Tales from a Boston Customs House: “Living Monuments”

The image of the amputee is a classic one in the memory of the American Civil War. Francis Clarke has argued that the long-suffering and sacrificial Union amputee became a national martyr to the righteousness of their cause. While this view was manifested in various ways throughout the postwar North, the case of double-arm amputee Lewis Horton serves to give depth insight into–and possibly push back against–this argument. [excerpt

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

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

Employment status, job characteristics and work-related health experience of people with a lower limb amputation in the Netherlands

Objectives: To describe the occupational situation of people with lower limb amputations in The Netherlands and to compare the health experience of workings and nonworking amputee patients with a nonimpaired reference population. Design: Cross-sectional study in which patients completed a questionnaire about their job participation. type of job, workplace adjustments to their limb loss, their position in the company, and a general health questionnaire. Setting: Orthopsdic workshops in The Netherlands with a population of lower limb amputees. Patients: Subjects were recruited from orthopedic workshops in the Netherlands. They ranged in age from Is to 60 years (mean, 44.5yr) and had a lower limb amputated at least 2 years (mean, 19.6yr) before this study. Main Outcome measures: A self-report questionnaire, with 1 part concerning patient characteristics and amputation-related factors, and the other concerning job characteristics, vocational handicaps, work adjustments, and working conditions; and a general health questionnaire (RAND-36) to measure health status. Results: Responses were received from 652 of the 687 patients (response: rate, 95%) who were sent the questionnaire. Sixty-foul percent of the respondents were working at the rime of the study (comparable with the employment rate of the general Dutch population), 31 % had work experience but were not presently working, and 5% had no work experience. After their amputations, people shifted to less physically demanding work. The mean delay between the amputation and the return to work was 2.3 years. Many people wished their work was better adjusted to the limitations presented by their disability and they mentioned having problems concerning possibilities fur promotion. Seventy-eight percent of those who stopped working within 2 years after the amputation said that amputation-related factors played a role in their decision. Thirty-four percent said that they might have worked longer if certain adjustments had been made. The health experience of people who were no longer working was significantly worse than that of the working people with amputations. Conclusions: Although amputee patients had a relatively good rate of job participation, they reported problems concerning the long delay between amputation and return to work, problems in finding suitable jobs, fewer possibilities for promotion, and problems in obtaining needed workplace modifications. People who had to stop working because of the amputation showed a worse health experience than working people

Bar-holding prosthetic limb

A prosthetic device for below-the-elbow amputees is disclosed. The device has a removable effector, which is attached to the end of an arm cuff. The effector is comprised of a pair of C-shaped members that are oriented so as to face each other. Working in concert, the C-shaped members are able to hold a bar such as a chainsaw handle. A flat spring is fitted around the C-shaped members to hold them together

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

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

Competing Stories: The Gardner Saga Continues

In 1893, two Philadelphia doctors from the Mütter Museum sent surveys to Civil War amputee veterans in order to compile records on their war amputations circa thirty years after seeing combat. One of those surveys found its way into the hands of Clark Gardner, a fifty-four year old double amputee vet who served in the 10th New York Heavy Artillery. (An introduction to Garnder can be found here.) Gardner’s responses to the survey are quite compelling and provided vivid details about his war amputations, the healing processes, difficulties he encountered, and artificial limb usage. [excerpt

The Influence of Socioeconomic Factors on Fear of Falling and Mobility Outcomes after Lower Limb Loss: a Preliminary Study

Background and Purpose: Current research has revealed that as much as 52.4% of individuals with lower limb loss report falling at least once in the past year. Previous research has also indicated that rehabilitation, including physical therapy (PT), generally improves patient outcomes after definitive amputation. Socioeconomic status has been shown to be an important factor in accessing healthcare but has yet to be investigated in this population. The purpose of this study was to investigate the effects of socioeconomic status and access to PT, and how limb loss affects mobility and fear of falling perception. We hypothesized: [1] individuals with socioeconomic difficulty would have reduced access to PT after amputation, and [2] individuals with limb loss will have increased fear of falling and decreased mobility performance when compared to non-amputee, age-matched controls. Subjects: 23 participants (7 females,16 males) mean age 51.30 years old (+ 13.17 SD, range 22-70) with lower limb loss ambulating with a definitive prosthesis. Materials/Methods: Participants completed a survey that included the Fear of Falling Avoidance Behavior Questionnaire (FFABQ), questions to determine their socioeconomic status, and whether they received PT after amputation. Mobility outcomes were measured using the standardized Timed Up and Go test (TUG) and the Six Minute Walk Test (6MWT). Results: There was no statistically significant difference in access to PT after amputation between those with and without financial difficulty (p=.354). However, 75% of participants who had no socioeconomic difficulty reported receiving PT, in comparison to only 25% in those who had socioeconomic difficulty. Additionally, 34.8% of our participants reported socioeconomic difficulties. When comparing the participants with amputation to the non-amputee, age-matched controls, there was a significant difference in the TUG (p\u3c.001), 6MWT (p\u3c.001), and FFABQ (p=.008). On average, participants with limb loss were 4.4 seconds slower on the TUG, walked 136.4m less on the 6MWT, and had an increased FFABQ score of 6.6 points out of 56 points. Discussion: Access to physical therapy and socioeconomic status have been overlooked in current literature for individuals after amputation. While the effect of socioeconomic status on PT access did not reach statistical significance in this preliminary study, only 25% of those who reported socioeconomic difficulty received physical therapy after amputation, compared to 75% in those who reported no difficulty. Further research is needed to determine whether low socioeconomic status is predictive of receiving rehabilitation services post-amputation and long-term outcomes. Our findings also showed that when compared to age-matched non-amputees, amputees tend to have impaired mobility and higher degree of fear of falling. These findings agree with current literature. Conclusion: Although not statistically significant, our preliminary findings showed that socioeconomic difficulty may affect access to physical therapy after amputation. Furthermore, our data demonstrated that individuals with lower limb loss exhibit reduced mobility performance and increased fear of falling when compared to the age-matched controls