Lower Limb Amputation Research Articles

Effectiveness of telerehabilitation-based structured exercise program in individuals with unilateral transtibial amputation: a randomized controlled study

Purpose The study aimed to compare the effects of home exercise alone and telerehabilitation combined with home exercise in individuals with transtibial amputation. Materials and methods The telerehabilitation group (n = 24) received telerehabilitation combined with home exercise, while the control group (n = 24) received home exercise alone. Outcomes included the timed up-and-go (TUG) test and the 30-second chair-stand test (30CST), the Activities-specific Balance Confidence (ABC) Scale, the Trinity Amputation and Prosthesis Experience Scales (TAPES), the Amputee Body Image Scale (ABIS), and the Nottingham Health Profile (NHP). The analysis used a 2 × 2 mixed repeated measures ANOVA. Results The group-by-time interactions were significant for TUG (p = 0.002, F[1;41] = 10.74) and 30CST (p = 0.001, F[1;41] = 11.48). The mean difference (6th week-baseline) was −0.49 for TUG and 0.95 for 30CST in the telerehabilitation group and −0.14 for TUG and 0.13 for 30CST in the control group. There were statistically meaningful group-by-time interactions on the ABC (p = 0.0004, F[1;41] = 14.47), the TAPES-activity restriction (p = 0.0001, F[1;41] = 28.96), TAPES-prosthesis satisfaction (p = 0.004, F[1;41] = 9.19), and the NHP (p = 0.0002, F[1;41] = 16.07) favoring the telerehabilitation group. Conclusions Telerehabilitation combined with home exercise can offer greater benefits in improving gait, muscle strength, balance confidence, activity restriction, prosthesis satisfaction, and quality of life compared to home exercise alone for individuals with transtibial amputation. Implications for rehabilitation Exercise helps individuals with lower limb amputation overcome their physical limitations and enables them to use their prostheses effectively. Physiotherapy and rehabilitation after amputation are not at the desired level, and individuals with lower limb amputation encounter various difficulties in accessing physiotherapy. Telerehabilitation has great potential to facilitate access to physiotherapy for individuals with amputation and reduce resource utilization. In a relatively small sample of amputees, this study shows that telerehabilitation-based exercise improves physical health and quality of life.

Assessing health-related quality of life and clinical outcomes of patients with diabetes accessing healthcare in two public hospitals in south-eastern Ghana: a cross-sectional descriptive study.

Diabetes is a significant contributor to kidney failure, heart attack, strokes, lower limb amputation, blindness, and other complications that negatively impact health-related quality of life (HRQOL). This study assessed the HRQOL and clinical outcomes of patients with diabetes accessing healthcare in south-eastern Ghana. This was a hospital-based cross-sectional descriptivestudy conducted in the Ho Municipal and Ho Teaching Hospitals in Ghana among patients with type 2 diabetes who were seeking healthcare at both hospitals for at least 12months. Systematic random sampling technique was used to select 310 respondents out of the total sample size of 326 patients with type 2diabetes and data were collected using diabetes-39 questionnaire. The data were analysed using STATA 16.0. Socio-demographic and clinical variables were expressed as frequencies and percentages. Differences between proportions were tested using Chi-square to identify predictors of poor HRQOL and Pearson correlation for association. The p < 0.05 was considered significant. Out of 310 respondents, 171 (55.0%) had poor HRQOL. The predictors of poor HRQOL were age (p < 0.008), education (p < 0.028), employment (p < 0.001), residence (p < 0.01), duration of diabetes (p < 0.002), diabetes education (p < 0.001), BMI (p < 0.005), and glycaemic control (p < 0.001). Energy and mobility (63.2%), anxiety and worry (53.9%), and diabetes control (49.6%) dimensions were the most prevalent of poor HRQOL. Diabetes education, complications, being diabetic for 16years and above, earning income, resident in rural area, being married, being pensioner and national Service Personnel, and diabetes comorbidities were significantly associated with HRQOL. More than half of the respondents had poor HRQOL. Clinical and public health efforts should focus on effective control and screening measures for the individual patients and general population.

Effect of Adding Virtual Reality Training to Traditional Exercise Program on Pain, Mental Status and Psychological Status in Unilateral Traumatic Lower Limb Amputees: A Randomized Controlled Trial.

Background: Lower limb amputation is an emotionally devastating condition that causes a complete change in the quality of life, may lead to phantom limb pain in most of the cases, and puts the individual in a high risk of developing psychological disorders. The objective of this study is to evaluate the consequence of adding virtual reality (VR) to a traditional exercise program on pain, mental status, and psychological status in traumatic unilateral lower limb amputees (LLAs). Methods: Thirty-two traumatic LLAs were randomly assigned into two equal groups in this randomized control trial. Participants did accomplish a postfitting exercise program at least 6 months before enrolment; the control group (CG) underwent a traditional rehabilitation program, and experimental group (EG) had the same program, in addition to VR training. Data were collected before and after 6 weeks of intervention using visual analog scale (VAS) for pain, Beck's depression inventory (BDI) for depression, and 12-item short form survey for mental health summary (MHS) and physical health summary (PHS). Results: Thirty-two amputees (29 males and 3 females) were included with mean age in CGs and EG (27.6 ± 4) and (27.6 ± 7.6) years, respectively. Postintervention, the VAS score was significantly reduced only in EG (P = 0.003). Both groups showed significant improvement in BDI, MHS, and PHS (P < 0.05). However, the EG showed a superior significance in BDI and MHS scores (P < 0.05). There was no significance between groups in PHS score. Conclusion: Adding VR to conventional training is beneficial in decreasing pain and in improving depression and MHS of traumatic unilateral LLAs.

A pilot on the use of stride cadence for the characterization of walking ability in lower limb amputees

Amputations are a prominent affliction that occur worldwide, with causes ranging from congenital, disease-based, or external reasons such as trauma. Prosthesis provides the closest alternative functional replacement to the loss of a limb. Before any form of rehabilitation support can be offered to amputee patients, an assessment of their degree and level of mobility first needs to be evaluated using the K-level grading system. The typical means towards the assigning of a K-level grading is through qualitative methods, which have been criticized for being subjective and, at times, imprecise. As a means towards remedying this shortcoming, we investigated the prospect of utilizing data from wearable sensors for analyzing the stride pattern and cadence of various subjects towards the quantitative inference of a K-level. This was accomplished using data from accelerometers, alongside advanced signal processing and machine learning models, towards the quantitative identification and differentiation of the various K-levels of amputees of varied levels of mobility. The experimental results showed that this aim could be accomplished under the circumstance investigated and the models applied as part of this research. Additional analysis was also done on the use of data from accelerometers towards the differentiation between amputated and non-amputated subjects, which showed that the cohorts could be classified and differentiated using purely accelerometer data and the accompanying postprocessing methods.

Factors associated with diabetic foot ulcers and lower limb amputations in type 1 and type 2 diabetes supported by real-world data from the German/Austrian DPV registry.

Diabetic foot ulcer (DFU) is a leading cause of lower limb amputations in people with diabetes. This study was aimed to retrospectively analyze factors affecting DFU using real-world data from a large, prospective central-European diabetes registry (DPV [Diabetes-Patienten-Verlaufsdokumentation]). We matched adults with type 1 (T1D) or type 2 diabetes (T2D) and DFU to controls without DFU by diabetes type, age, sex, diabetes duration, and treatment year to compare possible risk factors. Cox regression was used to calculate hazard ratios for amputation among those with DFU. In our cohort (N = 63 464), male sex, taller height, and diabetes complications such as neuropathy, peripheral artery disease, nephropathy, and retinopathy were associated with DFU (all p < .001). Glycated hemoglobin (HbA1c) was related to DFU only in T1D (mean with 95% confidence interval [CI]: 7.8 [6.9-9.0] % vs 7.5 [6.8-8.5] %, p < .001). High triglycerides and worse low-density lipoprotein/high-density lipoprotein ratio were also associated with DFU in T1D, whereas smoking (14.7% vs 13.1%) and alcohol abuse (6.4% vs 3.8%, both p < .001) were associated with DFU in T2D. Male sex, higher Wagner grades, and high HbA1c in both diabetes types and insulin use in T2D were associated with increased hazard ratios for amputations. Sex, body height, and diabetes complications were associated DFU risk in adults with T1D and T2D. Improvement in glycemic control and lipid levels in T1D and reduction of smoking and drinking in T2D may be appropriate interventions to reduce the risk for DFU or amputations.

Editor's Choice – Analysis of Lower Limb Amputations in Brazil’s Public Health System over 13 Years

Understanding the causes of amputation is crucial for defining health policies that seek to avoid such an outcome, but only a few studies have investigated the epidemiology of patients submitted to amputations in developing countries. The objective of this study was to analyse all lower limb amputations performed in the public health system in Brazil over a 13 year period, evaluating trends in the number of cases, patient demographics, associated aetiologies, hospital length of stay, and in hospital mortality rate. This was a retrospective, population based analysis of all lower limb amputations performed in the Brazilian public health system between 1 January 2008 and 31 December 2020. Using a public database, all types of amputations were selected, defining the number of procedures, their main aetiologies, anatomical level of limb loss, demographic data, regional distribution, and other variables of interest. A total of 633 455 amputations were performed between 2008 and 2020, mostly (55.6%) minor amputations, predominantly in males (67%). There was an upward trend in the number of amputations, determined mainly by the increase in major amputations (50.4% increase in the period). Elderly individuals have the highest rates of amputation. Diabetes mellitus (DM) is becoming the main primary diagnosis associated with amputations over the years. The highest in hospital mortality rate occurred after major amputations and was associated with peripheral arterial disease (PAD). Amputation rates in Brazil show an upward trend. DM is becoming the most frequent associated primary diagnosis, although PAD is the diagnosis most associated with major amputations and in hospital death.

Electrical Burn and Amputations in a Burn Center in Addis Ababa, Ethiopia.

Burn injuries are a global public health problem and continue to be one of the leading causes of unintentional death and injury. Electrical injuries, a relatively rare cause of burns, are increasingly being reported with higher rates of mortality in low and middle-income countries due to rapid industrialization in the absence of safety regulations. Electrical burn injuries can result in death, various organ system dysfunctions, or limb amputations. A 5-year retrospective, cross-sectional study was conducted to assess the rate of amputation and associated risk factors in electrical burn injuries among burn patients at AaBET Hospital in Addis Ababa, Ethiopia. The rate of amputation among the 150 patients admitted with electrical burn in the study period was 33.3% (n = 50). A majority (62%; n = 31) of the patients were men (M:F 1.6:1) in the age range of 18-65 years. A fallen electrical wire coming in contact with the patients was the cause of the electrical burns in 50% of the cases. 65.3% of the patients had upper limb amputations, whereas 34.7% had lower limb amputations. Major amputations were more likely to occur when the entry site was the hand, whereas minor amputations were more likely to occur when the entry site was the scalp (P = 0.005). Younger male patients were identified as the main victims of electrical burns that resulted in amputations. Electrical burns showed substantial morbidity and mortality of patients. Total body surface area and entry site being the hand significantly affected the level and site of amputation.

StructuralDPPIV: a novel deep learning model based on atom structure for predicting dipeptidyl peptidase-IV inhibitory peptides.

Diabetes is a chronic metabolic disorder that has been a major cause of blindness, kidney failure, heart attacks, stroke, and lower limb amputation across the world. To alleviate the impact of diabetes, researchers have developed the next generation of anti-diabetic drugs, known as dipeptidyl peptidase IV inhibitory peptides (DPP-IV-IPs). However, the discovery of these promising drugs has been restricted due to the lack of effective peptide-mining tools. Here, we presented StructuralDPPIV, a deep learning model designed for DPP-IV-IP identification, which takes advantage of both molecular graph features in amino acid and sequence information. Experimental results on the independent test dataset and two wet experiment datasets show that our model outperforms the other state-of-art methods. Moreover, to better study what StructuralDPPIV learns, we used CAM technology and perturbation experiment to analyze our model, which yielded interpretable insights into the reasoning behind prediction results. The project code is available at https://github.com/WeiLab-BioChem/Structural-DPP-IV.

Estimating Control Torque for Postural Balance Among Unilateral Lower Limb Amputees During Different Visual Environments

Estimating Control Torque for Postural Balance Among Unilateral Lower Limb Amputees During Different Visual Environments

Epidemiology of Non-Traumatic Lower Extremities Amputations in West Africa: Nationwide Data from Togo

Non-traumatic lower limb amputation (NT-LLA) has consequences at individual and public health levels. Population based studies in sub-Saharan Africa are scarce and often related to single centre series. This study aimed to estimate the incidence of NT-LLA (minor and major) and to describe epidemiological, clinical, and prognostic aspects in Togo. This was a population based observational study conducted among all patients who underwent NT-LLA. Traumatic amputations were excluded. Sociodemographic, clinical, and work up data were collected from clinical files in any Togolese health centre from 1 January 2016 to 31 December 2021. Incidence rates were adjusted for age. Over the six year period, 352 patients (59% males) underwent NT-LLA (mean ± standard deviation age 60 ± 15.7 years). The average age adjusted incidence rate of NT-LLA was 8.5 per million/year (95% confidence interval [CI] 7.6 - 9.4). Men were 1.7 times more likely to undergo a NT-LLA than women. The relative risk of NT-LLA was 48 times higher in patients with diabetes than in patients without diabetes. Around 61.0% of the NT-LLAs occurred within the 50 - 74 age group and 54.3% had diabetes mellitus. Among amputees, 54.5% had a diagnosis of peripheral artery disease (PAD) and 52.8% had diabetic ulcers, with co-existence of several factors. Less than 5% of participants had a history of smoking tobacco. Average length of hospital stay was 12 days. The in hospital mortality rate was 8.8% (9.0% for major, 6.7% for minor amputations). Only 18.2% had duplex ultrasound performed and 1.7% angiography prior to amputation. No patient underwent vascular intervention prior to amputation. This is the first study to report nationwide and contemporary epidemiological data on NT-LLAs in West Africa, highlighting several specificities. Large scale interventions are needed to ameliorate the care of diabetes and PAD and improve facilities for optimal management of patients at risk of amputation in Africa.

The role of medical-grade maggots in facilitating healing of diabetic foot ulcers in Kano, northern Nigeria: a case series.

Approximately 13% of people living with diabetes develop one or more ulcers during the course of the disease, and diabetic foot ulcer (DFU) is responsible for >60% of lower limb amputations worldwide. This case series aimed to demonstrate the effectiveness of medical-grade maggots on DFUs in promoting wound healing and reducing related hospital stays in northern Nigeria. Maggot debridement therapy (MDT) was applied to the DFUs of patients who consented to this treatment between January-August 2021 at the Orthopaedic Unit of the Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Sterile first instar larvae of Lucilia sericata were obtained indigenously and applied using the confinement (free-range) method under aseptic procedure. A total of 15 patients with DFUs of Wagner classification grades III (33.3%) and IV (66.7%), were seen and documented. The patients included 10 (66.7%) females and five (33.3%) males, giving a female:male ratio of 2:1. The mean age (±standard deviation) of the respondents was 51.6±10.8 years. The surface area of the wounds ranged from 24-140cm2, with a median value of 75cm2. Among the patients, 60% had two cycles of MDT, with a median duration of five days. Most of the wounds (53.3%) were debrided within five days; 13.3% (two wounds) took seven days to be fully debrided. A paired sample t-test showed a statistically significant association between wound surface area and therapy duration (t=8.0; p=0.000) and between wound surface area and cycles of therapy (t=8.3; p=0.000). Before maggot application, 14 (93.3%) DFUs were completely (100%) covered with slough and only one (6.7%) was 95% covered with slough. After maggot application, 10 (66.7%) wounds were completely debrided while five (33.3%) wounds required bedside surgical debridement to achieve complete debridement. A paired sample t-test showed statistically significant difference between the pre- and post-MDT slough covering the wounds (t=45.1; p=0.000). In this case series, MDT was successfully used in the debridement of DFUs, which facilitated the healing process with an encouraging clinical outcome.

Distinct patterns of metabolic motor cortex activity for phantom and residual limb pain in people with amputations: A functional near-infrared spectroscopy study

BackgroundPhantom pain limb (PLP) has gained more attention due to the large number of people with amputations around the world and growing knowledge of the pain process, although its mechanisms are not completely understood. ObjectivesThe aim of this study was to understand, in patients with amputations, the association between PLP and residual limb pain (RLP), and the brain metabolic response in cortical motor circuits, using functional near-infrared spectroscopy (fNIRS). MethodsSixty participants were recruited from the rehabilitation program in São Paulo, Brazil. Included patients were aged over 18 years, with traumatic unilateral lower-limb amputation, with PLP for at least 3 months after full recovery from amputation surgery. PLP and RLP levels were measured using visual analogue scales. fNIRS was performed during motor execution and motor mirror tasks for 20 s. In order to highlight possible variables related to variation in pain measures, univariate linear regression analyses were performed for both experimental conditions, resulting in four fNIRS variables (two hemispheres x two experimental conditions). Later, in order to test the topographic specificity of the models, eight multivariate regression analyses were performed (two pain scales x two experimental conditions x two hemispheres), including the primary motor cortex (PMC) related channel as an independent variable as well as five other channels related to the premotor area, supplementary area, and somatosensory cortex. All models were controlled for age, sex, ethnicity, and education. ResultsWe found that: i) there is an asymmetric metabolic activation during motor execution and mirror task between hemispheres (with a predominance that is ipsilateral to the amputated limb), ii) increased metabolic response in the PMC ipsilateral to the amputation is associated with increased PLP (during both experimental tasks), while increased metabolic response in the contralateral PMC is associated with increased RLP (during the mirror motor task only); ii) increased metabolic activity of the ipsilateral premotor region is associated with increased PLP during the motor mirror task; iii) RLP was only associated with higher metabolic activity in the contralateral PMC and lower metabolic activity in the ipsilateral inferior frontal region during motor mirror task, but PLP was associated with higher metabolic activity during both tasks. ConclusionThese results suggest there is both task and region specificity for the association between the brain metabolic response and the two different types of post-amputation pain. The metabolic predominance that is ipsilateral to the amputated limb during both tasks was associated with higher levels of PLP, suggesting a cortical motor network activity imbalance due to potential interhemispheric compensatory mechanisms. The present work contributes to the understanding of the underlying topographical patterns in the motor-related circuits associated with pain after amputations.

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.

Exploring the Role of Free Tissue Transfers in the Preservation of Bone Length and Knee Joint Function after Lower Limb Trauma: A Retrospective Analysis.

Lower limb trauma often results in mangled extremities, and in some cases, complete amputation may be necessary. However, limiting the extent of amputation and preserving the major knee joint are crucial to enhance mobility and overall functionality. By providing painless soft tissue coverage on the stump, early prosthesis use and the initiation of physiotherapy become more feasible. Soft tissue transfers hold the potential to benefit patients in two essential aspects: first, resolving soft tissue deficiencies without causing bone shortening, and second, preparing the stump to enhance overall functionality. A retrospective study conducted at Chang Gung Memorial Hospital (2009-2016) focused on lower limb amputation patients who underwent soft tissue transfers at different time periods compared to those without stump reconstruction. Out of the 2391 cases of lower limb injuries treated operatively, 117 amputations were performed in 110 patients (44 above the knee and 73 below the knee). Among them, 12 patients received soft tissue transfers for limb salvage and soft tissue deficiency after amputations. It was observed that patients in this group were typically younger, predominantly female, had longer hospital stays, and underwent a greater number of surgical procedures (p < 0.05). Through the use of soft tissue transfers, successfully preserved tibial bone length and functional knee joint in selected patients was achieved. This approach effectively resolved soft tissue deficiencies following lower limb amputations, optimizing physiotherapy and facilitating functional rehabilitation.

Assessment of 3D printed mechanical metamaterials for prosthetic liners.

This study focuses on novel design and evaluation of Elastic 50A (EL50) mechanical metamaterials with open-cell patterns for its potential application to lower limb residuum/socket interfaces, specifically that of a transtibial (TT) amputee. Mechanical characteristics, that is, effective Young's modulus (E), was tuned by altering metamaterial porosity, which was experimentally verified. Specifically, pore radius of the unit cell was varied to achieve a range of E-values (0.05-1.71 MPa) for these 3D printed metamaterials. Finite Element Analysis (FEA) was conducted to evaluate pressure distribution across key load-bearing anatomical sites of a TT residuum. Using designed metamaterials for homogeneous liners, pressure profiles were studied and compared with a silicone liner case. Additionally, a custom metamaterial liner was designed by assigning appropriate metamaterials to four load-sensitive and tolerant anatomical sites of the TT residuum. The results suggest that lowest pressure variation (PV), as a measure of pressure distribution levels and potential comfort for amputees, was achieved by the custom metamaterial liner compared to any of the homogeneous liners included in this study. It is envisaged that this work may aid future design and development of custom liners using now commonly available 3D printing technologies and available elastomer materials to maximise comfort, tissue safety and overall rehabilitation outcomes for lower limb amputees.

Traditional Herbal Medications Utilized in the Indian Medical System forthe Management of Diabetes: An Updated Review and Clinical Implications.

Phytomedicine, also called botanical medicine, is the practice of using plants to treat disease. Diabetes, for example, has been treated and prevented with herbal medication for a lot longer than Western medicine. Worldwide, diabetes has become a major health concern. The management of diabetes and hyperglycemia, two of the most common public health threats, is far from ideal. When hyperglycemia persists or is not under control, diabetes-related complications, like blindness, lower limb amputations, renal disease, and cardiovascular disease, play a significant role in the morbidity and mortality of the disease. Although chemicals and biochemical agents can assist in managing diabetes, there is currently no complete cure for the disease. Herbal remedies are one of many methods that can be used to treat and prevent diabetes and its subsequent problems. Numerous traditional treatments have been discovered for diabetes as a result of extensive research efforts. However, there are many factors to consider when deciding which herbs to use, such as the patient's financial status, the presence or absence of co-morbidities, and the accessibility, cost-effectiveness, and safety profile of the herbs. This article focuses on the use of herbal and natural remedies in the treatment and prevention of diabetes, the mechanisms by which these remedies lower blood glucose levels, and the specific herbal items now utilized in the management of diabetes.

Functional Mobility in Individuals With Lower Limb Amputation: An Observational Study.

Amputation leads to a permanent disability and brings a dramatic change in the life and function of the individual, more so in individuals with lower limb amputation. A lower limb amputation reduces mobility and can make persons dependent on assistive devices like crutches or a wheelchair. Restoring mobility and optimal physical functioning of an individual with lower limb amputation is the most important rehabilitation goal. There are very few studies that have quantified mobility deficits with valid outcome measures, especially in the Indian population. Our study aims to quantify the mobility deficit in individuals with lower limb amputation and add to the scant literature available on mobility values in the Indian population. This was a cross-sectional study. Individuals with lower limb amputation who attended an orthotic and prosthetic clinic in Vadodara city were recruited for the study. Those individuals who were above 18 years of age and had undergone either unilateral or bilateral amputation, at least six weeks prior to assessment, were included in the study. Those individuals who had total impairment of vision and hearing, cognitive impairment, upper limb amputation, and ankle and foot amputation were excluded from the study. Functional mobility was assessed with the prosthesis worn, using the Timed "Up and Go" (TUG) test. There was a total of 54 individuals with lower limb amputation, 47 males and seven females. The mean age was 47.38±18.83 years. Transtibial (66.67%) was the most common amputation followed by transfemoral (27.8%). The mean TUG score for the total population was 20.19 ± 11.95 sec, for unilateral transfemoral amputation20.26 ± 12.06 sec, and for unilateral transtibial amputation 20.01 ± 12.31 sec. There was a statistically significant direct relation of the TUG score with age (p=0.02), level of amputation (p<0.01), andlength of time prosthesis was used (in years) (p=0.02) and a statistically significant inverse relation of TUG score with the cause of amputation (traumatic, p=0.02, non-traumatic, p=0.03), assistive devices used for mobility (p<0.01), and number of hours the prosthesis was worn in a day (p<0.01). There was a significant negative correlation between the duration of amputation and TUG score (r=-0.282, p<0.05) Conclusion: The functional mobility was reduced in individuals with lower limb amputation. There was a statistically significant direct relation of functional mobility with age, cause of amputation, level of amputation, and length of time of prosthesis used, and a statistically significant inverse relation with the number of hours of use of prosthesis in a day and assistive devices used. Individuals who were old, had a non-traumatic amputation, a higher level of amputation, those wearing a prosthesis for a short duration since amputation, who wore the prosthesis for a shorter duration during the day, and who used assistive devices for ambulation in addition to a prosthesishad longer TUG times. As the duration of amputation increased, the time taken for TUG decreased.

Systematic review on the centrocentral anastomosis technique for the surgical treatment of traumatic neuromas

Aim: Centrocentral anastomosis (CCA) can be applied in the treatment of painful neuromas, by connecting nerve ends or fascicles after neuroma resection, with or without an interposed nerve graft. While this technique was developed directly after the introduction of microsurgical techniques, it is currently not frequently applied in neuroma treatment. Methods: In this article, the literature on CCA was systematically reviewed, both for clinical and experimental studies. Specific attention was paid to the different surgical techniques, potential applications, and pathophysiologic mechanisms that might explain how CCA can prevent neuroma formation. Results: A total of 15 articles were found on this subject, 11 clinical and 4 experimental studies. In clinical studies, CCA was mostly applied for neuroma treatment following amputation of fingers and lower limbs. In experimental studies, different combinations of nerve connections and grafts were investigated in the rat sciatic nerve model. Pain reduction in the clinical studies overall was good to excellent, but only in two studies control groups were used. Results from experimental studies showed that the use of an interposed graft was beneficial by entrapment of axons inside the graft. Conclusion: Although CCA has shown promising results for neuroma treatment, there are only a few case series to date, one cohort and one randomized study, and in the latter two, no graft was used. More research is needed to investigate the outcome of CCA, especially for the option of an interposed nerve graft. This investigation should involve comparisons with alternative techniques, utilization of standardized outcome measures, and, preferably, inclusion of longer follow-up periods.

Effect of Sensory Re-Education with Aerobic Training on Sensation and Balance among Diabetic Peripheral Neuropathy Patients: A Pilot Study

Background: People with diabetes have 10 to 30 times higher risk of lower limb amputation than people without thedisease. 85% of non-traumatic amputations in diabetic patients begin with a foot ulcer. Therefore, early interventionis necessary to control the symptoms of diabetic peripheral neuropathy and improve balance. Resistance andaerobic training reduce diabetic symptoms by lowering HbA1C levels. In order to restore functional sensibility,improve adaptive functioning, and improve balance, sensory re-education and aerobics are combined. Therefore,the aim of this study is to find out the effect of Sensory re-education and aerobics on sensation and balance amongdiabetic peripheral neuropathy patients.Purpose: The Purpose of the study is to determine the effects of sensory re-education with aerobic training onsensory perception and balance in Diabetic peripheral neuropathy patients.Material and Method: This study included diabetic individuals of both genders between the ages of 45-60, lowPAR-Q risk scores and Toronto clinical neuropathy scores (TCNS) between 6 and 11. A total of 20 participantswere randomly selected and received sensory re-education with aerobics for six weeks.Results: Individuals with diabetic peripheral neuropathy experienced statistically significant improvement inTCNS from 9.3±1.25 to 4.5± 1.3, in BBS 48.5 ± 2.70 to 41.7±1.41, in TUG 8.12±1.28 to 6.95 ±1.30, with a P value of &lt;0.01.Conclusion: Sensory re-education with aerobic training for 6 weeks of duration reported improvement in sensoryperception and balance among people with diabetic peripheral neuropathy patients.

Methodology to Investigate Effect of Prosthetic Interface Design on Residual Limb Soft Tissue Deformation.

Residual limb discomfort and injury is a common experience for people living with lower limb amputation. Frequently, inadequate load distribution between the prosthetic device and the residual limb is the root cause of this issue. To advance our understanding of prosthetic interface fit, tools are needed to evaluate the mechanical interaction at the prosthetic interface, allowing interface designs to be evaluated and optimised. Present a methodology report designed to facilitate comprehension of the mechanical interaction between the prosthetic interface and the residual limb. As a pilot study, this methodology is used to compare a hands-on and hands-off interface for a single transtibial prosthesis user using secondary Magnetic Resonance Imaging (MRI) data. MRI data of the residual limb while wearing a prosthetic interface is segmented into a hard tissue and a skin surface model. These models are exported as stereolithography (STL) files. Two methods are used to analyse the interface designs. Firstly, CloudCompare software is used to compute the nearest vertex on the skin surface for every vertex on the compiled internal bony surface for both interface types. Secondly, CloudCompare software is used to compare registered skin surfaces of the residual limb while wearing the hands-on and hands-off interfaces. The maximum and minimum nearest distances between the internal bony surface and skin surface were similar between interface types. However, the distribution of nearest distances was different. When comparing the skin surface while wearing both interfaces, where the fit is more compressive can be visualized. For the dataset used in this study, the classic features of a hands-on Patella Tendon Bearing interface and hands-off pressure cast interface could be identified. The methodology presented in this report may give researchers a further tool to better understand how interface designs affect the soft tissues of the residual limb.