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1
Jones, L. E. "Prosthetic limb use in Australia 1981-1985 under the Free Limb Scheme." Prosthetics and Orthotics International 13, no. 2 (1989): 76–81. http://dx.doi.org/10.3109/03093648909078216.
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A study has been made of data on 19,421 prosthetic limbs prescribed for 12,143 Australians under the Free Limb Scheme in the years 1981–1985. These prostheses consisted of 18,119 legs and 1,302 arms. The mean age of the lower limb prosthesis user was 52.8 and the upper limb prosthesis user 31.3 years. Males outnumbered females by 3 to 1 in the upper limb prosthesis users, and 2.8 to 1 with lower limb prosthesis users. Below-knee prostheses, patellar-tendon-bearing and thigh-lacing prostheses, made up 58.7% of all prostheses prescribed in the time span. Below-elbow prostheses were the commonest upper limb prostheses with children being the most frequent users. Comparisons with other studies of large number of prosthesis users show an older mean age in Australia and more below-knee prosthesis users than in American studies.
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Nair, A., R. S. Hanspal, M. S. Zahedi, M. Saif, and K. Fisher. "Analyses of prosthetic episodes in lower limb amputees." Prosthetics and Orthotics International 32, no. 1 (2008): 42–49. http://dx.doi.org/10.1080/03093640701610615.
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The provision and maintenance of prostheses in 100 trans-femoral amputees and 73 trans-tibial amputees were retrospectively analysed over a 10-year period. The aim of the study was to analyse the prosthetic episodes, i.e., the need for maintenance, repairs and replacements to a trans-femoral and a trans-tibial prosthesis and frequency of new sockets prescribed over the same period of use by established adult amputees. The study showed that the trans-femoral amputees needed 0.96 new prostheses, 3.27 new sockets, 2.31 major repairs, 3.36 component changes and 21.85 minor repairs. Younger trans-femoral amputees aged less than 60 years needed 1.1 new prostheses, 3.15 new sockets, 2.06 major repairs, 4.23 component changes and 20.49 minor repairs. Younger trans-femoral amputees needed significantly more changes of prosthetic components ( p = 0.04). The associated study on 73 trans-tibial amputees showed that they needed 1.4 new prosthesis, 2.9 new sockets, 3.2 major repairs and 14.1 minor repairs over the same 10-year period. The introduction and prescription of modular prosthesis as opposed to conventional limbs used earlier has possibly allowed components to be easily replaced thus reducing the need to replace a whole new prosthesis.
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Eshraghi, Arezoo, Noor Azuan Abu Osman, Hossein Gholizadeh, Mohammad Karimi, and Sadeeq Ali. "Pistoning assessment in lower limb prosthetic sockets." Prosthetics and Orthotics International 36, no. 1 (2012): 15–24. http://dx.doi.org/10.1177/0309364611431625.
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Background: One of the main indicators of the suspension system efficiency in lower limb prostheses is vertical displacement or pistoning within the socket. Decreasing pistoning and introducing an effective system for evaluating pistoning could contribute to the amputees’ rehabilitation process.Objectives: The main objective of this study was to review existing research studies that examine the occurrence of pistoning in lower limb prosthesis with different techniques in static (standing) and dynamic (walking and jumping) positions.Study Design: Literature review.Methods: Keywords related to slippage, suspension, pistoning and vertical movement in lower limb prosthetics were used to search the literature available in PubMed, ScienceDirect, Web of Science and Google Scholar databases. Sixteen articles were selected for further analysis according to the selection criteria.Results: The following methods have been used to measure the occurrence of pistoning in prosthetic limbs: radiological methods, photographic technique, motion analysis system, sensor and spiral computerized tomography (CT). Pistoning was measured both in standing and walking.Conclusions: The results of this review reveal that further research is needed to develop and evaluate easy, accurate and safe methods of measuring pistoning. Future studies should provide a gold standard for the acceptable range of pistoning in a prosthetic socket.Clinical relevanceThis literature review contributes to a further understanding of lower limb prosthetic biomechanics by highlighting the strengths and weaknesses of the techniques that are currently available for evaluating the occurrence of pistoning in a prosthetic socket. It provides a useful overview of the current methods of measuring residual limb movements relative to the socket and liner, and will be of use for both practitioners and researchers in prosthetics and orthotics fields.
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Resnik, Linda, Matthew Borgia, Allen W. Heinemann, and Melissa A. Clark. "Prosthesis satisfaction in a national sample of Veterans with upper limb amputation." Prosthetics and Orthotics International 44, no. 2 (2020): 81–91. http://dx.doi.org/10.1177/0309364619895201.
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Background: Many persons with upper limb amputation reject prostheses, and many are not satisfied with their devices. Research is needed to understand modifiable factors related to device satisfaction. Myoelectric devices with multiple degrees of freedom are now available; however, no studies have examined whether they lead to greater device satisfaction. Prosthetic training contributes to more skillful prosthesis use and greater likelihood of long-term use; however, the relationship between training and device satisfaction is unclear. Objectives: (1) To describe and compare satisfaction by prosthesis and terminal device type and (2) to identify factors associated with satisfaction. Study design: Cross-sectional study. Methods: Participants were 449 persons with unilateral upper limb amputation who used a prosthesis. Participants described their prostheses, prosthetic training, device repairs, visits to a prosthetist, and rated device satisfaction using two standardized measures (Trinity Amputation and Prosthesis Experience Scales Satisfaction scale and Orthotics and Prosthetics Users’ Survey - Client Satisfaction with Devices scale). Multivariate generalized linear regression models examined the relationship between prosthesis and terminal device type and satisfaction, controlling for covariates that were meaningful in bivariate analyses. Results: There were no differences in satisfaction by prosthesis type or terminal device degrees of freedom. Satisfaction was associated with receipt of training to use the initial prosthesis, amputation level, age, and race. Conclusion: No differences in satisfaction by device or terminal device type were observed. Worse satisfaction was associated with more proximal amputation level, younger age, and black race. The association between receipt of initial prosthetic training and device satisfaction points to the critical role of occupational or physical therapy in the early stages of prosthetic care. Clinical relevance Prosthetic satisfaction did not vary by device or terminal device degrees of freedom. Proximal amputation level, younger age, and black race were associated with lower prosthetic satisfaction. Receipt of initial prosthetic training was associated with greater device satisfaction, pointing to the critical role and lasting impact of early training.
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Jacobs, R., R. Brånemark, K. Olmarker, B. Rydevik, D. van Steenberghe, and PI Brånemark. "Evaluation of the psychophysical detection threshold level for vibrotactile and pressure stimulation of prosthetic limbs using bone anchorage or soft tissue support." Prosthetics and Orthotics International 24, no. 2 (2000): 133–42. http://dx.doi.org/10.1080/03093640008726536.
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In the present study the psychophysical detection threshold levels for mechanical stimulation of 32 prosthetic limbs were determined. Prosthetic limbs were anchored to the bone by means of an implant (n=17) or supported by a socket enclosing the amputation stump (n=15). Detection threshold levels were assessed for pressure and vibratory stimulation of the prosthesis and the limb at the contralateral side (control). Following vibratory stimulation, thresholds were increased on an avarage 20% for socket prostheses, but approached those of the control for boneanchored prostheses. For pressure stimulation, thresholds were increased up to 60% for socket prostheses and 40% for boneanchored prostheses compared to the control. While boneanchored prostheses yielded significantly lower threshold levels than socket prostheses, there was no significant difference between both treatments regarding pressure stimulation. Results were applicable to both upper and lower limb amputees. It could be concluded that detection thresholds for pressure and especially vibratory stimulation of prosthetic limbs were generally higher than for control limbs. The outcome was related to the prosthetic limb design with boneanchored prostheses yielding better perception than socket prostheses.
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Biktimirova, F. M., M. V. Fedorenko, and E. I. Aukhadeev. "Indices of physical activity, quality of life and psychological characteristics in patients with amputated lower limb." Kazan medical journal 95, no. 6 (2014): 830–35. http://dx.doi.org/10.17816/kmj1989.
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Aim. To study the physical activity in disabled patients who underwent an amputation of the lower limb in a late period of rehabilitation and prosthetics. Methods. The study included patients with structural and functional disorders of limbs. 308 patients aged 18 to 66 years were randomly selected to participate in the study as they were referred to Prosthetic and orthopedics center «Reabilitaciya invalidov», Kazan, Russia from 2008 to 2010. Patients were allocated to five age groups: 19 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years old and older than 60 years. Activity level, depending on the motor capacity was investigated in 308 patients who were offered prosthetics according to the classification subdividing locomotor activity on five levels. SF-36 questionnaire (quality of life), Spielberger-Hanin reactive and personal anxiety scales, Beck Depression Inventory, the Mehrabian Achieving Tendency Scale, Smisek-Leonhard characterological test were administered. Quality of lower limbs prostheses were assessed by «TWO LEGS» prosthesis evaluation questionnaire on a 5-point scale. Results. The majority of patients who were at the remote stage of rehabilitation after prosthesis had high level of physical activity - 141 (45.7%) patients, average activity level - 81 (26.2%) patients, reduced level of activity - 63 (20.5%) patients. High level of physical activity, depending on the locomotor activity, was more typical for the second (20-29) and third (30-39 years) age groups - 60 and 54%, respectively. Very high and high levels of physical activity was equally observed in patients with one and both amputated both lower legs: 8.4 and 7%, respectively. Conclusion. Level of amputation, age and psychological characteristics, as well as prosthesis quality and the term of prosthesis use were essential for motor activity, quality of life and functional independence of the disabled with structural and functional of the lower limb disorders.
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Christensen, B., B. Ellegaard, U. Bretler, and E.-L. østrup. "The effect of prosthetic rehabilitation in lower limb amputees." Prosthetics and Orthotics International 19, no. 1 (1995): 46–52. http://dx.doi.org/10.3109/03093649509078231.
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The objectives of this project were to ascertain whether, to date, the views concerning the determination of prosthetic candidacy have been optimal and whether the training methods applied have been effective and have resulted in constant use of the prosthesis after conclusion of the training programme. Secondly it was intended to set up guidelines for future budgeting as well as providing a reference framework for the process of rehabilitation. An inquiry based on questionnaires was the first phase in a quality assurance project carried out among 29 amputees trained in 1990 and 1991. The result of the inquiry was that rehabilitation using PTB prostheses for 19 trans-tibial amputations in 18 cases (one patient was a bilateral trans-tibial amputee) led to constant use of the prosthesis and that advanced age was no hindrance to constant use in this group. For 10 trans-femoral amputees the inquiry revealed that advanced age combined with problems of donning the prosthesis was a hindrance to constant use in two cases. It is concluded that there is a need for testing/developing new types of femoral prostheses. The patients' evaluation of the rehabilitation process and their prostheses stresses the need for communication between the team of professionals and the patients in the decision process concerning the provision of a prosthesis as well as the provision of complete information on the patients' future functional possibilities. Qualitative measurements must include the kind and number of medical complications and the social conditions of the amputee as well as tests of physical and mental resources.
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Takahashi, Kota Z., John R. Horne, and Steven J. Stanhope. "Comparison of mechanical energy profiles of passive and active below-knee prostheses: A case study." Prosthetics and Orthotics International 39, no. 2 (2014): 150–56. http://dx.doi.org/10.1177/0309364613513298.
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Background: With the recent technological advancements of prosthetic lower limbs, there is currently a great desire to objectively evaluate existing prostheses. Using a novel biomechanical analysis, the purpose of this case study was to compare the mechanical energy profiles of anatomical and two disparate prostheses: a passive prosthesis and an active prosthesis. Case description and methods: An individual with a transtibial amputation who customarily wears a passive prosthesis (Elation, Össur) and an active prosthesis (BiOM, iWalk, Inc.) and 11 healthy subjects participated in an instrumented gait analysis. The total mechanical power and work of below-knee structures during stance were quantified using a unified deformable segment power analysis. Findings and outcomes: Active prosthesis generated greater peak power and total positive work than passive prosthesis and healthy anatomical limbs. Conclusion: The case study will enhance future efforts to objectively evaluate prosthetic functions during gait in individuals with transtibial amputations. Clinical relevance A prosthetic limb should closely replicate the mechanical energy profiles of anatomical limbs. The unified deformable (UD) analysis may be valuable to facilitate future clinical prescription and guide fine adjustments of prosthetic componentry to optimize gait outcomes.
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Eberly, Valerie J., Sara J. Mulroy, JoAnne K. Gronley, Jacquelin Perry, William J. Yule, and Judith M. Burnfield. "Impact of a stance phase microprocessor-controlled knee prosthesis on level walking in lower functioning individuals with a transfemoral amputation." Prosthetics and Orthotics International 38, no. 6 (2013): 447–55. http://dx.doi.org/10.1177/0309364613506912.
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Background: For individuals with transfemoral amputation, walking with a prosthesis presents challenges to stability and increases the demand on the hip of the prosthetic limb. Increasing age or comorbidities magnify these challenges. Computerized prosthetic knee joints improve stability and efficiency of gait, but are seldom prescribed for less physically capable walkers who may benefit from them. Objective: To compare level walking function while wearing a microprocessor-controlled knee (C-Leg Compact) prosthesis to a traditionally prescribed non-microprocessor-controlled knee prosthesis for Medicare Functional Classification Level K-2 walkers. Study design: Crossover. Methods: Stride characteristics, kinematics, kinetics, and electromyographic activity were recorded in 10 participants while walking with non-microprocessor-controlled knee and Compact prostheses. Results: Walking with the Compact produced significant increase in velocity, cadence, stride length, single-limb support, and heel-rise timing compared to walking with the non-microprocessor-controlled knee prosthesis. Hip and thigh extension during late stance improved bilaterally. Ankle dorsiflexion, knee extension, and hip flexion moments of the prosthetic limb were significantly improved. Conclusions: Improvements in walking function and stability on the prosthetic limb were demonstrated by the K-2 level walkers when using the C-Leg Compact prosthesis. Clinical relevance Understanding the impact of new prosthetic designs on gait mechanics is essential to improve prescription guidelines for deconditioned or older persons with transfemoral amputation. Prosthetic designs that improve stability for safety and walking function have the potential to improve community participation and quality of life.
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Malchow, Connor, and Goeran Fiedler. "Effect of observation on lower limb prosthesis gait biomechanics: Preliminary results." Prosthetics and Orthotics International 40, no. 6 (2016): 739–43. http://dx.doi.org/10.1177/0309364615605374.
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Background: The Hawthorne effect, a subcategory of reactivity, causes human behavior to change when under observation. Such an effect may apply to gait variation of persons with prosthetics or orthotics devices. Objectives: This study investigated whether the presence of observers directly affects the gait pattern of users of lower limb prostheses. Study design: Within-subject intervention study. Methods: Primary outcome measures were gait parameters of initial double support time and upper body lateral tilt angle, which were collected with a mobile sensor attached to the subjects’ back. To make subjects feel unwatched, a certain amount of deception was necessary, and two different conditions were created and statistically compared against each other: one in which the subjects were initially unaware of the attention of observers and another one in which the same subjects were aware of a group of observers. Results: Data from two subjects using trans-femoral prosthesis are reported. Findings included a change in step initial double support percentage by up to 14.2% ( p = 0.019). Considerable changes were also noted in secondary outcome measures including speed, stride length, and stride symmetry. Conclusions: A reactivity effect of observation exists in prosthetics gait analysis. More comprehensive studies may be motivated by these preliminary findings. Clinical relevance Results of this study suggest that users of lower limb prostheses walk differently when their gait is being assessed (e.g. in the prosthetist’s office) than in situations without observers. This may in part explain the clinical experience that modifications of prosthetic fit or alignment provide only short-term betterment.
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Ennion, Liezel, and Sarah Manig. "Experiences of lower limb prosthetic users in a rural setting in the Mpumalanga Province, South Africa." Prosthetics and Orthotics International 43, no. 2 (2018): 170–79. http://dx.doi.org/10.1177/0309364618792730.
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Background: Ambulation with a prosthesis is the ultimate goal of rehabilitation for a person with a major lower limb amputation. Due to challenges with prosthetic service delivery in rural settings, many patients with amputations are not benefitting from prosthetic interventions. Inaccessibility to prosthetic services results in worse functional outcomes and quality of life. Learning from the experiences of current prosthetic users in this setting can assist to improve prosthetic service delivery. Objectives: To explore the experiences of lower limb prosthetic users and to understand the importance of a lower limb prosthesis to a prosthetic user in a rural area of South Africa. Study design: A generic qualitative approach and an explorative design were utilised in this study. Methods: A semi-structured interview guide was used to collect data from nine prosthetic users in a rural area in the Mpumalanga province of South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Demographic details and information related to acute in-patient rehabilitation were analysed descriptively. Results: All participants were independent in activities of daily living with their prosthesis and participated actively in their community. Participants reported that their prosthesis was essential to their functioning. High travel cost was highlighted as a barrier to the maintenance of their prosthesis. Patients were dissatisfied with being unemployed. Conclusion: Prosthetic intervention positively influences function, independence and community participation. Challenges relating to the accessibility, cost and maintenance of prosthetics should be a priority to ensure continued functional independence for prosthetic users. Clinical relevance Understanding the importance of a prosthesis to a prosthetic user validates prosthetic intervention for persons living with an amputation in a rural setting and is vital in establishing and remodelling effective systems for prosthetic service delivery.
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Desmond, Deirdre, Pamela Gallagher, David Henderson-Slater, and Rob Chatfield. "Pain and psychosocial adjustment to lower limb amputation amongst prosthesis users." Prosthetics and Orthotics International 32, no. 2 (2008): 244–52. http://dx.doi.org/10.1080/03093640802067046.
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The aim of this study was to investigate associations between post-amputation phantom and residual limb pain and prosthesis satisfaction, activity restriction and psychosocial adjustment to amputation among lower limb prosthesis users. Eighty-nine people with a lower limb amputation completed a postal survey. Characteristics of phantom and residual limb pain, prosthesis satisfaction, activity restriction and psychosocial adjustment to amputation were assessed using the Trinity Amputation and Prosthesis Experience Scales (TAPES). Comparisons of those who experienced residual and/or phantom limb pain in the preceding assessment with those who did not revealed significant differences in prosthesis satisfaction, psychosocial adjustment but not in activity restriction. Overall, it is important for clinicians to ascertain the type and level of pain that the person is experiencing and to separate the experiences of the pain from the experiences of the prosthetic limb.
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Bilodeau, S., R. Hébert, and J. Desrosiers. "Lower limb prosthesis utilisation by elderly amputees." Prosthetics and Orthotics International 24, no. 2 (2000): 126–32. http://dx.doi.org/10.1080/03093640008726535.
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The goal of prosthetic rehabilitation is to compensate for the loss of a limb by amputation by, in the case of a lower limb, encouraging walking, and to achieve the same level of autonomy as prior to the amputation. However, because of difficulties walking, elderly amputees may use their prosthesis to a greater or lesser degree or simply stop using it during the rehabilitation period. The objective of this research was to study factors such as physical and mental health, rehabilitation, physical independence and satisfaction with the prosthesis to understand why amputees use their prosthesis or not. The sample was composed of 65 unilateral vascular amputees 60 years old or over living at home. The information was collected from medical records, by telephone interview and by mail questionnaire. Prosthesis use was measured by a questionnaire on amputee activities developed by Day (1981). Eightyone per cent (81%) of the subjects wore their prosthesis every day and 89% of this group wore it 6 hours or more per day. Less use of the prosthesis was significantly related to age, female gender, possession of a wheelchair, level of physical disability, cognitive impairment, poorer selfperceived health and the amputee's dissatisfaction. A multiple regression analysis showed that satisfaction, not possessing a wheelchair and cognitive integrity explained 46% of the variance in prosthesis use.
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Gafoor, S. Abdul, and M. Mohan Raj. "Upper Extremity Prosthesis — What Is New in It?" Indian Journal of Physical Medicine and Rehabilitation 27, no. 3 (2016): 67–72. http://dx.doi.org/10.5005/ijopmr-27-3-67.
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Abstract Over the past 40 years, technology has dramatically affected the field of upper limb prosthesis. With improvement in the electronics industry, along with advances in the miniaturisation and mass production of electronic components, myoelectrically controlled prosthesis has become reliable and widespread in their use. Compared to lower extremity amputees, the acceptance of prosthetic replacement is less in upper extremity amputees. This may be due to different factors like functional needs, cosmetic factors, motivation of the patient, inadequate training following conventional prosthetic fitment, etc. More and more developments are going on in upper limb extremity prosthesis which will fulfill the need of the upper limb amputees. Such developments ensure better rehabilitation though cost is a limiting factor. This article is an earnest attempt to review the recent trends in upper limb prosthetics.
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Weerakkody, Thilina H., Thilina Dulantha Lalitharatne, and R. A. R. C. Gopura. "Adaptive Foot in Lower-Limb Prostheses." Journal of Robotics 2017 (2017): 1–15. http://dx.doi.org/10.1155/2017/9618375.
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The human foot consists of complex sets of joints. The adaptive nature of the human foot enables it to be stable on any uneven surface. It is important to have such adaptive capabilities in the artificial prosthesis to achieve most of the essential movements for lower-limb amputees. However, many existing lower-limb prostheses lack the adaptive nature. This paper reviews lower-limb adaptive foot prostheses. In order to understand the design concepts of adaptive foot prostheses, the biomechanics of human foot have been explained. Additionally, the requirements and design challenges are investigated and presented. In this review, adaptive foot prostheses are classified according to actuation method. Furthermore, merits and demerits of present-day adaptive foot prostheses are presented based on the hardware construction. The hardware configurations of recent adaptive foot prostheses are analyzed and compared. At the end, potential future developments are highlighted.
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Lundberg, Mari, Kerstin Hagberg, and Jennifer Bullington. "My prosthesis as a part of me: a qualitative analysis of living with an osseointegrated prosthetic limb." Prosthetics and Orthotics International 35, no. 2 (2011): 207–14. http://dx.doi.org/10.1177/0309364611409795.
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Background: Bone-anchored prosthesis is still a rather unusual treatment for patients with limb loss. Objectives: The aim of this study was to improve our understanding about the experience of living with an osseointegrated prosthesis (OI-prosthesis) compared to one suspended with a socket, through the use of qualitative research methodology. Study design: A qualitative phenomenological research method. Methods: Thirteen Swedish patients (37–67 years) with unilateral upper or lower limb amputation (10 transfemoral, 2 transhumeral, 1 transradial), who had been using OI-prostheses for 3 to 15 years, were recruited by means of purposive sampling. An audio-taped in-depth interview was performed. The guiding question was ‘How do you experience living with your osseointegrated prosthesis compared to your earlier prostheses suspended with sockets?’. The empirical phenomenological psychological method was used for data analysis. Results: The results showed that all participants described living with an OI-prosthesis as a revolutionary change. These experiences were described in terms of three typologies, called ‘Practical prosthesis’, ‘Pretend limb’ and ‘A part of me’. Conclusions: The most important finding was that the change went beyond the functional improvements, integrating the existential implications in the concept of quality of life. Clinical relevance This qualitative in-depth interview study on patients using bone-anchored prosthetic limbs showed that all described a revolutionary change in their lives as amputees and the meaning of that change went beyond the functional improvements, integrating existential implications in the concept of quality of life.
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Pohjolainen, T., H. Alaranta, and J. Wikström. "Primary survival and prosthetic fitting of lower limb amputees." Prosthetics and Orthotics International 13, no. 2 (1989): 63–69. http://dx.doi.org/10.3109/03093648909078214.
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During the period 1984-1985 amputation of the lower limb at a level potentially requiring a prosthesis was performed on 577 patients in 16 operative units. The mean age was 75.7 years for females and 68.1 for males. The most common site of the amputation was above the knee (49.9%). The majority of amputations (93.8%) were performed for vascular diseases and diabetes. Survival figures showed that 25.5% of amputees died within 2 months of amputation, 60.7% were alive after one year and 43.2% after two years. Out of a total of 577 patients, 26.9% were fitted with a prosthesis. Out of below-knee and above-knee amputees surviving over 2 months, 61.5% and 27.2% respectively were fitted with a prosthesis. There were markedly fewer prosthetic fittings in the over-60 age group. Diabetic patients of both sexes were fitted with a prosthesis more often than arterio-sclerotic patients. Among tumour patients 82.4% received a prosthesis. In the study area more emphasis must be put on the concept of preserving the knee joint and preoperative assessment of vascular patients for selection of amputation level. Every effort must be made to avoid delay in the postoperative mobilization and rehabilitation. Prosthetic fitting of amputees could be improved by better liaison between surgical unit and specialized rehabilitation unit and by closer team approach of amputee care.
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Rommers, G. M., L. D. W. Vos, L. Klein, J. W. Groothoff, and W. H. Eisma. "A study of technical changes to lower limb prostheses after initial fitting." Prosthetics and Orthotics International 24, no. 1 (2000): 28–38. http://dx.doi.org/10.1080/03093640008726519.
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There is little published material in recent years about the use of lower limb prostheses in an elderly amputee population. In this study the authors were interested in the technical changes to lower limb prostheses after a first limb fitting procedure in a postrehabilitation population in the Netherlands. The process of fitting a prosthesis and the technical changes to the artificial limb in the first year afterwards are studied.
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Nanayakkara, PR, KG Karunarathna, T. Gobyshanger, and MV Perera. "An autologus lower limb prosthesis." Ceylon Medical Journal 54, no. 3 (2009): 99. http://dx.doi.org/10.4038/cmj.v54i3.1207.
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Sasaki, Kazuhiko, Jutamat Pinitlertsakun, Pakwan Nualnim, et al. "The reversible adjustable coupling: A lightweight and low-cost alignment component for the lower limb prosthesis." Journal of Rehabilitation and Assistive Technologies Engineering 4 (January 2017): 205566831770642. http://dx.doi.org/10.1177/2055668317706427.
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Background The alignment of the lower limb prosthesis is an integral part of the prosthetic fitting. A properly aligned prosthesis contributes to optimal gait and overall function of the patient. The current offering of alignment componentry is expensive for low-income countries. The purpose of this study was to develop a lightweight and low-cost alignment coupler for the lower limb prosthesis. Methods An alignment coupler called the reversible adjustable coupling was designed and manufactured. Measurements of total anterior/posterior and medial/lateral and rotation in prostheses were recorded and mechanical testing performed. Swiftness and difficulty of use was also recorded. Results The reversible adjustable coupling permitted acceptable ranges of anterior/posterior and medial/lateral translation and 30° of internal and external rotation of prosthetic componentry. Repetitive loading of the coupling at a speed of 1 Hz under 1.28 kN load for 2000 cycles was successful, as were static and strength tests. Discussion The coupler provided acceptable ranges of anterior/posterior and medial/lateral and rotation adjustment and is acceptable for potential use in the alignment of both exoskeletal and endoskeletal prosthesis. The final weight of the component was 166 g and cost of $55.00 USD is affordable for low-income countries for use in clinical and educational settings.
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Safari, Reza. "Lower limb prosthetic interfaces: Clinical and technological advancement and potential future direction." Prosthetics and Orthotics International 44, no. 6 (2020): 384–401. http://dx.doi.org/10.1177/0309364620969226.
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The human–prosthesis interface is one of the most complicated challenges facing the field of prosthetics, despite substantive investments in research and development by researchers and clinicians around the world. The journal of the International Society for Prosthetics and Orthotics, Prosthetics and Orthotics International, has contributed substantively to the growing body of knowledge on this topic. In celebrating the 50th anniversary of the International Society for Prosthetics and Orthotics, this narrative review aims to explore how human–prosthesis interfaces have changed over the last five decades; how research has contributed to an understanding of interface mechanics; how clinical practice has been informed as a result; and what might be potential future directions. Studies reporting on comparison, design, manufacturing and evaluation of lower limb prosthetic sockets, and osseointegration were considered. This review demonstrates that, over the last 50 years, clinical research has improved our understanding of socket designs and their effects; however, high-quality research is still needed. In particular, there have been advances in the development of volume and thermal control mechanisms with a few designs having the potential for clinical application. Similarly, advances in sensing technology, soft tissue quantification techniques, computing technology, and additive manufacturing are moving towards enabling automated, data-driven manufacturing of sockets. In people who are unable to use a prosthetic socket, osseointegration provides a functional solution not available 50 years ago. Furthermore, osseointegration has the potential to facilitate neuromuscular integration. Despite these advances, further improvement in mechanical features of implants, and infection control and prevention are needed.
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Mayer, Á., K. Kudar, K. Bretz, and J. Tihanyi. "Body schema and body awareness of amputees." Prosthetics and Orthotics International 32, no. 3 (2008): 363–82. http://dx.doi.org/10.1080/03093640802024971.
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Aim: The phantom phenomenon is a well-known example of the difference between body awareness and body schema. The present study is aimed at showing how body changes and prosthesis use are reflected in body schema and body awareness–the latter relating to the image that various amputees have of their bodies.Subject and methods: (i) Examining the configuration of body schema: A trial examining the spatial location of the phantom limb (50 people with lower or upper limb loss); (ii) examining the functional aspect of body schema: The distribution of weight power between intact and prosthetic limbs (34 people with tibial amputation); (iii) examining body awareness: Body Focus Questionnaire by Fisher (44 people with lower limb amputation, 33 intact people); and (iv) Questionnaire on anamnesis- and prosthesis-wearing habits (people participating in research methods [i] and [iii] mentioned above).Results: We found that when the amputees wore their prostheses, the configuration of body schema did not change, however, the people who had not used their prosthesis for a long period of time (in our study, at least for six years), the phantom limb shortened, a phenomenon known as telescoping. The functional adaptation of the prosthesis to the body schema starts in a short time (within two weeks) after wearing it, and it becomes close to normal in carrying body weight after a longer period of time (two years). In the beginning phase of rehabilitation, the awareness of legs is similar to that of the control group, while later on it this awareness decreases. Over time, however, the lost limb, regardless of having a prosthesis or not, loses its importance. People with a more serious or vascular amputation of the upper limbs have a clearer image of them. Limb parts having a greater cortical representation appear more intensively in phantom sensations, while the strength of the cortical representation in body schema has no significance.Conclusion: From both configuration and functional aspects, wearing a prosthesis helps maintain a body schema in which the phantom limb remains similar to the intact one, which can be explained by the connectional schema model. This is needed for movements to be carried out properly. Although the amputee can see the prosthesis and senses the phantom limb, they do not consider it their own since they are aware of the loss. Therefore, the fact that a prosthesis is worn will not be represented in body awareness as the highest level of mental structure.
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Mohamed, Abeer, Andrew Sexton, Kirsten Simonsen, and Chris A. McGibbon. "Development of a Mechanistic Hypothesis Linking Compensatory Biomechanics and Stepping Asymmetry during Gait of Transfemoral Amputees." Applied Bionics and Biomechanics 2019 (February 3, 2019): 1–15. http://dx.doi.org/10.1155/2019/4769242.
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Objective. Gait asymmetry is a common adaptation observed in lower-extremity amputees, but the underlying mechanisms that explain this gait behavior remain unclear for amputees that use above-knee prostheses. Our objective was to develop a working hypothesis to explain chronic stepping asymmetry in otherwise healthy amputees that use above-knee prostheses. Methods. Two amputees (both through-knee; one with microprocessor knee, one with hydraulic knee) and fourteen control subjects participated. 3D kinematics and kinetics were acquired at normal, fast, and slow walking speeds. Data were analyzed for the push-off and collision limbs during a double support phase. We examined gait parameters to identify the stepping asymmetry then examined the external work rate (centre of mass) and internal (joint) power profiles to formulate a working hypothesis to mechanistically explain the observed stepping asymmetry. Results. Stepping asymmetry at all three gait speeds in amputees was characterized by increased stance phase duration of the intact limb versus relatively normal stance phase duration for the prosthesis limb. The prosthesis limb contributed very little to positive and negative work during the double support phase of gait. To compensate, the intact leg at heel strike first provided aid to the deficient prosthetic ankle/foot during its push-off by doing positive work with the intact knee, which caused a delayed stance phase pattern. The resulting delay in toe-off of the intact limb then facilitated the energy transfer from the more robust intact push-off limb to the weaker colliding prosthesis side. This strategy was observed for both amputees. Conclusions. There is a sound scientific rationale for a mechanistic hypothesis that stepping asymmetry in amputee participants is a result of a motor adaptation that is both facilitating the lower-leg trajectory enforced by the prosthesis while compensating for the lack of work done by the prosthesis, the cost of which is increased energy expenditure of the intact knee and both hips.
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Bragaru, Mihai, Rienk Dekker, and Jan HB Geertzen. "Sport prostheses and prosthetic adaptations for the upper and lower limb amputees: an overview of peer reviewed literature." Prosthetics and Orthotics International 36, no. 3 (2012): 290–96. http://dx.doi.org/10.1177/0309364612447093.
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Background:Sport prostheses are used by both upper- and lower-limb amputees while participating in sports and other physical activities. Although the number of these devices has increased over the past decade, no overview of the peer reviewed literature describing them has been published previously. Such an overview will allow specialists to choose appropriate prostheses based on available scientific evidence rather than on personal experience or preference.Objective:To provide an overview of the sport prostheses as they are described by the papers published in peer reviewed literature.Study Design:Literature review.Methods:Four electronic databases were searched using free text and Medical Subject Headings (MESH) terms. Papers were included if they concerned a prosthesis or a prosthetic adaptation used in sports. Papers were excluded if they did not originate from peer reviewed sources, if they concerned prostheses for body parts other than the upper or lower limbs, if they concerned amputations distal to the wrist or ankle, or if they were written in a language other than English.Results:Twenty-four papers were included in this study. The vast majority contained descriptive data and consisted of expert opinions and technical notes.Conclusion:Data concerning the energy efficiency, technical characteristics and special mechanical properties of prostheses or prosthetic adaptations for sports, other than running, are scarce.Clinical relevanceAn overview of the peer reviewed literature will enable rehabilitation specialists working with amputees to choose a prosthesis that best suits their patients’ expectations on the available scientific evidence. Identifying the information gaps present in the peer reviewed literature will stimulate new research and eventually broaden the base of scientific knowledge.
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Sreedharan, Sadhishaan, Steven Gray, and Frank Bruscino-Raiola. "Osseointegrated prostheses for lower limb amputees." Australasian Journal of Plastic Surgery 4, no. 1 (2021): 56–62. http://dx.doi.org/10.34239/ajops.v4n1.199.
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Background: Traditional socket-based prostheses are an important rehabilitation tool in lower limb amputation, however, patients often experience skin-related problems, pain, stump volume fluctuations and poor suspension. Osseointegration offers a suitable alternative by providing direct skeletal attachment for limb prosthesis. This study aims to review the complications following osseointegration for lower limb amputation, with attention to mechanical abutment failure. Method: A retrospective chart review was undertaken of all patients who underwent transfemoral osseointegration between January 2000 and June 2019 through the osseointegration and targeted muscle reinnervation surgical and rehabilitation program at The Alfred in Victoria, Australia. Ethics approval was obtained through The Alfred’s ethics committee (414/16). In 2016 this program was redesigned and in 2017 the osseointegration implant system was modified. Patients underwent a two-stage surgical procedure followed by a rehabilitation protocol that gradually increased their activity. Results: A total of 19 limbs were osseointegrated in 18 patients during the study period. Two patients had their implant removed due to failure of osseointegration. The most common complication was a mechanical abutment failure, occurring 46 times in 11 patients. Patients who suffered an abutment failure reported higher levels of postoperative activity. Soft-tissue infections occurred in five patients: three superficial skin infections and two collections. There were no mechanical abutment failures noted in the updated program.Conclusion: Osseointegration is a good option for patients who may have difficulties with traditional socket prosthesis. However, complications such as abutment fracture can occur, and appropriate patient selection and counselling are required
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Akarsu, Selim, Levent Tekin, Ismail Safaz, Ahmet Salim Göktepe, and Kamil Yazıcıoğlu. "Quality of life and functionality after lower limb amputations: comparison between uni- vs. bilateral amputee patients." Prosthetics and Orthotics International 37, no. 1 (2012): 9–13. http://dx.doi.org/10.1177/0309364612438795.
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Background: It is difficult for the lower limb amputee patients to adapt to their new lifestyles. Objective: To compare the life quality and functionality of patients with bilateral vs. unilateral lower extremity amputations. Study Design: Cross-sectional study. Methods: Fifteen bilateral and 15 unilateral lower extremity amputee patients were enrolled. Demographics, cause and level of amputations, frequency and duration of prosthesis use were evaluated. SF-36, Satisfaction with Prosthesis Questionnaire (SAT-PRO), Amputee Body Image Scale. (ABIS), Houghton Scale (HS), six-minute walk test (6MWT), and 10-metre walk test (10 MWT) were performed. Results: Physical function, physical and emotional role scores of SF-36 were significantly lower in the bilateral amputee group in comparison with the unilateral group. SAT-PRO and ABIS total scores were similar between the groups. There was a positive correlation between the frequency of prosthetic use and SF-36 subgroups (except pain). The unilateral amputee group had significantly better scores than the bilateral amputee group in terms of HS, 6MWT and 10 MWT. Conclusion: Physical capacity of bilateral lower extremity amputee patients is lower than the unilateral amputee patients; satisfaction with prosthesis and body image are not related with the amputation level; and the life quality and satisfaction with prostheses are increased in parallel with the use of the prostheses. Clinical relevance Although differences exist between the groups, in terms of quality of life and functionality, patients can reach an acceptable life standard with good rehabilitation and a suitable prosthesis.
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Singh, Rajiv Kumar, and Guru Prasad. "Long-term mortality after lower-limb amputation." Prosthetics and Orthotics International 40, no. 5 (2016): 545–51. http://dx.doi.org/10.1177/0309364615596067.
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Background:Mortality after amputation is known to be extremely high and is associated with a number of patient features. We wished to calculate this mortality after first-time lower-limb amputation and investigate whether any population or treatment factors are associated with worse mortality.Objective:To follow up individuals after lower limb amputation and ascertain the mortality rate as well as population or treatment features associated with mortality.Study design:A prospective cohort study.Methods:Prospective lower-limb amputations over 1 year ( N = 105) at a Regional Rehabilitation Centre were followed up for 3 years.Results:After 3 years, 35 individuals in the cohort had died, representing a mortality of 33%. On initial univariate analysis, those who died were more likely to have diabetes mellitus ( χ2 = 7.16, df = 1, p = 0.007) and less likely to have been fitted with a prosthesis ( χ2 = 5.84, df = 1, p = 0.016). There was no association with age, gender, level of amputation, social isolation, significant medical co-morbidity other than diabetes or presence of mood disorders. A multi-variable logistic regression (backward step) confirmed that diabetes (odds ratio = 3.04, confidence intervals = 1.25–7.40, p = 0.014) and absence of prosthesis-fitting (odds ratio = 2.60, confidence interval = 1.16–6.25, p = 0.028) were independent predictors of mortality.Conclusion:Mortality after amputation is extremely high and is increased in individuals with diabetes or in those who are not fitted with a prosthesis after amputation.Clinical relevanceThe link between diabetes and mortality after amputation has been noted by others, but this is the first study to find an effect from prosthetic limb-wearing. This requires further investigation to ascertain why the wearing of a prosthetic limb, confers an independent survival benefit that is not related to the presence of medical co-morbidity.
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Hafner, Brian J., Sara J. Morgan, Daniel C. Abrahamson, and Dagmar Amtmann. "Characterizing mobility from the prosthetic limb user’s perspective: Use of focus groups to guide development of the Prosthetic Limb Users Survey of Mobility." Prosthetics and Orthotics International 40, no. 5 (2016): 582–90. http://dx.doi.org/10.1177/0309364615579315.
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Background: Input from target respondents in the development of patient-reported outcome measures is necessary to ensure that the instrument is meaningful. Objectives: To solicit perspectives of prosthetic limb users about their mobility experiences and to inform development of the Prosthetic Limb Users Survey of Mobility. Study design: Qualitative study. Methods: Four focus groups of lower limb prosthesis users were held in different regions of the United States. Focus group transcripts were coded, and themes were identified. Feedback from participants was used to develop a framework for measuring mobility with a lower limb prosthesis. Results: Focus group participants ( N = 37) described mobility as a confluence of factors that included characteristics of the individual, activity, and environment. Identified themes were defined as individual characteristics, forms of movement, and environmental situations. Prosthetic mobility was conceptualized as movement activities performed in an environmental or situational context. Conclusion: Respondent feedback used to guide development of Prosthetic Limb Users Survey of Mobility established a foundation for a new person-centered measure of mobility with a prosthetic limb. Clinical relevance Perspectives of target respondents are needed to guide development of instruments intended to measure health outcomes. Focus groups of prosthetic limb users were conducted to solicit experiences related to mobility with a lower limb prosthesis. Results were used to inform development of a clinically meaningful, person-centered instrument.
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Scherbina, K. K., V. G. Suslyaev, Yu B. Golubeva, A. V. Sokurov, T. V. Ermolenko, and V. M. Yankovskiy. "The analysis of prosthetic and orthopedic factories production in the branch of lower extremities prothesis with possibilities of import substitution." Bulletin of the Russian Military Medical Academy 20, no. 4 (2018): 131–37. http://dx.doi.org/10.17816/brmma12317.
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The needs and possibilities of import substitution in the prosthetic and orthopedic industry for prosthetics and orthotics of lower limbs from local and imported component materials were determined. We analyzed the stock list of special equipment, materials, and modules used in the manufacture of prostheses and orthoses of the lower limbs, indicating local and foreign suppliers. The technical characteristics of equipment, materials, and modules of lower limb prostheses that are not manufactured in the Russian Federation were determined. We indicated the stock list, components, equipment, and materials, which production is more reasonable to be organized in Russia instead of using imported products of similar purpose. We carried out operational tests and clinical trials of prosthetic and orthopedic products that were made from new thermoplastic materials. These materials are developed by local manufacturers for the production of a bucket of the prosthesis for lower and upper limbs, orthoses and orthopedic devices, actively correcting braces, stop holders, etc. We indicated the ways of implementing the state policy to eliminate reliance of local prosthetic and orthopedic industry on import. Proposals for the optimization of reference documentation were developed. The role and position of research organizations that solve the problems of import substitution and that focus on the creation of new and improvement of existing technologies of physical medical rehabilitation of patients with muscle-skeleton disorders were defined. We determined the importance of institutions of advanced training for doctors and other specialists who work in prosthetic and orthopedic enterprises and rehabilitation centers.
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Major, Matthew J., Pooja Raghavan, and Steven Gard. "Assessing a low-cost accelerometer-based technique to estimate spatial gait parameters of lower-limb prosthesis users." Prosthetics and Orthotics International 40, no. 5 (2016): 643–48. http://dx.doi.org/10.1177/0309364614568411.
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Background and aim:Inexpensive methods for characterizing lower-limb prosthetic gait allow clinicians to monitor gait quality. This study assessed an established method for estimating step length using a low-cost accelerometer to estimate distance walked in lower-limb prosthesis users and explore the use of subject-specific correction factors.Technique:A three-axis accelerometer was attached to participants using straps. Validity and test–retest reliability of step length was assessed in able-bodied individuals using a motion capture system. Validity of distance walked was assessed with lower-limb prosthesis users. A regression equation was developed for prosthesis users to estimate a correction factor that minimized error.Discussion:The system demonstrated excellent reliability and minimal mean error for both participant groups, but subject-specific correction factors did not provide substantial benefit. Estimate variability was high, suggesting the need for further refinement. Estimating distance walked and step length from low-cost accelerometers may be a valid, clinically accessible method for characterizing prosthetic gait.Clinical relevanceThe use of a low-cost accelerometer may provide valid means for estimating step length and distance walked of lower-limb prosthesis users in a clinical environment for monitoring patient outcomes.
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Sinha, Richa, Wim JA van den Heuvel, and Perianayagam Arokiasamy. "Adjustments to amputation and an artificial limb in lower limb amputees." Prosthetics and Orthotics International 38, no. 2 (2013): 115–21. http://dx.doi.org/10.1177/0309364613489332.
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Background: Positive adjustments to amputation and an artificial limb play important roles in the rehabilitation process. Objectives: To study the different facets of adjustments to amputation and an artificial limb in lower limb amputees and to assess the possible role of different background and amputation-related factors that could potentially influence these adjustments. Study design: Cross-sectional. Methods: Adult unilateral and non-congenital lower limb amputees ( n = 368) met the inclusion/exclusion criteria. Face-to-face interviews were conducted using structured questionnaires including patient’s background, amputation and the Trinity Amputation and Prosthesis Experience Scales. Results: Amputees were on average satisfied with the functioning of the prosthesis, moderately psychosocially adjusted and not restricted in performing functional and social activities, except for athletic activities. Age, employment, daily use of prosthesis and assistive device use were the most important factors associated with adjustments to amputation and prosthesis, followed by gender, co-morbidity and amputation level. Conclusions: Evaluation of employment status and measures to curb unemployment through vocational rehabilitation and providing assistance for placement should be intrinsic to the rehabilitation programme. Future studies are envisaged to understand the underlying factors determining the extent of daily use of prosthesis and the reasons for the use of assistive devices by the amputees. Clinical relevance Proper appraisal and measures to alleviate employment and co-morbidity, related issues, routine evaluation of daily use of prosthesis and providing appropriate gait training might facilitate immediate and long-term adjustment.
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MIKAMI, Masahiro. "Recent Progress in Lower Limb Prosthesis." Japanese Journal of Rehabilitation Medicine 34, no. 3 (1997): 199–201. http://dx.doi.org/10.2490/jjrm1963.34.199.
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Baars, Erwin C., Ernst Schrier, Pieter U. Dijkstra, and Jan H. B. Geertzen. "Prosthesis satisfaction in lower limb amputees." Medicine 97, no. 39 (2018): e12296. http://dx.doi.org/10.1097/md.0000000000012296.
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Keri, McNiel-Inyani, Ahmed W. Shehata, Paul D. Marasco, Jacqueline S. Hebert, and Albert H. Vette. "A Cost-Effective Inertial Measurement System for Tracking Movement and Triggering Kinesthetic Feedback in Lower-Limb Prosthesis Users." Sensors 21, no. 5 (2021): 1844. http://dx.doi.org/10.3390/s21051844.
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Advances in lower-limb prosthetic technologies have facilitated the restoration of ambulation; however, users of such technologies still experience reduced balance control, also due to the absence of proprioceptive feedback. Recent efforts have demonstrated the ability to restore kinesthetic feedback in upper-limb prosthesis applications; however, technical solutions to trigger the required muscle vibration and provide automated feedback have not been explored for lower-limb prostheses. The study’s first objective was therefore to develop a feedback system capable of tracking lower-limb movement and automatically triggering a muscle vibrator to induce the kinesthetic illusion. The second objective was to investigate the developed system’s ability to provide kinesthetic feedback in a case participant. A low-cost, wireless feedback system, incorporating two inertial measurement units to trigger a muscle vibrator, was developed and tested in an individual with limb loss above the knee. Our system had a maximum communication delay of 50 ms and showed good tracking of Gaussian and sinusoidal movement profiles for velocities below 180 degrees per second (error < 8 degrees), mimicking stepping and walking, respectively. We demonstrated in the case participant that the developed feedback system can successfully elicit the kinesthetic illusion. Our work contributes to the integration of sensory feedback in lower-limb prostheses, to increase their use and functionality.
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Sreekala, V. K. "A Rare Indication for Amputation." Indian Journal of Physical Medicine and Rehabilitation 27, no. 3 (2016): 90–92. http://dx.doi.org/10.5005/ijopmr-27-3-90.
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Abstract A forty-two years old housewife came to the outpatient department. She met with a very bad road traffic accident in childhood resulting in a crush injury of left lower limb and a degloving injury on the right lower limb. She had undergone transtibial amputation on the left and skin grafting on the right lower limbs. The scar has been transformed into a large keloid. Now she is ambulant with patellar tendon bearing prosthesis on the left side and a rocky hard, heavy, insensate right lower limb with a grotesque appearance. She requests amputation and prosthetic fitting on the right side.
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Alvarez-Camacho, Michelin, Victor Alvarez-Guevara, Carlos Galvan Duque Gastelum, Daniel Flores Vazquez, Gerardo Rodriguez-Reyes, and Francisco Manuel Sanchez-Arevalo. "Use of three-dimensional digital image correlation to evaluate mechanical response of prosthetic systems." Prosthetics and Orthotics International 41, no. 1 (2016): 101–5. http://dx.doi.org/10.1177/0309364616637956.
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Background and aim:The need of comfortable and safe prosthetic systems is an important challenge for both prosthetists and engineers. The aim of this technical note is to demonstrate the use of three-dimensional digital image correlation to evaluate mechanical response of two prosthetic systems under real patient dynamic loads.Technique:This note describes the use of three-dimensional digital image correlation method to obtain full-field strain and displacement measurements on the surface of two lower limb prostheses for Chopart amputation. It outlines key points of the measurement protocol and illustrates the analysis of critical regions using data obtained on specific points of interest.Discussion:The results show that the use of three-dimensional digital image correlation can be a tool for the prosthetist to optimize the prosthesis considering features related to the material and design, in order to bear with real patient-specific load conditions.Clinical relevanceThree-dimensional digital image correlation can support decision-making on new designs and materials for prosthetics based on quantitative data. Better understanding of mechanical response could also assist prescription for appropriate prosthetic systems.
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Hewson, Alex, Shaquitta Dent, and Andrew Sawers. "Strength deficits in lower limb prosthesis users: A scoping review." Prosthetics and Orthotics International 44, no. 5 (2020): 323–40. http://dx.doi.org/10.1177/0309364620930176.
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Background: Strength deficits may play a central role in the severity of balance, mobility, and endurance impairments in lower limb prosthesis users. A body of literature detailing the scope and specifics of muscle weakness in lower limb prosthesis users is emerging, but has yet to be summarized. A synopsis of strength deficits, and their impact on functional abilities in lower limb prosthesis users, may inform rehabilitation and research needs. Objectives: Synthesize reported strength deficits in lower limb prosthesis users, and discuss possible causes, consequences, and solutions. Study Design: Scoping review. Methods: A search of biomedical databases was performed, and inclusion/exclusion criteria were applied to identify publications relevant to the purpose of the review. Results: In all, 377 publications were identified, of which 12 met the inclusion/exclusion criteria. When compared with the controls and the intact limb, the primary strength outcome, peak torque, was lower in transtibial residual limb knee flexors and extensors, as well as transfemoral residual limb hip muscles. Conclusions: The reviewed studies provide evidence of strength deficits in lower limb prosthesis users. These deficits appear to be consequential, as they may contribute to balance, mobility, and endurance impairments. Additional research exploring alternative strength metrics, clinical tests, and causal links to functional impairments is required. Clinical relevance Evidence of muscle weakness among lower limb prosthesis users, and its influence on balance, mobility, and endurance, suggests that greater clinical attention and scientific inquiry into physical conditioning of lower limb prosthesis users is merited and required.
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Verheul, Floor Jacoba Marie-Georgette, Olaf Verschuren, Maremka Zwinkels, et al. "Effectiveness of a crossover prosthetic foot in active children with a congenital lower limb deficiency: an explorative study." Prosthetics and Orthotics International 44, no. 5 (2020): 305–13. http://dx.doi.org/10.1177/0309364620912063.
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Background: Children with lower limb prostheses cannot always keep up with their peers during active play. A pediatric crossover foot may be a promising prosthetic alternative for children engaging in high-intensity movements necessary for active play. Objectives: To compare children’s walking performance, running performance, experienced competence, and cosmesis using their prescribed prosthesis compared with the crossover foot. Study Design: Pretest-posttest study. Methods: Children with lower limb amputation or deficiency were recruited. Measurements were taken at baseline with the prescribed prosthesis and 6 weeks later with the crossover foot. Walking speed, energy cost of walking, anaerobic muscle power, stair climbing speed, ankle power, and cosmesis were evaluated. Results: Four children participated in the study. Two children had increased walking speed with the same energy cost, one child had decreased speed with increased energy cost, and one child had the same speed with decreased energy cost. Muscle power increased for three of the four children and ankle power increased for all children while using the crossover foot compared to the prescribed prosthesis. Two children reported knee pain or feeling excessive knee flexion when running with the crossover foot. One child reported negative feelings toward cosmesis of the crossover foot. Conclusions: This study suggests crossover foot may benefit active children by improving walking and running performance, and decreasing energy cost. However, knee pain reports or negative feelings toward the atypical design suggest the crossover foot may not be ideal for every child. Further research is needed to determine which pediatric users would benefit from this type of prosthetic foot. Clinical relevance Children with lower limb deficiencies are active prosthetic users who often switch between low- and high-intensity movements in their daily activities. Therefore, they might benefit from a crossover prosthetic design. The preliminary findings of this study suggest the crossover foot (XF) may be a promising foot for active children.
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Xu, Dongfang, and Qining Wang. "Noninvasive Human-Prosthesis Interfaces for Locomotion Intent Recognition: A Review." Cyborg and Bionic Systems 2021 (June 4, 2021): 1–14. http://dx.doi.org/10.34133/2021/9863761.
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The lower-limb robotic prostheses can provide assistance for amputees’ daily activities by restoring the biomechanical functions of missing limb(s). To set proper control strategies and develop the corresponding controller for robotic prosthesis, a prosthesis user’s intent must be acquired in time, which is still a major challenge and has attracted intensive attentions. This work focuses on the robotic prosthesis user’s locomotion intent recognition based on the noninvasive sensing methods from the recognition task perspective (locomotion mode recognition, gait event detection, and continuous gait phase estimation) and reviews the state-of-the-art intent recognition techniques in a lower-limb prosthesis scope. The current research status, including recognition approach, progress, challenges, and future prospects in the human’s intent recognition, has been reviewed. In particular for the recognition approach, the paper analyzes the recent studies and discusses the role of each element in locomotion intent recognition. This work summarizes the existing research results and problems and contributes a general framework for the intent recognition based on lower-limb prosthesis.
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Rusu, Lucian, Mirela Toth-Taşcău, and Cristian Toader-Pasti. "Dynamic Analysis of a Lower Limb Prosthesis." Applied Mechanics and Materials 430 (September 2013): 230–34. http://dx.doi.org/10.4028/www.scientific.net/amm.430.230.
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The dynamic analysis of the lower limb prosthesis is necessary mainly for defining the joint mechanical specifications. This paper presents two models of lower limb prosthesis. Both models have two active joints (ankle and knee) and the same overall dimensions. The main difference between the two models consists in the joints mechanical parameters. The prosthesis elements are modeled according to the human anatomy, taking into account the weight of the amputated limb. Based on this preliminary data the two models were developed using the Solid Edge V20 software. The dynamic analysis was developed in Dynamic Designer Motion Professional module which is a subset of Motion Professional software. The gait cycle time was set to 2 seconds. There were studied two main stages during the gait cycle: extension (from hyper-flexion to hyper-extension), and flexion (vice versa), respectively. The input data are: geometrical model, material properties of the prosthesis elements, gravity force, joint laws of motions and ground reaction forces. Based on this input data the software calculates the path, velocity and acceleration of the prosthesis elements and reaction forces and torques in each joint.
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Geng, Yan Li, Peng Yang, and Ling Ling Chen. "Study of the Control of Active Transfemoral Prosthesis Based on CPG." Advanced Materials Research 468-471 (February 2012): 1710–13. http://dx.doi.org/10.4028/www.scientific.net/amr.468-471.1710.
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Commercial transfemoral prostheses remain limited to energetically passive devices. Intelligent prostheses still do not replace the power generation capabilities of the missing limb. Active Transfemoral Prosthesis is designed to compensate the movements of transfemoral amputees. Base on the function and principle of huaman lower limb, Active transfemoral prosthesis is designed. Virtual prototype of active transfemoral prosthesis 3D model is built through Solidworks. A dynamical system is used to generate a position trajectory to control a linear motor replacing the missing joint. Hopf oscillator is used to construct a central pattern generator (CPG), which makes up the dynamical system.
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De Vivo Nicoloso, Luca Gabriele, Joshua Pelz, Herb Barrack, and Falko Kuester. "Towards 3D printing of a monocoque transtibial prosthesis using a bio-inspired design workflow." Rapid Prototyping Journal 27, no. 11 (2021): 67–80. http://dx.doi.org/10.1108/rpj-06-2021-0136.
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Purpose There are over 40 million amputees globally with more than 185,000 Americans losing their limbs every year. For most of the world, prosthetic devices remain too expensive and uncomfortable. This paper aims to outline advancements made by a multidisciplinary research group, interested in advancing the restoration of human motion through accessible lower limb prostheses. Design/methodology/approach Customization, comfort and functionality are the most important metrics reported by prosthetists and patients. The work of this paper presents the design and manufacturing of a custom made, cost-effective and functional three-dimensional (3D) printed transtibial prosthesis monocoque design. The design of the prosthesis integrates 3D imaging, modelling and optimization techniques coupled with additive manufacturing. Findings The successful fabrication of a functional monocoque prosthesis through 3D printing indicates the workflow may be a solution to the worldwide accessibility crisis. The digital workflow developed in this work offers great potential for providing prosthetic devices to rural communities, which lack access to skilled prosthetic physicians. The authors found that using the workflow together with 3D printing, this study can create custom monocoque prostheses (Figure 16). These prostheses are comfortable, functional and properly aligned. In comparison with traditional prosthetic devices, the authors slowered the average cost, weight and time of production by 95%, 55% and 95%, respectively. Social implications This novel digital design and manufacturing workflow has the potential to democratize and globally proliferate access to prosthetic devices, which restore the patient’s mobility, quality of life and health. LIMBER’s toolbox can reach places where proper prosthetic and orthotic care is not available. The digital workflow reduces the cost of making custom devices by an order of magnitude, enabling broader reach, faster access and improved comfort. This is particularly important for children who grow quickly and need new devices every few months or years, timely access is both physically and psychologically important. Originality/value In this manuscript, the authors show the application of digital design techniques for fabricating prosthetic devices. The proposed workflow implements several advantageous changes and, most importantly, digitally blends the three components of a transtibial prosthesis into a single, 3D printable monocoque device. The development of a novel unibody transtibial device that is properly aligned and adjusted digitally, greatly reduces the number of visits an amputee must make to a clinic to have a certified prosthetist adjust and modify their prosthesis. The authors believe this novel workflow has the potential to ease the worldwide accessibility crisis for prostheses.
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Lee, Daniel Joseph, and Matthew C. Costello. "The effect of cognitive impairment on prosthesis use in older adults who underwent amputation due to vascular-related etiology: A systematic review of the literature." Prosthetics and Orthotics International 42, no. 2 (2017): 144–52. http://dx.doi.org/10.1177/0309364617695883.
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Background:Older adults with amputations secondary to vascular etiologies may additionally present with cognitive impairment. Cognition plays an important role in the adoption of a prosthetic limb, although the degree and type of impact are debated. Previous literature reviews have not been directed at the specific population of older adults who underwent vascular-related lower limb amputation.Objectives:First, to assess extant literature for relationships between cognitive function and prosthesis-related outcomes in older adults who underwent lower limb amputation for vascular-related etiologies. Second, to perform a critical analysis of prosthesis-related outcomes and cognitive assessments performed in the studies.Study design:Systematic literature review.Methods:A systematic review of the literature was performed in databases using keyword combinations. A total of nine articles were selected to be included in this review.Results:Seven of the nine included studies found a relationship between decreased cognitive function and reduced performance on a prosthesis-related outcome. There were eight different prosthesis-related outcome measures, with only one study utilizing a comprehensive outcome measure.Conclusion:Cognitive impairment can negatively impact successful prosthesis use in older adults with lower limb amputation secondary to vascular complications. Future studies should utilize comprehensive outcome measures that represent the multifaceted constructs of cognition and prosthesis use.Clinical relevanceCognitive assessment of older adults who have undergone lower limb amputation secondary to diabetes related complications or vascular disease can be used to inform clinical decision-making. Clinicians should consider selecting prosthesis-related outcome measures that capture the full breadth of prosthesis use when evaluating patients with cognitive impairment.
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Wang, Wen Jun, Juan Li, Wei Da Li, and Li Ning Sun. "An Echo-Based Gait Phase Determination Method of Lower Limb Prosthesis." Advanced Materials Research 706-708 (June 2013): 629–34. http://dx.doi.org/10.4028/www.scientific.net/amr.706-708.629.
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The gait phase determination is the basis of the control of intelligent prosthesis. The prosthetic usually determines the gait phase according to its own motion parameters, which will cause the asymmetry gait of the prosthesis wearer during level walking due to the lack of contralateral motion information. By using of a variety of sensors installed in the healthy leg and prosthesis, the gait phase determination method based on echo control can achieve good symmetry, but at the same time also made calculation difficult. Based on the existing echo method, a gait phase determination method by utilize of the contralateral motion parameters is proposed. According to gait test data collected from healthy subjects, motion parameters and their relation can be obtained. Then the proposed method can determine its gait phase and contralateral phase. Preliminary experiment is conducted and verified the effective of the method.
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Vannah, W. M., J. R. Davids, D. M. Drvaric, Y. Setoguchi, and B. J. Oxley. "A survey of function in children with lower limb deficiencies." Prosthetics and Orthotics International 23, no. 3 (1999): 239–44. http://dx.doi.org/10.3109/03093649909071640.
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Function and prosthesis technical problems were surveyed in 258 experienced paediatric lower-limb prosthesis wearers. The two-part survey form consisted of the modified Prosthesis Evaluation Scale and the core module of the American Academy of Orthopaedic Surgeons/Council of.Musculoskeletal Specialty Societies (AAOS/COMSS) Lower Limb Outcomes instrument. Eighty-eight percent (88%) of these paediatric subjects were able to wear their prosthesis more than 9 hours/day; only 3 subjects (1%) were not able to wear their limb at all. The average distance walked per day was reported to be 5.24 kilometres. Sixteen percent (16%) reported pain as “moderate” or worse. A majority reported not having a problem with perspiration, however, 20% had problems serious enough to limit prosthesis wearing time significantly. The most common reasons for temporary loss of limb use were pain (62 responses) and prosthesis failure (59 responses), followed by tissue breakdown (42 responses) and perspiration (30 responses). In general, the paediatric population achieves full use at a high rate, is much more active than the adult population, and experiences less limb pain.
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O'Keeffe, Bernard, and Shraddha Rout. "Prosthetic Rehabilitation in the Lower Limb." Indian Journal of Plastic Surgery 52, no. 01 (2019): 134–43. http://dx.doi.org/10.1055/s-0039-1687919.
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AbstractLower limb amputations form a considerable number with 5,436,000 Indians having locomotor disability. Most members of this group are young, active earning males. The major cause of amputation is trauma. Hence, this population must be rehabilitated with priority, and best concerted efforts must be made by the medical community. In this article, the authors present available modern technologies in India and share best practices from their experience of treating Indian amputees for the past 20 years. The objective is to demonstrate to the medical community the optimal outcomes that can be achieved and help them make correct decisions on behalf of patients and their families. The article discusses history of prostheses, how to select optimal amputation level, preamputation preparation, determinants of good outcomes, preprosthetic preparation, components of prosthesis, their function and significance, rehabilitation process and guidelines, prescription criteria, and also special considerations such as multiple amputees or children.
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Ferrapie, A. L., P. Brunel, W. Besse, E. Altermatt, L. Bontoux, and I. Richard. "Lower limb proximal amputation for a tumour: A retrospective study of 12 patients." Prosthetics and Orthotics International 27, no. 3 (2003): 179–85. http://dx.doi.org/10.1080/03093640308726680.
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Objective: To analyse survival, prosthetic fitting and functional status after trans-femoral amputation or hip disarticulation for a primitive tumour. Methods: Retrospective study of all patients admitted since 1985. Results: Mean age at amputation was 55. Causes of amputation were osteosarcoma in 50%. Eight (8) patients had initial conservative surgery. Local recurrence was never observed. Nine (9) developed metastasis and required further hospitalisation. Fifty percent (50%) of patients died. Inpatient rehabilitation started 14 days after amputation (7–27), and was of a mean duration of 32 days. Prosthetic fitting was performed 13 days after admission (7 days when a liner was used). Further improvement of the prosthesis was performed in 10 patients. Among the patients who died, 5 had gone home, 4 were wearing their prosthesis all day long and 2 walked indoors with no additional support at discharge. Three (3) patients lived less than 2 months at home. Among the patients who did survive, all went home, 5 were wearing their prosthesis all day long and 2 walked indoors without aid at discharge. Two (2) patients practised sport and 4 drove. All the patients who were active have gone back to work. Conclusions: Gain due to prosthesis provision is undebatable. Good functional results can be obtained with adapted materials. Initial problems due to the synchronisation of treatments are resolved with multidisciplinary care. All patients should have a rapid and short hospitalisation in a rehabilitation unit and receive a first, simple prosthesis that can be further adapted.
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van Eijk, Monica Spruit, Harmen van der Linde, Bianca Buijck, Alexander Geurts, Sytse Zuidema, and Raymond Koopmans. "Predicting prosthetic use in elderly patients after major lower limb amputation." Prosthetics and Orthotics International 36, no. 1 (2012): 45–52. http://dx.doi.org/10.1177/0309364611430885.
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Background: The main determinants of prosthetic use known from literature apply to the younger patient with lower limb amputation. Studies aimed at identifying determinants of outcome of lower limb amputation in elderly patients with multimorbidity that rehabilitate in skilled nursing facilities (SNFs) are scarce. Objectives: To predict prosthetic use and physical mobility in geriatric patients admitted to SNFs for rehabilitation after lower limb amputation and the impact of multimorbidity. Study Design: Prospective design. Methods: Univariate and multivariate logistic and linear regression analyses were used to identify determinants that were independently related to prosthetic use and the timed-up-and-go test (TUG test). Results: Of 55 eligible patients, 38 had complete assessments on admission and at discharge. Fifty per cent was provided with a prosthesis. Multimorbidity was present in 53% of the patients. Being able to ambulate independently, and having a transtibial amputation (rather than a higher level of amputation), without phantom pain determined prosthetic use (R2=56%), while cognitive abilities, low amputation level, and pre-operative functional abilities were independently associated with the TUG test (R2=82%). Conclusions: Elderly patients referred to an SNF for prosthetic training have a high probability of using a prosthesis when having an independent ambulation after transtibial amputation, without phantom pain. These patients should be considered for prosthetic training. Clinical relevance This study gives more insight into the outcomes of geriatric patients with lower limb amputation after rehabilitation in skilled nursing facilities. This is the first study that focuses on determinants of prosthetic use in these elderly patients, often with multimorbidity.
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Mughal, Amenah, and Ausaf Chaudhary. "LEVEL OF MOBILITY AND ITS ASSOCIATION WITH QUALITY OF LIFE IN LOWER LIMB AMPUTEES." Rehabilitation Journal 4, no. 2 (2020): 167–71. http://dx.doi.org/10.52567/trj.v4i02.1.
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Objectives: The objective of the study was to explore the levels of mobility and its association with quality of life in lower limb amputees. Methodology: A cross-sectional correlational study was conducted at Chal foundation, Fauji Foundation Hospital and PIPOS on the sample of 230 patients for time duration of six months from January–July 2019. The lower limb amputees aged between 18-57 years, and using prosthesis from more than four months were included in the study. The level of mobility was measured through Self-reporting Prosthetic Limb User Survey of Mobility (SF-PLUS-M) questionnaire, while Prosthetic Evaluation Questionnaire (PEQ) was used to determine the Quality of Life (QOL) among prosthesis users. This data was analyzed by SPSS version 21. Results: The mean age of study participants was 43±14.89 years. The mean PLUS-M score was 39.48±14.33. The results showed a positive significant association between level of mobility and quality of life in lower limb amputees (p<0.001). Conclusion: The study concluded that in Pakistan lower limb amputees has high level of mobility that contributes in improved quality of life.
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Gordon, Robert, Christopher Magee, Anna Frazer, Craig Evans, and Kathryn McCosker. "An Interim Prosthesis Program for Lower Limb Amputees: Comparison of Public and Private Models of Service." Prosthetics and Orthotics International 34, no. 2 (2010): 175–83. http://dx.doi.org/10.3109/03093640903510980.
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This study compared the outcomes of an interim mechanical prosthesis program for lower limb amputees operated under a public and private model of service. Over a two-year period, 60 transtibial amputees were fitted with an interim prosthesis as part of their early amputee care. Thirty-four patients received early amputee care under a public model of service, whereby a prosthetist was employed to provide the interim mechanical prosthesis service. The remaining 26 patients received early amputee care under a private model of service, where an external company was contracted to provide the interim mechanical prosthesis service. The results suggested comparable clinical outcomes between the two patient groups. However, the public model appeared to be less expensive with the average labour cost per patient being 29.0% lower compared with the private model. The results suggest that a public model of service may provide a more comprehensive and less expensive interim prosthesis program for lower limb amputees.