Amputee Clinic Research Articles

The Changing Role of the Amputee in the Rehabilitation Process

In early times, persons who lost arms or legs either did without, devised their own substitutes, or sought the assistance of local craftsmen—blacksmiths, cabinet makers, etc.—to fabricate limbs. The decision concerning their “rehabilitation” was the amputee’s, based on need. Following the Civil War, the demand for artificial limbs significantly increased and a number of limbmanufacturing companies were established, many by amputee veterans. The infusion of government research funds after World War II significantly improved the art and technology of limbmaking, but the simultaneous development of amputee clinic teams changed the role of amputees in the rehabilitation process to one of a passive recipient of services. Today, with technical information more readily available, as well as the organization of consumer support and self-help groups, amputees are again assuming responsibility for their return to productive living.

Prosthetic Usage Following Major Lower Extremity Amputation

There were 157 patients following major lower extremity amputation who were evaluated to determine functional prosthetic ambulation. Twenty-eight patients were evaluated in the amputee clinic and found not to be candidates for prosthetic fitting. Forty-one patients were fit with a prosthesis but did not become functional prosthetic ambulators. Eighty-eight patients became functional prosthetic ambulators. Of all above-the-knee amputees, 46% became functional prosthetic ambulators. Only 19% of bilateral lower extremity amputees became functional prosthetic ambulators. Of all below-the-knee amputees, 66% became functional ambulators. The presence of coronary artery disease decreased the ambulatory potential in above-the-knee or bilateral amputees but not in below-the-knee amputees. A screening method for elderly, dysvascular amputees should be instituted prior to prosthetic fitting.

Relationships between laterality of congenital upper limb reduction defects and school performance.

Eighty children (34 males, 46 females) with congenital upper limb reduction defects who attended a regional amputee clinic between 1956 and 1986 were classified as to whether they exhibited learning difficulties in school, as indicated by grade failure or by placement in learning disability classrooms. Children with right-sided defects were more likely to encounter learning difficulties than were children with left-sided defects (Chi-square = 6.8; df = 1; p less than 0.01). Children with right-limb defects also were more likely than children with left-limb defects to experience reading problems (Chi-square = 5.9; df = 1; p less than 0.05). These results suggest the need for neuropsychological and neurophysiological study of children with limb reduction defects.

A Comparison of Myo-Electric and Standard Prostheses — A Case Study of a Pre-School Aged Congenital Amputee

The major advantages of early fitting with a standard prosthesis, are related to future acceptance, skilled use, and functional use of the prosthesis. Increasingly more parents of juvenile amputees are requesting myo-electric prostheses for their children. This study explored the areas of acceptance and adjustment, skill level, and functional use of a myo-electric prosthesis compared to a standard prosthesis with a child selected from the Juvenile Amputee Clinic list at the Alberta Children's Hospital in Calgary, Alberta, Acceptance and adjustment were measured by the Prosthetic Adjustment Scale and by parent interviews: Skill level and functional use of the prostheses were measured by simple instruments devised by the writer. Differences in skill level, acceptance, and functional use between the standard and the myo-electric prostheses were outlined and discussed. This study lends support to the idea of early myo-electric fitting.

The Classic

George T. Aitken graduated from Indiana University, School of Medicine, in 1933, held the position of instructor in Anatomy at the University of Michigan, served in the U.S. Army in the European Theatre of Operations in World War II, became clinical professor of surgery (orthopedics) at Michigan State University College of Human Medicine, and was elected President of the American Academy of Orthopaedic Surgeons. Charles H. Frantz graduated from the University of Michigan in 1932, served in North Africa in World War II, and practiced orthopedic surgery alongside Dr. Aitken in Grand Rapids, Michigan. They shared a keen interest in the problems of crippled children, and were encouraged to set up a specialized juvenile amputee clinic for the children of Michigan. The clinic attracted world-wide attention and received children from all over the United States, its territories and possessions. The program grew from an interest in children with acquired amputations and extended to the treatment of children with skeletal limb deficiencies, with or without adjunctive surgery. Today, the work continues in the Area Child Amputee Center, located in the Mary Free Bed Rehabilitation Center. The pre- and postoperative fitting and training activities can be seen at the Center. The surgical procedures are performed at St. Mary's, Blodgett, and Butterworth Hospitals of Grand Rapids. Aitken and Frantz provided not only extraordinary energy and surgical talent, but also a divine spark that will illuminate the whole field for a long time.

A statewide amputee rehabilitation programme.

Patients are referred to the amputee clinic at the Medical College of Georgia from all areas of the State of Georgia. Most referrals are made a considerable time after amputation and most patients live from 50 to 250 miles from the amputee clinic. A special programme was designed to alleviate some of the problems incurred by the distance and the delayed referral. Physical therapists, prosthetists, social workers, the vocational counsellor and the orthopaedic surgeon co-operate to provide maximum care on the day of the amputee clinic. The cooperative efforts of all members of the team and the ability to plan ahead for optimum rehabilitation maximize the use of patients' time and his rehabilitation level.

Rehabilitation of the geriatric amputee.

ABSTRACT: During a five‐year period, 90 patients who had undergone lower‐extremity amputations when aged 60 or older were treated at the Amputee Clinic of the Jewish Hospital of St. Louis. Seventeen of the 90 were not fitted with prostheses because of various medical contraindications. Thirteen of the remaining 73 patients who were fitted with prostheses had died by the time of follow‐up, and 23 others could not be located. Of the 37 known survivors, 23 wore their prosthesis for more than six hours daily and used it as their main mode of locomotion; 14 used it only occasionally or not at all.Sex and age at the time of amputation were of little value in predicting the success of prosthetic rehabilitation. Patients with below‐knee amputations fared much better than those with above‐knee amputations. Contraindications to fitting an aged amputee with a prosthesis are mental deterioration, congestive heart failure, severe angina pectoris, and advanced chronic obstructive pulmonary disease. Neurologic disorders such as parkinsonism or stroke with a significant neurologic residual are additional contraindications. Patients who have ulcerations or infections of the remaining extremity or who have severe contractures of the stump usually cannot be fitted with a prosthesis. The ability to use axillary crutches is not a realistic prerequisite for supplying an aged amputee with a prosthesis. A patient who has walked before the amputation and who afterward can walk with a walker, usually will be able to use an artificial limb. Amputees who cannot be expected to use a prosthesis can still be rehabilitated to an independent wheelchair existence.

Surgeons and Amputations-Reply

<i>To the Editor</i>.—Dr. Miller stresses that optimal care is best provided by those with appropriate training, interest, and experience. Experience implies an evaluation of the long-term results of one's treatment. That is best obtained by following up the patient in the Amputee Clinic. The surgeon who sees the difficulties in prosthetic fitting and training arising from insensate or split-thickness grafts on weight-bearing surfaces; skin donor sites below the umbilicus; wide, irregular, poorly located or adherent scars; bone spurs or sharp edges; entrapped nerves; or an overly long stump won't make those surgical errors again. If he knows only that the surgical wound healed and did not need to be revised, he may never know the lifelong problems the patient suffered. My plea is for surgeons to learn the importance of proper amputation surgery and aftercare, and to evaluate their results by attending Amputee Clinics.

The vascular surgeon and amputation.

The best results in rehabilitating the amputee are obtained when the amputation surgeon is an integral part of the amputee clinic team, the other members of which are the physiatrist, the physical therapist, and the prosthetist. Yet, although approximately 90% of the amputations done in this country are performed by vascular and general surgeons, these individuals rarely attend amputee clinic sessions or otherwise serve as active members of the team. It is admittedly difficult for them to find the time, and surgeons often feel that of the many conflicting demands on their time, this one is the first that they can ignore, since the other members of the team will be there, and the patient will at least be seen. This must, however, be regarded as a dereliction of duty. That many general and vascular surgeons have thus shirked their obligation to participate in the total rehabilitation of the patient

Above-the-Knee Amputations and Prosthetics

The above-the-knee amputation level is used very frequently. If the level of amputation is at the surgeon's discretion, certain considerations that may make for improved prosthetic use should be respected. The prescription of a prosthesis needs to be detailed and should fit the individual patient's needs for comfort, efficiency, and appearance. Further, the surgeon's limited experience in this area should not prevent the amputee from obtaining the best possible prosthesis through an amputee clinic. In such a clinic, the optimum prosthetic prescription can be written and the patient can receive adequate training and follow-up care. Where such clinics are not available, the surgeon should learn something regarding local prosthetic facilities and thus work with the most competent prosthetist. An amputee should never be totally discharged from care but should be seen at intervals both to forestall stump problems and also to reveal malfunctions of the prosthesis before major repairs or even complete replacement is required.

AMPUTEE CLINIC IN A RURAL SETTING.

THIS REVIEW is an effort to expose the need for, and the problems encountered in, developing an amputee clinic in a rural area. The staff of James Decker Munson Hospital, a 250-bed general hospital with an adjacent 90-bed Tricounty Medical Care facility, located in Traverse City, Mich, originated a progressive plan for total patient care with the organization of the Department of Rehabilitation Medicine. The hospital is in a rural setting more than 150 miles from the nearest city with facilities for amputees. The community approximates 18,000 people and the immediate tricounty rural area approximates 50,000 people. The northern one third of the lower peninsula, served in part by the hospital and its facilities, has an estimated population of 100,000 people. In the surrounding several counties there are many small, well-staffed rural hospitals serving sparsely populated areas. Within the confines of the hospital, the concepts of intensive, intermediate, long-intermediate, ambulatory,