Amputee Rehabilitation Research Articles

Osseointegration: A new approach to improve functional performance of prostheses – a systematic review of the literature

Background: Individuals with amputations experience functional limitations in their daily activities, depending on the level of their injuries. They often encounter problems with socket-based prostheses. Osseointegration is a new method in prosthetic rehabilitation that aims to enhance the performance of amputees and reduce the issues associated with current prostheses. The objective of this review was to assess the advantages and disadvantages of this novel approach in the rehabilitation of amputees. Method: A search was conducted in various databases, including Google Scholar, PubMed, ISI Web of Knowledge, Embase, and Scopus. The search terms used were “osseointegration,” “prosthesis,” and “amputation.” The quality of the studies was evaluated using the Down and Black tool. Results: The search using the aforementioned keywords yielded 18 papers. Out of these, 10 papers focused on the use of osseointegration for lower limb amputations, while 5 papers focused on upper limb amputations. Additionally, 3 papers examined the occurrence of stump infections associated with this method. The quality of the studies ranged from 15 to 20. Conclusion: Based on the available literature, osseointegration addresses some of the challenges associated with socket-based prostheses. Furthermore, it improves the performance of prostheses. However, there are several issues with this method, including high costs, stump infections, and the need for extensive expertise to insert the implant. Further large-scale studies are necessary to determine the various limitations and advantages of this approach for different levels of amputations.

O RETORNO AO TRABALHO E AO SERVIÇO MILITAR DE ADULTOS AMPUTADOS: UMA REVISÃO DE ESCOPO

The rehabilitation of adult amputees involves, among other objectives, the return to work. In this sense, the present study seeks to investigate how the return to work and the return to military service occur for adults who have undergone amputation, identifying the factors of success and analyzing the impact of Occupational Therapy. This is a scoping review that follows the guide for scoping reviews from the Joanna Briggs Institute and includes 22 articles for final data analysis and collection. The following factors related to successful return to the labor market after amputation were identified: male gender; younger age; use of prosthesis; lower pain levels; unilateral amputations; availability of accessible infrastructure in the workplace; job function adaptations and assistive technologies; and administrative positions. Regarding the return to military service, the rank within the army was shown to be the main determinant in the individual's return to service. It is noteworthy that several demands pointed out by the studies regarding the rehabilitation process and return to work can be addressed by occupational therapists, such as the adaptation of prostheses for the specific tasks of the individual, analysis and adaptation of the work environment, pain management and reduction, work activity training, and spiritual support, since beliefs related to the sacred were indicated as the main factor of success for rehabilitation. However, only two articles mention Occupational Therapy, and in both, the service is characterized as inefficient.

Feasibility of self-management for amputee rehabilitation using technology and peer support for improving walking and confidence in individuals with lower limb loss

Background: Individuals with lower limb loss (LLL) require self-management education for amputation adaptation. eHealth technologies, like online platforms, widen access to educational resources. We developed an online self-management program for individuals with LLL called Self-Management for Amputee Rehabilitation using Technology (SMART). Objective: To assess the feasibility of SMART for improving walking capacity and confidence for adults with recent LLL. Study Design: A single-group pre-post intervention design. Methods: We recruited community-dwelling adults, with unilateral, transtibial, or transfemoral amputation. Self-management for amputee rehabilitation using technology included 6 weekly online educational modules, for example, pain management, diet, and sock management, and 6 weekly online meetings with a peer mentor to discuss goal setting and action planning. Outcomes were assessed at baseline (before SMART) and after 6 weeks using SMART. Feasibility indicators included process (retention rate), resource (duration of training sessions), management (participant processing), and treatment issues (effect size). The primary clinical outcome was walking capacity measured using Timed Up and Go, and secondary outcome was walking confidence measured using the Ambulatory Self-Confidence Questionnaire. Results: Twelve participants were recruited. The median (range) age was 56.0 (26–79) years. The retention rate was 100%. All participants were trained in less than 15 min. Four participants had an enrollment delay of more than 10 days. Two participants reported noninjurious falls because of amputation comorbidities and increased activity. The effect sizes for walking capacity and confidence were 0.51 and 0.86, respectively. Conclusions: Only small intervention and protocol refinements are required to SMART. These will be incorporated for a future multisite randomized controlled trial. SMART is an eHealth education program for people with LLL. Self-management for amputee rehabilitation using technology with peer support is a feasible intervention. However, adjustments to the study protocol and intervention safety are necessary before proceeding with the evaluation of SMART in a larger study.

Exploring the Effect of Preamputation Employment and Income on Ambulation in Dysvascular Lower Extremity Amputees After Amputee Rehabilitation: A Retrospective Cohort Study

ObjectiveTo assess the relationship between 2-minute walk test (2MWT) distance, employment status, and median household income in adult dysvascular amputee patients after a 6-week rehabilitation program. DesignRetrospective cohort study. SettingAmputation rehabilitation program. ParticipantsIn total, 505 patients were included in the analysis. Most (71.1%) were men and had below-knee amputations (78.3%); the average age was 65.3±11.6 years. InterventionsNot applicable. Main Outcome Measures2MWT distance at discharge. ResultsMen (68.3±32.6m) and below-knee amputation amputees (70.9±32.0m) walked significantly further than women (58.8±30.0m; P=.003) and above-knee amputees (47.2±25.7m; P<.001), respectively. A significant negative correlation was found between 2MWT distance and age (r=−.32; P<.001) as well as time from consultation to admission (r=−.23; P<.001). An unadjusted general linear model (GLM) revealed that employment status (F2,446=17.47; P<.001) but not income (F4,446=.714; P=.58) was statistically significantly associated with 2MWT distance. An adjusted (age, sex, time from consult to admission, and amputation level) GLM revealed employment status remained significant (F2,434=5.59; P=.004) and income remained insignificant (F4,434=.43; P=.784). Differences in 2MWT distance between employment and income groups did not meet clinical significance. ConclusionsPreamputation employment appears to be associated with postrehabilitation outcomes.

Single-Stage Press-Fit Osseointegration of the Radius and Ulna for Rehabilitation After Trans-Forearm Amputation.

Upper limb (UL) amputation is disabling. ULs are necessary for many domains of life1, and few effective motor and sensory replacements are accessible2. Approximately 41,000 people in the United States have UL amputation proximal to the fingers3, two-thirds of (all) traumatic amputations are UL4, and 80% of UL amputations are performed for trauma-related etiologies5. Socket prosthesis (SP) abandonment remains high because of the lack of sensation, limited prosthesis control, perceived weight, and difficulty comfortably wearing the SP6. Transcutaneous osseointegration7,8 surgically inserts a bone-anchored implant, passed through a transcutaneous portal to attach a terminal device, improving amputee rehabilitation by reducing perceived weight, conferring osseoperception9, and increasing wear time10. Without the socket, all residual skin and musculature remain available for transcutaneous myoelectrodes. The present article describes single-stage radius and ulna press-fit osseointegration (PFOI) after trans-forearm amputation. This technique resembles a lower-extremity PFOI11,12. Importantly, at-risk nerves and vessels are different, and implant impaction must be gentler as a result. The surgery is indicated for patients who are dissatisfied with SP rehabilitation or declining alternative rehabilitative options, and who are motivated and enabled to procure, train with, and utilize a forearm prosthesis. An engaged prosthetist is critical. Surgical steps are exposure, bone-end and canal preparation, first implant insertion (in the operative video shown, in the radius), purse-string muscle closure, confirmation that radius-ulna motion remains, performing the prior steps for the other bone (in the video, the ulna), and closure (including potential nerve reconstruction, soft-tissue contouring, and portal creation). Although the patient in the operative video did not require nerve procedures to address pain or to create targets for transcutaneous myoelectrodes, targeted muscle reinnervation or a regenerative peripheral nerve interface procedure could be performed following exposure. Alternatives include socket modification, bone lengthening and/or soft-tissue contouring13, Krukenberg-type reconstructions14, or accepting the situation. An alternative implant is a screw-type osseointegration implant. Our preference for press-fit implants is based on considerations such as our practice's 12-year history of >1,000 PFOI surgeries; that the screw-type implant requires sufficient cortical thickness for the threads15, which is compromised in some patients; the lower cost per implant; that the procedure is performed in 1 instead of 2 surgical episodes15,16; and the documented suitability of press-fit implants for patients with challenging anatomy or comorbidities17-19. PFOI can be provided for amputees having difficulty with socket wear. PFOI usually provides superior prosthesis stability, which can confer better prosthesis control versus nonoperative and other operative options in patients expressing dissatisfaction for reasons such as those mentioned above, or for poor fit, compromised energy transfer, skin pinching, compression, and abrasions. For patients who want myoelectric control of their prosthesis but who are unable because the optimal myoelectric location is obstructed by the socket, osseointegration may provide access for the electrodes by eliminating the socket. Only 3 trans-forearm osseointegration20-22 publications totaling 10 limbs could be identified, limiting the ability to determine generalizable outcomes. Osseointegrated prostheses, being skeletally anchored, feel lighter to patients than SPs, which should confer better outcomes. In 1 patient, multiple implant fractures and infection prompted additional surgeries. Periprosthetic bone fractures and non-infectious loosening have not been documented for UL osseointegration. Osseointegration eliminates the socket, relieving socket-based pain. However, neurogenic pain relief requires specific nerve procedures.Osseointegration provides a prosthesis connection. Nerve- or muscle-based prosthesis control requires separate, potentially integrated planning.Osseointegrated prostheses confer osseoperception (i.e., mechanical force transmission), not "normal" skin-mediated afferent sensation (i.e., light touch, temperature, pain) or native proprioception.Prostheses must be individualized to the patient's elbow flexion and radioulnar rotation. An attentive prosthetist must be ensured preoperatively.Achieving the demonstrated outcomes requires more therapy and retraining than walking with an osseointegrated lower-extremity prosthesis. Patients must expect at least several months of spending multiple hours daily engaging in self-directed rehabilitation.Prosthesis utilization decision aids23 may minimize non-beneficial surgeries. UL = upper limbSP = socket prosthesisPFOI = press-fit osseointegrationperi-pros fx = periprosthetic fractureMRI = magnetic resonance imagingCT = computed tomography.

Multi-objective optimization of prosthetic multi-cells foam liner

Restoring mobility using prosthetic limbs anchored in custom sockets is the primary goal of amputee rehabilitation. The contact pressure at the stump-liner interface is critical for improving prosthetic socket design and enhancing amputee satisfaction and comfort. This study aimed to develop and optimize a new customized multicellular foam liner model by identifying the optimal configuration of the liner’s cells to achieve minimal contact pressure between the transtibial limb (stump) and the prosthetic interface while simultaneously minimizing the stump’s immersion in the foam liner. The study employed a multi-objective optimization using the NSGA-II genetic algorithm to optimize the material configurations of the liner cells. The objective function was based on a finite element (FE) model of the customized foam liner, composed of 40 cells, each using one of six foam materials with varying firmness. The optimization process yielded nine different configurations representing the Pareto front. Contact pressure and immersion, represented by displacement in the load direction, were reduced from 140 KPa and 9 mm to 10 KPa and less than 1 mm, respectively. The results obtained in this study motivate future clinical trials on the efficacy of customized multicellular foam liners. These findings provide in-depth insights into prosthesis design and customization, potentially leading to further development in the use of foam rather than silicone for liner manufacturing.

Bone mineral density in osseointegration implant surgery: A review of current studies (Review).

Osseointegration implant (OI) surgery is the latest rehabilitation technology for amputees, where a bone-anchored implant obviates the limitations of traditional socket prostheses. The bone mineral density (BMD) in the periprosthetic and other anatomical regions can be used to assess bone remodelling following OI surgery. Currently, limited studies have used BMD measurements in reporting post-operative OI outcomes and the association between the maintenance of BMD and implant efficacy has remained elusive. This review captured and analysed all studies that have reported the BMD as an objective outcome measure in patients with trans-femoral or trans-tibial OI. The PubMed, Medline, Scopus and Web of Science databases were searched using the terms 'amputation', 'osseointegration' and 'bone mineral density'. A total of 6 studies involving human participants were included for analysis. All studies used dual X-ray absorptiometry and/or X-rays for measuring BMD. Rehabilitation of trans-femoral or trans-tibial amputation using OI may help restore healthy BMD by enabling physiological bone loading. However, there is a low correlation between the BMD around the OI and the success of OI surgery or the risk of periprosthetic fractures. This review summarises the current evidence on BMD assessment in OI for lower limb amputee rehabilitation. Despite the great variability in the results, the available evidence suggests that OI may help restore BMD following surgery. The limited evidence calls for further investigation, as well as the development of a standard BMD measurement protocol.

Topology of surface electromyogram signals: hand gesture decoding on Riemannian manifolds

Objective. Decoding gestures from the upper limb using noninvasive surface electromyogram (sEMG) signals is of keen interest for the rehabilitation of amputees, artificial supernumerary limb augmentation, gestural control of computers, and virtual/augmented realities. We show that sEMG signals recorded across an array of sensor electrodes in multiple spatial locations around the forearm evince a rich geometric pattern of global motor unit (MU) activity that can be leveraged to distinguish different hand gestures. Approach. We demonstrate a simple technique to analyze spatial patterns of muscle MU activity within a temporal window and show that distinct gestures can be classified in both supervised and unsupervised manners. Specifically, we construct symmetric positive definite covariance matrices to represent the spatial distribution of MU activity in a time window of interest, calculated as pairwise covariance of electrical signals measured across different electrodes. Main results. This allows us to understand and manipulate multivariate sEMG timeseries on a more natural subspace—the Riemannian manifold. Furthermore, it directly addresses signal variability across individuals and sessions, which remains a major challenge in the field. sEMG signals measured at a single electrode lack contextual information such as how various anatomical and physiological factors influence the signals and how their combined effect alters the evident interaction among neighboring muscles. Significance. As we show here, analyzing spatial patterns using covariance matrices on Riemannian manifolds allows us to robustly model complex interactions across spatially distributed MUs and provides a flexible and transparent framework to quantify differences in sEMG signals across individuals. The proposed method is novel in the study of sEMG signals and its performance exceeds the current benchmarks while being computationally efficient.

Gait Analysis of Knee Joint Walking Based on Image Processing.

With the in-depth development of assistive treatment devices, the application of artificial knee joints in the rehabilitation of amputees is becoming increasingly mature. The length of residual limbs and muscle strength of patients have individual differences, and the current artificial knee joint lacks certain adaptability in the personalized rehabilitation of patients. In order to deeply analyze the impact of different types of artificial knee joints on the walking function of unilateral thigh amputees, improve the performance of artificial knee joints, and enhance the rehabilitation effect of patients, this article combines image processing technology to conduct in-depth research on the walking gait analysis of different artificial knee joints of unilateral thigh amputees. This article divides patients into two groups: the experimental group consists of patients with single leg amputation, and the control group consists of patients with different prostheses. An image processing system is constructed using universal video and computer hardware, and relevant technologies are used to recognize and track landmarks; Furthermore, image processing technology was used to analyze the gait of different groups of patients. Finally, by analyzing the different psychological reactions of amputees, corresponding treatment plans were developed. Different prostheses worn by amputees have brought varying degrees of convenience to life to a certain extent. The walking stability of wearing hydraulic single axis prosthetic joints is only 79%, and the gait elegance is relatively low. The walking stability of wearing intelligent artificial joints is as high as 96%. Elegant gait is basically in good condition. Image processing technology helps doctors and rehabilitation practitioners better understand the gait characteristics and rehabilitation progress of patients wearing different artificial knee joints, providing objective basis for personalized rehabilitation of patients.

The Benefits of Peer Visitation on the Rehabilitation of New Amputees: A Qualitative Study

Purpose: For the purpose of this study a peer visitor is being defined as someone who has experienced some type of limb loss and is now mentoring other amputees. Their focus is on health and recovery as opposed to illness as they listen, provide emotional support, and most importantly inspire hope in an individual who has experienced a new amputation. The primary purpose of this study is to examine the reports of amputees regarding their personal experiences related to whether they spoke with a peer visitor following surgery. The study focuses on the benefits of peer visitation and how it impacts rehabilitation outcomes. Methods: This study utilizes a qualitative methodology, and in response to the research questions the benefits of phenomenological research will provide thoughtful and compelling representations of the different lived experiences from all participants. The sample for this study was drawn from across the U.S with the assistance of a local Hanger Inc. clinic, and the Amputee Coalition of America. The primary data collection tools for the investigation were in-depth, audiotaped interviews and a pre-interview questionnaire. All interviews were conducted either over the phone or through a Zoom platform. Results: Findings revealed that peer visitation improves coping strategies for anxiety and depression following surgery, increases confidence and hope in the patient, and influences mental health recovery. Conclusions: Based on the findings it was concluded that a peer visitor will improve overall mental health, improve patient attitudes, and overall improve rehabilitation outcomes for new amputees, and it is plausible to generalize these conclusions to the entire population of amputees. This study empowers new amputees and healthcare practitioners with knowledge to seek out a peer visitor following surgery, as it can improve the outcome of the patient’s rehabilitation.

Qualitative Analysis of the Lived Experience of Individuals After Undergoing Osseointegration for Transfemoral Amputation.

The purpose of this study was to qualitatively assess the first-hand lived experiences of patients with amputation who had transitioned from a traditional socket (TS) to Osseointegration (OI) to impact their overall quality of life (QOL) and function. This was a qualitative phenomenological study. Participants who had a unilateral transfemoral amputation and fit the study's inclusion criteria were interviewed in a semi-structured format regarding their quality of life and function before and after transitioning from a traditional socket (TS) to Osseointegration (OI). Responses were then analyzed through line-by-line coding to determine themes that were relevant to QOL outcomes for this study. Eleven participants were interviewed in this study. The qualitative analysis demonstrated an emergence of 6 main themes consisting of "Improved Quality of Life," "Supportive Community," "Previous Ill-fitting Socket," "Greater Function," "Improved Osseo-perception," and "Promotion of Community Accessibility". Strengths included the use of an OI-specific quality of life assessment with adapted questions from validated outcome measures, international participants, and use of thematic analysis for data analysis. Weaknesses included sample size, niche participant population, and OI as a revision procedure only. More research is still necessary to explore/determine the benefits and detriments of Osseointegration as an alternative to traditional sockets for prosthetic devices. Individuals who have undergone Osseointegration procedure discuss being more satisfied with their prosthesis and quality of life when compared to their previous experience of a traditional socket. This is a first of its kind study reporting on the lived experiences of those who have undergone OI. The field of amputation rehabilitation is expanding rapidly and knowing how this procedure impacts quality of life is important for healthcare professionals to understand as new frontiers are explored in this field.

Rehabilitation of a Lower Limb Amputee

The rehabilitation of the amputee patient must be early and therfore begins immediately after the operation. In the pre-prosthetic phase, the first objective is to allow good healing and a reduction of the edema of the stump with trophic and circulatory massages ; in a second step it is a question of obtaining a toned stump by exercises of reinforcemnt and joint mobilization. In the post-prothetic phase, the aim is to integrate the prosthesis into the patient’s body diagram and to correct the gait pattern with the ultimate objective of greater patient autonomy.

Understanding transitions in care for persons with limb loss: a qualitative study exploring health care providers’ perspectives

Purpose To explore health care providers’ (HCP) experiences related to transitions in care from inpatient rehabilitation to the community for patients with limb loss. Materials and Methods A qualitative study was conducted using semi-structured interviews. Participants were eligible if they were HCPs currently working in amputation rehabilitation at a rehabilitation hospital in Ontario, Canada, with at least 1-year experience in this setting, and could speak and understand English. Data were analyzed thematically using the six-step process of the DEPICT model dynamic reading, engaged codebook development, participatory coding, inclusive reviewing and summarizing of categories, collaborative analyzing and translating. Results Fourteen HCPs from a variety of health care professions participated in this study. Five key themes describe participants’ perspectives on the factors impacting patients’ transition in care following limb loss. Specifically, participants emphasized patient preparedness, HCP follow-up, finances and funding, patient self-management skills, and psychosocial support as factors that could influence the transition in care. Conclusion This study identified challenges to transitions in care for people with limb loss. Future research is needed to evaluate solutions to address these challenges in transitions in care.

Improving Walking Performance in Prosthetic Leg Users: The Role of Virtual Reality and Audio Feedback

Virtual reality (VR) has emerged as a promising technology for enhancing the rehabilitation process and improving the life quality for lower limb prosthetic user. The integration of audio within VR environments can significantly impact the performance of lower limb prosthetic user, improve their gait patterns, enhance balance control, and avoid user from falling. This research paper investigates the effectiveness of VR and audio stimuli in improving gait in amputees wearing prosthetic legs. A VR-based training system is developed, utilizing a head-mounted display (HMD) and audio cues synchronized with footsteps or slowed down. Thirteen transfemoral prosthetic leg users participate in the study, assessing the impact on gait parameters. Participants were asked to walk in 3 conditions: without audio (WA), with audio (A), and slow tempo audio (SA). Results demonstrate significant enhancements in step length, stride length, and step time, achieving balance between the prosthetic and normal limbs. The integration of audio stimuli proves advantageous in enhancing walking performance and addressing asymmetries. The findings suggest that VR with slow-tempo audio cues holds promise for improving rehabilitation outcomes for prosthetic leg users. Future research should focus on optimizing training methods and exploring full potential of audio-integrated VR for gait rehabilitation in amputees.

Design, Analysis, and Development of Low-Cost State-of-the-Art Magnetorheological-Based Microprocessor Prosthetic Knee.

For amputees, amputation is a devastating experience. Transfemoral amputees require an artificial lower limb prosthesis as a replacement for regaining their gait functions after amputation. Microprocessor-based transfemoral prosthesis has gained significant importance in the last two decades for the rehabilitation of lower limb amputees by assisting them in performing activities of daily living. Commercially available microprocessor-based knee joints have the needed features but are costly, making them beyond the reach of most amputees. The excessive cost of these devices can be attributed to custom sensing and actuating mechanisms, which require significant development cost, making them beyond the reach of most amputees. This research contributes to developing a cost-effective microprocessor-based transfemoral prosthesis by integrating off-the-shelf sensing and actuating mechanisms. Accordingly, a three-level control architecture consisting of top, middle, and low-level controllers was developed for the proposed prosthesis. The top-level controller is responsible for identifying the amputee intent and mode of activity. The mid-level controller determines distinct phases in the activity mode, and the low-level controller was designed to modulate the damping across distinct phases. The developed prosthesis was evaluated on unilateral transfemoral amputees. Since off-the-shelf sensors and actuators are used in i-Inspire, various trials were conducted to evaluate the repeatability of the sensory data. Accordingly, the mean coefficients of correlation for knee angle, force, and inclination were computed at slow and medium walking speeds. The obtained values were, respectively, 0.982 and 0.946 for knee angle, 0.942 and 0.928 for knee force, and 0.825 and 0.758 for knee inclination. These results confirmed that the data are highly correlated with minimum covariance. Accordingly, the sensors provide reliable and repeatable data to the controller for mode detection and intent recognition. Furthermore, the knee angles at self-selected walking speeds were recorded, and it was observed that the i-Inspire Knee maintains a maximum flexion angle between 50° and 60°, which is in accordance with state-of-the-art microprocessor-based transfemoral prosthesis.

Thighplasty at the Time of Stage-1 Bone-Anchored Osseointegration Surgery.

For patients with transfemoral amputations and difficulty tolerating conventional socket-based prostheses, osseointegrated (OI) implants have enabled increased prosthetic use, improved patient satisfaction, and shown promising functional outcomes1,2. Although the use of OI implants effectively eliminates the soft-tissue-related challenges that have plagued socket-based prostheses, the presence of a permanent, percutaneous implant imparts a host of new soft-tissue challenges that have yet to be fully defined. In patients undergoing OI surgery who have redundant soft tissue, we perform a thighplasty to globally reduce excess skin and fat, tighten the soft-tissue envelope, and improve the contour of the residual limb. First, the orthopaedic surgical team prepares the residual femur for implantation of the OI device. After the implant is inserted, the residual hamstrings and quadriceps musculature are closed over the end of the femur, and the subcutaneous tissue and skin are closed in a layered fashion. Although the anatomic location and amount of excess soft tissue are patient-dependent, we perform a standard pinch test to determine the amount of soft tissue that can be safely removed for the thighplasty. Once the proposed area of resection is marked, we proceed with longitudinal, sharp dissection down to the level of the muscular fascia. At this point, we use another pinch test to confirm the amount of soft-tissue resection that will allow for adequate resection without undue tension3. Excess subcutaneous fat and skin are carefully removed along the previously marked incisions, typically overlying the medial compartment of the thigh in the setting of patients with transfemoral amputations. The thighplasty incision is closed in a layered fashion over 1 or 2 Jackson-Pratt drains, depending on the amount of resection. Depending on the amount of redundant soft tissue, thighplasty may not be necessary at the time of OI surgery; however, in our experience, excess soft tissue surrounding the transcutaneous aperture can predispose the patient to increased shear forces at the aperture, increased drainage, and increased risk of infection4. Although superficial infectious complications are most common following OI surgery, the need for soft-tissue refashioning and excision is one of the most common reasons for reoperation1,5. Our group has been more aggressive than most in our use of a vertical thighplasty procedure to globally reduce soft-tissue motion in the residual limb to avoid reoperation. Although much of the OI literature has focused on infectious complications, recent studies have demonstrated reoperation rates of 18% to 36% for redundant soft tissue following OI surgery1,5. We believe that thighplasty at the time of OI not only reduces the likelihood of reoperation but may also decrease infectious complications by reducing relative motion and inflammation at the skin-implant interface4,6. The thighplasty procedure is ideally performed as part of the first stage of the OPRA (Osseointegrated Prosthesis for the Rehabilitation of Amputees) procedure to limit the likelihood of problematic ischemia-related complications.We utilize a confirmatory pinch test both before and throughout the thighplasty procedure to ensure adequate resection without undue tension.The thighplasty excision pattern utilizes a long vertical limb designed to decrease the circumferential laxity of the residual limb. Maximal tension is borne on the vertical limb and not on the transverse extensions, as these are prone to scar widening and distortion of surrounding tissues.Closed-suction drainage is utilized liberally to decrease the likelihood of a symptomatic seroma. OI = osseointegratedOPRA = Osseointegrated Prosthesis for the Rehabilitation of AmputeesPVNS = pigmented villonodular synovitisT-GCT = tenosynovial giant-cell tumor.BMI = body mass indexPMH = past medical history.

Effectiveness of mirror therapy for amputation patients at National Authority of Prosthesis and Orthosis in Sudan

Introduction. Mirror Therapy (MT) seems to be a promising strategy in amputation rehabilitation by creating a visual representation of the missing limb. The study exploring the effect of MT and conventional rehabilitation in the treatment of post-amputation phantom lower limp pain in National Authority of Prosthesis and Orthosis (NAPO). Method. An experimental study was done on 20 patients that were found for the study (these were the only available cases with phantom lower limb pain), was divided into: Group (A) conventional rehabilitation, Group (B) MT, 10 patients were selected randomly in each group. Questioner with sixteen close end questions was distributed to the patients of the two groups for post rehabilitation assessment to reassess the effect of each treatment for post amputated phantom lower limp pain. Results. There were 50% of the participants were above 60 years old and 60% of participants had Trans – Femoral amputation. Diabetic was the major cause of Amputation (55%). According to participants perception, 40% of participants undergone MT thing it is effective in reducing phantom lower pain while only 10% of participants undergone conventional therapy think it is effective in reducing phantom lower pain. Conclusion. As known, diabetes is still the major cause of lower limb amputation in Sudan. Both conventional therapy and MT are found to be effective in the treatment of phantom lower limb pain, but MT is shown to be more effective compared to conventional therapy.

The application of biomimetic limbs in postoperative rehabilitation of amputees

Due to the inability to provide recovery opportunities, amputation is generally considered a failure of treatment. Traditional prostheses cannot interact with the surrounding environment, and the contact surface between the prosthesis and the residual limb is prone to wear and tear, causing pain to patients. Therefore, prostheses are generally regarded by patients as tools rather than a part of the body. In recent years, with the continuous development of artificial intelligence, materials science, and biomedical engineering technology, bionic limb technology has received widespread attention and application. Currently, bone integration and electromyography interface technology are widely applied in bionic limbs, allowing for more realistic and diverse options for prostheses for patients. Material innovation and machine learning technology can improve the mechanical performance, perceptual feedback effects, and autonomous learning ability of bionic limbs, but further research and exploration are still needed. This review paper aims to summarize and evaluate the current development status, application areas, and future research directions of bionic limb technology.

A Review on the Usability, Flexibility, Affinity, and Affordability of Virtual Technology for Rehabilitation Training of Upper Limb Amputees.

(1) Background: Prosthetic rehabilitation is essential for upper limb amputees to regain their ability to work. However, the abandonment rate of prosthetics is higher than 50% due to the high cost of rehabilitation. Virtual technology shows potential for improving the availability and cost-effectiveness of prosthetic rehabilitation. This article systematically reviews the application of virtual technology for the prosthetic rehabilitation of upper limb amputees. (2) Methods: We followed PRISMA review guidance, STROBE, and CASP to evaluate the included articles. Finally, 17 articles were screened from 22,609 articles. (3) Results: This study reviews the possible benefits of using virtual technology from four aspects: usability, flexibility, psychological affinity, and long-term affordability. Three significant challenges are also discussed: realism, closed-loop control, and multi-modality integration. (4) Conclusions: Virtual technology allows for flexible and configurable control rehabilitation, both during hospital admissions and after discharge, at a relatively low cost. The technology shows promise in addressing the critical barrier of current prosthetic training issues, potentially improving the practical availability of prosthesis techniques for upper limb amputees.

Lower limb amputation rehabilitation status in India: A review.

Rehabilitation of lower limb amputation in developing countries is quite challenging. Though there are basic to highly advanced prostheses available in India, the set-up is still facing difficulties in developing countries. Prosthetic management is difficult due to lack of availability of prostheses and reduced affordability among low income populations. In this review we highlighted the lower limb amputation and prosthetic rehabilitation status in India. Currently, India is advancing well in the rehabilitation field, but further studies are required to provide more evidence and recommendation.