation at the time of the study. One hundred and five diabetics admitted to the Angiology wards of two general hospitals were interviewed. This survey was aimed at gathering information that allows us to characterize the present process of amputation and determine those pieces of information and practical orientations that these persons have received. 62.5% of the group did not check their feet systematically whereas 42.4% did not consider some home practices like callosity shaving, nail cutting,etc. as dangerous. Only 29.5% of them was able to identify one or two practical foot care procedures. It was confirmed that these persons had not received an adequate practical information in this regard and that in the 52.4 % the onset of the present foot complication was due to carelessness, behavioural mistakes or being unfamiliar with the practical procedures. It was concluded that educational intervention could have substantially contributed to the reduction of amputations

  20. Energy expenditure during walking in amputees after disarticulation of the hip. A microprocessor-controlled swing-phase control knee versus a mechanical-controlled stance-phase control knee.

    Science.gov (United States)

    Chin, T; Sawamura, S; Shiba, R; Oyabu, H; Nagakura, Y; Nakagawa, A

    2005-01-01

    We have compared the energy expenditure during walking in three patients, aged between 51 and 55 years, with unilateral disarticulation of the hip when using the mechanical-controlled stance-phase control knee (Otto Bock 3R15) and the microprocessor-controlled pneumatic swing-phase control knee (Intelligent Prosthesis, IP). All had an endoskeletal hip disarticulation prosthesis with an Otto Bock 7E7 hip and a single-axis foot. The energy expenditure was measured when walking at speeds of 30, 50, and 70 m/min. Two patients showed a decreased uptake of oxygen (energy expenditure per unit time, ml/kg/min) of between 10.3% and 39.6% when using the IP compared with the Otto Bock 3R15 at the same speeds. One did not show any significant difference in the uptake of oxygen at 30 m/min, but at 50 and 70 m/min, a decrease in uptake of between 10.5% and 11.6% was found when using the IP. The use of the IP decreased the energy expenditure of walking in these patients.

  1. Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy

    NARCIS (Netherlands)

    Braam, A.W.; Visser, S.; Cath, D.C.; Hoogendijk, W.J.G.

    2005-01-01

    Background: The syndrome of apotemnophilia, body integrity or amputee identity disorder, is defined as the desire for amputation of a healthy limb, and may be accompanied by behaviour of pretending to be an amputee and sometimes, but not necessarily, by sexual arousal. Sampling and Methods: A case

  2. The Functions of an Amputation Clinic | Birkenstock | South African ...

    African Journals Online (AJOL)

    In an effort towards a more positive approach to the treatment and rehabilitation of the amputee, an Amputation Clinic was commenced at Groote Schuur Hospital in 1968. During this period 301 new amputees were seen and assisted in rehabilitation. The importance of psychological trauma and readjustment is emphasized ...

  3. A Real-Time Gait Event Detection for Lower Limb Prosthesis Control and Evaluation.

    Science.gov (United States)

    Maqbool, H F; Husman, M A B; Awad, M I; Abouhossein, A; Iqbal, Nadeem; Dehghani-Sanij, A A

    2017-09-01

    Lower extremity amputees suffer from mobility limitations which will result in a degradation of their quality of life. Wearable sensors are frequently used to assess spatio-temporal, kinematic and kinetic parameters providing the means to establish an interactive control of the amputee-prosthesis-environment system. Gait events and the gait phase detection of an amputee's locomotion are vital for controlling lower limb prosthetic devices. The paper presents an approach to real-time gait event detection for lower limb amputees using a wireless gyroscope attached to the shank when performing level ground and ramp activities. The results were validated using both healthy and amputee subjects and showed that the time differences in identifying Initial Contact (IC) and Toe Off (TO) events were larger in a transfemoral amputee when compared to the control subjects and a transtibial amputee (TTA). Overall, the time difference latency lies within a range of ±50 ms while the detection rate was 100% for all activities. Based on the validated results, the IC and TO events can be accurately detected using the proposed system in both control subjects and amputees when performing activities of daily living and can also be utilized in the clinical setup for rehabilitation and assessing the performance of lower limb prosthesis users.

  4. Job satisfaction and health experience of people with a lower-limb amputation in comparison with healthy colleagues

    NARCIS (Netherlands)

    Schoppen, Tanneke; Boonstra, A; Groothoff, JW; de Vries, J; Goeken, LN; Eisma, Willem

    Objectives: To describe indicators of job dissatisfaction among amputee employees and to compare job satisfaction and health experience of working amputee employees with that of control subjects. Design: A cross-sectional study, mailed questionnaire. Setting: Patients were recruited by the

  5. Staying in dynamic balance on a prosthetic limb : A leg to stand on?

    NARCIS (Netherlands)

    Curtze, Carolin; Hof, At L; Postema, Klaas; Otten, Bert

    With the loss of a lower limb, amputees lack the active muscle empowered control of the ankle that is important for balance control. We examined single-leg stance on prosthesis vs. sound limb balancing on narrow ridges in transtibial amputees. When balancing on the prosthetic limb, the lateral

  6. The Locomotor Capabilities Index; validity and reliability of the Swedish version in adults with lower limb amputation

    Directory of Open Access Journals (Sweden)

    Andersson Ingemar H

    2009-05-01

    Full Text Available Abstract Background The Locomotor Capabilities Index (LCI is a validated measure of lower-limb amputees' ability to perform activities with prosthesis. We have developed the LCI Swedish version and evaluated its validity and reliability. Methods Cross-cultural adaptation to Swedish included forward/backward translations and field testing. The Swedish LCI was then administered to 144 amputees (55 women, mean age 74 (40–93 years, attending post-rehabilitation prosthetic training. Construct validity was assessed by examining the relationship between the LCI and Timed "Up-and-Go" (TUG test and between the LCI and EQ-5D health utility index in 2 subgroups of 40 and 20 amputees, respectively. Discriminative validity was assessed by comparing scores in different age groups and in unilateral and bilateral amputees. Test-retest reliability (1–2 weeks was evaluated in 20 amputees (14 unilateral. Results The Swedish LCI showed good construct convergent validity, with high correlation with the TUG (r = -0.75 and the EQ-5D (r = 0.84, and discriminative validity, with significantly worse mean scores for older than younger and for bilateral than unilateral amputees (p Conclusion The Swedish version of the LCI demonstrated good validity and internal consistency in adult amputees. Test-retest reliability in a small subsample appears to be acceptable. The high ceiling effect of the LCI may imply that it would be most useful in assessing amputees with low to moderate functional abilities.

  7. [Pre-prosthetics: role of the physiotherapist in the treatment of the residual limb and prosthetic preparation of the person].

    Science.gov (United States)

    Maffi, Alberto; Mulè, Chiara; Taveggia, Giovanni

    2015-01-01

    The rehabilitation of amputees requires a multi-discipline approach. Within the work of the team, physiotherapy plays a central role both in terms of the technical skills made available to the patient, as well as in terms of the psychological-motivational support offered to the amputee during treatment. The pre-prosthetic phase of rehabilitation is the beginning of a complex rehabilitative process during which starts with an assessment of the general clinical condition of the patient and their residual capacities, so as to develop personalised rehabilitative strategies based upon the needs of the amputee. This whole process aims to get the amputee standing with a prosthetic as quickly as possible, thus allowing the social reintegration of the amputee.

  8. The efficacy of the Ankle Mimicking Prosthetic Foot prototype 4.0 during walking: Physiological determinants.

    Science.gov (United States)

    De Pauw, Kevin; Cherelle, Pierre; Roelands, Bart; Lefeber, Dirk; Meeusen, Romain

    2018-04-01

    Evaluating the effectiveness of a novel prosthetic device during walking is an important step in product development. To investigate the efficacy of a novel quasi-passive ankle prosthetic device, Ankle Mimicking Prosthetic Foot 4.0, during walking at different speeds, using physiological determinants in transtibial and transfemoral amputees. Nonrandomized crossover design for amputees. Six able-bodied subjects, six unilateral transtibial amputees, and six unilateral transfemoral amputees underwent a 6-min walk test at normal speed, followed by series of 2-min walking at slow, normal, and fast speeds. The intensity of effort and subjective measures were determined. Amputees performed all walking tests on a treadmill with current and novel prostheses. Shapiro-Wilk normality tests and parametric and nonparametric tests were conducted (p < 0.05). Compared to able-bodied individuals, the rating of perceived exertion levels were significantly elevated in transtibial and transfemoral amputees for both prostheses (p ≤ 0.016). Compared to able-bodied individuals transfemoral amputees also showed significantly elevated heart rate for both prostheses at normal speed (p ≤ 0.043). Within-group comparisons demonstrated that walking with Ankle Mimicking Prosthetic Foot significantly increased the heart rate in transfemoral amputees and transtibial compared to current prosthesis (p = 0.002). Furthermore, transfemoral amputees reached a significantly higher rating of perceived exertion levels. Intensity of effort during walking with Ankle Mimicking Prosthetic Foot is higher compared to current prostheses. Clinical relevance Ankle Mimicking Prosthetic Foot 4.0 is a novel quasi-passive ankle prosthesis with state-of-the-art technological parts. Subjective measures show the importance of this technology, but the intensity of effort during walking still remains higher compared to current passive prostheses, especially in transfemoral amputees.

  9. Stiff upper lip: coping strategies of World War II veterans with phantom limb pain.

    Science.gov (United States)

    Machin, P; de C Williams, A C

    1998-12-01

    Study of coping with phantom pain in nonclinical war veteran amputees. Semistructured interview with amputees in their home setting. Residential home for war veteran amputees or respondents' own homes. Amputee veterans of World War II with phantom pain. Pain (McGill Pain Questionnaire) and pain history, coping (daily coping; Stone and Neale, J Pers Soc Psychol 1984;46:892-906), size of social network, and quality of war memories. No differences in pain or coping were associated with place of residence (and prevalence of cues) or social networks; war memories appeared not to be associated with availability of cues, whether media coverage or other amputees. There was some association between the emotional tone of war memories and pain intensity. Veteran amputees were in general accepting of high levels of pain and made little use of medical resources, relating that to past experience of their pain being dismissed. Coping with phantom pain in war veteran amputees is predominantly silent acceptance of the pain, with little use of social support however available, and rare recourse to medical help, based on past unhelpful experience. Pain and mood appeared to be unrelated to specific war cues, but higher pain scores were reported by those with unhappier war memories.

  10. Engagement in activities revealing the body and psychosocial adjustment in adults with a trans-tibial prosthesis.

    Science.gov (United States)

    Donovan-Hall, M K; Yardley, L; Watts, R J

    2002-04-01

    The purpose of this study was to examine the effects of the appearance of a prosthesis on social behaviour, social discomfort and psychological well-being in eleven amputees taking delivery of a prosthesis with a silicone cover. Two new scales were developed: the 'Engagement in everyday activities involving revealing the body' (EEARB); and the 'Discomfort-Engagement in everyday activities involving revealing the body' (Discomfort-EEARB) scales. The psychometric properties of these scales were determined using a sample of 101 able-bodied adults. The Hospital Anxiety and Depression Scale and the Rosenberg Self-Esteem Scale were also used to measure psychological well-being in the amputee sample. The EEARB and Discomfort-EEARB proved to have good reliability and validity. Comparison of amputees' scores prior to receiving the silicone cosmesis with those of the able-bodied adults revealed significant behavioural limitations and social discomfort, associated with low self-esteem, anxiety and depression. There was a significant increase in amputees' scores three months afier taking delivery of their prosthesis, indicating that amputees reported engaging in more activities which involved revealing their body, and that they would feel more comfortable in situations which involved revealing the body. As the amputee sample available was small and self-selected, it is not possible to generalise these findings to the amputee population as a whole. However, since there is little previous research investigating the effects of the appearance of the prosthesis, these findings demonstrate the need for further research in this area.

  11. Functional outcome of hip disarticulation and hemipelvectomy : a cross-sectional national descriptive study in the Netherlands

    NARCIS (Netherlands)

    Yari, Parwin; Dijkstra, Pieter U.; Geartzen, Jan H. B.; Geertzen, J.H.B.

    2008-01-01

    Objective: To describe characteristics of hip disarticulation and hemipelvectomy amputees, to assess their level of activities, participation and experienced limitations in mobility and to describe the amputation-related problems. Design: A cross-sectional study. Setting: Patients were mainly

  12. Advances in Prosthetics and Orthotics

    Science.gov (United States)

    2011-01-26

    Effect of Vacuum Assisted Suction Suspension on Limb-Socket Dynamics, Physical Performance and Perception (Wilken, Darter, Dingwell) 7 2011 MHS...Military Amputee Research Program – Telemedicine and Advanced Technology Research Program

  13. The BADER Consortium

    Science.gov (United States)

    2017-10-01

    their condition in relation to others – The quality of their healthcare and resources – The orthosis/prosthesis itself – Self - esteem /body image...biomechanics of athletes with uni- lateral transtibial amputations (affected and unaffected leg) and non -amputees differ from those of athletes with bilateral...lengths. Intuitively, athletes with longer legs take longer steps during running, yet non -amputees exhibit a very weak association between leg length

  14. Evaluation of the Mangled Extremity Severity Score in Combat-Related Type III Tibia Fracture

    Science.gov (United States)

    2014-09-01

    The mean MESS values for amputees and patients treated with limb salvage were 5.8 and 5.3 (P = 0.057), respectively. The sensitivity and specificity...Conclusions: There was no significant difference between MESS values of amputees and those treated with limb salvage. Moreover, these data demonstrate...would be particu- larly disappointing in the setting of some of the promising prosthetic and rehabilitation options that are being developed currently for

  15. The potential for non-invasive brain stimulation to improve function after amputation.

    Science.gov (United States)

    G Hordacre, Brenton; C Ridding, Michael; V Bradnam, Lynley

    2016-07-01

    Lower limb amputee rehabilitation has traditionally focussed on restoration of gait and balance through use of prosthetic limbs and mobility aids. Despite these efforts, some amputees continue to experience difficulties with mastering prosthetic mobility. Emerging techniques in rehabilitation, such as non-invasive brain stimulation (NIBS), may be an appropriate tool to enhance prosthetic rehabilitation outcomes by promoting "normal" brain reorganisation and function. The purpose of this review is to highlight the potential of NIBS to improve functional outcomes for lower limb amputees. To demonstrate the rationale for applying NIBS to amputees, this study will first review literature regarding human motor control of gait, followed by neurophysiological reorganisation of the motor system after amputation and the relationship between brain reorganisation and gait function. We will conclude by reviewing literature demonstrating application of NIBS to lower limb muscle representations and evidence supportive of subsequent functional improvements. Imaging, brain stimulation and behavioural evidence indicate that the cortex contributes to locomotion in humans. Following amputation both hemispheres reorganise with evidence suggesting brain reorganisation is related to functional outcomes in amputees. Previous studies indicate that brain stimulation techniques can be used to selectively promote neuroplasticity of lower limb cortical representations with improvements in function. We suggest NIBS has the potential to transform lower limb amputee rehabilitation and should be further investigated. Implications for Rehabilitation Despite extensive rehabilitation some amputees continue to experience difficulty with prosthetic mobility Brain reorganisation following amputation has been related to functional outcomes and may be an appropriate target for novel interventions Non-invasive brain stimulation is a promising tool which has potential to improve functional outcomes for

  16. The Use of Quantitative SPECT/CT Imaging to Assess Residual Limb Health

    Science.gov (United States)

    2016-10-01

    in Wound Care which is dedicated to “ Amputee Care and Rehabilitation ”. The focus of these knowledge products was that of this funded project – i.e...impact the progress of the patient’s rehabilitation and/or lead to prosthesis abandonment, thus reducing their mobility, function, and overall...quantification 6-18 0% Subtask 1.6 – Dissemination of results describing SPECT/CT imaging in an amputee population 18-20 0

  17. The College of Podiatry Annual Conference 2015: meeting abstracts

    OpenAIRE

    Tong, Jasper W. K.; Kong, Veni P.; Sze, Lily; Gale, Susie; Veto, John; McArdle, Carla; Tunprasert, Thanaporn; Bradley, Victoria; Strike, Siobhan; Tunprasert, Thanaporn; Bradley, Victoria; Strike, Siobhan; Ashford, Robert; Naemi, Roozbeth; Chocklingam, Nachiappan

    2016-01-01

    Table of content P3 Medial longitudinal arch development of school children Jasper W.K. Tong, Veni P. Kong P4 Is measuring the subtalar joint reliable? Lily Sze, Susie Gale, John Veto, Carla McArdle P5 Comparison of turning gait biomechanics between able-bodied and unilateral transtibial amputee participants Thanaporn Tunprasert, Victoria Bradley, Siobhan Strike P6 Comparison of walking gait biomechanics between able-bodied and unilateral transtibial amputee participants using a new model of ...

  18. Electro-cutaneous stimulation on the palm elicits referred sensations on intact but not on amputated digits

    Science.gov (United States)

    D'Alonzo, M.; Engels, L. F.; Controzzi, M.; Cipriani, C.

    2018-02-01

    Objective. Grasping and manipulation control critically depends on tactile feedback. Without this feedback, the ability for fine control of a prosthesis is limited in upper limb amputees. Early studies have shown that non-invasive electro-cutaneous stimulation (ES) can induce referred sensations that are spread to a wider and/or more distant area, with respect to the electrodes. Building on this, we sought to exploit this effect to provide somatotopically matched sensory feedback to people with partial hand (digital) amputations. Approach. For the first time, this work investigated the possibility of inducing referred sensations in the digits by activating the palmar nerves. Specifically, we electrically stimulated 18 sites on the palm of non-amputees to evaluate the effects of sites and stimulation parameters on modality, magnitude, and location of the evoked sensations. We performed similar tests with partial hand amputees by testing those sites that had most consistently elicited referred sensations in non-amputees. Main results. We demonstrated referred sensations in non-amputees from all stimulation sites in one form or another. Specifically, the stimulation of 16 of the 18 sites gave rise to reliable referred sensations. Amputees experienced referred sensations to unimpaired digits, just like non-amputees, but we were unable to evoke referred sensations in their missing digits: none of them reported sensations that extended beyond the tip of the stump. Significance. The possibility of eliciting referred sensations on the digits may be exploited in haptic systems for providing touch sensations without obstructing the fingertips or their movements. The study also suggests that the phenomenon of referred sensations through ES may not be exploited for partial hand prostheses, and it invites researchers to explore alternative approaches. Finally, the results seem to confirm previous studies suggesting that the stumps in partial hand amputees partially acquire the

  19. Exploring virtual reality and prosthetic training.

    OpenAIRE

    Phelan, Ivan; Arden, Madelynne; Garcia, Carol; Roast, Chris

    2015-01-01

    Working together with health care professionals and a world\\ud leading bionic prosthetic maker we created a prototype that aims to decrease the time it takes for a transradial amputee to train how to use a Myoelectric prosthetic arm. Our research indicates that the Oculus Rift, Microsoft’s Kinect and the Thalmic Labs Myo gesture control armband will allow us to create a unique, cost effective training tool that could be beneficial to amputee patients.

  20. Restoration of motor control and proprioceptive and cutaneous sensation in humans with prior upper-limb amputation via multiple Utah Slanted Electrode Arrays (USEAs) implanted in residual peripheral arm nerves

    OpenAIRE

    Wendelken, Suzanne; Page, David M.; Davis, Tyler; Wark, Heather A. C.; Kluger, David T.; Duncan, Christopher; Warren, David J.; Hutchinson, Douglas T.; Clark, Gregory A.

    2017-01-01

    Background Despite advances in sophisticated robotic hands, intuitive control of and sensory feedback from these prostheses has been limited to only 3-degrees-of-freedom (DOF) with 2 sensory percepts in closed-loop control. A Utah Slanted Electrode Array (USEA) has been used in the past to provide up to 81 sensory percepts for human amputees. Here, we report on the advanced capabilities of multiple USEAs implanted in the residual peripheral arm nerves of human amputees for restoring control o...

  1. Robotic lower limb prosthesis design through simultaneous computer optimizations of human and prosthesis costs

    Science.gov (United States)

    Handford, Matthew L.; Srinivasan, Manoj

    2016-02-01

    Robotic lower limb prostheses can improve the quality of life for amputees. Development of such devices, currently dominated by long prototyping periods, could be sped up by predictive simulations. In contrast to some amputee simulations which track experimentally determined non-amputee walking kinematics, here, we explicitly model the human-prosthesis interaction to produce a prediction of the user’s walking kinematics. We obtain simulations of an amputee using an ankle-foot prosthesis by simultaneously optimizing human movements and prosthesis actuation, minimizing a weighted sum of human metabolic and prosthesis costs. The resulting Pareto optimal solutions predict that increasing prosthesis energy cost, decreasing prosthesis mass, and allowing asymmetric gaits all decrease human metabolic rate for a given speed and alter human kinematics. The metabolic rates increase monotonically with speed. Remarkably, by performing an analogous optimization for a non-amputee human, we predict that an amputee walking with an appropriately optimized robotic prosthesis can have a lower metabolic cost - even lower than assuming that the non-amputee’s ankle torques are cost-free.

  2. Application of real-time machine learning to myoelectric prosthesis control: A case series in adaptive switching.

    Science.gov (United States)

    Edwards, Ann L; Dawson, Michael R; Hebert, Jacqueline S; Sherstan, Craig; Sutton, Richard S; Chan, K Ming; Pilarski, Patrick M

    2016-10-01

    Myoelectric prostheses currently used by amputees can be difficult to control. Machine learning, and in particular learned predictions about user intent, could help to reduce the time and cognitive load required by amputees while operating their prosthetic device. The goal of this study was to compare two switching-based methods of controlling a myoelectric arm: non-adaptive (or conventional) control and adaptive control (involving real-time prediction learning). Case series study. We compared non-adaptive and adaptive control in two different experiments. In the first, one amputee and one non-amputee subject controlled a robotic arm to perform a simple task; in the second, three able-bodied subjects controlled a robotic arm to perform a more complex task. For both tasks, we calculated the mean time and total number of switches between robotic arm functions over three trials. Adaptive control significantly decreased the number of switches and total switching time for both tasks compared with the conventional control method. Real-time prediction learning was successfully used to improve the control interface of a myoelectric robotic arm during uninterrupted use by an amputee subject and able-bodied subjects. Adaptive control using real-time prediction learning has the potential to help decrease both the time and the cognitive load required by amputees in real-world functional situations when using myoelectric prostheses. © The International Society for Prosthetics and Orthotics 2015.

  3. Maximum-speed curve-running biomechanics of sprinters with and without unilateral leg amputations.

    Science.gov (United States)

    Taboga, Paolo; Kram, Rodger; Grabowski, Alena M

    2016-03-01

    On curves, non-amputees' maximum running speed is slower on smaller radii and thought to be limited by the inside leg's mechanics. Similar speed decreases would be expected for non-amputees in both counterclockwise and clockwise directions because they have symmetric legs. However, sprinters with unilateral leg amputation have asymmetric legs, which may differentially affect curve-running performance and Paralympic competitions. To investigate this and understand the biomechanical basis of curve running, we compared maximum curve-running (radius 17.2 m) performance and stride kinematics of six non-amputee sprinters and 11 sprinters with a transtibial amputation. Subjects performed randomized, counterbalanced trials: two straight, two counterclockwise curves and two clockwise curves. Non-amputees and sprinters with an amputation all ran slower on curves compared with straight running, but with different kinematics. Non-amputees ran 1.9% slower clockwise compared with counterclockwise (Pleg on the inside compared with the outside of the curve (Pleg on the inside. During curve running, non-amputees and athletes with an amputation had longer contact times with their inside compared with their outside leg, suggesting that the inside leg limits performance. For sprinters with an amputation, the prolonged contact times of the affected versus unaffected leg seem to limit maximum running speed during both straight running and running on curves with the affected leg on the inside. © 2016. Published by The Company of Biologists Ltd.

  4. Combining human volitional control with intrinsic controller on robotic prosthesis: A case study on adaptive slope walking.

    Science.gov (United States)

    Chen, Baojun; Wang, Qining

    2015-01-01

    Affording lower-limb amputees the ability to volitionally control robotic prostheses can improve the adaptability to terrain changes as well as enhancing proprioception. However, it also increases amputees' conscious burdens for prosthesis control. Therefore, in this paper, we aim to propose a hybrid controller which combines human volitional control with the intrinsic controller on the robotic transtibial prosthesis, enabling the amputee actively controlling prosthesis with little conscious attention. In this preliminary study, a hybrid controller for adaptive slope walking was designed. A slope estimator was embedded in the intrinsic controller to estimate the ground slope of the previous step using signals measured by prosthetic sensors. And a myoelectric controller allows the amputee subject to convey slope changes to prosthetic controller by volitionally contract his residual muscles, whose electromyography signals were mapped to the slope increment. The hybrid controller combined these two results to obtain the estimated slope. One male transtibial amputee subject was recruited in this research. Experiment results showed that the intrinsic slope estimator produced satisfactory estimation results with an average absolute error of 0.70 ± 0.54 degrees. By adding amputee's volitional control, the hybrid controller is able to predict the upcoming slope changes.

  5. An Overview of the Running Performance of Athletes with Lower-Limb Amputation at the Paralympic Games 2004–2012

    Directory of Open Access Journals (Sweden)

    Hossein Hassani

    2015-06-01

    Full Text Available This paper analyses the performances of lower-limb amputees in the 100, 200 and 400 m running events from the 2004, 2008 and 2012 Paralympic Games. In this paper, four hypotheses are pursued. In the first, it investigates whether the running performance of lower-limb amputees over three consecutive Paralympic Games has changed. In the second, it asks whether a bi-lateral amputee has a competitive advantage over a uni-lateral amputee. In the third, the effect of blade classification has been considered and we attempt to see whether amputees in various classifications have different level of performance. Finally, it is considered whether the final round of competition obtains different levels of performance in comparison to the qualification heats. Based on the outcomes of these investigations, it is proposed that future amputee-based running events should be undertaken with separate and not combined events for the T42, T43 and T44 classifications at the Paralympic Games.

  6. Systematic variation of prosthetic foot spring affects center-of-mass mechanics and metabolic cost during walking.

    Science.gov (United States)

    Zelik, Karl E; Collins, Steven H; Adamczyk, Peter G; Segal, Ava D; Klute, Glenn K; Morgenroth, David C; Hahn, Michael E; Orendurff, Michael S; Czerniecki, Joseph M; Kuo, Arthur D

    2011-08-01

    Lower-limb amputees expend more energy to walk than non-amputees and have an elevated risk of secondary disabilities. Insufficient push-off by the prosthetic foot may be a contributing factor. We aimed to systematically study the effect of prosthetic foot mechanics on gait, to gain insight into fundamental prosthetic design principles. We varied a single parameter in isolation, the energy-storing spring in a prototype prosthetic foot, the controlled energy storage and return (CESR) foot, and observed the effect on gait. Subjects walked on the CESR foot with three different springs. We performed parallel studies on amputees and on non-amputees wearing prosthetic simulators. In both groups, spring characteristics similarly affected ankle and body center-of-mass (COM) mechanics and metabolic cost. Softer springs led to greater energy storage, energy return, and prosthetic limb COM push-off work. But metabolic energy expenditure was lowest with a spring of intermediate stiffness, suggesting biomechanical disadvantages to the softest spring despite its greater push-off. Disadvantages of the softest spring may include excessive heel displacements and COM collision losses. We also observed some differences in joint kinetics between amputees and non-amputees walking on the prototype foot. During prosthetic push-off, amputees exhibited reduced energy transfer from the prosthesis to the COM along with increased hip work, perhaps due to greater energy dissipation at the knee. Nevertheless, the results indicate that spring compliance can contribute to push-off, but with biomechanical trade-offs that limit the degree to which greater push-off might improve walking economy. © 2011 IEEE

  7. Evaluating EMG Feature and Classifier Selection for Application to Partial-Hand Prosthesis Control

    Directory of Open Access Journals (Sweden)

    Adenike A. Adewuyi

    2016-10-01

    Full Text Available Pattern recognition-based myoelectric control of upper limb prostheses has the potential to restore control of multiple degrees of freedom. Though this control method has been extensively studied in individuals with higher-level amputations, few studies have investigated its effectiveness for individuals with partial-hand amputations. Most partial-hand amputees retain a functional wrist and the ability of pattern recognition-based methods to correctly classify hand motions from different wrist positions is not well studied. In this study, focusing on partial-hand amputees, we evaluate (1 the performance of non-linear and linear pattern recognition algorithms and (2 the performance of optimal EMG feature subsets for classification of four hand motion classes in different wrist positions for 16 non-amputees and 4 amputees. Our results show that linear discriminant analysis and linear and non-linear artificial neural networks perform significantly better than the quadratic discriminant analysis for both non-amputees and partial-hand amputees. For amputees, including information from multiple wrist positions significantly decreased error (p<0.001 but no further significant decrease in error occurred when more than 4, 2, or 3 positions were included for the extrinsic (p=0.07, intrinsic (p=0.06, or combined extrinsic and intrinsic muscle EMG (p=0.08, respectively. Finally, we found that a feature set determined by selecting optimal features from each channel outperformed the commonly used time domain (p<0.001 and time domain/autoregressive feature sets (p<0.01. This method can be used as a screening filter to select the features from each channel that provide the best classification of hand postures across different wrist positions.

  8. Systematic variation of prosthetic foot spring affects center-of-mass mechanics and metabolic cost during walking

    Science.gov (United States)

    Zelik, Karl E.; Collins, Steven H.; Adamczyk, Peter G.; Segal, Ava D.; Klute, Glenn K.; Morgenroth, David C.; Hahn, Michael E.; Orendurff, Michael S.; Czerniecki, Joseph M.; Kuo, Arthur D.

    2014-01-01

    Lower-limb amputees expend more energy to walk than non-amputees and have an elevated risk of secondary disabilities. Insufficient push-off by the prosthetic foot may be a contributing factor. We aimed to systematically study the effect of prosthetic foot mechanics on gait, to gain insight into fundamental prosthetic design principles. We varied a single parameter in isolation, the energy-storing spring in a prototype prosthetic foot, the Controlled Energy Storage and Return (CESR) foot, and observed the effect on gait. Subjects walked on the CESR foot with three different springs. We performed parallel studies on amputees and on non-amputees wearing prosthetic simulators. In both groups, spring characteristics similarly affected ankle and body center-of-mass (COM) mechanics and metabolic cost. Softer springs led to greater energy storage, energy return and prosthetic limb COM push-off work. But metabolic energy expenditure was lowest with a spring of intermediate stiffness, suggesting biomechanical disadvantages to the softest spring despite its greater push-off. Disadvantages of the softest spring may include excessive heel displacements and COM collision losses. We also observed some differences in joint kinetics between amputees and non-amputees walking on the prototype foot. During prosthetic push-off, amputees exhibited reduced energy transfer from the prosthesis to the COM along with increased hip work, perhaps due to greater energy dissipation at the knee. Nevertheless, the results indicate that spring compliance can contribute to push-off, but with biomechanical trade-offs that limit the degree to which greater push-off might improve walking economy. PMID:21708509

  9. Life after lower extremity amputation in diabetics.

    Science.gov (United States)

    Cox, P St L; Williams, S K P; Weaver, S R

    2011-10-01

    Lower limb amputees typically have reduced mobility which affects their ability to perform daily tasks and to successfully reintegrate into community life. A major goal of rehabilitation for amputees is to improve quality of life (QOL). This study therefore focussed on QOL and functional independence for persons with lower limb amputations secondary to diabetes. To determine the QOL and functional independence of lower limb diabetic amputees one to three years post amputation, using variables such as age, gender and amputation level. A total of 87 participants were selected from the 2006-2009 physiotherapy records at the St Ann's Bay Hospital. These participants completed the World Health Organization Quality of Life Scale (WHO QOL-BREF) and the Functional Independence Measure (FIM). Data were analysed using SPSS (version 12) and the mean values for QOL and functional independence were calculated. Relationships between the variables: age, gender and level of amputation with QOL and functional independence were analysed using descriptive and inferential statistical techniques. Among the 35 males and 52 females participating in the study, below knee amputees recorded higher scores for QOL (p quality of life of all participants. The results showed that below knee amputees functioned better than those with above knee amputations and that females were more likely to cope and function with the disability than males.

  10. Bilateral changes in somatosensory sensibility after unilateral below-knee amputation.

    Science.gov (United States)

    Kavounoudias, Anne; Tremblay, Camille; Gravel, Denis; Iancu, Andreea; Forget, Robert

    2005-04-01

    To evaluate possible alteration in proprioceptive and cutaneous sensibility in the nonamputated leg of unilateral transtibial amputees. Cross-sectional study with between-subjects (amputees vs controls) and within-subjects (nonamputated vs amputated leg) comparisons. Canadian rehabilitation hospital research laboratory. Two groups of amputees (34 due to traumatic causes, 14 due to vascular causes), recruited more than 1 year after their prosthetic training; and 2 groups (n=34, n=14) of age-matched control subjects. Not applicable. Threshold of movement detection and touch-pressure perception at the knee and foot levels. In the traumatic group, the sensory thresholds of the nonamputated leg were significantly higher than the control values in the 2 modalities tested. The movement detection was reduced at the knee and ankle levels, whereas a decrease in touch-pressure sensibility was observed only at the plantar site. As expected, a large proportion of the vascular amputees presented with severe sensory deficits in the nonamputated leg, particularly a loss in touch-pressure perception at the foot. The thresholds of movement detection were similar and correlated at both knees in the 2 groups of amputees. For the touch-pressure thresholds, no significant relationship was found between sides at the knee level. Sensory changes observed in the nonamputated leg suggest that central sensory adaptations occur after amputation. For movement detection, they were marked by a matching of perception on both sides of the body. Functional significance of these changes remains to be determined.

  11. Exploring ethical justification for self-demand amputation.

    Science.gov (United States)

    Tomasini, Floris

    2006-01-01

    Self-demand amputees are persons who need to have one or more healthy limbs or digits amputated to fit the way they see themselves. They want to rid themselves of a limb that they believe does not belong to their body-identity. The obsessive desire to have appendages surgically removed to fit an alternative body-image is medically and ethically controversial. My purpose in this paper is to provide a number of normative and professional ethical perspectives on whether or not it is possible to justify surgery for self-demand amputees. In doing so I proceed dialogically, moving between empirical context and normative theory, revealing the taken for granted normative assumptions (what I call the natural attitude--a technical term borrowed from phenomenology) that provide ethical limits to justifying the treatment of self-demand amputees. While I critically examine both Kantian responses against as well as Utilitarian responses for amputation on demand, I conclude that neither normative tradition can fully incorporate an understanding of what it is like to be a self-demand amputee. Since neither theory can justify the apparent non-rational desire of amputation on demand, ethical justification, I argue, falls short of the recognition that there may be a problem. To end, I introduce a meta-ethical idea, "the struggle for recognition," opening up the theoretical possibility of a hermeneutics of recognition before ethical justification that may be more sensitive to the problem of radical embodied difference exemplified by self-demand amputees.

  12. Sensory feedback in upper limb prosthetics.

    Science.gov (United States)

    Antfolk, Christian; D'Alonzo, Marco; Rosén, Birgitta; Lundborg, Göran; Sebelius, Fredrik; Cipriani, Christian

    2013-01-01

    One of the challenges facing prosthetic designers and engineers is to restore the missing sensory function inherit to hand amputation. Several different techniques can be employed to provide amputees with sensory feedback: sensory substitution methods where the recorded stimulus is not only transferred to the amputee, but also translated to a different modality (modality-matched feedback), which transfers the stimulus without translation and direct neural stimulation, which interacts directly with peripheral afferent nerves. This paper presents an overview of the principal works and devices employed to provide upper limb amputees with sensory feedback. The focus is on sensory substitution and modality matched feedback; the principal features, advantages and disadvantages of the different methods are presented.

  13. Expert opinions on success factors for upper-limb prostheses.

    Science.gov (United States)

    Schultz, Aimee E; Baade, Susan P; Kuiken, Todd A

    2007-01-01

    The goal of this study was to gather the opinions of prosthetics experts on the most important factors for the successful use of upper-limb (UL) prostheses, compare them with those of prosthesis users, and ultimately direct research efforts in this field. UL prosthetics experts were asked to compare the importance of the comfort, function, and cosmesis of a prosthetic device for a transhumeral amputee. Categories were subdivided into weight, socket-interface comfort, power, agility, color, and shape. The majority of those who responded viewed comfort as the most important factor for a unilateral amputee and considered socket-interface comfort to be more important than weight. Function was considered to be the most important factor for a bilateral amputee, with agility considered more important than power. Cosmesis was consistently reported as being less important than comfort and function, and shape was considered more important than color.

  14. The effect of Dermo and Seal-In X5 prosthetic liners on pressure distributions and reported satisfaction during ramp ambulation in persons with transtibial limb loss.

    Science.gov (United States)

    Ali, S; Osman, N A; Razak, A; Hussain, S; Wan Abas, W A

    2015-02-01

    Lower limb amputee's are greatly affected in dealing with the environmental barriers such as ramps and stairs and reported high interface pressure between the residual limb and socket/liner. Interface pressure between the residual limb and socket/liner can affect the satisfaction and use of the prosthesis. Until now, little attention has been paid to interface pressure between socket and stump during ramp negotiation and its effect on amputee's satisfaction. The aim of this study was to evaluate the interface pressure produced by two different liners (Seal-In X5 and Dermo) between the residual limb and socket, and their effects on amputee's satisfaction during ramp negotiation. Observational study. The study was performed in rehabilitation and biomedical departments of University Malaya Medical Centre. Total ten (7 male, 3 female) transtibial amputees with unilateral amputation were included. Two prostheses were fabricated for each amputee. After four weeks of acclimation period, interface pressure between socket and residual limb was measured during walking on ramp and Prosthetic Evaluation Questionnaire (PEQ) was filled for each liner. Mean peak pressure was significantly (P<0.05) lower with the Dermo liner compared with the Seal-In X5 liner in ramp walking. In addition, the participants were more satisfied with the Dermo liner (83.50 vs. 71.50) and mentioned fewer problems (87.00 vs. 69.00) compared with the Seal-In X5 liner during ramp negotiation. It might be concluded that Dermo liner could be a good choice for the transtibial level of amputation due to relative decrease in interface pressure, satisfaction and fewer problems. The advantages of the Dermo liner may improve clinical rehabilitation of transtibial amputee's, as it provides more satisfaction and experienced fewer problems during ramp negotiation. This provides an improved walking and better quality of life in long term.

  15. The Capability of Fiber Bragg Grating Sensors to Measure Amputees’ Trans-Tibial Stump/Socket Interface Pressures

    Directory of Open Access Journals (Sweden)

    Faisal Rafiq Mahamd Adikan

    2013-08-01

    Full Text Available This study presents the first investigation into the capability of fiber Bragg grating (FBG sensors to measure interface pressure between the stump and the prosthetic sockets of a trans-tibial amputee. FBG element(s were recoated with and embedded in a thin layer of epoxy material to form a sensing pad, which was in turn embedded in a silicone polymer material to form a pressure sensor. The sensor was tested in real time by inserting a heavy-duty balloon into the socket and inflating it by using an air compressor. This test was conducted to examine the sensitivity and repeatability of the sensor when subjected to pressure from the stump of the trans-tibial amputee and to mimic the actual environment of the amputee’s Patellar Tendon (PT bar. The sensor exhibited a sensitivity of 127 pm/N and a maximum FSO hysteresis of around ~0.09 in real-time operation. Very good reliability was achieved when the sensor was utilized for in situ measurements. This study may lead to smart FBG-based amputee stump/socket structures for pressure monitoring in amputee socket systems, which will result in better-designed prosthetic sockets that ensure improved patient satisfaction.

  16. Residual-limb quality and functional mobility 1 year after transtibial amputation caused by vascular insufficiency

    NARCIS (Netherlands)

    H.J. Arwert (Henk); M.H. van Doorn-Loogman (Mirjam); J. Koning (Jan); M. Terburg (Martinus); M. Rol (Mathilde); M.E. Roebroeck (Marij)

    2007-01-01

    textabstractThis study identified which residual-limb quality factors are related to functional mobility 1 year after transtibial (TT) amputation. A group of 28 TT amputees were evaluated with respect to their functional mobility (Prosthesis Evaluation Questionnaire [PEQ], Locomotor Index, Timed Up

  17. Stair ascent with an innovative microprocessor-controlled exoprosthetic knee joint.

    Science.gov (United States)

    Bellmann, Malte; Schmalz, Thomas; Ludwigs, Eva; Blumentritt, Siegmar

    2012-12-01

    Climbing stairs can pose a major challenge for above-knee amputees as a result of compromised motor performance and limitations to prosthetic design. A new, innovative microprocessor-controlled prosthetic knee joint, the Genium, incorporates a function that allows an above-knee amputee to climb stairs step over step. To execute this function, a number of different sensors and complex switching algorithms were integrated into the prosthetic knee joint. The function is intuitive for the user. A biomechanical study was conducted to assess objective gait measurements and calculate joint kinematics and kinetics as subjects ascended stairs. Results demonstrated that climbing stairs step over step is more biomechanically efficient for an amputee using the Genium prosthetic knee than the previously possible conventional method where the extended prosthesis is trailed as the amputee executes one or two steps at a time. There is a natural amount of stress on the residual musculoskeletal system, and it has been shown that the healthy contralateral side supports the movements of the amputated side. The mechanical power that the healthy contralateral knee joint needs to generate during the extension phase is also reduced. Similarly, there is near normal loading of the hip joint on the amputated side.

  18. Accelerations due to impact at heel strike using below-knee prosthesis

    NARCIS (Netherlands)

    van Jaarsveld, H.W.L.; Grootenboer, H.J.; de Vries, J.

    1990-01-01

    The acceleration in the sagittal plane of the prosthetic tube at heel strike in normal walking was measured in five healthy amputees with their definitive below-knee prosthesis, every subject using six different prosthetic feet, wearing sport shoes as well as leather shoes. The experiments were

  19. Training Internal Medicine Residents in Geriatrics.

    Science.gov (United States)

    Wolf-Klein, Gisele P.; And Others

    1983-01-01

    A four-week geriatric rotation in a nursing home that emphasized rehabilitation for stroke victims, patients with fractured hips, and amputees, and the team approach in care for the elderly is described. Student response was very positive, student sensitivity was improved, and all students felt the team approach could be applied to later practice.…

  20. AI and Prosthetics

    OpenAIRE

    Kyriazi, Nefeli Evdokia

    2016-01-01

    Prosthetics are very important to an amputee.The introduction of technology to prosthetics has allowed bionic limbs to emerge and change the way we were thinking about prosthetic limbs.More and more companies create new innovative models,but not affordable for anyone.3D Printing gives more options.

  1. Calcanectomy, an alternative amputation? Two case reports

    NARCIS (Netherlands)

    Geertzen, Jan H. B.; Jutte, Paul; Rompen, Christiaan; Salvans, Merse

    2009-01-01

    A limb amputation is a traumatic experience for the amputee but it is also a challenge for the recipient to get used to a new situation and reach her/his greatest level of independence. Two patients are presented who had undergone a total calcanectomy. In the first case, a woman with spina bifida

  2. Preventable amputations in Ethiopia

    African Journals Online (AJOL)

    Ewing's sarcoma. -. 3 (15%). Melanoma of the fl. 1 (5%). Total. 1 16 (84%). 3 (16"' I. 19 (1 00%) amous oot. Table 5: Distribution of amputees by sex and types of infection eomyel. Type of infection. Chrc to those recently reported by Yinusa and Ugbeye from. Nigeria4. Conclusion. Sew. Mi. 6. Discussion. Gas gangre. Total.

  3. Injuries in Handicapped Alpine Ski Racers.

    Science.gov (United States)

    McCormick, David P.

    1985-01-01

    A study of 68 handicapped skiers showed a rate of two injuries per 1,000-skier days. Disabled skiers, while risking the same injuries as nondisabled skiers, also have problems related to their disabilities. A particular hazard for amputee skiers is the outrigger injury. Recommendations to reduce the injury rate are presented. (MT)

  4. Preliminary Evaluation of a Diagnostic Tool for Prosthetics

    Science.gov (United States)

    2017-10-01

    publications, conference papers, and presentations  Website(s) or other Internet site(s)  Technologies or techniques  Inventions, patent ...Date: ____________________ Gender :  Male  Female Date of birth...field (left/right leg amputee). You can ignore the Height, Weight, D.O.B., race, and gender fields. 7) Once all fields are filled out, verify that

  5. 21 CFR 888.3000 - Bone cap.

    Science.gov (United States)

    2010-04-01

    ... overgrowth in juvenile amputees. (b) Classification. Class I (general controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter, subject to the...-shaped device intended to be implanted made of either silicone elastomer or ultra-high molecular weight...

  6. Amputation of the limbs: 10 years' experience at Enugu State ...

    African Journals Online (AJOL)

    Male to female ratio was 1.2 to 1; age range was 5 to 88years with mean age 45.4years. Peak age incidence was in the 6th decade. Below knee amputation was the most common operation, and delayed wound healing, the commonest postoperative complication. Thirty amputees procured prosthesis within three months of ...

  7. Estimating Instantaneous Energetic Cost During Gait Adaptation

    Science.gov (United States)

    2014-08-31

    energetic penalties imposed by various gait disabilities, and the 30   evaluation of the effectiveness of rehabilitation interventions at mitigating...Jarasch R. Energy expenditure and biomechanical characteristics of 412   lower limb amputee gait:: The influence of prosthetic alignment and

  8. Bipolar hip hemiarthroplasty in a patient with an above knee amputation: a case report

    Directory of Open Access Journals (Sweden)

    Liebergall Meir

    2009-07-01

    Full Text Available Abstract The treatment of an above knee amputee who has sustained a fracture of femoral neck is a challenge for both the orthopaedic surgeon and the rehabilitation team. We present a case of such a patient and discuss different difficulties in his treatment.

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

    NARCIS (Netherlands)

    Rommers, GM; Vos, LDW; Klein, L; Groothoff, JW; Eisma, W H

    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

  10. Osseointegrated Transtibial Implants in Patients with Peripheral Vascular Disease: A Multicenter Case Series of 5 Patients with 1-Year Follow-up

    NARCIS (Netherlands)

    Atallah, R.; Li, J.J.; Lu, W.; Leijendekkers, R.A.; Frolke, J.P.M.; Muderis, M. Al

    2017-01-01

    BACKGROUND: Osseointegration is an alternative treatment for amputees who are unable to wear or have difficulty wearing a socket prosthesis. Although the majority of limb amputations are due to vascular disease, such amputations have been perceived as a contraindication to osseointegration surgery.

  11. Natural grasping, design and evaluation of a voluntary closing adaptive hand prosthesis

    NARCIS (Netherlands)

    Smit, G.

    2013-01-01

    Replacement of a missing hand by an artificial alternative remains one of the biggest challenges in rehabilitation. Although many different terminal devices are available, around 27% of the amputees does not actively use their device and 20% totally refrains from wearing it. There are various

  12. A systematic literature review of the effect of different prosthetic components on human functioning with a lower-limb prosthesis

    NARCIS (Netherlands)

    van der Linde, H; Hofstad, CJ; Postema, K; Geertzen, JHB

    2004-01-01

    A correct prosthetic prescription can be derived from adapting the functional benefits of a prosthesis to the functional needs of the prosthetic user. For adequate matching, the functional abilities of the amputees are of value, as well as the technical and functional aspects of the various

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

    NARCIS (Netherlands)

    Rommers, G.M.; Groothoff, J.W.; Eisma, W.H.

    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

  14. Disarticulation of the knee : Analysis of an extended database on survival, wound healing, and ambulation

    NARCIS (Netherlands)

    Nijmeijer, Rachelle; Voesten, Henricus G. J. M.; Geertzen, Joannes H. B.; Dijkstra, Pieter U.

    OBJECTIVE: This study analyzed survival of the amputee patients, wound healing, and ambulation after knee disarticulation (KD). METHODS: Between July 1989 and October 2015, 153 KDs in 138 patients were performed at Nij Smellinghe Hospital, Drachten. Data were retrieved from hospital medical records.

  15. Rehabilitation Engineering: The Design And Development Of A ...

    African Journals Online (AJOL)

    A – 4 bar link mechanism is utilized in the design and manufacture of an artificial lower limb for an amputee. The prosthetic device is produced with aluminum, plastic, and steel materials. The interior part of the mechanism is covered with polymer materials thereby improving the aesthetics of the product which gives the user ...

  16. Evaluating asymmetry in prosthetic gait with step-length asymmetry alone is flawed

    NARCIS (Netherlands)

    Roerdink, M.; Roeles, S.; van der Pas, S.C.H.; Bosboom, O.; Beek, P.J.

    2012-01-01

    Prosthetic gait is often asymmetric in step length, but the direction of this asymmetry varies inconsistently across amputees. This situation is akin to that seen in stroke patients, where step-length asymmetry has been shown to be the additive result of asymmetries in trunk progression and

  17. Prosthetic helping hand

    Science.gov (United States)

    Vest, Thomas W. (Inventor); Carden, James R. (Inventor); Norton, William E. (Inventor); Belcher, Jewell G. (Inventor)

    1992-01-01

    A prosthetic device for below-the-elbow amputees, having a C-shaped clamping mechanism for grasping cylindrical objects, is described. The clamping mechanism is pivotally mounted to a cuff that fits on the amputee's lower arm. The present invention is utilized by placing an arm that has been amputated below the elbow into the cuff. The clamping mechanism then serves as a hand whenever it becomes necessary for the amputee to grasp a cylindrical object such as a handle, a bar, a rod, etc. To grasp the cylindrical object, the object is jammed against the opening in the C-shaped spring, causing the spring to open, the object to pass to the center of the spring, and the spring to snap shut behind the object. Various sizes of clamping mechanisms can be provided and easily interchanged to accommodate a variety of diameters. With the extension that pivots and rotates, the clamping mechanism can be used in a variety of orientations. Thus, this invention provides the amputee with a clamping mechanism that can be used to perform a number of tasks.

  18. Comparative roll-over analysis of prosthetic feet

    NARCIS (Netherlands)

    Curtze, Carolin; Hof, At L.; van Keeken, Helco G.; Halbertsma, Jan P. K.; Postema, Klaas; Otten, Bert

    2009-01-01

    A prosthetic foot is a key element of a prosthetic leg, literally forming the basis for a stable and efficient amputee gait. We determined the roll-over characteristics of a broad range of prosthetic feet and examined the effect of a variety of shoes on these characteristics. The body weight of a

  19. Principles of obstacle avoidance with a transfemoral prosthetic limb

    NARCIS (Netherlands)

    van Keeken, Helco G.; Vrieling, Aline H.; Hof, At L.; Postema, Klaas; Otten, Bert

    2012-01-01

    In this study, conditions that enable a prosthetic knee flexion strategy in transfemoral amputee subjects during obstacle avoidance were investigated. This study explored the hip torque principle and the static ground principle as object avoidance strategies. A prosthetic limb simulator device was

  20. The Lightweight Delft Cylinder Hand, the First Multi-Articulating Hand That Meets the Basic User Requirements

    NARCIS (Netherlands)

    Smit, G.; Plettenburg, D.H.; Van der Helm, F.C.T.

    2014-01-01

    Rejection rates of upper limb prostheses are high (23-45%). Amputees indicate that the highest design priority should be reduction of the mass of the prosthetic device. Despite all efforts, the mass of the new prosthetic hands is 35-73% higher than that of older hands. Furthermore current hands are