Pain in traumatic upper limb amputees in Sierra Leone.

Data on 40 upper limb amputees (11 bilateral) with regard to stump pain, phantom sensation and phantom pain is presented. All the patients lost their limbs as a result of violent injuries intended to terrorise the population and were assessed 10-48 months after the injury. All amputees reported stump pain in the month prior to interview and ten of the 11 bilateral amputees had bilateral pain. Phantom sensation was common (92.5%), but phantom pain was only present in 32.5% of amputees. Problems in translation and explanation may have influenced the low incidence of phantom pain and high incidence of stump pain. In the bilateral amputees phantom sensation, phantom pain and telescoping all showed bilateral concordance, whereas stump pain and neuromas did not show concordance. About half the subjects (56%) had lost their limb at the time of injury (primary) while the remainder had an injury, then a subsequent amputation in hospital (secondary). There was no association between the incidence of phantom pain and amputation irrespective of being primary or secondary

Osseointegrated prostheses for rehabilitation following amputation : The pioneering Swedish model.

The direct attachment of osseointegrated (OI) prostheses to the skeleton avoids the inherent problems of socket suspension. It also provides physiological weight bearing, improved range of motion in the proximal joint, as well as osseoperceptive sensory feedback, enabling better control of the artificial limbs by amputees. The present article briefly reviews the pioneering efforts on extremity osseointegration surgeries in Sweden and the development of the OPRA (Osseointegrated Prostheses for the Rehabilitation of Amputees) program. The standard implant design of the OPRA system and surgical techniques are described as well as the special rehabilitation protocols based on surgical sites. The results of long-term follow-up for transradial, transhumeral, and thumb amputee operations are briefly reported including the prospective study of transfemoral amputees according to OPRA protocol. The importance of refinement on implant designs and surgical techniques based on the biomechanical analysis and early clinical trials is emphasized. Future aspects on osseointegration surgery are briefly described, including novel treatment options using implanted electrodes

Categorisation of activities of daily living of lower limb amputees during short-term use of a portable kinetic recording system: a preliminary study

The purpose of this preliminary study was to determine the relevance of the categorisation of the load regime data to assess the functional output and usage of the prosthesis of lower limb amputees. The objectives were (A) to introduce a categorisation of load regime, (B) to present some descriptors of each activity and (C) to report the results for a case. The load applied on the osseointegrated fixation of one transfemoral amputee was recorded using a portable kinetic system for five hours. The periods of directional locomotion, localised locomotion and stationary loading occurred 44%, 34% and 22% of recording time and each accounted for 51%, 38% and 12% of the duration of the periods of activity, respectively. The absolute maximum force during directional locomotion, localised locomotion and stationary loading was 19%, 15% and 8% of the BW on the antero-posterior axis, 20%, 19% and 12% on the medio-lateral axis as well as 121%, 106% and 99% on the long axis. A total of 2,783 gait cycles were recorded. Approximately 10% more gait cycles and 50% more of the total impulse than conventional analyses were identified. The proposed categorisation and apparatus have the potential to complement conventional instruments, particularly for difficult cases

Vaulting quantification during level walking of transfemoral amputees

Background: Vaulting is a gait compensatory mechanism used by transfemoral amputees to assist toe clearance during the prosthetic swing phase. It is defined by a plantar flexion of the contralateral ankle during the single-limb support phase. The aim of the study is to propose a method to quantify vaulting of transfemoral amputees. Methods: 17 transfemoral amputees and 28 asymptomatic subjects participated in the data collection. Kinematics and kinetics of thewhole bodywere recordedwhile subjectswerewalking on a level surface. Biomechanical gait analysis was focused on a reduced set of parameters linked to the contralateral ankle, the contralateral knee and the trajectory of the center of pressure. The patients were classified in two groups: with orwithout vaulting using video recordings. Differences between both groups and the control group were analyzed. Findings: A higher generated ankle powerwas found during the single support phase of the contralateral limb of transfemoralamputees presenting vaulting. These subjects presented also a higher dissipated knee flexion power before the peak in ankle flexion power. The trajectory of the center of pressurewas also modified by the vaulting. Interpretation: Vaulting for transfemoral amputees is characterized by a propulsive plantar flexion at the contralateral ankle. Quantifying the ankle flexion power during the contralateral single support phase will help in understanding vaulting.This study was supported by the French National Research Agency, under reference ANR-2010-TECS-020. The authors are deeply grateful to F. Lavaste, N. Martinet, J. Paysant, and N. Rapin for their contribution to the study

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

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

Mechanical work performed by individual limbs of transfemoral amputees during step-to-step transitions: Effect of walking velocity

The greater metabolic demand during the gait of people with a transfemoral amputation limits their autonomy and walking velocity. Major modifications of the kinematic and kinetic patterns of transfemoral amputee gait quantified using gait analysis may explain their greater energy cost. Donelan et al. proposed a method called the individual limb method to explore the relationships between the gait biomechanics and metabolic cost. In the present study, we applied this method to quantify mechanical work performed by the affected and intact limbs of transfemoral amputees. We compared a cohort of six active unilateral transfemoral amputees to a control group of six asymptomatic subjects. Compared to the control group, we found that there was significantly less mechanical work produced by the affected leg and significantly more work performed by the unaffected leg during the step-to-step transition. We also found that this mechanical work increased with walking velocity; the increase was less pronounced for the affected leg and substantial for the unaffected leg. Finally, we observed that the lesser work produced by the affected leg was linked to the increase in the hip flexion moment during the late stance phase, which is necessary for initiating knee flexion in the affected leg. It is possible to quantify the mechanical work performed during gait by people with a transfemoral amputation, using the individual limb method and conventional gait laboratory equipment. The method provides information that is useful for prosthetic fitting and rehabilitation

Factors related to successful job reintegration of people with a lower limb amputation

Objective: To study demographically, amputation-, and employment-related factors that show a relationship to successful job reintegration of patients after lower limb amputation. Design: Cross-sectional study. Setting: University hospital. Patients: Subjects had an acquired unilateral major amputation of the lower limb at least 2 years before, were aged 18 to 60 years (mean, 46yr), and were living in the Netherlands. All 322 patients were working at the time of amputation and were recruited from orthopedic workshops. Intervention: Questionnaires sent to subjects to self-report (1) demographic and amputation information and (2) job characteristics and readjustment postamputation. Questionnaire sent to rehabilitation specialists to assess physical work load. Main Outcome Measures: Demographically related (age, gender); amputation-related (comorbidity; reason and level; problems with stump, pain, prosthesis use and problems, mobility, rehabilitation); and employment-related (education, physical workload) information about the success of job reintegration. Results: Job reintegration was successful in 79% and unsuccessful in 21% of the amputees. Age at the time of amputation, wearing comfort of the prosthesis, and education level were significant indicators of successful job reintegration. Subjects with physically demanding jobs who changed type of job before and after the amputation more often successfully returned to work than subjects who tried to stay at the same type of job. Conclusions: Older patients with a low education level and problems with the wearing comfort of the prosthesis are a population at risk who require special attention during the rehabilitation process in order to return to work. Lowering the physical workload by changing to another type of work enhances the chance of successful reintegration

Physical activity and quality of life of amputees in southern Brazil

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