Prosthesis use in adult acquired major upper-limb amputees: patterns of wear, prosthetic skills and the actual use of prostheses in activities of daily life

Purpose: To describe patterns of prosthesis wear and perceived prosthetic usefulness in adult acquired upper-limb amputees (ULAs). To describe prosthetic skills in activities of daily life (ADL) and the actual use of prostheses in the performance of ADL tasks. To estimate the influence of prosthetic skills on actual prosthesis use and the influence of background factors on prosthetic skills and actual prosthesis use. Method: Cross-sectional study analysing population-based questionnaire data (n?=?224) and data from interviews and clinical testing in a referred/convenience sample of prosthesis-wearing ULAs (n?=?50). Effects were analysed using linear regression. Results: 80.8% wore prostheses. 90.3% reported their most worn prosthesis as useful. Prosthetic usefulness profiles varied with prosthetic type. Despite demonstrating good prosthetic skills, the amputees reported actual prosthesis use in only about half of the ADL tasks performed in everyday life. In unilateral amputees, increased actual use was associated with sufficient prosthetic training and with the use of myoelectric vs cosmetic prostheses, regardless of amputation level. Prosthetic skills did not affect actual prosthesis use. No background factors showed significant effect on prosthetic skills. Conclusions: Most major ULAs wear prostheses. Individualised prosthetic training and fitting of myoelectric rather than passive prostheses may increase actual prosthesis use in ADL. [Box: see text].     

Prosthesis rejection in acquired major upper-limb amputees: a population-based survey

Purpose: To estimate the rates of primary and secondary prosthesis rejection in acquired major upper-limb amputees (ULAs), to describe the most frequently reported reasons for rejection and to estimate the influence of background factors on the risk of rejection. Method: Cross-sectional study analysing population-based questionnaire data (n?=?224). Effects were analysed by logistic regression analyses and Cox regression analyses. Results: Primary prosthesis rejection was found in 4.5% whereas 13.4% had discontinued prosthesis use. The main reasons reported for primary non-wear were a perceived lack of need and discrepancies between perceived need and the prostheses available. The main reasons reported for secondary prosthesis rejection were dissatisfaction with prosthetic comfort, function and control. Primary prosthesis rejection was more likely in ULAs amputated at high age and in ULAs with proximal amputations. Secondary prosthesis rejection was more likely in proximal ULAs and in women. Conclusions: Clinicians should be aware of the increased risk of rejection in proximal ULAs, elderly ULAs and in women. Emphasising individual needs will probably facilitate successful prosthetic fitting. Improved prosthesis quality and individualised prosthetic training may increase long-term prosthesis use. Further studies of the effect of prosthetic training and of the reasons for rejection of different prosthetic types are suggested.

Implications for Rehabilitation

• Most acquired major upper-limb amputees (ULAs) are fitted with prostheses after the amputation.

• This population-based study shows that proximal ULAs, elderly ULAs and women have an increased risk of prosthesis rejection.

• Emphasising individual needs may facilitate successful prosthetic fitting.

• Improved prosthesis quality and individualised prosthetic training may increase long-term prosthesis use.

     

Evaluation of rehabilitated bilateral lower limb amputees – an Indian study

Objective: This study assessed activities of daily living (ADL) and ambulation of rehabilitated bilateral lower limb amputees with relation to their level of amputation in an Indian setting. Subjects and Methods: This retrospective study of 25 subjects comprised 12 bilateral Trans-femoral (TF) amputees, 8 bilateral Trans-tibial (TT) amputees and 5 a combination of ipsilateral Trans-femoral and contralateral Trans-tibial amputation. All subjects were contacted by post/telephone, were physically examined and assessed at the Orthopaedic clinic at a mean follow-up of 6.6 years. Physical rehabilitation was evaluated using ADL score and by grading the level of ambulation. Results: ADL scores showed no significant difference according to level of amputation (p > 0.05), but the scores of prosthetic users were significantly higher than non-prosthetic users (p?=?0.002). Only 11/25 amputees became prosthetic ambulators and most (50%, 6/12) were TF amputees. All prosthetically rehabilitated subjects were mobilising with their prostheses at follow-up and graded as unlimited or limited community ambulators. Conclusion: Though it is well documented that the potential for successful rehabilitation is best for bilateral TT amputees, given the subjects’ economic constraints, higher prosthesis rehabilitation among bilateral TF amputees indicates that successful rehabilitation is possible in most subjects irrespective of the level of amputation.

Implications for Rehabilitation

• Rehabilitation of a bilateral lower limb amputee requires a team effort and constitutes a very difficult challenge for the subject.

• Low prosthesis ownership is largely due to subjects’ inability to afford a pair of prostheses in a developing country like India.

• Activities of daily living improve significantly with use of prostheses.

• Though it is well documented that the potential for successful rehabilitation is best for a bilateral TT amputee, higher prosthesis rehabilitation among bilateral TF subjects in this study indicates that successful rehabilitation is possible in most subjects irrespective of the level of amputation.

     

The AirCirc: design and development of a thermal management prototype device for below-knee prosthesis leg socket

Abstract

This study describes a newly developed prosthetic leg socket design for a below-knee amputation. Excessive heat and the resulted perspiration within a prosthetic socket were the most common causes for reporting a reduced quality of life for prosthetic users. The product namely AirCirc means air circulation and it has been designed by approach of medical device design process in providing the amputees to maintain the skin temperature inside the socket. This device has been designed to provide the amputees with comfort and ultimate breathable. In order to design the device, the small hole was made in prosthetic socket surface since it has a function as air circulation. Four types of proposed sockets namely P1, P2, P3 and P4 and one control socket were compared on a single patient to determine the best design of prosthetic socket. The result successfully reveals that by using holes can be maintain the temperature inside prosthetic socket. In addition to the eco-friendly material, the woven kenaf was used as material that provides good strength as compared to glass fibre and offer sustainable and biodegradable product yet provides unique and aesthetic surface as came from woven kenaf itself. The objective of this paper is to provide the airflow prosthetic socket design and optimize the use of natural fibre in prostheses field. Thus, with the use of the environmental friendly material, functionality device and heat removal capability make the device suitable for maintaining a comfortable and healthy environment for prosthesis.

• Implications of Rehabilitation

• Newly developed prosthetic leg socket design for a below-knee amputation

• Device has been designed to provide the amputees with comfort and ultimate breathable

• Woven kenaf was used as material that provides good strength as compared to glass fibre for sustainable and biodegradable product

• Results show that by using holes can be maintain the temperature inside prosthetic socket

     

Iodine–Starch test for assessment of hyperhidrosis in amputees,evaluation of different methods of application*

Abstract

Purpose: Hyperhidrosis is a common problem for amputees. The iodine–starch test is frequently used to assess hyperhidrosis, but a method for its application has not been described for amputees.

Methods: We performed an unblinded comparison of the iodine–starch test using various methods to protect the prosthesis in 10 prosthetic limb users with hyperhidrosis.

Results: Plastic wrap produced a diffuse pattern of sweating in 70% of subjects. Forty percent had complaints about this method, and 50% experienced leakage of iodine stain onto prosthetic liners. The prosthetic sheath produced a focal or multifocal reaction in 100% of subjects after 10?min of ambulation. Eighty percent had minor leakage onto the liner, and complaints were noted in 10%. The proportion that experienced diffuse sweating was significantly higher in the plastic wrap condition (p?=?0.016; difference in proportions?=?70%; 95% confidence interval?=?32–100%). The prosthetic sock was tested in four subjects and all had at least mild complaints; three had minor leakage onto the liner. Repeated complaints and lack of stain prevention led to discontinuation with this method.

Conclusions: Of the three methods, the sheath produces a focal or multifocal reaction after 10?min of ambulation and tends to cause less subject complaints. It should be the preferred method to apply the iodine–starch test to amputees.

• Implications for rehabilitation

• Hyperhidrosis is a common problem in amputees which negatively affects quality of life.

• The iodine–starch test is commonly used to guide treatment decisions for hyperhidrosis, but a preferred method for applying it in amputees has not been described.

• This study describes different methods for applying the iodine–starch test.

• A prosthetic sheath covering should be the preferred method for the iodine–starch test in amputees.

     

Case study: survey of patient satisfaction with prosthesis quality and design among below-knee prosthetic leg socket users

The aim of this case study was to explore patient satisfaction with the quality of prosthetic leg sockets intended for persons with lower limb amputations. A qualitative study based on in-depth interviews, preceded by a questionnaire session, was carried out with patients from the Rehabilitation Center and Hospital in Malaysia. Twelve out-patient and in-patient amputees with lower limb amputations, specifically below-knee amputations, were chosen randomly. The analysis of patients’ narratives aimed to identify the functional and esthetic characteristics of currently used prosthetic leg sockets and any problems related to them. The obtained results indicated that out of the 12 participants, 41.7% and 25% were satisfied and somewhat satisfied with their current prosthetic sockets. Durability and comfort were rated by the participants as the most important characteristics of prosthetic sockets, with 83.3%. As regards the esthetic appearance of the socket, 66.7% of the respondents considered that the most important feature was the material from which the socket was fabricated. Thus, we conclude that current satisfaction levels with the quality of prosthetic sockets among amputees in Malaysia are suitable, prosthesis being preferred by many amputees. The results can be used to direct future research on cosmesis and functionality of prosthetic socket design.

• Implications for Rehabilitation

• Case study will help participants to get cost effective prosthetic leg socket.

• Develop prosthetic leg socket comfortable as comparative to existing one.

• Help Malaysian government to make policy to develop local prosthetic leg socket at affordable price.

     

The African disability scooter: efficiency testing in paediatric amputees in Malawi

Purpose: The African Disability Scooter (ADS) was developed for lower limb amputees, to improve mobility and provide access to different terrains. The aim of this study was to test the efficiency of the ADS in Africa over different terrains. Method: Eight subjects with a mean age of 12 years participated. Energy expenditure and speed were calculated over different terrains using the ADS, a prosthetic limb, and crutches. Repeated testing was completed on different days to assess learning effect. Results: Speed was significantly faster with the ADS on a level surface compared to crutch walking. This difference was maintained when using the scooter on rough terrain. Oxygen cost was halved with the scooter on level ground compared to crutch walking. There were no significant differences in oxygen consumption or heart rate. There were significant differences in oxygen cost and speed between days using the scooter over level ground, suggesting the presence of a learning effect. Conclusions: This study demonstrates that the ADS is faster and more energy efficient than crutch walking in young individuals with amputations, and should be considered as an alternative to a prosthesis where this is not available. The presence of a learning effect suggests supervision and training is required when the scooter is first issued.

• Implications for Rehabilitation

• The African Disability Scooter:

• is faster than crutch walking in amputees;

• is more energy efficient than walking with crutches;

• supervised use is needed when learning to use the device;

• is a good alternative/adjunct for mobility.

     

Safety and function of a prototype microprocessor-controlled knee prosthesis for low active transfemoral amputees switching from a mechanic knee prosthesis: a pilot study

Purpose: Aim of this pilot study was to assess safety and functioning of a microprocessor-controlled knee prosthesis (MPK) after a short familiarization time and no structured physical therapy.

Materials and methods: Five elderly, low-active transfemoral amputees who were fitted with a standard non-microprocessor controlled knee prosthesis (NMPK) performed a baseline measurement consisting of a 3?D gait analysis, functional tests and questionnaires. The first follow-up consisted of the same test procedure and was performed with the MPK after 4 to 6?weeks of familiarization. After being refitted to their standard NMPK again, the subjects undertook the second follow-up which consisted of solely questionnaires 4?weeks later.

Results: Questionnaires and functional tests showed an increase in the perception of safety. Moreover, gait analysis revealed more physiologic knee and hip extension/flexion patterns when using the MPK.

Conclusion: Our results showed that although the Genium with Cenior-Leg ruleset-MPK (GCL-MPK) might help to improve several safety-related outcomes as well as gait biomechanics the functional potential of the GCL-MPK may have been limited without specific training and a sufficient acclimation period.

• Implications for Rehabilitation

• Elderly transfemoral amputees are often limited in their activity by safety issues as well as insufficient functioning regarding the non microprocessor-controlled knee prostheses (NMPK), thing that could be eliminated with the use of suitable microprocessor-controlled prostheses (MPK).

• The safety and functioning of a prototype MPK (GCL-MPK) specifically designed for the needs of older and low-active transfemoral amputees was assessed in this pilot study.

• The GCL-MPK showed indicators of increased safety and more natural walking patterns in older and low-active transfemoral amputees in comparison to the standard NMPK already after a short acclimatisation time and no structured physical therapy.

• Regarding functional performance it seems as if providing older and low-active transfemoral amputees with the GCL-MPK alone without prescribing structured prosthesis training might be insufficient to achieve improvements over the standard NMPKs.

     

The potential for non-invasive brain stimulation to improve function after amputation

Purpose: Lower limb amputee rehabilitation has traditionally focussed on restoration of gait and balance through use of prosthetic limbs and mobility aids. Despite these efforts, some amputees continue to experience difficulties with mastering prosthetic mobility. Emerging techniques in rehabilitation, such as non-invasive brain stimulation (NIBS), may be an appropriate tool to enhance prosthetic rehabilitation outcomes by promoting “normal” brain reorganisation and function. The purpose of this review is to highlight the potential of NIBS to improve functional outcomes for lower limb amputees. Methods: To demonstrate the rationale for applying NIBS to amputees, this study will first review literature regarding human motor control of gait, followed by neurophysiological reorganisation of the motor system after amputation and the relationship between brain reorganisation and gait function. We will conclude by reviewing literature demonstrating application of NIBS to lower limb muscle representations and evidence supportive of subsequent functional improvements. Results: Imaging, brain stimulation and behavioural evidence indicate that the cortex contributes to locomotion in humans. Following amputation both hemispheres reorganise with evidence suggesting brain reorganisation is related to functional outcomes in amputees. Previous studies indicate that brain stimulation techniques can be used to selectively promote neuroplasticity of lower limb cortical representations with improvements in function.

Conclusions: We suggest NIBS has the potential to transform lower limb amputee rehabilitation and should be further investigated.

• Implications for Rehabilitation

• Despite extensive rehabilitation some amputees continue to experience difficulty with prosthetic mobility

• Brain reorganisation following amputation has been related to functional outcomes and may be an appropriate target for novel interventions

• Non-invasive brain stimulation is a promising tool which has potential to improve functional outcomes for lower limb amputees

     

The impact of lower-limb prosthetic limb use in international C4 track para-cycling

Abstract

An investigation was undertaken to ascertain any impact or significance of athletes within the C4 paracycling classification between those who use a lower-limb prostheses and those who do not. A statistical evaluation of event completion time was undertaken to assess C4 cyclists when competing at the World Championships and the Paralympic Games in the 1?km track time trial. The C4 athletes who utilize a prostheses consistently outperformed non-amputees in the C4 classification from 2011 to 2016 on a competition-to-competition basis. However, when the participations were grouped as a whole together and an identified outlier athlete was removed, it was then demonstrated that there was no statistical significance between those who required the use of a lower-limb prostheses to those that did not when either evaluated on a competition-by-competition or on an amputee and non-amputee group-by-group basis (p?≥?0.05). As a result, this study proposes that those requiring the use of lower-limb prostheses are neither advantaged nor disadvantaged in the C4 classification category when competing in the 1?km time trial at this time.

• Implications for Rehabilitation

• This analysis indicates that at this time, there is no evidence to suggest that use of such technology is advantageous in this category or should be seen as controversial.

• The design of lower-limb prosthetic limb technology in cycling should continue to be developed and optimized unabated.

• This study begins to address the cited lack of peer-reviewed information regarding paracycling with limb absence available to practitioners.

     

Kinematic comparison of the wrist movements that are possible with a biomechatronics wrist prosthesis and a body-powered prosthesis: a preliminary study

Purpose: This study examined the kinematic differences between a body-powered prosthesis and a biomechatronics prosthesis as a transradial amputee performed activities that involve flexion/extension and supination/pronation of the wrist.

Method: The subject’s wrist movements were calculated and compared as he completed a wrist range of motion test involving simulated flexion/extension and supination/pronation.

Results: The results revealed that, under the test conditions, the body-powered prosthesis limits an individual’s ability to complete four different tasks of wrist movement especially when it comes to complete the supination/pronation movement. Conversely, while using biomechatronics wrist prosthesis, the user was able to compensate for limited wrist motion through an ability to achieve a greater range of wrist movement.

Conclusions: The biomechatronics wrist prosthesis provides a greater degree of freedom of wrist flexion/extension and supination/pronation movements.

Implications for Rehabilitation

• Body powered prosthesis for transradial amputees involved the wrist movement that focus on flexion/extension and supination/pronation.

• The biomechatronics wrist prosthesis is a combination of controller that controlled the servo motor at the wrist.

• The biomechatronics wrist prosthesis provides a greater degree of freedom of wrist flexion/extension and supination/pronation movements compare to the body powered prosthesis.

     

Cognitive predictors of skilled performance with an advanced upper limb multifunction prosthesis: a preliminary analysis

Purpose The objectives were to 1) identify major cognitive domains involved in learning to use the DEKA Arm; 2) specify cognitive domain-specific skills associated with basic versus advanced users; and 3) examine whether baseline memory and executive function predicted learning. Method Sample included 35 persons with upper limb amputation. Subjects were administered a brief neuropsychological test battery prior to start of DEKA Arm training, as well as physical performance measures at the onset of, and following training. Multiple regression models controlling for age and including neuropsychological tests were developed to predict physical performance scores. Prosthetic performance scores were divided into quartiles and independent samples t-tests compared neuropsychological test scores of advanced scorers and basic scorers. Baseline neuropsychological test scores were used to predict change in scores on physical performance measures across time. Results Cognitive domains of attention and processing speed were statistically significantly related to proficiency of DEKA Arm use and predicted level of proficiency. Conclusions Results support use of neuropsychological tests to predict learning and use of a multifunctional prosthesis. Assessment of cognitive status at the outset of training may help set expectations for the duration and outcomes of treatment.

• Implications for Rehabilitation

• Cognitive domains of attention and processing speed were significantly related to level of proficiencyof an advanced multifunctional prosthesis (the DEKA Arm) after training.

• Results provide initial support for the use of neuropsychological tests to predict advanced learningand use of a multifunctional prosthesis in upper-limb amputees.

• Results suggest that assessment of patients’ cognitive status at the outset of upper limb prosthetictraining may, in the future, help patients, their families and therapists set expectations for theduration and intensity of training and may help set reasonable proficiency goals.

     

Improved design and development of a functional moulded prosthetic foot

Purpose: In the Indian scenario, the Jaipur foot is a low-cost breakthrough that enabled the disabled person to adapt to the Indian environment. The aim of this study is to modify the present foot in terms of ankle support design and method of fabrication, foot moulds profile and the inner core material in order to improve the performance and durability. Method: The optimized design of ankle support and flat foot profile moulds suitable for both left and right foot were developed through CAD/CAM and prosthetic feet were fabricated using ethylene vinyl acetate (EVA) foam as an appropriate alternative core material for microcellular rubber (MCR). The developed prosthetic feet were tested for rigidity by load-deflection analysis in universal testing machine. Result: EVA foot had shown better rigidity than conventional MCR foot, which will help in weight transfer during walking and increase the durability. The CAD modeled ankle support and single block EVA had made the manufacturing process easy and reduced the weight of foot and improved Gait to the person fitted with it due to improved flat foot profile. Conclusion: The new artificial foot had proven to be efficacious technically as well as functionally, which is clearly borne out from the extremely positive feedback given by the amputees.

• Implications of Rehabilitation

• Persons with below knee amputation are usually provided with transtibial prosthesis, which allows for easier ambulation and helps them to get back to their normal life.

• Transtibial prosthesis is an artificial limb that replaces a lower limb that is amputated below the knee.

• In our study, a new prosthetic foot with a modified ankle support and flat foot profile using better inner-core material than the conventional Jaipur foot was developed and the process was also optimized for mass production. The developed prosthetic foot can be fitted with both above and below knee exoskeleton type of prosthesis.

     

The influence of lower-limb prostheses technology on Paracanoeing time-trial performance

Within the Paracanoeing discipline, it is important to ensure that appropriate control is achieved by a paddler with a disability. However, this Paralympic Games discipline has seen very little attention to date. The aims of this study were to understand the kinematic impact to a paracanoeist when not utilizing the use of a prosthetic lower-limb. A kayaker with a uni-lateral transfemoral amputation completed several 200?m maximal efforts both with and without their prosthesis. When the prosthetic limb was removed, there were significant differences found in stroke rate, stroke speed, stroke length and overall power output. Sagittal and frontal video analysis demonstrated the residual limb movements when paddling and indicated where support would be required to improve the kayak’s control. It is recommended that those with lower-limb absence wishing to paddle a kayak competitively utilize the use of a prostheses designed for the kayaking environment that supports the residual limb at both the upper and inner thigh and the distal end.

• Implications for rehabilitation

• This paper is the first study to investigate both biomechanical and assistive technology-related issues in the new Paralympic Games sport of Paracanoeing.

• For participants possessing lower-limb absence, a prosthetic limb that is designed specifically for the kayaking environment is recommended when Paracanoeing to maximize efficient propulsion.

• Use of an ergometer and multiple 2D cameras provides practitioners the ability to optimize both the comfort and fit of a prosthetic limb.

• Use of an ergometer and multiple 2D cameras provides both athletes and practitioners the ability to optimize the points of human contact within a kayak to ensure comfort and control.

     

Musculoskeletal pain and overuse syndromes in adult acquired major upper-limb amputees

Østlie K, Franklin RJ, Skjeldal OH, Skrondal A, Magnus P. Musculoskeletal pain and overuse syndromes in adult acquired major upper-limb amputees.

Objectives

(1) To compare the prevalence of self-reported musculoskeletal pain in upper-limb amputees (ULAs) in Norway with that of a control group drawn from the Norwegian general population; (2) to describe musculoskeletal pain bothersomeness in ULAs; (3) to estimate the association between prosthesis wear and self-reported musculoskeletal pain in ULAs; and (4) to describe the occurrence of musculoskeletal overuse syndromes in a sample of ULAs.

Design

Cross-sectional study: postal questionnaires and clinical examinations.

Setting

Norwegian ULA population. Clinical examinations performed at 3 clinics.

Participants

Questionnaires: population-based amputee sample (n=224; 57.4% response rate). Random control sample (n=318; 33.1% response rate). Clinical examinations: combined referred sample and convenience sample (n=70; 83.3% of those invited). Survey inclusion criteria: adult, resident in Norway and mastering Norwegian (amputees and controls), acquired major upper-limb amputation (amputees only).

Interventions

Not applicable.

Main Outcome Measures

Self-reported musculoskeletal pain and pain bothersomeness. Self-reported pain in prosthesis wearers and nonwearers. Clinically assessed diagnoses of musculoskeletal overuse syndromes.

Results

Self-reported musculoskeletal pain was more frequent in ULAs than in the control group except for lower back pain. In ULAs, 57.0% reported neck/upper back pain (odds ratio [OR]=2.56; 95% confidence interval [CI], 1.64–3.98), and 58.9% reported shoulder pain (OR=4.00; 95% CI, 2.51–6.36). The percentage difference for arm pain was 24.8% (P<.001). All pain was reported as bothersome. We found no difference in pain prevalence between prosthesis wearers and nonwearers. Musculoskeletal overuse syndromes were found in 6.1% to 24.2% of ULAs, depending on diagnosis and case-definition criteria.

Conclusions

Upper-limb loss increases the risk of self-reported musculoskeletal pain in the neck/upper back, shoulders, and in the remaining arm. Prosthesis wear does not prevent musculoskeletal pain. Further studies should be conducted to investigate the effects of prosthesis wear and possible preventive measures, and to ascertain our preliminary prevalence estimates of overuse syndromes.     

A phenomenological approach to psychoprosthetics

The phenomenology of human embodiment can advance the practitioner’s understanding of the lived human body and in particular, what it means to incorporate a prosthetic device into one’s body. In order for a prosthesis to be incorporated into the lived body of the patient, the prosthesis must arguably be integrated into the body schema. This article uses the phenomenology of Maurice Merleau-Ponty and others to identify three of the necessary conditions of embodiment that determine the body schema: corporeal understanding, transparency and sensorimotor feedback. It then examines the structure of each of these conditions of embodiment and how they impact the lived body’s incorporation of prostheses and other artifacts.

Implications for Rehabilitation

• Phenomenology complements evidence-based research in the field of psychoprosthetics by a systematic study of the experience of what it is like for the prosthesis user to incorporate a prosthetic device into his or her body.

• The practictioner can use phenomenological insight to assess the qualitative progress of rehabilitation. In particular, significant progress towards the incorporation of the prosthetic device is achieved when the prothesis user experiences sensory and kinesthetic feedback as coming not from the interface between the residual limb and the prosthetic device, but from the combined residual limb – prosthetic device and its interface with the environment. An even more complete incorporation is experienced when the prosthesis becomes transparent, that is, when the prothesis user is focused on the perceptual object or behavioral goal rather than on the prosthetic device.

     

Impact of pain in vertebral column on activities of daily living in the Iranian amputees with bilateral lower limb amputation

Purpose: To determine the impact of pain in the vertebral column on the activities of daily living (ADL) level of war victims with bilateral lower limb amputation. Method: All the war-related bilateral lower limb amputees were invited. More than half of them (n?=?335) participated and underwent a thorough assessment after giving informed consent. Results: The majority of the participants were male (97.6%). Their mean age was 42 years and 97.6% of them were married. The most common causes of injury leading to amputation were shells of artillery and mortar (56.7%). The most common level of amputation was bilateral transtibial (37.6%) and 64% were wearing the prosthesis of both sides. The most ADL dependency were transfer activities (27.8%) and bathing (23.3%) and the most independent functioning was eating (97.6%). Upper cervical vertebral pain was associated with dependency in the bowel and bladder management and dressing (p < 0.03 and p < 0.04, respectively). Pain in the lower cervical vertebrae was associated with dependency in toileting and dressing (p < 0.01 and p < 0.01, respectively). There were significant relationships between pain in the thoracic vertebrae and dependency in bathing, transfer activities and toileting (p < 0.02, p < 0.003 and p < 0.03, respectively). Pain in the lumbosacral region had a relationship with the level of amputation, transfer activities and toileting (p < 0.006, p < 0.03 and p < 0.05, respectively). Conclusions: Vertebral pain in bilateral lower limb amputees, especially lumbosacral pain, was accompanied with higher dependency in ADL. Therefore, a multidisciplinary approach to the management of pain is required to minimize disability and maximize functioning.

Implications for Rehabilitation

• As common as back pain in the general population, some studies have found that people with lower limb amputation are at even greater risk of back pain and interference with their lifestyle.

• The results of this study suggest that after bilateral lower extremity amputations, some patients experience various kinds of pain in the spinal column, which may affect their activities of daily living.

• A multidisciplinary approach to the management of pain is necessary to minimize disability and maximize functioning in these patients.

     

Adults with congenital limb deficiency in Norway: demographic and clinical features,pain and the use of health care and welfare services. A cross-sectional study

Abstract

Purpose: To describe an adult population with congenital limb deficiency (CLD) recruited through the National Resource Centre for Rare Disorders (TRS) in Norway: (1) demographic factors, (2) clinical features, (3) pain and (4) use of health care and welfare services. Methods: Cross-sectional study. In 2012, a postal questionnaire was sent to 186 eligible persons with CLD, age 20 years and older. Results: Ninety-seven respondents, median-age 39 years (range: 20–82); 71% were women. The population was divided into two subgroups: (1) unilateral upper-limb deficiency (UULD) n?=?77, (2) multiple and/or lower-limb deficiency (MLD/LLD). About 40% worked full-time, 18% received disability pensions and 64% reported chronic pain, mostly bilateral pain. Grip-improving devices were used more often than prostheses; 23% were previous prosthesis users. Use of health care and welfare services are described. No significant differences were found between the subgroups regarding pain or employment status. Conclusions: Persons with CLD reported increased prevalence of chronic pain, mostly bilateral, and increased prevalence of early retirement. A greater focus on the benefits of the use of assistive devices, the consequences of overuse and vocational guidance may moderate pain and prevent early retirement. Further studies of more representative samples should be conducted to confirm our findings.

• Implications for Rehabilitation

• Most adults with congenital limb deficiency (CLD) live ordinary lives and experience normal life events. However, several report chronic pain and retire before normal retirement age.

• In spite of free and accessible prosthetic services, a large fraction chooses not to use prosthesis, more use grip-improving devices for specific activities. These preferences should be acknowledged by rehabilitation specialists.

• Focus on individually adapted environments, more information about the consequences of overuse, and vocational guidance may moderate pain and prevent early retirement.