Artificial Limb Centre Research Articles

Changing Trends in Aetiology of Amputations: A 12-year Retrospective Cross-sectional Study

Introduction: The Kashmir valley, which has experienced political instability since 1989, has witnessed a rise in amputations and a different aetiology compared to other parts of India. Limited data exists on the changing patterns of various causes of amputations before and after 1989 in the Kashmir valley, India. Aim: To analyse the demographic characteristics, amputation patterns, and different causes among amputees. Materials and Methods: A retrospective cross-sectional study was conducted at the Artificial Limb Centre (ALC) of Bone and Joint Hospital Barzulla, Srinagar, India. The study included 504 patients whose medical records were reviewed from 2006 to 2018 to identify the aetiology, geographical distribution, and level of amputation. Descriptive analysis was performed to determine the frequencies of various causes and levels of amputation. Results: The study found that the most common traumatic causes of amputation were Road Traffic Accidents (RTAs), firearm injuries, and blasts. Non traumatic amputations (vascular disease and malignancies) accounted for 30% of cases. Lower limb amputations (91.5%) were more prevalent than upper limb amputations (8.5%). Conclusion: Prior to 1989, RTA accidents were the major cause of amputations, but there was a surge in amputations caused by firearm injuries and blasts. Additionally, there has been increase in amputations caused by malignancies and dysvascular ischaemia in non traumatic causes.

Medical teacher in Tamil Nadu government sector: A role model for youngsters in India

Introduction: Government hospitals in India generally have a negative opinion among pubic due to lack of sanitation and facilities but in Institute of orthopaedics and traumatology, Coimbatore government medical college hospital headed by Prof. Dr. S. Vetrivel Cherian is having facilities and patient care in par with corporate hospitals. Aim of the article is to teach and inspire young doctors about the methods and innovations adopted by him for the welfare of patients.Materials and Methods: As a retrospective study from 2000–2022, the efforts of Dr. S. Vetrivel Chezian in the public sector and how he expanded the orthopaedic medical services at Coimbatore Medical College are covered in detail.Discussion: He revolutionized trauma care services by leg bone surgery fracture fixation within 6 hours of admission even during covid 19 pandemic. He established modern lightweight artificial limb centre during covid-19 pandemic for the welfare of differently abled people without direct expenditure to the government under AB PMJAY thus making Coimbatore the first district in India with no waiting list for artificial limbs. He improved new born and children care by prevention and surgical correction of foot deformities (Clubfoot) every Thursday even during covid-19 pandemic and established ward for no attender destitute patients for the first time in India. He upgraded department of orthopaedics to Institute of orthopaedics and traumatology and improved patient care by providing various amenities. He also had passion for teaching which enabled him to publish books and encouraging post graduates by giving medals.Conclusion: Various initiatives taken by Prof. Dr. S. Vetrivel Chezian not only improved the patient care but also changed the perception about government hospitals among public and also his actions serve as a role model for young doctors.

Prevalence of Anxiety, Depression, and Post-Traumatic Stress Disorder Among Amputees Attending Jaipur Foot Trust Artificial Limb Centre in Kenya

Background: Amputees have been noted to present various psychiatric disorders including anxiety, body image disturbances, depression, and Post-Traumatic Stress Disorder (PTSD). However, there is limited data available on the prevalence of anxiety, depression, and PTSD among amputees in Kenya despite the high incidences of amputations in Kenyan hospitals. This study aimed at finding out the prevalence of anxiety, depression, and post-traumatic stress disorder among amputees attending the Jaipur Foot Trust Centre in Kenya. Method: This study took a cross-sectional descriptive study design. One hundred and forty-one patients attending the Jaipur Foot Trust were recruited to participate in the study after giving informed consent using a non-probability purposive sampling method. A socio-demographic questionnaire was used to collect socio-demographic characteristics. The Patient Health Questionnaire (PHQ-9) was used to assess the patient's depression. The Generalized Anxiety Disorder (GAD-7) scale was used to assess the patient's anxiety level and The Impact of Event Scale (IES-R) was used to assess the severity of post-traumatic stress disorder (PTSD). Data analysis was done using Statistical Package for Social Science (SPSS) version 23. Results: Findings from this study showed high rates of psychiatric morbidity where two-thirds of the patients reported PTSD (65%) with more than three-quarters of patients being diagnosed with depression (89.4%) and anxiety (91.5%). Also, there was a significant correlation between depression, anxiety, and PTSD, such that participants who had higher scores on anxiety and depression had significantly higher PTSD scores. Conclusion: Anxiety, Depression, and PTSD are very common psychological reactions in patients who have undergone amputation. The researchers expected that some of the sociodemographic factors and some amputation-related characteristics would have a relation with psychiatric comorbidity. However, the findings of this study did not show any such relationship except the relation between anxiety, depression, and PTSD. Early psychological assessment and interventions after amputations will help alleviate psychological distress.

Prosthetic Satisfaction and Body Image among Lower Limb Amputee: A Cross-sectional Study

Introduction: Limb amputation not only brings functional and sensory loss, but also leads to loss or change of body image. These changes have significant effect on the Quality of Life (QoL) of an individual. Amputee adaptation varies widely between individuals. For an amputee a prosthesis not only bring back near normal physical appearance but also it significantly repair his disturbed body image. There is a significant correlation between body image and life satisfaction. Aim: To investigate the correlation between body image and prosthetic satisfaction among lower limb amputee. Materials and Methods: This cross-sectional study was conducted from July 2018 to January 2020 at King George’s Medical University, Lucknow, Uttar Pradesh, India. Participants with unilateral lower limb prosthesis using amputees of either sex from Regional Artificial Limb Centre, Lucknow were included in the study. Each participant was subjected offline questionnaire based assessment of satisfaction with respect to their prosthesis related to it`s function, aesthetic (cosmesis), weight of prosthesis and general (overall) by Revised Trinity Amputation and Prosthesis Experience Scale (R-TAPES). Change in body image was assessed by Amputee Body Image Scale (ABIS). Results were analysed by computer-based software Statistical Package for the Social Sciences (SPSS) windows version 20.0. Analysis of Variance (ANOVA) t-test was used for normally distributed and Mann-Whitney U test was used for abnormally distributed variables. Results: The study enrolled 119 patients in which the most common cause of amputation was an accident (69). Statistically significant difference was found for satisfaction between males and females for weight of prosthesis (p-value=0.038). Statistically significant difference was found between male and female for amputee body image with ABIS score (p-value=0.001). Significant correlation was found between ABIS and functional satisfaction (p-value=0.001; r=-0.38)) and between ABIS and weight satisfaction (p-value=0.001; r=-0.36). Conclusion: Amputation causes significantly deterioration of body image among the amputee, with such deteriorated body image prosthetic satisfaction remains a big challenge for healthcare worker and prosthetist.

Effectiveness of Proprioceptive Neuromuscular Facilitation Techniques as Compared to Traditional Strength Training in Gait Training Among Transtibial Amputees.

To determine the effects of proprioceptive neuromuscular facilitation (PNF) techniques as compared with the traditional prosthetic strength training (TPT), in improving ambulatory function in subjects with transtibial amputation. Randomized control trial. Artificial Limb Centre of Fauji Foundation Hospital, Rawalpindi, from July to December 2014. Patients with lower-limb amputation was selected through purposive sampling and randomly assigned into PNF group (n=31) and traditional group (n=32). The baseline and follow-up of 04 weeks treatment session was provided and measurement was noted through the locomotor capabilities index. The locomotor capabilities index abilities had significant difference in both groups. The mean index was 23.93 for PNF and 18.18 for TPT(p > 0.05), and the knee muscle strength was also significantly different (p > 0.05). There was no significant difference in gait parameters. Proprioceptive neuromuscular facilitation technique is better in improving the locomotor abilities and knee muscle strength as compared to traditional training. The basic gait parameters have same effect in both groups.

The rehabilitation of people with physical disabilities at the artificial limb and polio centre in Gaza

The rehabilitation of people with physical disabilities at the artificial limb and polio centre in Gaza

A study of psychological correlates after amputation

Background: Amputation of a limb affects almost all aspects of an individual's life. Psychological aspects are important factors for adjustment with the disability. Methods: The present study was carried out on 50 consecutive male patients admitted to the Artificial Limb Centre. Base line and post therapy psychological assessment was carried out on Hospital Anxiety and Depression Scale (HADS). Trauma Symptom Inventory (TSI) was administered along with Millon Index of personality styles (MIPS). Psychological intervention was given to them on a therapy module proposed by authors. Data was analyzed with the help of SPSS. Result: Findings revealed significant differences in scores on HADS, before and after therapy (p<0.05). On Trauma symptom Inventory defensive avoidance and depression were noted to be above cut off level of (>65). Predominant personality styles were self indulgence and internally focused in motivating styles (mean prevalence score <50) and thought guided in thinking styles, dominating and controlling in behaving styles. The analysis of prevalence score of above 50 and less than 50 indicated Confident/ Asserting (9B), Submissive/Yielding (11A), having significant change after therapy on score of anxiety (P<0.05). The personality dimension of dutiful and conforming had shown significant influence after therapy (P<0.05) on score of depression. Conclusion: The findings indicated psychological assessment and intervention is to be included as a part of the management after amputation.

Study of disabled treated at artifical limb centre

Background: Artificial Limb Centre (ALC), Pune provides comprehensive rehabilitation care to disabled soldiers of Armed Forces. A retrospective study of 16308 Armed Forces personnel treated at ALC, Pune was carried out to analyse the factors resulting in disability and their distribution among the soldiers. Methods: Records of disabled soldiers treated at ALC, Pune from 14 May 1944 to 31 Dec 2003 were analysed with respect to their age, rank structure, nature of disability, causation and body part involved to find out various factors contributing to disablement and its distribution amongst the soldiers. Result: Trauma was the commonest cause of disability in Armed forces personnel and mine blast injury was the most frequent mode of trauma followed by road traffic accident. Study also revealed that lower limb amputation is the most common type of disability and below knee amputation is the most common level of amputation. Maximum disabled personnel were in the age group of 21 to 40 years and other ranks accounted for 92.58 % of the total number. Conclusion: War related injuries were the most common cause of disability in the Armed Forces personnel, which affect the young soldiers in their most productive period of life.

Clinical appraisal of indigenous below knee endoskeletal carbon fibre prosthesis

Background: Amputation is a catastrophe, which results in physical, social, psychological and economic handicap. Provision of suitable prosthesis (artificial limb) is a major step towards rehabilitation of these patients. Method: With an aim to provide comfortable, prosthesis to these patients, Artificial Limb Centre (ALC) Pune, developed Below Knee Carbon Fibre Shaft Endo-Skeletal (BK ES CF) Prosthesis in collaboration with DEBEL, Bangalore, a DRDO establishment. 815 Below Knee Amputee patients have been provided with the newly developed Endo-skeletal prostheses at ALC Pune till 31 Dec 2003. New BK ESCF prosthesis was evaluated for its performance by feedback received from 500 patients. Results: More than 86% patients were satisfied with the performance of new prosthesis and they achieved almost normal gait. Conclusion: The performance of new BK ESCF prostheses was excellent and it achieved good clientele satisfaction.

Skew flap technique in trans-tibial amputation

The long posterior flap technique is an established technique for trans-tibial amputation in ischaemic limbs. Despite its success, it has a few drawbacks. It may be time-consuming and requires considerable planning, and at times the dog-ears cannot be avoided. The suture line passes over the distal end of the stump, which is usually a problem during prosthetic use. The skew flap technique retains the advantages of the long posterior flap technique and eliminates the difficulties of prosthetic fitting. The equal skin flaps are skewed so that the flaps become anteromedial and posterolateral, whereas the calf muscle flap remains long underneath the skewed skin flaps. The posterior muscles are brought anteriorly covering the cut ends of the bones and are buried in between the tibia and its anterior periosteum, by suturing their margins with the periosteum. The skew flap procedure was perceived in 1980 and was started at the Artificial Limb Centre, Pune in 1983 by the author. This procedure underwent many changes during the initial 5 years and by the end of April 1992, 85 trans-tibial amputations were performed using this technique. A 9-year follow-up of these patients, who had been using prostheses with ease and without any discomfort or problem, had been exceptionally good. Encouraged by the results, this technique is now being practised as routinely. By March 1998, a total of 125 such trans-tibial amputations had been performed in 119 patients, with excellent results.

The seating clinic

Provision of an appropriate seat for a child with poor postural control or deformity not only improves function by ensuring he feels secure and comfortable, but also forms an important part of his programme of postural management. Children with severe physical disability often spend the majority of their day sitting or lying down and receive comparatively short periods of therapy. Long periods of immobility, particularly in an asymmetric posture, are a recognised cause of deformity. 1 If special seating, together with devices to develop postural control in other positions such as lying and standing reflect and reinforce therapy aims, the child will be encouraged to develop and improve his postural control and the risks of deformity are reduced. A special seating clinic for children and teenagers was set up in Reading 9 years ago, as there were many young people with severe seating problems. At that time the wheelchair service was provided by the Artificial Limb and Appliance Centre and focused on mobility. The majority of patients seen were adults, frequently in the geriatric age group, and the needs of children were often poorly understood. Special seating depended on referral to the Regional Rehabilitation Service and this was usually not considered until deformity precluded use of a standard wheelchair. In 1991 the NHS took over the management of the Wheelchair Service. Their brief is now wider and includes consideration of their patients’ comfort, function, posture, pressure relief and changing needs as well as mobility. Seating advice for complex cases is available at supradistrict or regional level but dedicated children’s services are not available in all regions. This is disappointing as prescriptive seating has been developed for children with motor handicaps, combining bio-mechanical principles with therapy aims, so as to promote maturation of sitting posture and control deforming forces.

A study of 200 cases of congenital limb deficiencies

An analysis of 200 patients with congenital limb deficiency who attended the Artificial Limb Centre, Pune from January 1984 to April 1990 is presented. This group is representative of the congenital limb deficient population of the country. The commonest deficiencies were transverse phalangeal total/partial deficiency and transverse forearm partial deficiency (below elbow) in upper limbs, whereas transverse metatarsal total/partial deficiency and transverse leg partial deficiency (below knee) were commonest in lower limbs. Transverse forearm partial deficiency was more common in female, while transverse leg partial deficiency was more common in male children, 16 patients did not require any treatment, 6 needed only surgical correction. Some 30 patients needed surgery before prosthetic fitting, while 148 patients required only prostheses. Some 68% of patients achieved satisfactory to excellent results; 18% showed poor rehabilitation. No definitive cause for the deformities could be isolated; however, many parents believed that possible exposure to the eclipse during pregnancy was the cause of the deficiency. The eldest child was most affected.

Electrically Powered Upper Limb Prostheses: Their Development and Application

This article is based on experience gained at the Manchester Disablement Services Centre (formerly Artificial Limb and Appliance Centre) in the provision of electrically powered prostheses. Since 1978, considerable changes have taken place in the United Kingdom in the design and provision of upper limb prostheses for both adults and children. A history of the developments in the field of electrically powered prostheses is given and the role of the occupational therapist is discussed.

The Flek-shin

1Wellington School of Medicine, Wellington, New Zealand 2Wellington Artificial Limb Centre Correspondence: A. J. Thurston, Senior Lecturer in Orthopaedic Surgery, Wellington School of Medicine, University of Otago, Wellington Hospital, Wellington, New Zealand, PO Box 7343, Wellington South

FUTURE OF REHABILITATION AND ARTIFICIAL LIMB AND APPLIANCE CENTRE SERVICES IN ENGLAND: McCOLL REPORT REVIEWED

FUTURE OF REHABILITATION AND ARTIFICIAL LIMB AND APPLIANCE CENTRE SERVICES IN ENGLAND: McCOLL REPORT REVIEWED

Living with an amputation: The helper

One hundred and nine key helpers were interviewed in connection with a study of the psychosocial implications of amputation. They were found to carry formidable burdens. Social isolation was a major problem which increased over time and was associated with diminished capacity to express needs. The respondents discussed emotional problems readily. Social workers had little sustained contact with helpers: welfare agencies had intervened mainly to provide practical help. The Artificial Limb Centre did not routinely see helpers or communicate with General Practitioners. A more realistic approach to the support of those who implement community care policies is advocated, with particular reference to the need for respite care to be provided in the domestic setting. The dangers of the exploitation of women as carers are highlighted.

A clinical study of post polio infantile paralysis.

This study reports on 3,000 cases of poliomyelitis seen at the Rehabilitation and Artificial Limb Centre at Lucknow between January 1976 and December 1980. Factors such as age and sex incidence, extremity involvement, incidence of deformities at hip, knee and ankle, lower limb discrepancy, treatment and orthoses prescribed are discussed.

Retrospective study of 14,400 civilian disabled (new) treated over 25 years at an artificial limb centre.

This paper reports on 14,400 civilian disabled treated over 25 years at the Artificial Limb Centre, Pune, India. It examines in some detail sex and age distribution, cause of disability, levels of amputation, sources of payment and other factors relating to the rehabilitation of the patient.

Rehabilitation of the bilateral below-elbow amputee by the Krukenberg procedure.

This paper describes the surgical technique of the Krukenberg procedure being applied in the Artificial Limb Centre, Pune, India. The results of 95 amputations on 56 patients are examined with respect to cause, age and sex distribution, and level of amputation. The benefits of this amputation to the bilateral amputee are discussed.

A clinical study of amputations of the lower limb.

A retrospective study of 525 cases of lower limb amputation attending the Outpatient Department of the Rehabilitation and Artificial Limb Centre and various rural clinics from January 1976 to March 1978 was carried out. Males outnumbered females and the majority of cases were in the 3rd decade. Trauma was the most common cause of amputation followed by peripheral vascular disease and neoplastic lesions. The stump was considered to be satisfactory in more than half of the cases studied. Proper postoperative care was lacking in most of those amputated at other centres.