WorldWideScience

Sample records for amputees

  1. 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

  2. Instrumented joint mobility analysis in traumatic transtibial amputee patients

    OpenAIRE

    Kovač, Ida; Medved, Vladimir; KASOVIĆ, Mario; Heimer, Željko; LUŽAR-STIFFLER, VESNA; Pećina, Marko

    2010-01-01

    Aim: The presented study reports a quantitative gait analysis and different adaptive strategies evaluation on 12 male adults, war trauma transtibial (TT) amputees, fitted with prostheses. Methods: Gait analysis included kinematics (joint mobility variables) prosthetic and healthy legs in 12 TT amputees and 12 able-bodied persons/individuals. Results: The results disclose asymmetry in gait parameters between the amputated and sound legs, as well as between transtibial amputees and a...

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

    OpenAIRE

    Wieczorek Marta; Wiliński Wojciech; Struzik Artur; Rokita Andrzej

    2015-01-01

    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 conducte...

  4. Pain in traumatic upper limb amputees in Sierra Leone.

    OpenAIRE

    Lacoux, Philippe A; Crombie, Iain K; MacRae, William A

    2002-01-01

    Data on 40 upper limb amputees (11 bilateral) with regard to stump pain, phantom sensation and phantom pain is presented. All the patients lost their limbs as a result of violent injuries intended to terrorise the population and were assessed 10-48 months after the injury. All amputees reported stump pain in the month prior to interview and ten of the 11 bilateral amputees had bilateral pain. Phantom sensation was common (92.5%), but phantom pain was only present in 32.5% of amputees. Problem...

  5. Treatment effectiveness of complex casualty amputee patients

    OpenAIRE

    Farrar, Elizabeth D.

    2013-01-01

    Approved for public release; distribution is unlimited This study analyzes data from 182 Comprehensive Combat and Complex Casualty Care (C5) amputee patients with the goal to better understand the factors that influence their care. The data was provided from the Navy Bureau of Medicine and Surgery while visiting the Naval Medical Center at San Diego. The analysis examines two response variables, opiate drug usage and duration in the C5 program, as a function of a number of exploratory vari...

  6. Biomechanical analysis of stair ambulation in lower limb amputees.

    Science.gov (United States)

    Schmalz, Thomas; Blumentritt, Siegmar; Marx, Björn

    2007-02-01

    Lower extremity amputees have to cope with many activities in everyday life that are substantially more difficult than walking on level ground, and such demands require a high degree of functionality from their prosthetic components. The present study is a biomechanical evaluation (kinematics, kinetics and EMG) of stair ascent and descent in a group of eight transtibial amputees (mean (standard deviation): age 51(14) years, height 176(7)cm, mass 88(19)kg); a group of 12 transfemoral amputees (age 37(8) years, height 182(7)cm, mass 83(7)kg) fitted with the electronically controlled C-LEG knee joint system; and a group of 12 able bodied persons (age 30(10) years, height 174(12)cm, mass 69(12)kg). During stair descent the transfemoral amputees presented a strong reduction of the prosthetic ankle moments (0.11Nm/kg) compared to transtibial amputees (0.93Nm/kg) and control subjects (1.26Nm/kg). Loading of the prosthetic knee joint in the transfemoral amputees more closely resembles the loading seen in the control population when compared to transtibial amputees (mean maximum flexion moment: controls 1.31Nm/kg, transfemoral amputees 1.00Nm/kg, transtibial amputees 0.50Nm/kg). Overload of the contralateral limb is more prominent in the transfemoral amputee than in the transtibial amputee. During stair ascent, the transtibial amputee presents a significant reduction of the knee flexion moment compared to the controls (mean maximum flexion moment: transtibial amputees 0.28Nm/kg, controls 1.31Nm/kg). These differences correlate with a change in the muscle activity of the knee extensor and hamstring muscles. The results also show adaptations in motor strategies during stair negotiation, for those with the partial loss of a lower limb due to the functional limits of current prosthetic components. The present data may contribute to a further enhancement of the efficiency of prosthetic feet and knee joints. PMID:16725325

  7. 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.

  8. Freezing Technique May Ease 'Phantom Limb' Pain for Amputees

    Science.gov (United States)

    ... news/fullstory_158216.html Freezing Technique May Ease 'Phantom Limb' Pain for Amputees Targeted treatment of nerve and scar tissue found to improve symptoms in small study To use the sharing features ...

  9. 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.

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

    Directory of Open Access Journals (Sweden)

    Ashley Fisher, MA

    2010-08-01

    Full Text Available 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 traumatic injury resulting in an amputation largely depends on care from clinical providers as well as peer support.

  11. 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...

  12. Comparison of the effectiveness of different postoperative edema control methods in below knee amputees

    OpenAIRE

    ,

    2013-01-01

    Purpose: The classical elastic bandage (EB) application is a common method used in edema control in amputees. In recent years, however, complex decongestive physiotherapy (CDP) is found to be an effective approach in the treatment of edema. This study was planned to compare effectiveness of EB and CDP technique on the edema control and the period of transition to permanent prosthesis in below knee amputees. Methods: Twenty unilateral below knee amputees were included in the study. Ten amputee...

  13. 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.

  14. 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. PMID:26834881

  15. Amputee Socks: Thickness of Multiple Socks

    Science.gov (United States)

    Cagle, John C; Yu, Alan J; Ciol, Marcia A; Sanders, JE

    2015-01-01

    Background and Aim It is unclear how total sock ply and thickness are related when more than one sock is worn. The objectives were to determine if the thickness of one multi-ply amputee sock of ply P was the same as the thickness of a stack of reduced-ply socks of total ply P; and if the thickness of N single socks stacked one on top of the other was equal to the sum (1 to N) of the single sock thicknesses. Technique Using a custom instrument, compressive stresses were applied while sock thickness was measured. Discussion The thickness of one multi-ply sock of ply P was typically less than the thickness of a stack of reduced-ply socks of total ply P. The thickness of N single socks stacked one on top of the other was approximately equal to the sum (1 to N) of the single sock thicknesses. Clinical Relevance Our findings suggest three 1-ply socks to be 20% greater in thickness than one 3-ply sock, and one 3-ply + two 1-ply socks to be 30% greater in thickness than one 5-ply sock. PMID:24240023

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

    OpenAIRE

    Mário A. M. Simim; Bruno V. C. Silva; Moacir Marocolo Júnior; Edmar L. Mendes; de Mello, Marco T; Gustavo R. da Mota

    2013-01-01

    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. T...

  17. Cortical reorganization and phantom phenomena in congenital and traumatic upper-extremity amputees

    OpenAIRE

    Flor, Herta; Elbert, Thomas; Mühlnickel, Werner; Pantev, Christo; Wienbruch, Christian; Taub, Edward

    1998-01-01

    The relationship between phantom limb phenomena and cortical reorganization was examined in five subjects with congenital absence of an upper limb and nine traumatic amputees. Neuromagnetic source imaging revealed minimal reorganization of primary somatosensory cortex in the congenital amputees (M=0.69 cm, SD 0.24) and the traumatic amputees without phantom limb pain (M=0.27 cm, SD 0.25); the amputees with phantom limb pain showed massive cortical reorganization (M=2.22 cm, SD 0.78). Phantom ...

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

    Science.gov (United States)

    Soares, Alex Sandra Oliveira de Cerqueira; Yamaguti, Edward Yuji; Mochizuki, Luis; Amadio, Alberto Carlos; Serrão, Júlio Cerca

    2009-09-01

    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. PMID:20169280

  19. 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.

    2009-01-01

    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 i

  20. Somatic and movement inductions phantom limb in non-amputees

    Science.gov (United States)

    Casas, D. M.; Gentiletti, G. G.; Braidot, A. A.

    2016-04-01

    The illusion of the mirror box is a tool for phantom limb pain treatment; this article proposes the induction of phantom limb syndrome on non-amputees upper limb, with a neurological trick of the mirror box. With two study situations: a) Somatic Induction is a test of the literature reports qualitatively, and novel proposal b) Motor Induction, which is an objective report by recording surface EEG. There are 3 cases proposed for Motor illusion, for which grasped movement is used: 1) Control: movement is made, 2) illusion: the mirror box is used, and 3) Imagination: no movement is executed; the subject only imagines its execution. Three different tasks are registered for each one of them (left hand, right hand, and both of them). In 64% of the subjects for somatic experience, a clear response to the illusion was observed. In the experience of motor illusion, cortical activation is detected in both hemispheres of the primary motor cortex during the illusion, where the hidden hand remains motionless. These preliminary findings in phantom limb on non-amputees can be a tool for neuro-rehabilitation and neuro-prosthesis control training.

  1. 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

  2. Observation of limb movements reduces phantom limb pain in bilateral amputees

    OpenAIRE

    Tung, Monica L; Murphy, Ian C; Griffin, Sarah C; Alphonso, Aimee L.; Hussey-Anderson, Lindsey; Hughes, Katie E; Weeks, Sharon R; Merritt, Victoria; Yetto, Joseph M; Pasquina, Paul F.; Tsao, Jack W.

    2014-01-01

    Background Mirror therapy has been demonstrated to reduce phantom limb pain (PLP) experienced by unilateral limb amputees. Research suggests that the visual feedback of observing a limb moving in the mirror is critical for therapeutic efficacy. Objective Since mirror therapy is not an option for bilateral lower limb amputees, the purpose of this study was to determine if direct observation of another person’s limbs could be used to relieve PLP. Methods We randomly assigned 20 bilateral lower ...

  3. The Potency of Optical and Augmented Reality Mirror Boxes in Amputees and People with Intact Limbs

    OpenAIRE

    Kieran O'Neill; Annraoi de Paor

    2006-01-01

    Phantom limb pain is the distressing problem experienced by many amputees, defined as a painful sensation perceived in the area of the missing body part. Phantom limb pain can be very severe and disabling. It continues to be experienced by two thirds of amputees, eight years post-amputation. Augmented reality has the ability to change a person’s sensory experience. More applications of this technology are gradually being utilised for therapeutic purposes as augmented environments ...

  4. Characterization of evoked tactile sensation in forearm amputees with transcutaneous electrical nerve stimulation

    Science.gov (United States)

    Chai, Guohong; Sui, Xiaohong; Li, Si; He, Longwen; Lan, Ning

    2015-12-01

    Objective. The goal of this study is to characterize the phenomenon of evoked tactile sensation (ETS) on the stump skin of forearm amputees using transcutaneous electrical nerve stimulation (TENS). Approach. We identified the projected finger map (PFM) of ETS on the stump skin in 11 forearm amputees, and compared perceptual attributes of the ETS in nine forearm amputees and eight able-bodied subjects using TENS. The profile of perceptual thresholds at the most sensitive points (MSPs) in each finger-projected area was obtained by modulating current amplitude, pulse width, and frequency of the biphasic, rectangular current stimulus. The long-term stability of the PFM and the perceptual threshold of the ETS were monitored in five forearm amputees for a period of 11 months. Main results. Five finger-specific projection areas can be independently identified on the stump skin of forearm amputees with a relatively long residual stump length. The shape of the PFM was progressively similar to that of the hand with more distal amputation. Similar sensory modalities of touch, pressure, buzz, vibration, and numb below pain sensation could be evoked both in the PFM of the stump skin of amputees and in the normal skin of able-bodied subjects. Sensory thresholds in the normal skin of able-bodied subjects were generally lower than those in the stump skin of forearm amputees, however, both were linearly modulated by current amplitude and pulse width. The variation of the MSPs in the PFM was confined to a small elliptical area with 95% confidence. The perceptual thresholds of thumb-projected areas were found to vary less than 0.99 × 10-2 mA cm-2. Significance. The stable PFM and sensory thresholds of ETS are desirable for a non-invasive neural interface that can feed back finger-specific tactile information from the prosthetic hand to forearm amputees.

  5. Amputee Subject Testing Protocol, Results, and Analysis of a Powered Transtibial Prosthetic Device

    OpenAIRE

    Sun, Jinming; Fritz, Jessica M.; Del Toro, David R.; Voglewede, Philip A.

    2014-01-01

    A powered ankle-foot prothesis and its control system were previously designed and built. To evaluate this prosthesis, amputee subject testing was performed. The testing results are analyzed and compared between the powered prosthesis, passive prosthesis, and able-bodied gait. Qualitative comparison showed the prosthesis achieved the design objectives. During stance phase, active ankle moment was generated in the powered prosthesis before push-off to help the amputee walk more naturally. Duri...

  6. Self-Contained Powered Knee and Ankle Prosthesis: Initial Evaluation on a Transfemoral Amputee

    OpenAIRE

    Sup, Frank; Varol, Huseyin Atakan; Mitchell, Jason; Withrow, Thomas J.; Goldfarb, Michael

    2009-01-01

    This paper presents an overview of the design and control of a fully self-contained prosthesis, which is intended to improve the mobility of transfemoral amputees. A finite-state based impedance control approach, previously developed by the authors, is used for the control of the prosthesis during walking and standing. The prosthesis was tested on an unilateral amputee subject for over-ground walking. Prosthesis sensor data (joint angles and torques) acquired during level ground walking exper...

  7. Anticipatory postural adjustments during standing in below-the-knee amputees.

    Science.gov (United States)

    Aruin, A S; Nicholas, J J; Latash, M L

    1997-01-01

    OBJECTIVE: We studied the role of adaptive changes within the central nervous system in anticipatory postural adjustments seen in unilateral below-the-knee amputees. DESIGN: Changes in electromyographic and mechanical variables were compared during standardized tasks performed by standing subjects. BACKGROUND: Anticipatory postural adjustments represent an important mechanism of postural control which was expected to be changed in amputees because of both mechanical and secondary, neurological reasons. METHODS: Six patients after a below-the-knee amputation and six control subjects stood on a force platform and performed fast bilateral shoulder movements and also dropped or caught a load from (into) extended hands. Anticipatory changes in the background activity of postural muscles were analysed. RESULTS: In amputees, there were cases of marked asymmetry in anticipatory changes of the background muscle activity which were larger on the intact side of the body but were commonly small or absent on the side of the amputation. This asymmetry could lead to larger mediolateral forces and displacements of the centre of pressure. CONCLUSIONS: We suggest that asymmetrical patterns of anticipatory postural adjustments reflect central adaptive changes secondary to the amputation. Rehabilitation approaches would benefit from understanding and taking advantage of the adaptive changes within the central nervous system. RELEVANCE: We demonstrated asymmetries in patterns of anticipatory postural adjustments during voluntary arm movements and load manipulations by standing unilateral amputees. This finding is of potential importance for rehabilitation of amputees and their prosthetic training. PMID:11415672

  8. IMPORTANCE OF ILIOPSOAS AND ERECTOR SPINAE MUSCLES IN PREDICTING THE FUNCTIONAL COMPETENCE OF TRANSFEMORAL AMPUTEES

    Directory of Open Access Journals (Sweden)

    Lajja K Rishi

    2014-10-01

    Full Text Available Purpose: Muscle imbalance in transfemoral amputees impair physical mobility and activities of daily living. Aim of this study was to correlate the muscle imbalance with functional competence in transfemoral amputees. Methods: Thirty amputees were evaluated under inclusion criteria and randomly allocated into 2 groups. Group A received stretching(1 week followed by strengthening(3 weeks and in group B strengthening(3 weeks were followed by stretching(1 week . Phase I includes values after 1 week stretching program in group A and 3 weeks strengthening program in group B. Data were recorded at baseline, after phase I completion and end of treatment. Physical mobility was assessed by “Timed up and go” test. Results: Muscle imbalance and physical mobility improved significantly in both groups at the end of treatment. The correlation values of “Timed up and go” test with Iliopsoas and Erector spinae muscle showed significant improvement in both groups. Conclusion: Baseline measurements showed that Iliopsoas and Erector spinae muscles were tight whereas Gluteus maximus and Abdominal muscles were weak in transfemoral amputees. Functional mobility improved after correction of muscle imbalance. Stretching followed by strengthening gave more significant results than vice versa. Good posture in transfemoral amputee prevents muscle dysfunction and improves functional mobility.

  9. [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. PMID:21438258

  10. The Potency of Optical and Augmented Reality Mirror Boxes in Amputees and People with Intact Limbs

    Directory of Open Access Journals (Sweden)

    Kieran O'Neill

    2006-01-01

    Full Text Available Phantom limb pain is the distressing problem experienced by many amputees, defined as a painful sensation perceived in the area of the missing body part. Phantom limb pain can be very severe and disabling. It continues to be experienced by two thirds of amputees, eight years post-amputation. Augmented reality has the ability to change a person’s sensory experience. More applications of this technology are gradually being utilised for therapeutic purposes as augmented environments can be used both to distract the attention of patients from excruciatingly painful experiences and to promote cortical re-mapping at the site from where the pain arises. Using Augmented Reality, an environment has been created where upper limb amputees can both view and control motion of their phantom limb to help alleviate phantom limb pain.

  11. Investigation of sit-to-stand and stand-to-sit in an above knee amputee

    OpenAIRE

    Gao, Fan; Zhang, Fan; Huang, He

    2011-01-01

    the objective of this pilot study is twofold: 1) to extract key factors/features in sit-to-stand and stand-to-sit (STS) performed by an above knee (AK) amputee; 2) to propose a convenient way to quantify symmetry. One male unilateral transfemoral amputee participated in the pilot study. The subject was instructed to rise in a comfortable and natural manner and conduct a series of sit-to-stand, stand-to-sit. We simultaneously measured kinematics, kinetics and muscle activities. Principal compo...

  12. [The reorganization of the schema and body image of the amputee].

    Science.gov (United States)

    Giorgi, Ines; Gobba, Omar; Manera, Marina

    2015-01-01

    The paper deals with the psychological problems related to the amputee's experience. The stages of the reorganization of the body image and the problems that may arise, are described. In this process the phantom limb syndrome represents an important paradigm for study and reflection. PMID:26731960

  13. Bioimpedance system for monitoring muscle and cardiovascular activity in the stump of lower-limb amputees

    International Nuclear Information System (INIS)

    A bioimpedance system for the continuous measurement of non-invasive physiological parameters in lower-limb amputees is presented. The aim of the system is to monitor as many physiological parameters as possible from a single bioimpedance electrode configuration. In this way, a simple, low-cost and low-size autonomous system is developed that is able to continuously monitor the amputee in different environments (home, work, etc). The system measures both electrical impedance myography and electrical impedance plethysmography in the stump with electrodes placed in the inside face of a silicone interface. Such a system allows for the monitoring of a patient's muscle activity, and heart and breath rate, thus enabling the study and continuous monitoring of prosthesis adaptation and improvement of patient's gait to reduce physiological stress. Additionally, it can prevent cardiovascular problems due to the effort involved in the use of prostheses, which can decrease the life expectancy of amputees with previous vascular diseases. Experimental results obtained from different amputees' test validate the purpose of the system. (paper)

  14. Effect of Stump Length on Postural Steadiness During Quiet Stance in Unilateral Trans-Tibial Amputee

    Directory of Open Access Journals (Sweden)

    P. Lenka

    2010-01-01

    Full Text Available Although force platform based Center of pressure (COP measures of postural steadiness have been used to test the diagnostic significance of various cerebellar and labyrinthine lesions, but very few literature are available on amputees. The aim of this work is to measure the effect of stump length of Trance-Tibial amputee on postural steadiness during quiet stance. The COP variation, which is the major determinant of stability, has been evaluated. Twenty transtibial amputee patients (age: 34±9.57 years participated in this study. Among them, ten patients were having stump length of (19.33±2.04 cm and ten patients were having stump length of (9.2±0.91 cm. Postural stability is evaluated considering following factors like, AP range, ML range, RMS distance, mean distance, sway velocity, sway area and mean power frequency. The result shows that the mean value of all the measure parameters are having higher values in case of patients having shorter stump length than there counterpart. Therefore, it is concluded that transtibial amputee with longer stump length has better postural steadiness.

  15. 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.

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

    Science.gov (United States)

    Stastny, Petr; Maszczyk, Adam; Tománková, Kristina; Kubový, Petr; Richtrová, Michaela; Otáhal, Jakub; Čichoň, Rostislav; Mostowik, Aleksandra; Żmijewski, Piotr; Cięszczyk, Paweł

    2015-11-22

    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. PMID:26834871

  17. 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.

  18. Kinematics and kinetics with an adaptive ankle foot system during stair ambulation of transtibial amputees.

    Science.gov (United States)

    Alimusaj, Merkur; Fradet, Laetitia; Braatz, Frank; Gerner, Hans J; Wolf, Sebastian I

    2009-10-01

    Conventional prosthetic feet cannot adapt to specific conditions such as walking on stairs or ramps. Amputees are therefore forced to compensate their prosthetic deficits by modifying the kinematics and kinetics of their lower limbs. The Proprio-Foot (Ossur) intends to reduce these compensation mechanisms by automatically increasing dorsiflexion during stair ambulation thanks to an adaptive microprocessor-controlled ankle. The present investigation proposes to analyze the biomechanical effects of the dorsiflexion adaptation in transtibial (TT) amputees during stair ambulation. Sixteen TT amputees and sixteen healthy controls underwent conventional 3D gait analysis. Kinematics and kinetics of the lower limbs were compared during stair ascent and descent performed by patients with the prosthetic foot set to a neutral ankle angle and with an adapted dorsiflexion ankle angle of 4 degrees . Norm distance as well as minimum and maximal values of sagittal kinematics and kinetics were calculated for comparisons between patients and control subjects. For both stair ascent and descent, an improvement of the knee kinematics and kinetics could particularly be noticed on the involved side with an increase of the knee flexion and an increase of the knee moment during stance. Therefore, despite its additional weight compared to a conventional prosthetic ankle, the Proprio-Foot should be beneficial to active TT amputees whose knee musculature strength does not constitute a handicap. PMID:19616436

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

    International Nuclear Information System (INIS)

    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.)

  20. 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.)

  1. 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

  2. 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. PMID:26295593

  3. Optimization of Prosthetic Foot Stiffness to Reduce Metabolic Cost and Intact Knee Loading During Below-Knee Amputee Walking: A Theoretical Study

    OpenAIRE

    Fey, Nicholas P.; Klute, Glenn K.; Neptune, Richard R.

    2012-01-01

    Unilateral below-knee amputees develop abnormal gait characteristics that include bilateral asymmetries and an elevated metabolic cost relative to non-amputees. In addition, long-term prosthesis use has been linked to an increased prevalence of joint pain and osteoarthritis in the intact leg knee. To improve amputee mobility, prosthetic feet that utilize elastic energy storage and return (ESAR) have been designed, which perform important biomechanical functions such as providing body support ...

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

    International Nuclear Information System (INIS)

    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)

  5. Phantom pain and phantom sensations in upper limb amputees: an epidemiological study

    OpenAIRE

    Kooijman, CM; Dijkstra, PU; Geertzen, JHB; Elzinga, A; Van Der Schans, CP

    2000-01-01

    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 elapsed since the amputation. The purposes of this study were to determine prevalence and factors associated with phantom pain and phantom sensations in upper limb amputees in The Netherlands. Addition...

  6. Perceptual abnormalities in amputees: phantom pain, mirror-touch synaesthesia and referred tactile sensations

    OpenAIRE

    Goller, Aviva Idit

    2012-01-01

    It is often reported that after amputation people experience "a constant or inconstant... sensory ghost... faintly felt at time, but ready to be called up to [their] perception" (Mitchell, 1866). Perceptual abnormalities have been highlighted in amputees, such as sensations in the phantom when being stroked elsewhere (Ramachandran et al., 1992) or when observing someone in pain (Giummarra and Bradshaw, 2008). This thesis explored the perceptual changes that occur following amputation...

  7. Powered ankle-foot prosthesis for the improvement of amputee ambulation.

    Science.gov (United States)

    Au, Samuel K; Herr, Hugh; Weber, Jeff; Martinez-Villalpando, Ernesto C

    2007-01-01

    This paper presents the mechanical design, control scheme, and clinical evaluation of a novel, motorized ankle-foot prosthesis, called MIT Powered Ankle-Foot Prosthesis. Unlike a conventional passive-elastic ankle-foot prosthesis, this prosthesis can provide active mechanical power during the stance period of walking. The basic architecture of the prosthesis is a unidirectional spring, configured in parallel with a force-controllable actuator with series elasticity. With this architecture, the anklefoot prosthesis matches the size and weight of the human ankle, and is also capable of delivering high mechanical power and torque observed in normal human walking. We also propose a biomimetic control scheme that allows the prosthesis to mimic the normal human ankle behavior during walking. To evaluate the performance of the prosthesis, we measured the rate of oxygen consumption of three unilateral transtibial amputees walking at self-selected speeds to estimate the metabolic walking economy. We find that the powered prosthesis improves amputee metabolic economy from 7% to 20% compared to the conventional passive-elastic prostheses (Flex-Foot Ceterus and Freedom Innovations Sierra), even though the powered system is twofold heavier than the conventional devices. This result highlights the benefit of performing net positive work at the ankle joint to amputee ambulation and also suggests a new direction for further advancement of an ankle-foot prosthesis. PMID:18002631

  8. Brain responses to acupuncture stimulation in the prosthetic hand of an amputee patient.

    Science.gov (United States)

    Lee, In-Seon; Jung, Won-Mo; Lee, Ye-Seul; Wallraven, Christian; Chae, Younbyoung

    2015-10-01

    This report describes the brain responses to acupuncture in an upper limb amputee patient. A 62-year-old male had previously undergone a lower left arm amputation following an electrical accident. Using functional MRI, we investigated brain responses to acupuncture stimulation in the aforementioned amputee under three conditions: (a) intact hand, (b) prosthetic hand (used by the patient), and (c) fake fabric hand. The patient described greater de qi sensation when he received acupuncture stimulation in his prosthetic hand compared to a fake hand, with both stimulations performed in a similar manner. We found enhanced brain activation in the insula and sensorimotor cortex in response to acupuncture stimulation in the amputee's prosthetic hand, while there was only minimal activation in the visual cortex in response to acupuncture stimulation in a fake hand. The enhanced brain responses to acupuncture stimulation of the patient's prosthetic hand might be derived from cortical reorganisation, as he has been using his prosthetic hand for over 40 years. Our findings suggest the possible use of acupuncture stimulation in a prosthetic hand as an enhanced sensory feedback mechanism, which may represent a new treatment approach for phantom limb pain. PMID:26033865

  9. A Robotic Model of Transfemoral Amputee Locomotion for Design Optimization of Knee Controllers

    Directory of Open Access Journals (Sweden)

    Mohsen Akbari Shandiz

    2013-03-01

    Full Text Available A two‐dimensional, seven link, nine degrees of freedom biped model was developed to investigate the dynamic characteristics of normal and transfemoral amputee locomotion during the entire gait cycle. The equations of motion were derived using the Lagrange method and the stance foot‐ground contact was simulated using a five‐point penetration model. The joint driving torques were obtained using forward dynamic optimization of the normal human gait and applied to the intact joints of the amputee. Three types of motion controllers; frictional, elastic and hydraulic were considered for the prosthetic joints of the amputee and their design parameters were optimized to achieve the closest kinematics to that of the normal gait. It was found that, if optimally designed, all three passive controllers could reasonably reproduce a normal kinematical pattern in the swing phase. However, the stance phase kinematics could only be replicated by the hydraulic and elastic controllers; the performance of the latter was highly sensitive to the design parameters. It was concluded that an appropriately designed hydraulic motion controller can provide reasonably normal kinematics and reliable stability for stance knee flexion prostheses.

  10. Ethnicity and spatiotemporal parameters of bilateral and unilateral transtibial amputees in a 100-m sprint.

    Science.gov (United States)

    Hobara, Hiroaki; Hashizume, Satoru; Kobayashi, Yoshiyuki; Usami, Yuko; Mochimaru, Masaaki

    2016-01-01

    Similar to able-bodied sprinters, most of the medals for the 100-m sprint in past Paralympic Games and IPC Athletics World Championships were dominated by West African (WA) and Caucasian (CC) amputee sprinters, not Asian (AS) sprinters. Although these results indicate differences in sprint performance due to ethnicity, little is known about the ethnicity and spatiotemporal parameters of the 100-m sprint for amputee sprinters. The purpose of this study was to investigate the differences in the spatiotemporal parameters of WA, CC and AS sprinters with bilateral and unilateral transtibial amputations during a 100-m sprint. We analyzed 6 WA, 28 CC, and 10 AS amputee sprinters from publicly available Internet broadcasts. For each sprinter's run, the average speed, average step length, and step frequency were calculated by using the number of steps in conjunction with the official race time. No significant differences were found in the spatiotemporal parameters of the 100-m sprint for the WA and CC groups. On the other hand, the average speed of the AS group was significantly lower because of its shorter step length during the 100-m sprint. The results suggest that WA and CC sprinters would perform similarly during a 100-m sprint, but AS sprinters would not. PMID:27066362

  11. Analysis of weight distribution strategies in unilateral transtibial amputees during the stand-to-sit activity.

    Science.gov (United States)

    Agrawal, Vibhor; O'Toole, Christopher; Gaunaurd, Ignacio A; Gailey, Robert S

    2016-01-01

    Current methods of quantifying the stand-to-sit activity (StTS) are resource intensive and have not been applied to unilateral transtibial amputees (TTAs). The purpose of this study is to define five phases of arm-rest assisted and unassisted StTS using simple instrumentation and implement this method for assessing TTA movement patterns. Twelve TTAs and 12 age-matched non-amputees performed StTS with and without arm-rest support. Symmetry of weight distribution between lower limbs was calculated for five StTS phases: Descent Initiation; Descent Deceleration; Seat-Contact; Stabilisation and Sitting. TTAs demonstrated an asymmetrical weight distribution pattern and a tendency to transfer weight to the intact limb during the course of the activity. Non-amputees had relatively higher symmetry and did not exhibit substantial weight shifts during the activity. Symmetry indices were similar for assisted and unassisted sitting in both subject groups. These results highlight a need for therapeutic interventions in TTAs for reducing loading asymmetries and associated co-morbidities. PMID:26043080

  12. 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.

  13. Concurrent multibody and Finite Element analysis of the lower-limb during amputee running.

    Science.gov (United States)

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

    2015-08-01

    Lower-limb amputee athletes use Carbon fiber Energy Storage and Return (ESAR) prostheses during high impact activities such as running. The advantage provided to amputee athletes due to the energy-storing properties of ESAR prostheses is as yet uncertain. Conventional energy analysis methods for prostheses rely upon multibody models with articulating joints. Alternatively, Finite Element (FE) analysis treats bodies as a deforming continuum and can therefore calculate the energy stored without using these rigid-body mechanics assumptions. This paper presents a concurrent multibody and FE model of the femur, tibia, socket and ESAR prosthesis of a transtibial amputee athlete during sprinting. Gait analysis spatial data was used to conduct an offline simulation of the affected leg's stance phase in COMSOL Multiphysics. The calculated peak elastic strain energy of the prosthesis was 80J, with an overall RMSE of simulated marker displacement of 4.19 mm. This concurrent model presents a novel method for analyzing in vivo ESAR prosthesis behavior. PMID:26736785

  14. 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.

  15. 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

  16. 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

    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-risk......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...

  17. A prosthetic knee using magnetorhelogical fluid damper for above-knee amputees

    Science.gov (United States)

    Park, Jinhyuk; Choi, Seung-Bok

    2015-04-01

    A prosthetic knee for above-knee (AK) amputees is categorized into two types; namely a passive and an active type. The passive prosthetic knee is generally made by elastic materials such as carbon fiber reinforced composite material, titanium and etc. The passive prosthetic knee easy to walk. But, it has disadvantages such that a knee joint motion is not similar to ordinary people. On the other hand, the active prosthetic knee can control the knee joint angle effectively because of mechanical actuator and microprocessor. The actuator should generate large damping force to support the weight of human body. But, generating the large torque using small actuator is difficult. To solve this problem, a semi-active type prosthetic knee has been researched. This paper proposes a semi-active prosthetic knee using a flow mode magneto-rheological (MR) damper for AK amputees. The proposed semi-active type prosthetic knee consists of the flow mode MR damper, hinge and prosthetic knee body. In order to support weight of human body, the required energy of MR damper is smaller than actuator of active prosthetic leg. And it can control the knee joint angle by inducing the magnetic field during the stance phase.

  18. The development of a rapid prototyping prosthetic socket coated with a resin layer for transtibial amputees.

    Science.gov (United States)

    Hsu, L H; Huang, G F; Lu, C T; Hong, D Y; Liu, S H

    2010-03-01

    This article proposes a type of transtibial socket composed of an inner layer fabricated by a rapid prototyping (RP) machine and an outer layer coated with unsaturated polyester resin. This work integrates contemporary technologies including a handheld scanner and CAD systems, to design a thin primary socket shape and then manufactures the socket using a fused deposition-modeling machine. To prevent breakage caused by the layer-based forming process and to reinforce flexural strength, the current research coats the preliminary RP socket with a layer of unsaturated polyester resin. After shaping the proximal brim of the resin-reinforced RP socket to match the specific stump, this study assembles and aligns a shank and a prosthetic foot to form a prosthesis set. After completing a trial safety walk wearing the prosthesis, which is satisfactory to the amputee and a registered prosthetist, this research measures interface pressures between the stump and the resin-reinforced RP socket. Experiment results demonstrate that the resin-reinforced RP socket is applicable for transtibial amputees. In addition to strengthening the FDM socket and producing consistent socket fit, this study also demonstrates a feasible procedure that employs current technologies to design and manufacture transtibial sockets without plaster moulds. PMID:19947824

  19. 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.

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

    International Nuclear Information System (INIS)

    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

  1. 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…

  2. Classification of motor intent in transradial amputees using sonomyography and spatio-temporal image analysis

    Science.gov (United States)

    Hariharan, Harishwaran; Aklaghi, Nima; Baker, Clayton A.; Rangwala, Huzefa; Kosecka, Jana; Sikdar, Siddhartha

    2016-04-01

    In spite of major advances in biomechanical design of upper extremity prosthetics, these devices continue to lack intuitive control. Conventional myoelectric control strategies typically utilize electromyography (EMG) signal amplitude sensed from forearm muscles. EMG has limited specificity in resolving deep muscle activity and poor signal-to-noise ratio. We have been investigating alternative control strategies that rely on real-time ultrasound imaging that can overcome many of the limitations of EMG. In this work, we present an ultrasound image sequence classification method that utilizes spatiotemporal features to describe muscle activity and classify motor intent. Ultrasound images of the forearm muscles were obtained from able-bodied subjects and a trans-radial amputee while they attempted different hand movements. A grid-based approach is used to test the feasibility of using spatio-temporal features by classifying hand motions performed by the subjects. Using the leave-one-out cross validation on image sequences acquired from able-bodied subjects, we observe that the grid-based approach is able to discern four hand motions with 95.31% accuracy. In case of the trans-radial amputee, we are able to discern three hand motions with 80% accuracy. In a second set of experiments, we study classification accuracy by extracting spatio-temporal sub-sequences the depict activity due to the motion of local anatomical interfaces. Short time and space limited cuboidal sequences are initially extracted and assigned an optical flow behavior label, based on a response function. The image space is clustered based on the location of cuboids and features calculated from the cuboids in each cluster. Using sequences of known motions, we extract feature vectors that describe said motion. A K-nearest neighbor classifier is designed for classification experiments. Using the leave-one-out cross validation on image sequences for an amputee subject, we demonstrate that the classifier is

  3. Inter-Individual Difference in the Effect of Mirror Reflection-Induced Visual Feedback on Phantom Limb Awareness in Forearm Amputees

    OpenAIRE

    Kawashima, Noritaka; Mita, Tomoki; Yoshikawa, Masahiro

    2013-01-01

    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 ...

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Multiple Neuromas Cause Painful "Jumping Stump" in a Transfemoral Amputee: A Case Report.

    Science.gov (United States)

    Buntragulpoontawee, Montana; Pattamapaspong, Nuttaya; Tongprasert, Siam

    2016-09-01

    Painful "jumping stump" is an uncommon but very disturbing complication postamputation. This condition is one of the movement disorder entities resulting from peripheral nerve pathology, often known as "peripherally induced movement disorders." Previously case reports have been written about painful and nonpainful incidence of "jumping stump"; however, only the earliest "jumping stump" article in 1852 suspected that neuromas might influence the involuntary movement. In this study, we describe a 38-year-old man with bilateral transfemoral amputee who suffered from painful "jumping stump" with multiple neuromas confirmed by imaging. He was treated successfully by ultrasound-guided phenol injection into the sciatic neuroma stalks. The pathophysiology of jumping stump and its possible association with neuroma are briefly discussed. PMID:27440797

  6. 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

    Abstract Purpose: 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. Method: 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. Results: 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. Conclusions: 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 RehabilitationThe 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. PMID:25316033

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Energy consumption during prosthetic walking and physical fitness in older hip disarticulation amputees

    Directory of Open Access Journals (Sweden)

    Takaaki Chin, MD

    2012-12-01

    Full Text Available The objective of this study is to investigate energy consumption during prosthetic walking and physical fitness in older hip disarticulation (HD subjects and to examine the ambulatory outcome in a community setting. The subjects were seven unilateral HD amputees with an average age of 67.7 +/– 3.9 yr. Energy consumption was measured during prosthetic walking at each individual’s comfortable walking speed (CWS by means of a portable telemetric system. An incremental exercise test was performed to evaluate fitness. The average CWS for the subjects was 30.5 +/– 9.6 m/min. The average oxygen consumption rate at each CWS was 18.3 +/– 2.4 mL/kg/min, and the average oxygen cost was 0.639 +/– 0.165 mL/kg/m. The maximum oxygen uptake during exercise as a proportion of predicted maximum oxygen uptake (%VO2max for the subjects was 57.2 +/– 11.1. Five subjects continued prosthetic walking on return to their communities. Two subjects abandoned prosthetic walking. The %VO2max for the five who continued prosthetic walking after discharge ranged from 55.8 to 72.0. The subjects who abandoned prosthetic walking had lower %VO2max of 43.3 and 44.2. Energy consumption during prosthetic walking at CWS seemed not to be excessive. Older HD amputees in good physical condition were able to successfully walk with a prosthesis in a community setting. A lower level of fitness appears to make community walking prohibitive.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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...... 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 was...... performed on the 3R60 prosthesis. The outcome measures were temporospatial symmetry, duration of single support on the sound side and the prosthetic side, and the introduced butterfly symmetry ratio. Spatial symmetry was not significantly different between the two prosthetic knees. Temporal symmetry was not...

  12. Center of pressure and total force analyses for amputees walking with a backpack load over four surfaces.

    Science.gov (United States)

    Sinitski, Emily H; Herbert-Copley, Andrew G; Lemaire, Edward D; Doyle, Sean S; Besemann, Markus; Dudek, Nancy L

    2016-01-01

    Understanding how load carriage affects walking is important for people with a lower extremity amputation who may use different strategies to accommodate to the additional weight. Nine unilateral traumatic transtibial amputees (K4-level) walked over four surfaces (level-ground, uneven ground, incline, decline) with and without a 24.5 kg backpack. Center of pressure (COP) and total force were analyzed from F-Scan insole pressure sensor data. COP parameters were greater on the intact limb than on the prosthetic limb, which was likely a compensation for the loss of ankle control. Double support time (DST) was greater when walking with a backpack. Although longer DST is often considered a strategy to enhance stability and/or reduce loading forces, changes in DST were only moderately correlated with changes in peak force. High functioning transtibial amputees were able to accommodate to a standard backpack load and to maintain COP progression, even when walking over different surfaces. PMID:26360208

  13. The combined plastic surgery/physical medicine and rehabilitation amputee clinic at the University of Western Ontario

    OpenAIRE

    Neinstein, Ryan; Death, A Barry; Siang Gan, Bing

    2008-01-01

    Since the autumn of 2001, a multidisciplinary plastic surgery (PS) and physical medicine and rehabilitation (PMR) outpatient amputee clinic has been in place at St Joseph’s Health Centre/Parkwood Hospital in London, Ontario. To date, more than 140 new patients have been seen in combined consultations. The present paper reviews the demographics, interventions and outcomes of the patients seen between 2001 and 2005. The majority of primary PMR patients had problems that prevented optimal use of...

  14. Interdependence of movement and anatomy persists when amputees learn a physiologically impossible movement of their phantom limb

    OpenAIRE

    Moseley, G L; Brugger, P

    2009-01-01

    The feeling we have of our own body, sometimes called "body image," is fundamental to self-awareness. However, by altering sensory input, the body image can be modified into impossible configurations. Can impossible movements of the body image be conjured solely via internally generated mechanisms, and, if so, do the structural characteristics of the body image modify to accommodate the new movements? We encouraged seven amputees with a vivid phantom arm to learn to perform a phantom wrist mo...

  15. Acupuncture for the treatment of phantom limb pain in lower limb amputees: study protocol for a randomized controlled feasibility trial

    OpenAIRE

    Trevelyan, Esmé G; Turner, Warren A; Robinson, Nicola

    2015-01-01

    Background Phantom limb pain is a prevalent condition that is difficult to manage, with a lack of robust evidence to support the use of many adjunctive treatments. Acupuncture can be effective in the management of many painful conditions but little is known about its effectiveness in treating phantom limb pain. The aim of this study is to explore the feasibility of conducting a randomized controlled trial comparing acupuncture and routine care in a group of lower limb amputees with phantom li...

  16. 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

    Objective. 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. Approach. Multi-contact cuff electrodes were implanted in the median, ulnar, and radial nerves of the upper-limb. Main results. 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. Significance. 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.

  17. Effects of short-term training on sensory and motor function in severed nerves of long-term human amputees.

    Science.gov (United States)

    Dhillon, G S; Krüger, T B; Sandhu, J S; Horch, K W

    2005-05-01

    Much has been studied and written about plastic changes in the CNS of humans triggered by events such as limb amputation. However, little is known about the extent to which the original pathways retain residual function after peripheral amputation. Our earlier, acute study on long-term amputees indicated that central pathways associated with amputated peripheral nerves retain at least some sensory and motor function. The purpose of the present study was to determine if these functional connections would be strengthened or improved with experience and training over several days time. To do this, electrodes were implanted within fascicles of severed nerves of long-term human amputees to evaluate the changes in electrically evoked sensations and volitional motor neuron activity associated with attempted phantom limb movements. Nerve stimulation consistently resulted in discrete, unitary, graded sensations of touch/pressure and joint-position sense. There was no significant change in the values of stimulation parameters required to produce these sensations over time. Similarly, while the amputees were able to improve volitional control of motor neuron activity, the rate and pattern of change was similar to that seen with practice in normal individuals on motor tasks. We conclude that the central plasticity seen after amputation is most likely primarily due to unmasking, rather than replacement, of existing synaptic connections. These results also have implications for neural control of prosthetic limbs. PMID:15846000

  18. A Classification Method for User-Independent Intent Recognition for Transfemoral Amputees Using Powered Lower Limb Prostheses.

    Science.gov (United States)

    Young, Aaron J; Hargrove, Levi J

    2016-02-01

    Powered lower limb prosthesis technologies hold the promise of providing greater ability and mobility to transfemoral amputees. Intent recognition systems for these devices may allow amputees to perform automatic, seamless transitions between locomotion modes. Prior studies in which pattern recognition algorithms have been trained to recognize subject-specific patterns within device-mounted sensor data have shown the feasibility of such systems. While effective, these strategies require substantial training regimens. To reduce this training burden, we developed and evaluated user-independent intent recognition systems. A novel mode-specific classification system was developed that allowed each locomotion transition to be statistically considered its own class. Various pattern recognition algorithms were trained with sensor data from a pool of eight lower limb amputees and performance was tested using data on a novel subject. For both user-dependent and user-independent classification, mode-specific classification reduced error ( ) on transitional steps by  ∼ 50% without affecting steady-state classification. Incorporating sensor time history and level-ground walking data from the novel subject into the training data resulted in decreasing errors ( ) on steady-state classification by over 60% without affecting transitional error. These strategies were combined to demonstrate significant overall system improvements from baseline conditions presented in prior research. PMID:25794392

  19. Abnormal access of axial vibrotactile input to deafferented somatosensory cortex in human upper limb amputees.

    Science.gov (United States)

    Kew, J J; Halligan, P W; Marshall, J C; Passingham, R E; Rothwell, J C; Ridding, M C; Marsden, C D; Brooks, D J

    1997-05-01

    We studied two human subjects with total deafferentation of one upper limb secondary to traumatic multiple cervical root avulsions. Both subjects developed a phantom limb and underwent elective amputation of the paralyzed, deafferentated limb. Psychophysical study revealed in each subject an area of skin in the pectoral region ipsilateral to the amputation where vibrotactile stimulation (VS) elicited referred sensations (RS) in the phantom limb. Positron emission tomography was then used to measure regional cerebral blood flow changes during VS of the pectoral region ipsilateral to the amputation with RS and during VS of a homologous part of the pectoral region adjacent to the intact arm without RS. A voxel-based correlation analysis was subsequently used to study functional connectivity. VS of the pectoral region adjacent to the intact arm was associated with activation of the dorsal part of the contralateral primary somatosensory cortex (S1) in a position consistent with the S1 trunk area. In contrast, VS of the pectoral region ipsilateral to the amputation with RS was associated with activation of the contralateral S1 that extended from the level of the trunk representation ventrally over distances of 20 and 12 mm, respectively, in the two subjects. The area of S1 activated during VS of the digits in a normal control subject was coextensive with the ventral S1 region abnormally activated during VS of the ectopic phantom representation in the two amputees, suggesting that the deafferented digit or hand/arm area had been activated by sensory input from the pectoral region. Correlation analysis showed an abnormal pattern of intrinsic connectivity within the deafferented S1 hand/arm area of both amputees. In one subject, the deafferented S1 was functionally connected with 3 times as many S1 voxels as the normally afferented S1. This abnormal functional connectivity extended in both the rostrocaudal and ventrodorsal dimensions. The results demonstrate that sensory

  20. Voices from the past: Mental and physical outcomes described by American Civil War amputees.

    Science.gov (United States)

    Bonnan-White, Jess; Yep, Jewelry; Hetzel-Riggin, Melanie D

    2016-01-01

    Studies of trauma commonly concentrate on the psychological and physiological effects of recent violent events. Although today connections are becoming more explicitly drawn, early studies of the aftermath of amputation serve to shed light on modern understanding of the interaction of the physical and emotional. The study of combat amputation, dissociation, and related posttraumatic stress largely began with the work of 19th-century Philadelphia physician Silas Weir Mitchell, who brought attention to the phenomenon of phantom limb pain. Less known, however, are the data he and his son, John K. Mitchell, also collected on the mental outcomes of trauma. Using an archived collection of original surveys of double-amputee patients dating largely from 1893 housed at the Historical Medical Library at the College of Physicians of Philadelphia, an interdisciplinary team explored the historical, anthropological, and psychological background of the study of combat trauma. Almost 30 years following the end of hostilities, the majority of the sample of U.S. Civil War veterans indicated that their general disposition, general health, and sleeping or eating patterns had changed following limb amputation. More telling, possibly, are the written comments on the surveys and letters that indicate frustration with the continuous suffering and the knowledge of their mental and physical changes. These data illustrate the value of historical archives in documenting the development of the study of trauma and modern concepts of combat experiences. PMID:26158228

  1. 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.

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

    Science.gov (United States)

    Luchetti, Martina; Montebarocci, Ornella; Rossi, Nicolino; Cutti, Andrea G; Sutin, Angelina R

    2014-01-01

    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. PMID:24924483

  3. 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.

  4. Glasgow Coma Scale scores, early opioids, and 4-year psychological outcomes among combat amputees

    Directory of Open Access Journals (Sweden)

    Ted Melcer, PhD

    2014-09-01

    Full Text Available Morphine and fentanyl are frequently used for analgesia after trauma, but there is debate over the advantages and disadvantages of these opioids. Among combat amputees, intravenous (IV morphine (vs IV fentanyl after injury was associated with reduced likelihood of posttraumatic stress disorder (PTSD. The previous results were based on military health diagnoses over 2 yr postinjury. The present study followed psychological diagnoses of patients with amputation for 4 yr using military and Department of Veterans Affairs health data. In-­theater combat casualty records (n = 145 documented Glasgow Coma Scale (GCS scores and/or morphine, fentanyl, or no opioid treatment within hours of injury. We found that (1 GCS scores were not significantly associated with PTSD; (2 longitudinal modeling using four (yearly time points showed significantly reduced odds of PTSD for patients treated with morphine (vs fentanyl across years (adjusted odds ratio = 0.40; 95% confidence interval = 0.17–0.94; (3 reduced PTSD prevalence for morphine (vs IV fentanyl; morphine = 25%, fentanyl = 59%, p < 0.05 was significant, specifically among patients with traumatic brain injury during the first 2 yr postinjury; and (4 PTSD prevalence, but not other disorders (e.g., mood, increased between year 1 (PTSD = 18% and years 2 through 4 postinjury (PTSD range = 30%–32%.

  5. Phantom hand and wrist movements in upper limb amputees are slow but naturally controlled movements.

    Science.gov (United States)

    De Graaf, J B; Jarrassé, N; Nicol, C; Touillet, A; Coyle, T; Maynard, L; Martinet, N; Paysant, J

    2016-01-15

    After limb amputation, patients often wake up with a vivid perception of the presence of the missing limb, called "phantom limb". Phantom limbs have mostly been studied with respect to pain sensation. But patients can experience many other phantom sensations, including voluntary movements. The goal of the present study was to quantify phantom movement kinematics and relate these to intact limb kinematics and to the time elapsed since amputation. Six upper arm and two forearm amputees with various delays since amputation (6months to 32years) performed phantom finger, hand and wrist movements at self-chosen comfortable velocities. The kinematics of the phantom movements was indirectly obtained via the intact limb that synchronously mimicked the phantom limb movements, using a Cyberglove® for measuring finger movements and an inertial measurement unit for wrist movements. Results show that the execution of phantom movements is perceived as "natural" but effortful. The types of phantom movements that can be performed are variable between the patients but they could all perform thumb flexion/extension and global hand opening/closure. Finger extension movements appeared to be 24% faster than finger flexion movements. Neither the number of types of phantom movements that can be executed nor the kinematic characteristics were related to the elapsed time since amputation, highlighting the persistence of post-amputation neural adaptation. We hypothesize that the perceived slowness of phantom movements is related to altered proprioceptive feedback that cannot be recalibrated by lack of visual feedback during phantom movement execution. PMID:26556065

  6. 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.

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

    International Nuclear Information System (INIS)

    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. 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.

  9. A myoelectric-controlled virtual hand for the assessment and treatment of phantom limb pain in trans-radial upper extremity amputees: a research protocol.

    Science.gov (United States)

    Gaggioli, Andrea; Amoresano, Amedeo; Gruppioni, Emanuele; Verni, Gennaro; Riva, Giuseppe

    2010-01-01

    At least 90% of individuals of limb amputees experience phantom limb pain (PLP). Recent clinical research suggests that providing patients with the mirror image representation of the amputated limb may alleviate PLP. However, mirror therapy cannot be used with bilateral amputees, as visual feedback is dependent on the movement of the intact limb. To overcome this limitation, we designed a novel myoelectric-controlled virtual reality (VR) system for the treatment of phantom limb pain in trans-radial upper extremity amputees. The proposed system allows the patient to directly control the virtual limb by recognizing stump muscle patterns recorded with EMG sensors. The hypothesis behind this strategy is that the VR image of the amputated limb induces better limb imagery than the reflected image of their intact limb and, therefore, is more effective in reducing PLP. A research protocol to test this hypothesis is described. PMID:20543301

  10. The effect of prosthetic ankle energy storage and return properties on muscle activity in below-knee amputee walking.

    Science.gov (United States)

    Ventura, Jessica D; Klute, Glenn K; Neptune, Richard R

    2011-02-01

    In an effort to improve amputee gait, energy storage and return (ESAR) prosthetic feet have been developed to provide enhanced function by storing and returning mechanical energy through elastic structures. However, the effect of ESAR feet on muscle activity in amputee walking is not well understood. Previous studies have analyzed commercial prosthetic feet with a wide range of material properties and geometries, making it difficult to associate specific ESAR properties with changes in muscle activity. In contrast, prosthetic ankles offer a systematic way to manipulate ESAR properties while keeping the prosthetic heel and keel geometry intact. In the present study, ESAR ankles were added to a Seattle Lightfoot2 to carefully control the energy storage and return by altering the ankle stiffness and orientation in order to identify its effect on lower extremity muscle activity during below-knee amputee walking. A total of five foot conditions were analyzed: solid ankle (SA), stiff forward-facing ankle (FA), compliant FA, stiff reverse-facing ankle (RA) and compliant RA. The ESAR ankles decreased the activity of muscles that contribute to body forward propulsion and increased the activity of muscles that provide body support. The compliant ankles generally caused a greater change in muscle activity than the stiff ankles, but without a corresponding increase in energy return. Ankle orientation also had an effect, with RA generally causing a lower change in muscle activity than FA. These results highlight the influence of ESAR stiffness on muscle activity and the importance of prescribing appropriate prosthetic foot stiffness to improve rehabilitation outcomes. PMID:21145747

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

    Science.gov (United States)

    Kawashima, Noritaka; Mita, Tomoki

    2016-01-01

    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. PMID:27227973

  12. Microchannel-based regenerative scaffold for chronic peripheral nerve interfacing in amputees.

    Science.gov (United States)

    Srinivasan, Akhil; Tahilramani, Mayank; Bentley, John T; Gore, Russell K; Millard, Daniel C; Mukhatyar, Vivek J; Joseph, Anish; Haque, Adel S; Stanley, Garrett B; English, Arthur W; Bellamkonda, Ravi V

    2015-02-01

    Neurally controlled prosthetics that cosmetically and functionally mimic amputated limbs remain a clinical need because state of the art neural prosthetics only provide a fraction of a natural limb's functionality. Here, we report on the fabrication and capability of polydimethylsiloxane (PDMS) and epoxy-based SU-8 photoresist microchannel scaffolds to serve as viable constructs for peripheral nerve interfacing through in vitro and in vivo studies in a sciatic nerve amputee model where the nerve lacks distal reinnervation targets. These studies showed microchannels with 100 μm × 100 μm cross-sectional areas support and direct the regeneration/migration of axons, Schwann cells, and fibroblasts through the microchannels with space available for future maturation of the axons. Investigation of the nerve in the distal segment, past the scaffold, showed a high degree of organization, adoption of the microchannel architecture forming 'microchannel fascicles', reformation of endoneurial tubes and axon myelination, and a lack of aberrant and unorganized growth that might be characteristic of neuroma formation. Separate chronic terminal in vivo electrophysiology studies utilizing the microchannel scaffolds with permanently integrated microwire electrodes were conducted to evaluate interfacing capabilities. In all devices a variety of spontaneous, sensory evoked and electrically evoked single and multi-unit action potentials were recorded after five months of implantation. Together, these findings suggest that microchannel scaffolds are well suited for chronic implantation and peripheral nerve interfacing to promote organized nerve regeneration that lends itself well to stable interfaces. Thus this study establishes the basis for the advanced fabrication of large-electrode count, wireless microchannel devices that are an important step towards highly functional, bi-directional peripheral nerve interfaces. PMID:25522974

  13. 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.

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

    Directory of Open Access Journals (Sweden)

    Claudio Castellini

    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.

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

    Science.gov (United States)

    Sierra González, David; Castellini, Claudio

    2013-01-01

    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 20 N 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. PMID:24155719

  16. Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: Five case histories and results from a small series of patients

    Directory of Open Access Journals (Sweden)

    Ted Melcer, PhD

    2011-01-01

    Full Text Available Heterotopic ossification (HO is excess bone growth in soft tissues that frequently occurs in the residual limbs of combat amputees injured in Operation Iraqi Freedom and Operation Enduring Freedom, or Iraq and Afghanistan wars, respectively. HO can interfere with prosthetic use and walking and delay patient rehabilitation. This article describes symptomatic and/or radiographic evidence of HO in a patient series of combat amputees rehabilitating at a military amputee care clinic (27 patients/33 limbs. We conducted a retrospective review of patient records and physician interviews to document evidence of HO symptoms in these limbs (e.g., pain during prosthetic use, skin breakdown. Results showed HO-related symptoms in 10 of the 33 residual limbs. Radiographs were available for 25 of the 33 limbs, and a physician identified at least moderate HO in 15 of the radiographs. However, 5 of the 15 patients who showed at least moderate radiographic HO did not report adverse symptoms. Five individual patient histories described HO onset, symptoms, treatments, and outcomes. These case histories illustrated how HO location relative to pressure-sensitive/pressure-tolerant areas of the residual limb may determine whether patients experienced symptoms. These histories revealed the uncommon but novel finding of potential benefits of HO for prosthetic suspension.

  17. Amputee Mobility Predictor-Bilateral: A performance-based measure of mobility for people with bilateral lower-limb loss

    Directory of Open Access Journals (Sweden)

    Michele A. Raya, PhD, PT, SCS, ATC

    2013-10-01

    Full Text Available The Amputee Mobility Predictor (AMP is an outcome measure designed to assess mobility and functional capabilities for people with unilateral lower-limb amputation. No comparable measure exists for those with bilateral lower-limb amputation (BLLA. The purpose of this study was to examine the utility of the AMP-Bilateral (AMP-B to measure the ability to perform functional tasks related to participation in advanced skill activities in those with BLLA and to determine whether AMP-B scores correlated with 6-minute walk test (6MWT performance. Twenty-six male servicemembers (SMs completed the study: 12 with bilateral transtibial amputation (BTTA, 7 with bilateral transfemoral amputation (BTFA, and 7 with combination transtibial and transfemoral amputation (TTA/TFA. Significant differences existed between the AMP-B scores (p < 0.001, AMP scores (p < 0.001, and 6MWT distance (p < 0.05 for SMs with BTTA and TTA/TFA and SMs with BTTA and BTFA but not between those with BTFA and TTA/TFA. Scoring of five AMP items was modified because they necessitate at least one intact knee joint to generate the necessary torque requirements to perform the activity without upper-limb assistance. Minor modifications in scoring of the AMP do not alter total score and allow clinicians to determine the mobility and functional capabilities of SMs with BTFA and TFA/TTA.

  18. Techniques for Interface Stress Measurements within Prosthetic Sockets of Transtibial Amputees: A Review of the Past 50 Years of Research.

    Science.gov (United States)

    Al-Fakih, Ebrahim A; Abu Osman, Noor Azuan; Mahmad Adikan, Faisal Rafiq

    2016-01-01

    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. PMID:27447646

  19. 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.

  20. Gait Measures and Dynamic Weight bearing in Young and Elder Trans-tibal Amputee using PTB Prosthesis with SACH foot

    Directory of Open Access Journals (Sweden)

    Prasanna K. Lenka

    2008-12-01

    Full Text Available Objective: to investigate the changes associated with age in gait characteristics and dynamic weight bearing pattern of sound and prosthetic limb of persons with unilateral amputation. Participant: two groups of seven young (24±3.8 years and seven elderly unilateral amputee (71±6 years were selected for this study. Setting: both groups walked at their self selected speed over a 20 second duration plane surface walk way in trans-tibial prosthesis with PTB socket and SACH foot. The raw data of force and EMG sensors of gait analyzer were filtered, processed and analyzed with help of ‘matlab 7.0. A blue tooth enabled heart rate telemetry system was used for calculating gait efficiency in terms of physiological cost index (PCI. Results: significant differences were found in stride duration, (p=0.003, step duration sound limb (p<0.002, stance duration sound limb (p=0.002, stance duration prosthetic limb (p=0.006 and cadence (p=0.001<0.05, however no difference was found in EMG pattern of vastus lateralis between the two groups. The dynamic weight distribution showed more normalized load on anterior parts of heel and minimum load at calcaneal max in elderly group. The results of vertical ground reaction force found the prosthetic side of elderly group takes more weight than young group during loading response. In comparison, PCI was observed to be greater in case of elderly group. Conclusion: most of difference between two groups could be explained by speed variations and biomechanical limitation of ankle joint due to natural aging process.

  1. 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. PMID:26736176

  2. 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.

  3. Inter-individual difference in the effect of mirror reflection-induced visual feedback on phantom limb awareness in forearm amputees.

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    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.

  4. Amputee Coalition of America

    Science.gov (United States)

    ... donation for each time you purchase. It’s no cost to you but a big help to us. ... and Improving Care: Recommendations From the ... Read more Leadership Change August 15, 2016 Susan Stout is no ...

  5. 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

  6. Pain Management and the Amputee

    Science.gov (United States)

    ... have very individual beliefs about pain and its meaning. When you have severe pain, it may be ... trapped by other tissue, such as muscle. In contrast, phantom pain is thought to originate in the ...

  7. 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

  8. 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

    Directory of Open Access Journals (Sweden)

    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

  9. 地震儿童截肢伤员血清酶学检查指标初步分析%Preliminary analysis of serum enzymes indicators in childhood amputees due to earthquake resulting trauma

    Institute of Scientific and Technical Information of China (English)

    蒋欣; 刘利君; 李卉

    2014-01-01

    目的 回顾分析地震中儿童截肢伤员的血清酶学检查结果,并讨论其临床意义.方法 从2008年四川汶川和2013年四川芦山两次特大地震150例地震创伤患儿中,选择血清酶学检查结果完整的、以肢体外伤为主的患儿45例,分为3组:截肢组6例、骨筋膜室切开减压组5例、普通创伤组34例.统计各组患儿的血清酶学检查数据,配对后进行统计分析.以同期随机选取的10例非地震创伤的骨科患儿作为对照;以20例成人地震截肢伤员作为对照.结果 各组地震创伤患儿损伤严重度评分(ISS)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBDH)等血清酶学指标比较差异均有统计学意义(FISS=15.474,P<0.001;FASTT=10.770,P<0.001;FALT=12.799,P<0.001;FCK=12.848,P<0.001;FLDH=13.126,P<0.001;FHBDH=13.186,P<0.001),以截肢组患儿升高最为明显;且儿童截肢组AST、LDH、HBDA明显高于成人截肢组,而ALT、CK略为升高.血清酶学指标对病情及预后的正确判断有很大的帮助.同时在统计中还发现,CK是一个对急性重症创伤患者特别是伴随严重软组织损伤患者病情进行评估的极其敏感的生化检查指标,在各组病例中增高极为显著,CK可从非地震创伤组的(129±62) U/L升高到地震截肢组的(44208±39 788) U/L,超过300多倍,增高极为显著,其中有的患者最高值竟达到117 513 U/L,超过840倍.而一旦及时进行了截肢手术或骨筋膜室切开减压等治疗处理后,患儿的CK值又会迅速下降,直至正常.结论 完善而连续的血清生化检查在急性重度创伤儿童的治疗过程中极为必要,对临床医生正确判断病情并确定治疗方案有着非常重要的临床意义.%Objective To retrospectively analyze the serum enzymes in childhood amputees as a result of earthquake,and to discuss their clinical significance.Methods From 150 children amputees who

  10. Amputees and sports : a systematic review

    NARCIS (Netherlands)

    Bragaru, M.; Dekker, R.; Geertzen, J.H.B.; Dijkstra, P.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 co

  11. 神经断端肌肉内埋入法治疗汶川地震截肢伤员痛性神经瘤%Treatment of painful stump neuroma by resection and nerve stump implantation into muscle in twelve Wenchuan earthquake amputees

    Institute of Scientific and Technical Information of China (English)

    何纯青; 赵正恩; 许猛; 张立海; 柳现飞; 唐佩福

    2011-01-01

    目的:探讨神经断端肌肉内埋入法治疗地震伤截肢残端痛性神经瘤的临床疗效.方法:应用神经断端肌肉内埋入法治疗汶川地震伤截肢伤员痛性神经瘤12例27处,观察术后症状、体征及患肢功能改变情况.结果:12例全部获随访12~26个月,平均16个月.随访时患者主诉肢体残端疼痛和触电感消失;局部无压痛、叩击痛和Tinel征,残端软组织内未触及硬性结节或包块;患肢功能较术前明显改善.结论:采用神经断端肌肉内埋入法治疗地震伤截肢残端痛性神经瘤,可减轻痛苦,疗效确切.%Objective To investigate the clinical efficacy of a painful stump neuroma treatment by resection and nerve stump implantation into muscle in treating Wenchuan earthquake amputees. Methods In 12 Wenchuan earthquake amputees (27 painful neuromas), painful neuroma underwent resection and implantation into the nearby muscle. Changes of symptoms and limb function were observed. Results All the cases were followed up for 12 -26 months with an average of 16 months. It was shown that limb stump pain and “electric -shock” sensation disappeared without any local tenderness, percussion tenderness or Tinel sign. The soft tissue nodule or mass of limb stump disappeared. Limb function improved, compared with preoperative evaluation. Conclusions Pesection and nerve stump implantation into muscle is a feasible and effective method for treatment of painful stump neuroma after amputation.

  12. Imaginative resonance training (IRT) achieves elimination of amputees' phantom pain (PLP) coupled with a spontaneous in-depth proprioception of a restored limb as a marker for permanence and supported by pre-post functional magnetic resonance imaging (fMRI).

    Science.gov (United States)

    Meyer, Paul; Matthes, Christoph; Kusche, Karl Erwin; Maurer, Konrad

    2012-05-31

    Non-pharmacological approaches such as mirror therapy and graded motor imagery often provide amelioration of amputees' phantom limb pain (PLP), but elimination has proved difficult to achieve. Proprioception of the amputated limb has been noted in studies to be defective and/or distorted in the presence of PLP, but has not, apparently, been researched for various stages of amelioration up to the absence of PLP. Previous studies using functional magnetic resonance imaging (fMRI) suggested that pathological cortical reorganisation after amputation may be the underlying neurobiological correlate of PLP. We report two cases of permanent elimination of PLP after application of imaginative resonance training. The patients, 69 years and 84 years old, reported freedom from PLP together with in-depth achievement of proprioception of a restored limb at the end of the treatment, which may thus be taken as an indication of permanence. Pre/post fMRI for the first case showed, against a group of healthy controls, analogous changes of activation in the sensorimotor cortex. PMID:22748628

  13. 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

  14. Amputee socks: how does sock ply relate to sock thickness?

    Science.gov (United States)

    Sanders, Joan E; Cagle, John C; Harrison, Daniel S; Karchin, Ari

    2015-01-01

    Background The term “sock ply” may be a source of confusion in prosthetics practice, because there may not be a consistent relationship between sock ply and sock thickness. Objectives The purpose of this study was to characterize how sock ply related to sock thickness for different sock materials commonly used in limb prosthetics. We also evaluated how sock thickness changed under loading conditions experienced while wearing a lower-limb prosthesis compared with unstressed. Study Design Experimental. Mechanical assessment. Methods Seven sock materials of varying ply were tested using a custom instrument. Sock thickness under eight different compressive stress conditions and two different in-plane tensile strain conditions were measured. Results For socks woven from a single material, thickness under walking stance phase conditions averaged 0.7, 1.2, and 1.5 mm for 1, 3, and 5-ply, respectively. For socks woven from several materials, the corresponding results were 0.4, 0.7, and 0.8 mm, respectively. Sock ply did not sum, e.g. a 3-ply sock was not three times the thickness of a 1-ply sock. Conclusions Sock thickness and compressive stiffness are strongly dependent upon sock material and interface pressure. Clinical Relevance Data may be useful towards selecting socks during fitting and towards understanding volume changes induced by adding socks. PMID:22228614

  15. 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. PMID:25793347

  16. 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.

  17. When Are Prostheses the Right Choice for Older Amputees?

    Science.gov (United States)

    ... serious heart disease. Mr. A still wanted to learn how to use a prosthesis. Three years later, Mr. A does well with a prosthesis. He is thrilled to still play golf, though he decides each day whether or not ...

  18. Consumer Guide for Amputees: A Guide to Lower Limb Prosthetics

    Science.gov (United States)

    ... aluminum or graphite with either stainless steel or titanium connectors at the foot and socket or knee. The connectors generally have alignment capability, even after the prosthesis is fabricated and finished. Prostheses for knee disarticulation ( ...

  19. 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...

  20. Prosthetic Frequently Asked Questions for the New Amputee

    Science.gov (United States)

    ... Navigation HOME WHO WE ARE About Us Mission & Goals History Impact Leadership Financials Ethics Policy Press Room Work With Us ... Search HOME WHO WE ARE About Us Mission & Goals History Impact Leadership Financials Ethics Policy Press Room Work With Us ...

  1. Heart rate variability and phantom pain in male amputees: Application of linear and nonlinear methods

    Directory of Open Access Journals (Sweden)

    Elena Sarabia Cachadiña, PhD

    2013-05-01

    Full Text Available Phantom-limb pain (PLP is a phenomenon that may appear among people with amputation. Some studies reveal that 70% of people with amputation experience PLP years postamputation. There is a lack of scientific evidence about the cause of PLP. It has been hypothesized that the autonomic nervous system (ANS could be involved in the mechanism that triggers PLP, but this hypothesis remains unclear. The aim of this study was to correlate ANS function, through heart rate variability (HRV analysis, with PLP in adult males with amputation. The study population comprised 35 subjects, with 27 reporting PLP often or always. The rest of the subjects did not report any PLP. In order to calculate linear and nonlinear parameters of HRV, all subjects underwent 10 min of resting heart rate monitoring. The study did not find correlations between HRV parameters and PLP. Most of the subjects showed decreased values in linear parameters of HRV while nonlinear values were normal. HRV is not implicated in PLP. Linear and nonlinear methods for HRV analysis might reflect different physiological phenomena; while linear values place people with amputation at cardiovascular risk, nonlinear values indicate normality.

  2. 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.

  3. Heart rate variability and phantom pain in male amputees: application of linear and nonlinear methods.

    Science.gov (United States)

    Sarabia Cachadiña, Elena; Granados García, Pablo; Tonon Da Luz, S C; Goya Esteban, Rebeca; Barquero Pérez, Oscar; Naranjo Orellana, J; Berral de la Rosa, F J

    2013-01-01

    Phantom-limb pain (PLP) is a phenomenon that may appear among people with amputation. Some studies reveal that 70% of people with amputation experience PLP years postamputation. There is a lack of scientific evidence about the cause of PLP. It has been hypothesized that the autonomic nervous system (ANS) could be involved in the mechanism that triggers PLP, but this hypothesis remains unclear. The aim of this study was to correlate ANS function, through heart rate variability (HRV) analysis, with PLP in adult males with amputation. The study population comprised 35 subjects, with 27 reporting PLP often or always. The rest of the subjects did not report any PLP. In order to calculate linear and nonlinear parameters of HRV, all subjects underwent 10 min of resting heart rate monitoring. The study did not find correlations between HRV parameters and PLP. Most of the subjects showed decreased values in linear parameters of HRV while nonlinear values were normal. HRV is not implicated in PLP. Linear and nonlinear methods for HRV analysis might reflect different physiological phenomena; while linear values place people with amputation at cardiovascular risk, nonlinear values indicate normality. PMID:23881769

  4. 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. PMID:21920525

  5. Percutaneous Osseointegrated Prostheses for Amputees: Limb Compensation in a 12-Month Ovine model

    OpenAIRE

    Shelton, Trevor J.; Beck, J. Peter; Bloebaum, Roy D.; Bachus, Kent N.

    2011-01-01

    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.

  6. How do activities walking, standing, and resting influence trans-tibial amputee residual limb fluid volume?

    OpenAIRE

    Sanders, Joan; Cagle, John; Allyn, Katheryn; Harrison, Daniel; Ciol, Marcia

    2014-01-01

    The purpose of this research was to determine how fluid volume changes in the residual limbs of people with trans-tibial amputation were affected by activity during test sessions with equal durations of resting, standing, and walking. Residual limb extracellular fluid volume was measured using biompedance analysis on 24 participants. Results showed that all subjects lost fluid volume during standing with equal weight-bearing, averaging a loss rate of 0.4%/min, and a mean loss over the 25 min ...

  7. How do walking, standing, and resting influence transtibial amputee residual limb fluid volume?

    OpenAIRE

    Joan E. Sanders, PhD; John C. Cagle, BSE; Katheryn J. Allyn, CPO; Daniel S. Harrison, BS; Marcia A. Ciol, PhD

    2014-01-01

    The purpose of this research was to determine how fluid volume changes in the residual limbs of people with transtibial amputation were affected by activity during test sessions with equal durations of resting, standing, and walking. Residual limb extracellular fluid volume was measured using biompedance analysis in 24 participants. Results showed that all subjects lost fluid volume during standing with equal weight-bearing, averaging a loss rate of –0.4%/min and a mean loss over the 25 min t...

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

    OpenAIRE

    Seyedali Mahyo; Czerniecki Joseph M; Morgenroth David C; Hahn Michael E

    2012-01-01

    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 my...

  9. Detecting asymmetries in balance control with system identification: first experimental results from above knee amputees

    NARCIS (Netherlands)

    Kooij, van der H.; Asseldonk, van E.H.F.; Nederhand, M.J.; Driessen, B.; Helder, J.L.; Gelderblom, G.J.

    2007-01-01

    A prosthetic leg can influence balance in various ways, but not all changes in postural performance can easily be identified with the naked clinical eye. Various studies have shown that dynamic posturography is able to detect more subtle changes in balance control. Here, we describe a modification o

  10. 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. PMID:15948330

  11. Algorithm for the prediction of the reactive forces developed in the socket of transfemoral amputees

    OpenAIRE

    JUAN FERNANDO RAMÍREZ; EMMANUEL JARAMILLO MUÑOZ; JAIME ANDRÉS VÉLEZ

    2012-01-01

    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 experiment...

  12. How do walking, standing, and resting influence transtibial amputee residual limb fluid volume?

    Directory of Open Access Journals (Sweden)

    Joan E. Sanders, PhD

    2014-08-01

    Full Text Available The purpose of this research was to determine how fluid volume changes in the residual limbs of people with transtibial amputation were affected by activity during test sessions with equal durations of resting, standing, and walking. Residual limb extracellular fluid volume was measured using biompedance analysis in 24 participants. Results showed that all subjects lost fluid volume during standing with equal weight-bearing, averaging a loss rate of –0.4%/min and a mean loss over the 25 min test session of 2.6% (standard deviation [SD] 1.1. Sixteen subjects gained limb fluid volume during walking (mean gain of 1.0% [SD 2.5], and fifteen gained fluid volume during rest (mean gain of 1.0% [SD 2.2]. Walking explained only 39.3% of the total session fluid volume change. There was a strong correlation between walk and rest fluid volume changes (−0.81. Subjects with peripheral arterial disease experienced relatively high fluid volume gains during sitting but minimal changes or losses during sit-to-stand and stand-to-sit transitioning. Healthy female subjects experienced high fluid volume changes during transitioning from sit-to-stand and stand-to-sit. The differences in fluid volume response among subjects suggest that volume accommodation technologies should be matched to the activity-dependent fluid transport characteristics of the individual prosthesis user.

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

    OpenAIRE

    Sierra González, David; Castellini, Claudio

    2013-01-01

    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...

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

    OpenAIRE

    Claudio Castellini

    2013-01-01

    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, widesp...

  15. Design and control of a prosthetic leg for above-knee amputees operated in semi-active and active modes

    Science.gov (United States)

    Park, Jinhyuk; Yoon, Gun-Ha; Kang, Je-Won; Choi, Seung-Bok

    2016-08-01

    This paper proposes a new prosthesis operated in two different modes; the semi-active and active modes. The semi-active mode is achieved from a flow mode magneto-rheological (MR) damper, while the active mode is obtained from an electronically commutated (EC) motor. The knee joint part of the above knee prosthesis is equipped with the MR damper and EC motor. The MR damper generates reaction force by controlling the field-dependent yield stress of the MR fluid, while the EC motor actively controls the knee joint angle during gait cycle. In this work, the MR damper is designed as a two-end type flow mode mechanism without air chamber for compact size. On other hand, in order to predict desired knee joint angle to be controlled by EC motor, a polynomial prediction function using a statistical method is used. A nonlinear proportional-derivative controller integrated with the computed torque method is then designed and applied to both MR damper and EC motor to control the knee joint angle. It is demonstrated that the desired knee joint angle is well achieved in different walking velocities on the ground ground.

  16. Correlation of Pain Scores, Analgesic Use, and Beck Anxiety Inventory Scores During Hospitalization in Lower Extremity Amputees

    OpenAIRE

    Trame, Cathy D; Greene, Erin; Moddeman, Gail; Booth, Branyan A; Konstantakos, Emmanuel K; Parada, Stephen; Siebuhr, Karl; Laughlin, Richard T.

    2008-01-01

    Post amputation pain can be debilitating for patients and families. Chronic pain is a common phenomenon after lower extremity amputation, occurring in up to 80% of this population. The purpose of this pilot study was to correlate post amputation pain scores to opioid analgesic consumption and Beck Anxiety Inventory (BAI) scores. Twenty-three patients with lower extremity amputation at an 827-bed acute care inner-city hospital were surveyed pre-operatively and post-operatively to determine if ...

  17. Assessment of transfemoral amputees using C-Leg and Power Knee for ascending and descending inclines and steps

    Directory of Open Access Journals (Sweden)

    Erik J. Wolf, PhD

    2012-08-01

    Full Text Available Adding active power to a prosthetic knee unit may improve function and reduce the potential for overuse injuries in persons with transfemoral amputation (TFA. Servicemembers who have sustained a TFA are often young and motivated to perform at high functional levels. The goal of this article is to compare the biomechanics of ramp and stair descent and ascent for participants using the C-Leg and the Power Knee (PK. Subjects were asked to ascend and descend an instrumented staircase and 12 degree ramp at their comfortable pace while equipped with retroreflective markers. Temporal-spatial and kinetic data were collected. Knee power generated by the nondisabled limb during stair ascent for subjects wearing the C-Leg was significantly greater than for those wearing the PK. Knee power generated by prosthetic knee units was significantly greater for subjects while wearing the PK. Although the PK reduced the power required from the nondisabled knee during stair climbing, it does not appear to be superior to the C-Leg for other tasks. Adding power to a prosthetic knee may reduce wear on the nondisabled limb; however, there are still limitations that require improvement.

  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

    OpenAIRE

    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...

  19. Expert Panel recommendations—Based on research and deliberations from VA HSR&D project “Impact of the DOD paradigm shift on VA amputee prosthetic care”

    OpenAIRE

    Gayle E. Reiber, PhD, MPH

    2010-01-01

    Major limb amputations are part of the sacrifices made by over 2,500 living Vietnam veterans and nearly 1,000 servicemembers to date from the conflicts in Afghanistan and Iraq. The men and women from both conflicts who completed our survey report favorable health and quality of life ratings, tremendous resilience, and hard work to reintegrate into society despite seriousinjuries and comorbidities.

  20. Robotic lower limb prosthesis design through simultaneous computer optimizations of human and prosthesis costs

    OpenAIRE

    Handford, Matthew L.; Manoj Srinivasan

    2016-01-01

    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 si...

  1. Can PC-9 Zhong chong replace K-1 Yong quan for the acupunctural resuscitation of a bilateral double-amputee? Stating the “random criterion problem” in its statistical analysis

    Science.gov (United States)

    Inchauspe, Adrián Angel

    2016-01-01

    AIM: To present an inclusion criterion for patients who have suffered bilateral amputation in order to be treated with the supplementary resuscitation treatment which is hereby proposed by the author. METHODS: This work is based on a Retrospective Cohort model so that a certainly lethal risk to the control group is avoided. RESULTS: This paper presents a hypothesis on acupunctural PC-9 Zhong chong point, further supported by previous statistical work recorded for the K-1 Yong quan resuscitation point. CONCLUSION: Thanks to the application of the resuscitation maneuver herein proposed on the previously mentioned point, patients with bilateral amputation would have another alternative treatment available in case basic and advanced CPR should fail. PMID:27152257

  2. Importance of Gait Training

    Science.gov (United States)

    The Importance of Gait Training by Scott Cummings, PT, CPO, FAAOP It is the goal of most every lower-limb amputee to walk “normally” again. ... all lower-limb amputees will benefit from gait training at some point in their recovery to help ...

  3. 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.

  4. 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 h

  5. Immersive virtual reality as a rehabilitative technology for phantom limb experience: a protocol.

    Science.gov (United States)

    Murray, Craig D; Patchick, Emma; Pettifer, Stephen; Caillette, Fabrice; Howard, Toby

    2006-04-01

    This paper describes a study protocol to investigate the use of immersive virtual reality as a treatment for amputees' phantom limb pain. This work builds upon prior research using mirror box therapy to induce vivid sensations of movement originating from the muscles and joints of amputees' phantom limbs. The present project transposes movements of amputees' anatomical limbs into movements of a virtual limb presented in the phenomenal space of their phantom limb. It is anticipated that the protocol described here will help reduce phantom limb pain. PMID:16640472

  6. Combined Analysis of Cortical (EEG) and Nerve Stump Signals Improves Robotic Hand Control

    OpenAIRE

    Tombini, Mario; Rigosa, Jacopo; Zappasodi, Filippo; Porcaro, Camillo; Citi, Luca; Carpaneto, Jacopo; Rossini, Paolo Maria; Micera, Silvestro

    2012-01-01

    Background. Interfacing an amputee's upper-extremity stump nerves to control a robotic hand requires training of the individual and algorithms to process interactions between cortical and peripheral signals. Objective. To evaluate for the first time whether EEG-driven analysis of peripheral neural signals as an amputee practices could improve the classification of motor commands. Methods. Four thin-film longitudinal intrafascicular electrodes (tf-LIFEs-4) were implanted in the median and ulna...

  7. Plasticity in the Visual System is Associated with Prosthesis Use in Phantom Limb Pain

    OpenAIRE

    Sandra Preißler; Hofmann, Gunther O.

    2013-01-01

    The experience of strong phantom limb pain (PLP) in arm amputees was previously shown to be associated with structural neural plasticity in parts of the cortex that belong to dorsal and ventral visual streams. It has been speculated that this plasticity results from the extensive use of a functional prosthesis which is associated with increased visual feedback to control the artificial hand. To test this hypothesis, we reanalyzed data of cortical volumes of 21 upper limb amputees and tested t...

  8. Epidural electrocorticography of phantom hand movement following long-term upper-limb amputation

    OpenAIRE

    Alireza Gharabaghi

    2014-01-01

    Introduction: Prostheses for upper-limb amputees are currently controlled by either myoelectric or peripheral neural signals. Performance and dexterity of these devices is still limited, particularly when it comes to controlling hand function. Movement-related brain activity might serve as a complementary bio-signal for motor control of hand prosthesis. Methods: We introduced a methodology to implant a cortical interface without direct exposure of the brain surface in an upper-limb amputee. T...

  9. Regenerative Engineering and Bionic Limbs

    OpenAIRE

    James, Roshan; Laurencin, Cato T.

    2015-01-01

    Amputations of the upper extremity are severely debilitating, current treatments support very basic limb movement, and patients undergo extensive physiotherapy and psychological counselling. There is no prosthesis that allows the amputees near-normal function. With increasing number of amputees due to injuries sustained in accidents, natural calamities and international conflicts, there is a growing requirement for novel strategies and new discoveries. Advances have been mad...

  10. Development of Phantom Limb Pain after Femoral Nerve Block

    OpenAIRE

    Sadiah Siddiqui; Anthony N. Sifonios; Vanny Le; Martinez, Marc E.; Eloy, Jean D.; Andrew G. Kaufman

    2014-01-01

    Historically, phantom limb pain (PLP) develops in 50–80% of amputees and may arise within days following an amputation for reasons presently not well understood. Our case involves a 29-year-old male with previous surgical amputation who develops PLP after the performance of a femoral nerve block. Although there have been documented cases of reactivation of PLP in amputees after neuraxial technique, there have been no reported events associated with femoral nerve blockade. We base our discussi...

  11. The College of Podiatry Annual Conference 2015: meeting abstracts

    OpenAIRE

    Tong, Jasper W. K.; Kong, Veni P.; Sze, Lily; Gale, Susie; Veto, John; Tunprasert, Thanaporn; Bradley, Victoria; Strike, Siobhan; Ashford, Robert; Naemi, Roozbeth; Chocklingam, Nachiappan; de Blasc, Xavi; Robinson, Vicki; Nicholls, Emily; Birch, Tabitha

    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 ...

  12. WalkMECH: design and control of an energy recycling transfemoral prosthesis

    OpenAIRE

    Ünal, R.

    2014-01-01

    This study presents the design and realization of an energy-efficient trans-femoral prosthesis called WalkMECH. Trans-femoral amputees consume significant amount of extra metabolic energy (more than 65% extra) during walking compared to the ablebodied person. Therefore, we mainly focused on the design possibilities for reducing the metabolic cost of an amputee during walking. Both clinical and bio-mechanical research studies have shown that the lack of energetic relations between the hip, kne...

  13. Preliminary Evaluations of a Self-Contained Anthropomorphic Transfemoral Prosthesis

    OpenAIRE

    Sup, Frank; Varol, Huseyin Atakan; Mitchell, Jason; Withrow, Thomas J.; Goldfarb, Michael

    2009-01-01

    This paper presents a self-contained powered knee and ankle prosthesis, intended to enhance the mobility of transfemoral amputees. A finite-state based impedance control approach, previously developed by the authors, is used for the control of the prosthesis during walking and standing. Experiments on an amputee subject for level treadmill and overground walking are described. Knee and ankle joint angle, torque, and power data taken during walking experiments at various speeds demonstrate the...

  14. 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. PMID:12043922

  15. Using virtual reality environment to facilitate training with advanced upper-limb prosthesis

    Directory of Open Access Journals (Sweden)

    Linda Resnik, PT, PhD, OCS

    2011-07-01

    Full Text Available Technological advances in upper-limb prosthetic design offer dramatically increased possibilities for powered movement. The DEKA Arm system allows users 10 powered degrees of movement. Learning to control these movements by utilizing a set of motions that, in most instances, differ from those used to obtain the desired action prior to amputation is a challenge for users. In the Department of Veterans Affairs "Study to Optimize the DEKA Arm," we attempted to facilitate motor learning by using a virtual reality environment (VRE program. This VRE program allows users to practice controlling an avatar using the controls designed to operate the DEKA Arm in the real world. In this article, we provide highlights from our experiences implementing VRE in training amputees to use the full DEKA Arm. This article discusses the use of VRE in amputee rehabilitation, describes the VRE system used with the DEKA Arm, describes VRE training, provides qualitative data from a case study of a subject, and provides recommendations for future research and implementation of VRE in amputee rehabilitation. Our experience has led us to believe that training with VRE is particularly valuable for upper-limb amputees who must master a large number of controls and for those amputees who need a structured learning environment because of cognitive deficits.

  16. Determinants of Quality of Life in the Caregivers of Iranian War Survivors with Bilateral Lower-Limb Amputation after More than Two Decades

    Science.gov (United States)

    Ganjparvar, Zohreh; Mousavi, Batool; Masumi, Mehdi; Soroush, Mohammadreza; Montazeri, Ali

    2016-01-01

    Background: Providing care to a disable relative at home exposes the caregiver to a potentially higher risk of physical and mental problems. We measured health-related quality of life (HRQOL) and its determinants among the caregivers of the Iranian survivors of the Iran-Iraq war (1980–1988) with bilateral lower-limb amputation. Methods: Data were collected from 464 individuals comprising war-related bilateral lower-limb amputees (n=232) and their caregivers (n=232) in January 2015 in Shiraz, Iran. The 36-Item Short-Form Health Survey (SF-36) questionnaire was used to evaluate the caregivers’ QOL. Logistic regression analysis was performed to determine the most significant contributing factors. Results: The mean age of the caregivers and the amputees was 39.4±6.2 and 42.5±6.2 years, respectively. The mean duration of disability was 22.8±3.9 years in the amputees. Most of the caregivers were reported to be in their first marriage. The highest and lowest mean scores of the SF-36 domains in the sample population were observed for physical function (76.65±21.97) and bodily pain (53.54±24.95). QOL in the caregivers was significantly lower than that in a sample of the general Iranian female population (Phealth problems (OR: 1.79, 95% CI: 1.02 to 3.15, P=0.04) in the amputees constituted the most important predicting factors in the caregivers’ QOL. Conclusion: The caregivers of the bilateral lower-limb amputees in the current study suffered from a poor QOL. Hospitalization and mental problems were the most significant contributing factors vis-à-vis the caregivers’ HRQOL. Health care and services should, therefore, be provided to both amputees and their caregivers. PMID:27365546

  17. Designing for scale: development of the ReMotion Knee for global emerging markets.

    Science.gov (United States)

    Hamner, Samuel R; Narayan, Vinesh G; Donaldson, Krista M

    2013-09-01

    Amputees living in developing countries have a profound need for affordable and reliable lower limb prosthetic devices. The World Health Organization estimates there are approximately 30 million amputees living in low-income countries, with up to 95% lacking access to prosthetic devices. Effective prosthetics can significantly affect the lives of these amputees by increasing opportunity for employment and providing improvements to long-term health and well-being. However, current solutions are inadequate: state-of-the-art solutions from the US and Europe are cost-prohibitive, while low-cost devices have been challenged by poor quality and/or unreliable performance, and have yet to achieve large scale impact. The introduction of new devices is hampered by the lack of a cohesive prosthetics industry in low-income areas; the current network of low-cost prosthetic clinics is informal and loosely organized with significant disparities in geography, patient volume and demographics, device procurement, clinical and logistical infrastructure, and funding. At D-Rev (Design Revolution) we are creating the ReMotion Knee, which is an affordable polycentric prosthetic knee joint that performs on par with devices in more industrialized regions, like the US and Europe. As of September 2012, over 4200 amputees have been fitted with the initial version of the ReMotion Knee through a partnership with the JaipurFoot Organization, with an 79% compliance rate after 2 years. We are currently scaling production of the ReMotion Knee using centralized manufacturing and distribution to serve the existing clinics in low-income countries and increase the availability of devices for amputees without access to appropriate care. At D-Rev, we develop products that target these customers through economically-sustainable models and provide a measurable impact in the lives of the world's amputees. PMID:23525749

  18. Phantom pain: natural history and association with rehabilitation.

    OpenAIRE

    Houghton, A D; Nicholls, G.; Houghton, A. L.; Saadah, E.; L. McColl

    1994-01-01

    All 338 lower limb amputees under the care of one disablement services centre were asked to assess phantom pain severity at different times after amputation. Of 212 (63%) replies, 13 had died, 22 were non-limb wearers and 22 were unable to complete the questionnaire. In all, 176 useful replies were received--96 below-knee, 74 above-knee and 6 through-knee. Of these, 98 amputations were performed for trauma and 78 for vascular disease. Below-knee amputees rehabilitated better than above-knee a...

  19. Management of neglected femoral neck fracture in above knee amputated limb: A case report

    Institute of Scientific and Technical Information of China (English)

    Umesh Meena; Ramesh Meena; Balaji S; Sahil Gaba

    2015-01-01

    The treatment of an above knee amputee who has sustained a fracture of the femoral neck is a challenging situation for both the orthopedic surgeon and the rehabilitation team.These fractures may be managed acutely either by reduction and internal fixation or by endoprosthetic replacement based on the same criteria as in any other patient with otherwise intact limbs.We present a neglected case treated successfully with valgus osteotomy.We conclude that these fractures should be treated with the same urgency and expertise as similar fractures in non-amputees as long-term survival and good quality of life can be expected.

  20. Management of neglected femoral neck fracture in above knee amputated limb: A case report.

    Science.gov (United States)

    Meena, Umesh; Meena, Ramesh; S, Balaji; Gaba, Sahil

    2015-01-01

    The treatment of an above knee amputee who has sustained a fracture of the femoral neck is a chal- lenging situation for both the orthopedic surgeon and the rehabilitation team. These fractures may be managed acutely either by reduction and internal fixation or by endoprosthetic replacement based on the same criteria as in any other patient with otherwise intact limbs.We present a neglected case treated successfully with valgus osteotomy. We conclude that these fractures should be treated with the same urgency and expertise as similar fractures in non-amputees as long-term survival and good quality of life can be expected. PMID:26917032

  1. Development of an implantable transverse intrafascicular multichannel electrode (TIME) system for relieving phantom limb pain

    OpenAIRE

    Jensen W.; Micera S.; Navarro X.; Stieglitz T.; Guiraud D.; Divoux J.L.; Rossini P.M.; Yoshida K.

    2010-01-01

    Phantom limb pain frequently follows amputation. Currently there is no fully effective treatment available. Our aim is to develop an innovative Human Machine Interface (HMI) where we apply multi-channel microstimulation to the nerve stump of an amputee subject to manipulate the phantom limb sensations and explore the possibility of using microstimulation as a treatment for phantom limb pain.

  2. A Clinical Evaluation of Postamputation Phenomena Including Phantom Limb Pain after Lower Limb Amputation in Dysvascular Patients.

    Science.gov (United States)

    Richardson, Cliff; Crawford, Kath; Milnes, Karen; Bouch, Elizabeth; Kulkarni, Jai

    2015-08-01

    To explore the effects of phantom phenomena on a group of dysvascular lower limb amputees. This was a cross-sectional study of dysvascular lower limb amputees. A modified version of the phantom phenomena questionnaire was used to measure the prevalence of phantom phenomena and the effects of those phenomena on daily life. Eighty-nine amputees were recruited. The majority were inpatients (72%) and male (72%). Most had pain before amputation (83%). Sixty-three percent had phantom limb pain. No associations were found between phantom limb pain and preamputation pain (p = .397). Phantom limb pain was present immediately on waking from amputation in 23%. Phantom limb pain is highly fluctuant. It is more likely that phantom limb pain was present with more time passed since amputation (p = .002). Outpatients with unhealed wounds were less likely to have phantom limb pain (p = .007). The effects of postamputation phenomena include sleep loss and social restrictions. These results challenge the belief that phantom limb pain reduces over time as more outpatients reported phantom limb pain than inpatients. Preamputation pain is not linked to the presence of phantom limb pain. The fluctuant nature of phantom limb pain makes its treatment complex. Some may wish intensity to reduce, whereas others may prefer to reduce the number of episodes or duration of each episode instead. More research is needed to clarify the needs of amputees in relation to the postamputation phenomena. PMID:26092194

  3. Phantom limb perception interferes with motor imagery after unilateral upper-limb amputation.

    Science.gov (United States)

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

    2016-01-01

    A potential contributor to impaired motor imagery in amputees is an alteration of the body schema as a result of the presence of a phantom limb. However, the nature of the relationship between motor imagery and phantom experiences remains unknown. In this study, the influence of phantom limb perception on motor imagery was investigated using a hand mental rotation task by means of behavioral and electrophysiological measures. Compared with healthy controls, significantly prolonged response time for both the intact and missing hand were observed specifically in amputees who perceived a phantom limb during the task but not in amputees without phantom limb perception. Event-related desynchronization of EEG in the beta band (beta-ERD) in central and parietal areas showed an angular disparity specifically in amputees with phantom limb perception, with its source localized in the right inferior parietal lobule. The response time as well as the beta-ERD values were significantly positively correlated with phantom vividness. Our results suggest that phantom limb perception during the task is an important interferential factor for motor imagery after amputation and the interference might be related to a change of the body representation resulting from an unnatural posture of the phantom limb. PMID:26879749

  4. The neural basis of phantom limb pain.

    Science.gov (United States)

    Flor, Herta; Diers, Martin; Andoh, Jamila

    2013-07-01

    A recent study suggests that brain changes in amputees may be pain-induced, questioning maladaptive plasticity as a neural basis of phantom pain. These findings add valuable information on cortical reorganization after amputation. We suggest further lines of research to clarify the mechanisms that underlie phantom pain. PMID:23608362

  5. Brug af nervestimulator ved anlaeggelse af nervus ischiadicus-blokade hos en crusamputeret patient

    DEFF Research Database (Denmark)

    Heiring, Christian; Kristensen, Billy B

    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...

  6. Take Care of Yourself After an Amputation or Other Surgery

    Centers for Disease Control (CDC) Podcasts

    2010-02-18

    This podcast provides health information for amputees on how to take care of yourself after an amputation or other surgery.  Created: 2/18/2010 by National Center on Birth Defects and Developmental Disability, Disability and Health Program.   Date Released: 2/18/2010.

  7. Psychological and Educational Studies with Spina Bifida Children. Final Report.

    Science.gov (United States)

    Diller, Leonard; And Others

    To measure school achievements in spina bifida children, to relate these measures to certain variables, to obtain information on educational problems, and to study facets of cognition and its changes with age, 77 spina bifida children and 53 amputees (all aged 5 to 15) were tested. Sixty non-disabled children were at times used for controls. The…

  8. Clinical utility of in-socket residual limb volume change measurement: Case study results

    OpenAIRE

    Sanders, JE; Harrison, DS; Allyn, KJ; Myers, TR

    2009-01-01

    Bioimpedance analysis was used to measure conductive tissue, extracellular fluid volume changes in the residual limbs of four unilateral trans-tibial amputee subjects during standing and walking conditions. Results were useful towards clinical assessment, patient education, and decision-making about treatment.

  9. Energy storage and release of prosthetic feet Part 1: Biomechanical analysis related to user benefits

    NARCIS (Netherlands)

    Postema, K.; Hermens, H.J.; Vries, de J.; Koopman, H.F.J.M.; Eisma, W.H.

    1997-01-01

    The energy storing and releasing behaviour of 2 energy storing feet (ESF) and 2 conventional prosthetic feet (CF) were compared (ESF: Otto Bock Dynamic Pro and Hanger Quantum; CF: Otto Bock Multi Axial and Otto Bock Lager). Ten trans-tibial amputees were selected. The study was designed as a double-

  10. Studies in Reaction to Disability. XII: Structure of Attitudes toward the Physically Disabled; Disability Factor Scales--Amputation, Blindness, Cosmetic Conditions.

    Science.gov (United States)

    Siller, Jerome; And Others

    To describe and to develop instruments to measure attitudes toward amputees, the blind, and those with cosmetic conditions, three groups of subjects responded to one of three large pools of items tapping attitudes toward the three disability conditions. Three new groups of about 500 subjects of diverse demographic characteristics were given one of…

  11. How Depressive Levels Are Related to the Adults' Experiences of Lower-Limb Amputation: A Mixed Methods Pilot Study

    Science.gov (United States)

    Senra, Hugo

    2013-01-01

    The current pilot study aims to explore whether different adults' experiences of lower-limb amputation could be associated with different levels of depression. To achieve these study objectives, a convergent parallel mixed methods design was used in a convenience sample of 42 adult amputees (mean age of 61 years; SD = 13.5). All of them had…

  12. Ventilatory thresholds during wheelchair exercise in individuals with spinal cord injuries.

    Science.gov (United States)

    Coutts, K D; McKenzie, D C

    1995-07-01

    The ventilatory thresholds of 30 male wheelchair athletes were determined from their respiratory and metabolic responses to a continuously progressive exercise protocol to peak oxygen uptake on a wheelchair ergometer. The peak oxygen uptake (peak VO2), ventilatory threshold in 1 min-1 (VTL), and ventilatory threshold expressed as a percentage of peak VO2 (VT%) were measured for all subjects. Statistical analyses of selected subsamples were used to note sport and functional ability level differences in these variables. Analysis of peak VO2 by functional classification (old International Stoke Mandeville Games Federation system; classes 1A-5, plus an amputee class) indicated that paraplegic (classes 2-5) and the amputee class athletes (2.48 1 min-1) were higher than tetraplegic (classes 1A-1C) athletes (0.95 1 min-1). The paraplegic and amputee classes were combined for a comparison of peak VO2 by sport which showed that track athletes (2.80 1 min-1) were higher than basketball players (2.41 1 min-1) who were higher than athletes from other sports (1.88 1 min-1). The VTL analyses demonstrated differences similar to the peak VO2 analyses. The VT% analyses, however, showed no sport differences, but the tetraplegic athletes had higher VT% values (87%) than the paraplegic plus amputee group (69%). PMID:7478733

  13. 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.

  14. Bipolar hip hemiarthroplasty in a patient with an above knee amputation: a case report

    OpenAIRE

    Liebergall Meir; Schwartz Isabella; Safran Ori; Hernandez Miguel; Kandel Leonid; Mattan Yoav

    2009-01-01

    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.

  15. Restoring natural sensory feedback in real-time bidirectional hand prostheses

    DEFF Research Database (Denmark)

    Raspopovic, Stanisa; Capogrosso, Marco; Petrini, Francesco Maria;

    2014-01-01

    amputee during the real-time decoding of different grasping tasks to control a dexterous hand prosthesis. This feedback enabled the participant to effectively modulate the grasping force of the prosthesis with no visual or auditory feedback. Three different force levels were distinguished and consistently...

  16. A robust design procedure for improvement of quality of lower-limb prosthesis.

    Science.gov (United States)

    Chen, Nian-Zhong; Lee, Winson C C; Zhang, Ming

    2006-01-01

    Lower-limb prostheses are used to restore amputee's walking. Monolimb is one of the designs referring to socket and the shank being molded into one piece of thermoplastic material. Appropriate shank flexibility of a monolimb can improve gait of an amputee. However, during the fabrication, the variations of design variables are inevitably produced which may lead the unexpected shank deflection and directly influence on gait efficiency of an amputee. This paper presents a robust design procedure for improvement of quality of the monolimb by simultaneously minimizing performance variations caused by variations in design variables and bringing the mean value of performance on target. The robust design procedure embodies the integration of response surface methodology with genetic algorithms. Response surface models are developed for the responses of monolimb as functions of design variables over the region of interest and genetic algorithms are employed to find the robust solution. A robust design of monolimb is performed for an amputee subject and the results show that the robust design can design a "robust" monolimb which provides specified performance targets that are minimally sensitive to the variations of design variables. This indicates that robust design may have the potential application in improving the quality of the prescribed prosthesis. PMID:17075166

  17. 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 reason

  18. Accelerations due to impact at heel strike using below-knee prosthesis

    NARCIS (Netherlands)

    Jaarsveld, van H.W.L.; Grootenboer, H.J.; Vries, de 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 carr

  19. Dual Window Pattern Recognition Classifier for Improved Partial-Hand Prosthesis Control

    Science.gov (United States)

    Earley, Eric J.; Hargrove, Levi J.; Kuiken, Todd A.

    2016-01-01

    Although partial-hand amputees largely retain the ability to use their wrist, it is difficult to preserve wrist motion while using a myoelectric partial-hand prosthesis without severely impacting control performance. Electromyogram (EMG) pattern recognition is a well-studied control method; however, EMG from wrist motion can obscure myoelectric finger control signals. Thus, to accommodate wrist motion and to provide high classification accuracy and minimize system latency, we developed a training protocol and a classifier that switches between long and short EMG analysis window lengths. Seventeen non-amputee and two partial-hand amputee subjects participated in a study to determine the effects of including EMG from different arm and hand locations during static and/or dynamic wrist motion in the classifier training data. We evaluated several real-time classification techniques to determine which control scheme yielded the highest performance in virtual real-time tasks using a three-way ANOVA. We found significant interaction between analysis window length and the number of grasps available. Including static and dynamic wrist motion and intrinsic hand muscle EMG with extrinsic muscle EMG significantly reduced pattern recognition classification error by 35%. Classification delay or majority voting techniques significantly improved real-time task completion rates (17%), selection (23%), and completion (11%) times, and selection attempts (15%) for non-amputee subjects, and the dual window classifier significantly reduced the time (8%) and average number of attempts required to complete grasp selections (14%) made in various wrist positions. Amputee subjects demonstrated improved task timeout rates, and made fewer grasp selection attempts, with classification delay or majority voting techniques. Thus, the proposed techniques show promise for improving control of partial-hand prostheses and more effectively restoring function to individuals using these devices. PMID

  20. Combined mirror visual and auditory feedback therapy for upper limb phantom pain: a case report

    Directory of Open Access Journals (Sweden)

    Yan Kun

    2011-01-01

    Full Text Available Abstract Introduction Phantom limb sensation and phantom limb pain is a very common issue after amputations. In recent years there has been accumulating data implicating 'mirror visual feedback' or 'mirror therapy' as helpful in the treatment of phantom limb sensation and phantom limb pain. Case presentation We present the case of a 24-year-old Caucasian man, a left upper limb amputee, treated with mirror visual feedback combined with auditory feedback with improved pain relief. Conclusion This case may suggest that auditory feedback might enhance the effectiveness of mirror visual feedback and serve as a valuable addition to the complex multi-sensory processing of body perception in patients who are amputees.

  1. The status of application and physiotherapy-rehabilitation of prosthetics in Turkey.

    Science.gov (United States)

    Ünver, Banu; Şahan, Tezel Yıldırım; Türkyılmaz, Seda; Karagözoğlu, Ayşe; Ülger, Özlem

    2016-05-01

    [Purpose] The aim of this study was to determine the frequency of prosthetic applications and to appraise the importance of amputee rehabilitation in Turkey. [Subjects and Methods] Questionnaires were administered to owners or employees of 36 institutions and the obtained data were evaluated. [Results] While 75% of institutions had no physiotherapist, 25% had 1 or 2 physiotherapists; there were 4 or fewer technicians in 86.1%, and the majority of employees were out of profession in almost all institutions. A total of 83.3% of institutions reported falls, 75% reported complications, 58.3% of them occasionally noted the need of repair; 55.6% of institutions made preprosthetic assessments, 63.9% used gait analysis, and 50% performed prosthetic rehabilitation frequently. [Conclusion] The results of this study reveal the need for more physiotherapists in these centers, the utilization of standardized-objective assessment methods, and development of rehabilitation processes for successful prosthetic applications and amputee rehabilitation in Turkey. PMID:27313365

  2. Metal bar prevents phantom limb motion: case study of an amputation patient who showed a profound change in the awareness of his phantom limb.

    Science.gov (United States)

    Kawashima, Noritaka; Mita, Tomoki

    2009-12-01

    This case report describes an amputee (patient A.S., a 60-year-old male forelimb amputee) who had an extraordinary experience with a phantom limb. He complained that he could not move the wrist of his phantom limb because a metal bar was perceived to be grasped by the hand. As a solution for removing the metal bar, we invited the patient to undergo mirror reflection-induced visual feedback therapy. The patient reported that the metal bar previously grasped by his hand was successfully removed from the phantom during the course of therapy. Interestingly, this experience was accompanied by profound changes in the EMG modulation in the residual wrist muscles. In this article, the possible mechanisms underlying this interesting phenomenon will be discussed. PMID:19585348

  3. Online human training of a myoelectric prosthesis controller via actor-critic reinforcement learning.

    Science.gov (United States)

    Pilarski, Patrick M; Dawson, Michael R; Degris, Thomas; Fahimi, Farbod; Carey, Jason P; Sutton, Richard S

    2011-01-01

    As a contribution toward the goal of adaptable, intelligent artificial limbs, this work introduces a continuous actor-critic reinforcement learning method for optimizing the control of multi-function myoelectric devices. Using a simulated upper-arm robotic prosthesis, we demonstrate how it is possible to derive successful limb controllers from myoelectric data using only a sparse human-delivered training signal, without requiring detailed knowledge about the task domain. This reinforcement-based machine learning framework is well suited for use by both patients and clinical staff, and may be easily adapted to different application domains and the needs of individual amputees. To our knowledge, this is the first my-oelectric control approach that facilitates the online learning of new amputee-specific motions based only on a one-dimensional (scalar) feedback signal provided by the user of the prosthesis. PMID:22275543

  4. Development of phantom limb pain after femoral nerve block.

    Science.gov (United States)

    Siddiqui, Sadiah; Sifonios, Anthony N; Le, Vanny; Martinez, Marc E; Eloy, Jean D; Kaufman, Andrew G

    2014-01-01

    Historically, phantom limb pain (PLP) develops in 50-80% of amputees and may arise within days following an amputation for reasons presently not well understood. Our case involves a 29-year-old male with previous surgical amputation who develops PLP after the performance of a femoral nerve block. Although there have been documented cases of reactivation of PLP in amputees after neuraxial technique, there have been no reported events associated with femoral nerve blockade. We base our discussion on the theory that symptoms of phantom limb pain are of neuropathic origin and attempt to elaborate the link between regional anesthesia and PLP. Further investigation and understanding of PLP itself will hopefully uncover a relationship between peripheral nerve blocks targeting an affected limb and the subsequent development of this phenomenon, allowing physicians to take appropriate steps in prevention and treatment. PMID:24872817

  5. Metabolics of stair ascent with a powered transfemoral prosthesis.

    Science.gov (United States)

    Ledoux, E D; Lawson, B E; Shultz, A H; Bartlett, H L; Goldfarb, M

    2015-01-01

    This paper evaluates the effectiveness of a powered knee and ankle prosthesis for stair ascent through a metabolic assessment comparing energy expenditure of a single transfemoral amputee subject while ascending stairs with the powered prosthesis relative to his passive daily use device, as well as comparing the kinematics and kinetics obtained with the passive prosthesis to healthy biomechanics. The subject wore a portable system that measured pulmonary gaseous exchange rates of oxygen and carbon dioxide while he ascended stairs with each of the prostheses in alternating tests. The results indicated that the amputee's energy expenditure decreased by 32 percent while climbing with the powered prosthesis as compared to his passive one, and the kinematics and kinetics achieved were representative of healthy biomechanics. PMID:26737489

  6. Studies on regeneration of central nervous system and social ability of the earthworm Eudrilus eugeniae.

    Science.gov (United States)

    Gopi Daisy, Nino; Subramanian, Elaiya Raja; Selvan Christyraj, Jackson Durairaj; Sudalai Mani, Dinesh Kumar; Selvan Christyraj, Johnson Retnaraj Samuel; Ramamoorthy, Kalidas; Arumugaswami, Vaithilingaraja; Sivasubramaniam, Sudhakar

    2016-09-01

    Earthworms are segmented invertebrates that belong to the phylum Annelida. The segments can be divided into the anterior, clitellar and posterior parts. If the anterior part of the earthworm, which includes the brain, is amputated, the worm would essentially survive even in the absence of the brain. In these brain amputee-derived worms, the nerve cord serves as the primary control center for neurological function. In this current work, we studied changes in the expression levels of anti-acetylated tubulin and serotonin as the indicators of neuro-regenerative processes. The data reveal that the blastemal tissues express the acetylated tubulin and serotonin from day four and that the worm amputated at the 7th segment takes 30 days to complete the regeneration of brain. The ability of self-assemblage is one of the specific functions of the earthworm's brain. The brain amputee restored the ability of self-assemblage on the eighth day. PMID:27279085

  7. [Psychological adjustment following lower limb amputation].

    Science.gov (United States)

    Panyi, Lilla Krisztina; Lábadi, Beatrix

    2015-09-27

    Rehabilitation of lower limb amputees and the fitting of their prosthesis depend highly on the psychological adjustment process and motivational state of the patient. The loss of a limb is extremely challenging and can cause various physical and psychological problems. Depression, anxiety, decreased well-being and quality of life, body image dissatisfaction and changes in self-concept and identity are frequent after lower limb amputation. In the interest of adjustment patients have to cope with the emerging changes and difficulties in their lifes as well as the problems in psychological functioning. It is important for them to accept the alterations in their body and identity, and integrate them in a new self-concept in which process motivation is a fundamental issue. The aim of this article is to review the literature on psychological consequences of lower limb amputation, and to propose an integrative way of rehabilitation for lower limb amputees. PMID:26550913

  8. Clinical detection and movement recognition of neuro signals

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xiao-wen; YANG Yu-pu; XU Xiao-ming; HU Tian-pei; GAO Zhong-hua; ZHANG Jian; CHEN Tong-yi; CHEN Zhong-wei

    2005-01-01

    Neuro signal has many more advantages than myoelectricity in providing information for prosthesis control, and can be an ideal source for developing new prosthesis. In this work, by implanting intrafascicular electrode clinically in the amputee's upper extremity, collective signals from fascicules of three main nerves (radial nerve, ulnar nerve and medium nerve) were successfully detected with sufficient fidelity and without infection. Initial analysis of features under different actions was performed and movement recognition of detected samples was attempted. Singular value decomposition features (SVD) extracted from wavelet coefficients were used as inputs for neural network classifier to predict amputee's movement intentions. The whole training rate was up to 80.94% and the test rate was 56.87% without over-training. This result gives inspiring prospect that collective signals from fascicules of the three main nerves are feasible sources for controlling prosthesis. Ways for improving accuracy in developing prosthesis controlled by neuro signals are discussed in the end.

  9. Patient-Specific Prosthetic Fingers by Remote Collaboration - A Case Study

    CERN Document Server

    Cabibihan, John-John

    2011-01-01

    The concealment of amputation through prosthesis usage can shield an amputee from social stigma and help improve the emotional healing process especially at the early stages of hand or finger loss. However, the traditional techniques in prosthesis fabrication defy this as the patients need numerous visits to the clinics for measurements, fitting and follow-ups. This paper presents a method for constructing a prosthetic finger through online collaboration with the designer. The main input from the amputee comes from the Computer Tomography (CT) data in the region of the affected and the non-affected fingers. These data are sent over the internet and the prosthesis is constructed using visualization, computer-aided design and manufacturing tools. The finished product is then shipped to the patient. A case study with a single patient having an amputated ring finger at the proximal interphalangeal joint shows that the proposed method has a potential to address the patient's psychosocial concerns and minimize the ...

  10. Accelerations due to impact at heel strike using below-knee prosthesis.

    Science.gov (United States)

    Van Jaarsveld, H W; Grootenboer, H J; De Vries, J

    1990-08-01

    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 carried out in the rehabilitation centre "Het Roessingh", Enschede, The Netherlands. Maximum accelerations were extracted from the acceleration-time-signal. Mean acceleration maxima of all subjects were calculated for each foot-shoe combination to eliminate the individual influence of the subjects. In the axial direction the maximal accelerations demonstrate a clear difference among the prosthetic feet and the shoes, while in dorsoventral (tangential) direction the inter-individual variation in the acceleration extremes dominates the difference between the types of footwear. In comparison with non-amputees the magnitude of the maximal axial acceleration at heel strike does not differ significantly. PMID:2235301

  11. Assessment of AK (Above Knee) Prosthesis with Different Ankle Assembly Using GRF Pattern in Stance Phase

    Science.gov (United States)

    Kim, Sung-Min; Kim, Sung-Jae; Bae, Ha-Suk

    In this study, ground reaction force (GRF), absolute symmetry index (ASI) and coefficient of variation (CV) of fixed, single-axis and multi-axis prosthetic ankle assemblies were investigated by biomechanical evaluation of above knee amputees. In the experiments, 37 normal male volunteers, two male and two female Above Knee (AK) amputees GRF data were tested with fixed, single-axis and multi-axis prosthetic ankle assembly. A gait analysis was carried out to derive the ratio of GRF to weight as the percentage of total stance phase for ten points. The results showed that fixed-axis ankle assembly was superior to other two ankle assemblies for forwarding and braking forces. Multi-axis ankle was relatively superior to other two ankle assemblies for gait balancing and movement of the mass center. Single-axis ankle was relatively superior to the other two ankle assemblies for CV and ASI of GRF.

  12. Development on an implantable system for relieving phantom pain using transversal intrafascicular electrodes

    OpenAIRE

    Stieglitz, Thomas; Boretius, Tim; Navarro, Xavier; Badia, Jordi; Guiraud, David; Divoux, Jean-Louis; Micera, Silvestro; Maria Rossini, Paolo; Yoshida, Ken; Jensen, Winnie

    2011-01-01

    Phantom limb pain develops in the majority of amputees. The underlying mechanisms are not yet com- pletely understood and thus, no treatment is fully effective. Based on recent studies with electrical stimu- lation, we hypothesize that electrical stimulation of afferent nerves with a sufficiently high spatial resolu- tion might alleviate phantom limb pain by giving sensory input to the patient. We present our system con- cepts in general and focus here on a novel electrode concept to selectiv...

  13. Development of a neurotechnological system for relieving phantom limb pain using transverse intrafascicular electrodes (TIME)

    OpenAIRE

    Stieglitz, Thomas; Boretius, Tim; Navarro, Xavier; Badia, Jordi; Guiraud, David; Divoux, Jean-Louis; Micera, Silvestro; Maria Rossini, Paolo; Yoshida, Ken; Harreby, Kristian Rauhe; Kundu, Aritra; Jensen, Winnie

    2012-01-01

    Phantom limb pain (PLP) is a chronic condition that develops in the majority of amputees. The underlying mechanisms are not completely understood, and thus, no treatment is fully effective. Based on recent studies, we hypothesize that electrical stimulation of afferent nerves might alleviate PLP by giving sensory input to the patient if nerve fibers can be activated selectively. The critical component in this scheme is the implantable electrode structure. We present a review of a novel electr...

  14. Human brain somatic representation: a functional magnetic resonance mapping

    Science.gov (United States)

    Romero-Romo, Juan; Rojas, Rafael; Salgado, Perla; Sánchez-Cortázar, Julián; Vazquez-Vela, Arturo; Barrios, Fernando A.

    2001-10-01

    Central nervous system studies of injury and plasticity for the reorganization in the phantom limb sensation area presented. In particular functional magnetic resonance imaging (fMRI) mapping of the somatic and motor cortex of amputee patients, in the case of referred sensations. Using fMRI we can show the correlation between structure and functional field and study the reorganization due to plasticity in the brain.

  15. Treatment of phantom pain with contralateral injection into tender points: a new method of treatment

    Directory of Open Access Journals (Sweden)

    Alaa A El Aziz Labeeb

    2015-01-01

    Conclusion Contralateral injections of 1 ml of 0.25% bupivacaine in the myofascial hyperalgesic areas attenuated phantom limb pain and affected phantom limb sensation. Our study gives a basis of a new method of management of that kind of severe pain to improve the method of rehabilitation of amputee. However, further longitudinal studies with larger number of patients are needed to confirm our study.

  16. Validity of method to quantify transtibial amputees’ free-living prosthetic wearing times and physical activity levels when using suction suspension sockets

    OpenAIRE

    Kit Tzu Tang, EngD; William D. Spence; Douglas Maxwell; Benedict William Stansfield, PhD

    2012-01-01

    Prostheses are prescribed to restore the mobility of people with amputated lower limbs. Monitoring the prosthesis wearing times and physical activity of prosthesis users would provide invaluable information regarding rehabilitation progress and suitability of the prosthesis. The validation of a method to determine wearing times and physical activity state, as well as strides taken, of amputees wearing suction suspension sockets is reported. Eight participants with transtibial amputation were ...

  17. Bilateral transtibial amputation with concomitant thoracolumbar vertebral collapse in a Sichuan earthquake survivor

    OpenAIRE

    Lau Herman; Law Sheung-Wai; Yu Joseph; Wong Caroline; Chan Cavor

    2010-01-01

    Abstract The devastating earthquake in Sichuan, China on 12 May 2008 left thousands of survivors requiring medical care and intensive rehabilitation. In view of this great demand, the Chinese Speaking Orthopaedic Society established the "Stand Tall" project to provide voluntary services to aid amputee victims in achieving total rehabilitation and social integration. This case report highlights the multidisciplinary rehabilitation of a girl who suffered thoracolumbar vertebral collapse and und...

  18. Phantom pain

    OpenAIRE

    Duca, Kristina; Muscat, Richard

    2016-01-01

    Almost anyone with a limb amputation experiences phantom sensations. Moreover, the majority of amputees experience pain. This phenomenon is known as ‘Phantom pain’ and is described as the pain felt from a body part, usually a limb, which is no longer present. Several mechanisms have been proposed in attempt to explain this phenomenon with some being more prevalent than others. Cortical remapping seems to explain a substantial part of the occurrence of phantom pain and will be focu...

  19. Combined mirror visual and auditory feedback therapy for upper limb phantom pain: a case report

    OpenAIRE

    Yan Kun; Chernev Ivan; Wilcher Delia G

    2011-01-01

    Abstract Introduction Phantom limb sensation and phantom limb pain is a very common issue after amputations. In recent years there has been accumulating data implicating 'mirror visual feedback' or 'mirror therapy' as helpful in the treatment of phantom limb sensation and phantom limb pain. Case presentation We present the case of a 24-year-old Caucasian man, a left upper limb amputee, treated with mirror visual feedback combined with auditory feedback with improved pain relief. Conclusion Th...

  20. Treatment of phantom limb pain (PLP) based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient

    OpenAIRE

    Ortiz-Catalan, Max; Sander, Nichlas; Kristoffersen, Morten B.; Håkansson, Bo; Brånemark, Rickard

    2014-01-01

    A variety of treatments have been historically used to alleviate phantom limb pain (PLP) with varying efficacy. Recently, virtual reality (VR) has been employed as a more sophisticated mirror therapy. Despite the advantages of VR over a conventional mirror, this approach has retained the use of the contralateral limb and is therefore restricted to unilateral amputees. Moreover, this strategy disregards the actual effort made by the patient to produce phantom motions. In this work, we investig...

  1. From injured body to changes in self-identity: A research on adults with acquired physical impairments

    OpenAIRE

    Senra, Hugo Renato Carreira Gomes

    2011-01-01

    Background: The experience of becoming physically impaired, especially in lower limb adult amputees and in working-aged patients with vision loss, has deserved little attention by research in general. The weight of some variables associated with these experiences on depressive levels has been stressed by some studies. However, little is known about it. Aims: The current dissertation aimed at filing in the knowledge gap regarding these topics. We intended to explore the exper...

  2. Myoelectric control of prosthetic hands: state-of-the-art review

    OpenAIRE

    Geethanjali, Purushothaman

    2016-01-01

    Purushothaman Geethanjali School of Electrical Engineering Department of Control and Automation VIT University, Vellore, Tamil Nadu, India Abstract: Myoelectric signals (MES) have been used in various applications, in particular, for identification of user intention to potentially control assistive devices for amputees, orthotic devices, and exoskeleton in order to augment capability of the user. MES are also used to estimate force and, hence, torque to actuate the assistive device. The appli...

  3. Anxiety and Depression in Patients with Amputated Limbs Suffering from Phantom Pain: A Comparative Study with Non-Phantom Chronic Pain

    OpenAIRE

    Hadi Kazemi; Shahin Ghassemi; Seyed Mohammad Fereshtehnejad; Afshin Amini; Pier Hossein Kolivand; Taher Doroudi

    2013-01-01

    Background: Phantom limb pain (PLP) is approximately a common condition after limb amputation, which potentially affects the quality of life. We aimed to evaluate anxiety and depression in patients with amputated limbs suffering from PLP and to compare these psychological dysfunctions with that of patients with non-phantom chronic pain. Methods : A total number of 16 male amputees with PLP and 24 male age-matched patients with non-phantom chronic pain were recruited in this study, which wa...

  4. Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery

    OpenAIRE

    MacIver, K.; Lloyd, D M; Kelly, S.; Roberts, N.; Nurmikko, T.

    2008-01-01

    Using functional MRI (fMRI) we investigated 13 upper limb amputees with phantom limb pain (PLP) during hand and lip movement, before and after intensive 6-week training in mental imagery. Prior to training, activation elicited during lip purse showed evidence of cortical reorganization of motor (M1) and somatosensory (S1) cortices, expanding from lip area to hand area, which correlated with pain scores. In addition, during imagined movement of the phantom hand, and executed movement of the in...

  5. Psychophysical correlates of phantom limb experience.

    OpenAIRE

    Katz, J

    1992-01-01

    Phantom limb phenomena were correlated with psychophysiological measures of peripheral sympathetic nervous system activity measured at the amputation stump and contralateral limb. Amputees were assigned to one of three groups depending on whether they reported phantom limb pain, non-painful phantom limb sensations, or no phantom limb at all. Skin conductance and skin temperature were recorded continuously during two 30 minute sessions while subjects continuously monitored and rated the intens...

  6. An MR Safe Algometer to Study Phantom and Residual Limb Pain

    OpenAIRE

    Hui, Benedict; Hughes, Daren; Wu, Hong; Bhatti, Omar; Zhao, Shi; Johnson, Michelle

    2012-01-01

    Researchers are interested in understanding phantom limb pain (PLP) and residual limb pain (RLP) in amputees and the neural mechanisms leading to it. fMRI can provide information on the intensity and the location of activated centers in the brain that control PLP and RLP. MR safe algometers are important to this work. This paper described the new pneumatically actuated algometer and the evaluation methods for MR safety. Our results indicate that the custom device is an improved MR safe algome...

  7. Disappearance of “phantom limb” and amputated arm usage during dreaming in REM sleep behaviour disorder

    OpenAIRE

    Vetrugno, Roberto; Arnulf, Isabelle; Montagna, Pasquale

    2009-01-01

    Limb amputation is followed, in approximately 90% of patients, by “phantom limb” sensations during wakefulness. When amputated patients dream, however, the phantom limb may be present all the time, part of the time, intermittently or not at all. Such dreaming experiences in amputees have usually been obtained only retrospectively in the morning and, moreover, dreaming is normally associated with muscular atonia so the motor counterpart of the phantom limb experience cannot be observed directl...

  8. Phantom limb perception interferes with motor imagery after unilateral upper-limb amputation

    OpenAIRE

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

    2016-01-01

    A potential contributor to impaired motor imagery in amputees is an alteration of the body schema as a result of the presence of a phantom limb. However, the nature of the relationship between motor imagery and phantom experiences remains unknown. In this study, the influence of phantom limb perception on motor imagery was investigated using a hand mental rotation task by means of behavioral and electrophysiological measures. Compared with healthy controls, significantly prolonged response ti...

  9. Factors associated with phantom limb pain: a 31/2-year prospective study

    OpenAIRE

    Bosmans, J.C.; Geertzen, J. H. B.; Post, W.J.; van der Schans, C P; Dijkstra, P.U.

    2010-01-01

    Objective: To analyse the prevalence of phantom (limb) pain over time and to analyse factors associated with phantom (limb) pain in a prospective cohort of amputees. Design: A multicentre longitudinal study. Patients: One hundred and thirty-four patients scheduled for amputation were included. Methods: Patients filled in questionnaires before amputation, and postal questionnaires six months, 1 years and 2 years to a maximum of 3 years after amputation. Preoperative assessment included patient...

  10. A Robot Hand Testbed Designed for Enhancing Embodiment and Functional Neurorehabilitation of Body Schema in Subjects with Upper Limb Impairment or Loss

    OpenAIRE

    Hellman, Randall B.; Justin Tanner; Santos, Veronica J.

    2015-01-01

    Many upper limb amputees experience an incessant, post-amputation “phantom limb pain” and report that their missing limbs feel paralyzed in an uncomfortable posture. One hypothesis is that efferent commands no longer generate expected afferent signals, such as proprioceptive feedback from changes in limb configuration, and that the mismatch of motor commands and visual feedback is interpreted as pain. Non-invasive therapeutic techniques for treating phantom limb pain, such as mirror visual fe...

  11. Advances in Propulsive Bionic Feet and Their Actuation Principles

    OpenAIRE

    Cherelle, Pierre; Mathijssen, Glenn; Wang, Qining; Vanderborght, Bram; lefeber, Dirk

    2014-01-01

    In the past decades, researchers have deeply studied pathological and nonpathological gait to understand the human ankle function during walking. These efforts resulted in the development of new lower limb prosthetic devices aiming at raising the 3C-level (control, comfort, and cosmetics) of amputees. Thanks to the technological advances in engineering and mechatronics, challenges in the field of prosthetics have become an important source of interest for roboticists. Currently, most of the b...

  12. Use of Powered Prosthesis for Children with Upper Limb Deficiency at Hyogo Rehabilitation Center

    OpenAIRE

    Toda, Mitsunori; Chin, Takaaki; Shibata, Yaeko; Mizobe, Futoshi

    2015-01-01

    Background There has been no research investigating the use of powered prosthetic for children in Japan. Objective To gain better insight into the state of powered prosthesis usage and identify a ratio of rejection among children. Methods Subjects were 37 unilateral below elbow amputees between the ages of 0 and 16 at the time of their first experienced fitting with a powered prosthesis at our Center. The information was collected from medical records and through face-to-face interviews, and ...

  13. The Lightweight Delft Cylinder Hand, the First Multi-Articulating Hand That Meets the Basic User Requirements

    OpenAIRE

    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 thicker than a human hand, they operate slower and do not provide proprioceptive force and position feedback. This study presents the Delft Cylinder Hand, a body powered prosthetic hand which mass ...

  14. Painful neuroma requiring surgical excision after lower limb amputation caused by landmine explosions

    OpenAIRE

    Sehirlioglu, Ali; Ozturk, Cagatay; Yazicioglu, Kamil; Tugcu, Ilknur; Yilmaz, Bilge; Goktepe, Ahmet Salim

    2007-01-01

    This article reports an analysis of 75 consecutive lower limb amputees who developed painful neuroma requiring surgical excision after lower limb amputation following landmine explosions. This retrospective study analyses the results of 75 patients who were treated for painful neuroma after lower limb amputation following landmine explosions between the years 2000 and 2006. The average time period from use of prosthesis to start of symptoms suggesting neuroma was 9.6 months. The average time ...

  15. Cybernetic prosthesis

    Science.gov (United States)

    Mann, R. W.

    1974-01-01

    Design and development of a prosthetic device fitted to an above elbow amputee is reported that derives control information from the human to modulate power to an actuator to drive the substitute limb. In turn, the artificial limb generates sensory information feedback to the human nervous system and brain. This synergetic unity feeds efferent or motor control information from the human to the machine, and the machine responds, delivering afferent or sensory information back to the man.

  16. Controlling Knee Swing Initiation and Ankle Plantarflexion With an Active Prosthesis on Level and Inclined Surfaces at Variable Walking Speeds

    OpenAIRE

    ,

    2014-01-01

    Improving lower-limb prostheses is important to enhance the mobility of amputees. The purpose of this paper is to introduce an impedance-based control strategy (consisting of four novel algorithms) for an active knee and ankle prosthesis and test its generalizability across multiple walking speeds, walking surfaces, and users. The four algorithms increased ankle stiffness throughout stance, decreased knee stiffness during terminal stance, as well as provided powered ankle plantarflexion and k...

  17. Practical Artifact Cancellation for Myoelectric Prosthesis Control

    OpenAIRE

    Sæther, Marthe

    2008-01-01

    Prostheses are artificial body parts that can be used by amputees. Myoelectric prostheses are controlled by so-called surface electromyograms (sEMG) that are acquired on the skin surface of the residual limb. A well-known problem in myoelectric prostheses is motion artifacts, these artifacts cause unwanted behaviour of the prosthesis. The purpose of this study is to try to cancel the effect motion artifacts have on myoelectric prosthesis control, in order to avoid unsolicited prosthesis be...

  18. Sensory cortical re-mapping following upper-limb amputation and subsequent targeted reinnervation: A case report

    OpenAIRE

    Jun Yao; Albert Chen; Todd Kuiken; Carolina Carmona; Julius Dewald

    2015-01-01

    This case study demonstrates the change of sensory cortical representations of the residual parts of the arm in an individual who underwent a trans-humeral amputation and subsequent targeted reinnervation (TR). As a relatively new surgical technique, TR restores a direct neural connection from amputated sensorimotor nerves to specific target muscles. This method has been successfully applied to upper-limb and lower-limb amputees, and has shown effectiveness in regaining control signals via th...

  19. Epidemiological Study on Reasons for Leg Amputation in Japanese

    OpenAIRE

    Hayashi, Yoshitaka; IMAKI, Masahide; Ogawa, Yukiko; FUCHOKA, Satoshi; OKUDA, Kuniharu

    2006-01-01

    This study was conducted, with special reference to elucidating the causes for lower limb amputation, which would have the most significant effect on "locomotion", the basis of independence of the aged. The subjects were leg amputees for whom artificial limbs had been fitted financed by various insurance policies in Osaka prefecture. The survey was conducted on 3, 138 subjects, from whom acceptable responses were obtained from 1, 460 (recovery rate, 46.5%). Questionnaires were mailed to each ...

  20. Early Interfaced Neural Activity from Chronic Amputated Nerves

    OpenAIRE

    Garde, Kshitija; Keefer, Edward; Botterman, Barry; Galvan, Pedro; Romero, Mario I.

    2009-01-01

    Direct interfacing of transected peripheral nerves with advanced robotic prosthetic devices has been proposed as a strategy for achieving natural motor control and sensory perception of such bionic substitutes, thus fully functionally replacing missing limbs in amputees. Multi-electrode arrays placed in the brain and peripheral nerves have been used successfully to convey neural control of prosthetic devices to the user. However, reactive gliosis, micro hemorrhages, axonopathy and excessive i...

  1. Early interfaced neural activity from chronic amputated nerves

    OpenAIRE

    Kshitija Garde; Barry Botterman; Pedro Galvan

    2009-01-01

    Direct interfacing of transected peripheral nerves with advanced robotic prosthetic devices has been proposed as a strategy for achieving natural motor control and sensory perception of such bionic substitutes, thus fully functionally replacing missing limbs in amputees. Multi-electrode arrays placed in the brain and peripheral nerves have been used successfully to convey neural control of prosthetic devices to the user. However, reactive gliosis, micro hemorrhages, axonopathy and excessive i...

  2. Prosthesis Material

    Science.gov (United States)

    2004-01-01

    In this photograph, Amputee Amie Bradly uses a NASA-developed prosthesis to paint her fingernails. Derived from foam insulation technology used to protect the Space Shuttle External Tank from excessive heat, FAB/CAD, a subsidiary of the Harshberger Prosthetic and Orthotic Center, utilized the technology to replace the heavy, fragile plaster they used to produce master molds for prosthetics. The new material was lighter, cheaper and easier to manufacture than plaster, resulting in lower costs to the customer.

  3. Transverse Carpal Ligament and Forearm Fascia Release for the Treatment of Carpal Tunnel Syndrome Change the Entrance Angle of Flexor Tendons to the A1 Pulley: The Relationship between Carpal Tunnel Surgery and Trigger Finger Occurence

    OpenAIRE

    Nazım Karalezli; Harun Kütahya; Ali Güleç; Serdar Toker; Hakan Karabörk; Ogun, Tunc C.

    2013-01-01

    Purpose. The appearance of trigger finger after decompression of the carpal tunnel without a preexisting symptom has been reported in a few articles. Although, the cause is not clear yet, the loss of pulley action of the transverse carpal ligament has been accused mostly. In this study, we planned a biomechanical approach to fresh cadavers. Methods. The study was performed on 10 fresh amputees of the arm. The angles were measured with (1) the transverse carpal ligament and the distal forearm ...

  4. Novel Method to Evaluate Angular Stiffness of Prosthetic Feet From Linear Compression Tests

    OpenAIRE

    Adamczyk, Peter G.; Roland, Michelle; Hahn, Michael E.

    2013-01-01

    Lower limb amputee gait during stance phase is related to the angular stiffness of the prosthetic foot, which describes the dependence of ankle torque on angular progression of the shank. However, there is little data on angular stiffness of prosthetic feet, and no method to directly measure it has been described. The objective of this study was to derive and evaluate a method to estimate the angular stiffness of prosthetic feet using a simple linear compression test. Linear vertical compress...

  5. 3D ultrasound imaging for prosthesis fabrication and diagnostic imaging

    Energy Technology Data Exchange (ETDEWEB)

    Morimoto, A.K.; Bow, W.J.; Strong, D.S. [and others

    1995-06-01

    The fabrication of a prosthetic socket for a below-the-knee amputee requires knowledge of the underlying bone structure in order to provide pressure relief for sensitive areas and support for load bearing areas. The goal is to enable the residual limb to bear pressure with greater ease and utility. Conventional methods of prosthesis fabrication are based on limited knowledge about the patient`s underlying bone structure. A 3D ultrasound imaging system was developed at Sandia National Laboratories. The imaging system provides information about the location of the bones in the residual limb along with the shape of the skin surface. Computer assisted design (CAD) software can use this data to design prosthetic sockets for amputees. Ultrasound was selected as the imaging modality. A computer model was developed to analyze the effect of the various scanning parameters and to assist in the design of the overall system. The 3D ultrasound imaging system combines off-the-shelf technology for image capturing, custom hardware, and control and image processing software to generate two types of image data -- volumetric and planar. Both volumetric and planar images reveal definition of skin and bone geometry with planar images providing details on muscle fascial planes, muscle/fat interfaces, and blood vessel definition. The 3D ultrasound imaging system was tested on 9 unilateral below-the- knee amputees. Image data was acquired from both the sound limb and the residual limb. The imaging system was operated in both volumetric and planar formats. An x-ray CT (Computed Tomography) scan was performed on each amputee for comparison. Results of the test indicate beneficial use of ultrasound to generate databases for fabrication of prostheses at a lower cost and with better initial fit as compared to manually fabricated prostheses.

  6. Bionic ankle–foot prosthesis normalizes walking gait for persons with leg amputation

    OpenAIRE

    Herr, Hugh M.; Grabowski, Alena M

    2011-01-01

    Over time, leg prostheses have improved in design, but have been incapable of actively adapting to different walking velocities in a manner comparable to a biological limb. People with a leg amputation using such commercially available passive-elastic prostheses require significantly more metabolic energy to walk at the same velocities, prefer to walk slower and have abnormal biomechanics compared with non-amputees. A bionic prosthesis has been developed that emulates the function of a biolog...

  7. The Plasticity of Brain Gray Matter and White Matter following Lower Limb Amputation.

    Science.gov (United States)

    Jiang, Guangyao; Yin, Xuntao; Li, Chuanming; Li, Lei; Zhao, Lu; Evans, Alan C; Jiang, Tianzi; Wu, Jixiang; Wang, Jian

    2015-01-01

    Accumulating evidence has indicated that amputation induces functional reorganization in the sensory and motor cortices. However, the extent of structural changes after lower limb amputation in patients without phantom pain remains uncertain. We studied 17 adult patients with right lower limb amputation and 18 healthy control subjects using T1-weighted magnetic resonance imaging and diffusion tensor imaging. Cortical thickness and fractional anisotropy (FA) of white matter (WM) were investigated. In amputees, a thinning trend was seen in the left premotor cortex (PMC). Smaller clusters were also noted in the visual-to-motor regions. In addition, the amputees also exhibited a decreased FA in the right superior corona radiata and WM regions underlying the right temporal lobe and left PMC. Fiber tractography from these WM regions showed microstructural changes in the commissural fibers connecting the bilateral premotor cortices, compatible with the hypothesis that amputation can lead to a change in interhemispheric interactions. Finally, the lower limb amputees also displayed significant FA reduction in the right inferior frontooccipital fasciculus, which is negatively correlated with the time since amputation. In conclusion, our findings indicate that the amputation of lower limb could induce changes in the cortical representation of the missing limb and the underlying WM connections. PMID:26587289

  8. Quantifying prosthetic gait deviation using simple outcome measures

    Science.gov (United States)

    Kark, Lauren; Odell, Ross; McIntosh, Andrew S; Simmons, Anne

    2016-01-01

    AIM: To develop a subset of simple outcome measures to quantify prosthetic gait deviation without needing three-dimensional gait analysis (3DGA). METHODS: Eight unilateral, transfemoral amputees and 12 unilateral, transtibial amputees were recruited. Twenty-eight able-bodied controls were recruited. All participants underwent 3DGA, the timed-up-and-go test and the six-minute walk test (6MWT). The lower-limb amputees also completed the Prosthesis Evaluation Questionnaire. Results from 3DGA were summarised using the gait deviation index (GDI), which was subsequently regressed, using stepwise regression, against the other measures. RESULTS: Step-length (SL), self-selected walking speed (SSWS) and the distance walked during the 6MWT (6MWD) were significantly correlated with GDI. The 6MWD was the strongest, single predictor of the GDI, followed by SL and SSWS. The predictive ability of the regression equations were improved following inclusion of self-report data related to mobility and prosthetic utility. CONCLUSION: This study offers a practicable alternative to quantifying kinematic deviation without the need to conduct complete 3DGA. PMID:27335814

  9. Symptoms of PTSD Associated With Painful and Nonpainful Vicarious Reactivity Following Amputation.

    Science.gov (United States)

    Giummarra, Melita J; Fitzgibbon, Bernadette M; Tsao, Jack W; Gibson, Stephen J; Rich, Anina N; Georgiou-Karistianis, Nellie; Chou, Michael; Bradshaw, John L; Alphonso, Aimee L; Tung, Monica L; Drastal, Carol A; Hanling, Steven; Pasquina, Paul F; Enticott, Peter G

    2015-08-01

    Although the experience of vicarious sensations when observing another in pain have been described postamputation, the underlying mechanisms are unknown. We investigated whether vicarious sensations are related to posttraumatic stress disorder (PTSD) symptoms and chronic pain. In Study 1, 236 amputees completed questionnaires about phantom limb phenomena and vicarious sensations to both innocuous and painful sensory experiences of others. There was a 10.2% incidence of vicarious sensations, which was significantly more prevalent in amputees reporting PTSD-like experiences, particularly increased arousal and reexperiencing the event that led to amputation (φ = .16). In Study 2, 63 amputees completed the Empathy for Pain Scale and PTSD Checklist-Civilian Version. Cluster analyses revealed 3 groups: 1 group did not experience vicarious pain or PTSD symptoms, and 2 groups were vicarious pain responders, but only 1 had increased PTSD symptoms. Only the latter group showed increased chronic pain severity compared with the nonresponder group (p = .025) with a moderate effect size (r = .35). The findings from both studies implicated an overlap, but also divergence, between PTSD symptoms and vicarious pain reactivity postamputation. Maladaptive mechanisms implicated in severe chronic pain and physical reactivity posttrauma may increase the incidence of vicarious reactivity to the pain of others. PMID:26243674

  10. [Amputation in low-income countries: particularities in epidmiological features and management practices].

    Science.gov (United States)

    Bisseriex, H; Rogez, D; Thomas, M; Truffaut, S; Compere, S; Mercier, H; Dochez, F; Lapeyre, E; Thefenne, L

    2011-12-01

    The epidemiological features and management practices associated with amputation in low-income countries, generally synonymous with the tropics, are different from those observed in Western countries. Unlike developed countries, amputation most frequently involves traumatic injury in young active people. However, Westernization of the lifestyle is leading to an increasing number of cases involving diabetes and atherosclerotic disease. In the developing world, leprosy and Buruli ulcer are still significant etiologic factors for amputation. In war-torn countries, use of antipersonnel landmines is another major cause of amputation with characteristic features. Management of amputees in the developing world is hindered by the lack of facilities for rehabilitation and prosthetic fitting. Many international organizations are supporting national programs to develop such facilities. In addition to being affordable, prosthetics and orthotics must be adapted to the living conditions of a mostly rural amputee population, i.e., heat, humidity, and farm work. The rehabilitation process must be part of a global handicap policy aimed at changing attitudes about disability and reintegrating amputees both socially and professionally. PMID:22393622

  11. A sensory feedback system for prosthetic hand based on evoked tactile sensation.

    Science.gov (United States)

    Liu, X X; Chai, G H; Qu, H E; Lan, N

    2015-08-01

    The lack of reliable sensory feedback has been one of the barriers in prosthetic hand development. Restoring sensory function from prosthetic hand to amputee remains a great challenge to neural engineering. In this paper, we present the development of a sensory feedback system based on the phenomenon of evoked tactile sensation (ETS) at the stump skin of residual limb induced by transcutaneous electrical nerve stimulation (TENS). The system could map a dynamic pattern of stimuli to an electrode placed on the corresponding projected finger areas on the stump skin. A pressure transducer placed at the tip of prosthetic fingers was used to sense contact pressure, and a high performance DSP processor sampled pressure signals, and calculated the amplitude of feedback stimulation in real-time. Biphasic and charge-balanced current pulses with amplitude modulation generated by a multi-channel laboratory stimulator were delivered to activate sensory nerves beneath the skin. We tested this sensory feedback system in amputee subjects. Preliminary results showed that the subjects could perceive different levels of pressure at the tip of prosthetic finger through evoked tactile sensation (ETS) with distinct grades and modalities. We demonstrated the feasibility to restore the perceptual sensation from prosthetic fingers to amputee based on the phenomenon of evoked tactile sensation (ETS) with TENS. PMID:26736798

  12. Epidural electrocorticography of phantom hand movement following long-term upper-limb amputation

    Directory of Open Access Journals (Sweden)

    Alireza eGharabaghi

    2014-05-01

    Full Text Available Introduction: Prostheses for upper-limb amputees are currently controlled by either myoelectric or peripheral neural signals. Performance and dexterity of these devices is still limited, particularly when it comes to controlling hand function. Movement-related brain activity might serve as a complementary bio-signal for motor control of hand prosthesis. Methods: We introduced a methodology to implant a cortical interface without direct exposure of the brain surface in an upper-limb amputee. This bi-directional interface enabled us to explore the cortical physiology following long-term transhumeral amputation. In addition, we investigated neurofeedback of electrocorticographic brain activity related to the patient’s motor imagery to open his missing hand, i.e. phantom hand movement, for real-time control of a virtual hand prosthesis.Results: Both event-related brain potentials and cortical stimulation revealed mutually overlapping cortical representations of the phantom hand. Phantom hand movements could be robustly classified and the patient required only three training sessions to gain reliable control of the virtual hand prosthesis in an online closed-loop paradigm that discriminated between hand opening and rest. Conclusion: Epidural implants may constitute a powerful and safe alternative communication pathway between the brain and external devices for upper-limb amputees, thereby facilitating the integrated use of different signal sources for more intuitive and specific control of multi-functional devices in clinical use.

  13. The Plasticity of Brain Gray Matter and White Matter following Lower Limb Amputation

    Science.gov (United States)

    Jiang, Guangyao; Yin, Xuntao; Li, Chuanming; Li, Lei; Zhao, Lu; Evans, Alan C.; Jiang, Tianzi; Wu, Jixiang; Wang, Jian

    2015-01-01

    Accumulating evidence has indicated that amputation induces functional reorganization in the sensory and motor cortices. However, the extent of structural changes after lower limb amputation in patients without phantom pain remains uncertain. We studied 17 adult patients with right lower limb amputation and 18 healthy control subjects using T1-weighted magnetic resonance imaging and diffusion tensor imaging. Cortical thickness and fractional anisotropy (FA) of white matter (WM) were investigated. In amputees, a thinning trend was seen in the left premotor cortex (PMC). Smaller clusters were also noted in the visual-to-motor regions. In addition, the amputees also exhibited a decreased FA in the right superior corona radiata and WM regions underlying the right temporal lobe and left PMC. Fiber tractography from these WM regions showed microstructural changes in the commissural fibers connecting the bilateral premotor cortices, compatible with the hypothesis that amputation can lead to a change in interhemispheric interactions. Finally, the lower limb amputees also displayed significant FA reduction in the right inferior frontooccipital fasciculus, which is negatively correlated with the time since amputation. In conclusion, our findings indicate that the amputation of lower limb could induce changes in the cortical representation of the missing limb and the underlying WM connections. PMID:26587289

  14. The Plasticity of Brain Gray Matter and White Matter following Lower Limb Amputation

    Directory of Open Access Journals (Sweden)

    Guangyao Jiang

    2015-01-01

    Full Text Available Accumulating evidence has indicated that amputation induces functional reorganization in the sensory and motor cortices. However, the extent of structural changes after lower limb amputation in patients without phantom pain remains uncertain. We studied 17 adult patients with right lower limb amputation and 18 healthy control subjects using T1-weighted magnetic resonance imaging and diffusion tensor imaging. Cortical thickness and fractional anisotropy (FA of white matter (WM were investigated. In amputees, a thinning trend was seen in the left premotor cortex (PMC. Smaller clusters were also noted in the visual-to-motor regions. In addition, the amputees also exhibited a decreased FA in the right superior corona radiata and WM regions underlying the right temporal lobe and left PMC. Fiber tractography from these WM regions showed microstructural changes in the commissural fibers connecting the bilateral premotor cortices, compatible with the hypothesis that amputation can lead to a change in interhemispheric interactions. Finally, the lower limb amputees also displayed significant FA reduction in the right inferior frontooccipital fasciculus, which is negatively correlated with the time since amputation. In conclusion, our findings indicate that the amputation of lower limb could induce changes in the cortical representation of the missing limb and the underlying WM connections.

  15. Staying in dynamic balance on a prosthetic limb: A leg to stand on?

    Science.gov (United States)

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

    2016-06-01

    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 displacement of the center of pressure was reduced and was compensated by an increase in counter-rotation. We show that single-leg stance on a prosthetic limb can be compared to balancing on a narrow ridge. Standing on a prosthetic limb involves the same balance mechanisms as balancing on narrow ridges of 40-mm to 20-mm width. Yet, the ability to balance on a narrow ridge with the sound limb was only a weak predictor for an amputee's ability to stand on the prosthetic limb. Balancing in single-leg stance on a prosthetic limb is not a common activity. The ability to compensate with the sound limb may therefore be functionally more important than the ability to stay in dynamic balance on the prosthetic limb. PMID:27052518

  16. Myoelectric control of prosthetic hands: state-of-the-art review

    Directory of Open Access Journals (Sweden)

    Geethanjali P

    2016-07-01

    Full Text Available Purushothaman Geethanjali School of Electrical Engineering Department of Control and Automation VIT University, Vellore, Tamil Nadu, India Abstract: Myoelectric signals (MES have been used in various applications, in particular, for identification of user intention to potentially control assistive devices for amputees, orthotic devices, and exoskeleton in order to augment capability of the user. MES are also used to estimate force and, hence, torque to actuate the assistive device. The application of MES is not limited to assistive devices, and they also find potential applications in teleoperation of robots, haptic devices, virtual reality, and so on. The myoelectric control-based prosthetic hand aids to restore activities of daily living of amputees in order to improve the self-esteem of the user. All myoelectric control-based prosthetic hands may not have similar operations and exhibit variation in sensing input, deciphering the signals, and actuating prosthetic hand. Researchers are focusing on improving the functionality of prosthetic hand in order to suit the user requirement with the different operating features. The myoelectric control differs in operation to accommodate various external factors. This article reviews the state of the art of myoelectric prosthetic hand, giving description of each control strategy. Keywords: EMG, assistive device, amputee, myoelectric control, electric powered, body ­powered, bioelectric signal control

  17. Experimental induction of a perceived “telescoped” limb using a full-body illusion

    Directory of Open Access Journals (Sweden)

    Laura Schmalzl

    2011-04-01

    Full Text Available Phantom limbs refer to the sensation that an amputated or missing limb is still attached to the body. Phantom limbs may be perceived as continuous with the stump so as to resemble a normal limb, or as “telescoped” with the more distal portion of the phantom being perceived as having withdrawn within the stump. Telescoping tends to be related to increased levels of phantom pain, making it a clinically relevant phenomenon to investigate. In the current study we show that a full-body illusion can be used to induce the sensation of a telescoped limb in healthy individuals. For the induction of the full-body illusion, participants saw the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking. Crucially, the mannequin was missing its left hand so as to resemble an amputee. By manipulating the positioning of the strokes applied to the mannequin’s stump with respect to the participants’ hand we were able to evoke the sensation of the participants’ hand being located either below the stump or, more crucially, “inside” the stump, i.e. telescoped. In three separate experiments these effects were supported by complementary subjective data from questionnaires, verbally reported perceived location of the hand, and manual pointing movements indicating hand position (proprioceptive drift. Taken together our results show that healthy individuals can experience the body of an upper limb amputee as their own, and that this can be associated with telescoping sensations. This is a theoretically important observation as it shows that ownership of an entire body can be evoked in the context of gross anatomical incongruence for a single limb, and that telescoping sensations occur as a consequence of the body representation system trying to reduce this incongruence. Furthermore, the present study might provide a new platform for future studies of the relationship between

  18. "Pulling telescoped phantoms out of the stump": manipulating the perceived position of phantom limbs using a full-body illusion.

    Science.gov (United States)

    Schmalzl, Laura; Thomke, Erik; Ragnö, Christina; Nilseryd, Maria; Stockselius, Anita; Ehrsson, H Henrik

    2011-01-01

    Most amputees experience phantom limbs, or the sensation that their amputated limb is still attached to the body. Phantom limbs can be perceived in the location previously occupied by the intact limb, or they can gradually retract inside the stump, a phenomenon referred to as "telescoping".  Telescoping is relevant from a clinical point of view, as it tends to be related to increased levels of phantom pain. In the current study we demonstrate how a full-body illusion can be used to temporarily revoke telescoping sensations in upper limb amputees. During this illusion participants view the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking, which makes them experience the mannequin's body as their own. In Experiment 1 we used an intact mannequin, and showed that amputees can experience ownership of an intact body as well as referral of touch from both hands of the mannequin. In Experiment 2 and 3 we used an amputated mannequin, and demonstrated that depending on the spatial location of the strokes applied to the mannequin, participants experienced their phantom hand to either remain telescoped, or to actually be located below the stump. The effects were supported by subjective data from questionnaires, as well as verbal reports of the perceived location of the phantom hand in a visual judgment task. These findings are of particular interest, as they show that the temporary revoking of telescoping sensations does not necessarily have to involve the visualization of an intact hand or illusory movement of the phantom (as in the rubber hand illusion or mirror visual feedback therapy), but that it can also be obtained through mere referral of touch from the stump to the spatial location corresponding to that previously occupied by the intact hand. Moreover, our study also provides preliminary evidence for the fact that these manipulations can have an effect on phantom pain sensations

  19. Designing and testing lightweight shoulder prostheses with hybrid actuators for movements involved in typical activities of daily living and impact absorption

    Directory of Open Access Journals (Sweden)

    Sekine M

    2015-07-01

    Full Text Available Masashi Sekine,1,2 Kahori Kita,1 Wenwei Yu1 1Center for Frontier Medical Engineering, 2Graduate School of Engineering, Chiba University, Chiba, Japan Abstract: Unlike forearm amputees, transhumeral amputees have residual stumps that are too small to provide a sufficient range of operation for their prosthetic parts to perform usual activities of daily living. Furthermore, it is difficult for small residual stumps to provide sufficient impact absorption for safe manipulation in daily living, as intact arms do. Therefore, substitution of upper limb function in transhumeral amputees requires a sufficient range of motion and sufficient viscoelasticity for shoulder prostheses under critical weight and dimension constraints. We propose the use of two different types of actuators, ie, pneumatic elastic actuators (PEAs and servo motors. PEAs offer high power-to-weight performance and have intrinsic viscoelasticity in comparison with motors or standard industrial pneumatic cylinder actuators. However, the usefulness of PEAs in large working spaces is limited because of their short strokes. Servo motors, in contrast, can be used to achieve large ranges of motion. In this study, the relationship between the force and stroke of PEAs was investigated. The impact absorption of both types of actuators was measured using a single degree-of-freedom prototype to evaluate actuator compliance for safety purposes. Based on the fundamental properties of the actuators identified, a four degree-of-freedom robotic arm is proposed for prosthetic use. The configuration of the actuators and functional parts was designed to achieve a specified range of motion and torque calculated from the results of a simulation of typical movements performed in usual activities of daily living. Our experimental results showed that the requirements for the shoulder prostheses could be satisfied. Keywords: shoulder prosthesis, hybrid actuation, pneumatic elastic actuator, antagonistic

  20. Development of a Wearable Sensor System for Dynamically Mapping the Behavior of an Energy Storing and Returning Prosthetic Foot

    Science.gov (United States)

    Hawkins, James; Noroozi, Siamak; Dupac, Mihai; Sewell, Philip

    2016-06-01

    It has been recognized that that the design and prescription of Energy Storing and Returning prosthetic running feet are not well understood and that further information on their performance would be beneficial to increase this understanding. Dynamic analysis of an amputee wearing a prosthetic foot is typically performed using reflective markers and motion-capture systems. High-speed cameras and force plates are used to collect data of a few strides. This requires specialized and expensive equipment in an unrepresentative environment within a large area. Inertial Measurement Units are also capable of being used as wearable sensors but suffer from drift issues. This paper presents the development of a wearable sensing system that records the action of an Energy Storing and Returning prosthetic running foot (sagittal plane displacement and ground contact position) which could have research and/or clinical applications. This is achieved using five standalone pieces of apparatus including foot-mounted pressure sensors and a rotary vario-resistive displacement transducer. It is demonstrated, through the collection of profiles for both foot deflection and ground contact point over the duration of a stride, that the system can be attached to an amputee's prosthesis and used in a non-laboratory environment. It was found from the system that the prosthetic ground contact point, for the amputee tested, progresses along the effective metatarsal portion of the prosthetic foot towards the distal end of the prosthesis over the duration of the stride. Further investigation of the effective stiffness changes of the foot due to the progression of the contact point is warranted.

  1. Demographics of Lower Limb Amputations in the Pakistan Military: A Single Center, Three-Year Prospective Survey.

    Science.gov (United States)

    Rathore, Farooq A; Ayaz, Saeed B; Mansoor, Sahibzada N; Qureshi, Ali R; Fahim, Muhammad

    2016-01-01

    INTRODUCTION : The Pakistan military has been actively engaged in the war against terror for more than a decade. Many officers and soldiers have lost their limbs in this war. But the data on traumatic lower limb amputations in Pakistan is sparse. The aim of this study is to prospectively document the epidemiological profile of lower limb military amputees presenting at the largest rehabilitation centre of Pakistan over a three-year period. MATERIALS & METHODS : A prospective three-year survey was conducted at the Armed Forces Institute of Rehabilitation Medicine (AFIRM), Pakistan. One hundred twenty-three consecutive patients with lower limb amputations were enrolled in the survey. The demographic data, etiology, associated injuries, complications profile, and type of prosthesis provided were documented. The data analysis was done using the statistical analysis tool SPSS V 20 (IBM®,NY, USA). RESULTS : All patients were male. Most had traumatic amputation (119), were between 20-40 years (106), with unilateral amputation (115). Mine blast injury was the leading cause in 73 (59.3%) and most (58.5%) were fitted with modular prosthesis. Transtibial amputation was the commonest level (65), followed by transfemoral (30). The time of surgical amputation was not documented in 87% of the patients. Half of the patients (54%) had associated injuries. Seventy-nine patients had at least one complication with phantom pain being the commonest in 25% cases. CONCLUSIONS : This is the largest prospective demographic survey of lower limb amputees in Pakistan military to date. Scores of soldiers and civilians in Pakistan have suffered lower limb amputation. The availability of demographic data can improve the trauma and rehabilitation services for better understanding and management of such cases. There is a need to conduct large scale community-based epidemiological surveys to direct future policies and develop amputee rehabilitation services in the public sector. PMID:27186448

  2. A bio-inspired test system for bionic above-knee prosthetic knees

    Science.gov (United States)

    Wang, Dai-Hua; Xu, Lei; Fu, Qiang; Yuan, Gang

    2013-04-01

    Recently, prosthetic knees in the developing stage are usually tested by installing them on amputees' stumps directly or on above-knee prostheses (AKPs) test platforms. Although amputees can fully provide the actual motion state of the thigh, immature prosthetic knees may hurt amputees. For AKPs test platforms, it just can partly simulate the actual motion state of the thigh with limitation of the motion curve of the thigh, the merits or demerits of newly developed bionic above-knee prosthetic knees cannot be accessed thoroughly. Aiming at the defects of two testing methods, this paper presents a bio-inspired AKPs test system for bionic above-knee prosthetic knees. The proposed bio-inspired AKPs test system is composed of a AKPs test platform, a control system, and a bio-inspired system. The AKPs test platform generates the motion of the thigh simulation mechanism (TSM) via two screw pairs with servo motors. The bio-inspired system includes the tester and the bio-inspired sensor wore by the tester. The control system, which is inspired by the bio-inspired system, generates the control command signal to move the TSM of the AKPs test platform. The bio-inspired AKPs test system is developed and experimentally tested with a commercially available prosthetic knee. The research results show that the bio-inspired AKPs test system can not only ensure the safety of the testers, but also track all kinds of the actual motion state of the thigh of the testers in real time.

  3. Clinical and theoretical parallels between desire for limb amputation and gender identity disorder.

    Science.gov (United States)

    Lawrence, Anne A

    2006-06-01

    Desire for amputation of a healthy limb has usually been regarded as a paraphilia (apotemnophilia), but some researchers propose that it may be a disorder of identity, similar to Gender Identity Disorder (GID) or transsexualism. Similarities between the desire for limb amputation and nonhomosexual male-to-female (MtF) transsexualism include profound dissatisfaction with embodiment, related paraphilias from which the conditions plausibly derive (apotemnophilia and autogynephilia), sexual arousal from simulation of the sought-after status (pretending to be an amputee and transvestism), attraction to persons with the same body type one wants to acquire, and an elevated prevalence of other paraphilic interests. K. Freund and R. Blanchard (1993) proposed that nonhomosexual MtF transsexualism represents an erotic target location error, in which men whose preferred erotic targets are women also eroticize their own feminized bodies. Desire for limb amputation may also reflect an erotic target location error, occurring in combination with an unusual erotic target preference for amputees. This model predicts that persons who desire limb amputation would almost always be attracted to amputees and would display an increased prevalence of gender identity problems, both of which have been observed. Persons who desire limb amputation and nonhomosexual MtF transsexuals often assert that their motives for wanting to change their bodies reflect issues of identity rather than sexuality, but because erotic/romantic orientations contribute significantly to identity, such distinctions may not be meaningful. Experience with nonhomosexual MtF transsexualism suggests possible directions for research and treatment for persons who desire limb amputation. PMID:16799838

  4. Biomechanics of the human walk-to-run gait transition in persons with unilateral transtibial amputation.

    Science.gov (United States)

    Giest, Tracy N; Chang, Young-Hui

    2016-06-14

    Propulsive force production (indicative of intrinsic force-length-velocity characteristics of the plantar flexor muscles) has been shown to be a major determinant of the human walk-to-run transition. The purpose of this work was to determine the gait transition speed of persons with unilateral transtibial amputation donning a passive-elastic prosthesis and assess whether a mechanical limit of their intact side plantar flexor muscles is a major determinant of their walk-to-run transition. We determined each individual׳s gait transition speed (GTS) via an incremental protocol and assessed kinetics and kinematics during walking at speeds 50%, 60%, 70%, 80%, 90%, 100%, 120%, and 130% of that gait transition speed (100%:GTS). Unilateral transtibial amputees transitioned between gaits at significantly slower absolute speeds than matched able-bodied controls (1.73±0.13 and 2.09±0.05m/s respectively, p120%: 0.23±0.05BW, p<0.05). In contrast, amputee subjects' intact side generated significantly higher peak anterior-posterior propulsive forces while walking at speeds above their preferred gait transition speed (100%: 0.28±0.04<110%: 0.30±0.04BW, p<0.05). Changes in propulsive force production were found to be a function of changes in absolute speed, rather than relative to the walk-to-run transition speed. Therefore, the walk-to-run transition in unilateral transtibial amputees is not likely dictated by propulsive force production or the force-length-velocity characteristics of the intact side plantar flexor muscles. PMID:27087677

  5. Pulling telescoped phantoms out of the stump: Manipulating the perceived position of phantom limbs using a full-body illusion

    Directory of Open Access Journals (Sweden)

    Laura eSchmalzl

    2011-11-01

    Full Text Available Most amputees experience phantom limbs, or the sensation that their amputated limb is still attached to the body. Phantom limbs can be perceived in the location previously occupied by the intact limb, or they can gradually retract inside the stump, a phenomenon referred to as telescoping. Telescoping is relevant from a clinical point of view, as it tends to be related to increased levels of phantom pain. In the current study we demonstrate how a full-body illusion can be used to temporarily revoke telescoping sensations in upper limb amputees. During this illusion participants view the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking, which makes them experience the mannequin’s body as their own. In Experiment 1 we used an intact mannequin, and showed that amputees can experience ownership of an intact body as well as referral of touch from both hands of the mannequin. In Experiment 2 and 3 we used an amputated mannequin, and demonstrated that depending on the spatial location of the strokes applied to the mannequin, participants experienced their phantom hand to either remain telescoped, or to actually be located below the stump. The effects were supported by subjective data from questionnaires, as well as verbal reports of the perceived location of the phantom hand in a visual judgment task. These findings are of particular interest, as they show that the temporary revoking of telescoping sensations does not necessarily have to involve the visualization of an intact hand or illusory movement of the phantom (as in the rubber hand illusion or mirror visual feedback therapy, but that it can also be obtained through mere referral of touch from the stump to the spatial location corresponding to that previously occupied by the intact hand. Moreover, our study also provides preliminary evidence for the fact that these manipulations can have an effect on phantom pain

  6. Motor cortex changes after amputation are modulated by phantom limb motor control rather than pain

    DEFF Research Database (Denmark)

    Raffin, Estelle E.; Pascal, Giraux,; Karen, Reilly,; Nathalie, Richard,

    retains a residual M1-c activity when amputees perform phantom limb movements (4-5). Except a correlation between phantom limb pain and M1-c expansion of the face (2-3), the relationship between the ability to voluntary move the phantom hand, the level of phantom limb pain, the degree of M1-c......Amputation of a limb induces reorganization within the contralateral primary motor cortex (M1-c) (1-3). In the case of hand amputation, M1-c areas evoking movements in the face and the remaining part of the upper-limb expand toward the hand area. Despite this expansion, the amputated hand still...

  7. Determinants of Quality of Life in the Caregivers of Iranian War Survivors with Bilateral Lower-Limb Amputation after More than Two Decades

    OpenAIRE

    Zohreh Ganjparvar; Batool Mousavi; Mehdi Masumi; Mohammadreza Soroush; Ali Montazeri

    2016-01-01

    Background: Providing care to a disable relative at home exposes the caregiver to a potentially higher risk of physical and mental problems. We measured health-related quality of life (HRQOL) and its determinants among the caregivers of the Iranian survivors of the Iran-Iraq war (1980–1988) with bilateral lower-limb amputation. Methods: Data were collected from 464 individuals comprising war-related bilateral lower-limb amputees (n=232) and their caregivers (n=232) in January 2015 in Shira...

  8. Effect of primary and secondary wartime below-knee amputation on length of hospitalization and rehabilitation

    OpenAIRE

    Jandrić Slavica; Topić Brano

    2002-01-01

    The results of below-knee amputations in 36 war wounded (mean age 35,42) were reviewed. The majority of the patients was wounded by land mines (94.4%). Most of them were between 25 and 35 years old. Bilateral amputation was done in 2.8% of cases. The amputation was performed on the day of wounding (primary below-knee amputation) in 30 (83.3%) amputees. Secondary amputation after the attempt to save the severely injured lower-limb was performed in 6 patients (16,7%) average 4.61 ± 11.67 days a...

  9. [Phantom limb pain syndrome: therapeutic approach using mirror therapy in a Geriatric Department].

    Science.gov (United States)

    González García, Paloma; Manzano Hernández, M Pilar; Muñoz Tomás, M Teresa; Martín Hernández, Carlos; Forcano García, Mercedes

    2013-01-01

    The clinical use of mirror visual feedback was initially introduced to alleviate phantom pain by restoring motor function through plastic changes in the human primary motor cortex. It is a promising novel technique that gives a new perspective to neurological rehabilitation. Using this therapy, the mirror neuron system is activated and decrease the activity of those systems that perceive protopathic pain, making somatosensory cortex reorganization possible. This paper reports the results of the mirror therapy in three patients with phantom limb pain after recent lower limb amputation, showing its analgesic effects and its benefits as a comprehensive rehabilitation instrument for lower limb amputee geriatric patients. PMID:23498652

  10. “Pulling Telescoped Phantoms Out of the Stump”: Manipulating the Perceived Position of Phantom Limbs Using a Full-Body Illusion

    OpenAIRE

    Laura Schmalzl; Christina Ragnö

    2011-01-01

    Most amputees experience phantom limbs, or the sensation that their amputated limb is still attached to the body. Phantom limbs can be perceived in the location previously occupied by the intact limb, or they can gradually retract inside the stump, a phenomenon referred to as “telescoping”.  Telescoping is relevant from a clinical point of view, as it tends to be related to increased levels of phantom pain. In the current study we demonstrate how a full-body illusion can be used to temporaril...

  11. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation

    OpenAIRE

    Flor, Herta; Elbert, Thomas; Knecht, Stefan; Wienbruch, Christian; Pantev, Christo; Birbaumer, Niels; Larbig, Wolfgang; Taub, Edward

    1995-01-01

    Although phantom-limb pain is a frequent consequence of the amputation of an extremity, little is known about its origin1-4. On the basis of the demonstration of substantial plasticity of the somatosensory cortex after amputation5 or somatosensory deafferentation in adult monkeys6, it has been suggested that cortical reorganization could account for some non-painful phantom-limb phenomena in amputees and that cortical reorganization has an adaptive (that is, pain-preventing) function2,5,7,8. ...

  12. Sexual and food preference in apotemnophilia and anorexia: interactions between 'beliefs' and 'needs' regulated by two-way connections between body image and limbic structures.

    Science.gov (United States)

    Ramachandran, Vilayanur S; Brang, David; McGeoch, Paul D; Rosar, William

    2009-01-01

    Apotemnophilia straddles the boundary between neurology and psychiatry. It is a condition in which individuals experience the strong and specific desire for amputation of a healthy limb. Research suggests this disorder may be of neurological origin, specifically that the body image centers of the brain lack a cortical representation for a particular limb. A curious aspect of this condition is that sufferers often report an attraction to amputees in addition to desiring their own limb be removed. We postulate that sexual 'aesthetic preference' for certain body morphology is dictated in all individuals in part by the cortical representation of one's body image. PMID:19662952

  13. The SmartHand transradial prosthesis

    Directory of Open Access Journals (Sweden)

    Carrozza Maria Chiara

    2011-05-01

    Full Text Available Abstract Background Prosthetic components and control interfaces for upper limb amputees have barely changed in the past 40 years. Many transradial prostheses have been developed in the past, nonetheless most of them would be inappropriate if/when a large bandwidth human-machine interface for control and perception would be available, due to either their limited (or inexistent sensorization or limited dexterity. SmartHand tackles this issue as is meant to be clinically experimented in amputees employing different neuro-interfaces, in order to investigate their effectiveness. This paper presents the design and on bench evaluation of the SmartHand. Methods SmartHand design was bio-inspired in terms of its physical appearance, kinematics, sensorization, and its multilevel control system. Underactuated fingers and differential mechanisms were designed and exploited in order to fit all mechatronic components in the size and weight of a natural human hand. Its sensory system was designed with the aim of delivering significant afferent information to the user through adequate interfaces. Results SmartHand is a five fingered self-contained robotic hand, with 16 degrees of freedom, actuated by 4 motors. It integrates a bio-inspired sensory system composed of 40 proprioceptive and exteroceptive sensors and a customized embedded controller both employed for implementing automatic grasp control and for potentially delivering sensory feedback to the amputee. It is able to perform everyday grasps, count and independently point the index. The weight (530 g and speed (closing time: 1.5 seconds are comparable to actual commercial prostheses. It is able to lift a 10 kg suitcase; slippage tests showed that within particular friction and geometric conditions the hand is able to stably grasp up to 3.6 kg cylindrical objects. Conclusions Due to its unique embedded features and human-size, the SmartHand holds the promise to be experimentally fitted on transradial

  14. An extremely lightweight fingernail worn prosthetic interface device

    Science.gov (United States)

    Yetkin, Oguz; Ahluwalia, Simranjit; Silva, Dinithi; Kasi-Okonye, Isioma; Volker, Rachael; Baptist, Joshua R.; Popa, Dan O.

    2016-05-01

    Upper limb prosthetics are currently operated using several electromyography sensors mounted on an amputee's residual limb. In order for any prosthetic driving interface to be widely adopted, it needs to be responsive, lightweight, and out of the way when not being used. In this paper we discuss the possibility of replacing such electrodes with fingernail optical sensor systems mounted on the sound limb. We present a prototype device that can detect pinch gestures and communicate with the prosthetic system. The device detects the relative position of fingers to each other by measuring light transmitted via tissue. Applications are not limited to prosthetic control, but can be extended to other human-machine interfaces.

  15. Amputation and prosthesis implantation shape body and peripersonal space representations

    OpenAIRE

    Elisa Canzoneri; Marilena Marzolla; Amedeo Amoresano; Gennaro Verni; Andrea Serino

    2013-01-01

    Little is known about whether and how multimodal representations of the body (BRs) and of the space around the body (Peripersonal Space, PPS) adapt to amputation and prosthesis implantation. In order to investigate this issue, we tested BR in a group of upper limb amputees by means of a tactile distance perception task and PPS by means of an audio-tactile interaction task. Subjects performed the tasks with stimulation either on the healthy limb or the stump of the amputated limb, while wearin...

  16. Novel Approaches for Robotic Control Using Flex Sensor

    OpenAIRE

    Sangeetha.P; Deepika R

    2015-01-01

    The aim of the project is to develop the Prosthetic robotic hand using flex sensor for amputees. The main aim of the project is to develop the robotic hand that performs pick and place activities. Here we are using flex sensors to sense the signals from artificial hand signal is transmitted and that signal is used to drive the mechanical hand. Stroke is the third leading cause of the death. Nearly 7, 00,000 people suffered from stroke last year and 2/3 rd of them survived but were...

  17. Optimization-Based Design of a Small Pneumatic-Actuator-Driven Parallel Mechanism for a Shoulder Prosthetic Arm with Statics and Spatial Accessibility Evaluation

    OpenAIRE

    Masashi Sekine; Kento Sugimori; Jose Gonzalez; Wenwei Yu

    2013-01-01

    Human arms undertake most tasks in the activities of daily living (ADLs). When designing shoulder prostheses for high‐level upper‐limb amputees, we should consider not only how to realize high degrees of freedom under weight and shape constraints but also the user’s individual task space in daily life. An appropriate mechanical structure that can make full use of state‐of‐the‐art actuators and a scheme to optimize the structure’s configuration to match users’ spatial access and manipulability...

  18. Automatic segmentation of magnetic resonance images of the trans-femoral residual limb.

    Science.gov (United States)

    Douglas, T S; Solomonidis, S E; Lee, V S; Spence, W D; Sandham, W A; Hadley, D M

    1998-12-01

    An automatic algorithm for the extraction of the skin and bone boundaries from axial magnetic resonance images of the residual limb of trans-femoral amputees is presented. The method makes use of K-means clustering and mathematical morphology. Statistical analysis of the results indicates that the computer-generated boundaries compare favourably to those drawn by human observers. The boundaries may be used in biomechanical modelling of the interaction between the residual limb and the prosthetic socket. The limb/socket interface determines the quality of prosthetic fit, therefore knowledge of this interface is important for the improvement of socket design in order to achieve patient comfort and mobility. PMID:10223645

  19. Prosthetic hand sensor placement: Analysis of touch perception during the grasp

    Directory of Open Access Journals (Sweden)

    Mirković Bojana

    2014-01-01

    Full Text Available Humans rely on their hands to perform everyday tasks. The hand is used as a tool, but also as the interface to “sense” the world. Current prosthetic hands are based on sophisticated multi-fingered structures, and include many sensors which counterpart natural proprioceptors and exteroceptors. The sensory information is used for control, but not sent to the user of the hand (amputee. Grasping without sensing is not good enough. This research is part of the development of the sensing interface for amputees, specifically addressing the analysis of human perception while grasping. The goal is to determine the small number of preferred positions of sensors on the prosthetic hand. This task has previously been approached by trying to replicate a natural sensory system characteristic for healthy humans, resulting in a multitude of redundant sensors and basic inability to make the patient aware of the sensor readings on the subconscious level. We based our artificial perception system on the reported sensations of humans when grasping various objects without seeing the objects (obstructed visual feedback. Subjects, with no known sensory deficits, were asked to report on the touch sensation while grasping. The analysis included objects of various sizes, weights, textures and temperatures. Based on this data we formed a map of the preferred positions for the sensors that is appropriate for five finger human-like robotic hand. The final map was intentionally minimized in size (number of sensors.

  20. Peripheral nervous system origin of phantom limb pain.

    Science.gov (United States)

    Vaso, Apostol; Adahan, Haim-Moshe; Gjika, Artan; Zahaj, Skerdi; Zhurda, Tefik; Vyshka, Gentian; Devor, Marshall

    2014-07-01

    Nearly all amputees continue to feel their missing limb as if it still existed, and many experience chronic phantom limb pain (PLP). What is the origin of these sensations? There is currently a broad consensus among investigators that PLP is a top-down phenomenon, triggered by loss of sensory input and caused by maladaptive cortical plasticity. We tested the alternative hypothesis that PLP is primarily a bottom-up process, due not to the loss of input but rather to exaggerated input, generated ectopically in axotomized primary afferent neurons in the dorsal root ganglia (DRGs) that used to innervate the limb. In 31 amputees, the local anesthetic lidocaine was applied intrathecally and/or to the DRG surface (intraforaminal epidural block). This rapidly and reversibly extinguished PLP and also nonpainful phantom limb sensation (npPLS). Control injections were ineffective. For intraforaminal block, the effect was topographically appropriate. The suppression of PLP and npPLS could also be demonstrated using dilute lidocaine concentrations that are sufficient to suppress DRG ectopia but not to block the propagation of impulses generated further distally in the nerve. PLP is driven primarily by activity generated within the DRG. We recommend the DRG as a target for treatment of PLP and perhaps also other types of regional neuropathic pain. PMID:24769187

  1. Development of a neurotechnological system for relieving phantom limb pain using transverse intrafascicular electrodes (TIME).

    Science.gov (United States)

    Stieglitz, Thomas; Boretius, Tim; Navarro, Xavier; Badia, Jordi; Guiraud, David; Divoux, Jean-Louis; Micera, Silvestro; Rossini, Paolo Maria; Yoshida, Ken; Harreby, Kristian R; Kundu, Aritra; Jensen, Winnie

    2012-12-01

    Phantom limb pain (PLP) is a chronic condition that develops in the majority of amputees. The underlying mechanisms are not completely understood, and thus, no treatment is fully effective. Based on recent studies, we hypothesize that electrical stimulation of afferent nerves might alleviate PLP by giving sensory input to the patient if nerve fibers can be activated selectively. The critical component in this scheme is the implantable electrode structure. We present a review of a novel electrode concept to distribute highly selective electrode contacts over the complete cross section of a peripheral nerve to create a distributed activation of small nerve fiber ensembles at the fascicular level, the transverse intrafascicular multichannel nerve electrode (TIME). The acute and chronic implantations in a small animal model exhibited a good surface and structural biocompatibility as well as excellent selectivity. Implantation studies on large animal models that are closer to human nerve size and anatomical complexity have also been conducted. They proved implant stability and the ability to selectively activate nerve fascicles in a limited proximity to the implant. These encouraging results have opened the way forward for human clinical trials in amputees to investigate the effect of selective electrical stimulation on PLP. PMID:23037514

  2. Where is hidden the ghost in phantom sensations?

    Science.gov (United States)

    Buonocore, Michelangelo

    2015-07-16

    The term phantom sensations (PS) refers to sensations in a missing body part. They are almost universal in amputees and can be both painful and not painful. Although PS have been frequently described in limb amputees, they can also occur in other clinical conditions and several pathophysiological interpretations have been proposed, with a predominance of theories based on a central origin. Actually, different mechanisms are able to create a phantom sensation. After an amputation, PS are frequently generated by the genesis of ectopic action potentials in the interrupted nerve fibers but the PS generator can also be more proximal. Sometimes PS are not created by the stimulation of somatosensory fibers with a missing territory, but they can be the result of central sensitization or neuroplastic changes that allow for the convergence of impulses coming from different body parts (referred sensations), one of which is missing. In conclusion, PS can be generated by both neuropathic and non-neuropathic mechanisms developed in the amputated body part or in other parts of the nervous system. Since these mechanisms are not pathognomonic of amputation there are no hidden ghosts to look for in phantom sensations. The only interpretative rule is just to follow the pathophysiological principles. PMID:26244147

  3. [Mirror, mirror of the wall: mirror therapy in the treatment of phantom limbs and phantom limb pain].

    Science.gov (United States)

    Casale, Roberto; Furnari, Anna; Lamberti, Raul Coelho; Kouloulas, Efthimios; Hagenberg, Annegret; Mallik, Maryam

    2015-01-01

    Phantom limb and phantom limb pain control are pivotal points in the sequence of intervention to bring the amputee to functional autonomy. The alterations of perception and sensation, the pain of the residual limb and the phantom limb are therefore aspects of amputation that should be taken into account in the "prise en charge" of these patients. Within the more advanced physical therapies to control phantom and phantom limb pain there is the use of mirrors (mirror therapy). This article willfocus on its use and on the possible side effects induced by the lack of patient selection and a conflict of body schema restoration through mirror therapy with concurrent prosthetic training and trauma acceptance. Advice on the need to select patients before treatment decisions, with regard to their psychological as well as clinical profile (including time since amputation and clinical setting), and the need to be aware of the possible adverse effects matching different and somehow conflicting therapeutic approaches, are put forward. Thus a coordinated sequence of diagnostic, prognostic and therapeutic procedures carried out by an interdisciplinary rehabilitation team that works globally on all patients' problems is fundamental in the management of amputees and phantom limb pain. Further studies and the development of a multidisciplinary network to study this and other applications of mirror therapy are needed. PMID:26731959

  4. Phantom limb pain--a phenomenon of proprioceptive memory?

    Science.gov (United States)

    Anderson-Barnes, Victoria C; McAuliffe, Caitlin; Swanberg, Kelley M; Tsao, Jack W

    2009-10-01

    Despite the amount of research that has been conducted on phantom limb pain (PLP), the etiology of the condition remains unknown, and treatment options are limited. After an individual loses a limb, the brain continues to detect the presence of the missing limb even though it is no longer attached to the body, likely through proprioceptive signals. The majority of patients with amputations either report the feeling of volitional control over their phantom or a phantom limb that is frozen in a specific position. Many patients also experience PLP. Here we propose a new theory, termed "proprioceptive memory," which may explain some of the unique experiences amputees encounter. We also suggest that memories of the limb's position prior to amputation remain embedded within an individual's subconscious, and pain memories that may be associated with each limb position contribute not only to PLP, but to the experience of a fixed or frozen limb. We suspect that there are memory networks for pain--and other sensations, either positive or negative--that are associated with each limb position, and propose that these memories evolved to protect our bodies from repeated injury. A discussion of mirror therapy as a treatment option for PLP is also provided, as well as an explanation for the efficacy of mirror therapy. The paper offers a unique insight into how and why amputees experience these unusual phenomena. PMID:19556069

  5. Redefining prosthetic ankle mechanics: non-anthropomorphic ankle design.

    Science.gov (United States)

    LaPrè, Andrew K; Sup, Frank

    2013-06-01

    The moment transferred at the residual limb socket interface of transtibial amputees can be a limiting factor of the comfort and activity level of lower limb amputees. The high pressures seen can be a significant source of pain, as well as result in deep tissue damage. The compensation of the sound limbs causes an asymmetrical gait which can be a contributor of early onset osteoarthritis in the sound limbs. It has been shown that the moment transferred with conventional passive prostheses can be lowered in magnitude by aligning the tibia with ground reaction forces, but this limits the effectiveness of the device. With recent powered prosthetics designed to mimic the missing limb, power can be injected into the gait cycle, but can also be limited by this pressure threshold. This paper shows the results of calculations that suggest that altering the prosthetic ankle mechanism can reduce the socket interface moments by as much as 50%. This supports the development of an active non-anthropomorphic ankle prosthesis which reduces socket interface moments while still injecting substantial power levels into the gait cycle. PMID:24187257

  6. Proximal tibiofibular bifurcation synostosis for the management of longitudinal deficiency of the tibia.

    Science.gov (United States)

    Davids, J R; Meyer, L C

    1998-01-01

    Three adults with severe longitudinal deficiency of the tibia (LDT), in which an unossified proximal tibial anlage was present, who had been treated with proximal tibiofibular bifurcation synostosis (PTFBS) in early childhood, were evaluated between 20 and 31 years after the index procedure. All three were found to be functioning well as below-the-knee (BK) amputees. Mediolateral stability and anteroposterior instability of the knee were present in all cases. Instrumented motion analysis revealed diminished loading characteristics of the prosthetic limb, similar to that described for BK amputees in general. The most significant gait deviations at the knee unique to this study group were a quadriceps-avoidance gait pattern and an increased dynamic varus alignment. Instrumented muscle testing suggested that these deviations were a consequence of ligamentous instability. This study supports the concept that the presence of a proximal tibial anlage in severe LDT is indication for a surgical strategy that preserves the biological knee joint. The PTFBS maintains the integrity of the knee-extensor mechanism, the fibular collateral ligament, the tibiofemoral joint capsule, and the medial collateral ligament, enhancing the long-term stability and function of the knee joint. PMID:9449111

  7. User adaptation in long-term, open-loop myoelectric training: implications for EMG pattern recognition in prosthesis control

    Science.gov (United States)

    He, Jiayuan; Zhang, Dingguo; Jiang, Ning; Sheng, Xinjun; Farina, Dario; Zhu, Xiangyang

    2015-08-01

    Objective. Recent studies have reported that the classification performance of electromyographic (EMG) signals degrades over time without proper classification retraining. This problem is relevant for the applications of EMG pattern recognition in the control of active prostheses. Approach. In this study we investigated the changes in EMG classification performance over 11 consecutive days in eight able-bodied subjects and two amputees. Main results. It was observed that, when the classifier was trained on data from one day and tested on data from the following day, the classification error decreased exponentially but plateaued after four days for able-bodied subjects and six to nine days for amputees. The between-day performance became gradually closer to the corresponding within-day performance. Significance. These results indicate that the relative changes in EMG signal features over time become progressively smaller when the number of days during which the subjects perform the pre-defined motions are increased. The performance of the motor tasks is thus more consistent over time, resulting in more repeatable EMG patterns, even if the subjects do not have any external feedback on their performance. The learning curves for both able-bodied subjects and subjects with limb deficiencies could be modeled as an exponential function. These results provide important insights into the user adaptation characteristics during practical long-term myoelectric control applications, with implications for the design of an adaptive pattern recognition system.

  8. Design and Testing of a Bionic Dancing Prosthesis.

    Science.gov (United States)

    Rouse, Elliott J; Villagaray-Carski, Nathan C; Emerson, Robert W; Herr, Hugh M

    2015-01-01

    Traditionally, prosthetic leg research has focused on improving mobility for activities of daily living. Artistic expression such as dance, however, is not a common research topic and consequently prosthetic technology for dance has been severely limited for the disabled. This work focuses on investigating the ankle joint kinetics and kinematics during a Latin-American dance to provide unique motor options for disabled individuals beyond those of daily living. The objective of this study was to develop a control system for a bionic ankle prosthesis that outperforms conventional prostheses when dancing the rumba. The biomechanics of the ankle joint of a non-amputee, professional dancer were acquired for the development of the bionic control system. Subsequently, a professional dancer who received a traumatic transtibial amputation in April 2013 tested the bionic dance prosthesis and a conventional, passive prosthesis for comparison. The ability to provide similar torque-angle behavior of the biological ankle was assessed to quantify the biological realism of the prostheses. The bionic dancing prosthesis overlapped with 37 ± 6% of the non-amputee ankle torque and ankle angle data, compared to 26 ± 2% for the conventional, passive prosthesis, a statistically greater overlap (p = 0.01). This study lays the foundation for quantifying unique, expressive activity modes currently unavailable to individuals with disabilities. Future work will focus on an expansion of the methods and types of dance investigated in this work. PMID:26285201

  9. Use of probabilistic weights to enhance linear regression myoelectric control

    Science.gov (United States)

    Smith, Lauren H.; Kuiken, Todd A.; Hargrove, Levi J.

    2015-12-01

    Objective. Clinically available prostheses for transradial amputees do not allow simultaneous myoelectric control of degrees of freedom (DOFs). Linear regression methods can provide simultaneous myoelectric control, but frequently also result in difficulty with isolating individual DOFs when desired. This study evaluated the potential of using probabilistic estimates of categories of gross prosthesis movement, which are commonly used in classification-based myoelectric control, to enhance linear regression myoelectric control. Approach. Gaussian models were fit to electromyogram (EMG) feature distributions for three movement classes at each DOF (no movement, or movement in either direction) and used to weight the output of linear regression models by the probability that the user intended the movement. Eight able-bodied and two transradial amputee subjects worked in a virtual Fitts’ law task to evaluate differences in controllability between linear regression and probability-weighted regression for an intramuscular EMG-based three-DOF wrist and hand system. Main results. Real-time and offline analyses in able-bodied subjects demonstrated that probability weighting improved performance during single-DOF tasks (p linear regression control. Significance. Use of probability weights can improve the ability to isolate individual during linear regression myoelectric control, while maintaining the ability to simultaneously control multiple DOFs.

  10. Patient-specific prosthetic fingers by remote collaboration--a case study.

    Directory of Open Access Journals (Sweden)

    John-John Cabibihan

    Full Text Available The concealment of amputation through prosthesis usage can shield an amputee from social stigma and help improve the emotional healing process especially at the early stages of hand or finger loss. However, the traditional techniques in prosthesis fabrication defy this as the patients need numerous visits to the clinics for measurements, fitting and follow-ups. This paper presents a method for constructing a prosthetic finger through online collaboration with the designer. The main input from the amputee comes from the Computer Tomography (CT data in the region of the affected and the non-affected fingers. These data are sent over the internet and the prosthesis is constructed using visualization, computer-aided design and manufacturing tools. The finished product is then shipped to the patient. A case study with a single patient having an amputated ring finger at the proximal interphalangeal joint shows that the proposed method has a potential to address the patient's psychosocial concerns and minimize the exposure of the finger loss to the public.

  11. Evaluation of dissociative life of male athletes in some disability sportive branches

    Directory of Open Access Journals (Sweden)

    Hüseyin Kırımoğlu

    2016-03-01

    Full Text Available This research focused on evaluation of dissociative lives of male disabled athletes who played in teams of amputee football league and regional wheelchair basketball league. In this research; general survey method, one of the descriptive research methods, was used. As data collection tools; “Personal Information Form”, “Household Income Form” and “The Dissociation Scale Questioner” were used. A total of 92 male disabled participants (55 amputee football players and 37 wheelchair basketball players were included in the study. There were no significant statistical differences between participants’ dissociation levels and age, educational status, marital status, whether or not being a national player and employment status. However; there was statistically significant difference in terms of use of prostheses-use, sportive branch, household income and time of disability. It may be argued that acquired traumatic events that occur after birth have stronger traumatic life levels/effects compared to congenital traumatic events that occur before or during birth

  12. [Basic principles and difficulties relating to rehabilitation in diabetic patients following amputation].

    Science.gov (United States)

    Jindra, Martin; Věchtová, Bohuslava; Bielmeierová, Jana

    2015-06-01

    Vascular diseases as a result of diabetes mellitus are the most frequent indication for amputation in the Czech republic. Diabetic patients following amputation, unlike the other amputees, very frequently suffer multiple complications. These are both of general and local nature and pose a limitation to rehabilitation care as well as a prosthesis use. The main goal of therapeutic rehabilitation is the practice of locomotion with a prosthesis (artificial limb) and the patients full return to normal life. A team of closely cooperating specialists is involved. The rehabilitation care of amputees is divided into acute and aftercare. Within preoperative care we try to improve the patients physical and psychological condition. Following surgery we verticalize the patient as soon as possible depending on his/her possibilities and condition, we carry out breathing and vascular gymnastics and prevention of thromboembolic disease and we start the care of the stump. When the stump has been healed and shaped, the patient is provided with an artificial limb. The patients equipped with an artificial limb take a walking course where they learn how to handle the limb as well as walk indoors and outdoors and cope with common terrain unevenness.Key words: amputation - diabetes mellitus - walking with an artificial limb - prosthesis - lower limb prosthetics. PMID:26258981

  13. Myoelectric control of prosthetic hands: state-of-the-art review.

    Science.gov (United States)

    Geethanjali, Purushothaman

    2016-01-01

    Myoelectric signals (MES) have been used in various applications, in particular, for identification of user intention to potentially control assistive devices for amputees, orthotic devices, and exoskeleton in order to augment capability of the user. MES are also used to estimate force and, hence, torque to actuate the assistive device. The application of MES is not limited to assistive devices, and they also find potential applications in teleoperation of robots, haptic devices, virtual reality, and so on. The myoelectric control-based prosthetic hand aids to restore activities of daily living of amputees in order to improve the self-esteem of the user. All myoelectric control-based prosthetic hands may not have similar operations and exhibit variation in sensing input, deciphering the signals, and actuating prosthetic hand. Researchers are focusing on improving the functionality of prosthetic hand in order to suit the user requirement with the different operating features. The myoelectric control differs in operation to accommodate various external factors. This article reviews the state of the art of myoelectric prosthetic hand, giving description of each control strategy. PMID:27555799

  14. A Cyber Expert System for Auto-Tuning Powered Prosthesis Impedance Control Parameters.

    Science.gov (United States)

    Huang, He; Crouch, Dustin L; Liu, Ming; Sawicki, Gregory S; Wang, Ding

    2016-05-01

    Typically impedance control parameters (e.g., stiffness and damping) in powered lower limb prostheses are fine-tuned by human experts (HMEs), which is time and resource intensive. Automated tuning procedures would make powered prostheses more practical for clinical use. In this study, we developed a novel cyber expert system (CES) that encoded HME tuning decisions as computer rules to auto-tune control parameters for a powered knee (passive ankle) prosthesis. The tuning performance of CES was preliminarily quantified on two able-bodied subjects and two transfemoral amputees. After CES and HME tuning, we observed normative prosthetic knee kinematics and improved or slightly improved gait symmetry and step width within each subject. Compared to HME, the CES tuning procedure required less time and no human intervention. Hence, using CES for auto-tuning prosthesis control was a sound concept, promising to enhance the practical value of powered prosthetic legs. However, the tuning goals of CES might not fully capture those of the HME. This was because we observed that HME tuning reduced trunk sway, while CES sometimes led to slightly increased trunk motion. Additional research is still needed to identify more appropriate tuning objectives for powered prosthetic legs to improve amputees' walking function. PMID:26407703

  15. Design and Testing of a Bionic Dancing Prosthesis.

    Directory of Open Access Journals (Sweden)

    Elliott J Rouse

    Full Text Available Traditionally, prosthetic leg research has focused on improving mobility for activities of daily living. Artistic expression such as dance, however, is not a common research topic and consequently prosthetic technology for dance has been severely limited for the disabled. This work focuses on investigating the ankle joint kinetics and kinematics during a Latin-American dance to provide unique motor options for disabled individuals beyond those of daily living. The objective of this study was to develop a control system for a bionic ankle prosthesis that outperforms conventional prostheses when dancing the rumba. The biomechanics of the ankle joint of a non-amputee, professional dancer were acquired for the development of the bionic control system. Subsequently, a professional dancer who received a traumatic transtibial amputation in April 2013 tested the bionic dance prosthesis and a conventional, passive prosthesis for comparison. The ability to provide similar torque-angle behavior of the biological ankle was assessed to quantify the biological realism of the prostheses. The bionic dancing prosthesis overlapped with 37 ± 6% of the non-amputee ankle torque and ankle angle data, compared to 26 ± 2% for the conventional, passive prosthesis, a statistically greater overlap (p = 0.01. This study lays the foundation for quantifying unique, expressive activity modes currently unavailable to individuals with disabilities. Future work will focus on an expansion of the methods and types of dance investigated in this work.

  16. Combining Vibrotactile Feedback with Volitional Myoelectric Control for Robotic Transtibial Prostheses.

    Science.gov (United States)

    Chen, Baojun; Feng, Yanggang; Wang, Qining

    2016-01-01

    In recent years, the development of myoelectric control for robotic lower-limb prostheses makes it possible for amputee users to volitionally control prosthetic joints. However, the human-centered control loop is not closed due to the lack of sufficient feedback of prosthetic joint movement, and it may result in poor control performance. In this research, we propose a vibrotactile stimulation system to provide the feedback of ankle joint position, and validate the necessity of combining it with volitional myoelectric control to achieve improved control performance. The stimulation system is wearable and consists of six vibrators. Three of the vibrators are placed on the anterior side of the thigh and the other three on the posterior side of the thigh. To explore the potential of applying the proposed vibrotactile feedback system for prosthetic ankle control, eight able-bodied subjects and two transtibial amputee subjects (TT1 and TT2) were recruited in this research, and several experiments were designed to investigate subjects' sensitivities to discrete and continuous vibration stimulations applied on the thigh. Then, we proposed a stimulation controller to produce different stimulation patterns according to current ankle angle. Amputee subjects were asked to control a virtual ankle displayed on the computer screen to reach different target ankle angles with a myoelectric controller, and control performances under different feedback conditions were compared. Experimental results indicated that subjects were more sensitive to stimulation position changes (identification accuracies were 96.39 ± 0.86, 91.11, and 93.89% for able-bodied subjects, TT1, and TT2, respectively) than stimulation amplitude changes (identification accuracies were 89.89 ± 2.40, 87.04, and 85.19% for able-bodied subjects, TT1, and TT2, respectively). Response times of able-bodied subjects, TT1, and TT2 to stimulation pattern changes were 0.47 ± 0.02 s, 0.53 s, and 0.48

  17. Know pain know gain: proposing a treatment approach for phantom limb pain.

    Science.gov (United States)

    Le Feuvre, Peter; Aldington, D

    2014-03-01

    Phantom limb pain affects between 50 and 80% of amputees. With an increasing number of battle casualties having had an amputation after combat trauma, it is inevitable that both primary and secondary care clinicians will come into contact with a patient with phantom limb pain (PLP). It is widely acknowledged that its complex aetiology means that this condition is often poorly understood and difficult to manage. A growing pathophysiological understanding is shedding new light on the mechanisms which underlie PLP. Knowledge of these mechanisms will inform treatment and enable clinicians to plan and implement solutions which make a difference to those individuals with this condition. This paper seeks to outline current research into this condition and proposes an approach to treatment. This approach has been formulated from an amalgamation of clinical experience working with battle casualties at the Defence Medical Rehabilitation Centre, Headley Court. PMID:24109117

  18. Phantom limb pain: a nursing perspective.

    Science.gov (United States)

    Virani, Anila; Green, Theresa; Turin, Tanvir C

    2014-09-01

    Phantom limb pain (PLP) is a neuropathic pain condition occurring after amputation of a limb. PLP affects amputees' quality of life and results in loss of productivity and psychological distress. The origin of pain from a non-existing limb creates a challenging situation for both patients and nurses. It is imperative to provide patients and nurses with the knowledge that PLP is a real phenomenon that requires care and treatment. This knowledge will lead to reduced problems for patients by allowing them to talk about PLP and ask for help when needed. Understanding of this phenomenon will enable nurses to appreciate the unique features of this form of neuropathic pain and apply appropriate techniques to promote effective pain management. Performing accurate and frequent assessments to understand the unique characteristics of PLP, displaying a non-judgemental attitude towards patients and teaching throughout the peri-operative process are significant nursing interventions. PMID:25182922

  19. Relationship between mechanical sensitivity and postamputation pain: A prospective study

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; IlKjær, Susanne; Jensen, Troels Staehelin

    2000-01-01

    Limb amputation is followed by stump and phantom pain in a large proportion of amputees and postamputation pain may be associated with signs of hyperexcitability such as hyperalgesia to mechanical stimulation. The present study examined the possible relationship between mechanical pain threshold of...... the limb and early (after 1 week) and late (after 6 months) phantom pain. Thirty-five patients scheduled for amputation of the lower limb were examined before, 1 week and 6 months after amputation. On all three examination days pressure-pain thresholds were measured and compared with the simultaneous...... amputation there was a significant and inverse relationship between mechanical thresholds and phantom pain but no relationship was found after 6 months. The findings suggest that although tenderness of the limb before and after amputation is related to early stump and phantom pain, the relationship is weak...

  20. Noise-driven neuroplasticity in self-organizing feature maps: a neurocomputational model of phantom limbs.

    Science.gov (United States)

    Spitzer, M

    1997-01-01

    The term "phantom limb" denotes the sensation that an extremity is present although it has been lost. A number of clinical features and recent findings of cortical map plasticity after destruction of afferent pathways (deafferentation) suggest that phantom limbs are caused by large-scale cortical reorganization processes. However, in paraplegics, who also suffer from cortical deafferentation, phantom sensations rarely develop, and if they do, they are weak, lacking in detail, and delayed, occurring after months. This has been taken to suggest a non-cortical genesis of phantom limbs. This article proposes a biologically plausible minimal neural network model to solve this apparent puzzle. Deafferentation was simulated in trained self-organizing feature maps. Reorganization was found to be directed by input noise. According to the model, the production of input noise by the deafferented primary sensory neuron promotes cortical reorganization in amputees. No such noise is generated or conducted to the cortex in paraplegics. PMID:9151509

  1. Phantom lower limb as a perceptual marker of neural plasticity in the mature human brain.

    Science.gov (United States)

    Aglioti, S; Bonazzi, A; Cortese, F

    1994-03-22

    Three lower limb amputees, who reported phantom sensations, referred somatic stimuli delivered to skin regions proximal to the stump to select points on the phantom limb. Stimuli on the rectum and anus (e.g. during defecation) and on genital areas (e.g. during sexual intercourse) induced analogous, although less precise, mislocation to the phantom limb. Although the representation of the stump in the somatosensory pathway is lateral to that of the amputated lower limb, both anus and genitals are mapped medially to the areas formerly subserving the amputated lower limb. Therefore the mislocalization phenomenon can be considered as a perceptual landmark of new functional connections between the deprived areas and the adjacent ones, thus suggesting a dynamic neural remodelling in the mature nervous system, which was previously considered as a static entity. PMID:8022843

  2. Can neural blocks prevent phantom limb pain?

    Science.gov (United States)

    Borghi, Battista; D'Addabbo, Marco; Borghi, Raffaele

    2014-07-01

    Phantom limb syndrome (PLS) is a syndrome including stump pain, phantom limb pain and not-painful phantom sensations, which involves a large part of amputee patients and often has devastating effects on their quality of life. The efficacy of standard therapies is very poor. Nerve blocks have been investigated for the treatment and prevention of PLS. Epidural and peripheral blocks limited to the first three postamputation days can only reduce acute pain but cannot prevent the later development of PLS. Recent studies have shown that ambulatory prolonged peripheral nerve block (up to 30 days postamputation) may represent a new possible option to treat phantom pain and prevent the development of PLS and chronic pain. PMID:25300383

  3. Mirror visual feedback therapy. A practical approach.

    Science.gov (United States)

    McCabe, Candy

    2011-01-01

    Mirror visual feedback (MVF) was first proposed as a therapy to relieve amputee phantom limb pain in the early 1990s. It is increasingly used to treat a range of other chronic pain conditions. The evidence base to date is limited. Much of the literature consists of pilot projects or case study designs although larger randomized controlled trails are now emerging. However, the described protocols for MVF are inadequate to adapt to clinical practice. In addition, the therapist sees a heterogeneous population whose characteristics may fall outside those of the tight inclusion/exclusion criteria of research studies. This article provides the theoretical background to MVF and a detailed description of applying this therapy in clinical practice. PMID:21106347

  4. Phantom limb pain from spinal sarcoma: a case report.

    Science.gov (United States)

    Cruz, Ernesto; Dangaria, Harsh T

    2013-07-01

    Phantom limb pain is a frequent sequela of amputation. A high prevalence of residual limb pain and back pain also exists among amputees. We present a case of a new-onset severe phantom limb pain resulting from a metastatic spinal mass in an 81-year-old patient with a history of malignant sarcoma and an old hip disarticulation amputation. The metastatic lesion, upon imaging, was found to involve the L3 vertebra and caused moderate compression of the thecal sac on the right and severe right lateral recess stenosis. After the mass was resected, the patient's phantom limb pain resolved. Our case report demonstrates that spinal metastatic pathologies may be a cause of phantom limb pain and should be included in the differential diagnosis of new-onset phantom limb pain or a change in phantom limb pain. PMID:23880049

  5. [Amputations. A five-year epidemiological study in Buenos Aires City].

    Science.gov (United States)

    Mendelevich, Alejandro; Kramer, Marcia; Maiarú, Mariano; Módica, Mariela; Ostolaza, Marco; Peralta, Federico

    2015-01-01

    An amputation is the removal of a limb by surgery or accident. The aim of this paper was to carry out an epidemiological analysis on patients with amputations treated at the Instituto de Rehabilitación Psicofísica between 2009 and 2013. This is a retrospective, observational and cross-sectional study. The analyzed data included a total of 262 patients: 180 men (68.7%) and 82 women (31.3%). Our population mainly included subjects with only one amputated lower limb (83.6%), of vascular etiology (mostly diabetics) and with an average age of 63.5 years. The second sample group comprised traumatic amputees (29.8%), with an average age of 37 years and with a higher frequency of phantom pain. The characteristics of these groups can make them to behave differently during rehabilitation. PMID:26707661

  6. Heterotopic ossification in victims of the London 7/7 bombings.

    Science.gov (United States)

    Edwards, D S; Clasper, J C; Patel, H D L

    2015-12-01

    Heterotopic ossification (HO) is the formation of bone at extraskeletal sites. Over 60% of amputees injured by improvised explosive devices in the recent conflict in Afghanistan have developed HO, resulting in functional impairment. It is hypothesised that a key aetiological factor is the blast wave; however, other environmental and medical risk factors, which the casualties have been exposed to, have also been postulated. The suicide terrorist bombings in London in 2005 resulted in many blast-related casualties, many of whom were managed by the Royal London Hospital. This cohort of severely injured patients whose injuries also included trauma-related amputations shared some, but not all, of the risk factors identified in the military population. We reviewed these patients, in particular to assess the presence or absence of military-established risk factors for the formation of HO in these casualties. PMID:25645697

  7. Proceedings of the first workshop on Peripheral Machine Interfaces: Going beyond traditional surface electromyography

    Directory of Open Access Journals (Sweden)

    Claudio eCastellini

    2014-08-01

    Full Text Available One of the hottest topics in rehabilitation robotics is that of proper control of prosthetic devices. Despite decades of research, the state of the art is dramatically behind the expectations. To shed light on this issue, in June, 2013 the first international workshop on Present and future of non-invasive PNS-Machine Interfaces was convened, hosted by the International Conference on Rehabilitation Robotics. The keyword PNS-Machine Interface (PMI has been selected to denote human-machine interfaces targeted at the limb-deficient, mainly upper-limb amputees, dealing with signals gathered from the peripheral nervous system (PNS in a non-invasive way, that is, from the surface of the residuum. The workshop was intended to provide an overview of the state of the art and future perspectives of such interfaces; this paper represents is a collection of opinions expressed by each and every researcher/group involved in it.

  8. Designing and constructing prototype hand and forearm models (pronation and supination for myoelectric hand prostheses

    Directory of Open Access Journals (Sweden)

    Claudia Marcela Sánchez R

    2010-04-01

    Full Text Available Rehabilitation engineering’s work consists of developing products associated with physical rehabilitation, mainly prostheses for upper and lower extremity amputees. Developing such products implies mechanical design and the suitable selection of materials and manufacturing process to replace some of the functions which a patient may have lost. The work presented here was aimed at establishing an optimal solution for substituting the needs of a patient having had the forearm amputated at the proximal level of the elbow. This article describes the whole process followed, from understanding the medical language to developing a functional prototype able to replace the arm’s two functions (i.e. the hand and forearm’s pronation and supination movements.

  9. Doing it with mirrors: a case study of a novel approach to neurorehabilitation.

    Science.gov (United States)

    Sathian, K; Greenspan, A I; Wolf, S L

    2000-01-01

    Arm amputees can experience the perception of movement of a phantom limb while looking at a mirror reflection of the moving, intact arm superimposed on the perceived phantom. Such use of a mirror to provide illusory visual feedback of movement can be useful in rehabilitation of hemiparetic patients. In this case report, we describe the successful application of "mirror therapy" to the post-stroke rehabilitation of a patient with poor functional use of an upper extremity, due mainly to somatosensory deficits. Mirror therapy facilitated employment of a motor copy strategy (bimanual movements) and later progression to "forced use" of the affected arm. The end result was increased functional use of the affected upper limb. PMID:11228952

  10. Disability pornography: the fetishization of women's vulnerabilities.

    Science.gov (United States)

    Elman, R A

    1997-06-01

    This paper offers a critical exploration of a form of pornography consisting in sexual abuse and exploitation of women and girls with disabilities. This practice allows men to create and maintain their sexual dominance over the female gender. Disability pornography, like all other forms of pornography, but in its own way, contributes to the second-class status of all women, particularly those who are suffering from limitations in mobility and other disabilities. By promoting the castrating, dominant, violent image of women, pornography allows men to justify their abusive behaviors toward women. This form of pornography preys on the vulnerability of disabled women and increases the possibility that they will be abused. The sexually explicit lack of physical mobility is as celebrated in disability pornography as the political mobility of women is condemned in all genres of pornography. Amputee pornography is just one example of this brutal practice. PMID:12319742

  11. Dynamic stability of running: The effects of speed and leg amputations on the maximal Lyapunov exponent

    International Nuclear Information System (INIS)

    In this paper, we study dynamic stability during running, focusing on the effects of speed, and the use of a leg prosthesis. We compute and compare the maximal Lyapunov exponents of kinematic time-series data from subjects with and without unilateral transtibial amputations running at a wide range of speeds. We find that the dynamics of the affected leg with the running-specific prosthesis are less stable than the dynamics of the unaffected leg and also less stable than the biological legs of the non-amputee runners. Surprisingly, we find that the center-of-mass dynamics of runners with two intact biological legs are slightly less stable than those of runners with amputations. Our results suggest that while leg asymmetries may be associated with instability, runners may compensate for this effect by increased control of their center-of-mass dynamics

  12. Cognitive-emotional sensitization contributes to wind-up-like pain in phantom limb pain patients

    DEFF Research Database (Denmark)

    Vase, Lene; Nikolajsen, Lone; Christensen, Bente;

    2011-01-01

    Peripheral mechanisms are known to play a role in phantom pain following limb amputation, and more recently it has been suggested that central mechanisms may also be of importance. Some patients seem to have a psychological sensitivity that predisposes them to react with pain catastrophizing after...... amputation of a limb, and this coping style may contribute to increased facilitation, impaired modulation of nociceptive signals, or both. To investigate how pain catastrophizing, independently of anxiety and depression, may contribute to phantom limb pain and to alterations in pain processing twenty......-four upper-limb amputees with various levels of phantom limb pain were included in the study. Patients' level of pain catastrophizing, anxiety and depression was assessed and they went through quantitative sensory testing (QST) of thresholds (mechanical and thermal) and wind-up-like pain (brush and pinprick...

  13. Mechanical Design, Control Choices and first Return of Use of a Prosthetic Arm

    CERN Document Server

    Thomann, Guillaume

    2007-01-01

    In the world of upper limb prostheses, few companies dominate the majority of the market. They propose different kinds of hand, wrist and elbow prostheses but their control is often difficult to understand by the patients. We have decided to develop new myoelectric prosthetic arm (elbow, wrist and hand) by axing our development on the use of new technologies and facility of use for the patient. In this paper, we are explaining in details the different kinds of prostheses currently proposed to the amputees, their advantages and their drawbacks, the descriptions of the patients' needs and the possible improvements of the product. We will develop the designing choices of our prosthesis and the movements it can realize. Then we will explain the simplified control of the product by the patient and its first reactions. Finally, we will conclude by the news ideas and the next researches to concretize.

  14. Dynamic stability of running: The effects of speed and leg amputations on the maximal Lyapunov exponent

    Energy Technology Data Exchange (ETDEWEB)

    Look, Nicole [Department of Applied Mathematics, University of Colorado Boulder, Boulder, Colorado 80309 (United States); Arellano, Christopher J.; Grabowski, Alena M.; Kram, Rodger [Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado 80309 (United States); McDermott, William J. [The Orthopedic Specialty Hospital, Murray, Utah 84107 (United States); Bradley, Elizabeth [Department of Computer Science, University of Colorado Boulder, Boulder, Colorado 80309, USA and Santa Fe Institute, Santa Fe, New Mexico 87501 (United States)

    2013-12-15

    In this paper, we study dynamic stability during running, focusing on the effects of speed, and the use of a leg prosthesis. We compute and compare the maximal Lyapunov exponents of kinematic time-series data from subjects with and without unilateral transtibial amputations running at a wide range of speeds. We find that the dynamics of the affected leg with the running-specific prosthesis are less stable than the dynamics of the unaffected leg and also less stable than the biological legs of the non-amputee runners. Surprisingly, we find that the center-of-mass dynamics of runners with two intact biological legs are slightly less stable than those of runners with amputations. Our results suggest that while leg asymmetries may be associated with instability, runners may compensate for this effect by increased control of their center-of-mass dynamics.

  15. Neuroprostheses for increasing disabled patients' mobility and control.

    Science.gov (United States)

    Mikołajewska, Emilia; Mikołajewski, Dariusz

    2012-01-01

    Neuroprostheses are electronic devices using electrophysiological signals to stimulate muscles, electronic/ mechanical devices such as substitutes for limbs or parts of limbs, or computers. The development of neuroprostheses was possible thanks to advances in understanding of the physiology of the human brain and in the capabilities of hardware and software. Recent progress in the area of neuroprosthetics may offer important breakthroughs in therapy and rehabilitation. New dedicated solutions for disabled people can lead to their increased participation in social, educational and professional areas. It is worth focussing particular attention on new solutions for people with paralysis, people with communication disorders and amputees. This article aims at investigating the extent to which the available opportunities are being exploited, including current and potential future applications of brain-computer interfaces. PMID:23214292

  16. Physical and social factors determining quality of life for veterans with lower-limb amputation(s)

    DEFF Research Database (Denmark)

    Christensen, Jan; Ipsen, Thomas; Doherty, Patrick; Langberg, Henning

    Purpose Most veterans live for many years after their war-related traumatic lower-limb amputation, which is why understanding which factors influence health-related quality of life (HRQoL) remains important to their long-term management. The objective of this study was to perform a review of the......-limb amputation(s), HRQoL outcome and veterans. Physical and social factors that influence HRQoL were extracted. Results The literature search identified 2073 citations, leading to the inclusion of 10 studies in the systematic review. Physical activity level, sport participation, level of amputation, back pain......, years of education, as well as duration and severity of phantom pain were found to be determining factors for HRQoL among veterans with lower-limb amputation. Conclusions The identified physical and social determinants were similar to those found in civilian traumatic amputees. More high quality...

  17. Biomechanical and clinical evaluation of a newly designed polycentric knee of transfemoral prosthesis.

    Science.gov (United States)

    Yokogushi, Kazutoshi; Narita, Hiroshi; Uchiyama, Eiichi; Chiba, Susumu; Nosaka, Toshiya; Yamakoshi, Ken-ichi

    2004-09-01

    We have designed a new polycentric knee adopting a hydraulic unit and an intelligent mechanism. The biomechanical parameters of this prototype, such as the stance duration, peak knee flexion angle in stance and swing, peak hip flexion angle, and peak hip extension moments were analyzed at three different cadences (88, 96, 104 steps/min) in three amputees, and then compared to those of polycentric hydraulic knees currently in use. The same parameters were also measured for 10 healthy volunteers and subsequently analyzed. In the prototype, almost all the values of the parameters showed no significant variety in individuals at the different cadences. The situation was the same with the healthy volunteers. However, the values of the parameter for the conventional knee varied significantly with the individual at the different cadences. The prototype may be of practical use, contributing to a stable walk even at different cadences. PMID:15558397

  18. Preliminary evaluation of the tactile feedback system based on artificial skin and electrotactile stimulation.

    Science.gov (United States)

    Franceschi, M; Seminara, L; Pinna, L; Dosen, S; Farina, D; Valle, M

    2015-08-01

    This research is motivated by the need of integrating cutaneous sensing into a prosthetic device, enabling a bidirectional communication between the amputee and the prosthetic limb. An electronic skin based on piezoelectric polymer sensors transduces mechanical contact into electrical response which is conveyed to the human subject by electrotactile stimulation. Rectangular electrode arrays are placed on each patient's forearm and experiments are conducted on five different subjects to determine how well the orientation, position and direction of single lines are recognized. Overall, subjects discriminate the different touch modalities with acceptable success rates. In particular, the direction is identified at best and longitudinal lines on the patient's skin are recognized with the highest success rates. These preliminary results assess the feasibility of the artificial skin - electrostimulation system for prosthetic applications. PMID:26737307

  19. Online Phase Detection Using Wearable Sensors for Walking with a Robotic Prosthesis

    Directory of Open Access Journals (Sweden)

    Maja Goršič

    2014-02-01

    Full Text Available This paper presents a gait phase detection algorithm for providing feedback in walking with a robotic prosthesis. The algorithm utilizes the output signals of a wearable wireless sensory system incorporating sensorized shoe insoles and inertial measurement units attached to body segments. The principle of detecting transitions between gait phases is based on heuristic threshold rules, dividing a steady-state walking stride into four phases. For the evaluation of the algorithm, experiments with three amputees, walking with the robotic prosthesis and wearable sensors, were performed. Results show a high rate of successful detection for all four phases (the average success rate across all subjects >90%. A comparison of the proposed method to an off-line trained algorithm using hidden Markov models reveals a similar performance achieved without the need for learning dataset acquisition and previous model training.

  20. Integrated and flexible multichannel interface for electrotactile stimulation

    Science.gov (United States)

    Štrbac, Matija; Belić, Minja; Isaković, Milica; Kojić, Vladimir; Bijelić, Goran; Popović, Igor; Radotić, Milutin; Došen, Strahinja; Marković, Marko; Farina, Dario; Keller, Thierry

    2016-08-01

    Objective. The aim of the present work was to develop and test a flexible electrotactile stimulation system to provide real-time feedback to the prosthesis user. The system requirements were to accommodate the capabilities of advanced multi-DOF myoelectric hand prostheses and transmit the feedback variables (proprioception and force) using intuitive coding, with high resolution and after minimal training. Approach. We developed a fully-programmable and integrated electrotactile interface supporting time and space distributed stimulation over custom designed flexible array electrodes. The system implements low-level access to individual stimulation channels as well as a set of high-level mapping functions translating the state of a multi-DoF prosthesis (aperture, grasping force, wrist rotation) into a set of predefined dynamic stimulation profiles. The system was evaluated using discrimination tests employing spatial and frequency coding (10 able-bodied subjects) and dynamic patterns (10 able-bodied and 6 amputee subjects). The outcome measure was the success rate (SR) in discrimination. Main results. The more practical electrode with the common anode configuration performed similarly to the more usual concentric arrangement. The subjects could discriminate six spatial and four frequency levels with SR >90% after a few minutes of training, whereas the performance significantly deteriorated for more levels. The dynamic patterns were intuitive for the subjects, although amputees showed lower SR than able-bodied individuals (86% ± 10% versus 99% ± 3%). Significance. The tests demonstrated that the system was easy to setup and apply. The design and resolution of the multipad electrode was evaluated. Importantly, the novel dynamic patterns, which were successfully tested, can be superimposed to transmit multiple feedback variables intuitively and simultaneously. This is especially relevant for closing the loop in modern multifunction prostheses. Therefore, the proposed

  1. [Coping psychologically with amputation].

    Science.gov (United States)

    Schulz, M

    2009-02-01

    An amputation is a "tragic event" in someone's biography which causes a dramatic change in the outer appearance, the loss of mobility, independence and self esteem. The following article is about how people learn to cope with this difficult situation; with the practical problems of everyday life as well as their emotional problems. It is important for the amputees to go through the different stages of mourning: The first stage is the rejection of the situation. Repression and denial of the loss protects the patient from emotional overstrain. Confrontation is the next step: emotionally as well as mentally. "How could it happen?", (understanding the reasons why ...) "What will my future be like?", "How will I cope?" (ability of coping) "Why did it happen to me?" (sense) The last stage of coping with the amputation is to accept and deal with the new situation and to build up new self-confidence. A successful process of coping leads to a new identity. If a person fails to adapt to the new situation, he will develop an inferiority complex and fall into a depression. He might also try to look for culprit and blame the situation on someone else. About two thirds of all amputees don't cope with their amputation and become depressive. 15% develop symptoms of anxiety. Therefore it is important to offer help. The patients should get together in self helping groups and talk about their experiences and problems. If they need more intensive and individual help, they should have the opportunity to contact a psychologist. During the process of coping with their amputation the patients often alternate between optimistic and pessimistic moods. Sometimes they fall back into a negative and resigned state of mind. This is natural and part of the process as long as they find their own way to a positive attitude and view of life. PMID:19259934

  2. Medicine and Design Investigate Residual Limb Volume Fluctuations: Three case studies

    Directory of Open Access Journals (Sweden)

    Molly Staker

    2009-11-01

    Full Text Available BackgroundVolume fluctuations dramatically affect the daily fit andfunction of amputees’ prosthetic limbs. Prosthetists haveexperiential knowledge of patient volume fluctuations;however they rarely have access to quantitative evidence.Information regarding volume fluctuations is crucial whendetermining prosthetic socket design, component selection,and rehabilitation regimens. A collaboration between theHuman Dimensioning© Lab (HDL and Dan Rowe andAssociates, a community prosthetic and orthotic providerquantified volume data of individual residuum anatomy.MethodThe project used a 3-dimensional optical body scanner andpoint cloud digitizing technology, currently used for appareldesign, to quantify the daily residuum volume fluctuations inthree lower limb amputees. Utilizing the HDL designresources, three amputees were scanned three times at fourintervals over a six-hour period. The scans were analyzedusing Polyworks® software. Each group of three scans wasmeshed into an average and each of the four averaged scanswas compared to the amputee’s remaining three averagedscans.ResultsThe results document the changes in volume of the subjects’residuum over the six-hour period. The subjects experienceda range of volume fluctuations from 0.5% to 7.5% of totalvolume. To validate the method, scanned volumemeasurements were compared to a simple waterdisplacement measurement. The results from the scanningmethod and displacement method differed between .71%and 1.16%. The magnitude and period of fluctuation werenot consistent between the subjects.ConclusionPresently, little is known of the magnitude of short-termvolume fluctuations, nor is it known if shape changesaccompany short-term volume changes. This design andmedicine collaboration provides a platform for compilingaccurate and consistent residuum volume data and shapecharacterization. The method has the potential to affectprosthetic limb design and fit.

  3. Recent advancements in prosthetic hand technology.

    Science.gov (United States)

    Saikia, Angana; Mazumdar, Sushmi; Sahai, Nitin; Paul, Sudip; Bhatia, Dinesh; Verma, Suresh; Rohilla, Punit Kumar

    2016-07-01

    Recently, significant advances over the past decade have been made in robotics, artificial intelligence and other cognitive related fields, allowing development of highly sophisticated bio-mimetic robotics systems. In addition, enormous number of robots have been designed and assembled by explicitly realising their biological oriented behaviours. To enhance skill behaviours and adequate grasping abilities in these devices, a new phase of dexterous hands has been developed recently with bio-mimetically oriented and bio-inspired functionalities. The aim in writing this review paper is to present a detailed insight towards the development of the bio-mimetic based dexterous robotic multi-fingered artificial hand. An "ideal" upper limb prosthesis should be perceived as a part of their natural body by the amputee and should replicate sensory-motor capabilities of the amputated limb. Upper-limb amputations are most often the result of sudden trauma to the body, although they also can be caused by malignancy, congenital deficiencies and vascular diseases. This paper discusses the different bio-mimetic approaches using a framework that permits for a common description of biological and technical based hand manipulation behaviour. In particular, the review focuses on a number of developments in the inspired robotic systems. In conclusion, the study found that a huge amount of research efforts in terms of kinematics, dynamics, modelling and control methodologies are being put in to improve the present hand technology, thereby providing more functionality to the prosthetic limb of the amputee. This would improve their quality-of-life and help in performing activities of daily living (ADL) tasks with comparative ease in the near future. PMID:27098838

  4. Optical Myography: Detecting Finger Movements by Looking at the Forearm

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    Christian eNissler

    2016-04-01

    Full Text Available One of the crucial problems found in the scientific community of assistive / rehabilitation robotics nowadays is that of automatically detecting what a disabled subject (for instance, a hand amputee wants to do, exactly when she wants to do it and strictly for the time she wants to do it. This problem, commonly called intent detection, has traditionally been tackled using surface electromyography, a technique which suffers from a number of drawbacks, including the changes in the signal induced by sweat and muscle fatigue. With the advent of realistic, physically plausible augmented- and virtual-reality environments for rehabilitation, this approach does not suffice anymore. In this paper we explore a novel method to solve the problem, that we call Optical Myography (OMG. The idea is to visually inspect the human forearm (or stump to reconstruct what fingers are moving and to what extent. In a psychophysical experiment involving ten intact subjects, we used visual fiducial markers (AprilTags and a standard web-camera to visualize the deformations of the surface of the forearm, which then were mapped to the intended finger motions. As ground truth, a visual stimulus was used, avoiding the need for finger sensors (force/position sensors, datagloves, etc.. Two machine-learning approaches, a linear and a non-linear one, were comparatively tested in settings of increasing realism. The results indicate an average error in the range of 0.05 to 0.22 (root mean square error normalized over the signal range, in line with similar results obtained with more mature techniques such as electromyography. If further successfully tested in the large, this approach could lead to vision-based intent detection of amputees, with the main application of letting such disabled persons dexterously and reliably interact in an augmented- / virtual-reality setup.

  5. Sensor fusion and computer vision for context-aware control of a multi degree-of-freedom prosthesis

    Science.gov (United States)

    Markovic, Marko; Dosen, Strahinja; Popovic, Dejan; Graimann, Bernhard; Farina, Dario

    2015-12-01

    Objective. Myoelectric activity volitionally generated by the user is often used for controlling hand prostheses in order to replicate the synergistic actions of muscles in healthy humans during grasping. Muscle synergies in healthy humans are based on the integration of visual perception, heuristics and proprioception. Here, we demonstrate how sensor fusion that combines artificial vision and proprioceptive information with the high-level processing characteristics of biological systems can be effectively used in transradial prosthesis control. Approach. We developed a novel context- and user-aware prosthesis (CASP) controller integrating computer vision and inertial sensing with myoelectric activity in order to achieve semi-autonomous and reactive control of a prosthetic hand. The presented method semi-automatically provides simultaneous and proportional control of multiple degrees-of-freedom (DOFs), thus decreasing overall physical effort while retaining full user control. The system was compared against the major commercial state-of-the art myoelectric control system in ten able-bodied and one amputee subject. All subjects used transradial prosthesis with an active wrist to grasp objects typically associated with activities of daily living. Main results. The CASP significantly outperformed the myoelectric interface when controlling all of the prosthesis DOF. However, when tested with less complex prosthetic system (smaller number of DOF), the CASP was slower but resulted with reaching motions that contained less compensatory movements. Another important finding is that the CASP system required minimal user adaptation and training. Significance. The CASP constitutes a substantial improvement for the control of multi-DOF prostheses. The application of the CASP will have a significant impact when translated to real-life scenarious, particularly with respect to improving the usability and acceptance of highly complex systems (e.g., full prosthetic arms) by amputees.

  6. A Haptic Feedback Scheme to Accurately Position a Virtual Wrist Prosthesis Using a Three-Node Tactor Array.

    Directory of Open Access Journals (Sweden)

    Andrew Erwin

    Full Text Available In this paper, a novel haptic feedback scheme, used for accurately positioning a 1DOF virtual wrist prosthesis through sensory substitution, is presented. The scheme employs a three-node tactor array and discretely and selectively modulates the stimulation frequency of each tactor to relay 11 discrete haptic stimuli to the user. Able-bodied participants were able to move the virtual wrist prosthesis via a surface electromyography based controller. The participants evaluated the feedback scheme without visual or audio feedback and relied solely on the haptic feedback alone to correctly position the hand. The scheme was evaluated through both normal (perpendicular and shear (lateral stimulations applied on the forearm. Normal stimulations were applied through a prototype device previously developed by the authors while shear stimulations were generated using an ubiquitous coin motor vibrotactor. Trials with no feedback served as a baseline to compare results within the study and to the literature. The results indicated that using normal and shear stimulations resulted in accurately positioning the virtual wrist, but were not significantly different. Using haptic feedback was substantially better than no feedback. The results found in this study are significant since the feedback scheme allows for using relatively few tactors to relay rich haptic information to the user and can be learned easily despite a relatively short amount of training. Additionally, the results are important for the haptic community since they contradict the common conception in the literature that normal stimulation is inferior to shear. From an ergonomic perspective normal stimulation has the potential to benefit upper limb amputees since it can operate at lower frequencies than shear-based vibrotactors while also generating less noise. Through further tuning of the novel haptic feedback scheme and normal stimulation device, a compact and comfortable sensory substitution

  7. Mechanical characterization and validation of poly (methyl methacrylate)/multi walled carbon nanotube composite for the polycentric knee joint.

    Science.gov (United States)

    Arun, S; Kanagaraj, S

    2015-10-01

    Trans femoral amputation is one of the most uncomfortable surgeries in patient׳s life, where the prosthesis consisting of a socket, knee joint, pylon and foot is used to do the walking activities. The artificial prosthetic knee joint imitates the functions of human knee to achieve the flexion-extension for the above knee amputee. The objective of present work is to develop a light weight composite material for the knee joint to reduce the metabolic cost of an amputee. Hence, an attempt was made to study the mechanical properties of multi walled carbon nanotubes (MWCNT) reinforced Poly (methyl methacrylate) (PMMA) prepared through melt mixing technique and optimize the concentration of reinforcement. The PMMA nanocomposites were prepared by reinforcing 0, 0.1, 0.2, 0.25, 0.3 and 0.4 wt% of MWCNT using injection moulding machine via twin screw extruder. It is observed that the tensile and flexural strength of PMMA, which were studied as per ASTM D638 and D790, respectively, were increased by 32.9% and 26.3% till 0.25 wt% reinforcement of MWCNT. The experimental results of strength and modulus were compared with theoretical prediction, where a good correlation was noted. It is concluded that the mechanical properties of PMMA were found to be increased to maximum at 0.25 wt% reinforcement of MWCNT, where the Pukanszky model and modified Halpin-Tsai model are suggested to predict the strength and modulus, respectively, of the PMMA/MWCNT composite, which can be opted as a suitable materiel for the development of polycentric knee joint. PMID:26099200

  8. Optical Myography: Detecting Finger Movements by Looking at the Forearm.

    Science.gov (United States)

    Nissler, Christian; Mouriki, Nikoleta; Castellini, Claudio

    2016-01-01

    One of the crucial problems found in the scientific community of assistive/rehabilitation robotics nowadays is that of automatically detecting what a disabled subject (for instance, a hand amputee) wants to do, exactly when she wants to do it, and strictly for the time she wants to do it. This problem, commonly called "intent detection," has traditionally been tackled using surface electromyography, a technique which suffers from a number of drawbacks, including the changes in the signal induced by sweat and muscle fatigue. With the advent of realistic, physically plausible augmented- and virtual-reality environments for rehabilitation, this approach does not suffice anymore. In this paper, we explore a novel method to solve the problem, which we call Optical Myography (OMG). The idea is to visually inspect the human forearm (or stump) to reconstruct what fingers are moving and to what extent. In a psychophysical experiment involving ten intact subjects, we used visual fiducial markers (AprilTags) and a standard web camera to visualize the deformations of the surface of the forearm, which then were mapped to the intended finger motions. As ground truth, a visual stimulus was used, avoiding the need for finger sensors (force/position sensors, datagloves, etc.). Two machine-learning approaches, a linear and a non-linear one, were comparatively tested in settings of increasing realism. The results indicate an average error in the range of 0.05-0.22 (root mean square error normalized over the signal range), in line with similar results obtained with more mature techniques such as electromyography. If further successfully tested in the large, this approach could lead to vision-based intent detection of amputees, with the main application of letting such disabled persons dexterously and reliably interact in an augmented-/virtual-reality setup. PMID:27148039

  9. Silicone Molding and Lifetime Testing of Peripheral Nerve Interfaces for Neuroprostheses

    Energy Technology Data Exchange (ETDEWEB)

    Gupte, Kimaya [Case Western Reserve Univ., Cleveland, OH (United States). Dept. of Biomedical Engineering; Tolosa, Vanessa [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States). Center for Micro- and Nanotechnology

    2016-08-10

    Implantable peripheral nerve cuffs have a large application in neuroprostheses as they can be used to restore sensation to those with upper limb amputations. Modern day prosthetics, while lessening the pain associated with phantom limb syndrome, have limited fine motor control and do not provide sensory feedback to patients. Sensory feedback with prosthetics requires communication between the nervous system and limbs, and is still a challenge to accomplish with amputees. Establishing this communication between the peripheral nerves in the arm and artificial limbs is vital as prosthetics research aims to provide sensory feedback to amputees. Peripheral nerve cuffs restore sensation by electrically stimulating certain parts of the nerve in order to create feeling in the hand. Cuff electrodes have an advantage over standard electrodes as they have high selective stimulation by bringing the electrical interface close to the neural tissue in order to selectively activate targeted regions of a peripheral nerve. In order to further improve the selective stimulation of these nerve cuffs, there is need for finer spatial resolution among electrodes. One method to achieve a higher spatial resolution is to increase the electrode density on the cuff itself. Microfabrication techniques can be used to achieve this higher electrode density. Using L-Edit, a layout editor, microfabricated peripheral nerve cuffs were designed with a higher electrode density than the current model. This increase in electrode density translates to an increase in spatial resolution by at least one order of magnitude. Microfabricated devices also have two separate components that are necessary to understand before implantation: lifetime of the device and assembly to prevent nerve damage. Silicone molding procedures were optimized so that devices do not damage nerves in vivo, and lifetime testing was performed on test microfabricated devices to determine their lifetime in vivo. Future work of this project

  10. Optical Myography: Detecting Finger Movements by Looking at the Forearm

    Science.gov (United States)

    Nissler, Christian; Mouriki, Nikoleta; Castellini, Claudio

    2016-01-01

    One of the crucial problems found in the scientific community of assistive/rehabilitation robotics nowadays is that of automatically detecting what a disabled subject (for instance, a hand amputee) wants to do, exactly when she wants to do it, and strictly for the time she wants to do it. This problem, commonly called “intent detection,” has traditionally been tackled using surface electromyography, a technique which suffers from a number of drawbacks, including the changes in the signal induced by sweat and muscle fatigue. With the advent of realistic, physically plausible augmented- and virtual-reality environments for rehabilitation, this approach does not suffice anymore. In this paper, we explore a novel method to solve the problem, which we call Optical Myography (OMG). The idea is to visually inspect the human forearm (or stump) to reconstruct what fingers are moving and to what extent. In a psychophysical experiment involving ten intact subjects, we used visual fiducial markers (AprilTags) and a standard web camera to visualize the deformations of the surface of the forearm, which then were mapped to the intended finger motions. As ground truth, a visual stimulus was used, avoiding the need for finger sensors (force/position sensors, datagloves, etc.). Two machine-learning approaches, a linear and a non-linear one, were comparatively tested in settings of increasing realism. The results indicate an average error in the range of 0.05–0.22 (root mean square error normalized over the signal range), in line with similar results obtained with more mature techniques such as electromyography. If further successfully tested in the large, this approach could lead to vision-based intent detection of amputees, with the main application of letting such disabled persons dexterously and reliably interact in an augmented-/virtual-reality setup. PMID:27148039

  11. Design and technical construction of a tactile display for sensory feedback in a hand prosthesis system

    Directory of Open Access Journals (Sweden)

    Antfolk Christian

    2010-09-01

    Full Text Available Abstract Background The users of today's commercial prosthetic hands are not given any conscious sensory feedback. To overcome this deficiency in prosthetic hands we have recently proposed a sensory feedback system utilising a "tactile display" on the remaining amputation residual limb acting as man-machine interface. Our system uses the recorded pressure in a hand prosthesis and feeds back this pressure onto the forearm skin. Here we describe the design and technical solution of the sensory feedback system aimed at hand prostheses for trans-radial/humeral amputees. Critical parameters for the sensory feedback system were investigated. Methods A sensory feedback system consisting of five actuators, control electronics and a test application running on a computer has been designed and built. Firstly, we investigate which force levels were applied to the forearm skin of the user while operating the sensory feedback system. Secondly, we study if the proposed system could be used together with a myoelectric control system. The displacement of the skin caused by the sensory feedback system would generate artefacts in the recorded myoelectric signals. Accordingly, EMG recordings were performed and an analysis of the these are included. The sensory feedback system was also preliminarily evaluated in a laboratory setting on two healthy non-amputated test subjects with a computer generating the stimuli, with regards to spatial resolution and force discrimination. Results We showed that the sensory feedback system generated approximately proportional force to the angle of control. The system can be used together with a myoelectric system as the artefacts, generated by the actuators, were easily removed using a simple filter. Furthermore, the application of the system on two test subjects showed that they were able to discriminate tactile sensation with regards to spatial resolution and level of force. Conclusions The results of these initial experiments

  12. Postamputation pain: studies on mechanisms.

    Science.gov (United States)

    Nikolajsen, Lone

    2012-10-01

    Amputation is followed by both painful and non-painful phantom phenomena in a large number of amputees. Non-painful phantom sensations rarely pose any clinical problem, but 60-80% of all amputees also experience painful sensations (i.e. phantom pain) located to the missing limb. The severity of phantom pain usually decreases with time, but severe pain persists in 5-10% of patients. Pain in the residual limb (i.e. stump pain) is another consequence of amputation. Both stump and phantom pain can be very difficult to treat. Treatment guidelines used for other neuropathic pain conditions are probably the best approximation, especially for the treatment of stump pain. The aim of the present doctoral thesis was to explore some of the mechanisms underlying pain after amputation. Ten studies were carried out (I-X). My PhD thesis from 1998 dealt with pain before the amputation and showed that preamputation pain increases the risk of phantom pain after amputation (I). A perioperative epidural blockade, however, did not reduce the incidence of pain or abnormal sensory phenomena after amputation (II, III). The importance of sensitization before amputation for the subsequent development of pain is supported by study IV, in which pressure pain thresholds obtained at the limb before amputation were inversely related to stump and phantom pain after 1 week. Afferent input from the periphery is likely to contribute to postamputation pain as sodium channels were upregulated in human neuromas (VI), although neuroma removal did not always alleviate phantom pain (V). Sensitization of neurons in the spinal cord also seems to be involved in pain after amputation as phantom pain was reduced by ketamine, an NMDA-receptor antagonist. Another NMDA-receptor antagonist, memantine, and gabapentin, a drug working by binding to the δ2α-subunit of voltage-gated calcium channels, had no effect on phantom pain (VII-IX). Supraspinal factors are also important for pain after amputation as

  13. Reassessing cortical reorganization in the primary sensorimotor cortex following arm amputation.

    Science.gov (United States)

    Makin, Tamar R; Scholz, Jan; Henderson Slater, David; Johansen-Berg, Heidi; Tracey, Irene

    2015-08-01

    The role of cortical activity in generating and abolishing chronic pain is increasingly emphasized in the clinical community. Perhaps the most striking example of this is the maladaptive plasticity theory, according to which phantom pain arises from remapping of cortically neighbouring representations (lower face) into the territory of the missing hand following amputation. This theory has been extended to a wide range of chronic pain conditions, such as complex regional pain syndrome. Yet, despite its growing popularity, the evidence to support the maladaptive plasticity theory is largely based on correlations between pain ratings and oftentimes crude measurements of cortical reorganization, with little consideration of potential contributions of other clinical factors, such as adaptive behaviour, in driving the identified brain plasticity. Here, we used a physiologically meaningful measurement of cortical reorganization to reassess its relationship to phantom pain in upper limb amputees. We identified small yet consistent shifts in lip representation contralateral to the missing hand towards, but not invading, the hand area. However, we were unable to identify any statistical relationship between cortical reorganization and phantom sensations or pain either with this measurement or with the traditional Euclidian distance measurement. Instead, we demonstrate that other factors may contribute to the observed remapping. Further research that reassesses more broadly the relationship between cortical reorganization and chronic pain is warranted. PMID:26072517

  14. 3D optical imagery for motion compensation in a limb ultrasound system

    Science.gov (United States)

    Ranger, Bryan J.; Feigin, Micha; Zhang, Xiang; Mireault, Al; Raskar, Ramesh; Herr, Hugh M.; Anthony, Brian W.

    2016-04-01

    Conventional processes for prosthetic socket fabrication are heavily subjective, often resulting in an interface to the human body that is neither comfortable nor completely functional. With nearly 100% of amputees reporting that they experience discomfort with the wearing of their prosthetic limb, designing an effective interface to the body can significantly affect quality of life and future health outcomes. Active research in medical imaging and biomechanical tissue modeling of residual limbs has led to significant advances in computer aided prosthetic socket design, demonstrating an interest in moving toward more quantifiable processes that are still patient-specific. In our work, medical ultrasonography is being pursued to acquire data that may quantify and improve the design process and fabrication of prosthetic sockets while greatly reducing cost compared to an MRI-based framework. This paper presents a prototype limb imaging system that uses a medical ultrasound probe, mounted to a mechanical positioning system and submerged in a water bath. The limb imaging is combined with three-dimensional optical imaging for motion compensation. Images are collected circumferentially around the limb and combined into cross-sectional axial image slices, resulting in a compound image that shows tissue distributions and anatomical boundaries similar to magnetic resonance imaging. In this paper we provide a progress update on our system development, along with preliminary results as we move toward full volumetric imaging of residual limbs for prosthetic socket design. This demonstrates a novel multi-modal approach to residual limb imaging.

  15. Validity of method to quantify transtibial amputees’ free-living prosthetic wearing times and physical activity levels when using suction suspension sockets

    Directory of Open Access Journals (Sweden)

    Kit Tzu Tang, EngD

    2012-04-01

    Full Text Available Prostheses are prescribed to restore the mobility of people with amputated lower limbs. Monitoring the prosthesis wearing times and physical activity of prosthesis users would provide invaluable information regarding rehabilitation progress and suitability of the prosthesis. The validation of a method to determine wearing times and physical activity state, as well as strides taken, of amputees wearing suction suspension sockets is reported. Eight participants with transtibial amputation were fitted with custom-made suction sockets. Analysis algorithms were used to automatically characterize physical activity based on the pressure at the socket’s relief valve. The algorithms were validated in a laboratory-based protocol that included walking, stair climbing, standing, sitting, donning, and doffing. Intraclass correlation coefficient (2,1 values of >0.98 were achieved with mean differences of –2.0%, 0.3%, 1.3%, and 0.7% for agreement between "off," "static," and "dynamic" times and stride count, respectively, as determined by the analysis algorithms and a concurrent video analysis. This study demonstrates that an interpretation of the pressure at the pressure-relief valve of suction suspension sockets can be used to determine wearing times and activity state.

  16. An insight into the use and assessment of lower limb running prostheses in sport with a disability: A mixed method approach

    Directory of Open Access Journals (Sweden)

    Bryce Dyer

    2016-12-01

    Full Text Available In able-bodied sport, controversy has occasionally been caused through the adoption or introduction of sports technology. However, scant attention has specifically been paid to sport with a disability with respect to such concerns. This article therefore investigates the use of lower limb running prostheses (LLRPs in competition by below-knee amputees. This study uses a four-phase mixed method approach to investigate the nature, use and assessment of LLRPs. The first phase conducted a statistical analysis of the sports time series data to ascertain the progression of the sport when considering the impact of sports technology. The second phase performed a stakeholder assessment of the sport using the Delphi method and provided a proposed series of guidelines for lower limb prostheses technology inclusion. The third phase assessed the behaviour of LLRPs in a competitive environment. Ultimately, the three previous phases provided information that led to the fourth phase. This phase investigated the use of a dynamic drop jump technique as an assessment strategy for further development in the future. This information would prove of intrinsic value when developing sports policy in the future.

  17. Experimental Forelimb Allotransplantation in Canine Model

    Science.gov (United States)

    2016-01-01

    As reconstructive transplantation is gaining popularity as a viable alternative for upper limb amputees, it is becoming increasingly important for plastic surgeons to renew surgical skills and knowledge of this area. Forelimb allotransplantation research has been performed previously in rodent and swine models. However, preclinical canine forelimb allotransplantation studies are lacking in the literature. The purpose of this paper is to provide an overview of the surgical skills necessary to successfully perform forelimb transplantation in canines as a means to prepare for clinical application. A total of 18 transplantation operations on canines were performed. The recipient limb was shortened at the one-third proximal forearm level. The operation was performed in the following order: bones (two reconstructive plates), muscles and tendons (separately sutured), nerves (median, ulnar, and radial nerve), arteries (two), and veins (two). The total mean time of transplantation was 5 hours ± 30 minutes. All of the animals that received transplantation were treated with FK-506 (tacrolimus, 2 mg/kg) for 7 days after surgery. Most allografts survived with perfect viability without vascular problems during the early postoperative period. The canine forelimb allotransplantation model is well qualified to be a suitable training model for standard transplantation and future research work. PMID:27597952

  18. A Control Strategy with Tactile Perception Feedback for EMG Prosthetic Hand

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    Changcheng Wu

    2015-01-01

    Full Text Available To improve the control effectiveness and make the prosthetic hand not only controllable but also perceivable, an EMG prosthetic hand control strategy was proposed in this paper. The control strategy consists of EMG self-learning motion recognition, backstepping controller with stiffness fuzzy observation, and force tactile representation. EMG self-learning motion recognition is used to reduce the influence on EMG signals caused by the uncertainty of the contacting position of the EMG sensors. Backstepping controller with stiffness fuzzy observation is used to realize the position control and grasp force control. Velocity proportional control in free space and grasp force tracking control in restricted space can be realized by the same controller. The force tactile representation helps the user perceive the states of the prosthetic hand. Several experiments were implemented to verify the effect of the proposed control strategy. The results indicate that the proposed strategy has effectiveness. During the experiments, the comments of the participants show that the proposed strategy is a better choice for amputees because of the improved controllability and perceptibility.

  19. Quality of life in the Iranian Blind War Survivors in 2007: a cross-sectional study

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    Amini Reza

    2010-08-01

    Full Text Available Abstract Background Quality of Life measurements are necessary tools for effectively evaluating health services. In the population of patients afflicted with war-related blindness in Iran, such measurements have yet to be documented and utilized. "The design and implementation of this study involved the determination of a baseline score for QOL in a population of Iranian blinded in the Iraq-Iran war in order to facilitate the design of interventions intended to improve the population's QOL." Methods This was a cross-sectional study of a representative population of 250 war victims blind in both eyes at a 14-day recreational conference. Results Participants had a mean age of 43.20(SD8.34 and their composition was 96.5% male and 3.5% female with a mean SF-36 QOL score of 59.20(SD22.80. An increasing level of education among the participants correlated with a higher QOL score (p = 0.006. The QOL also has a significant correlation to number of injuries (p Conclusions As blind war survivors' age, they will present with a greater set of burdens despite their relatively better QOL in the physical component scale when compared with lower limb amputees. Risk factors of cardiovascular attack such as high blood pressure and hypercholesterolemia were present and need future interventions. Key words Quality of life, blindness, SF36, health

  20. Automatic misclassification rejection for LDA classifier using ROC curves.

    Science.gov (United States)

    Menon, Radhika; Di Caterina, Gaetano; Lakany, Heba; Petropoulakis, Lykourgos; Conway, Bernard A; Soraghan, John J

    2015-08-01

    This paper presents a technique to improve the performance of an LDA classifier by determining if the predicted classification output is a misclassification and thereby rejecting it. This is achieved by automatically computing a class specific threshold with the help of ROC curves. If the posterior probability of a prediction is below the threshold, the classification result is discarded. This method of minimizing false positives is beneficial in the control of electromyography (EMG) based upper-limb prosthetic devices. It is hypothesized that a unique EMG pattern is associated with a specific hand gesture. In reality, however, EMG signals are difficult to distinguish, particularly in the case of multiple finger motions, and hence classifiers are trained to recognize a set of individual gestures. However, it is imperative that misclassifications be avoided because they result in unwanted prosthetic arm motions which are detrimental to device controllability. This warrants the need for the proposed technique wherein a misclassified gesture prediction is rejected resulting in no motion of the prosthetic arm. The technique was tested using surface EMG data recorded from thirteen amputees performing seven hand gestures. Results show the number of misclassifications was effectively reduced, particularly in cases with low original classification accuracy. PMID:26736304

  1. Alteration of Skin Properties with Autologous Dermal Fibroblasts

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    Rajesh L. Thangapazham

    2014-05-01

    Full Text Available Dermal fibroblasts are mesenchymal cells found between the skin epidermis and subcutaneous tissue. They are primarily responsible for synthesizing collagen and glycosaminoglycans; components of extracellular matrix supporting the structural integrity of the skin. Dermal fibroblasts play a pivotal role in cutaneous wound healing and skin repair. Preclinical studies suggest wider applications of dermal fibroblasts ranging from skin based indications to non-skin tissue regeneration in tendon repair. One clinical application for autologous dermal fibroblasts has been approved by the Food and Drug Administration (FDA while others are in preclinical development or various stages of regulatory approval. In this context, we outline the role of fibroblasts in wound healing and discuss recent advances and the current development pipeline for cellular therapies using autologous dermal fibroblasts. The microanatomic and phenotypic differences of fibroblasts occupying particular locations within the skin are reviewed, emphasizing the therapeutic relevance of attributes exhibited by subpopulations of fibroblasts. Special focus is provided to fibroblast characteristics that define regional differences in skin, including the thick and hairless skin of the palms and soles as compared to hair-bearing skin. This regional specificity and functional identity of fibroblasts provides another platform for developing regional skin applications such as the induction of hair follicles in bald scalp or alteration of the phenotype of stump skin in amputees to better support their prosthetic devices.

  2. Three-dimensional finite element stress and strain analysis of a transfemoral osseointegration implant.

    Science.gov (United States)

    Xu, Wei; Xu, Dong Hao; Crocombe, A D

    2006-08-01

    The percutaneous transfemoral osseointegration implant is an alternative technique for direct prosthetic limb attachment. In order to investigate the stress and strain in the transfemoral osseointegration implant system, finite element (FE) analyses were carried out using three-dimensional femur-implant models and the commercial FE software ABAQUS. The three-dimensional femoral model was reconstructed from presurgery CT scans of an above-knee amputee. The implant was then inserted into the femoral model using Boolean operations in CAD software. Under a typical walking load, stress and strain from the femur-implant FE model were investigated. Stress concentrations were found near to the distal and proximal regions of the femur. To study the effect of different contact ratios between femur and implant, FE analyses were carried out using different implant diameters. The results showed that there were local stress variations near the contact discontinuity areas. A comparison was also made between the results of this study and a previous study using axisymmetric FE models. The results of the two studies revealed different stress levels, but good correlation was found in the overall stress distribution. PMID:16961185

  3. Effect of primary and secondary wartime below-knee amputation on length of hospitalization and rehabilitation

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    Jandrić Slavica

    2002-01-01

    Full Text Available The results of below-knee amputations in 36 war wounded (mean age 35,42 were reviewed. The majority of the patients was wounded by land mines (94.4%. Most of them were between 25 and 35 years old. Bilateral amputation was done in 2.8% of cases. The amputation was performed on the day of wounding (primary below-knee amputation in 30 (83.3% amputees. Secondary amputation after the attempt to save the severely injured lower-limb was performed in 6 patients (16,7% average 4.61 ± 11.67 days after wounding. Reamputation was necessary in 6 cases (16.7%. Time period from the beginning of rehabilitation to the fitting of prosthesis, was 36.25 ± 14.97 days for primary amputations, 32 ± 17.8 days for secondary amputations and 68.66 ± 33.52 days for reamputations. There was no significant correlation between the duration of rehabilitation to prosthetic management and the period between wounding and amputation (r = -0.102. The attempt to save the limb after severe below-knee injuries and the secondary amputation afterwards, did not significantly influence the ensuing rehabilitation and prosthetic works.

  4. Agency over a phantom limb and electromyographic activity on the stump depend on visuomotor synchrony: a case study

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    Shu Imaizumi

    2014-07-01

    Full Text Available Most patients, post-amputation, report the experience of a phantom limb. Some even sense voluntary movements when viewing a mirror image of the intact limb superimposed onto the phantom limb. While delayed visual feedback of an action is known to reduce a sense of agency, the effect of delayed visual feedback on phantom motor sensation (i.e., sense of controlling a phantom limb has not been examined. Using a video-projection system, we examined the effect of delayed visual feedback on phantom motor sensation in an upper-limb amputee (male; left upper-limb amputation. He was instructed to view mirrored video images of his intact hand clasping and unclasping during a phantom limb movement. He then rated the intensity of the phantom motor sensation. Three types of hand movement images were presented as follows: synchronous, asynchronous with a 250-ms delay, and asynchronous with a 500-ms delay. Results showed that phantom motor sensation decreased when the image was delayed by 250 and 500 ms. However, when we instructed the patient to adjust the phase of phantom limb movement to that of the image with a 500-ms delay, phantom motor sensation increased. There was also a positive correlation between intensity of phantom motor sensation and electromyographic activity on deltoids at the patient’s stump. These results suggest that phantom motor sensation and electromyographic activity on the stump depend on visuomotor synchrony and top-down effects.

  5. Plasticity of plasticity? Changes in the pattern of perceptual correlates of reorganization after amputation.

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    Knecht, S; Henningsen, H; Höhling, C; Elbert, T; Flor, H; Pantev, C; Taub, E

    1998-04-01

    We report a follow-up study on seven arm amputees in whom magnetic source imaging had originally revealed a strong correlation between the amount of cortical invasion of the deafferented cortex and the amount of pain evoked sensation mislocalized to the phantom limb. This re-examination was performed in order to corroborate the phenomenon of mislocalization. On follow-up examination for mislocalization 4 weeks later, a close correlation had remained between the original amount of cortical representational reorganization of the amputation zone (at the first examination) and the number of sites from where painful stimuli evoked sensations referred to the phantom limb, i.e. the amount of perceptual mislocalization, at the second examination. However, contrary to our expectation, the topography of referred sensation had completely changed in every patient. These results suggest that while the overall extent of reorganization is a rather stable phenomenon, the concomitant changes in the pattern of sensory processing are not. This may be due to the fact that alterations of sensory processing are not hardwired, but are rather mediated by an extensive and interconnected neural network with fluctuating synaptic strengths. This mechanism may be of importance for neurological rehabilitation. PMID:9577396

  6. Noise in models of neurological and psychiatric disorders.

    Science.gov (United States)

    Spitzer, M; Neumann, M

    1996-09-01

    The concept of noise has only recently been applied to modelling neuropsychiatric disorders. Two examples of such models are presented. 1. A phantom limb is a neurological condition after the amputation of an extremity. It consists of sensations of the presence of the lost limb and has been attributed to cortical as well as non-cortical mechanisms. A neural network model of phantom limbs is proposed which can parsimoniously account for a large number of clinical features and recent findings of cortical map plasticity after deafferentation. In trained self-organizing feature maps, deafferentation was simulated. Reorganization is shown to be driven by input noise. According to the model, the production of input noise by the deafferented primary sensory neuron drives cortical reorganization in amputees. No such noise is generated and/or conducted to the cortex in paraplegics. 2. Several clinical features of schizophrenia have been related to the ratio of signal to noise in neuronal information processing. In particular, dopamine--which has been implicated in the causation of schizophrenia for decades--has been proposed to modulate signal-to-noise ratio. Data are presented which suggest that schizophrenic thought disorder is the result of a hypodopaminergic state and concomitant increased effects of noise in semantic information processing. Possible functions of noise in the nervous systems are discussed. PMID:8968824

  7. A comparative study of surface EMG classification by fuzzy relevance vector machine and fuzzy support vector machine

    International Nuclear Information System (INIS)

    We present a multiclass fuzzy relevance vector machine (FRVM) learning mechanism and evaluate its performance to classify multiple hand motions using surface electromyographic (sEMG) signals. The relevance vector machine (RVM) is a sparse Bayesian kernel method which avoids some limitations of the support vector machine (SVM). However, RVM still suffers the difficulty of possible unclassifiable regions in multiclass problems. We propose two fuzzy membership function-based FRVM algorithms to solve such problems, based on experiments conducted on seven healthy subjects and two amputees with six hand motions. Two feature sets, namely, AR model coefficients and room mean square value (AR-RMS), and wavelet transform (WT) features, are extracted from the recorded sEMG signals. Fuzzy support vector machine (FSVM) analysis was also conducted for wide comparison in terms of accuracy, sparsity, training and testing time, as well as the effect of training sample sizes. FRVM yielded comparable classification accuracy with dramatically fewer support vectors in comparison with FSVM. Furthermore, the processing delay of FRVM was much less than that of FSVM, whilst training time of FSVM much faster than FRVM. The results indicate that FRVM classifier trained using sufficient samples can achieve comparable generalization capability as FSVM with significant sparsity in multi-channel sEMG classification, which is more suitable for sEMG-based real-time control applications. (paper)

  8. Illusion-related brain activations: a new virtual reality mirror box system for use during functional magnetic resonance imaging.

    Science.gov (United States)

    Diers, Martin; Kamping, Sandra; Kirsch, Pinar; Rance, Mariela; Bekrater-Bodmann, Robin; Foell, Jens; Trojan, Joerg; Fuchs, Xaver; Bach, Felix; Maaß, Heiko; Cakmak, Hüseyin; Flor, Herta

    2015-01-12

    Extended viewing of movements of one's intact limb in a mirror as well as motor imagery have been shown to decrease pain in persons with phantom limb pain or complex regional pain syndrome and to increase the movement ability in hemiparesis following stroke. In addition, mirrored movements differentially activate sensorimotor cortex in amputees with and without phantom limb pain. However, using a so-called mirror box has technical limitations, some of which can be overcome by virtual reality applications. We developed a virtual reality mirror box application and evaluated its comparability to a classical mirror box setup. We applied both paradigms to 20 healthy controls and analyzed vividness and authenticity of the illusion as well as brain activation patterns. In both conditions, subjects reported similar intensities for the sensation that movements of the virtual left hand felt as if they were executed by their own left hand. We found activation in the primary sensorimotor cortex contralateral to the actual movement, with stronger activation for the virtual reality 'mirror box' compared to the classical mirror box condition, as well as activation in the primary sensorimotor cortex contralateral to the mirrored/virtual movement. We conclude that a virtual reality application of the mirror box is viable and that it might be useful for future research. PMID:25446453

  9. Decoding of grasping information from neural signals recorded using peripheral intrafascicular interfaces

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    Cipriani Christian

    2011-09-01

    Full Text Available Abstract Background The restoration of complex hand functions by creating a novel bidirectional link between the nervous system and a dexterous hand prosthesis is currently pursued by several research groups. This connection must be fast, intuitive, with a high success rate and quite natural to allow an effective bidirectional flow of information between the user's nervous system and the smart artificial device. This goal can be achieved with several approaches and among them, the use of implantable interfaces connected with the peripheral nervous system, namely intrafascicular electrodes, is considered particularly interesting. Methods Thin-film longitudinal intra-fascicular electrodes were implanted in the median and ulnar nerves of an amputee's stump during a four-week trial. The possibility of decoding motor commands suitable to control a dexterous hand prosthesis was investigated for the first time in this research field by implementing a spike sorting and classification algorithm. Results The results showed that motor information (e.g., grip types and single finger movements could be extracted with classification accuracy around 85% (for three classes plus rest and that the user could improve his ability to govern motor commands over time as shown by the improved discrimination ability of our classification algorithm. Conclusions These results open up new and promising possibilities for the development of a neuro-controlled hand prosthesis.

  10. Terrain and Direction Classification of Locomotion Transitions Using Neuromuscular and Mechanical Input.

    Science.gov (United States)

    Joshi, Deepak; Hahn, Michael E

    2016-04-01

    To perform seamless transitions in powered lower limb prostheses, accurate classification of transition type is required a priori. We propose a structure to detect direction (ascent or descent) and terrain (ramp or stairs) patterns when a person transitions from over ground to stairs or ramp locomotion. We compared electromyography (EMG) and accelerometry performance with an emphasis on sensor fusion for improving classification. Seven healthy subjects were recruited for this initial study. Data were collected with accelerometers and EMG electrodes on the dominant leg, while subjects transitioned from over ground to ramp (ascent and descent) and stair (ascent and descent) locomotion. Linear discriminant analysis and support vector machine approaches were used as classifiers using feature spaces of both sensor types. The results indicate that transitions are better classified as terrain type than direction type (p < 0.001), suggesting a terrain focused approach for an efficient structure. We also show that EMG and accelerometry data sources are complementary across the transitional gait cycle, suggesting sensor fusion for robust classification. These findings suggest that a terrain and direction focused classification approach will be useful for inclusion in classification approaches utilized in lower limb amputee samples. PMID:26224525

  11. Real-time prediction learning for the simultaneous actuation of multiple prosthetic joints.

    Science.gov (United States)

    Pilarski, Patrick M; Dick, Travis B; Sutton, Richard S

    2013-06-01

    Integrating learned predictions into a prosthetic control system promises to enhance multi-joint prosthesis use by amputees. In this article, we present a preliminary study of different cases where it may be beneficial to use a set of temporally extended predictions--learned and maintained in real time--within an engineered or learned prosthesis controller. Our study demonstrates the first successful combination of actor-critic reinforcement learning with real-time prediction learning. We evaluate this new approach to control learning during the myoelectric operation of a robot limb. Our results suggest that the integration of real-time prediction and control learning may speed control policy acquisition, allow unsupervised adaptation in myoelectric controllers, and facilitate synergies in highly actuated limbs. These experiments also show that temporally extended prediction learning enables anticipatory actuation, opening the way for coordinated motion in assistive robotic devices. Our work therefore provides initial evidence that realtime prediction learning is a practical way to support intuitive joint control in increasingly complex prosthetic systems. PMID:24187253

  12. Enhancing the versatility of wireless biopotential acquisition for myoelectric prosthetic control

    Science.gov (United States)

    Bercich, Rebecca A.; Wang, Zhi; Mei, Henry; Hammer, Lauren H.; Seburn, Kevin L.; Hargrove, Levi J.; Irazoqui, Pedro P.

    2016-08-01

    Objective. A significant challenge in rehabilitating upper-limb amputees with sophisticated, electric-powered prostheses is sourcing reliable and independent channels of motor control information sufficient to precisely direct multiple degrees of freedom simultaneously. Approach. In response to the expressed needs of clinicians, we have developed a miniature, batteryless recording device that utilizes emerging integrated circuit technology and optimal impedance matching for magnetic resonantly coupled (MRC) wireless power transfer to improve the performance and versatility of wireless electrode interfaces with muscle. Main results. In this work we describe the fabrication and performance of a fully wireless and batteryless EMG recording system and use of this system to direct virtual and electric-powered limbs in real-time. The advantage of using MRC to optimize power transfer to a network of wireless devices is exhibited by EMG collected from an array of eight devices placed circumferentially around a human subject’s forearm. Significance. This is a comprehensive, low-cost, and non-proprietary solution that provides unprecedented versatility of configuration to direct myoelectric prostheses without wired connections to the body. The amenability of MRC to varied coil geometries and arrangements has the potential to improve the efficiency and robustness of wireless power transfer links at all levels of upper-limb amputation. Additionally, the wireless recording device’s programmable flash memory and selectable features will grant clinicians the unique ability to adapt and personalize the recording system’s functional protocol for patient- or algorithm-specific needs.

  13. Construct validity of Comprehensive High-Level Activity Mobility Predictor (CHAMP for male servicemembers with traumatic lower-limb loss

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    Robert S. Gailey, PhD, PT

    2013-10-01

    Full Text Available This study examined the convergent construct validity of a new performance-based assessment instrument called the Comprehensive High-Level Activity Mobility Predictor (CHAMP as a measure of high-level mobility in servicemembers (SMs with traumatic lower-limb loss (LLL. The study was completed by 118 SMs. Convergent construct validity of the CHAMP was established using the 6-minute walk test (6MWT as a measure of overall mobility and physical function and the Amputee Mobility Predictor (AMP as a measure of basic prosthetic mobility. The known group methods construct validity examined disparities in high-level mobility capability among SMs with different levels of LLL. The CHAMP score demonstrated a strong positive relationship between 6MWT distance (r = 0.80, p < 0.001 and AMP score (r = 0.87, p < 0.001, respectively. In addition, the CHAMP can discriminate between different levels of LLL. Study findings support the CHAMP as a valid performance-based assessment instrument of high-level mobility for SMs with traumatic LLL.

  14. Prosthetic EMG control enhancement through the application of man-machine principles

    Science.gov (United States)

    Simcox, W. A.

    1977-01-01

    An area in medicine that appears suitable to man-machine principles is rehabilitation research, particularly when the motor aspects of the body are involved. If one considers the limb, whether functional or not, as the machine, the brain as the controller and the neuromuscular system as the man-machine interface, the human body is reduced to a man-machine system that can benefit from the principles behind such systems. The area of rehabilitation that this paper deals with is that of an arm amputee and his prosthetic device. Reducing this area to its man-machine basics, the problem becomes one of attaining natural multiaxis prosthetic control using Electromyographic activity (EMG) as the means of communication between man and prothesis. In order to use EMG as the communication channel it must be amplified and processed to yield a high information signal suitable for control. The most common processing scheme employed is termed Mean Value Processing. This technique for extracting the useful EMG signal consists of a differential to single ended conversion to the surface activity followed by a rectification and smoothing.

  15. Detection of Prosthetic Knee Movement Phases via In-Socket Sensors: A Feasibility Study

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    Amr M. El-Sayed

    2015-01-01

    Full Text Available This paper presents an approach of identifying prosthetic knee movements through pattern recognition of mechanical responses at the internal socket’s wall. A quadrilateral double socket was custom made and instrumented with two force sensing resistors (FSR attached to specific anterior and posterior sites of the socket’s wall. A second setup was established by attaching three piezoelectric sensors at the anterior distal, anterior proximal, and posterior sites. Gait cycle and locomotion movements such as stair ascent and sit to stand were adopted to characterize the validity of the technique. FSR and piezoelectric outputs were measured with reference to the knee angle during each phase. Piezoelectric sensors could identify the movement of midswing and terminal swing, pre-full standing, pull-up at gait, sit to stand, and stair ascent. In contrast, FSR could estimate the gait cycle stance and swing phases and identify the pre-full standing at sit to stand. FSR showed less variation during sit to stand and stair ascent to sensitively represent the different movement states. The study highlighted the capacity of using in-socket sensors for knee movement identification. In addition, it validated the efficacy of the system and warrants further investigation with more amputee subjects and different sockets types.

  16. Global trends in incidence of lower limb amputation: a review of the literature

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    L. Godlwana

    2008-02-01

    Full Text Available The aim of this paper was to compile a literature report on the global epidemiology of lower limb amputations. Specifically it aimed at capturing information on the incidence of traumatic and non-traumatic lowerlimb amputations throughout the world, to identify the etiology including diseases and lifestyle habits associated with lower limb amputees (LLA in boththe developed and the developing countries, to identify the demographiccharacteristics, age, sex, race, geographical location of the people undergoing LLA including the levels of amputation as pointed out by the literature. Aliterature search was conducted. Different keyword combinations were used togather as much literature on the subject as possible. The authors systemicallyreviewed literature from some parts of Europe, Asia, North and South America and South Africa. The data was analyzed and presented under various themes. The existing literature shows that diabetes is the leading cause of LLA and trauma accounts for the minority of these cases. The incidence of LLA can be predicted by gender, age, maritalstatus, level of education and socio-economic status. Information on LLA in South Africa is almost absent.

  17. Systematic characterisation of silicon-embedded accelerometers for mechanomyography.

    Science.gov (United States)

    Silva, J; Chau, T; Naumann, S; Heim, W

    2003-05-01

    Silicon soft suction sockets (roll-on sleeves) currently used in passive prostheses for below-elbow amputees could also be used in externally powered prostheses, enhancing their functionality and comfort. However, as it is extremely difficult to hold currently used electromyography (EMG) sensors in place reliably within a silicon socket, an alternative measurement of muscular activity as the control input is necessary. Mechanomyography (MMG) is the epidermal measurement of the low-frequency vibrations produced by a contracting muscle. MMG sensors do not have to be in direct contact with the skin. Moreover, the embedding of sensors in the roll-on sleeve may also solve attachment issues, making sensor placement flexible. Therefore the objective was to determine the feasibility of recording MMG signals using silicon-embedded, micro-machined accelerometers. Fifteen embedded accelerometers were excited with predefined vibration patterns. The signal-to-noise ratio (SNR) and frequency response of each sample were measured and compared with those of non-embedded accelerometers. The SNR of embedded samples (approximately equal to 19 dB) was significantly higher than that of non-embedded samples (approximately equal to 12 dB), owing to the considerable mechanical damping effect of the silicon in the 300-900 Hz bandwidth (p=0.0028). This has implications for the application of silicon-embedded accelerometers for externally powered prosthesis control. PMID:12803293

  18. IMU-Based Joint Angle Measurement for Gait Analysis

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    Thomas Seel

    2014-04-01

    Full Text Available This contribution is concerned with joint angle calculation based on inertial measurement data in the context of human motion analysis. Unlike most robotic devices, the human body lacks even surfaces and right angles. Therefore, we focus on methods that avoid assuming certain orientations in which the sensors are mounted with respect to the body segments. After a review of available methods that may cope with this challenge, we present a set of new methods for: (1 joint axis and position identification; and (2 flexion/extension joint angle measurement. In particular, we propose methods that use only gyroscopes and accelerometers and, therefore, do not rely on a homogeneous magnetic field. We provide results from gait trials of a transfemoral amputee in which we compare the inertial measurement unit (IMU-based methods to an optical 3D motion capture system. Unlike most authors, we place the optical markers on anatomical landmarks instead of attaching them to the IMUs. Root mean square errors of the knee flexion/extension angles are found to be less than 1° on the prosthesis and about 3° on the human leg. For the plantar/dorsiflexion of the ankle, both deviations are about 1°.

  19. The mechanical design of a transfemoral prosthesis using computational tools and design methodology

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    John Sánchez Otero

    2012-12-01

    Full Text Available Artificial limb replacement with lower limb prostheses has been widely reported in current scientific literature. There are many lower limb prosthetic designs ranging from a single-axis knee mechanism to complex mechanisms involving microcontrollers, made from many materials ranging from lightweight, high specific strength ones (e.g., carbon fibre to traditional forms (e.g., stainless steel. However, the challenge is to design prostheses whose movement resembles the human body’s natural movement as closely as possible. Advances in prosthetics have enabled many amputees to return to their everyday activities; however, such prostheses are expensive, some costing as much as $60,000. Many of the affected population in Colombia have scarce economic resources; there is therefore a need to develop affordable functional prostheses.The Universidad del Norte’s Materials, Processes and Design Research Group and the Robotics and Intelligent Systems Group have been working on this line of research to develop modular prostheses which can be adjusted to each patient’s requirements. This research represents an initial methodological approach to developing a prosthesis in which software tools have been used (the finite element method with a criteria relationship matrix for selecting the best alternative while considering different aspects such as mod-ularity, cost, stiffness and weight.

  20. Estimation of the knee joint angle from surface electromyographic signals for active control of leg prostheses

    International Nuclear Information System (INIS)

    The surface electromyographic (SEMG) signal is very convenient for prosthesis control because it is non-invasively acquired and intrinsically related to the user's intention. This work presents a feature extraction and pattern classification algorithm for estimation of the intended knee joint angle from SEMG signals acquired using two sets of electrodes placed on the upper leg. The proposed algorithm uses a combination of time-domain and frequency-domain approaches for feature extraction (signal amplitude histogram and auto-regressive coefficients, respectively), a self-organizing map for feature projection and a Levenberg–Marquardt multi-layer perceptron neural network for pattern classification. The new algorithm was quantitatively compared with the method proposed by Wang et al (2006 Med. Biol. Eng. Comput. 44 865–72), which uses wavelet packet feature extraction, principal component analysis and a multi-layer perceptron neural classifier. The proposed method provided lower error-to-signal percentage and peak error amplitudes, higher correlation and fewer error events. The algorithm presented in this work may be useful as part of a myoelectric controller for active leg prostheses designed for transfemoral amputees

  1. Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III

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    Frederico Carlos Jaña Neto

    2016-04-01

    Full Text Available OBJECTIVE: To analyze the characteristics of patients with Gustilo-Anderson Type III open tibial fractures treated at a tertiary care hospital in São Paulo between January 2013 and August 2014. METHODS: This was a cross-sectional retrospective study. The following data were gathered from the electronic medical records: age; gender; diagnosis; trauma mechanism; comorbidities; associated fractures; Gustilo and Anderson, Tscherne and AO classifications; treatment (initial and definitive; presence of compartment syndrome; primary and secondary amputations; MESS (Mangled Extremity Severity Score index; mortality rate; and infection rate. RESULTS: 116 patients were included: 81% with fracture type IIIA, 12% IIIB and 7% IIIC; 85% males; mean age 32.3 years; and 57% victims of motorcycle accidents. Tibial shaft fractures were significantly more prevalent (67%. Eight patients were subjected to amputation: one primary case and seven secondary cases. Types IIIC (75% and IIIB (25% predominated among the patients subjected to secondary amputation. The MESS index was greater than 7 in 88% of the amputees and in 5% of the limb salvage group. CONCLUSION: The profile of patients with open tibial fracture of Gustilo and Anderson Type III mainly involved young male individuals who were victims of motorcycle accidents. The tibial shaft was the segment most affected. Only 7% of the patients underwent amputation. Given the current controversy in the literature about amputation or salvage of severely injured lower limbs, it becomes necessary to carry out prospective studies to support clinical decisions.

  2. Experimental Forelimb Allotransplantation in Canine Model.

    Science.gov (United States)

    Hong, Sa-Hyeok; Eun, Seok-Chan

    2016-01-01

    As reconstructive transplantation is gaining popularity as a viable alternative for upper limb amputees, it is becoming increasingly important for plastic surgeons to renew surgical skills and knowledge of this area. Forelimb allotransplantation research has been performed previously in rodent and swine models. However, preclinical canine forelimb allotransplantation studies are lacking in the literature. The purpose of this paper is to provide an overview of the surgical skills necessary to successfully perform forelimb transplantation in canines as a means to prepare for clinical application. A total of 18 transplantation operations on canines were performed. The recipient limb was shortened at the one-third proximal forearm level. The operation was performed in the following order: bones (two reconstructive plates), muscles and tendons (separately sutured), nerves (median, ulnar, and radial nerve), arteries (two), and veins (two). The total mean time of transplantation was 5 hours ± 30 minutes. All of the animals that received transplantation were treated with FK-506 (tacrolimus, 2 mg/kg) for 7 days after surgery. Most allografts survived with perfect viability without vascular problems during the early postoperative period. The canine forelimb allotransplantation model is well qualified to be a suitable training model for standard transplantation and future research work. PMID:27597952

  3. [The beginnings of orthopedic surgery in Israel].

    Science.gov (United States)

    Tauber, Chanan

    2013-08-01

    In early mandatory Israel, orthopedics was mainly conservative, The first modern orthopedic surgeon was Ernst Spira from Czechoslovakia who established an orthopedic service at the Beilinson Hospital in Petah Tikva and left in 1948 to establish the Orthopedic Department and the Rehabilitation Center in Tel Hashomer, which treated the War of Independence casualties including amputees and victims of spinal cord injuries. A second orthopedic department was opened in Tel Hashomer by Shmuel Weissman who left in 1961 to open the Orthopedic Department at the Ichilov hospital in Tel Aviv. Shmuel Weissman became the first Chairman of Orthopedic Surgery at the Tel Aviv University medical school. In 1955, Myer Makin opened a modern orthopedic department in the Hadassah Hospital in Jerusalem and the Alyn Hospital for crippled children. In 1951, Assaf Harofeh Hospital opened the Department of Orthopedic Surgery headed by Anatol Axer who specialized in the treatment and rehabilitation of polio patients. The majority of the second generation of orthopedic department directors was trained by these four surgeons. Major developments in the 1960s and 1970s were the introduction of the AO system revolutionizing fracture treatment from conservative to operative treatment, the advent of total hip and knee replacements, Harrington instrumentation in spinal surgery and arthroscopy were major advances in orthopedic patient care brought to Israel by the aforementioned second generation of orthopedic surgeons. Hand surgery became an independent subspecialty of orthopedics and was lead by the internationally renowned hand surgeon, Isidore Kessler. PMID:24167938

  4. Early interfaced neural activity from chronic amputated nerves

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    Kshitija Garde

    2009-05-01

    Full Text Available Direct interfacing of transected peripheral nerves with advanced robotic prosthetic devices has been proposed as a strategy for achieving natural motor control and sensory perception of such bionic substitutes, thus fully functionally replacing missing limbs in amputees. Multi-electrode arrays placed in the brain and peripheral nerves have been used successfully to convey neural control of prosthetic devices to the user. However, reactive gliosis, micro hemorrhages, axonopathy and excessive inflammation, currently limit their long-term use. Here we demonstrate that enticement of peripheral nerve regeneration through a non-obstructive multi-electrode array, after either acute or chronic nerve amputation, offers a viable alternative to obtain early neural recordings and to enhance long-term interfacing of nerve activity. Non restrictive electrode arrays placed in the path of regenerating nerve fibers allowed the recording of action potentials as early as 8 days post-implantation with high signal-to-noise ratio, as long as 3 months in some animals, and with minimal inflammation at the nerve tissue-metal electrode interface. Our findings suggest that regenerative on-dependent multi-electrode arrays of open design allow the early and stable interfacing of neural activity from amputated peripheral nerves and might contribute towards conveying full neural control and sensory feedback to users of robotic prosthetic devices. .

  5. DESCRIPCIÓN DEL PROCESO DE DUELO EN MILITARES VÍCTIMAS DE MINAS ANTIPERSONA -- DESCRIPTION OF GRIEF PROCESS IN MILITARY VICTIMS OF ANTI-PERSONNEL MINES

    Directory of Open Access Journals (Sweden)

    PAULO DANIEL ACERO RODRÍGUEZ

    2008-06-01

    Full Text Available The conflict of which is setting Colombia, has brought with himself the utilization of anti-perssonel mines which the groups use to protect their territories of influence and in the moments in which they are pursued for the public force. This paper shows the results obtained from the investigation realised by the authors with a group of the military who key in minefields thus took place amputations, the central objectives were to describe the grief process that these people by the lost one of members of their body confront and to explore on the elements that affect the facing of the traumatic event. A qualitative methodology was used, interviewing to 8 members of Colombian army affected by mines person. The results allow to observe two classes of psychological mechanisms of facing: the mechanisms of defense before the originating anguish of the hostility of external means, (negation, minimisation regression, rationalization, repression and isolation which make its appearance at the first the psychological moments of the explosive impact and mechanisms that help the amputee to adapt to their new condition, (comparison, atemporality, importance and spirituality which they appear at a second moment when the amputation is realised under surgical conditions and therefore already is perceived like a measurement for the preservation of the life.

  6. Does unilateral transtibial amputation lead to greater metabolic demand during walking?

    Directory of Open Access Journals (Sweden)

    Elizabeth Russell Esposito, PhD

    2015-01-01

    Full Text Available Previous literature reports greater metabolic demand of walking following transtibial amputation. However, most research focuses on relatively older, less active, and often dysvascular amputees. Servicemembers with traumatic amputation are typically young, fit, and highly active before and often following surgical amputation of their lower limb. This study compared the metabolic demand of walking in young, active individuals with traumatic unilateral transtibial amputation (TTA and nondisabled controls. Heart rate (HR, rate of oxygen consumption, and rating of perceived exertion (RPE were calculated as subjects walked at a self-selected velocity and at five standardized velocities based on leg length. The TTA group completed a Prosthetics Evaluation Questionnaire. Oxygen consumption (p = 0.89, net oxygen consumption (p = 0.32, and RPE (p = 0.14 did not differ between groups. Compared with controls, HR was greater in the TTA group and increased to a greater extent with velocity (p < 0.001. Overall, the TTA group rated their walking abilities as high (mean: 93% out of 100%. This is the first study to report equivalent metabolic demand between persons with amputation and controls walking at the same velocity. These results may reflect the physical fitness of the young servicemembers with traumatic amputations and may serve to guide outcome expectations in the future.

  7. Looking Ahead to Engineering Epimorphic Regeneration of a Human Digit or Limb.

    Science.gov (United States)

    Quijano, Lina M; Lynch, Kristen M; Allan, Christopher H; Badylak, Stephen F; Ahsan, Tabassum

    2016-06-01

    Approximately 2 million people have had limb amputations in the United States due to disease or injury, with more than 185,000 new amputations every year. The ability to promote epimorphic regeneration, or the regrowth of a biologically based digit or limb, would radically change the prognosis for amputees. This ambitious goal includes the regrowth of a large number of tissues that need to be properly assembled and patterned to create a fully functional structure. We have yet to even identify, let alone address, all the obstacles along the extended progression that limit epimorphic regeneration in humans. This review aims to present introductory fundamentals in epimorphic regeneration to facilitate design and conduct of research from a tissue engineering and regenerative medicine perspective. We describe the clinical scenario of human digit healing, featuring published reports of regenerative potential. We then broadly delineate the processes of epimorphic regeneration in nonmammalian systems and describe a few mammalian regeneration models. We give particular focus to the murine digit tip, which allows for comparative studies of regeneration-competent and regeneration-incompetent outcomes in the same animal. Finally, we describe a few forward-thinking opportunities for promoting epimorphic regeneration in humans. PMID:26603349

  8. Application of self-report and performance-based outcome measures to determine functional differences between four categories of prosthetic feet

    Directory of Open Access Journals (Sweden)

    Robert S. Gailey, PhD, PT

    2012-06-01

    Full Text Available We examined the application of outcome measures to determine changes in function caused by standardized functional prosthetic gait training and the use of four different prosthetic feet in people with unilateral transtibial limb loss. Two self-report measures (Prosthetic Evaluation Questionnaire-Mobility Scale [PEQ-13] and Locomotor Capabilities Index [LCI], and three performance-based measures (Amputee Mobility Predictor with a prosthesis [AMPPRO], 6-minute walk test [6MWT] and step activity monitor [SAM] were used. Ten people with unilateral transtibial limb loss, five with peripheral vascular disease (PVD and five without PVD, completed testing. Subjects were tested at baseline and after receiving training with their existing prosthesis and with the study socket and four prosthetic feet, i.e., SACH (solid ankle cushion heel, SAFE (stationary attachment flexible endoskeletal, Talux, and Proprio feet, over 8 to 10 weeks. Training was administered between testing sessions. No differences were detected by the PEQ-13, LCI, 6MWT, or SAM following training and after fitting with test feet. The AMPPRO demonstrated differences following training with the existing prosthesis in the PVD group and between selected feet from baseline testing (p

  9. A cam-displacement transducer device for measuring small two-degree of freedom inter-component motion in a prosthesis.

    Science.gov (United States)

    Twiste, M; Rithalia, S V S; Kenney, L

    2004-05-01

    An electromechanical system is described that comprises a cam and two linear displacement transducers for measuring two-degree of freedom. This is aimed at quantifying the extent and pattern of both transverse rotation and longitudinal translation that takes place during amputee gait at what is sometimes termed a "torque-shock absorbing adapter" located between the prosthetic socket and foot. Both types of motion are measured independently by mounting the cam around the adapter and the two transducers orthogonal to one another with their spring loaded plungers moving separately against the cam's perimeter and distal, flat face. The cam geometry should be an arc of a spiral and not a circle for the angular displacement measurement to be linear in response to rotation. Over a range of +/-18 degrees for transverse rotation the maximum deviation of the ideal cam geometry away from an arc of a circle is less than +/-0.5% of the transducers' 10 mm stroke. The transducer's linearity is +/-2% and it could therefore be assumed that this would be the dominant source of error. The theoretical predictions are supported by the calibration results, in which the pattern of errors that are found in the transducers' calibration can also be seen in the calibration of the cam. PMID:15121059

  10. Decellular biological scaffold polymerized with PEDOT for improving peripheral nerve interface charge transfer.

    Science.gov (United States)

    Frost, Christopher M; Cederna, Paul S; Martin, David C; Shim, Bong Sup; Urbanchek, Melanie G

    2014-01-01

    Regenerative peripheral nerve interfaces (RPNIs) are for signal transfer between peripheral nerves inside the body to controllers for motorized prosthetics external to the body. Within the residual limb of an amputee, surgical construction of a RPNI connects a remaining peripheral nerve and spare muscle. Nerve signals become concentrated within the RPNI. Currently metal electrodes implanted on the RPNI muscle transfer signals but scarring around metal electrodes progressively diminishes charge transfer. Engineered materials may benefit RPNI signal transfer across the neural interface if they lower the power and charge density of the biologically meaningful signals. Poly3,4-ethylenedioxythiophene (PEDOT) is known to mediate ionic potentials allowing excitation across a critical nerve gap. We hypothesize that the capacity of an interface material to conduct electron mediated current is significantly increased by polymerized coating of PEDOT. SIS was either used plain or after PEDOT coating by electrochemical polymerization. Muscle forces are a direct representation of stimulating current distribution within an RPNI. In situ muscle forces were measured for the same muscle by electrically stimulating: a) the muscle's innervating nerve, b) directly on the muscle, c) on plain SIS laid on the muscle, and d) on SIS polymerized with PEDOT laid on the muscle. Electro-chemically coating PEDOT on SIS resulted in a thin, flexible material. PEDOT coated SIS distributed electrical stimulation more efficiently than SIS alone. Conductive polymer containing biological material allowed ionic signal distribution within the RPNI like muscle at lower charge density. PMID:25569986

  11. Modelling muscle spindle dynamics for a proprioceptive prosthesis.

    Science.gov (United States)

    Williams, Ian; Constandinou, Timothy G

    2013-01-01

    Muscle spindles are found throughout our skeletal muscle tissue and continuously provide us with a sense of our limbs' position and motion (proprioception). This paper advances a model for generating artificial muscle spindle signals for a prosthetic limb, with the aim of one day providing amputees with a sense of feeling in their artificial limb. By utilising the Opensim biomechanical modelling package the relationship between a joint's angle and the length of surrounding muscles is estimated for a prosthetic limb. This is then applied to the established Mileusnic model to determine the associated muscle spindle firing pattern. This complete system model is then reduced to allow for a computationally efficient hardware implementation. This reduction is achieved with minimal impact on accuracy by selecting key mono-articular muscles and fitting equations to relate joint angle to muscle length. Parameter values fitting the Mileusnic model to human spindles are then proposed and validated against previously published human neural recordings. Finally, a model for fusimotor signals is also proposed based on data previously recorded from reduced animal experiments. PMID:24110089

  12. Brain-computer interface control along instructed paths

    Science.gov (United States)

    Sadtler, P. T.; Ryu, S. I.; Tyler-Kabara, E. C.; Yu, B. M.; Batista, A. P.

    2015-02-01

    Objective. Brain-computer interfaces (BCIs) are being developed to assist paralyzed people and amputees by translating neural activity into movements of a computer cursor or prosthetic limb. Here we introduce a novel BCI task paradigm, intended to help accelerate improvements to BCI systems. Through this task, we can push the performance limits of BCI systems, we can quantify more accurately how well a BCI system captures the user’s intent, and we can increase the richness of the BCI movement repertoire. Approach. We have implemented an instructed path task, wherein the user must drive a cursor along a visible path. The instructed path task provides a versatile framework to increase the difficulty of the task and thereby push the limits of performance. Relative to traditional point-to-point tasks, the instructed path task allows more thorough analysis of decoding performance and greater richness of movement kinematics. Main results. We demonstrate that monkeys are able to perform the instructed path task in a closed-loop BCI setting. We further investigate how the performance under BCI control compares to native arm control, whether users can decrease their movement variability in the face of a more demanding task, and how the kinematic richness is enhanced in this task. Significance. The use of the instructed path task has the potential to accelerate the development of BCI systems and their clinical translation.

  13. Informing Ankle-Foot Prosthesis Prescription through Haptic Emulation of Candidate Devices

    Science.gov (United States)

    Caputo, Joshua M.; Adamczyk, Peter G.; Collins, Steven H.

    2016-01-01

    Robotic prostheses can improve walking performance for amputees, but prescription of these devices has been hindered by their high cost and uncertainty about the degree to which individuals will benefit. The typical prescription process cannot well predict how an individual will respond to a device they have never used because it bases decisions on subjective assessment of an individual’s current activity level. We propose a new approach in which individuals ‘test drive’ candidate devices using a prosthesis emulator while their walking performance is quantitatively assessed and results are distilled to inform prescription. In this system, prosthesis behavior is controlled by software rather than mechanical implementation, so users can quickly experience a broad range of devices. To test the viability of the approach, we developed a prototype emulator and assessment protocol, leveraging hardware and methods we previously developed for basic science experiments. We demonstrated emulations across the spectrum of commercially available prostheses, including traditional (e.g. SACH), dynamic-elastic (e.g. FlexFoot), and powered robotic (e.g. BiOM® T2) prostheses. Emulations exhibited low error with respect to reference data and provided subjectively convincing representations of each device. We demonstrated an assessment protocol that differentiated device classes for each individual based on quantitative performance metrics, providing feedback that could be used to make objective, personalized device prescriptions.

  14. Shape-memory alloy overload protection device for osseointegrated transfemoral implant prosthetic limb attachment system

    Science.gov (United States)

    Xu, Wei; Shao, Fei; Hughes, Steven

    2002-11-01

    The osseointegrated trans-femoral implant system provides a direct anchoring technique to attach prosthetic limb. This technique was first introduced PI Brenmark in Sweden. The UK had the first clinical trial in 1997 and currently has 6 active limb wearers. The success of this procedure has the potential for improved gait function and mobility, increased employability and significant long-term improvements in the quality of life for above knee amputees. However, the significant load involved in the trans-femoral implant system has caused permanent deformation and/or fractures of the implant abutment in several occasions. To protect the implant system, the implant abutment in particularly, an overloading protection device was introduced. The device uses mechanical mechanism to release torsion overload on the abutment. However, the bending overload protection remains unsolved. To solve the problem, a new overload protection device was developed. This device uses SMA component for bending overload protection. In this paper, the results of non-linear finite element modelling of the SMA and steel (AISI 1040) components were presented. Experiments were also carried out using steel components to assess the design which is based on the non-linear property of the materials.

  15. Optimization-Based Design of a Small Pneumatic-Actuator-Driven Parallel Mechanism for a Shoulder Prosthetic Arm with Statics and Spatial Accessibility Evaluation

    Directory of Open Access Journals (Sweden)

    Masashi Sekine

    2013-07-01

    Full Text Available Human arms undertake most tasks in the activities of daily living (ADLs. When designing shoulder prostheses for high‐level upper‐limb amputees, we should consider not only how to realize high degrees of freedom under weight and shape constraints but also the user’s individual task space in daily life. An appropriate mechanical structure that can make full use of state‐of‐the‐art actuators and a scheme to optimize the structure’s configuration to match users’ spatial access and manipulability requirements are essential. In our previous research, a small pneumatic‐actuator‐driven parallel mechanism was studied as a shoulder prosthetic arm. In this paper, a systematic procedure is proposed to design the mechanism for a shoulder prosthesis considering force and spatial accessibility. This procedure includes ADL measurements to obtain the task spaces for individual subjects, indexes to evaluate the force and spatial accessibility and an optimization process based on kinematic and statics models. With this approach, the parallel mechanism was optimized for one important ADL task group, considering the trade‐off between its required force and working space. Moreover, it was confirmed that the proposed design procedure could find solutions for various spatial specifications. That is, the approach could be used for individualized shoulder prosthesis design.

  16. Microchannel neural interface manufacture by stacking silicone and metal foil laminae

    Science.gov (United States)

    Lancashire, Henry T.; Vanhoestenberghe, Anne; Pendegrass, Catherine J.; Ajam, Yazan Al; Magee, Elliot; Donaldson, Nick; Blunn, Gordon W.

    2016-06-01

    Objective. Microchannel neural interfaces (MNIs) overcome problems with recording from peripheral nerves by amplifying signals independent of node of Ranvier position. Selective recording and stimulation using an MNI requires good insulation between microchannels and a high electrode density. We propose that stacking microchannel laminae will improve selectivity over single layer MNI designs due to the increase in electrode number and an improvement in microchannel sealing. Approach. This paper describes a manufacturing method for creating MNIs which overcomes limitations on electrode connectivity and microchannel sealing. Laser cut silicone—metal foil laminae were stacked using plasma bonding to create an array of microchannels containing tripolar electrodes. Electrodes were DC etched and electrode impedance and cyclic voltammetry were tested. Main results. MNIs with 100 μm and 200 μm diameter microchannels were manufactured. High electrode density MNIs are achievable with electrodes present in every microchannel. Electrode impedances of 27.2 ± 19.8 kΩ at 1 kHz were achieved. Following two months of implantation in Lewis rat sciatic nerve, micro-fascicles were observed regenerating through the MNI microchannels. Significance. Selective MNIs with the peripheral nervous system may allow upper limb amputees to control prostheses intuitively.

  17. Development of an Air Pneumatic Suspension System for Transtibial Prostheses

    Directory of Open Access Journals (Sweden)

    Gholamhossein Pirouzi

    2014-09-01

    Full Text Available The suspension system and socket fitting of artificial limbs have major roles and vital effects on the comfort, mobility, and satisfaction of amputees. This paper introduces a new pneumatic suspension system that overcomes the drawbacks of current suspension systems in donning and doffing, change in volume during daily activities, and pressure distribution in the socket-stump interface. An air pneumatic suspension system (APSS for total-contact sockets was designed and developed. Pistoning and pressure distribution in the socket-stump interface were tested for the new APSS. More than 95% of the area between each prosthetic socket and liner was measured using a Tekscan F-Scan pressure measurement which has developed matrix-based pressure sensing systems. The variance in pressure around the stump was 8.76 kPa. APSS exhibits less pressure concentration around the stump, improved pressure distribution, easy donning and doffing, adjustability to remain fitted to the socket during daily activities, and more adaptability to the changes in stump volume. The volume changes were adjusted by utility of air pressure sensor. The vertical displacement point and reliability of suspension were assessed using a photographic method. The optimum pressure in every level of loading weight was 55 kPa, and the maximum displacement was 6 mm when 90 N of weight was loaded.

  18. Influence of Perspective of Action Observation Training on Residual Limb Control in Naïve Prosthesis Usage.

    Science.gov (United States)

    Lawson, Delisa T; Cusack, William F; Lawson, Regan; Hardy, Ashley; Kistenberg, Robert; Wheaton, Lewis A

    2016-01-01

    Prior work in amputees and partial limb immobilization have shown improved neural and behavioral outcomes in using their residual limb with prosthesis when undergoing observation-based training with a prosthesis-using actor compared to an intact limb. It was posited that these improvements are due to an alignment of user with the actor. It may be affected by visual angles that allow emphasis of critical joint actions which may promote behavioral changes. The purpose of this study was to examine how viewing perspective of observation-based training effects prosthesis adaptation in naïve device users. Twenty nonamputated prosthesis users learned how to use an upper extremity prosthetic device while viewing a training video from either a sagittal or coronal perspective. These views were chosen as they place visual emphasis on different aspects of task performance to the device. The authors found that perspective of actions has a significant role in adaptation of the residual limb while using upper limb prostheses. Perspectives that demonstrate elbow adaptations to prosthesis usage may enhance the functional motor outcomes of action observation therapy. This work has potential implications on how prosthetic device operation is conveyed to persons adapting to prostheses through action observation based therapy. PMID:27253208

  19. Incidence, severity, and impact of hyperhidrosis in people with lower-limb amputation

    Directory of Open Access Journals (Sweden)

    Colby Hansen, MD

    2015-04-01

    Full Text Available To assess the incidence and severity of self-reported hyperhidrosis in patients with amputation and understand its effects on prosthetic fit or function, a cross-sectional survey of patients at two amputee clinics was performed. Responses from 121 subjects with lower-limb amputation were analyzed. Of these subjects, 66% reported sweating to a degree that it interfered with daily activities, as measured by the Hyperhidrosis Disease Severity Scale. There was a significant association between sweating and interference with prosthetic fit and function. Sweating was more severe in cases of transtibial amputations, patients under the age of 60 yr, warm weather, and vigorous activity. There was no relationship between severity of sweating and time since amputation, etiology of amputation, duration of daily prosthetic use, or reported ability to perform functional tasks. Subjects reported trying multiple interventions, but the self-reported effectiveness of these treatments was low. Hyperhidrosis, a common problem associated with prosthetic usage, varies in severity and often interferes with daily activities. Sweating severity is associated with poor prosthetic fit and function. Risk factors include younger age and transtibial amputation status. Treatment strategies generally lack efficacy. The results of this study may provide guidance for future interventions and treatment options.

  20. Dermatological changes of amputation stump

    Directory of Open Access Journals (Sweden)

    Arora P

    1993-01-01

    Full Text Available Dermatological changes of stumps of 174 amputees are presented. The commonest dermatological change recorded at the site of amputation stump was hyperpigmentation in 46 (26.4% followed by callosities in 32 (18.3%, scaling in 29 (16.7%, cutaneous atrophy in 20 (11.5%, lichenification in 19(10.9%, traumatic ulcer and bacterial infections in 18 (10.3% each, hypertrophic scar in 14 (8.1%, hypopigmentation and corns in 13 (7.4% each, verrucous hypertrophy of stump in 12 (6.9%, dermatophytic infection in 5(2.9%, stump oedema and phantom limb in 4 (2.3% each, intertriginous dermatitis in 3( 1.7%, allergic contact dermatitis (resin and frictional eczema in 2(1.1% each. Epidermoid cyst, keloid formation, anaesthesia, gangrene and cutaneous horn were recorded in 1 (0.6% each. Atrophy (epidermal and derma, anaesthesia, alopecia and elephantiasis of the stump have not been documented in the literature earlier.

  1. 3D probe array integrated with a front-end 100-channel neural recording ASIC

    International Nuclear Information System (INIS)

    Brain–machine interface technology can improve the lives of spinal cord injury victims and amputees. A neural interface system, consisting of a 3D probe array and a custom low-power (1 mW) 100-channel (100-ch) neural recording application-specific integrated circuit (ASIC), was designed and implemented to monitor neural activity. In this study, a microassembly 3D probe array method using a novel lead transfer technique was proposed to overcome the bonding plane mismatch encountered during orthogonal assembly. The proposed lead transfer technique can be completed using standard micromachining and packaging processes. The ASIC can be stacking-integrated with the probe array, minimizing the form factor of the assembled module. To minimize trauma to brain cells, the profile of the integrated probe array was controlled within 730 μm. The average impedance of the assembled probe was approximately 0.55 MΩ at 1 kHz. To verify the functionality of the integrated neural probe array, bench-top signal acquisitions were performed and discussed. (paper)

  2. Haptic wearables as sensory replacement, sensory augmentation and trainer - a review.

    Science.gov (United States)

    Shull, Peter B; Damian, Dana D

    2015-01-01

    Sensory impairments decrease quality of life and can slow or hinder rehabilitation. Small, computationally powerful electronics have enabled the recent development of wearable systems aimed to improve function for individuals with sensory impairments. The purpose of this review is to synthesize current haptic wearable research for clinical applications involving sensory impairments. We define haptic wearables as untethered, ungrounded body worn devices that interact with skin directly or through clothing and can be used in natural environments outside a laboratory. Results of this review are categorized by degree of sensory impairment. Total impairment, such as in an amputee, blind, or deaf individual, involves haptics acting as sensory replacement; partial impairment, as is common in rehabilitation, involves haptics as sensory augmentation; and no impairment involves haptics as trainer. This review found that wearable haptic devices improved function for a variety of clinical applications including: rehabilitation, prosthetics, vestibular loss, osteoarthritis, vision loss and hearing loss. Future haptic wearables development should focus on clinical needs, intuitive and multimodal haptic displays, low energy demands, and biomechanical compliance for long-term usage. PMID:26188929

  3. Estimation of ground reaction force and zero moment point on a powered ankle-foot prosthesis.

    Science.gov (United States)

    Martinez-Villalpando, Ernesto C; Herr, Hugh; Farrell, Matthew

    2007-01-01

    The ground reaction force (GRF) and the zero moment point (ZMP) are important parameters for the advancement of biomimetic control of robotic lower-limb prosthetic devices. In this document a method to estimate GRF and ZMP on a motorized ankle-foot prosthesis (MIT Powered Ankle-Foot Prosthesis) is presented. The method proposed is based on the analysis of data collected from a sensory system embedded in the prosthetic device using a custom designed wearable computing unit. In order to evaluate the performance of the estimation methods described, standing and walking clinical studies were conducted on a transtibial amputee. The results were statistically compared to standard analysis methodologies employed in a gait laboratory. The average RMS error and correlation factor were calculated for all experimental sessions. By using a static analysis procedure, the estimation of the vertical component of GRF had an averaged correlation coefficient higher than 0.94. The estimated ZMP location had a distance error of less than 1 cm, equal to 4% of the anterior-posterior foot length or 12% of the medio-lateral foot width. PMID:18003052

  4. Military Orthopaedic Trauma Registry: Quality Data Now Available.

    Science.gov (United States)

    Rivera, Jessica C; Greer, Renee M; Wenke, Joseph C; Ficke, James R; Johnson, Anthony E

    2016-01-01

    The Military Orthopaedic Trauma Registry (MOTR) orginally began as part of the Department of Defense Trauma Registry (DoDTR) and became a live registry in 2013. As a quality improvement process, this study examined MOTR data for 20 female amputees compared with DoDTR data. The DoDTR provided diagnosis and procedure codes as a list but no details. The MOTR provided additional data, including specific limb, fracture classifications, and associated injuries per limb. The MOTR allowed for construction of a treatment time line for each limb, including number and timing of debridements, antibiotics, and implant types. Orthopaedic-specific complications were also coded more frequently in the MOTR and clearly identified with a specific injury and treatment. During initial quality control checks, the MOTR provides a greater volume and granularity of detail for orthopaedic-specific injury and treatment information, indicating that the MOTR is on track to provide a valuable repository for data-driven orthopaedic management of combat injury. PMID:27518292

  5. Contact dermatitis from a prosthesis.

    Science.gov (United States)

    Munoz, Carla A; Gaspari, Anthony; Goldner, Ronald

    2008-01-01

    Patients wearing a prosthesis face a wide variety of medical problems. Skin complications have long been recognized, but their prevalence is still unknown. The most frequently reported disorders are allergic contact dermatitis (ACD), acroangiodermatitis, epidermoid cysts, epidermal hyperplasia, follicular hyperkeratosis, verrucous hyperplasia, bullous diseases, hyperhidrosis, infections, malignancies, and ulcerations. Contact dermatitis represents one-third of the dermatoses in amputees wearing prostheses. All patients who are suspected of having ACD should be patch tested with standard allergen series as well as materials from the patient's own prosthesis, topical medicaments, moisturizers, and cosmetics. We report a patient with an ACD to mixed dialkyl thiourea present in the rubber parts of his below-the-knee prosthesis. Thiourea derivates are used as accelerators in the manufacture of chloroprene rubber and as fixatives in photography and photocopy paper. Allergy to thiourea is relatively uncommon; different studies have shown a prevalence of 0.7% up to 2.4% in patch-tested patients. Thiourea derivates are often the allergic sources in ACD involving high-grade rubber products made of neoprene such as diving suits, protective goggles, knee braces, and continuous positive airway pressure masks. They are also present in the rubber material of prostheses, as in the case of our patient. PMID:18413115

  6. Novel Approaches for Robotic Control Using Flex Sensor

    Directory of Open Access Journals (Sweden)

    Sangeetha.P

    2015-02-01

    Full Text Available The aim of the project is to develop the Prosthetic robotic hand using flex sensor for amputees. The main aim of the project is to develop the robotic hand that performs pick and place activities. Here we are using flex sensors to sense the signals from artificial hand signal is transmitted and that signal is used to drive the mechanical hand. Stroke is the third leading cause of the death. Nearly 7, 00,000 people suffered from stroke last year and 2/3 rd of them survived but were left with many number of disabilities; one such disability is upper extremity hemiplegia. If the hand and the arm do not have therapy immediately after stroke, it will lose its power and muscle control, resulting in a claw like appearance and loss of function. Activities of the patient, daily living activities will be significantly affected.Prosthetic hand must resemble human hand in size and shape and must perform like human hand.

  7. Upper extremity myoelectric prosthetics.

    Science.gov (United States)

    Uellendahl, J E

    2000-08-01

    Myoelectric control of upper limb prostheses has proven to be an effective and efficient means of controlling prosthetic components. This means of control has been used extensively for over 30 years, during which time these systems have become reliable and durable in most situations. Myoelectric control, or any other prosthetic control scheme, should not be considered as the optimal control for arm prostheses, but rather as one of the several effective ways of producing desired function. Advanced clinical practice calls for a blending of all control schemes, as appropriate, to allow the prosthesis to serve the intentions of the user efficiently and with little mental effort. Technology continues to change, bringing with it new and sometimes better ways of fitting amputees. Microprocessors and programmable controllers have opened new and exciting avenues for improvement in function. New, and as of yet unidentified, electronic and mechanical advances are certainly on the horizon. There is much work to be done before upper limb prostheses rightfully are called arm replacements. But progress is occurring and advances are being made toward the goal of replacing the function and appearance of that marvelous tool, the human arm. PMID:10989484

  8. Cine Club

    CERN Multimedia

    Cine Club

    2015-01-01

    Wednesday 18 November 2015 at 20:00 CERN Council Chamber Johnny Got His Gun Directed by Dalton Trumbo USA, 1971, 111 minutes Joe, a young American soldier, is hit by a mortar shell on the last day of World War I. He lies in a hospital bed in a fate worse than death - a quadruple amputee who has lost his arms, legs, eyes, ears, mouth and nose. He remains conscious and able to think, thereby reliving his life through strange dreams and memories, unable to distinguish whether he is awake or dreaming. He remains frustrated by his situation, until one day he discovers a unique way to communicate with his caregivers. Original version english; french subtitles   Wednesday 25 November 2015 at 20:00 CERN Council Chamber War Horse Directed by JSteven Spielberg USA, 2011, 146 minutes Dartmoor 1914: To his wife's dismay farmer Narracott buys a thoroughbred horse rather than a plough animal, but when his teenage son Albert trains the horse and calls him Joey, the two become inseparable. When harvest...

  9. Computationally Efficient Modelling of Proprioceptive Signals in the Upper Limb for Prostheses: a Simulation Study

    Directory of Open Access Journals (Sweden)

    Ian eWilliams

    2014-06-01

    Full Text Available Accurate models of proprioceptive neural patterns could one day play an important role in the creation of an intuitive proprioceptive neural prosthesis for amputees. This paper looks at combining efficient implementations of biomechanical and proprioceptor models in order to generate signals that mimic human muscular proprioceptive patterns for future experimental work in prosthesis feedback. A neuro-musculoskeletal model of the upper limb with 7 degrees of freedom and 17 muscles is presented and generates real time estimates of muscle spindle and Golgi Tendon Organ neural firing patterns. Unlike previous neuro-musculoskeletal models, muscle activation and excitation levels are unknowns in this application and an inverse dynamics tool (static optimisation is integrated to estimate these variables. A proprioceptive prosthesis will need to be portable and this is incompatible with the computationally demanding nature of standard biomechanical and proprioceptor modelling. This paper uses and proposes a number of approximations and optimisations to make real time operation on portable hardware feasible. Finally technical obstacles to mimicking natural feedback for an intuitive proprioceptive prosthesis, as well as issues and limitations with existing models, are identified and discussed.

  10. Characteristics of a volume-adjustable compression chamber for transradial prosthetic interface.

    Science.gov (United States)

    Sang, Yuanjun; Li, Xiang; Luo, Yun

    2016-07-01

    In the transradial limb-socket contact interface, the physiological properties and prosthetic operating habits of the residual limb might affect the comfort and functionality of the prosthesis. To enhance the comfort and functionality of the interface, a frame-type socket with four volume-adjustable compression chambers was proposed for the transradial amputation level. The contact pressure of the limb-socket interface was adjusted by the volume changes in the chambers and controlled by a vacuum pump and the corresponding control system. The parameters of the chamber were designed in accordance with the biomechanics of the forearm soft tissue. The chamber with a negative stiffness characteristic was theoretically compared with the chamber with a positive stiffness characteristic. The results showed that the former had a superior performance to the latter in safety and pump performance requirements. A physical model of the transradial frame-type prosthetic interface was also manufactured with four negative stiffness chambers. The experimental results showed that this new prosthetic interface achieved more fitting time and better performance in comfort and functionality than the fixed frame-type socket. This new prosthetic interface with volume-adjustable compression chambers might be an alternative choice for transradial amputees. PMID:27146289

  11. Precision and accuracy of 3D lower extremity residua measurement systems

    Science.gov (United States)

    Commean, Paul K.; Smith, Kirk E.; Vannier, Michael W.; Hildebolt, Charles F.; Pilgram, Thomas K.

    1996-04-01

    Accurate and reproducible geometric measurement of lower extremity residua is required for custom prosthetic socket design. We compared spiral x-ray computed tomography (SXCT) and 3D optical surface scanning (OSS) with caliper measurements and evaluated the precision and accuracy of each system. Spiral volumetric CT scanned surface and subsurface information was used to make external and internal measurements, and finite element models (FEMs). SXCT and OSS were used to measure lower limb residuum geometry of 13 below knee (BK) adult amputees. Six markers were placed on each subject's BK residuum and corresponding plaster casts and distance measurements were taken to determine precision and accuracy for each system. Solid models were created from spiral CT scan data sets with the prosthesis in situ under different loads using p-version finite element analysis (FEA). Tissue properties of the residuum were estimated iteratively and compared with values taken from the biomechanics literature. The OSS and SXCT measurements were precise within 1% in vivo and 0.5% on plaster casts, and accuracy was within 3.5% in vivo and 1% on plaster casts compared with caliper measures. Three-dimensional optical surface and SXCT imaging systems are feasible for capturing the comprehensive 3D surface geometry of BK residua, and provide distance measurements statistically equivalent to calipers. In addition, SXCT can readily distinguish internal soft tissue and bony structure of the residuum. FEM can be applied to determine tissue material properties interactively using inverse methods.

  12. Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III☆

    Science.gov (United States)

    Jaña Neto, Frederico Carlos; de Paula Canal, Marina; Alves, Bernardo Aurélio Fonseca; Ferreira, Pablício Martins; Ayres, Jefferson Castro; Alves, Robson

    2016-01-01

    Objective To analyze the characteristics of patients with Gustilo–Anderson Type III open tibial fractures treated at a tertiary care hospital in São Paulo between January 2013 and August 2014. Methods This was a cross-sectional retrospective study. The following data were gathered from the electronic medical records: age; gender; diagnosis; trauma mechanism; comorbidities; associated fractures; Gustilo and Anderson, Tscherne and AO classifications; treatment (initial and definitive); presence of compartment syndrome; primary and secondary amputations; MESS (Mangled Extremity Severity Score) index; mortality rate; and infection rate. Results 116 patients were included: 81% with fracture type IIIA, 12% IIIB and 7% IIIC; 85% males; mean age 32.3 years; and 57% victims of motorcycle accidents. Tibial shaft fractures were significantly more prevalent (67%). Eight patients were subjected to amputation: one primary case and seven secondary cases. Types IIIC (75%) and IIIB (25%) predominated among the patients subjected to secondary amputation. The MESS index was greater than 7 in 88% of the amputees and in 5% of the limb salvage group. Conclusion The profile of patients with open tibial fracture of Gustilo and Anderson Type III mainly involved young male individuals who were victims of motorcycle accidents. The tibial shaft was the segment most affected. Only 7% of the patients underwent amputation. Given the current controversy in the literature about amputation or salvage of severely injured lower limbs, it becomes necessary to carry out prospective studies to support clinical decisions. PMID:27069881

  13. 都江堰友爱学校地震伤员康复状况调查分析%Rehabilitation needs of earthquake victims in Dujiangyan Youai primary school in Sichuan Province

    Institute of Scientific and Technical Information of China (English)

    潘福琼; 黎浩然; 杨玉龙; 田金艳; 赵冠兰; 彭博; 陈启明; 罗尚蔚; 何锦华; 彭元宏

    2011-01-01

    Objective To investigate the status of dysfunction and rehabilitation needs of earthquake victims in Dujiangyan Youai primary school in Sichuan Province,to provide a guideline for further rehabilitation. Methods Live investigation was performed for 105 patients in the school. Amputation Body Image Scale (ABIS)was used as psychological assessment to investigate the psychological status of 40 amputees. Results Among the 105 victims,there were 44 cases of fracture (41.9%) ,40 cases of amputee ( 39% ),15 cases of crush syndrome ( 14. 2% ) and 6 cases of head injury (5. 7% ). Most of them had different levels of physical dysfunction,including 62 cases of decreased muscle strength ( 59. 1% ) ,32 cases of muscular atrophy ( 30. 2% ) ,49 cases of limited range of motion ( ROM ) ( 46. 7% ) , 70 cases of cicatricial adhesion ( 66. 7% ) , 14 cases of sensory disorder ( 13.3% ) , 32 cases of arthrogryposis ( 30. 5% ) ,23 cases of abnormal gait ( 21.9% ) and 26 cases of limitation in activities of daily living ( ADL ) ( 24. 8% ). Conclusions Sichuan earthquake victims in Youai primary school had different levels of rehabilitation needs. Further rehabilitation is needed and intensive attention should be paid to those wounded with psychological problems.%目的 分析全国首家无障碍学校--四川省都江堰友爱学校地震伤员的伤情、功能障碍、康复现状及需求,为下一步康复医疗提供依据.方法 对105例在校伤员进行现场功能评估,采用截肢身体意象评估量表(ABIS),对40名截肢伤员进行问卷调查.结果 105例伤员中,骨折44例(41.9%)、截肢40例(39%)、挤压伤15例(14.2%)、脑外伤6例(5.7%);大都存在的不同程度、多种功能障碍问题,其中肌力减退62例(59.1%),肌肉萎缩32例(30.2%),关节活动度(ROM)受限49例(46.7%),瘢痕粘连增生70例(66.7%),感觉障碍14例(13.3%),关节挛缩32例(30.5%),步态异常23例(21.9%),生活不能完全自理26例(24.8%).结论 105

  14. Clinical analysis of diabetic foot and the epidemiology of diabetic foot amputation%糖尿病足流行病学及糖尿病足截肢的临床分析

    Institute of Scientific and Technical Information of China (English)

    彭小兵

    2015-01-01

    Objective Discussion for diabetic foot (DF) patients were analyzed epidemiological situation and amputation.Methods Our hospital in October 2012 -2014 October diabetes, diabetic foot and DF patients require amputation. The clinical data of all patients were analyzed retrospectively. Statistics clinical diabetic foot amputation rate, and analyze the reasons for amputees after the completion, resulting in clinical death.Results Clinical manifestations of diabetic foot in a higher amputation rate.For patients with diabetic foot amputation, after the completion of their cases with surgical wound healing in patients with amputation, as well as whether the patient showed a partial case of infection in the presence of a close relationship. Patients with diabetic foot main cause of death for patients appeared in the case of multiple organ failure. The deadline for the 10 patients, 1 patient clinical death, the remaining patients in the healing section showed significant differences in the extent (P<0.05).Conclusion For patients with diabetic foot disease, more common in the elderly population. For amputees, after its complete amputation surgery ensure good blood supply, which can effectively ensure the effective healing of surgical incisions. For diabetic foot amputation patients before surgery, after surgery, the patient needs to make the necessary comprehensive treatment, the patient's body organ function effectively guarantee all normal, you can effectively deal with stress situations for surgery, reduce postoperative mortality.%目的:探讨针对糖尿病足(DF)患者,对其流行病学以及截肢的情况进行分析。方法选取该院2012年10月—2014年10月糖尿病患者、糖尿病足患者以及需要截肢的DF患者。对所有患者的临床资料进行回顾性分析。统计糖尿病足患者临床截肢率,并分析患者完成截肢后,导致患者临床死亡的原因。结果糖尿病足患者于临床表现出较高的截肢率。针对糖尿

  15. Towards a naturalistic brain-machine interface: hybrid torque and position control allows generalization to novel dynamics.

    Science.gov (United States)

    Chhatbar, Pratik Y; Francis, Joseph T

    2013-01-01

    Realization of reaching and grasping movements by a paralytic person or an amputee would greatly facilitate her/his activities of daily living. Towards this goal, control of a computer cursor or robotic arm using neural signals has been demonstrated in rodents, non-human primates and humans. This technology is commonly referred to as a Brain-Machine Interface (BMI) and is achieved by predictions of kinematic parameters, e.g. position or velocity. However, execution of natural movements, such as swinging baseball bats of different weights at the same speed, requires advanced planning for necessary context-specific forces in addition to kinematic control. Here we show, for the first time, the control of a virtual arm with representative inertial parameters using real-time neural control of torques in non-human primates (M. radiata). We found that neural control of torques leads to ballistic, possibly more naturalistic movements than position control alone, and that adding the influence of position in a hybrid torque-position control changes the feedforward behavior of these BMI movements. In addition, this level of control was achievable utilizing the neural recordings from either contralateral or ipsilateral M1. We also observed changed behavior of hybrid torque-position control under novel external dynamic environments that was comparable to natural movements. Our results demonstrate that inclusion of torque control to drive a neuroprosthetic device gives the user a more direct handle on the movement execution, especially when dealing with novel or changing dynamic environments. We anticipate our results to be a starting point of more sophisticated algorithms for sensorimotor neuroprostheses, eliminating the need of fully automatic kinematic-to-dynamic transformations as currently used by traditional kinematic-based decoders. Thus, we propose that direct control of torques, or other force related variables, should allow for more natural neuroprosthetic movements by

  16. Within-socket myoelectric prediction of continuous ankle kinematics for control of a powered transtibial prosthesis

    Science.gov (United States)

    Farmer, Samuel; Silver-Thorn, Barbara; Voglewede, Philip; Beardsley, Scott A.

    2014-10-01

    Objective. Powered robotic prostheses create a need for natural-feeling user interfaces and robust control schemes. Here, we examined the ability of a nonlinear autoregressive model to continuously map the kinematics of a transtibial prosthesis and electromyographic (EMG) activity recorded within socket to the future estimates of the prosthetic ankle angle in three transtibial amputees. Approach. Model performance was examined across subjects during level treadmill ambulation as a function of the size of the EMG sampling window and the temporal ‘prediction’ interval between the EMG/kinematic input and the model’s estimate of future ankle angle to characterize the trade-off between model error, sampling window and prediction interval. Main results. Across subjects, deviations in the estimated ankle angle from the actual movement were robust to variations in the EMG sampling window and increased systematically with prediction interval. For prediction intervals up to 150 ms, the average error in the model estimate of ankle angle across the gait cycle was less than 6°. EMG contributions to the model prediction varied across subjects but were consistently localized to the transitions to/from single to double limb support and captured variations from the typical ankle kinematics during level walking. Significance. The use of an autoregressive modeling approach to continuously predict joint kinematics using natural residual muscle activity provides opportunities for direct (transparent) control of a prosthetic joint by the user. The model’s predictive capability could prove particularly useful for overcoming delays in signal processing and actuation of the prosthesis, providing a more biomimetic ankle response.

  17. Primary motor cortex changes after amputation correlate with phantom limb pain and the ability to move the phantom limb.

    Science.gov (United States)

    Raffin, Estelle; Richard, Nathalie; Giraux, Pascal; Reilly, Karen T

    2016-04-15

    A substantial body of evidence documents massive reorganization of primary sensory and motor cortices following hand amputation, the extent of which is correlated with phantom limb pain. Many therapies for phantom limb pain are based upon the idea that plastic changes after amputation are maladaptive and attempt to normalize representations of cortical areas adjacent to the hand area. Recent data suggest, however, that higher levels of phantom pain are associated with stronger local activity and more structural integrity in the missing hand area rather than with reorganization of neighbouring body parts. While these models appear to be mutually exclusive they could co-exist, and one reason for the apparent discrepancy between them might be that no single study has examined the organisation of lip, elbow, and hand movements in the same participants. In this study we thoroughly examined the 3D anatomy of the central sulcus and BOLD responses during movements of the hand, elbow, and lips using MRI techniques in 11 upper-limb amputees and 17 healthy control subjects. We observed different reorganizational patterns for all three body parts as the former hand area showed few signs of reorganization, but the lip and elbow representations reorganized and shifted towards the hand area. We also found that poorer voluntary control and higher levels of pain in the phantom limb were powerful drivers of the lip and elbow topological changes. In addition to providing further support for the maladaptative plasticity model, we demonstrate for the first time that motor capacities of the phantom limb correlate with post-amputation reorganization, and that this reorganization is not limited to the face and hand representations but also includes the proximal upper-limb. PMID:26854561

  18. Phantoms in artists: the lost limbs of Blaise Cendrars,Arthur Rimbaud, and Paul Wittgenstein.

    Science.gov (United States)

    Tatu, Laurent; Bogousslavsky, Julien; Boller, François

    2014-01-01

    There have been an increasing number of reports of postamputation pain and problems linked to phantom limbs over recent years, particularly in relation to war-related amputations. These problems, which are often poorly understood and considered rather mysterious, are still relevant because they are difficult to treat medically. Functional neuroimaging techniques now enable us to better understand their pathophysiology and to consider new rehabilitation techniques. Phantom limbs have often been a source of inspiration to writers, particularly in the period following the First World War, which was responsible for thousands of amputees. Some artists have suffered from postamputation complications themselves and have expressed them through their artistic works. Blaise Cendrars (1887-1961), one of the greatest authors of the twentieth century, suffered from stump pain and phantom limb phenomena for almost half a century following the amputation of his right arm during the First World War. He suffered from these phenomena until the end of his life and his literary work and personal correspondence are peppered with references to them. Arthur Rimbaud (1854-1891), one of the most famous poets in world literature, developed severe stump pain after his right leg was amputated due to a tumor. He survived for only six months after the procedure but left behind an account of the pain he experienced in correspondence to his family. The famous pianist Paul Wittgenstein (1887-1961), whose right arm was amputated during the First World War, became a famous left-handed concert pianist. The phantom movements of his right hand helped him to develop the dexterity of his left hand. The impact on the artistic life of these three men provides an original illustration of the various postamputation complications, specifically phantom limbs, stump pain, and moving phantom. PMID:24956238

  19. A robot hand testbed designed for enhancing embodiment and functional neurorehabilitation of body schema in subjects with upper limb impairment or loss.

    Science.gov (United States)

    Hellman, Randall B; Chang, Eric; Tanner, Justin; Helms Tillery, Stephen I; Santos, Veronica J

    2015-01-01

    Many upper limb amputees experience an incessant, post-amputation "phantom limb pain" and report that their missing limbs feel paralyzed in an uncomfortable posture. One hypothesis is that efferent commands no longer generate expected afferent signals, such as proprioceptive feedback from changes in limb configuration, and that the mismatch of motor commands and visual feedback is interpreted as pain. Non-invasive therapeutic techniques for treating phantom limb pain, such as mirror visual feedback (MVF), rely on visualizations of postural changes. Advances in neural interfaces for artificial sensory feedback now make it possible to combine MVF with a high-tech "rubber hand" illusion, in which subjects develop a sense of embodiment with a fake hand when subjected to congruent visual and somatosensory feedback. We discuss clinical benefits that could arise from the confluence of known concepts such as MVF and the rubber hand illusion, and new technologies such as neural interfaces for sensory feedback and highly sensorized robot hand testbeds, such as the "BairClaw" presented here. Our multi-articulating, anthropomorphic robot testbed can be used to study proprioceptive and tactile sensory stimuli during physical finger-object interactions. Conceived for artificial grasp, manipulation, and haptic exploration, the BairClaw could also be used for future studies on the neurorehabilitation of somatosensory disorders due to upper limb impairment or loss. A remote actuation system enables the modular control of tendon-driven hands. The artificial proprioception system enables direct measurement of joint angles and tendon tensions while temperature, vibration, and skin deformation are provided by a multimodal tactile sensor. The provision of multimodal sensory feedback that is spatiotemporally consistent with commanded actions could lead to benefits such as reduced phantom limb pain, and increased prosthesis use due to improved functionality and reduced cognitive burden

  20. Imagining is not doing but involves specific motor commands: a review of experimental data related to motor inhibition

    Directory of Open Access Journals (Sweden)

    Aymeric Guillot

    2012-09-01

    Full Text Available There is now compelling evidence that motor imagery (MI and actual movement share common neural substrate. However, the question of how MI inhibits the transmission of motor commands into the efferent pathways in order to prevent any movement is largely unresolved. Similarly, little is known about the nature of the electromyographic activity that is apparent during MI. In addressing these gaps in the literature, the present paper argues that MI includes motor execution commands for muscle contractions which are blocked at some level of the motor system by inhibitory mechanisms. We first assemble data from neuroimaging studies that demonstrate that the neural networks mediating MI and motor performance are not totally overlapping, thereby highlighting potential differences between MI and actual motor execution. We then review MI data indicating the presence of subliminal muscular activity reflecting the intrinsic characteristics of the motor command as well as increased corticomotor excitability. The third section not only considers the inhibitory mechanisms involved during MI but also examines how the brain resolves the problem of issuing the motor command for action while supervising motor inhibition when people engage in voluntary movement during MI. The last part of the paper draws on imagery research in clinical contexts to suggest that some patients move while imagining an action, although they are not aware of such movements. In particular, experimental data from amputees as well as from patients with Parkinson’s disease are discussed. We also review recent studies based on comparing brain activity in tetraplegic patients with that from healthy matched controls that provide insights into inhibitory processes during MI. We conclude by arguing that based on available evidence, a multifactorial explanation of motor inhibition during MI is warranted.

  1. Treatment of phantom limb pain (PLP) based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient.

    Science.gov (United States)

    Ortiz-Catalan, Max; Sander, Nichlas; Kristoffersen, Morten B; Håkansson, Bo; Brånemark, Rickard

    2014-01-01

    A variety of treatments have been historically used to alleviate phantom limb pain (PLP) with varying efficacy. Recently, virtual reality (VR) has been employed as a more sophisticated mirror therapy. Despite the advantages of VR over a conventional mirror, this approach has retained the use of the contralateral limb and is therefore restricted to unilateral amputees. Moreover, this strategy disregards the actual effort made by the patient to produce phantom motions. In this work, we investigate a treatment in which the virtual limb responds directly to myoelectric activity at the stump, while the illusion of a restored limb is enhanced through augmented reality (AR). Further, phantom motions are facilitated and encouraged through gaming. The proposed set of technologies was administered to a chronic PLP patient who has shown resistance to a variety of treatments (including mirror therapy) for 48 years. Individual and simultaneous phantom movements were predicted using myoelectric pattern recognition and were then used as input for VR and AR environments, as well as for a racing game. The sustained level of pain reported by the patient was gradually reduced to complete pain-free periods. The phantom posture initially reported as a strongly closed fist was gradually relaxed, interestingly resembling the neutral posture displayed by the virtual limb. The patient acquired the ability to freely move his phantom limb, and a telescopic effect was observed where the position of the phantom hand was restored to the anatomically correct distance. More importantly, the effect of the interventions was positively and noticeably perceived by the patient and his relatives. Despite the limitation of a single case study, the successful results of the proposed system in a patient for whom other medical and non-medical treatments have been ineffective justifies and motivates further investigation in a wider study. PMID:24616655

  2. Towards a naturalistic brain-machine interface: hybrid torque and position control allows generalization to novel dynamics.

    Directory of Open Access Journals (Sweden)

    Pratik Y Chhatbar

    Full Text Available Realization of reaching and grasping movements by a paralytic person or an amputee would greatly facilitate her/his activities of daily living. Towards this goal, control of a computer cursor or robotic arm using neural signals has been demonstrated in rodents, non-human primates and humans. This technology is commonly referred to as a Brain-Machine Interface (BMI and is achieved by predictions of kinematic parameters, e.g. position or velocity. However, execution of natural movements, such as swinging baseball bats of different weights at the same speed, requires advanced planning for necessary context-specific forces in addition to kinematic control. Here we show, for the first time, the control of a virtual arm with representative inertial parameters using real-time neural control of torques in non-human primates (M. radiata. We found that neural control of torques leads to ballistic, possibly more naturalistic movements than position control alone, and that adding the influence of position in a hybrid torque-position control changes the feedforward behavior of these BMI movements. In addition, this level of control was achievable utilizing the neural recordings from either contralateral or ipsilateral M1. We also observed changed behavior of hybrid torque-position control under novel external dynamic environments that was comparable to natural movements. Our results demonstrate that inclusion of torque control to drive a neuroprosthetic device gives the user a more direct handle on the movement execution, especially when dealing with novel or changing dynamic environments. We anticipate our results to be a starting point of more sophisticated algorithms for sensorimotor neuroprostheses, eliminating the need of fully automatic kinematic-to-dynamic transformations as currently used by traditional kinematic-based decoders. Thus, we propose that direct control of torques, or other force related variables, should allow for more natural

  3. Human-Machine Interface for the Control of Multi-Function Systems Based on Electrocutaneous Menu: Application to Multi-Grasp Prosthetic Hands.

    Directory of Open Access Journals (Sweden)

    Jose Gonzalez-Vargas

    Full Text Available Modern assistive devices are very sophisticated systems with multiple degrees of freedom. However, an effective and user-friendly control of these systems is still an open problem since conventional human-machine interfaces (HMI cannot easily accommodate the system's complexity. In HMIs, the user is responsible for generating unique patterns of command signals directly triggering the device functions. This approach can be difficult to implement when there are many functions (necessitating many command patterns and/or the user has a considerable impairment (limited number of available signal sources. In this study, we propose a novel concept for a general-purpose HMI where the controller and the user communicate bidirectionally to select the desired function. The system first presents possible choices to the user via electro-tactile stimulation; the user then acknowledges the desired choice by generating a single command signal. Therefore, the proposed approach simplifies the user communication interface (one signal to generate, decoding (one signal to recognize, and allows selecting from a number of options. To demonstrate the new concept the method was used in one particular application, namely, to implement the control of all the relevant functions in a state of the art commercial prosthetic hand without using any myoelectric channels. We performed experiments in healthy subjects and with one amputee to test the feasibility of the novel approach. The results showed that the performance of the novel HMI concept was comparable or, for some outcome measures, better than the classic myoelectric interfaces. The presented approach has a general applicability and the obtained results point out that it could be used to operate various assistive systems (e.g., prosthesis vs. wheelchair, or it could be integrated into other control schemes (e.g., myoelectric control, brain-machine interfaces in order to improve the usability of existing low

  4. Effects of the physiological parameters on the signal-to-noise ratio of single myoelectric channel

    Directory of Open Access Journals (Sweden)

    Zhang YT

    2007-08-01

    Full Text Available Abstract Background An important measure of the performance of a myoelectric (ME control system for powered artificial limbs is the signal-to-noise ratio (SNR at the output of ME channel. However, few studies illustrated the neuron-muscular interactive effects on the SNR at ME control channel output. In order to obtain a comprehensive understanding on the relationship between the physiology of individual motor unit and the ME control performance, this study investigates the effects of physiological factors on the SNR of single ME channel by an analytical and simulation approach, where the SNR is defined as the ratio of the mean squared value estimation at the channel output and the variance of the estimation. Methods Mathematical models are formulated based on three fundamental elements: a motoneuron firing mechanism, motor unit action potential (MUAP module, and signal processor. Myoelectric signals of a motor unit are synthesized with different physiological parameters, and the corresponding SNR of single ME channel is numerically calculated. Effects of physiological multi factors on the SNR are investigated, including properties of the motoneuron, MUAP waveform, recruitment order, and firing pattern, etc. Results The results of the mathematical model, supported by simulation, indicate that the SNR of a single ME channel is associated with the voluntary contraction level. We showed that a model-based approach can provide insight into the key factors and bioprocess in ME control. The results of this modelling work can be potentially used in the improvement of ME control performance and for the training of amputees with powered prostheses. Conclusion The SNR of single ME channel is a force, neuronal and muscular property dependent parameter. The theoretical model provides possible guidance to enhance the SNR of ME channel by controlling physiological variables or conscious contraction level.

  5. Sensory cortical re-mapping following upper-limb amputation and subsequent targeted reinnervation: A case report

    Directory of Open Access Journals (Sweden)

    Jun Yao

    2015-01-01

    Full Text Available This case study demonstrates the change of sensory cortical representations of the residual parts of the arm in an individual who underwent a trans-humeral amputation and subsequent targeted reinnervation (TR. As a relatively new surgical technique, TR restores a direct neural connection from amputated sensorimotor nerves to specific target muscles. This method has been successfully applied to upper-limb and lower-limb amputees, and has shown effectiveness in regaining control signals via the newly re-innervated muscles. Correspondingly, recent study results have shown that motor representations for the missing limb move closer to their original locations following TR. Besides regaining motor control signals, TR also restores the sensation in the re-innervated skin areas. We therefore hypothesize that TR causes analogous cortical sensory remapping that may return closer to their original locations. In order to test this hypothesis, cortical activity in response to sensory-level electrical stimulation in different parts of the arm was studied longitudinally in one amputated individual before and up to 2 years after TR. Our results showed that 1 before TR, the cortical response to sensory electrical stimulation in the residual limb showed a diffuse bilateral pattern without a clear focus in either the time or spatial domain; and 2 2 years after TR, the sensory map of the reinnervated median nerve reorganized, showing predominant activity over the contralateral S1 hand area as well as moderate activity over the ipsilateral S1. Therefore, this work provides new evidence for long-term sensory cortical plasticity in the human brain after TR.

  6. Restoring motor control and sensory feedback in people with upper extremity amputations using arrays of 96 microelectrodes implanted in the median and ulnar nerves

    Science.gov (United States)

    Davis, T. S.; Wark, H. A. C.; Hutchinson, D. T.; Warren, D. J.; O'Neill, K.; Scheinblum, T.; Clark, G. A.; Normann, R. A.; Greger, B.

    2016-06-01

    Objective. An important goal of neuroprosthetic research is to establish bidirectional communication between the user and new prosthetic limbs that are capable of controlling >20 different movements. One strategy for achieving this goal is to interface the prosthetic limb directly with efferent and afferent fibres in the peripheral nervous system using an array of intrafascicular microelectrodes. This approach would provide access to a large number of independent neural pathways for controlling high degree-of-freedom prosthetic limbs, as well as evoking multiple-complex sensory percepts. Approach. Utah Slanted Electrode Arrays (USEAs, 96 recording/stimulating electrodes) were implanted for 30 days into the median (Subject 1-M, 31 years post-amputation) or ulnar (Subject 2-U, 1.5 years post-amputation) nerves of two amputees. Neural activity was recorded during intended movements of the subject’s phantom fingers and a linear Kalman filter was used to decode the neural data. Microelectrode stimulation of varying amplitudes and frequencies was delivered via single or multiple electrodes to investigate the number, size and quality of sensory percepts that could be evoked. Device performance over time was assessed by measuring: electrode impedances, signal-to-noise ratios (SNRs), stimulation thresholds, number and stability of evoked percepts. Main results. The subjects were able to proportionally, control individual fingers of a virtual robotic hand, with 13 different movements decoded offline (r = 0.48) and two movements decoded online. Electrical stimulation across one USEA evoked >80 sensory percepts. Varying the stimulation parameters modulated percept quality. Devices remained intrafascicularly implanted for the duration of the study with no significant changes in the SNRs or percept thresholds. Significance. This study demonstrated that an array of 96 microelectrodes can be implanted into the human peripheral nervous system for up to 1 month durations. Such an

  7. Combat-related bridge synostosis versus traditional transtibial amputation: comparison of military-specific outcomes.

    Science.gov (United States)

    Plucknette, Benjamin F; Krueger, Chad A; Rivera, Jessica C; Wenke, Joseph C

    2016-04-01

    The aim of our study was to determine military-specific outcomes for transtibial amputations of US Service members using either the traditional technique (Burgess) or the Ertl technique. All US Service members sustaining transtibial, combat-related amputation from September 2001 through July 2011 were reviewed. Amputation type, mechanism of injury, time interval to amputation, age, sex, branch of service, rank, force, nature, and injury severity score were recorded. Outcomes were determined by analyzing military-specific medical review results, to include the following: Physical Evaluation Board Liaison Office (PEBLO) rating (0-100), PEBLO outcome (permanent retirement, temporary disability retirement, separation without benefits, continuation of active duty, or fit for redeployment), and the rate of redeployment. Amputation type (Ertl vs. Burgess) was determined by reviewing postoperative radiographs and radiology reports. Data from all of the above categories were compared for both Ertl and Burgess amputees. Of 512 subjects identified, 478 had radiographs or radiology reports distinguishing between Ertl or Burgess transtibial amputation. A total of 406 subjects underwent the Burgess procedure, and 72 subjects underwent the Ertl procedure. There was not a significant difference between the two groups in review board rating (p = 0.858), review board outcome (p = 0.102), or ability to deploy (p = 0.106); however, subjects that underwent the Ertl procedure remained on active duty at a significantly higher rate (p = 0.021). There is a higher rate of remaining on active duty using the Ertl technique. This study suggests that there is an improvement in functional outcome with the Ertl technique. PMID:26644067

  8. Incidence of major amputations, bypass procedures and percutaneous transluminal angioplasties (PTA) in the treatment of peripheral arterial occlusive disease in a German referral center 1996-2003; Inzidenzen von Major-Amputationen, Bypass-Operationen und perkutanen transluminalen Angioplastien (PTA) zur Behandlung der peripheren arteriellen Verschlusskrankheit in einer deutschen Klinik der Maximalversorgung 1996-2003

    Energy Technology Data Exchange (ETDEWEB)

    Wohlgemuth, W.A. [Klinik fuer Diagnostische Radiologie und Neuroradiologie, Zentralklinikum Augsburg (Germany); Inst. fuer Medizinmanagement und Gesundheitswissenschaften, Univ. Bayreuth (Germany); Freitag, M.H. [Inst. fuer Medizinmanagement und Gesundheitswissenschaften, Univ. Bayreuth (Germany); Woelfle, K.D. [Chirurgisches Zentrum, Klinik fuer Gefaesschirurgie, Zentralklinikum Augsburg (Germany); Bohndorf, K.; Kirchhof, K. [Klinik fuer Diagnostische Radiologie und Neuroradiologie, Zentralklinikum Augsburg (Germany)

    2006-09-15

    Purpose: To determine the current incidence of major amputations, bypass procedures and percutaneous transluminal angioplasties (PTA) in a study population of patients with peripheral arterial occlusive disease in a German referral center. Materials and Methods: In a retrospective study, we recruited patients with peripheral arterial occlusive disease who underwent an amputation, bypass procedure, or PTA in the region of the pelvis or lower limbs between 1996 and 2003 at the Augsburg Medical Center. Patients were identified via the hospital database. This was performed with the help of the International Classification of Diseases (ICD 9 and 10), the operation code (OPS), and appropriate invoices. The incidence of PTAs was further estimated with 200 charts. Results: Of 5379 patients, 627 underwent amputation, 1832 a bypass procedure, and 2920 a PTA. The incidence of PTAs increased during the study period from 51.3/100 000/year to 64.4/100 000/year (p<0.01), while the number of amputations and bypass procedures remained stable. The incidence of PTAs was exceeded by that of bypass procedures only in patients older than 85 years. The age of the amputees decreased during the study period from 72.2 to 70.5 years (p<0.01). The age of patients who underwent a bypass procedure increased from 67.2 to 69.4 years, and the age of patients who underwent PTA increased form 66.3 to 69.8 years (p<0.01). Bypass procedures and PTAs were performed in men 6.3 years earlier than in women (p<0.01). Conclusion: The result is a population-corrected need of 8.4/100 000/year major amputations, 23/100 000/year bypass procedures and 64.4/100 000/year PTAs for patients with peripheral arterial occlusive disease within the referral area of our hospital. The performance of major amputations and bypass procedures stagnates, while the incidence of PTAs is increasing. (orig.)

  9. A clinicomicrobial study of diabetic foot ulcer infections in South India

    Directory of Open Access Journals (Sweden)

    Ranjini Chittur Yerat

    2015-07-01

    Full Text Available Background: Approximately 85% of all diabetes-related lower-extremity amputations are preceded by foot ulcers. Diabetic foot ulcers are at high risk of infection secondary to high glucose levels and poor tissue perfusion. Aims of the Study: To identify the microbial pathogens and the antimicrobial sensitivity pattern of the bacterial isolates involved in the different grades of diabetic foot ulcers. Materials and Methods: Pus samples from 104 diabetic foot ulcers were processed for aerobic, anaerobic, and fungal culture. Antimicrobial sensitivity was performed as per clinical and laboratory Standards Institute guidelines. Results: Aerobic (81.66%, anaerobic (14.79%, and fungal (3.55% isolates were obtained on culture with Gram-negative bacilli (78.98% being isolated more than the Gram-positive cocci (21.01%. Proteus mirabilis was the most common isolate (26.08% while Bacteroides fragilis and Peptococcus sp. were the common anaerobes obtained. 56.73% of patients had polymicrobial infection, and 23.08% of staphylococci were methicillin resistant Staphylococcus aureus. In hospitalized patients and amputees, infections were often polymicrobial (74.32% involving anaerobic and fungal pathogens. Multi-drug resistance was seen in 28.26% of isolates. Conclusion: Our study showed polymicrobial diabetic foot infections. The isolation pattern varied according to the grade of ulcer with S. aureus being predominant in Wagner I diabetic foot and Gram-negative organisms and anaerobes being isolated as the foot grade advanced to gangrene. Management of early stages includes treatment with oral quinolones/cloxacillin/cephalosporins. Imipenem monotherapy or third-generation cephalosporins with beta lactamase inhibitors plus an anti-anaerobe drug are regimens that can be used for the advanced stage of the disease.

  10. Treatment of phantom limb pain (PLP based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient

    Directory of Open Access Journals (Sweden)

    MaxOrtiz-Catalan

    2014-02-01

    Full Text Available A variety of treatments have been historically used to alleviate phantom limb pain (PLP with varying efficacy. Recently, virtual reality (VR has been employed as a more sophisticated mirror therapy. Despite the advantages of VR over a conventional mirror, this approach has retained the use of the contralateral limb and is therefore restricted to unilateral amputees. Moreover, this strategy disregards the actual effort made by the patient to produce phantom motions. In this work, we investigate a treatment in which the virtual limb responds directly to myoelectric activity at the stump, while the illusion of a restored limb is enhanced through augmented reality (AR. Further, phantom motions are facilitated and encouraged through gaming.The proposed set of technologies was administered to a chronic PLP patient who has shown resistance to a variety of treatments (including mirror therapy for 48 years. Individual and simultaneous phantom movements were predicted using myoelectric pattern recognition and were then used as input for VR and AR environments, as well as for a racing game.The sustained level of pain reported by the patient was gradually reduced to complete pain-free periods. The phantom posture initially reported as a strongly closed fist was gradually relaxed, interestingly resembling the neutral posture displayed by the virtual limb. The patient acquired the ability to freely move his phantom limb and a telescopic effect was observed where the position of the phantom hand was restored to the anatomically correct distance. More importantly, the effect of the interventions was positively and noticeably perceived by the patient and his relatives.Despite the limitation of a single case study, the successful results of the proposed system in a patient for whom other medical and non-medical treatments have been ineffective justifies and motivates further investigation in a wider study.

  11. Prevalence and Risk Factors for Diabetic Lower Limb Amputation: A Clinic-Based Case Control Study

    Science.gov (United States)

    Rodrigues, Beverly T.; Vangaveti, Venkat N.

    2016-01-01

    Objective. The aim of the study was to evaluate the prevalence of and risk factors for lower limb amputation in a specialist foot clinic-based setting. Methods. A retrospective quantitative study was conducted, using clinical and biochemical profiles of diabetic foot patients attending the High Risk Foot Clinic at The Townsville Hospital, Australia, between January 1, 2011, and December 31, 2013. Results. The total study sample included 129 subjects, comprising 81 males and 48 females with M : F ratio of 1.7 : 1. Twenty-three subjects were Indigenous Australians, representing 17.8% of the study population. The average age of the cohort was 63.4 years ± 14.1 years [CI 90.98–65.89]. Lower limb amputation was identified as a common and significant outcome (n = 44), occurring in 34.1%, more commonly amongst the Indigenous Australians (56.5% versus 29.2%; p = 0.94, OR 0.94). Risk factors most closely associated with amputation included diabetic retinopathy (p = 0.00, OR 4.4), coronary artery bypass graft (CABG) surgery (p = 0.01, OR 4.1), Charcot's arthropathy (p = 0.01, OR 2.9), and Indigenous ethnicity (p = 0.01, OR 3.4). Although average serum creatinine, corrected calcium, and glycosylated haemoglobin A1c (Hba1c) levels were higher amongst amputees they were statistically insignificant. Conclusions. Lower limb amputation is a common outcome and linked to ethnicity and neurovascular diabetic complications amongst subjects with diabetic foot ulcer. Further research is needed to identify why risk of lower limb amputation seems to differ according to ethnicity.

  12. Hand posture classification using electrocorticography signals in the gamma band over human sensorimotor brain areas

    Science.gov (United States)

    Chestek, Cynthia A.; Gilja, Vikash; Blabe, Christine H.; Foster, Brett L.; Shenoy, Krishna V.; Parvizi, Josef; Henderson, Jaimie M.

    2013-04-01

    , and characterization of non-stationarities such that ECoG could be a viable signal source for grasp control for amputees or individuals with paralysis.

  13. Transverse Carpal Ligament and Forearm Fascia Release for the Treatment of Carpal Tunnel Syndrome Change the Entrance Angle of Flexor Tendons to the A1 Pulley: The Relationship between Carpal Tunnel Surgery and Trigger Finger Occurence

    Directory of Open Access Journals (Sweden)

    Nazım Karalezli

    2013-01-01

    Full Text Available Purpose. The appearance of trigger finger after decompression of the carpal tunnel without a preexisting symptom has been reported in a few articles. Although, the cause is not clear yet, the loss of pulley action of the transverse carpal ligament has been accused mostly. In this study, we planned a biomechanical approach to fresh cadavers. Methods. The study was performed on 10 fresh amputees of the arm. The angles were measured with (1 the transverse carpal ligament and the distal forearm fascia intact, (2 only the transverse carpal ligament incised, (3 the distal forearm fascia incised to the point 3 cm proximal from the most proximal part of the transverse carpal ligament in addition to the transverse carpal ligament. The changes between the angles produced at all three conditions were compared to each other. Results. We saw that the entrance angle increased in all of five fingers in an increasing manner from procedure 1 to 3, and it was seen that the maximal increase is detected in the middle finger from procedure 1 to procedure 2 and the minimal increase is detected in little finger. Discussion. Our results support that transverse carpal ligament and forearm fascia release may be a predisposing factor for the development of trigger finger by the effect of changing the enterance angle to the A1 pulley and consequently increase the friction in this anatomic area. Clinical Relevance. This study is a cadaveric study which is directly investigating the effect of a transverse carpal ligament release on the enterance angle of flexor tendons to A1 pulleys in the hand.

  14. Functional Reorganization of the Primary Somatosensory Cortex of a Phantom Limb Pain Patient.

    Science.gov (United States)

    Zhao, Jia; Guo, Xiaoli; Xia, Xiaolei; Peng, Weiwei; Wang, Wuchao; Li, Shulin; Zhang, Ya; Hu, Li

    2016-07-01

    Functional reorganization of the somatosensory system was widely observed in phantom limb pain patients. Whereas some studies demonstrated that the primary somatosensory cortex (S1) of the amputated limb was engaged with the regions around it, others showed that phantom limb pain was associated with preserved structure and functional organization in the former brain region. However, according to the law of use and disuse, the sensitivity of S1 of the amputated limb to pain-related context should be enhanced due to the adaptation to the long-lasting phantom limb pain experience. Here, we collected neurophysiological data from a patient with 21-year phantom limb pain using electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) techniques. EEG data showed that both laser-evoked potentials (LEPs) and tactile-evoked potentials (TEPs) were clearly presented only when radiant-heat laser pulses and electrical pulses were delivered to the shoulder of the healthy limb, but not of the amputated limb. This observation suggested the functional deficit of somatosensory pathways at the amputated side. FMRI data showed that significant larger brain activations by painful rather than non-painful stimuli in video clips were observed not only at visual-related brain areas and anterior/mid-cingulate cortex, but also at S1 contralateral to the amputated limb. This observation suggested the increased sensitivity of S1 of the amputated limb to the pain-related context. In addition, such increase of sensitivity was significantly larger if the context was associated with the amputated limb of the patient. In summary, our findings provided novel evidence for a possible neuroplasticity of S1 of the amputated limb: in an amputee with long-lasting phantom limb pain, the sensitivity of S1 to pain-related and amputated-limb-related context was greatly enhanced. PMID:27389122

  15. A robot hand testbed designed for enhancing embodiment and functional neurorehabilitation of body schema in subjects with upper limb impairment or loss

    Directory of Open Access Journals (Sweden)

    Randall B. Hellman

    2015-02-01

    Full Text Available Many upper limb amputees experience an incessant, post-amputation phantom limb pain and report that their missing limbs feel paralyzed in an uncomfortable posture. One hypothesis is that efferent commands no longer generate expected afferent signals, such as proprioceptive feedback from changes in limb configuration, and that the mismatch of motor commands and visual feedback is interpreted as pain. Non-invasive therapeutic techniques for treating phantom limb pain, such as mirror visual feedback (MVF, rely on visualizations of postural changes. Advances in neural interfaces for artificial sensory feedback now make it possible to combine MVF with a high-tech rubber hand illusion, in which subjects develop a sense of embodiment with a fake hand when subjected to congruent visual and somatosensory feedback. We discuss clinical benefits that could arise from the confluence of known concepts such as MVF and the rubber hand illusion, and new technologies such as neural interfaces for sensory feedback and highly sensorized robot hand testbeds, such as the BairClaw presented here. Our multi-articulating, anthropomorphic robot testbed can be used to study proprioceptive and tactile sensory stimuli during physical finger-object interactions. Conceived for artificial grasp, manipulation, and haptic exploration, the BairClaw could also be used for future studies on the neurorehabilitation of somatosensory disorders due to upper limb impairment or loss. A remote actuation system enables the modular control of tendon-driven hands. The artificial proprioception system enables direct measurement of joint angles and tendon tensions while temperature, vibration, and skin deformation are provided by a multimodal tactile sensor. The provision of multimodal sensory feedback that is spatiotemporally consistent with commanded actions could lead to benefits such as reduced phantom limb pain, and increased prosthesis use due to improved functionality and reduced

  16. Towards reducing the impacts of unwanted movements on identification of motion intentions.

    Science.gov (United States)

    Li, Xiangxin; Chen, Shixiong; Zhang, Haoshi; Samuel, Oluwarotimi Williams; Wang, Hui; Fang, Peng; Zhang, Xiufeng; Li, Guanglin

    2016-06-01

    Surface electromyogram (sEMG) has been extensively used as a control signal in prosthesis devices. However, it is still a great challenge to make multifunctional myoelectric prostheses clinically available due to a number of critical issues associated with existing EMG based control strategy. One such issue would be the effect of unwanted movements (UMs) that are inadvertently done by users on the performance of movement classification in EMG pattern recognition based algorithms. Since UMs are not considered in training a classifier, they would decay the performance of a trained classifier in identifying the target movements (TMs), which would cause some undesired actions in control of multifunctional prostheses. In this study, the impact of UMs was systemically investigated in both able-bodied subjects and transradial amputees. Our results showed that the UMs would be unevenly classified into all classes of the TMs. To reduce the impact of the UMs on the performance of a classifier, a new training strategy that would categorize all possible UMs into a new movement class was proposed and a metric called Reject Ratio that is a measure of how many UMs is rejected by a trained classifier was adopted. The results showed that the average Reject Ratio across all the participants was greater than 91%, meanwhile the average classification accuracy of TMs was above 99% when UMs occurred. This suggests that the proposed training strategy could greatly reduce the impact of UMs on the performance of the trained classifier in identifying the TMs and may enhance the robustness of myoelectric control in clinical applications. PMID:27093136

  17. Meeting the needs of disabled village children.

    Science.gov (United States)

    Werner, D

    1993-01-01

    Villagers have operated a primary health care program in western Mexico called Project Piaxtla for almost 30 years. The project often selects disabled persons to be village health workers, sine they are not in involved in hard physical farm work and thus are most available. They have excelled as village health workers and eventually started the Programme of Rehabilitation Organized by Disabled Youth of Western Mexico (PROJIMO) to address the needs of disabled children. The disables workers are more sensitive to the needs of disabled children than others are. They involve the children in meeting their own needs. The disabled adult leaders and artisans in a community program provide role models for the disabled children and their families. In fact, the program lets parents see that they do not need to overprotect their disables children or to do everything for them. PROJIMO has built a rehabilitation playground where disabled and nondisabled youth play together. All the equipment is made from local materials. Disabled and nondisabled children make toys and sometimes rehabilitation aids (e.g., a walker) in a small workshop. PROJIMO uses various child-to-child activities to promote understanding between disabled and nondisabled children. For example, the fastest runner in the class ties a pole around his/her leg. All the children run the race or play a tag. Later, all the children talk to the pseudo-disabled child to learn what she/he experienced. Disabled technicians at PROJIMO fabricate modem resin-and-fiberglass prosthetics for amputees. They also make orthopedic braces (modem thermoplastics). PROJIMO works not just with children with congenital disabilities but also those who suffer from accident- and violence-related disabilities. PMID:8279065

  18. Incidence of major amputations, bypass procedures and percutaneous transluminal angioplasties (PTA) in the treatment of peripheral arterial occlusive disease in a German referral center 1996-2003

    International Nuclear Information System (INIS)

    Purpose: To determine the current incidence of major amputations, bypass procedures and percutaneous transluminal angioplasties (PTA) in a study population of patients with peripheral arterial occlusive disease in a German referral center. Materials and Methods: In a retrospective study, we recruited patients with peripheral arterial occlusive disease who underwent an amputation, bypass procedure, or PTA in the region of the pelvis or lower limbs between 1996 and 2003 at the Augsburg Medical Center. Patients were identified via the hospital database. This was performed with the help of the International Classification of Diseases (ICD 9 and 10), the operation code (OPS), and appropriate invoices. The incidence of PTAs was further estimated with 200 charts. Results: Of 5379 patients, 627 underwent amputation, 1832 a bypass procedure, and 2920 a PTA. The incidence of PTAs increased during the study period from 51.3/100 000/year to 64.4/100 000/year (p<0.01), while the number of amputations and bypass procedures remained stable. The incidence of PTAs was exceeded by that of bypass procedures only in patients older than 85 years. The age of the amputees decreased during the study period from 72.2 to 70.5 years (p<0.01). The age of patients who underwent a bypass procedure increased from 67.2 to 69.4 years, and the age of patients who underwent PTA increased form 66.3 to 69.8 years (p<0.01). Bypass procedures and PTAs were performed in men 6.3 years earlier than in women (p<0.01). Conclusion: The result is a population-corrected need of 8.4/100 000/year major amputations, 23/100 000/year bypass procedures and 64.4/100 000/year PTAs for patients with peripheral arterial occlusive disease within the referral area of our hospital. The performance of major amputations and bypass procedures stagnates, while the incidence of PTAs is increasing. (orig.)

  19. Design and Preliminary Evaluation of a Two DOFs Cable-Driven Ankle-Foot Prosthesis with Active Dorsiflexion-Plantarflexion and Inversion-Eversion.

    Science.gov (United States)

    Ficanha, Evandro Maicon; Ribeiro, Guilherme Aramizo; Dallali, Houman; Rastgaar, Mohammad

    2016-01-01

    This paper describes the design of an ankle-foot robotic prosthesis controllable in the sagittal and frontal planes. The prosthesis was designed to meet the mechanical characteristics of the human ankle including power, range of motion, and weight. To transfer the power from the motors and gearboxes to the ankle-foot mechanism, a Bowden cable system was used. The Bowden cable allows for optimal placement of the motors and gearboxes in order to improve gait biomechanics such as the metabolic energy cost and gait asymmetry during locomotion. Additionally, it allows flexibility in the customization of the device to amputees with different residual limb sizes. To control the prosthesis, impedance controllers in both sagittal and frontal planes were developed. The impedance controllers used torque feedback from strain gages installed on the foot. Preliminary evaluation was performed to verify the capability of the prosthesis to track the kinematics of the human ankle in two degrees of freedom (DOFs), the mechanical efficiency of the Bowden cable transmission, and the ability of the prosthesis to modulate the impedance of the ankle. Moreover, the system was characterized by describing the relationship between the stiffness of the impedance controllers to the actual stiffness of the ankle. Efficiency estimation showed 85.4% efficiency in the Bowden cable transmission. The prosthesis was capable of properly mimicking human ankle kinematics and changing its mechanical impedance in two DOFs in real time with a range of stiffness sufficient for normal human walking. In dorsiflexion-plantarflexion (DP), the stiffness ranged from 0 to 236 Nm/rad and in inversion-eversion (IE), the stiffness ranged from 1 to 33 Nm/rad. PMID:27200342

  20. Ectopic major transplantation for salvage of upper and lower extremity amputations

    Directory of Open Access Journals (Sweden)

    Nazerani Shahram

    2013-12-01

    Full Text Available 【Abstract】Objective: Ectopic tissue transplanta- tion is not a new idea. Godina and his colleagues pioneered this method in the 1980s. This method is a last resort method of preserving an amputated body part, which consists of banking the amputated segment in an ectopic area and re- turning it to its native place at a later date. In this article we present our experience with this demanding procedure. Methods: Debridement was the mainstay of this procedure. The stump and amputated part are carefully de- brided and the stump was either closed primarily or covered by a flap. The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting. Results: Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study. The over- all success rate was about 70%, lower than expected but these are cases of severe crush injury. Although the func- tional recovery of these patients are very low, all of the successful cases except one could find a job as a janitor or light manual worker. No patient could return to his previous job. Conclusion: Ectopic transplantation of body parts is an accepted method of treatment of severely crushed ex- tremity or finger injuries. In our country an amputee has very little chance of finding a job instead a disabled person can. In addition in Iran cultures amputation is seen as pu- nishment of either the God or the society, so it is not well accepted and many patients persist on saving the limb even with no functional recovery. None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers. Key words: Replantation; Transplantation; Extremities; Amputation, traumatic

  1. Adaptação à prótese híbrida de extremidade superior: estudo termográfico de um caso Adaptation to upper extremity hybrid prosthesis: a thermographic case study

    Directory of Open Access Journals (Sweden)

    Soraia Cristina Tonon da Luz

    2010-06-01

    Full Text Available O objetivo do estudo foi verificar, por meio de termografia, a adaptação à prótese híbrida de extremidade superior de um sujeito do sexo masculino, 42 anos, amputado proximal de braço esquerdo. Imagens termográficas foram captadas por uma câmara de infravermelho imediatamente após a retirada da prótese, que vinha sendo usada por 8 horas ininterruptas, e 20 minutos de repouso mais tarde, quando foi alcançado equilíbrio térmico em ambiente a 21°C. As imagens foram adquiridas nos planos frontal anterior, sagital direito e esquerdo, tendo sido definidas e analisadas regiões de interesse em cada uma. Os resultados mostram que as temperaturas das regiões avaliadas reduziram-se em média 0,79°C (pThe aim of this study was to assess, by means of thermography, the adaptation to upper-extremity hybrid prosthesis by a male subject, 42 years old, with proximal amputation of left arm. Thermographic images were captured by an infrared camera immediately after prosthesis withdrawal (which had been used for full 8 hours and 20 minutes later, when thermal balance was reached, in an environment of constant 21°C. Images were captured of frontal and sagittal planes (both right and left, on which seven regions of interest (ROI were defined and analysed. Results showed that mean ROI temperatures decreased 0.79°C (p<0,05 after thermal balance was reached. Along the chest strap path and at the sound side axilla - which coincides with subject's main discomfort complaint - high temperatures were found, indicating friction; high temperature in the ipsilateral to amputation anterior shoulder suggests overload; and low temperature on the residual limb suggests poor circulation, thus pointing to difficulty of adaptation. Results suggest that thermography may contribute to identifying amputees' discomfort and may be used for monitoring upper-limb prostheses users' rehabilitation; also, suggestion is made to foster developing new suspension systems in order

  2. Surface EMG pattern recognition for real-time control of a wrist exoskeleton

    Directory of Open Access Journals (Sweden)

    Khokhar Zeeshan O

    2010-08-01

    Full Text Available Abstract Background Surface electromyography (sEMG signals have been used in numerous studies for the classification of hand gestures and movements and successfully implemented in the position control of different prosthetic hands for amputees. sEMG could also potentially be used for controlling wearable devices which could assist persons with reduced muscle mass, such as those suffering from sarcopenia. While using sEMG for position control, estimation of the intended torque of the user could also provide sufficient information for an effective force control of the hand prosthesis or assistive device. This paper presents the use of pattern recognition to estimate the torque applied by a human wrist and its real-time implementation to control a novel two degree of freedom wrist exoskeleton prototype (WEP, which was specifically developed for this work. Methods Both sEMG data from four muscles of the forearm and wrist torque were collected from eight volunteers by using a custom-made testing rig. The features that were extracted from the sEMG signals included root mean square (rms EMG amplitude, autoregressive (AR model coefficients and waveform length. Support Vector Machines (SVM was employed to extract classes of different force intensity from the sEMG signals. After assessing the off-line performance of the used classification technique, the WEP was used to validate in real-time the proposed classification scheme. Results The data gathered from the volunteers were divided into two sets, one with nineteen classes and the second with thirteen classes. Each set of data was further divided into training and testing data. It was observed that the average testing accuracy in the case of nineteen classes was about 88% whereas the average accuracy in the case of thirteen classes reached about 96%. Classification and control algorithm implemented in the WEP was executed in less than 125 ms. Conclusions The results of this study showed that

  3. Translational neural engineering: multiple perspectives on bringing benchtop research into the clinical domain.

    Science.gov (United States)

    Rousche, Patrick; Schneeweis, David M; Perreault, Eric J; Jensen, Winnie

    2008-03-01

    strongly encouraged open industrial-academic partnerships as an efficient path forward in the translational process. Joe Pancrazio, PhD, a Program Director at NIH's National Institute of Neurological Disorders and Stroke, emphasized that NIH funding for translational research was aimed at breaking down scientific barriers to clinic entrance. Vivian Weil, PhD, (Director of Center for the Study of Ethics in the Professions at the Illinois Institute of Technology) a specialist on ethics in science and engineering, spoke of the usefulness of developing a code of ethics for addressing ethical aspects of translation from the bench to clinical implementation and of translation across disciplines in multi-disciplinary projects. Finally, the patient perspective was represented by Mr Jesse Sullivan. A double-arm amputee and patient of Dr Kuiken's, Mr Sullivan demonstrated the critically important role of the patient in successful translational neural engineering research. PMID:18310805

  4. Real-time myoelectric control of a multi-fingered hand prosthesis using principal components analysis

    Directory of Open Access Journals (Sweden)

    Matrone Giulia C

    2012-06-01

    Full Text Available Abstract Background In spite of the advances made in the design of dexterous anthropomorphic hand prostheses, these sophisticated devices still lack adequate control interfaces which could allow amputees to operate them in an intuitive and close-to-natural way. In this study, an anthropomorphic five-fingered robotic hand, actuated by six motors, was used as a prosthetic hand emulator to assess the feasibility of a control approach based on Principal Components Analysis (PCA, specifically conceived to address this problem. Since it was demonstrated elsewhere that the first two principal components (PCs can describe the whole hand configuration space sufficiently well, the controller here employed reverted the PCA algorithm and allowed to drive a multi-DoF hand by combining a two-differential channels EMG input with these two PCs. Hence, the novelty of this approach stood in the PCA application for solving the challenging problem of best mapping the EMG inputs into the degrees of freedom (DoFs of the prosthesis. Methods A clinically viable two DoFs myoelectric controller, exploiting two differential channels, was developed and twelve able-bodied participants, divided in two groups, volunteered to control the hand in simple grasp trials, using forearm myoelectric signals. Task completion rates and times were measured. The first objective (assessed through one group of subjects was to understand the effectiveness of the approach; i.e., whether it is possible to drive the hand in real-time, with reasonable performance, in different grasps, also taking advantage of the direct visual feedback of the moving hand. The second objective (assessed through a different group was to investigate the intuitiveness, and therefore to assess statistical differences in the performance throughout three consecutive days. Results Subjects performed several grasp, transport and release trials with differently shaped objects, by operating the hand with the myoelectric

  5. 基于有限状态机控制的智能假肢踝关节*☆%Intelligent prosthetic ankle based on the finite state machine control

    Institute of Scientific and Technical Information of China (English)

    杨鹏; 柏健; 王欣然; 耿艳利

    2013-01-01

    BACKGROUND: At present, intel igent prosthesis only focuses on the function of knee joint, while ankle joint prosthesis is only used as the aid of prosthetic knee joint. So the normal gait cannot be realized according to the change of external environment and gait. OBJECTIVE: To develop a reliable intel igent prosthetic ankle in order to improve the gait of amputees effectively. METHODS: Based on the variable damping ankle-foot prosthesis, the control method of finite state machine was proposed. The ankle joint gait was planned in detail, and the relevant control strategy was developed. RESULTS AND CONCLUSION: Results indicate that the intel igent prosthetic ankle based on the finite state machine control can effectively fol ow health limb lateral movement, and can adapt to different paces, which lays an experimental basement for later knee ankle coordinated movement.%  背景:目前智能假肢只是考虑了膝关节的作用,假肢踝关节只是作为假肢膝关节的辅助工具,无法根据外部环境和步态的变化实现假肢自然的行走。目的:研制出可靠的智能假肢踝关节,有效改善截肢者的步态。方法:在阻尼可变式踝足假肢的基础上,提出了有限状态机的控制方法,对踝足步态进行了详细的划分,在每个步态内制定了相关的控制策略。结果与结论:实验结果表明,基于有限状态机控制的智能假肢踝关节能够有效的跟随健肢侧运动,能够适应不同的步速,为以后膝踝协调运动奠定了一定的实验基础。

  6. An implantable wireless neural interface for recording cortical circuit dynamics in moving primates

    Science.gov (United States)

    Borton, David A.; Yin, Ming; Aceros, Juan; Nurmikko, Arto

    2013-04-01

    Objective. Neural interface technology suitable for clinical translation has the potential to significantly impact the lives of amputees, spinal cord injury victims and those living with severe neuromotor disease. Such systems must be chronically safe, durable and effective. Approach. We have designed and implemented a neural interface microsystem, housed in a compact, subcutaneous and hermetically sealed titanium enclosure. The implanted device interfaces the brain with a 510k-approved, 100-element silicon-based microelectrode array via a custom hermetic feedthrough design. Full spectrum neural signals were amplified (0.1 Hz to 7.8 kHz, 200× gain) and multiplexed by a custom application specific integrated circuit, digitized and then packaged for transmission. The neural data (24 Mbps) were transmitted by a wireless data link carried on a frequency-shift-key-modulated signal at 3.2 and 3.8 GHz to a receiver 1 m away by design as a point-to-point communication link for human clinical use. The system was powered by an embedded medical grade rechargeable Li-ion battery for 7 h continuous operation between recharge via an inductive transcutaneous wireless power link at 2 MHz. Main results. Device verification and early validation were performed in both swine and non-human primate freely-moving animal models and showed that the wireless implant was electrically stable, effective in capturing and delivering broadband neural data, and safe for over one year of testing. In addition, we have used the multichannel data from these mobile animal models to demonstrate the ability to decode neural population dynamics associated with motor activity. Significance. We have developed an implanted wireless broadband neural recording device evaluated in non-human primate and swine. The use of this new implantable neural interface technology can provide insight into how to advance human neuroprostheses beyond the present early clinical trials. Further, such tools enable mobile

  7. Positive pacing strategies are utilised by elite male and female para-cyclists in short time trials in the velodrome

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    Rachel Lindsey Wright

    2016-01-01

    Full Text Available In para-cycling, competitors are classed based on functional impairment resulting in cyclists with neurological and locomotor impairments competing against each other. In Paralympic competition, classes are combined by using a factoring adjustment to race times to produce the overall medallists. Pacing in short-duration track cycling events is proposed to utilise an all-out strategy in able-bodied competition. However, pacing in para-cycling may vary depending on the level of impairment. Analysis of the pacing strategies employed by different classification groups may offer scope for optimal performance; therefore, this study investigated the pacing strategy adopted during the 1-km time trial (TT and 500-m TT in elite C1 to C3 para-cyclists and able-bodied cyclists. Total times and intermediate split times (125-m intervals; measured to 0.001s were obtained from the C1-C3 men’s 1-km TT (n=28 and women’s 500-m TT (n=9 from the 2012 Paralympic Games and the men’s 1-km TT (n=19 and women’s 500-m TT (n=12 from the 2013 UCI World Track Championships from publically available video. Split times were expressed as actual time, factored time (for the para-cyclists and as a percentage of total time. A two-way analysis of variance was used to investigate differences in split times between the different classifications and the able-bodied cyclists in the men’s 1-km TT and between the para-cyclists and able-bodied cyclists in the women’s 500-m TT. The importance of position at the first split was investigated with Kendall’s Tau-b correlation. The first 125-m split time was the slowest for all cyclists, representing the acceleration phase from a standing start. C2 cyclists were slowest at this 125-m split, probably due to a combination of remaining seated in this acceleration phase and a high proportion of cyclists in this group being trans-femoral amputees. Not all cyclists used aero-bars, preferring to use drop, flat or bullhorn handlebars

  8. PERSPECTIVE: Translational neural engineering: multiple perspectives on bringing benchtop research into the clinical domain

    Science.gov (United States)

    Rousche, Patrick; Schneeweis, David M.; Perreault, Eric J.; Jensen, Winnie

    2008-03-01

    strongly encouraged open industrial academic partnerships as an efficient path forward in the translational process. Joe Pancrazio, PhD, a Program Director at NIH's National Institute of Neurological Disorders and Stroke, emphasized that NIH funding for translational research was aimed at breaking down scientific barriers to clinic entrance. Vivian Weil, PhD, (Director of Center for the Study of Ethics in the Professions at the Illinois Institute of Technology) a specialist on ethics in science and engineering, spoke of the usefulness of developing a code of ethics for addressing ethical aspects of translation from the bench to clinical implementation and of translation across disciplines in multi-disciplinary projects. Finally, the patient perspective was represented by Mr Jesse Sullivan. A double-arm amputee and patient of Dr Kuiken's, Mr Sullivan demonstrated the critically important role of the patient in successful translational neural engineering research.

  9. SLAM algorithm applied to robotics assistance for navigation in unknown environments

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    Lobo Pereira Fernando

    2010-02-01

    Full Text Available Abstract Background The combination of robotic tools with assistance technology determines a slightly explored area of applications and advantages for disability or elder people in their daily tasks. Autonomous motorized wheelchair navigation inside an environment, behaviour based control of orthopaedic arms or user's preference learning from a friendly interface are some examples of this new field. In this paper, a Simultaneous Localization and Mapping (SLAM algorithm is implemented to allow the environmental learning by a mobile robot while its navigation is governed by electromyographic signals. The entire system is part autonomous and part user-decision dependent (semi-autonomous. The environmental learning executed by the SLAM algorithm and the low level behaviour-based reactions of the mobile robot are robotic autonomous tasks, whereas the mobile robot navigation inside an environment is commanded by a Muscle-Computer Interface (MCI. Methods In this paper, a sequential Extended Kalman Filter (EKF feature-based SLAM algorithm is implemented. The features correspond to lines and corners -concave and convex- of the environment. From the SLAM architecture, a global metric map of the environment is derived. The electromyographic signals that command the robot's movements can be adapted to the patient's disabilities. For mobile robot navigation purposes, five commands were obtained from the MCI: turn to the left, turn to the right, stop, start and exit. A kinematic controller to control the mobile robot was implemented. A low level behavior strategy was also implemented to avoid robot's collisions with the environment and moving agents. Results The entire system was tested in a population of seven volunteers: three elder, two below-elbow amputees and two young normally limbed patients. The experiments were performed within a closed low dynamic environment. Subjects took an average time of 35 minutes to navigate the environment and to learn how

  10. Psycho-physiological assessment of a prosthetic hand sensory feedback system based on an auditory display: a preliminary study

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    Gonzalez Jose

    2012-06-01

    Full Text Available Abstract Background Prosthetic hand users have to rely extensively on visual feedback, which seems to lead to a high conscious burden for the users, in order to manipulate their prosthetic devices. Indirect methods (electro-cutaneous, vibrotactile, auditory cues have been used to convey information from the artificial limb to the amputee, but the usability and advantages of these feedback methods were explored mainly by looking at the performance results, not taking into account measurements of the user’s mental effort, attention, and emotions. The main objective of this study was to explore the feasibility of using psycho-physiological measurements to assess cognitive effort when manipulating a robot hand with and without the usage of a sensory substitution system based on auditory feedback, and how these psycho-physiological recordings relate to temporal and grasping performance in a static setting. Methods 10 male subjects (26+/-years old, participated in this study and were asked to come for 2 consecutive days. On the first day the experiment objective, tasks, and experiment setting was explained. Then, they completed a 30 minutes guided training. On the second day each subject was tested in 3 different modalities: Auditory Feedback only control (AF, Visual Feedback only control (VF, and Audiovisual Feedback control (AVF. For each modality they were asked to perform 10 trials. At the end of each test, the subject had to answer the NASA TLX questionnaire. Also, during the test the subject’s EEG, ECG, electro-dermal activity (EDA, and respiration rate were measured. Results The results show that a higher mental effort is needed when the subjects rely only on their vision, and that this effort seems to be reduced when auditory feedback is added to the human-machine interaction (multimodal feedback. Furthermore, better temporal performance and better grasping performance was obtained in the audiovisual modality. Conclusions The performance

  11. Irradiated long bone transplants in limb saving surgeries for extremity bone cancers

    International Nuclear Information System (INIS)

    In the Philippines, the treatment of cancers of the limbs has always been by amputation. In recent decades, better understanding of these cancers and advances in the disciplines of cancer medicine have made the saving of these limbs almost routine in better developed countries. Surgeries entail two steps: (1) excision of the tumor and the bone from which the tumor arose, followed by (2) reconstruction of the defect resulting from the excision. Tumor implants, however, are not available locally, and are too costly for the average Filipino patient. Microvascular surgery is limited by the size of the defect it can bridge; and bone cement, not being biologic, can result in greater long term problems. Recently, the option of long bone transplants (aka large-segment allografts) to reconstruct these defects has become available locally. These bones are harvested from both cadaveric and live amputee donors after appropriate consent and medical work-up. After processing at the UP-PGH Tissue and Bone Bank, the bones are sterilized by irradiation at the PNRI(Philippine Nuclear Research Institute), and store in deep freezers until use. In the Philippines, limb saving surgery for bone cancers of the extremities using these large-segment alloografts was introduced in 1993 at the UP-PGH Musculoskeletal Tumor Unit. This paper will present the author's initial 3-year experience with 19 patients whose limbs were saved using bone transplantation. All surgeries were performed by the author and all patients have been personally followed up by the author (follow-up ranging from 6 months to 3-1/2 years). Cases will be presented to show the pre- and intraoperative processing of the irradiated bone; and the patients before and after the operations with emphasis on their improved quality of life and return to function. These results would seem to show that irradiated long bone transplants coupled with skills for limb saving surgery may make amputations a thing of the past for many of our

  12. 上肢残肢的常规康复治疗和肌电信号反馈训练%The prosthetic rehabilitation and training of myoelectric signal for upper limb stumps

    Institute of Scientific and Technical Information of China (English)

    武继祥; 刘宏亮; 周贤丽; 林永辉; 赵正福; 陈东; 吴宗耀

    2008-01-01

    Objective To evaluate the effect of prosthetic rehabilitation and analyze the exercise training program with myoelectric signal for upper limb stumps.Methods Twenty canes with 22 upper limb stumps were treated with exercise for strength training,muscle contraction and control training and the complication of stump were managed.The myoelectrlc signal of upper limb stumps were detected and the stumps were trained with electronic biofeedback software system,including basic signal of biofeedback training and visual biofeedback training.Then the myoelectric prostheses were assembled.Results After prosthetic rehabilitation and myoelectfic signal training,there Wan no significant atrophy of muscle of stumps,muscle strength and range of motion of these twenty limb stumps increased.The amputees could control muscle contraction and grasp,pinch,wrist rotation,elbow extension or flexion consciously.Twenty myoelectrie prostheses were assembled.Conclusion The prosthetic rehabilitation and myoelectric signal training of limb stump is important for assembling myoelectric prosthesis.%目的 探讨上肢截肢患者的常规康复治疗、残肢肌电信号训练程序以及装配肌电假肢的方法 ,并观察其效果.方法 对20例截肢患者(22个残肢)进行常规康复治疗,包括肌力训练、肌肉收缩控制训练和残肢并发症的处理.采用德国Otto Bock公司提供的肌电信号检测和训练软件系统进行肌电信号训练(分为基础肌电信号训练和视觉反馈训练两个阶段),并装配肌电假肢.观察患者的治疗效果.结果 20例截肢患者22个残肢肌肉无明显萎缩,肌力好,关节活动范围无明显受限,患者能较好地控制残肢肌肉收缩.装配肌电假肢20例(20个),所有残肢均能有意识地引出肌电信号,控制假肢的手指打开、闭合以及腕关节的旋转或肘关节的屈伸.结论 残肢常规康复治疗和肌电信号训练对装配肌电假肢,实现有意识地控制假肢功能极为重要.

  13. Comparação dos fatores de risco para amputações maiores e menores em pacientes diabéticos de um Programa de Saúde da Família Comparison of risk factors for major and minor amputation in diabetic patients included in a Family Health Program

    Directory of Open Access Journals (Sweden)

    Elvira Cancio Assumpção

    2009-06-01

    sequelae, such as lower limb amputation. Peripheral vascular insufficiency is a common early occurrence in these patients. The coexistence of neuropathy, ischemia, and immunodeficiency favors the development of infections in the lower limbs, which if not treated properly can lead to amputation and even death. OBJECTIVE: Compare risk factors for major and minor amputations in diabetic patients in the Family Health Program of the health care facility CAIC Virgem dos Pobres III, in Maceió, state of Alagoas, Brazil. METHODS: We examined 93 patients diagnosed with diabetes, assessing whether or not lower limb amputation was performed. The variables analyzed were: sex, age, type of diabetes, blood pressure, previous amputation (whether major or minor, skin changes, changes in arterial pedal and posterior tibial pulses, deformities, and neuropathy. Variables were classified according to the Wagner and Texas wound classification. RESULTS: All patients were diagnosed with type 2 diabetes. We found that 4.30% of the patients progressed to lower limb amputation. There was no significant variation in hypertension, deformities and neuropathy in relation to the amputee group. However, absence of distal pulses in the lower limb proved to be quite significant in relation to amputation outcome. CONCLUSION: Diabetic patients should receive appropriate outpatient medical care in order to prevent or minimize diabetes-related complications.

  14. 下肢创伤性截肢后残端问题的影响因素及其手术治疗%Surgical strategies for stump problems following trauma-related amputation of lower extremity

    Institute of Scientific and Technical Information of China (English)

    刘克敏; 王安庆; 唐涛; 赵利; 崔寿昌

    2010-01-01

    47 men and 25 women, aged from 9 to 60 (average, 28.8±12.4) years old. The stump problems in all these cases were analyzed retrospectively. Gender, unilateral or bilateral amputation, amputation level, trauma cause were hypothesized as group factors; duration between the original amputation and the first revision surgery, soft tissue redundancy, scar, ulcer, neuroma, and exostosis were taken as levels in each group. The correlations between factors and levels were analyzed statistically. Activities of daily living (ADL) scores were also obtained to estimate effectiveness of the management strategies. Results Eighty problem stumps were treated surgically, including 48 above-knee amputations and 32 below-knee amputations. The duration from the original amputation to the first revision surgery in the below-knee amputation cases was longer than that in the above-knee amputation ones( P = 0.030); the soft tissue redundancy in the above-knee amputation cases was higher than in the below-knee amputation ones (P=0.007); the exostosis in the unilateral amputation was higher than in the bilateral one (P=0.018). The differences in the A DL scores in 41 cases between initial hospitalization and discharge were significant (t=-11.536, P=0.000) . Conclusion Since stump problems following trauma-related amputation of lower limb can have crucial influence on living and work of the amputees, appropriate surgical management should be recommended due to its reliable therapeutic effects.

  15. Assessment of postural stability in patients with a transtibial amputation with various times of prosthesis use [Hodnocení posturální stability pacientů s transtibiální amputací s různou dobou používání protézy

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    Dagmar Kozáková

    2009-09-01

    Full Text Available BACKGROUND: Postural confidence is an initial precondition for all activities within the activity of daily living. Subjects with lower limb amputation have, due to somatosensory loss of information from the lower limb, more difficult conditions for maintaining postural stability in comparison with healthy subjects. Early prosthetic fitting with a prosthesis (with regard to amputation level, health state, financial claims, etc. is crucial for amputee reintegration into daily life. OBJECTIVE: The aim of this study was to assess the selected biomechanical parameters of standing stability in patients with a transtibial lower limb amputation with various times of prosthesis use. The next aim was to assess how the waiting time for the prosthesis fitting influences standing stability in different situations. METHODS: The tested group was made up of 21 patients (the average age was 64.4 ± 9.18 years with a unilateral transtibial amputation. The reason for amputation was in the case of 12 tested patients a vascular disease, in 8 patients trauma and in one it was a tumor. The average length of prosthesis use was 156.4 ± 359.6 days. A right side transtibial amputation had been performed on 10 patients and on the left side in 11 patients. To define the basic parameters of postural stability, two force plates of the Kistler (type 9286AA were used. Stability was tested for 30 seconds in 4 standing positions (natural bipedal stand, bipedal stand with a narrow base, natural bipedal stand with closed eyes and standing on foam. For an influence assessment of the period of prosthesis use on the level of postural stability, correlation analysis was used. The difference between each standing modification was analysed by ANOVA for repeated measurements and LSD post hoc test. RESULTS: In all tested situations, the loading of the sound limb is greater compared to the prosthetic limb in patients with a transtibial amputation (from 17.8% to 22.8%. This is also valid