Side Of Amputation Research Articles

Reorganisation of Postural Control Following Lower Limb Amputation: Theoretical Considerations and Implications for Rehabilitation

The reorganisation of standing balance after a lower limb amputation is considered, with emphasis on persons with an acquired unilateral amputation above the ankle and below the hip joint. In the first section, three major peripheral motor and sensory impairments are discussed: (a) a lack of ankle torque generation to restore equilibrium in the sagittal plane, (b) a lack of weight-shifting capacity to control posture in the frontal plane and (c) a distorted somatosensory input from the side of amputation. In the second part of die paper, it is argued that a lower limb amputation, as any other serious peripheral lesion, also affects the highest levels of the sensorimotor system, because the functional recovery after amputation requires a central adaptation to the alterations of peripheral motor and sensory conditions. A reduction in the cognitive regulation of posture as well as a decrease in visual dependency are proposed as two of the most critical parameters of the long-term central adaptation process a...

Stroke hemiplegia and subsequent lower extremity amputation: which side is at risk?

The purpose of this study was to see 1) if there is a relationship between side of hemiparesis and subsequent lower extremity amputation and 2) if time from onset of cerebrovascular accident (CVA) to onset of amputation is less in patients with diabetes mellitus than in those without that disease. Twenty-two subjects with a mean age of 63.9 +/- 11.4 years met the criterion of having a CVA followed by a lower extremity amputation. Date and side of hemiparesis and amputation were noted and a relationship was determined using the two-tailed chi-square test. Twenty-one of 22 subjects had the amputation on the same side as their hemiparesis which represents a significant relationship (chi 2 = 18.16, p less than 0.001). Mean time from CVA to amputation was 32.5 +/- 26.12 mo for diabetics and 55.0 +/- 33.1 mo for nondiabetics which also represents a significant difference (t = 1.74, p less than 0.05). It is concluded there is a strong relationship between side of hemiparesis and subsequent lower extremity amputation with the amputation occurring most often on the hemiparetic side and earlier in patients with diabetes mellitus. The causal relationship between side of CVA and subsequent same sided amputation may be due to altered autonomic nervous system control, altered sensation with increased incidence of local unobserved trauma or decreased/altered muscle fiber use on the affected side. Implications for clinical rehabilitation include education for skin protection and attempting to increase muscle fiber activity.

Biomechanical significance of the correct length of lower limb prostheses: a clinical and radiological study.

The length of the lower limb prosthesis was compared with the length of the contralateral lower extremity in 113 Finnish war-disabled amputees by a radiological weight bearing method developed by the author. Considering a shortening of 10 mm for above-knee prostheses and of 5 mm for below-knee prostheses as tolerance limits, the length of the prosthesis was acceptable only in 17 cases (15% of the total group). In 79 cases (70%) the prosthesis was up to 47 mm too short and in 17 cases (15%) up to 40 mm too long. Chronic pain symptoms of low back, hip and knee correlated significantly with the lateral asymmetry caused by incorrect length of the prosthesis. Independently of the side of amputation, the unilateral sciatica and chronic hip pain occurred mainly on the long leg side. Physical activity of the lower limb amputees seemed to correlate with the suitability of the length of the prosthesis, and was unrelated to the length of the amputation stump.

Phantom limb: a phenomenological study.

Phantom limb phenomena during the post-operative period were studied in 72 amputees. All were right handed. Phantom limb was present in 86.1 per cent of the cases, significantly more commonly amputation of the right arm. Nearly half of the phantoms developed within the first 24 hours and another quarter in the next 24 hours, appearing earlier in lower limb amputees. Movements in the phantom were felt by three-quarters of the cases, an incidence unaffected by site or side of amputation. Telescopy was present in nearly two-thirds and phantom limb pain in over two-thirds, significantly more commonly in the upper limb amputees but uninfluenced by the side of amputation. Thirty-one of the patients dreamed that their limbs were intact.