Considerations for staff involved in amputee rehabilitation

In order to examine the personal experiences of patients undergoing an amputation, 10 patients at the Dulwich Hospital, and their relatives, were interviewed to investigate their personal experiences and their perceptions of undergoing a lower limb amputation. The information obtained has been used to compile an information booklet which is more sensitive to the problems identified by patients in the study.     

Prosthetic rehabilitation of geriatric amputee patients: a follow-up study

During a four-year period, 116 lower extremity amputee patients older than 65 years were evaluated and treated by our department. Fifty-nine patients with below-knee (BK) amputations, 22 with above-knee (AK) amputations, and 15 with bilateral amputations were fitted with prostheses and trained in their use. A follow-up study on all patients was done at an average of 22 months after they had completed their training program but not earlier than after 6 months. Of all BK amputees who had been fitted with a prosthesis, 73% were using it fulltime and as their main mode of locomotion; 25% were using it part of the time. The results were less favorable for AK and for bilateral amputee patients: 50% of AK amputees and 33% of the bilateral amputees had become fulltime users of their prostheses. Age alone was not a major determining factor in success or failure of prosthetic rehabilitation. Failures usually were due to concurrent medical disease or mental deterioration. The study indicates that the effort and expense of fitting and training geriatric patients with prostheses may be well worthwhile.     

Clinical evaluation of two prosthetic suspension systems in a bilateral transtibial amputee

ABSTRACT: The effects of Seal-In X5 and Dermo liner (?ssur) on suspension and patient's comfort in lower limb amputees are unclear. In this report, we consider the case of a 51-yr-old woman with bilateral transtibial amputation whose lower limbs were amputated because of peripheral vascular disease. The subject had bony and painful residual limbs, especially at the distal ends. Two prostheses that used Seal-In X5 liners and a pair of prostheses with Dermo liners were fabricated, and the subject wore each for a period of 2 wks. Once the 2 wks had passed, the pistoning within the socket was assessed and the patient was questioned as to her satisfaction with both liners. This study revealed that Seal-In X5 liner decreased the residual limb pain experienced by the patient and that 1-2 mm less pistoning occurred within the socket compared with the Dermo liner. However, the patient needed to put in extra effort for donning and doffing the prosthesis. Despite this, it is clear that the Seal-In X5 liner offers a viable alternative for individuals with transtibial amputations who do not have enough soft tissue around the bone, especially at the end of the residual limb.     

Patient rehabilitation following hand transplantation at forearm distal third level

The results of hand transplantations in terms of both graft survival (49/52, i.e. 94.3%) and hand function recovery are very inspiring. The degree of functional recovery is similar to that achieved after hand replantation at the same level. With regard to function recovery, the most favorable level of replantation seems to be the distal third of the forearm, with 75% of hand transplantations performed at this level. The aim of this paper was to present the process of limb rehabilitation following a hand transplantation at the level of the forearm's distal third. The recipient, a 29-year-old male, lost his right dominant hand 6 years before the operation in a drum flaker accident. The donor was a 52-year-old female. The limb was transplanted in a standard manner, with an uneventful postoperative period. The multidirectional rehabilitation focused on motor and sensory function as well as the recipient's psychological status. First passive finger movements were introduced on postoperative day 2, followed by assisted active movements from day 21 post-transplant onwards, and from day 28 we implemented exercises with an outrigger extension splint. Favorable hand position positioning was ensured by changing ortheses frequently. Motor rehabilitation relied on Perfetti's visual-motor training (from d 28 p-op.) together with continuous passive motion (Artromot F device). We also used electrical stimulation of the nerve trunks and intrinsic muscles of the hand as well as discrimination exercises of tactile sensation. The rehabilitation process was very similar to the one we use in patients after limb replantation. We assessed the motor and sensory functions of the grafted limb as very good despite diminished muscle strength, which does not affect the general functional result. The recipient adapted perfectly to living with a transplanted limb. The outcomes achieved by the hand transplant recipient confirm the need of early and multidirectional rehabilitation.     

深度手烧伤患者植皮术后功能康复护理

通过对100例手深度烧伤(深Ⅱ-Ⅲ度)削切痂、植皮术病人术后2周实施加压疗法、浸浴疗法、局部按摩、药物治疗、功能锻炼及心理护理、创面护理，结果 100例131只手获得较满意效果。提出护理时尽量减少康复活动引起的疼痛，训练强度循序渐进，以病人耐受为度。     

Case report: occupational therapy with a traumatic bilateral shoulder disarticulation amputee

This report describes the application of occupational therapy to a patient with traumatic bilateral shoulder disarticulation. Treatment goals and methods for acute care, preprosthetic training, and prosthetic training are described and illustrated.     

Treadmill training program for a bilateral below-knee amputee patient with cardiopulmonary disease

This study was undertaken to determine the degree of progress an elderly bilateral below-knee amputee with cardiopulmonary disease could achieve by endurance training on a treadmill. Aspects of medications, orthotic/prosthetic evaluation, and energy expenditure are discussed. The subject was a 63-year-old Class IV cardiac patient with combined restrictive-obstructive pulmonary disease of moderate severity. He had undergone a coronary artery bypass graft (two-vessel) followed by a bilateral below-knee amputation for an ascending dry gangrene. The initial ambulatory aerobic evaluation showed the patient achieving only 50% of predicted maximal heart rate and 20% of maximal oxygen consumption. An individualized daily training program started the patient walking at .5 mph, 0% elevation, for five repetitions at two minutes each. By the end of the six-month training program the workload reached 1.4 mph at 2.5% elevation, for 30 minutes of total external work. The final exercise test evaluation showed an overall increase in age-predicted maximal heart rate (90%) and oxygen consumption (55%). The patient improved from cardiac Class IV to Class II, and therapeutically from Class E (bed rest) to Class C (moderate exercise restriction). These findings suggest a need for endurance training programs for patients with cardiopulmonary disease hindered by additional physical disabilities. The program enabled the participant to engage in significantly higher levels of activity for daily living within the community.     

The status of outcome measurement in amputee rehabilitation in Canada

OBJECTIVE: To describe how centers of amputee care in Canada evaluate program and patient outcome. DESIGN: National postal survey. SETTING: Amputee rehabilitation centers across Canada. PARTICIPANTS: Forty-four medical directors. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Type and frequency of use of program evaluation, formal and informal patient outcome measures data, and how collected data was used. RESULTS: Forty-four clinics responded (response rate, 72%). Program evaluation was conducted in some format by at least 18 centers. Twelve centers conducted regular chart audits, whereas 15 indicated their intention to submit an annual program report. The majority of centers collected information on patient outcomes; however, most used informal measures. Thirty-nine clinics used part or all of a checklist of informal measures of skill attainment. The most common standardized outcome measure was the FIM instrument (18 centers). Eighteen centers used a form of mobility performance such as walking speed or timed walk test. Eighteen of 39 centers that responded to this section did not collect any formal patient outcome measures. The most frequently used outcome measures were the nonstandardized informal measures of independence. CONCLUSION: A diverse selection of program- and patient-related outcome measures were used by Canadian amputee centers. Outcomes could be better compared if all centers used similar outcome measures.     

综合康复疗法治疗脑卒中后肩手综合征的疗效观察

目的观察综合康复疗法治疗脑卒中后肩手综合征（shoulder-hand syndrome after stroke,SHSAS）的临床效果。方法将我院2009年1月至2010年12月确诊为SHSAS的患者分为综合康复组和对照组。对照组采用常规康复训练;综合康复组在常规康复训练基础上加用针灸治疗。对两组治疗前后临床疗效进行比较,采用Fugl-Meyer评定法（Fugl-Meyer as-sessment,FMA）和改良Barthel指数（modified Barthel index,MBI）对运动功能及日常生活活动能力进行评分。结果综合康复组有效率、FMA积分和MBI积分的增加均明显高于对照组（P〈0.05）。结论综合性康复治疗能进一步提高SHSAS患者的治疗效果,临床上值得推广。     

Inpatient multitrauma rehabilitation in a U.S. military hospital

Rehabilitation serves a vital role in the care of multiply injured patients in the military, from diagnosis of occult injuries to gaining functional independence. Optimal rehabilitative care of the war casualties is predicated on diligent and rigorous training and evaluation of similar care during peacetime.     

手部烧伤治疗后早期系统康复护理及效果评价

INTRODUCTION Hand is the most common site in burn. Early timely and late systemic rehabilitation treatment can avoid or reduce scar.     

手外伤后指关节僵硬的系统康复治疗

目的 观察系统康复治疗对手外伤后指关节僵硬的临床疗效。方法 配合物理因子治疗。对213例外伤后指关节僵硬的手指先行牵引与手法治疗，后行ROM训练并结合矫形夹板与中药水浴治疗。结果 治疗后AROM优良率82.2%。有效率97.7%；PROM优良率94.8%。有效率100%；手指综合功能从治疗前的17%增至56%。结论 运动治疗的同时结合物理因子治疗与作业疗法能较好地改善手外伤后僵硬指关节的活动范围，促进手功能的恢复。