Unilateral Lower Limb Amputation Research Articles

Thermographic Evaluation, Residual Limb Skin Sensitivity, and Adaptation to the Prosthesis of Individuals with Lower-Limb Amputation with Prosthesis Provided by the Universal Health System

ABSTRACT Introduction Prosthesis fixation is considered the central point for functionality, which promotes social reintegration of the individual with amputation. The deficits in the making of the prosthetic socket may trigger excessive friction on the residual limb and socket discomfort, possibly leading to a poor adaptation and consequent reduction of activity. Thermography is an evaluation and diagnostic method that may aid in the verification of the functionality of the prosthesis. The objective of the study was to analyze the superficial thermal distribution characteristics, the skin sensitivity of the residual limb, and the adaptation to the prosthesis of individuals with lower-limb amputation with prostheses provided by the Universal Health System. Materials and Methods Sixteen individuals of both genders with unilateral lower-limb amputation with ages between 18 and 64 years were recruited. The data collection protocol was composed of completing the physiotherapeutic evaluation form, assessment of residual limb skin sensitivity, application of the Prosthesis Evaluation Questionnaire (PEQ), treadmill walk for 10 minutes, thermographic evaluation immediately after the removal of the prosthesis, and lastly postacclimatization thermographic assessment. Results Before the acclimatization, the region of the L3 dermatome of those who had altered sensitivity, the maximum (31.43°C), mean (28.97°C), and minimum (28.27°C) temperatures were significantly lower compared with those who had normal sensitivity (32.81°C, 29.68°C, and 28.91°C, respectively) (P < 0.05). Regarding the period after the acclimatization, there was no significant difference in the comparison performed between temperature and sensitivity. The individuals with transtibial amputation obtained results above the overall median for the PEQ items, whereas the individuals with transfemoral amputation obtained results above the overall median for the “total score.” There is a strong negative relationship between the mean temperature of the residual limb extremity with item “utility” in the preacclimatization moment and a strong negative relationship between the mean and minimum temperatures at the residual limb extremity with the “residual limb health” item at the moment after the acclimatization. There is no association between the PEQ items and residual limb sensitivity. Conclusions One may conclude that high temperatures at the postacclimatization moment indicate areas of friction that trigger a poor adaptation of the residual limb with the prosthetic socket, in which case the development of new strategies for improving the quality of the prostheses supplied is suggested. Clinical Relevance Thermography helps in evaluating the residual limb and adapting the prosthesis, as it is a noninvasive clinical assessment tool. Thermography aids health professionals for management of the patient with amputation in the preprosthesis and postprosthesis phases.

The lower limb-loss rehabilitation continuum (LLRC) – a framework for program design and implementation

Purpose: The multistep journey to prosthetic device-enabled functioning following amputation requires a structured approach for optimal care delivery, but such program structures and outcomes are inadequately characterized. The study is responsive by describing an implementation framework for lower limb loss rehabilitation and evaluating its utility. Materials and methods: The lower limb loss rehabilitation continuum framework (LLRC) was developed using literature-based continuum of care and amputation phase concepts as well as input from limb loss rehabilitation stakeholders. LLRC structure includes five sequential steps (Postsurgical Stabilization (PS), Preprosthetic Rehabilitation (PPR), Limb Healing and Maturation (LHM), Prosthetic Fitting (PF), Prosthetic Rehabilitation (PR)) between six touchpoints of patient-healthcare interaction (Surgery, Preprosthetic Rehabilitation Admission and Discharge, Functioning Evaluation and Prescription, Prosthetic Rehabilitation Admission and Discharge). The utility of this framework was evaluated through LLRC program implementation in a semiurban US setting and program functioning and process outcomes assessment from an IRB-approved, retrospective observational study about patients with unilateral lower-limb amputations completing this program. Results: Program functional (FIM gain; efficiency) scores were greater for PPR(32.6(8);3.1) compared with PR(24.3(8.5);3.8). Program completion duration was 149.7(63.4) days. LHM(75.8(58.5) days) and PF(51.4(24.3) days) were the longest steps. PR duration was significantly longer(p = 0.033) for the transfemoral level. Conclusion: The LLRC framework is useful for the design and implementation of structured limb loss rehabilitation programs. IMPLICATIONS FOR REHABILITATION The lower limb-loss rehabilitation continuum (LLRC) is a novel implementation framework with a five-step structure from limb loss to completion of prosthetic rehabilitation between six touchpoints of patient-healthcare interaction, with standardized terminology and baseline and outcome metrics. The utility of the program was demonstrated by successful program development in a suburban health setting and actionable process outcomes and superior functioning outcomes compared with literature. The LLRC can be adapted by health systems, institutions, and care providers for program development. Programs can expect high FIM gains and efficiency for Preprosthetic rehabilitation and Prosthetic rehabilitation steps. With an LLRC completion time of 5 months, long Limb healing and maturation and Prosthetic fitting steps present areas of opportunity for improvement.

The frequency and risk factors associated with the development of knee and hip osteoarthritis of the intact limb after unilateral lower limb amputation at PIPOS Bannu.

Objective: To determine the frequency and risk factors associated with the development of osteoarthritis of the knee and hip joints of the intact limbs after unilateral amputation of the lower extremities with PIPOS Bannu. Study Design: Cross Sectional. Setting: Pakistan Institute for Prosthetics and Orthotics (PIPOS). Period: June 2019 to November 2019. Material & Methods: The presence of osteoarthritis (OA) was determined by a standardized questionnaire, primarily based on laboratory tests/physical examination. Participants were evaluated by experts who diagnosed symptomatic hip and knee OA using a structured questionnaire and standardized joint tests based on American College of Rheumatology (ACR) clinical standards. Individuals who tested positive were tested by a rheumatologist, who checked for the presence of clinical ACR criteria to confirm the diagnosis. Results: A total of 150 patients were included in the study. Data is analyzed by SPSS 21. The average age of the patients was 38.12 ± 14.82 years. Of the total of 150 patients, 131 (87.3%) were male and 19 (12.7%) were female. According to the degree of amputation, 79.3% (n = 119) patients were traumatic and 20.7% (n = 31) were non-traumatic limbs. The incidence of knee osteoarthritis is 9.3% (9.3% for men and 0.0% for women) and 4.0% for hip osteoarthritis (2.7% for men and 1.3% for women), both in hip and knee osteoarthritis. 2.7% (2.0% for men and 0.7% for women). Conclusion: According to this study, traumatic and non-traumatic lower limb amputees are more likely to develop knee and hip osteoarthritis in the intact lower limb. Demographics and patient characteristics are major risk factors for osteoarthritis.

Functional outcomes and associated factors of individuals with unilateral traumatic lower limb amputation in Sri Lanka: An observational study.

Rehabilitation is important after an amputation surgery. This study was conducted to find the level of functional outcomes of individuals with unilateral traumatic lower limb amputation and the impact of sociodemographic, amputation, and rehabilitation characteristics on functional outcomes. An observational cross-sectional study was conducted with 48 participants (aged 20-60 years) who visited the Center for Handicapped from across the country. Functional outcomes were measured using the Locomotor Capabilities Index, Amputee Mobility Predictor with Prosthesis, 6-minute walk distance, and spirometry test and sociodemographic, amputation, and rehabilitation characteristics using a self-constructed questionnaire. Amputee Mobility Predictor with Prosthesis K levels showed 65% had the ability to ambulate in the community and could master environmental barriers. Locomotor Capabilities Index scores showed 96% could independently perform basic daily activities with or without using assistive devices and 83% could perform advanced daily activities. None of the individuals had achieved their predicted 6-minute walk distance, but 52% had "good and above" level of maximum oxygen consumption; restrictive respiratory pattern was indicated among 31%. Amputee Mobility Predictor with Prosthesis and Locomotor Capabilities Index scores were significantly ( p < 0.005) affected by mobility hours/day, amputation level, prosthesis usage, and satisfaction. Six-minute walk distance was significantly ( p < 0.005) related to income, time since amputation, duration of rehabilitation, mobility hours/day, sex, job engagement, previous job, amputation level, K levels, and satisfaction with prosthesis. Rehabilitation in Sri Lanka mainly focuses on basic walking training, not on long-term survival, distance walking, and cardiorespiratory endurance, which can lead to future comorbidities. Raising awareness in the society about rehabilitation services and more effective rehabilitation programs are recommended.

Quality of Life in People With Unilateral Lower Limb Amputation at a Tertiary Rehabilitation Centre in Northern India: A Cross-Sectional Study.

Background and purpose The patients after amputation undergo a sudden transformation in their quality of life. In India, amputation done at the appropriate time is a rare phenomenon because usually, the patients present themselves at the later stages. The surgeons, however, while performing amputation surgeries, primarily consider saving the life of a patient under adverse conditions when patients report to them very late that the surgeries are carried out urgently. Assessing the quality of life (QOL) and the various sociodemographic factors affecting the QOL paves the way for future rehabilitation programs. Aims and objectives To evaluate the quality of life of subjects with unilateral lower limb amputation among the North Indian population. Materials and methods This cross-sectional study was conducted in the tertiary rehabilitation center. A total of 106 Subjects were recruited. Informed consent was taken. WHOQOL-BREF contains 26 items covering four important aspects of QOL. The WHOQOL-BREF self-administered free questionnaire was used as a data collection tool, and the Hindi version downloaded from the WHO website was also used for those who can't understand English. Results The range of the physical domain, psychological domain, social domain, and environmental domain were 0 and 100. The mean score of different QOL transformed domain scores (on a scale of 100) were 47.91±20.12, 57.37±20.46, 59.36±25.32 and 51.50±21.96, respectively. Trauma was the leading cause of amputation, followed by diabetes mellitus, cancer, peripheral vascular disease, and other causes. Transtibial amputees were more in number compared to transfemoral. The percentage of male and female amputees was 78.30%, and 21.70%, respectively. Conclusion The physical domain was the most affected domain, followed by the psychological, social, and environmental domains. A delay in the prosthesis fitment aggravates the physical burden of amputees. Early prosthesis & psychological counseling will improve the QOL significantly.

Development of an item bank for measuring prosthetic mobility in people with lower limb amputation: The Prosthetic Limb Users Survey of Mobility (PLUS-M).

Achieving mobility with a prosthesis is a common post-amputation rehabilitation goal and primary outcome in prosthetic research studies. Patient-reported outcome measures (PROMs) available to measure prosthetic mobility have practical and psychometric limitations that inhibit their use in clinical care and research. To develop a brief, clinically meaningful, and psychometrically robust PROM to measure prosthetic mobility. A cross-sectional study was conducted to administer previously developed candidate items to a national sample of lower limb prosthesis users. Items were calibrated to an item response theory model and two fixed-length short forms were created. Instruments were assessed for readability, effective range of measurement, agreement with the full item bank, ceiling and floor effects, convergent validity, and known groups validity. Participants were recruited using flyers posted in hospitals and prosthetics clinics across the United States, magazine advertisements, notices posted to consumer websites, and direct mailings. Adult prosthesis users (N=1091) with unilateral lower limb amputation due to traumatic or dysvascular causes. Not applicable. Candidate items (N=105) were administered along with the Patient Reported Outcome Measurement Information System Brief Profile, Prosthesis Evaluation Questionnaire - Mobility Subscale, and Activities-Specific Balance Confidence Scale, and questions created to characterize respondents. A bank of 44 calibrated self-report items, termed the Prosthetic Limb Users Survey of Mobility (PLUS-M), was produced. Clinical and statistical criteria were used to select items for 7- and 12-item short forms. PLUS-M instruments had an 8th grade reading level, measured with precision across a wide range of respondents, exhibited little-to-no ceiling or floor effects, correlated expectedly with scores from existing PROMs, and differentiated between groups of respondents expected to have different levels of mobility. ThePLUS-M appearstobe well suited to measuring prosthetic mobility in people with lower limb amputation. PLUS-M instruments are recommended for use in clinical and research settings.

Weight Changes in Young Service Members After Lower Limb Amputation: Insights From Group-Based Trajectory Modeling.

Weight gain can contribute to osteoarthritis, cardiovascular disease, low back pain, and poor health-related quality of life. Weight trajectory patterns have been described in older veterans with limb loss; however, there is limited evidence of changes in weight in younger veterans with limb loss. Service members with unilateral or bilateral lower limb amputations (LLAs) (and without an upper limb amputation) were included in this retrospective cohort analysis (n = 931). The mean postamputation baseline weight was 78.0 ± 14.1 kg. Bodyweight and sociodemographic data were extracted from clinical encounters within electronic health records. Group-based trajectory modeling assessed weight change patterns 2 years postamputation. Three weight change trajectory groups were identified: 58% (542 of 931) of the cohort had stable weight, 38% (352 of 931) had weight gain (mean gain = 19.1 kg), and 4% (31 of 931) had weight loss (mean loss = 14.5 kg). Individuals with bilateral amputations were more frequently noted in the weight loss group compared with those with unilateral amputations. Individuals with LLAs because of trauma other than blasts were more frequently found in the stable weight group compared with those with amputations because of disease or a blast. Younger individuals (<20 years old) with amputations were more likely to be in the weight gain group compared with older individuals. More than half the cohort maintained a stable weight for two years after amputation, and more than a third experienced weight gain during the same time frame. Knowledge of underlying factors that were associated with weight gain could inform preventative strategies for young individuals with LLAs.

Unilateral Lower Limb Amputations from Traumatic Events: A Systematic Review and Meta-Analysis

Background&#x0D; Limb amputations are one of the most devastating injuries for young people in traumatic settings. People with lower extremity loss face challenges in performing daily activities and managing life-long complications; thus, rehabilitation and prostheses are critical in improving the quality of life. This systematic review and meta-analysis aims to determine the outcomes of people who had unilateral transtibial and transfemoral amputations in terms of mobility, physical activity, prosthesis usage, and associated pain.&#x0D; Methods&#x0D; An in-depth search was conducted on the electronic databases of PubMed and Science Direct databases in September 2022 to find studies that investigated the health outcomes of traumatic unilateral leg amputees. Observational studies, clinical studies, comparative studies, and randomized controlled trials in the English language and within the last 10 years (2012-2022) were thoroughly screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The quality of search results was checked by the Newcastle-Ottawa Scale (NOS). The current meta-analysis included four observational studies which comprised 563 patients, 352 transtibial, and 211 transfemoral amputations. RevMan 5.4 software was used to calculate risk ratios (RRs) with 95% confidence intervals (CI) to conduct this meta-analysis.&#x0D; Results&#x0D; The pooled effect estimate showed no statistically significant difference between transtibial and transfemoral amputees(RR = 1.15, 95% CI [0.93, 1.43], P = 0.21) in terms of physical activity. People who had transfemoral amputations used prostheses more frequently than those who had transtibial amputations(RR = 1.21,95% CI [1.09, 1.35], P = 0.0004). There was no statistical difference between the two groups who reported pain during prosthesis wearing (RR = 1.03, 95% CI [0.62, 1.73], P = 0.91).&#x0D; Conclusion&#x0D; People who used leg prostheses more frequently were associated with more independent mobility and adequate physical activity. Leg prostheses with better accommodation and mobility benefit people with traumatic unilateral transfemoral amputations.

Evaluation of a Vibrotactile Biofeedback System Targeting Stance Time Symmetry Ratio of Individuals With Lower-Limb Amputation: A Pilot Study

Individuals with lower-limb amputation (LLA) often exhibit atypical gait patterns and asymmetries. These patterns can be corrected using biofeedback (BFB). Real-time BFB strategies have demonstrated to be effective to various degrees in BFB systems. However, no studies have evaluated the use of corrective vibrotactile BFB strategies to improve temporal gait symmetry of LLA. The aim of this study was to evaluate a wearable vibrotactile BFB system to improve stance time symmetry ratio (STSR) of LLA, and compare two corrective BFB strategies that activate either one or two vibrating motors at two different frequency and amplitude levels, based on a pre-set STSR target. Gait patterns of five unilateral LLA were assessed with and without BFB. Spatiotemporal and kinematic gait parameters were measured and assessed using a wearable motion capture system. Usability and workload were assessed using the System Usability Scale and NASA Task Load Index questionnaires, respectively. Results showed that participants significantly (p<0.001) improved STSR with BFB; however, this coincided with a reduction in gait speed and cadence compared to walking without feedback. Knee and hip flexion angles improved and changes in other parameters were variable. Immediate post-test retention effects were observed, suggesting that gait changes due to BFB were preserved for at least a short-time after feedback was withdrawn. System usability was found to be acceptable while using BFB. The outcomes of this study provide new insights into the development and implementation of clinically practical and viable BFB systems. Future work should focus on assessing the long-term use and retention effects of BFB outside controlled-laboratory conditions.

Improvements in disability and function in people with lower-limb amputation one year after prosthesis osseointegration.

People with lower-limb amputation (LLA) are routinely prescribed a socket prosthesis; however, many socket prosthesis users experience severe complications with the fit of their prosthesis including residual limb wounds and pain. Osseointegration is a procedure that creates a direct connection between the bone and prosthetic limb through a bone-anchored prosthesis, eliminating the need for a socket interface. It is offered as a secondary procedure to people with LLA who experience significant complications with socket prostheses. To evaluate change in disability and function 1 year postosseointegration compared with preosseointegration in people with LLA. Single group, pretest, and post-test. Twelve participants (9 transfemoral and 3 transtibial amputations, age: 44 ± 10 years, 7 female participants, 14 ± 12 years since amputation) with unilateral LLA underwent osseointegration with press-fit implants. Disability was measured with the World Health Organization Disability Assessment Schedule 2.0, and function was measured with both Prosthetic Limb Users Mobility Survey and the Activities-Specific Balance Confidence Scale. Questionnaires were administered preosseointegration and 1 year postosseointegration. Paired t tests assessed change in outcomes between time points. Postosseointegration, participants demonstrated reduced disability measured with World Health Organization Disability Assessment Schedule 2.0 (%Δ = -52.6, p = 0.01), improved mobility measured with Prosthetic Limb Users Mobility Survey (%Δ = 21.8, P < 0.01), and improved balance confidence measured with the Activities-Specific Balance Confidence Scale (%Δ = 28.4, P < 0.01). Participants report less disability and greater function in their prosthesis postosseointegration. Osseointegration is a novel procedure for people experiencing complications with their socket prosthesis, and this study is the first to show improvements in disability postosseointegration.

Factors influencing the self-perceived mobility of active unilateral lower limb amputees assessed with the Prosthetic Mobility Questionnaire: a brief report.

The Prosthetic Mobility Questionnaire (PMQ 2.0) represents a reliable solution for evaluating amputees' self-perceived mobility. The study aimed to evaluate the perceived mobility of middle-aged users with a traumatic amputation using the PMQ 2.0 and to assess the influence of age, stump and phantom limb pain, amputation level, time since amputation, and prosthesis use on it. Fifty subjects were recruited. The median value of the score was higher than previously published reference values, reflecting the 'active' mobility status of the sample. The hours of prosthesis use per day explained about 21% of the variance of the questionnaire score and was a significant predictor of perceived mobility. Reference values for the recently developed PMQ 2.0 survey and relative to active, traumatic amputees were reported. As prosthesis use was a significant predictor of the amputees' perceived mobility, prolonged use of the artificial limb should be always encouraged in clinical practice.

Lumbar Degenerative Disease and Muscle Morphology Before and After Lower Limb Loss in Four Military Patients.

Low back pain (LBP) is highly prevalent after lower limb amputation (LLA). Reports describing longitudinal changes in spine health before and after amputation are rare. This study describes lumbar spine pathology, muscle morphology, and the continuum of care for LBP before and after LLA. We queried electronic medical records of patients who sought care for LBP before and after unilateral LLA between January 2002 and April 2020 and who had documented lumbar imaging pre- and post-LLA. Patient demographics, muscle morphology, spinal pathology, premorbid and comorbid conditions, self-reported pain, and treatment interventions were assessed. Four patients with LBP and imaging before and after LLA were identified. Intervertebral disc degeneration progressed after amputation in three patients, whereas facet arthrosis progressed in both female patients. The fat content of lumbar musculature generally increased after amputation. Conservative management of LBP before and after amputation was standard, with progression to steroidal injections. Lumbar spine health may degrade after amputation. Here, lumbar muscle size did not change after LLA, yet the fat content increased in combination with increases in facet and intervertebral disc degeneration.

Disability, economic and work-role status of individuals with unilateral lower-limb amputation and their families in Bangladesh, post-amputation, and pre-rehabilitation: A cross-sectional study.

Amputation has significant negative impacts on physical, psychological, social and economic wellbeing of individuals and families. This is potentially compounded by significant delays to rehabilitation in Bangladesh. To quantify disability, occupation and socioeconomic status of people with unilateral lower-limb amputation (LLA) and their families in Bangladesh, post-amputation and pre-rehabilitation. Between November 2017 and February 2018, people with unilateral LLA attending two locations of Center for the Rehabilitation of the Paralyzed, Bangladesh, for prosthetic rehabilitation were surveyed pre-rehabilitation, using the World Health Organization Disability Assessment Schedule (WHODAS-2.0) with additional socio-economic questions. Data were analysed descriptively, using cross-tabulation with Chi-square and Fisher's exact tests. Seventy-six individuals participated. The majority had traumatic (64.5%), transtibial amputation (61.8%), were young adults (37.92±12.35 years), in paid work prior to LLA (80%), married (63.2%), male (81.6%), from rural areas (78.9%), with primary/no education (72.4%). After LLA mobility (WHODAS score 74.61±13.19) was their most negatively affected domain. Most (60.5%) did not return to any occupation. Acute healthcare costs negatively impacted most families (89.5%), over 80% becoming impoverished. Nearly 70% of previous income-earners became economically dependent changing traditional family roles. Following LLA, most participants experienced significant mobility impairment and became economically dependent. The impact of LLA extends beyond the individual, to families who often face challenges to traditional primary earner gendered roles. Improved access to timely and affordable rehabilitation is required to reduce the significant personal and societal costs of disability after LLA.

Interference of unilateral lower limb amputation on motor imagery rhythm and remodeling of sensorimotor areas.

The effect of sensorimotor stripping on neuroplasticity and motor imagery capacity is unknown, and the physiological mechanisms of post-amputation phantom limb pain (PLP) illness remain to be investigated. In this study, an electroencephalogram (EEG)-based event-related (de)synchronization (ERD/ERS) analysis was conducted using a bilateral lower limb motor imagery (MI) paradigm. The differences in the execution of motor imagery tasks between left lower limb amputations and healthy controls were explored, and a correlation analysis was calculated between level of phantom limb pain and ERD/ERS. The multiple frequency bands showed a significant ERD phenomenon when the healthy control group performed the motor imagery task, whereas amputees showed significant ERS phenomena in mu band. Phantom limb pain in amputees was negatively correlated with bilateral sensorimotor areas electrode powers. Sensorimotor abnormalities reduce neural activity in the sensorimotor cortex, while the motor imagination of the intact limb is diminished. In addition, phantom limb pain may lead to over-activation of sensorimotor areas, affecting bilateral sensorimotor area remodeling.

Sporting activity does not fully prevent bone demineralization at the impaired hip in athletes with amputation.

There is lack of information about bone mineralization at the lumbar spine and bilateral hips of athletes with unilateral lower limb amputation. The present study assessed for the first time the areal bone mineral density at the lumbar spine and at the hip of the able and impaired leg by means of Dual-Energy X-Ray Absorptiometry using a large sample (N = 40) of male athletes. Results showed that bone demineralization in athletes with unilateral lower limb amputation is found at the impaired hip but not at the lumbar spine and may therefore be site-specific. The extent of hip demineralization was influenced by the level of amputation, with about 80% of athletes with above knee amputation and 10% of athletes with below knee amputation showing areal bone mineral density below the expected range for age. Nevertheless, a reduced percentage of fat mass and a lower fat-to-lean mass ratio in the residual impaired leg as well as a greater amount of weekly training was positively associated with bone mineralization at the impaired hip (partial correlation coefficients = 0.377-0.525, p = 0.040-0.003). Results showed that participation in adapted sport has a positive effect on bone health in athletes with unilateral lower limb amputation but is not sufficient to maintain adequate levels of bone mineralization at the impaired hip in athletes with above-knee amputation. Accordingly, physical conditioners should consider implementing sporting programs, according to the severity of the impairment, aimed at improving bone mineralization at the impaired hip and improve body composition in the residual impaired leg.

Motor Imagery-Related Changes of Neural Oscillation in Unilateral Lower Limb Amputation.

An amputation is known to seriously affect patient quality of life. This study aimed to investigate changes in neural activity in amputees during the postoperative period using neural electrophysiological techniques. In total, 14 patients with left lower limb amputation and 18 healthy participants were included in our study. All participants were required to perform motor imagery paradigm tasks while electroencephalogram (EEG) data were recorded. Data analysis results indicated that the beta frequency band showed significantly decreased oscillatory activity in motor imaging-related brain regions such as the frontal lobe and the precentral and postcentral gyri in amputees. Furthermore, the functional independent component analysis (fICA) value of neural oscillation negatively correlated with the C4 electrode power value of the motor imagery task in amputees (p < 0.05). Therefore, changes in neural oscillations and beta frequency band in motor imagery regions may be related to brain remodeling in amputees.

Kinetic Gait Parameters in Unilateral Lower Limb Amputations and Normal Gait in Able-Bodied: Reference Values for Clinical Application.

Unilateral lower limb amputations usually present with asymmetric interlimb gait patterns, in the long term leading to secondary physical conditions and carrying the risk of low physical activity and impairment of general health. To assess prosthetic fittings and rehabilitation measures, reference values for asymmetries as well as the most significant gait parameters are required. Kinetic gait data of 865 patients with unilateral lower limb amputations (hip and knee disarticulations, transfemoral, transtibial and foot amputations) and 216 able-bodied participants were quantitatively assessed by instrumented gait analyses. Characteristic spatiotemporal (stance time, walking speed, step length and width) and ground reaction force parameters (weight-acceptance and push-off peak) were contrasted to normal gait. All spatiotemporal and ground reaction force parameters differed significantly from normal gait with the largest differences in transfemoral amputations. These also differed between amputation levels and showed age-dependencies. The stance time and push-off peak difference were identified as the most discriminative parameters with the highest diagnostic specificity and sensitivity. The present results mark the first step to establishing universal reference values for gait parameters by means of which the quality and suitability of a prosthetic fitting and the rehabilitation progress can be assessed, and are generalizable for all adults with unilateral lower limb amputations in terms of level walking.

Using theoretical frameworks to examine fall history and associated prosthetic mobility in people with nondysvascular lower limb amputation.

Over a million people live with lower limb amputation (LLA) in the United States, and many of them will experience a fall in the next year. The aim of this study was to use existing theoretical frameworks in an attempt to organize the complex interactions of reported fall history and prosthetic mobility in community-ambulating people with LLA. Self-reported fall rate and fall circumstances were recorded in a cross-section of people with unilateral LLA due to nondysvascular causes. Self-report and performance-based standardized outcome measures assessed prosthetic mobility and balance confidence. All variables were considered and appropriately placed within a proposed International Classification of Functioning, Disability, and Health framework while using a fall-type classification framework to classify fall circumstances. Information from 69 participants was analyzed. The reported fall rate was at 46%, with those with transfemoral amputation reporting significantly more falls than those with transtibial amputation ( P = 0.001). Tripping over an object was the most common cause (62.5%), and fallers reported significantly lower perceived prosthetic mobility than nonfallers ( P = 0.001). Despite reporting high levels of balance confidence, results indicate that all groups of fallers and nonfallers are at increased fall risk according to performance-based prosthetic mobility score cutoffs. Community-dwelling people with nondysvascular LLA are at increased fall risk. Classifying fall-related variables using theoretical frameworks provides a means to structure more informative fall risk surveys for people with LLA in an attempt to identify those at greater risk for falling and its potential detrimental effects.

Are lower back demands reduced by improving gait symmetry in unilateral transtibial amputees?

BackgroundGait asymmetry and a high incidence of lower back pain are typical for people with unilateral lower limb amputation. A common therapeutic objective is to improve gait symmetry; however, it is unknown whether better gait symmetry reduces lower back pain risk. To begin investigating this important clinical question, we examined a preexisting dataset to explore whether L5/S1 vertebral joint forces in people with unilateral lower limb amputation can be improved with better symmetry. MethodsL5/S1 compression and resultant shear forces were estimated in each participant with unilateral lower limb amputation (n = 5) with an OpenSim musculoskeletal model during different levels of guided gait asymmetry. The amount of gait asymmetry was defined by bilateral stance times and guided via real-time feedback. A theoretical lowest L5/S1 force was determined from the minimum of a best-fit quadratic curves of L5/S1 forces at levels of guided asymmetry ranging from −10 to +15%. The forces found at the theoretical lowest force and during the 0% asymmetry level were compared to forces at preferred levels of asymmetry and to those from an able-bodied group (n = 5). FindingsResults indicated that the forces for the people with unilateral lower limb amputation group at the preferred level of asymmetry were not different then at their 0% asymmetry condition, theoretical lowest L5/S1 forces, or the able-bodied group (all p-values > .23). InterpretationThese preliminary results challenge the premise that restoring symmetric gait in people with unilateral lower limb amputation will reduce risk of lower back pain.

Measuring discomfort-An objective method for quantifying peak pressure discomfort and improved fit in adults with transtibial amputation.

Prosthetic socket coupling with the residual limb should be comfortable without causing skin breakdown or excessive pressure. However, users report socket discomfort, and there is a scarcity of objective measurements available to assess this feeling of discomfort. Quantifying the specific pressure may enable clinicians and users to determine and improve comfort levels objectively. (1) To evaluate if a peak pressure reduction assists in resolving wounds, redness, and pain inside prosthetic sockets in people with transtibial amputation. (2) To determine if peak pressures measured inside the prosthetic socket due to external forces could be used to quantify the level of improvement in socket discomfort. In this cohort study, we used a pressure sensor to quantify and facilitate adjustments to the prosthetic socket, correlating this information to the user's socket comfort. Outpatient clinic in a tertiary hospital in Singapore. People (N=16) with unilateral transtibial lower limb amputation using a prosthesis. NA. Peak pressure and socket comfort score (SCS). The peak pressure value showed a statistically significant reduction across all participants following adjustments at a 50% delta change in pressure (p=.001). This was achieved with a mean number of 2.6 ± 1.4 adjustments per participant. Following the adjustments, the paired t-test results showed a mean increase between the first SCS and final SCS was 2.6 (p=.001). The wound, redness, and pain resolved in 15 of 16 participants regardless of diabetic status following socket adjustments. Although the peak pressures values did not correlate to the SCS score, the reduction in peak pressure saw significant improvement to the SCS. The use of a portable sensor is a fast and efficient means to quantify adjustments inside the prosthetic socket and could potentially be considered as part of future care delivery.