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

Behavioural and psychological symptoms in the older population without dementia - Relationship with socio-demographics, health and cognition

Abstract Background Behavioural and psychological symptoms are associated with dementia, but are also present in a significant number of the older population without dementia. Here we explore the distribution of behavioural and psychological symptoms in the population without dementia, and their relationship with domains and severity of health and cognitive impairment. Methods The Medical Research Council Cognitive Function and Ageing Study is a two-phase longitudinal study of ageing representative of the population aged 65 and over of England and Wales. A subsample of 1781 participants without a study diagnosis of dementia was included in this study. Information on symptoms including depression, apathy, anxiety, feelings of persecution, hallucination, agitated behaviour, elation, irritability, sleep problems, wandering, confabulation and misidentification, cognitive function, health related factors and socio-demographic information was extracted from interviews with participants and knowledgeable informants. Participants were classified according to the Mini-Mental State Examination and by criteria for subtypes of mild cognitive impairment (MCI). The prevalence of behavioural and psychological symptoms and associations with cognitive function, health and socio-demographics was examined. Co-occurrence of symptoms was tested using factor analysis. Results Most symptoms were reported more frequently in those with more severe cognitive impairment. Subjective memory complaints were the strongest independent predictor of reported symptoms, and most were reported more often in those classified as having MCI than in those with cognitive impairments that did not meet the MCI criteria. The pattern of co-occurrence of symptoms is similar to that seen in dementia. Conclusions Our results highlight that behavioural and psychological symptoms are prevalent in the cognitively impaired older population, and partly explain the variation observed in previous cohorts of individuals with MCI. Behavioural and psychological symptoms offer a target for intervention and so are an important consideration in the assessment of cognitively impaired older people.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Een inventarisatie van vindplaatsen in het buitengebied van Oss

Wetensch. publicatieFaculty of Archeolog

Ion–molecule reactions of CoAr₆⁺ with nitrogen oxides N₂O, NO, and NO₂: measuring absolute pressure by shock-freezing of the collision complex

A new method to determine the absolute pressure in an ultra-high vacuum apparatus is tested using ion molecule reactions with CoAr₆⁺. In a collision with a neutral reactant, the complex between Co⁺ and the collision partner is stabilized by evaporation of argon atoms. If CoAr₆⁺ reacts with collision rate, the absolute pressure can be determined by comparing the experimental collision rate with the collision rate calculated from average dipole orientation theory. The experimental results with N₂O, NO, and NO₂ indeed show that the collision complex is frozen out. Comparison of the rates of primary, secondary and tertiary reaction products, however, suggests that not all collisions of CoAr₆⁺ are reactive

The role of dissociation-related beliefs about memory in trauma-focused treatment

OBJECTIVE: Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms.METHOD: Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD ( n = 111) or the dissociative subtype of PTSD ( n  = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated. RESULTS: Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome.CONCLUSION: The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.</p