Unilateral Below-knee Amputees Research Articles

The home-based mirror therapy in the reduction of phantom limb pain in unilateral below-knee amputees

The home-based mirror therapy in the reduction of phantom limb pain in unilateral below-knee amputees

Effect of pain on activity and participation in individuals with unilateral lower-extremity amputation based on the International Classification of Functioning, Disability, and Health.

Amputation is a major life-changing event and is regarded as one of the loading causes of permanent disability. However, amputation often causes changes in painful and nonpainful sensory experiences. Pain after amputation has been shown to increase functional limitations caused by limb loss and lower quality of life. This study aimed to examine the effect of pain on activity and participation in individuals with unilateral below-knee amputations according to the International Classification of Functioning, Disability, and Health. Cross-sectional study. In the study, 64 individuals were divided into 2 groups: those who experienced pain and those who did not. Group 1 included 33 below-knee amputees who experienced pain (27 males, mean age 43.9 ± 12.6 years) and Group 2 included 31 below-knee amputees who did not experience pain (25 males, mean age 47.4 ± 12.1 years). The McGill Pain Questionnaire and visual analog scale were used to assess pain, the Prosthetic Limb Users Survey of Mobility was used to assess activity, and the Reintegration to Normal Living Index was used to assess participation. Demographic characteristics of the 2 groups were statistically insignificant (P > 0.05). The nonpainful group had significantly higher activity and participation scores than the painful group (P < 0.001). It was found that phantom pain and stump pain in below-knee amputees limited activity and participation. It was also shown that phantom pain has a more negative effect on the activity level of individuals than stump pain.

Feasibility of Freedom of Information Requests for Amputee Epidemiology in the United Kingdom.

While each of the 44 National Health Service commissioned artificial limb clinics in the United Kingdom record information about their own prosthetic limb users, these are not collated to give a national picture of amputee epidemiology. The requirement to respond to Freedom of Information (FoI) requests within 20 working days offers another way of extracting data from all centres, and this study describes a first attempt to use this method to update national epidemiological data. Questions were sent to the FoI email addresses of all 44 centres, requesting numbers of adult unilateral below-knee amputees, adult unilateral above or through-knee amputees and child unilateral above or through-knee amputees (all of K2 level mobility), numbers of people consistently using a prosthesis with a single axis myoelectric hand, and access to an occupational therapist with skills to teach someone to use a myoelectric hand. A FoI request was sent to NHS England seeking release of data that they collect every month from all the prosthetic services which they commission in England. All but one of the UK centres responded, the great majority within 31 days. Incomplete results were generally due to centres finding the questions ambiguous and many did not record mobility levels consistently. While 33 centres had access to skilled occupational therapy, only 4 reported more than 10 patients who constantly used a single axis myoelectric hand. Eighteen centres were unable to provide complete data, and the remainder reported a ranges of 5 to 992 below-knee amputees, 7 to 574 adult above-knee amputees and 0 to 137 child above-knee amputees, suggesting different approaches to managing missing mobility level data. Freedom of Information requests are an inexpensive way of gathering data from NHS prosthetic clinics, which can identify age, sex, level of amputation but not activity levels or use of a prosthesis and hence only gives limited demographic information of the amputee cohort.

Motion Analysis of a Frontal Plane Adaptable Prosthetic Foot.

ABSTRACT Introduction An objective of designing a prosthetic foot is to achieve the natural adaptability of the foot and ankle on various surfaces and different forms of gait. Frontal plane position of the foot relative to the shank changes with many functional aspects of gait, such as turning, stairs, and walking on uneven ground. Prosthetic foot designs have variable frontal plane adaptability. An investigation foot with a linkage with ±10° of frontal plane motion was developed to improve frontal plane response under various conditions. The purpose of this study was to compare the kinematics of locked and unlocked conditions of a frontal plane adaptable prosthetic foot and the person’s usual foot while walking forward on a level surface, on an unstable rock surface, and sidestep, using a crossover design. These different conditions result in changes in frontal plane motion in the anatomical foot and ankle, and the current study evaluates whether there are similar trends in prosthetic feet. Materials and Methods People were included if they had a unilateral below-knee amputation, intact residual limb skin, were over 16 years old, and were able to walk more than 400 m on level ground without using a walking aid and without an increase in pain. The control group was people without amputations who completed the procedures once. Participants with amputations completed forward walking on level ground, on an unstable rock surface, and sidestep with their usual foot. Then after 2 weeks of accommodation, participants repeated these tests with the investigational foot unlocked and locked. Motion analysis data were collected with a 12-camera optically based system. Primary outcomes were sagittal and frontal plane motions of the foot relative to the shank. In addition, step length, step width, and stride velocity were obtained from the kinematic measures. Paired t-tests were used for statistical inference for individual participant comparisons. Unpaired t-tests were used for comparisons between the controls and people with amputations. Results Twenty-one people with amputations and 10 controls completed the tests. Participants with amputation had 16 different usual feet. There was a wide variation in usual foot motion during forward walking, whereas investigational foot conditions showed less variability. During level walking, control subjects had more frontal plane motion than any of the foot conditions, and the unlocked had more frontal plane motion than the usual foot and locked condition. Walking across an unstable rock surface showed similar trends, with control participants having more sagittal and frontal plane ankle motion compared with any prosthetic foot condition. Also, the unlocked had statistically greater frontal plane motion than the usual foot or locked condition. Sidestep results were also consistent with other gait tests. The control participants’ sagittal plane ankle range of motion was significantly more than the prosthetic sagittal plane motion for all foot conditions, whether the prosthetic side was leading or trailing. There was significantly more frontal plane motion with the unlocked than the usual foot and locked condition when the prosthetic foot was trailing or leading. Discussion and Conclusions Wide variation in usual foot range of motions in the frontal and sagittal planes confirmed the need for additional controls when considering the effect of the linkage alone. The unlocked had increased frontal plane ranges of motion compared with the locked and the majority of usual foot for all gait conditions, including level walking. This finding demonstrated that people with amputations were functionally using the additional range of motion provided by the linkage. However, control subjects used more range of motion in both the sagittal and frontal planes for the unstable rock surface and sidestepping. Increased frontal plane range of motion did not translate into improved stride length and velocity, step width, or center of mass deviations. Clinical Relevance The person-specific functional activities should be considered when choosing a prosthetic foot. A prosthesis with frontal plane motion may be applicable for a person who moves in a sidestep pattern or on uneven ground.

Utility outcomes score assessment of living with below-knee amputation

Objectives: Lower limb trauma that involves severe soft-tissue injuries continues to pose treatment challenges when considering whether to perform an amputation or salvage the injured extremity. This study aimed to measure the perceived health burden of living with unilateral below-knee amputation (BKA). A secondary aim was to compare the health burden of living with BKA and single-eye blindness and/or double-eye blindness (SEB and DEB). Methods: A web-based survey was utilized to establish the effectiveness of outcome scores for three health states (unilateral BKA, SEB, and DEB) in a sample of 116 participants recruited from the general population. The outcome measures included the time trade-off (TTO), standard gamble (SG), and visual analog scale (VAS) tests. Results: The TTO, SG, and VAS scores for BKA were 0.75 ± 0.2, 0.78 ± 0.18, and 0.57 ± 0.16, respectively. These measures indicate that participants were willing to undergo a theoretical surgery that carries a 22% chance of mortality and trade 9 years of life to avoid a BKA. These were lower than the values of SEB VAS (P = 0.02) and TTO (P = 0.002) tests and the SG measure (0.8 ± 0.17, P = 0.09). Age, gender, race, income, and education were not statistically significant independent predictors of the utility scores for BKA. Conclusion: When faced with a BKA, individuals in our sample population would choose to undergo reconstructive surgery with a hypothetical 22% chance of mortality. They would be willing to sacrifice 9 years of their life for such a surgery to avoid a BKA. These data can be beneficial to understand better how patients perceive their disability and help in patients’ counseling.

Biomechanical evaluation over level ground walking of user-specific prosthetic feet designed using the lower leg trajectory error framework

The walking pattern and comfort of a person with lower limb amputation are determined by the prosthetic foot’s diverse set of mechanical characteristics. However, most design methodologies are iterative and focus on individual parameters, preventing a holistic design of prosthetic feet for a user’s body size and walking preferences. Here we refined and evaluated the lower leg trajectory error (LLTE) framework, a novel quantitative and predictive design methodology that optimizes the mechanical function of a user’s prosthesis to encourage gait dynamics that match their body size and desired walking pattern. Five people with unilateral below-knee amputation walked over-ground at self-selected speeds using an LLTE-optimized foot made of Nylon 6/6, their daily-use foot, and a standardized commercial energy storage and return (ESR) foot. Using the LLTE feet, target able-bodied kinematics and kinetics were replicated to within 5.2% and 13.9%, respectively, 13.5% closer than with the commercial ESR foot. Additionally, energy return and center of mass propulsion work were 46% and 34% greater compared to the other two prostheses, which could lead to reduced walking effort. Similarly, peak limb loading and flexion moment on the intact leg were reduced by an average of 13.1%, lowering risk of long-term injuries. LLTE-feet were preferred over the commercial ESR foot across all users and preferred over the daily-use feet by two participants. These results suggest that the LLTE framework could be used to design customized, high performance ESR prostheses using low-cost Nylon 6/6 material. More studies with large sample size are warranted for further verification.

Para-Sports can Promote Functional Reorganization in the Ipsilateral Primary Motor Cortex of Lower Limbs Amputee

Background. Drastic functional reorganization was observed in the ipsilateral primary motor cortex (M1) of a Paralympic long jumper with a unilateral below-knee amputation in our previous study. However, it remains unclear whether long-term para-sports are associated with ipsilateral M1 reorganization since only 1 athlete with amputation was investigated. Objective. This study aimed to investigate the relationship between the long-term para-sports and ipsilateral M1 reorganization after lower limb amputation. Methods. Lower limb rhythmic muscle contraction tasks with functional magnetic resonance imaging and T1-weighted structural imaging were performed in 30 lower limb amputees with different para-sports experiences in the chronic phase. Results. Brain activity in the ipsilateral primary motor and somatosensory areas (SM1) as well as the contralateral dorsolateral prefrontal cortex, SM1, and inferior temporal gyrus showed a positive correlation with the years of routine para-sports participation (sports years) during contraction of the amputated knee. Indeed, twelve of the 30 participants who exhibited significant ipsilateral M1 activation during amputated knee contraction had a relatively longer history of para-sports participation. No significant correlation was found in the structural analysis. Conclusions. Long-term para-sports could lead to extensive reorganization at the brain network level, not only bilateral M1 reorganization but also reorganization of the frontal lobe and visual pathways. These results suggest that the interaction of injury-induced and use-dependent cortical plasticity might bring about drastic reorganization in lower limb amputees.

A Computational Gait Model With a Below-Knee Amputation and a Semi-Active Variable-Stiffness Foot Prosthesis.

Simulations based on computational musculoskeletal models are powerful tools for evaluating the effects of potential biomechanical interventions, such as implementing a novel prosthesis. However, the utility of simulations to evaluate the effects of varied prosthesis design parameters on gait mechanics has not been fully realized due to the lack of a readily-available limb loss-specific gait model and methods for efficiently modeling the energy storage and return dynamics of passive foot prostheses. The purpose of this study was to develop and validate a forward simulation-capable gait model with lower-limb loss and a semi-active variable-stiffness foot (VSF) prosthesis. A seven-segment 28-DoF gait model was developed and forward kinematics simulations, in which experimentally observed joint kinematics were applied and the resulting contact forces under the prosthesis evolved accordingly, were computed for four subjects with unilateral below-knee amputation walking with a VSF. Model-predicted resultant ground reaction force (GRFR) matched well under trial-specific optimized parameter conditions (mean R2: 0.97, RMSE: 7.7% body weight (BW)) and unoptimized (subject-specific, but not trial-specific) parameter conditions (mean R2: 0.93, RMSE: 12% BW). Simulated anterior-posterior center of pressure demonstrated a mean R2 = 0.64 and RMSE = 14% foot length. Simulated kinematics remained consistent with input data (0.23 deg RMSE, R2 > 0.99) for all conditions. These methods may be useful for simulating gait among individuals with lower-limb loss and predicting GRFR arising from gait with novel VSF prostheses. Such data are useful to optimize prosthesis design parameters on a user-specific basis.

Understanding patient preference in prosthetic ankle stiffness

BackgroundUser preference has the potential to facilitate the design, control, and prescription of prostheses, but we do not yet understand which physiological factors drive preference, or if preference is associated with clinical benefits.MethodsSubjects with unilateral below-knee amputation walked on a custom variable-stiffness prosthetic ankle and manipulated a dial to determine their preferred prosthetic ankle stiffness at three walking speeds. We evaluated anthropomorphic, metabolic, biomechanical, and performance-based descriptors at stiffness levels surrounding each subject’s preferred stiffness.ResultsSubjects preferred lower stiffness values at their self-selected treadmill walking speed, and elected to walk faster overground with ankle stiffness at or above their preferred stiffness. Preferred stiffness maximized the kinematic symmetry between prosthetic and unaffected joints, but was not significantly correlated with body mass or metabolic rate.ConclusionThese results imply that some physiological factors are weighted more heavily when determining preferred stiffness, and that preference may be associated with clinically relevant improvements in gait.

Asymmetry in Three-Dimensional Sprinting with and without Running-Specific Prostheses

As a whole, human sprinting seems to be a completely periodic and symmetrical motion. This view is changed when a person runs with a running-specific prosthesis after a unilateral amputation. The aim of our study is to investigate differences and similarities between unilateral below-knee amputee and non-amputee sprinters—especially with regard to whether asymmetry is a distracting factor for sprint performance. We established three-dimensional rigid multibody models of one unilateral transtibial amputee athlete and for reference purposes of three non-amputee athletes. They consist of 16 bodies (head, ipper, middle and lower trunk, upper and lower arms, hands, thighs, shanks and feet/running specific prosthesis) with 30 or 31 degrees of freedom (DOFs) for the amputee and the non-amputee athletes, respectively. Six DOFs are associated with the floating base, the remaining ones are rotational DOFs. The internal joints are equipped with torque actuators except for the prosthetic ankle joint. To model the spring-like properties of the prosthesis, the actuator is replaced by a linear spring-damper system. We consider a pair of steps which is modeled as a multiphase problem with each step consisting of a flight, touchdown and single-leg contact phase. Each phase is described by its own set of differential equations. By combining motion capture recordings with a least squares optimal control problem formulation including constraints, we reconstructed the dynamics of one sprinting trial for each athlete. The results show that even the non-amputee athletes showed less symmetrical sprinting than expected when examined on an individual level. Nevertheless, the asymmetry is much more pronounced in the amputee athlete. The amputee athlete applies larger torques in the arm and trunk joints to compensate the asymmetry and experiences a destabilizing influence of the trunk movement. Hence, the inter-limb asymmetry of the amputee has a significant effect on the control of the sprint movement and the maintenance of an upright body position.

Phantom pain decreases with vibrating silicone liner in lower limb amputee: a prospective study

Background: The purpose of this study was to design, construct, and evaluate the effectiveness of a vibrating silicone liner on the phantom pain of traumatic below-knee amputees. Methods: Twelve unilateral below-knee amputees who had phantom pain and did not use another treatment participated in this study. The patients were asked to use vibrating silicone liners for three 10-minute sessions daily for 30 days. The severity of pain was evaluated by the short form of the McGill Pain Questionnaire before and after 30 days of using the vibrating silicone liner. Results: The mental aspect of pain intensity, pain intensity based on visual analog scale (VAS), momentary pain intensity, and overall pain intensity decreased significantly after 30 days of using the vibrating silicone liner (P&lt;0.05). Also, there was a significant correlation between initial pain score and psychological aspect of pain (P=0.007). Conclusions: Using a vibrating silicone liner for three 10-minute sessions daily for a period of 30 days had a significant effect on the reduction of all the components of phantom pain in the patients who were included in this study. It seems that the vibrating silicone liner reduced phantom pain by creating heat, controlling gate of pain in the spinal cord, and psychological effects. Level of Evidence: Level II

Spatiotemporal Gait Asymmetry Distinguishes Fallers And Non-fallers In Below-knee Amputees

Introduction: Below-knee-amputees (BKA) are at a higher risk of falling compared to non-amputee controls. Gait patterns have been reported to be an important risk factor of falls: in particular, great disparity in asymmetry of kinematic parameters between lower limbs are observed in BKA. PURPOSE: To investigate differences between spatiotemporal symmetry gait patterns, functional mobility and balance confidence among unilateral BKA fallers and non-fallers. Method: Twenty-six unilateral BKA (14 fallers: 47.5±8.6 yrs; 29.5±4.5 kg/m2 and 12 non-fallers: 47.5±8.6 yrs; 31.1±5.5 kg/m2) completed 5 walking trials, at a self-selected pace, on a 4.3 m GaitRite system. Step length, swing time, and stance time for each limb was collected. Symmetry ratios between limbs were calculated. Self-reported falls within the past 12 months, Timed Up and Go (TUG) Test and the Activity-Specific Balance Confidence (ABC) questionnaire were also collected. Independent t-tests were performed to compare the fallers with the non-fallers. RESULTS: The fallers had significantly lower functional mobility (12.1±2.7 v. 8.5±1.1 sec) and reported lower balance confidence (77.4±10.9 v. 87.7±13.7) than the non-fallers (p < 0.05). The fallers also had significantly larger step length (1.12±0.05 v. 1.01±0.05), stance time (10.6±0.03 v. 1.02±0.02) and swing time (1.11±0.05 v. 1.04±0.05) asymmetries (p < 0.05). Discussion: These results suggest that spatiotemporal asymmetry could be useful in distinguishing prospective fallers from non-fallers among BKA. BKA fallers had increased gait asymmetry compared to the non-fallers, which may be attributed to prosthetic alignment, as well as acquired gait changes because of pain, and diminished strength and range of motion. These findings should be used by clinicians to identify BKA at a greater risk of falling, and specific functional and psychological interventions should be considered for these individuals to improve gait asymmetry, functional mobility, and balance confidence.

Ambulatory searching task reveals importance of somatosensation for lower-limb amputees

The contribution of somatosensation to locomotor deficits in below-knee amputees (BKAs) has not been fully explored. Unilateral disruption of plantar sensation causes able-bodied individuals to adopt locomotor characteristics that resemble those of unilateral BKAs, suggesting that restoring somatosensation may improve locomotion for amputees. In prior studies, we demonstrated that electrically stimulating the residual nerves of amputees elicited somatosensory percepts that were felt as occurring in the missing foot. Subsequently, we developed a sensory neuroprosthesis that modulated stimulation-evoked sensation in response to interactions between the prosthesis and the environment. To characterize the impact of the sensory neuroprosthesis on locomotion, we created a novel ambulatory searching task. The task involved walking on a horizontal ladder while blindfolded, which engaged plantar sensation while minimizing visual compensation. We first compared the performance of six BKAs to 14 able-bodied controls. Able-bodied individuals demonstrated higher foot placement accuracy than BKAs, indicating that the ladder test was sensitive enough to detect locomotor deficits. When three of the original six BKAs used the sensory neuroprosthesis, the tradeoff between speed and accuracy significantly improved for two of them. This study advanced our understanding of how cutaneous plantar sensation can be used to acquire action-related information during challenging locomotor tasks.

Limb saving by profundoplasty in patients with no distal runoff

Background With the great advancement of endovascular intervention in the management of both chronic and acute peripheral vascular disease, the need for open surgical intervention has markedly decreased over the past decade; however, in certain cases, a simple surgical intervention remains the only hope for limb saving. In this study, the authors presented a review for the effect of one of the oldest surgical vascular procedures, which is ‘profundoplasty’ and the authors focused on its role and outcome in cases presented with threatened limb with no distal runoff to the foot. Patients and methods This is a retrospective study conducted on 18 cases presented with 20 threatened limbs with no distal runoff and managed with either isolated profundoplasty or combined with other procedures in the period between May 2016 and May 2018 at the Vascular Surgery Department of Kasr Al Aini with the limb salvage as the end point. Results The study included 18 male patients with mean age of 50 years presented with 20 threatened limbs: 10 patients presented with critical limb ischemia classified according to Rutherford classification between class 4 and 6, and eight patients with 10 delayed acute limb ischemia category IIb (two patients presented with bilateral lower limb affection). Technical success was 100%; two cases of critical limb ischemia ended up with unilateral below-knee amputation, with limb salvage rate of 90%. Conclusion Profundoplasty remains a very effective procedure in the management of lower limb ischemia either acute or chronic, especially when other options cannot be performed and the case seems to be hopeless.

Chronic musculoskeletal pain, phantom sensation, phantom and stump pain in veterans with unilateral below-knee amputation.

Many individuals with lower limb loss report concerns about other musculoskeletal symptoms resulting from amputation. The objective of this study was to assess chronic musculoskeletal pain in Iranian veterans with unilateral below-knee amputation. The participants agreed to take part in a health needs assessment and were interviewed face-to-face by trained interviewers. The assessment consisted of demographic information, wearing a prosthesis, pain locations in extremities, stump complications, severity of pains related to amputation and low back pain. Of 247 unilateral below knee amputees, 97.9% wore a prosthetic limb and times walking or standing with the prosthesis were 12.47 ± 3.84 and 4.22 ± 3.53 h a day, respectively. Low soft tissue coverage of the stump (15.4%) and symptomatic osteoarthritis in the contralateral lower extremity (40.1%) were the most common complications. The prevalence of stump pain, phantom sensations, phantom pain, low back pain, and knee pain was 84.2%, 77.3%, 73.7%, 78.1%, and 54.7% respectively. The odds ratio of stump pain in amputees with phantom pain was 2.22 times higher than those who did not experience phantom pain [OR = 2.22 (CI: 1.19-4.17); p = 0.012] and the odds ratio of low back pain was higher in amputees with stump pain [OR = 3.06 (CI: 1.50-6.21); p = 0.002]. This research enhances our understanding of comorbid musculoskeletal problems in below-knee amputees which can help health providers to identify rehabilitation needs and emphasizes the importance of regular assessments. These findings underline the importance of paying closer attention to different dimensions and aspects of musculoskeletal complications in veterans with unilateral below-knee amputation.

Clinical and demographic characteristics of patients with lower limb amputation

Aim: Lower limb loss affects an individual’s ability to stand, transfer, and ambulate. The aim of this study is to assess clinical and demographic characteristics of patients with lower limb amputation.Materials and Methods: Our study is a retrospective cohort study. 836 patients with lower limb amputation applied to our hospital between January 2012 and May 2013 were included in this study. Demographic and clinical characteristics of patients were reviewed and saved from patient’s folder. Descriptive variables were shown as mean±standard deviation(min–max). And categorical variables were shown as the number of cases (n%).SPSS software Version 15.0 was used in the evaluation of the data.Results: The mean age of total 836 lower limb amputees was 36.12±11.69 years (9-78). The percentage of unilateral amputation was 770(92.3%) and bilateral lower limb amputation was 59(7.1%). According to the level of amputation, 456(54.5%) of the patients had unilateral above-knee, 236(28.3%) had unilateral below-knee amputation. For etiology, we found that 373(44.6%) of them were traffic accidents, 103(12.5%) occupational accidents. The majority of patients 456(54.5%) were ambulated microprocessor-controlled above-knee prosthesis and then below-knee prosthesis with active vacuum system 224(26.7%).Conclusion: Although trauma is recognized to be the most common cause of amputation among applying amputees, we think that those amputees do not reflect the general profile in our country but that it is instructive with regard to the features of amputees. This data is important for the community rehabilitation of amputees and the development of new prosthetics.

Functional plasticity of the ipsilateral primary sensorimotor cortex in an elite long jumper with below-knee amputation.

Functional plasticity of the sensorimotor cortex occurs following motor practice, as well as after limb amputation. However, the joint effect of limb amputation and intensive, long-term motor practice on cortical plasticity remains unclear. Here, we recorded brain activity during unilateral contraction of the hip, knee, and ankle joint muscles from a long jump Paralympic gold medalist with a unilateral below-knee amputation (Amputee Long Jumper, ALJ). He used the amputated leg with a prosthesis for take-off. Under similar conditions to the ALJ, we also recorded brain activity from healthy long jumpers (HLJ) and non-athletes with a below-knee amputation. During a rhythmic isometric contraction of knee extensor muscles with the take-off/prosthetic leg, the ALJ activated not only the contralateral primary sensorimotor cortex (M1/S1), but also the ipsilateral M1/S1. In addition, this ipsilateral M1/S1 activation was significantly greater than that seen in the HLJ. However, we did not find any significant differences between the ALJ and HLJ in M1/S1 activation during knee muscle contraction in the non-take-off/intact leg, nor during hip muscle contraction on either side. Region of interest analysis revealed that the ALJ exhibited a greater difference in M1/S1 activity and activated areas ipsilateral to the movement side between the take-off/prosthetic and non-take-off/intact legs during knee muscle contraction compared with the other two groups. However, difference in activity in M1/S1 contralateral to the movement side did not differ across groups. These results suggest that a combination of below-knee amputation and intensive, prolonged long jump training using a prosthesis (i.e. fine knee joint control) induced an expansion of the functional representation of the take-off/prosthetic leg in the ipsilateral M1/S1 in a muscle-specific manner. These results provide novel insights into the potential for substantial cortical plasticity with an extensive motor rehabilitation program.

The Effects of Ankle Turner Unit on the Quality of Life of Unilateral Below Knee Amputees

Background: Unilateral below knee amputation is a permanent surgical procedure that can influence the quality of life (QOL) of the person with amputation. The aim of this study was to assess the effects of ankle turner unit on the quality of life of unilateral below knee amputees. Methods: In a cross-sectional study, a total of twenty unilateral below-knee amputee patients were selected by simple random sampling. Quality of life of subjects was assessed with Trinity Amputation and Prosthesis Experience Scales (TAPES) questionnaire baseline and after 30 minute of using the unit. The participants were evaluated by five major criteria including: total TAPES score, conformity of movement restrictions, level of athletic activities, level of daily routine activities, and social activities, which were part of the TAPES survey. Results: In this study, 20 below-knee amputee male patients with average age of 47.7 years participated. Total index of TAPES with P = 0.01, matching of athletic restrictions with P = 0.04, athletic activity level with P = 0.006, and social activity level with P = 0.04 showed a significant difference compared to before using the unit. The difference in the level of daily routine activities, despite 5.15% increase in respect to before using the unit, was not significant (P = 0.2). Conclusions: The results implied that this unit can effectively improve the quality of life in amputees. In a detailed review of the study, it was proven that his unit resulted in an increase of the conformity with restrictions, and reduction of restrictions in athletic and social activities while it did not provide a positive effect on functional restrictions. Keywords: Ankle Turner Prosthesis; Quality of Life; Limb Loss; Below-Knee Prosthesis

Comparison of self-reported physical activity levels and quality of life between individuals with dysvascular and non-dysvascular below-knee amputation: A cross-sectional study

BackgroundDecreased physical ability of individuals with a dysvascular amputation when compared with non-dysvascular counterpart may impact on their ability to participate in regular physical activity and concomitant quality of life. ObjectiveTo compare physical activity, quality of life (QoL), and perceptions towards exercise between individuals with dysvascular and individuals with non-dysvascular amputation. MethodsA random sample of individuals identified from the New Zealand Artificial Limb Service database, aged 18 years and over, with a unilateral below-knee amputation due to a dysvascular condition (n = 61) and trauma (n = 116) completed the self-reported survey. Main constructs measured were: self-reported physical activity levels (MET-hours/day); quality of life (EuroQoL); perceptions towards exercise (Exercise Barriers and Benefits Scale [EBBS]); mobility capability (Locomotor Capability Index [LCI]) and a customized screening questionnaire. ResultsSignificant differences (p ≤ 0.05) were observed between dysvascular and non-dysvascular groups for total MET-hours/day [13.2 ± 12.7; 27.0 ± 23.2], LCI [36.3 ± 17.7; 49.9 ± 13.7], EuroQoL [72.1 ± 21.7; 80.9 ± 19.3] and EBBS [78.5 ± 10.3; 85.0 ± 14.3]. Cause of amputation, age, experience with the prosthesis, presence of co-morbidities and LCI were significant (p ≤ 0.008) correlates (simple linear regression) of MET-hours/day. Age was the only significant correlate in multivariable model with 0.43 MET-hours/day [F (5,161) = 9.28; p < 0.001], for each 1-year increase in age. ConclusionPhysical activity levels and quality of life of individuals with dysvascular amputation were lower when compared with non-dysvascular amputation. Person-centred behavioural interventions to increase physical activity levels are needed to decrease the risk for developing long-term co-morbidities and to lessen the effects of co-morbidities already present in this population.

The influence of prosthetic foot stiffness on energy expenditure in unilateral below-knee amputees

The influence of prosthetic foot stiffness on energy expenditure in unilateral below-knee amputees