Showing papers in "Prosthetics and Orthotics International in 1983"
TL;DR: A post-clinical investigation has been carried out among 42 unilateral amputees who lost their hand due to an accident, directed at the amputee, the problems he has to cope with, and the role the prosthesis plays in his life.
Abstract: A postclinical investigation has been carried out among 42 unilateral amputees who lost their hand due to an accident. The investigation was directed at two main topics of interest. Firstly the amputee, the problems he has to cope with, and the role the prosthesis plays in his life; and secondly the prosthesis, its use and its potential benefits and burdens. The group of amputees consisted of above-elbow and belowelbow amputees. Body powered as well as myoelectric prostheses were represented in the group. Most of the information was obtained during a twoday home visit where a semi-structured interview was conducted, and where a number of daily life activities were observed. The information thus obtained has led to a number of conclusions and recommendations with respect to the rehabilitation of this category of amputees, and with respect to the design criteria of protheses for unilateral amputees.
90 citations
TL;DR: The gait patterns of unilateral below-knee amputees wearing prostheses with either a SACH foot or a single axis foot were compared and major differences (excepting the ankle at foot-flat) between the prosthetic devices were not found.
Abstract: The gait patterns of unilateral below-knee amputees wearing prostheses with either a SACH foot or a single axis foot were compared. A temporary below-knee prosthesis was fabricated for each subject using plaster of Paris and Plastazote for the socket, a pylon and an artificial foot. Eight subjects were filmed at two separate sessions, one in which the SACH foot was worn on their prosthesis and one with the single axis foot on their prosthesis.Measurements of the normal leg with a SACH foot on the prosthetic limb were compared to measurements of the normal leg with a single axis foot on the prosthesis. Measurements of the prosthetic leg with both devices were also compared. A one tailed t test (p<.05) was used to determine statistical significance of the results obtained in six measurements of lower limb joint angles and on the percentage of the time of gait cycle for stance and swing phase of the prosthetic leg.Discussion centres on the interpretation of the results from both statistical and clinical poin...
41 citations
TL;DR: The dimensions and healing of 93 consecutive below-knee stumps were studied and based on observations a standard formula of stump classification was constructed and discussed at the ISPO Meeting in Bologna 1980.
Abstract: The dimensions and healing of 93 consecutive below-knee stumps were studied and based on observations a standard formula of stump classification was constructed (and discussed at the ISPO Meeting in Bologna 1980). Muscular atrophy and redistribution of oedema caused a mean reduction of calculated arbitrary stump volume of about 7% during the first 12 post-operative weeks accompanied by a change in distal circumferential measurement ranging between 7 centimetres reduction and 5 centimetres increase. The classification formula was tested in 135 examinations in 86 patients with 96 stumps in Lund. A new proportional definition of stump length was used. Eighty per cent were ordinary in length and shape. Ten of 59 were conical before one year compared to 12 of 42 after more than one year following amputation. Pain was a problem in 20%. Scar problems are common early but other skin damage increases with time. Skin problems are separated according to cause, i.e. pressure, suction, infection and allergy. One third of below-knee stumps had unhealed wound or damaged skin. Surgical correction was indicated in 2% and prosthetic correction in 7%. Prosthetic correction seemed to be more often needed in below-knee stumps and surgical correction in above-knee stumps.
38 citations
TL;DR: The gait characteristics of eight amputees during their ambulation training were investigated with the use of the new microcomputer-based system for measuring the temporal factors of amputee gait.
Abstract: This paper reports the development of a microcomputer-based system for measuring the temporal factors of amputee gait. The system has been designed for possible use in a standard clinical environment. It consists of a simple walkway, two photoelectric beam relays, a control unit and an APPLE II Plus microcomputer.Preliminary clinical assessment of the system has been conducted. The gait characteristics of eight amputees during their ambulation training were investigated with the use of the new system. A comparison of the results from different groups of subjects, selected primarily on level of amputation, is presented.
25 citations
TL;DR: The stability diagram illustrates how voluntary and involuntary stability can be utilized by using different polycentric linkage mechanisms for through-knee amputees.
Abstract: The most widely used knee mechanisms for through-knee amputees can be characterized as three principal types of design. These types are metal side bars with heavy duty joints, conventional knee mec...
23 citations
TL;DR: The physical and psychological effects of amputation on marriage and family life are examined, and the extent to which the needs of the younger amputee are being met from current rehabilitation resources are assessed.
Abstract: This study sets out to examine the physical and psychological effects of amputation on marriage and family life; assess the extent to which the needs of the younger amputee are being met from current rehabilitation resources, and to ascertain how the non-disabled regard amputation and its consequences. Interviews were conducted with a group of 19 amputees and a group of 40 non-disabled individuals within the same age range and the results are reported.
22 citations
TL;DR: Preliminary results of laser Doppler velocimetry use in the evaluation of amputation levels in 16 patients discussed.
Abstract: Laser Doppler velocimetry is a newly available technique for the continuous and non-invasive measurement of capillary perfusion. The technique is presented and preliminary results of its use in the evaluation of amputation levels in 16 patients discussed.
19 citations
TL;DR: Rehabilitation after amputation at through-knee level is described and analysed in relation to amputations at above-Knee and below- knee levels.
Abstract: Rehabilitation after amputation at through-knee level is described and analysed in relation to amputations at above-knee and below-knee levels.
19 citations
TL;DR: This survey analyses the levels of all major lower limb amputations in Denmark performed in 1980 and concludes that amputation rates in Denmark are at their lowest level since records began.
Abstract: This survey analyses the levels of all major lower limb amputations in Denmark performed in 1980. During that year a total of 2,404 amputations were carried out on 2,177 patients.
18 citations
TL;DR: The through-knee stump is generally problem free, functional and end-bearing, allowing for a high rehabilitation rate in independent ambulation, and is therefore well suited for the geriatric amputee.
Abstract: Physiotherapeutic treatment considerations specific to the through-knee amputee are presented. Treatment is determined by the assessment findings. The physiotherapy programme includes post-operative exercises, early weight-bearing, bed to chair transfers, bandaging techniques, the counteracting of contractures and gait training. Physiotherapy is a vital part of the rehabilitation of through-knee amputees. Principles of treatment are based on normal human locomotion, the individual patient's health status, biomechanical changes and expected stump functions. The through-knee stump is generally problem free, functional and end-bearing, allowing for a high rehabilitation rate in independent ambulation. It is therefore well suited for the geriatric amputee.
18 citations
TL;DR: The risk of death and possibility of returning through-knee amputees to their own home, relating the results to other major levels of amputation of the lower limb is described.
Abstract: Amputation surgery for gangrene of the lower limb has two primary goals, to save life and to bring the patients back to their previous living conditions. If this can be achieved with restored walking ability the result of the treatment is considered a full success. The purpose of this paper is to describe the risk of death and possibility of returning through-knee amputees to their own home, relating the results to other major levels of amputation of the lower limb.
TL;DR: A pneumatic walking training aid for amputees is described, developed by the late Biomechanical Research and Development Unit, Roehampton, from an original design by Professor Little in Australia.
Abstract: A pneumatic walking training aid for amputees is described. It was developed by the late Biomechanical Research and Development Unit, Roehampton, from an original design by Professor Little in Australia. The walking aid has been used successfully on the majority of below-knee and through-knee patients rehabilitated in the Roehampton Walking Training School since 1976. There have been no complications that could be attributed to the use of the pneumatic walking aid.
TL;DR: The biomechanics of the through-Knee prosthesis is considered in detail and comparisons made with the above-knee case.
Abstract: The biomechanics of the through-knee prosthesis is considered in detail and comparisons made with the above-knee case. Socket shape and suspension are discussed and comment offered on knee function in both stance and swing phases.
TL;DR: There is an urgent need to lower the level of amputation without increasing the rate of complications, and there is a need for further information about the problems involved in rehabilitation of above-knee amputees.
Abstract: A study was carried out of 302 major amputations for vascular insufficiency in the lower limb with respect to levels of amputation, postoperative revisions, re-amputations on a higher level and postoperative mortality. This information was related to vascular disease (diabetes mellitus/arteriosclerosis) and to the experience of the surgeon.There was a high incidence of above-knee amputations both of diabetics and arteriosclerotics and the rate of complications was high for “senior” as well as “junior” surgeons. The amputations were performed during 1978 and the study has shown that there is an urgent need to lower the level of amputation without increasing the rate of complications. The study indicates that there is a need for further information about the problems involved in rehabilitation of above-knee amputees.
TL;DR: A randomized study of 95 below-knee amputees with a re-usable temporary one-size prosthesis of endoskeletal type with adjustable tube length found no negative influence on maturing of stump, hospital stay and walking ability three months after amputation was found.
Abstract: In order to reduce the need for repeated changes of socket due to postoperative atrophy and resorption of oedema simple temporary limbs are required to delay the casting of individual sockets until the stump is more mature. A randomized study of 95 below-knee amputees was performed with a re-usable temporary one-size prosthesis of endoskeletal type with adjustable tube length. Total contact was obtained by moulding a thin plastic pillow containing small plastic pellets around the stump in parallel connected sections. As air was evacuated the pillow became rigid. The pillow was kept in place about the stump by Velcro bands. Physiotherapists were able to make all adjustments and ambulate the patient 1-2 hours a day. The training started 2-4 weeks after amputation and lasted for 1-4 weeks. Healing problems due to training did not occur in well healed stumps where training started 3 weeks or more after amputation. No negative influence on maturing of stump, hospital stay and walking ability three months after amputation was found.
TL;DR: The major points brought out by the survey are presented and discussed.
Abstract: Surveys and questionnaires were sent to 3, 400 upper limb and lower limb amputees ranging in age from 18 to 72. Replies were received from 2, 176 (64%). The major points brought out by the survey are presented and discussed.
TL;DR: The operative technique is described in detail and Pitfalls are emphasized and comparisons made with other techniques.
Abstract: The operative technique is described in detail. Pitfalls are emphasized and comparisons made with other techniques.
TL;DR: Refinement of the dermofluorometer by addition of a shielded probe and fibreoptic bundles has reduced the bulk of the instrument and permitted rapid testing, and reliability has been virtually 10% in preliminary tests.
Abstract: There is a continuous search for more reliable, locally non-invasive tests for prediction of leg viability and for the selection of amputation levels in dysvascular lower limbs. Refinement of the dermofluorometer by addition of a shielded probe and fibreoptic bundles has reduced the bulk of the instrument and permitted rapid testing. Excitation light is carried to the tissues and emitted fluoresence is returned to a photo multiplier. The Index of Fluorescein Uptake is 20–30 units in control areas. Healing is constant above 15 units, inconstant from 5 to 15 units, and absent below 5 units. Reliability has been virtually 10% in preliminary tests.
TL;DR: This paper emphasizes frequent causes of failure in the selection of the level of amputation, the operative technique, post-operative treatment and prosthetic rehabilitation in order to reduce the complication rate.
Abstract: Long-term results over a period of more than 10 years give evidence of the superiority of the through-knee compared to the above-knee stump. However, failures in through-knee stumps before, during and after operation and pitfalls in prosthetic fitting are still too frequent. They are mostly due to errors because the peculiarities of the stump and the prosthetic management are not recognised. This paper emphasizes frequent causes of failure in the selection of the level of amputation, the operative technique, post-operative treatment and prosthetic rehabilitation in order to reduce the complication rate.
TL;DR: The socket is manufactured according to the double wall technique commonly used in below-knee sockets, which provides a maximum of comfort and cosmesis without extra costs.
Abstract: This paper describes a socket design and manufacturing technique for through-knee stumps, based on 14 years experience with 290 prostheses. The bulbous shape of the stump and its full end-bearing quality requires a socket which has very little resemblance to above-knee sockets. The requirements of the through-knee socket are listed and the manufacturing technique is described and illustrated in detail. Emphasis is put on the quality of the negative plaster mould. The socket is manufactured according to the double wall technique commonly used in below-knee sockets. It provides a maximum of comfort and cosmesis without extra costs.
TL;DR: There is a need in Physical Therapy Departments of hospitals for an inexpensive ergometer which can be used to gauge the improvement in the physical performance of a wheelchair occupant in his or her own chair.
Abstract: There is a need in Physical Therapy Departments of hospitals for an inexpensive ergometer which can be used to gauge the improvement in the physical performance of a wheelchair occupant in his or her own chair. This technical note describes such a device.
TL;DR: It is suggested that a useful clinical tool could be based on the presented alignment optimization procedure and may be expanded to include other factors associated with swing and stance phase comfort and performance.
Abstract: It is suggested that a major source of discomfort for above-knee amputees during the swing phase of walking, is the thigh axial torque (TAT) transferred at the stump-socket interface. The relation between TAT and variations in its six relevant alignment adjustments, has been investigated. A computerized routine has been established which indicates optimum choice of alignment setting, based on minimal TAT peaks. Feasibility for attenuating swing phase TAT has been demonstrated in three simulated patterns of amputee gait. As a conclusion, it is suggested that a useful clinical tool could be based on the presented alignment optimization procedure and may be expanded to include other factors associated with swing and stance phase comfort and performance.
TL;DR: The healing in 20 through-knee amputations was compared with preoperatively measured skin perfusion pressure, determined as the minimal external pressure required to stop the washout of isotopes injected intradermally 10 cm distal to the knee joint to conclude that the through-Knee amputation must be considered in cases where the circulation is borderline for healing in below-k knee amputation.
Abstract: The healing in 20 through-knee amputations was compared with preoperatively measured skin perfusion pressure, determined as the minimal external pressure required to stop the washout of isotopes injected intradermally 10 cm distal to the knee joint. Out of 18 amputations with a skin perfusion pressure of above 20 mmHg only 2 failed to heal, whereas 2 out of 4 cases with skin perfusion pressure below 20 mmHg failed to heal. It is concluded that the through-knee amputation must be considered in cases where the circulation is borderline for healing in below-knee amputation.
TL;DR: All ulcers with a relative hyperemia over 1.5 healed and prediction of healing of ulcers in ischaemic limbs can preclude unnecessary treatment for ulcers that cannot heal.
Abstract: Prediction of healing of ulcers in ischaemic limbs can preclude unnecessary treatment for ulcers that cannot heal. Non-invasive methods are of marked value as the ischaemic limb is susceptible to further ulceration from local skin penetration. Relative hyperemia of the ulcer was measured by scintillation count over the ulcer and at points 2.5 cm from the edge of the ulcer. Relative hyperemia was determined by dividing the count per unit area of the ulcer by the counts per unit area of the surrounding tissue. All ulcers with a relative hyperemia over 1.5 healed.
TL;DR: The purpose of the study was to investigate if a subject's knee could be classified as “normal” or “unstable” by using just the data provided by the electrogoniometer during walking trials, which is difficult to interpret in their time series form because they are multidimensional.
Abstract: Ligamentous injuries to a knee joint increase the risk of post-traumatic degenerative changes. Successful early diagnosis and treatment of such injuries remains a challenging and controversial task.There are a variety of clinical tests available and some of these are difficult to perform and interpret. These clinical tests are really static in nature and may not reveal the presence of what is essentially a dynamic event. A complete assessment would need to be “dynamic” and by its application during ambulation, incorporate the effects of ground-foot forces, joint motions and muscle activities.At the Ontario Crippled Children's Centre (OCCC) a triaxial electrogoniometer system (extensively modified CARS-UBC) has been used, together with complementary, gait laboratory instrumentation, in order to study the knees of 16 male subjects. Ten subjects had knees without evidence of injury and six had a variety of cruciate and menisceal tears.The purpose of the study was to investigate if a subject's knee could be c...
TL;DR: Four aids, developed by the Department for Research and Development from existing ideas and being used in Revalidatiecentrum “De Hoogstraat” by patients with a spinal cord injury, are described.
Abstract: Four aids, developed by the Department for Research and Development from existing ideas and being used in Revalidatiecentrum “De Hoogstraat” by patients with a spinal cord injury, are described. These aids are: a dynamic elbow extension orthosis; a modified flexor hinge splint; a rolling writing aid, and a urinary device for females.
TL;DR: Different types of treatment of the amputation stump are reviewed, including bandaging, semi-rigid dressings, rigid cast dressing and controlled environment treatment.
Abstract: This paper reviews different types of treatment of the amputation stump. Following an examination of the historical development there are sections on bandaging, semi-rigid dressings, rigid cast dressing and controlled environment treatment. The merits and demerits of each type of treatment are discussed.
TL;DR: Factors such as age and sex incidence, extremity involvement, incidence of deformities at hip, knee and ankle, lower limb discrepancy, treatment and orthoses prescribed are discussed.
Abstract: This study reports on 3,000 cases of poliomyelitis seen at the Rehabilitation and Artificial Limb Centre at Lucknow between January 1976 and December 1980. Factors such as age and sex incidence, extremity involvement, incidence of deformities at hip, knee and ankle, lower limb discrepancy, treatment and orthoses prescribed are discussed.
TL;DR: A self-propelled mobile standing device is described with the facility of patient-operated inclination of the support platform, enabling objects on the floor to be reached.
Abstract: A self-propelled mobile standing device is described with the facility of patient-operated inclination of the support platform, enabling objects on the floor to be reached. The device is provided with a removable tray at the level of the occupant's chest.
TL;DR: The development of a stronger and more adjustable matrix than was previously reported is detailed, together with the principles necessary to achieve this, and application of this new matrix to adult seating is described.
Abstract: Progress is reported on the development and application of structural matrices in rehabilitation. The development of a stronger and more adjustable matrix than was previously reported is detailed, together with the principles necessary to achieve this. Application of this new matrix to adult seating is described. The emergence of programmable beams and the need for containment matrices are also documented and the advantages of these approaches to a variety of problems in rehabilitation are given.