Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: A chart review

Resources, relationships, and resilience: The psychosocial experiences of women with lower limb absence during pregnancy and postpartum

Purpose Little information is available to women with lower limb absence (LLA) and their health care providers regarding the impacts they may experience during the perinatal period. This study explores the physical impacts of pregnancy on women with LLA, including mobility, prosthesis fit and prosthesis use. Methods We conducted semi-structured interviews with 19 women with LLA who had experienced pregnancy in the last 10 years. Interviews were analyzed using thematic analysis. Results Substantial variation exists in the experience of women’s physical symptoms, prosthesis management and mobility. Physical symptoms were similar to any pregnant individual, but the impacts were more substantial. As volume change in the residual limb can impact prosthesis fit, self-management techniques and prosthetist adjustments were used to manage it. Pregnancy impacted the way in which women were mobile and the activities they chose to participate in. A wide variety of creative mobility solutions were utilized to complete activities including prosthesis use, assistive equipment and adaptive movement. Conclusions Women with LLA and their health care providers must be aware of the wide range of experiences women face during pregnancy and treat each pregnancy uniquely. Planning ahead and working with a health care team can mitigate many of these challenges.

Purpose The purpose of this study was to investigate the use of running-specific prostheses (RSPs) by children with lower limb absence (LLA) along with the benefits and challenges of RSPs. Materials and methods In this descriptive qualitative study, eight children (ages 8–20 years) and their parents participated in semi-structured interviews. The interviews were audio-recorded and transcribed. Coded data were the foundation for central theme development. Results Three main themes were generated. “Run faster, jump higher, do more” (the benefits of RSP use), “Every leg serves its purpose” (comparing functionality between daily use prostheses and RSPs), and “A lot more to think about” (additional considerations with RSP use). Conclusions RSPs have a positive impact in promoting children’s engagement in sports and physical activities. While some children used their RSP primarily for running, others wore it for a broader range of physical activities. Issues with balance and discomfort caused by leg length discrepancies and/or ill-fitting sockets limited daily wear time. Limitations related to current RSP designs and clinical implementation should be addressed to optimize the functional potential of children with unilateral or bilateral LLA. Implications for rehabilitation Running-specific prostheses (RSPs) positively impacted children’s ability to participate in some sports with peers promoting their physical and social well-being. The main issues that children faced were discomfort, difficulty balancing, and inability to use RSPs for certain sports, while parents’ issues focused on supporting prosthesis use and transport, and adjustments of different prostheses to keep up with their child’s growth. Clinicians should be aware of the challenges of RSP use to best support children and their families. Designers should focus on addressing limitations with current RSPs to facilitate the diverse needs of pediatric users.

Purpose This study explored healthcare providers’ (HCPs’) experiences providing care for individuals with lower limb amputation (LLA) during the perinatal period, the perceived impact of pregnancy on individuals with LLA, and strategies to improve perinatal support for individuals with LLA. Methods This is a qualitative descriptive study. Semi-structured interviews were conducted with HCPs with experience caring for individuals with LLA during the perinatal period. A thematic analysis was conducted, informed by the DEPICT model. Results Eleven HCPs (prosthetists, n = 6; physiatrists, n = 5) participated. Three themes were identified that describe HCPs’ perspectives on the impact of pregnancy on LLA and their approach to providing care during the perinatal period: (1) Clinical Approach: Problem Solving and Preparation, (2) Managing the Physical Impacts of Pregnancy by Maintaining Mobility, and (3) Tailoring Care to Individual Needs. Participants described using clinical expertise and trial and error to support individuals during pregnancy with limited education and resources. They reported variability in patients’ physical (e.g. swelling, fatigue) and psychosocial needs necessitating tailored management. Conclusion There is a lack of resources and education for clinicians regarding pregnancy and LLA. While clinicians managed this by using clinical reasoning and planning ahead, more resources for HCPs who provide care are needed.

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

The objective of this study was to measure the health-related quality of life (HRQoL) among pregnant women in the perinatal and postpartum periods and determine influencing factors that predict their HRQoL. The study was conducted among pregnant women who live in a semi-urban area of Chandpur, Bangladesh. A total of 465 women were recruited. The EuroQoL 5-Dimension 3-Level (EQ-5D-3L) and EuroQoL visual analog scale (EQ-VAS) instruments were used to measure the HRQoL of participants. Two-sample mean test (t test) was performed to examine the changes in HRQoL between the perinatal and postnatal periods of the same individuals. Multivariate linear regression was employed to identify the factors influencing HRQoL during the two periods. Overall, the HRQoL scores improved significantly from the perinatal (0.49) to postpartum (0.86) period. Approximately 58% of women experienced moderate or extreme levels of health problems during the perinatal period regardless of their health status. However, most women had significantly improved health status in the postpartum period. Gestational weight gain and recommended postnatal care were significantly associated with improved HRQoL. Factors that negatively influenced changes in HRQoL included adolescent motherhood, caesarean delivery, inadequate antenatal care consultations and living in a poor household, during both the perinatal and postpartum periods. Overall health status is found to be poor among women during the perinatal period compared with the postpartum period. The study indicates that interventions to address the influencing factors are needed to ensure better quality of life for women both pre- and post-birth. Community-based initiatives, such as awareness building, might address negative factors and subsequently improve health status and reduce adverse health outcomes related to pregnancy and postnatal care.

VEGF receptor 2 blockade leads to renal cyst formation in mice

The perinatal and postpartum period is of great significance for women due to physiological changes, shifts in circadian rhythms, social setting, and psychological well-being, all of which affect the quality and quantity of their sleep. A mixed-studies systematic review was undertaken to enhance our understanding of sleep disturbances and mood disorders in women in late pregnancy and the postpartum period, their connection with breastfeeding, and the assessment of interventions for sleep disturbance. Three electronic databases (PUBMED, EMBASE and Google Scholar) were searched for qualitative, observational, and mixed-method studies from the year 2016 to June 2023. Twenty-nine articles were included in the analysis. The results were synthesized into four overarching themes: (і) the sleep quality of women in the perinatal period; (ii) the relationship between sleep and breastfeeding; (iii) the relationship between sleep quality and emotional disturbance in the perinatal period; (iv) sleep interventions in the researched group. The subjective nature of the perception of sleep disturbances, along with the absence of an objective measurement tool is clearly an inconvenience. It is advisable to include the assessment of maternal sleep hygiene and family sleep patterns during postpartum healthcare provider appointments to develop strategies not only for women's sleep quality but also for their mental well-being.

Segmental Limb Volume Change as a Predictor of the Onset of Lymphedema in Women With Early Breast Cancer

Daily changes in the shape and size of the residual limb affect prosthetic socket fit. Prosthetic socks are often added or removed to manage changes in limb volume. Little has been published about how persons with transtibial amputations use socks to manage diurnal changes in volume and comfort. To investigate prosthetic sock use with a customized, self-report questionnaire. Cross-sectional survey. Persons with transtibial amputation reported number, thickness, and timing of socks used over a 14-day period. Data from 23 subjects (16 males and 7 females) were included. On average, socks were changed less than once per day (0.6/day) and ply increased over the day (4.8-5.5 ply). Subjects wore prostheses significantly longer (15.0-14.1 h, p = 0.02) and changed socks significantly more often (0.6/day-0.4/day, p = 0.03) on weekdays compared to weekends. Participants were also divided into two subgroups: those who used socks to manage limb volume and those who used socks for socket comfort. Sock use did not differ (p > 0.05) between subgroups. Sock changes are infrequent among persons with lower limb loss. Initial, verbal reports of sock use were often inconsistent with data measured by logs. Tools (e.g. sock logs or objective instruments) to better understand sock-use habits among persons with limb loss are needed. Knowledge of prosthetic patients' sock use may help practitioners enhance volume management strategies or troubleshoot fitting issues. Results showed that subjects generally added socks to account for volume loss, and end-of-day sock thickness frequently exceeded 5 ply. Use of sock logs in clinical practice may facilitate improved residual limb health.

Previous research has shown attachment avoidance in adulthood to be a strongnegative predictor of desire to have children, bonding in pregnancy, and abilityto relate to children after birth (Rholes, Simpson, & Blakely, 1995; Rholes,Simpson, Blakely, Lanigan, & Allen, 1997). Other research has shown that relationships between adult attachment and prenatal bonding and parenting style are sometimes mediated by caregiving style (Walsh et al., 2011; Millings, Walsh, & O’Brien, 2008). The two studies presented here explore the roles of attachment and caregiving in how individuals without children think about their intentions to become a parent and their expectations of what future parenting will be like. Study 1 demonstrated that, in accordance with other literature, attachment avoidance was a good negative predictor of desire to have children, but that caregiving style did not mediate this relationship. There appeared to be different predictors for young men and young women such that attachment avoidance predicted desire to have children for women, but caregiving responsiveness to partner predicted desire to have children for men. The second study sought to replicate and extend these results by examining attachment, caregiving, and relationship influences on expectations of future parenting. This research adds to our understanding of the correlates and predictors of parenting intentions and expectations, and the relative importance of relationship and individual processes.

The purpose of this research was to investigate the influence of sock addition and removal on residual-limb fluid volume in people using prosthetic limbs. We used bioimpedance analysis to measure residual-limb extracellular fluid volume on 28 transtibial amputee subjects during 30 min test sessions. Upon addition of a one-ply polyester sock, residual-limb fluid volume changes ranged from -4.0% to 0.8% (mean -0.9 +/- 1.3%) of the initial limb fluid volume. Changes for sock removal ranged from -1.2% to 2.8% (mean 0.5 +/- 0.8%). Subjects who reduced in fluid volume with both addition and removal of a sock and subjects with high positive ratios between the fluid-volume loss upon sock addition and gain upon sock removal (high add/remove [AR] ratios) tended to have arterial disease, were obese, and were smokers. Subjects with low positive AR ratios, subjects who increased in fluid volume both with sock addition and removal, and a single subject who increased in fluid volume with sock addition and decreased with sock removal tended to be nonsmokers and either individuals in good health without complications or individuals without arterial problems. Results are relevant for the anticipation of limb volume changes during prosthetic fitting and toward the design of adjustable-socket technologies.

Management of Psychiatric Disorders during the Perinatal Period.

Dynamic alignment in prosthetic fitting is important because it affects the user’s stability, kinematics, and kinetics such as socket reaction moments. It is performed by tuning the spatial relationship between the transtibial prosthetic socket and the foot following sequential observational gait analysis in the three anatomical planes. However, the order of planes in which the adjustment should be performed is still unclear. To investigate the appropriate sequence of dynamic alignment adjustment, ten participants with transtibial amputation were asked to walk in different alignment conditions (flexion, extension, adduction, abduction; lateral, medial, anterior, and posterior translation of the socket, and plantarflexion, dorsiflexion, inversion, and eversion of the foot) to measure socket reaction moments in the out-of-planes (e.g., the effect of sagittal alignment on the coronal moment). A significant difference was found only among socket posterior translation, socket flexion, and baseline alignment in the coronal moment (P = 0.02). The results of the current and previous studies suggest that moments in the coronal plane are affected by alignment changes in all three planes, whereas moments in the sagittal plane are affected only by sagittal alignment changes. It is suggested that the procedure of alignment adjustments should be finalized in the coronal plane.

Also in the field of technical orthopedics, electronics and computer technology are being is used more and more often. This paper describes a microprocessor-controlled prosthetic knee joint with swing phase control and stance phase stability, the so-called C-Leg. The function of this electronic knee joint is explained. Prosthetic treatment using the C-Leg is compared with traditional prosthetic knee joints. 15 patients using the C-Leg have been observed over periods of 6 to 14 months. The treating prosthetists have given an assessment regarding the function and the improvements in comparison with the previously fitted knee joints. The patients, too, were asked to compare function and comfort of the new prosthetic fitting with the previous one. Both, prosthetists and patients marked this new type of microprocessor-controlled knee joint in nearly all points with "very good" and described a clear improvement to the previous, purely mechanical prosthetic fitting. Obviously, this new technology seems to be a milestone in prosthetic knee joint fitting, in order to clearly improve the prosthetic fitting of transfemoral amputees and thus their quality of life, especially of people who have several disabilities.