Prescription of prostheric ankle-foot mechanisms after lower limb amputation

BACKGROUND: A prosthesis can be divided into several components: the prosthetic socket; the prosthetic ankle‐foot mechanism; and for higher levels of amputation, the prosthetic knee. This review focuses on the prosthetic ankle‐foot mechanism, which forms an important part of the prosthesis in terms of mobility. A correct prosthetic prescription can be derived by matching the functional abilities of the individual with a lower limb amputation with the technical and functional aspects of the various prosthetic ankle‐foot mechanisms. However, there seems to be no clear clinical consensus on the precise prescription criteria for the various prosthetic ankle‐foot mechanisms in relation to the functional abilities of individuals with a lower limb amputation. OBJECTIVES: To obtain information about aspects of prosthetic ankle‐foot mechanisms and daily functioning of individuals with a lower limb prosthesis, for appropriate prosthetic prescription criteria. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2), MEDLINE (1966 to April 2006), EMBASE (1983 to April 2006), CINAHL (1982 to April 2006), AMED (Allied and Complimentary Medicine) (1985 to April 2006), and reference lists of articles. No language restrictions were applied. SELECTION CRITERIA: All randomised controlled trials and quasi‐randomised controlled trials comparing different ankle foot mechanisms for lower limb amputation in adults. No language restrictions were applied. DATA COLLECTION AND ANALYSIS: Two review authors independently identified potential articles from the literature search. Methodological quality was assessed using a checklist comprising 13 criteria. The reviewers extracted data using pre‐defined extraction forms. MAIN RESULTS: Twenty‐six trials were included, with a total of 245 participants. The numbers of participants in the included trials ranged from three to sixteen. The methodological quality was moderate. Only one study was of high quality. All included studies used cross‐over designs allowing sufficient control for confounding. In individuals with a transtibial amputation, there seems to be a small tendency towards a greater stride length when walking with the Flex‐foot in comparison to the SACH (solid‐ankle cushioned heel) foot. When walking speed was increased, the energy cost was lower. In high activity individuals with a transfemoral amputation, there is limited evidence for the superiority of the Flex foot during level walking compared with the SACH foot in respect of energy cost and gait efficiency. AUTHORS' CONCLUSIONS: There is insufficient evidence from high quality comparative studies for the overall superiority of any individual type of prosthetic ankle‐foot mechanism, although there is a small trend towards the Flex‐foot in comparison with the SACH foot for greater stride length and lower energy cost in individuals with a transtibial amputation, and improved gait efficiency and lower energy cost in high activity individuals with a transfemoral amputation. In prescribing prosthetic‐ankle foot mechanisms for individuals with a lower limb amputation, practitioners should take into account availability, patient functional needs, the type of knee mechanism to be prescribed and the inter‐relationship with ankle‐foot mechanisms, and cost

Prostetic prescription in lower limb amputation. Development of a clinical guideline in the Netherlands.

In the year 2000 a Prosthetics and Orthotics Guidetine Development Group within the Dutch Society of Physical and Rehabititation Medicine (VRAw) ascommissioned by the Dutch College of Health Care Insurance (sCvZ) and the Ministry of Heatth Care to develop a clinical guideline on prosthetic prescriptionin lower timb amputation. The aim of this Prosthesis Guideline Development project (Proguide) is to obtain a guidetine on a scientific basis. Zie: Summary

Study of the human pelvis using CAT-scan: gender differences and anatomy of the ramus ossis ischii.

Contains fulltext : 70911.pdf (publisher's version ) (Closed access)OBJECTIVE: In a descriptive study we present the CAT-scan norm data of pelvic sizes in Caucasian men and women. The study was performed to investigate possible differences in pelvic sizes between men and women and the inter-individual range of pelvic sizes. The data may be useful as a guide in the development of orthoses and prostheses. METHODS: Pelvis CAT-scans of 40 subjects, 20 males (23-66 years) and 20 females (20-72 years) were investigated. The research was approved by the regional ethics committee. RESULTS: The angle of the ramus ossis ischii (ROI) with the line of progression in the transverse plane (angle a) was 38.6 degrees (SD 3.4) in females and 31.8 degrees (SD 4.4) in males. This difference was statistically significant (Student's t-test (p < 0.0001). The ROI angle in the coronal plane (angle b) was negative or zero both in males and females. The horizontal distance between the medial border of the ROI and the lateral border of the femur (RF distance) was slightly smaller in females (95 mm) compared to males (107 mm), but this difference was not statistically significant. The distance between the midfemoral line and the anterior surface of the leg was also slightly smaller in females (89 mm) than in males (106 mm) but the difference was not statistically significant. We found a linear relation between the total AP soft tissue distance and the soft tissue circumference of the proximal leg at the level of the ROI. CONCLUSION: There are significant gender differences in pelvic size and shape. The medial plane of the ROI is not in a slight angle of inclination towards the midline but appears to be zero. The medial contour of the ROI in the AP direction is slightly curved

"Ich bin Empfindung und Gesang"

"Ich bin Empfindung und Gesang" : Schlesiens dt. Sappho Anna Louisa Karsch (1722-1791). - In: Kontinuität und Wandel / hrsg. von Peter Baumgart. - Sigmaringen : Thorbecke, 1990. - S. 335-348. - (Schlesische Forschungen ; 4

Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity:Rehabilitation process and prosthetics. Part 2

Background: A structured, multidisciplinary approach in the rehabilitation process after amputation is needed that includes a greater focus on the involvement of both (para)medics and prosthetists. There is considerable variation in prosthetic prescription concerning the moment of initial prosthesis fitting and the use of replacement parts. Objectives: To produce an evidence-based guideline for the amputation and prosthetics of the lower extremities. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. Part 2 focuses on rehabilitation process and prosthetics. Study design: Systematic literature design. Methods: Literature search in five databases and quality assessment on the basis of evidence-based guideline development. Results: An evidence-based multidisciplinary guideline on amputation and prosthetics of the lower extremity. Conclusion: The best care (in general) for patients undergoing amputation of a lower extremity is presented and discussed. This part of the guideline provides recommendations for treatment and reintegration of patients undergoing amputation of a lower extremity and can be used to provide patient information. Clinical relevance This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice

Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity:Amputation surgery and postoperative management. Part 1

BACKGROUND: Surgeons still use a range of criteria to determine whether amputation is indicated. In addition, there is considerable debate regarding immediate postoperative management, especially concerning the use of 'immediate/delayed fitting' versus conservative elastic bandaging.OBJECTIVES: To produce an evidence-based guideline for the amputation and prosthetics of the lower extremities. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. Part 1 focuses on amputation surgery and postoperative management.STUDY DESIGN: Systematic literature design.METHODS: Literature search in five databases. Quality assessment on the basis of evidence-based guideline development.RESULTS: An evidence-based multidisciplinary guideline on amputation and prosthetics of the lower extremity.CONCLUSION: The best care (in general) for patients undergoing amputation of a lower extremity is presented and discussed. This part of the guideline provides recommendations for diagnosis, referral, assessment, and undergoing amputation of a lower extremity and can be used to provide patient information.CLINICAL RELEVANCE: This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice.Geriatrics in primary car