Rehabilitation setting and associated mortality and medical stability among persons with amputations

Dillingham TR, Pezzin LE. Rehabilitation setting and associated mortality and medical stability among persons with amputations.

Objective

To estimate the differences in outcomes across postacute care settings—inpatient rehabilitation, skilled nursing facility (SNF), or home—for dysvascular lower-limb amputees.

Design

Medicare claims data for 1996 were used to identify a cohort of elderly persons with major lower-limb dysvascular amputations. One-year outcomes were derived by analyzing claims for this cohort in 1996 and 1997.

Setting

Postacute care after amputation.

Participants

Dysvascular lower-limb elderly amputees (N=2468).

Interventions

Not applicable.

Main Outcome Measures

Mortality, medical stability, reamputations, and prosthetic device acquisition.

Results

The 1-year mortality for the elderly amputees was 41%. Multivariate probit models controlling for patient characteristics indicated that patients discharged to inpatient rehabilitation were significantly (P<.001) more likely to have survived 12 months postamputation (75%) than those discharged to an SNF (63%) or those sent home (51%). Acquisition of a prosthesis was significantly (P<.001) more frequent for persons going to inpatient rehabilitation (73%) compared with SNF (58%) and home (49%) dispositions. The number of nonamputee-related hospital admissions was significantly less for persons sent to a rehabilitation service than for those sent home or to an SNF. Subsequent amputations were significantly (P<.025) less likely for amputees receiving inpatient rehabilitation (18%) than for those sent home (25%).

Conclusions

Receiving inpatient rehabilitation care immediately after acute care was associated with reduced mortality, fewer subsequent amputations, greater acquisition of prosthetic devices, and greater medical stability than for patients who were sent home or to an SNF. Such information is vital for health policy makers, physicians, and insurers.     

Intradermal botulinum toxin type A injection effectively reduces residual limb hyperhidrosis in amputees: a case series

Charrow A, DiFazio M, Foster L, Pasquina PF, Tsao JW. Intradermal botulinum toxin type A injection effectively reduces residual limb hyperhidrosis in amputees: a case series.

Objective

To study the effectiveness of botulinum toxin type A (BTX-A) therapy for residual limb hyperhidrosis, prosthesis fit and function, and residual and phantom limb pain in patients with limb amputation.

Design

Consecutive case series.

Setting

Outpatient physical medicine and rehabilitation clinic.

Participants

Walter Reed Army Medical Center patients (N=8) with unilateral traumatic upper- or lower-limb amputation.

Intervention

BTX-A was injected transdermally in a circumferential pattern around the residual limb by using a 1-cm matrix grid.

Main Outcome Measure

A 10-cm continuous Likert visual analog scale was used to assess residual limb sweating and pain and prosthesis fit and function before and 3 weeks after BTX-A injections.

Results

Patients reported a significant reduction in sweating and improvement in prosthesis fit and function after treatment. However, residual limb and phantom pain were unaffected by treatment.

Conclusions

BTX-A may be an effective treatment for residual limb hyperhidrosis, resulting in subjective improvement in prosthesis fit and functioning. BTX-A should be considered as a method to manage excessive sweating in the residual limb of traumatic amputees.     

Effects of Early Mobilization on Unhealed Dysvascular Transtibial Amputation Stumps: A Clinical Trial

VanRoss ER, Johnson S, Abbott CA. Effects of early mobilization on unhealed dysvascular transtibial amputation stumps: a clinical trial.

Objective

To observe the effects of early mobilization on unhealed transtibial (TT) amputation stump wounds of dysvascular etiology. An “unhealed” stump was defined as having a wound greater than 1cm × 1cm at least 3 weeks after surgery.

Design

An observational cohort study.

Setting

This center receives about 250 new lower-limb amputees a year from over 50 surgeons working in 16 hospitals. Over 35% are unhealed.

Participants

Sixty-six consecutive new TT amputees (age 62.8±10.8y) of dysvascular etiology (diabetes 50%) with unhealed stumps were recruited. Sixty-one percent were current or past smokers. The mean ± SD stump wound size was 7.7±2.7cm × 3.2±2.0cm.

Interventions

The wound size was measured, and stump transcutaneous oxygen (TcpO₂) and transcutaneous carbon dioxide (TcpCO₂) were measured. Wounds were debrided and dressed by using a standard protocol. Mobilization using a Pneumatic Post-Amputation Mobility (PPAM) Aid for approximately 3 weeks was followed by provision of a TT prosthesis. A standard physiotherapy walking training program was performed.

Main Outcome Measures

Stump wound healing, time to achieve healing, and resting transcutaneous oxygen pressure pre- and posttherapy.

Results

Of the 66 amputees, 4 did not start. Sixty-two started; 6 withdrew, and 56 completed the trial. Complete wound healing was achieved in 74% (46/62) over a mean of 141 (87-270) days. The mean ± SD stump TcpO₂ at baseline was 41.3±19.8mmHg and increased significantly to 50.6±21.9mmHg (P<.02) after 97 (34-185) days of mobilization. Nine of 46 required revision plastic surgery. Five subjects, whose wounds were healing, became unwell, dropped out, and later deceased. Five subjects, all current smokers, did not heal and underwent higher amputation.

Conclusions

Patients with large unhealed TT stump wounds can simultaneously undergo walking training by using a prosthesis and can achieve wound healing. Seventy-four percent of subjects achieved full wound healing. The small minority of patients who did not heal were current smokers whose TcpO₂ levels did not improve throughout the trial. Rising levels of stump TcpO₂were associated with wound healing.     

Construct Validity and Test-Retest Reliability of the Climbing Stairs Questionnaire in Lower-Limb Amputees

de Laat FA, Rommers GM, Geertzen JH, Roorda LD. Construct validity and test-retest reliability of the Climbing Stairs Questionnaire in lower-limb amputees.

Objective

To investigate the construct validity and test-retest reliability of the Climbing Stairs Questionnaire, a patient-reported measure of activity limitations in climbing stairs, in lower-limb amputees.

Design

A cross-sectional study.

Setting

Outpatient department of a rehabilitation center.

Participants

Lower-limb amputees (N=172; mean ± SD age, 65±12y; 71% men; 82% vascular cause) participated in the study; 33 participated in the reliability study.

Interventions

Not applicable.

Main Outcome Measure(s)

Construct validity was investigated by testing 10 hypotheses: limitations in climbing stairs according to the Climbing Stairs Questionnaire will be greater in lower-limb amputees who: (1) are older, (2) have a vascular cause of amputation, (3) have a bilateral amputation, (4) have a higher level of amputation, (5) have more comorbid conditions, (6) had their rehabilitation treatment in a nursing home, and (7) climb fewer flights of stairs. Furthermore, limitations in climbing stairs will be related positively to activity limitations according to: (8) the Locomotor Capabilities Index, (9) the Questionnaire Rising and Sitting down, and (10) the Walking Questionnaire. Construct validity was quantified by using the Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation coefficient. Test-retest reliability was assessed with a 3-week interval and quantified using the intraclass correlation coefficient (ICC).

Results

Construct validity (8 of 10 null hypotheses not rejected) and test-retest reliability were good (ICC=.79; 95% confidence interval, .57-.90).

Conclusion

The Climbing Stairs Questionnaire has good construct validity and test-retest reliability in lower-limb amputees.     

A prospective study of patients with chronic back pain randomised to group exercise, physiotherapy or osteopathy

Objective

To investigate the difference in outcome between patients treated with group exercise, physiotherapy or osteopathy.

Design

Prospective study of patients referred at random to one of three treatments, with follow-up 6 weeks after discharge and after 12 months.

Setting

National Health Service physiotherapy department at St Albans City Hospital, part of the West Hertfordshire Musculoskeletal Therapy Service.

Participants

Two hundred and thirty-nine patients aged 18-65 years recruited from referrals to the physiotherapy department with chronic low back pain.

Interventions

Eligible patients were randomised to group exercises led by a physiotherapist, one-to-one predominantly manipulative physiotherapy, or osteopathy.

Main outcomes

Oswestry Disability Index (ODI), EuroQol-5D, shuttle walking test and patients’ subjective responses to pain and treatment.

Results

All three treatments indicated comparable reductions in mean (95% confidence intervals) ODI at 6-week follow-up: group exercise, −4.5 (−0.9 to −8.0); physiotherapy, −4.1 (−1.4 to −6.9); and osteopathy, −5.0 (−1.6 to −8.4). Attendance rates were significantly lower among the group exercise patients. One-to-one therapies provided evidence of greater patient satisfaction.

Conclusion

The study supports the use of a variety of approaches for the treatment of chronic low back pain. Particular attention needs to be given to the problems of attracting enough participants for group sessions, as these can be difficult to schedule in ways that are convenient for different participants.     

Interlimb Muscle and Fat Comparisons in Persons With Lower-Limb Amputation

Sherk VD, Bemben MG, Bemben DA. Interlimb muscle and fat comparisons in persons with lower-limb amputation.

Objectives

To investigate differences in muscle and fat tissue between amputated and intact limbs in subjects with transfemoral and transtibial amputations and to determine the effect of amputation level on limb differences. We hypothesized that the amputated limb would have a higher relative amount of fat than the intact limb, and transfemoral amputees would have greater limb differences in muscle size than transtibial amputees.

Design

Cross-sectional, repeated-measures design.

Setting

Laboratory.

Participants

Subjects included persons with unilateral transfemoral (TF) (n=5) and transtibial (TT) (n=7) amputations and age- and sex-matched nonamputation controls (n=12).

Interventions

Not applicable.

Main Outcome Measures

Muscle cross-sectional areas and fat cross-sectional areas of the end of residual limbs were compared with similar cross-sectional sites of the intact limb by using peripheral quantitative computed tomography scans. Thigh and lower-leg fat mass (FM) and bone-free lean body mass were measured by dual-energy x-ray absorptiometry.

Results

There was a 93% to 117% difference between limbs in muscle cross-sectional areas for TF and TT. TT had a between-limb difference of 39% for fat cross-sectional areas. Thigh bone-free lean body masses and FM were significantly (P<.05) lower for the amputated limb for both TF and TT. Thigh percent fat was significantly (P<.05) higher in the amputated thigh for TF and TT, but limb differences were greater in TF.

Conclusions

Muscle atrophy was prevalent in the residual limb with larger relative amounts of fat in the thighs, especially in TF subjects.     

Effects of an exercise program on respiratory function, posture and on quality of life in osteoporotic women: a pilot study

Objectives

To investigate the effects of an exercise program on respiratory function, thoracic kyphosis, tolerance to exercise and quality of life in women with osteoporosis.

Design

Pilot observational study.

Setting

Department of Physiotherapy, Federal University of Sao Carlos, Brazil.

Participants

Fourteen women with densitometric diagnosis of osteoporosis in the spine.

Interventions

An exercise program comprising of three sessions per week, lasting 1 hour each, over an 8-week period. Each session incorporated: 5 minutes of stretching exercises, including the lower limb and upper limb muscles; 15 minutes of posture exercises; 20 minutes of walking; 15 minutes of exercises to improve the strength of respiratory muscles and a 5-minutes, cool-down and relaxation.

Main outcome measures

Respiratory function evaluation, submaximal exercise tolerance test measurement of the thoracic kyphosis angle, and the Osteoporosis Assessment Questionnaire (OPAQ) to measure the quality of life at baseline and at 8-week follow-up.

Results

At follow-up, increases of between 12% and 23% in respiratory pressures were noted. The results also suggest an increase of 13% in submaximal exercise tolerance and a small increase of approximately 5% in the magnitude of thoracic curvature. The value of the OPAQ for this group of subjects is questionable. Sample size calculations based on the results of this pilot study are provided.

Conclusions

After an 8-week exercise program, benefits to the fitness of the participants were observed. The results suggest that exercise may have a role in the management of this group of patients. The outcome measures, with the possible exception of the OPAQ, and the protocol used in this pilot study would be feasible for a definitive study. Further research is recommended in a sufficiently powered study and should include an appropriate control group.     

Upper-arm anthropometry: an alternative indicator of nutritional health to body mass index in unilateral lower-extremity amputees?

Miller M, Wong WK, Wu J, Cavenett S, Daniels L, Crotty M. Upper-arm anthropometry: an alternative indicator of nutritional health to body mass index in unilateral lower-extremity amputees?

Objective

To evaluate the utility of body mass index (BMI) and corrected-arm-muscle area (CAMA) as measures of nutritional health for lower-limb amputees attending prosthetics clinics.

Design

Cross-sectional study.

Setting

Prosthetics clinic in Australia.

Participants

Unilateral lower-extremity amputees (N=58; age range, 21-91y; 37 transtibial, 21 transfemoral) attending a regional prosthetics clinic between May and November 2003.

Interventions

Not applicable.

Main Outcome Measures

Weight (without prosthesis), corrected and uncorrected for the amputated limb was used with height estimated from knee height to calculate corrected BMI (cBMI) and uncorrected BMI (uBMI). CAMA was calculated using the mean of triplicate mid-upper-arm circumference (MUAC) and triceps skinfold thickness (TST) measurements. The Mini Nutritional Assessment (MNA) and Assessment of Quality of Life were administered according to recommended protocols. The Pearson correlation was used to determine the strength and significance of associations between variables, and bivariate regression analyses were performed to determine whether an association existed between the nutritional variables (BMI, CAMA, MNA) and quality of life (QOL).

Results

There were no statistically significant differences in the measures of nutritional health according to site (transtibial, transfemoral) of amputation. MUAC, TST, and CAMA all showed moderate to high positive correlations (r range, .541−.782) with both cBMI and uBMI. The strength of the relationship between the MNA and cBMI/uBMI was weaker (r=.383, r=.380, respectively) but remained positive and statistically significant (P=.003). QOL was not associated with cBMI or uBMI but was related to CAMA (β=−.132; P=.030) and MNA (β=−.561; P=.017).

Conclusions

For persons with unilateral lower-extremity amputation, measurement of upper-arm anthropometry may be a more useful indicator of nutritional health and its consequences than BMI.     

Feasibility and Outcomes of a Home-Based Exercise Program on Improving Balance and Gait Stability in Women With Lower-Limb Osteoarthritis or Rheumatoid Arthritis: A Pilot Study

Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study.

Objective

To evaluate the feasibility and gait stability and balance outcomes of a 4-month individualized home exercise program for women with arthritis.

Design

Pre-post interventional study.

Setting

General community.

Participants

Women (N=49) (volunteers) with lower-limb osteoarthritis or lower-limb rheumatoid arthritis were enrolled. Only 39 subjects were eligible and completed the study.

Intervention

After completion of the initial assessment, all participants received home balance exercises from an experienced physiotherapist based on assessment findings and exercises available from commercially available kits. All measures were repeated 4 months later.

Main Outcome Measures

Falls risk (Falls Risk of Older People—Community Setting) and balance measures.

Results

Thirty-nine women (mean age, 69.3y; 95% confidence interval, 65.7-72.9) completed the 4-month program. At baseline, 64% of participants reported falling in the preceding 12 months, and the average falls risk (Falls Risk of Older People—Community Setting) score was 14.5, with 42% rated as moderate risk (16-23). Participants achieved improved performance on most balance and related measures after the exercise program, including falls risk (P=.01), activity levels (P=.015), fear of falling (P=.022), functional reach test (P=.001), rising index for sit to stand (P=.001), step width in walking (P=.001), and body mass index (P=.006).

Conclusions

An individualized balance training home exercise program is feasible for older women with osteoarthritis or rheumatoid arthritis and may improve stability during walking and other functional activities.     

Leisure Time Physical Activity in a Population-Based Sample of People With Spinal Cord Injury Part I: Demographic and Injury-Related Correlates

Martin Ginis KA, Latimer AE, Arbour-Nicitopoulos KP, Buchholz AC, Bray SR, Craven BC, Hayes KC, Hicks AL, McColl M, Potter PJ, Smith K, Wolfe DL. Leisure time physical activity in a population-based sample of people with spinal cord injury part I: demographic and injury-related correlates.

Objectives

To estimate the number of minutes a day of leisure time physical activity (LTPA) performed by people with chronic spinal cord injury (SCI) and to identify the demographic and injury-related characteristics associated with LTPA in a population-based sample of people with chronic SCI.

Design

Cross-sectional telephone survey.

Setting

General community.

Participants

Men and women with SCI (N=695).

Interventions

Not applicable.

Main Outcome Measures

The number of minutes/day of LTPA performed at a mild intensity or greater.

Results

Respondents reported mean minutes ± SD of 27.14±49.36 of LTPA/d; however, 50% reported no LTPA whatsoever. In a multiple regression analysis, sex, age, years postinjury, injury severity, and primary mode of mobility each emerged as a unique predictor of LTPA. Multiple correspondence analysis indicated that being a man over the age of 34 years and greater than 11 years postinjury was associated with inactivity, while being a manual wheelchair user and having motor complete paraplegia were associated with the highest level of daily LTPA.

Conclusions

Daily LTPA levels are generally low in people with SCI. Women, older adults, people with less recent injuries, people with more severe injuries, and users of power wheelchairs and gait aids are general subgroups that may require special attention and resources to overcome unique barriers to LTPA. Specific subgroups may also require targeted interventions.     

Mild Traumatic Brain Injury and Posttraumatic Stress Disorder and Their Associations With Health Symptoms

Vanderploeg RD, Belanger HG, Curtiss G. Mild traumatic brain injury and posttraumatic stress disorder and their associations with health symptoms.

Objective

To determine the association of various symptoms and psychiatric diagnoses with a remote history of mild traumatic brain injury (MTBI) and a current diagnosis of posttraumatic stress disorder (PTSD).

Design

Cross-sectional cohort study.

Setting

Nonclinical.

Participants

Three groups of randomly selected community dwelling male U.S. Army Vietnam-era veterans: healthy control (n=3218), those injured in a motor vehicle collision (MVC) but without a head injury (MVC injury control; n=548), and those who had an MTBI (n=278).

Interventions

None.

Main Outcome Measures

Prevalence of psychiatric diagnoses, physical, cognitive, and emotional symptoms, and course of PTSD across time.

Results

Logistic regression procedures were used to determine group association with symptoms and psychiatric diagnosis after controlling for demographic variables, combat intensity, medical disorders, and other current psychiatric conditions. MTBI was associated with headaches, memory problems, sleep problems, and fainting even after controlling for current psychiatric problems (including PTSD), as well as demographic variables, combat intensity, and comorbid medical conditions. MTBI also was associated with a current diagnosis of PTSD even controlling for other demographic, psychiatric, and medical covariates. MTBI did not moderate or mediate the relationship between PTSD and current symptomatology. However, MTBI did adversely affect long-term recovery from PTSD (odds ratio=1.59, 95% CI, 1.07-2.37). PTSD also was associated with physical, cognitive, and emotional symptoms, and had a larger effect size than MTBI.

Conclusions

MTBI, even in the chronic phase years postinjury, is not a benign condition. It is associated with increased rates of headaches, sleep problems, and memory difficulties. Furthermore, it can complicate or prolong recovery from preexisting or comorbid conditions such as PTSD. Similarly, PTSD is a potent cocontributor to physical, cognitive, and emotional symptoms.     

The Prevalence of Osteoarthritis of the Intact Hip and Knee Among Traumatic Leg Amputees

Struyf PA, van Heugten CM, Hitters MW, Smeets RJ. The prevalence of osteoarthritis of the intact hip and knee among traumatic leg amputees.

Objective

To determine the prevalence of osteoarthritis (OA) in the knee and/or hip of the intact leg among traumatic leg amputees compared with the general population and its relationship with amputation level, time since amputation, age, and mobility.

Design

Cross-sectional observational study.

Setting

Outpatient population of 2 Dutch rehabilitation centers.

Participants

Patients (N=78) with a unilateral traumatic transtibial amputation, knee disarticulation, or transfemoral amputation of at least 5 years ago; ability to walk with a prosthesis; older than 18 years of age; and able to understand Dutch. Patients were excluded if they had bilateral amputations, other pathologies of the knee or hip, or central neurologic pathologies.

Interventions

Not applicable.

Main Outcome Measure

The prevalence of OA.

Results

The prevalence of knee OA was 27% (men 28.3%, women 22.2%) and hip OA was 14% (men 15.3%, women 11.1%). This was higher compared with the general population (knee OA men 1.58%, women 1.33%, hip OA men 1.13%, women 0.98%, age adjusted). No significant relationships between the prevalence of OA and level of amputation, time since amputation, mobility, and age were found.

Conclusions

The prevalence of OA is significantly greater for both the knee and hip in the traumatic leg amputee population. No specific risk factors were identified. Although no specific risk factors in this specific population could be identified, it might be relevant to apply commonly known strategies to prevent OA as soon as possible after the amputation.     

Measurement of soft tissue temperature and impedance following the application of transdermal direct current

Objective

To measure temperature and impedance changes at various depths in human tissue in vivo, after the application of transdermal direct current (TDC).

Design

Prospective experimental single cohort study.

Setting

Genesis Surgery Center.

Participants

Eight patients who underwent a lumbar rhizotomy for chronic low back pain consented to an additional procedure involving TDC with saline solution. Two TDC electrodes (active, 55 mm; dispersive, 62 mm) were placed 51-56 cm apart, and a current amplitude of 4.0 mA was delivered for an average of 18.4 minutes.

Main outcome measures

Temperature and impedance readings recorded by the RFG-3CF Lesion Generator probe, from depths of 5 cm to the skin surface were obtained before TDC, and just before TDC was terminated. Data were analyzed using non-parametric statistics.

Results

A statistically significant decrease in impedance (mean 48 Ω, 95% confidence interval: 26-70) was detected, but there was no interaction of impedance change with tissue depth. Overall, tissue temperature decreased by 2 °C (95% confidence interval: 1.9-2.8) from baseline to the second measurement and the change was greatest within 1 cm of the surface.

Conclusion

The data suggest that transdermal delivery of medications to deep tissues of the lumbar region may not be enhanced by use of direct current as applied clinically.     

Gender differences in heart failure self-care: A multinational cross-sectional study

Background

Despite a common view that women are better at self-care, there is very little evidence to support or challenge this perspective in the heart failure (HF) population.

Objective

The purpose of this study was to determine if there are cross-cultural gender differences in self-reported HF self-care and to describe gender differences in the determinants of HF self-care.

Design, setting, and participants

A secondary analysis was completed of cross-sectional study data collected on 2082 adults with chronic HF from the United States, Australia and Thailand.

Methods

Comparisons were made between men and women regarding self-care maintenance, management and confidence as assessed by the Self-Care of Heart Failure Index, as well as the proportion of subjects engaged in adequate self-care. Multivariate comparisons were made to determine if gender explained sufficient variance in HF self-care and the likelihood of reporting adequate self-care, controlling for nine model covariates.

Results

The sample was comprised of 1306 men and 776 women. Most (73.5%) had systolic or mixed systolic and diastolic HF and 45% had New York Heart Association class III or IV HF. Although small and clinically insignificant gender differences were found in self-care maintenance, gender was not a determinant of any aspect of HF self-care in multivariate models. Married women were 37% less likely to report adequate self-care maintenance than unmarried women. Comorbidities only influenced the HF self-care of men. Being newly diagnosed with HF also primarily affected men. Patients with diastolic HF (predominantly women) had poorer self-care maintenance and less confidence in self-care.

Conclusion

Differences in HF self-care are attributable to factors other than gender; however, there are several gender-specific determinants of HF self-care that help identify patients at risk for practicing poor self-care.     

Prosthetic device provision to landmine survivors in Bosnia and Herzegovina: outcomes in 3 ethnic groups

Burger H, Marin?ek ?, Jaeger RJ. Prosthetic device provision to landmine survivors in Bosnia and Herzegovina: outcomes in 3 ethnic groups. Arch Phys Med Rehabil 2004;85:19-28.

Objective

To determine differences in prosthetic provision, use, and effectiveness among unilateral lower-extremity amputees from 3 ethnic groups in Bosnia and Herzegovina.

Design

Case series with a consecutive sample of patients seen in field clinics.

Setting

Multiple field clinics in Bosnia and Herzegovina from October 1998 to May 2002.

Participants

A total of 671 patients were examined, and information about their prosthetic history was recorded from observation or verbal responses. The majority of the amputations resulted from injuries inflicted by landmines.

Interventions

Not applicable.

Main outcome measures

Self-reported walking distance per day, prosthesis functionality (functional or nonfunctional as assessed by a physician and a prothetist), prosthesis status (broken or nonbroken as assessed by a physician and a prothetist), and employment status.

Results

Ethnic groups differed significantly in types of prostheses provided, functional status of the prostheses, and use of the prostheses for community ambulation.

Conclusion

Prosthetic devices and delivery of rehabilitation services for unilateral lower-extremity amputees differed between ethnic groups. Despite these differences, functional prosthetic devices increased mobility. Persons in all 3 ethnic groups with functional prostheses were more mobile than persons with nonfunctional prostheses. The employment rate was higher for people with functional prostheses.     

Effects of Mirror Feedback on Upright Stance Control in Elderly Transfemoral Amputees

Hlavackova P, Fristios J, Cuisinier R, Pinsault N, Janura M, Vuillerme N. Effects of mirror feedback on upright stance control in elderly transfemoral amputees.

Objective

To investigate the effects of mirror feedback on upright stance control in elderly transfemoral amputees.

Design

Before and after intervention trials.

Setting

University medical bioengineering laboratory.

Participants

Elderly transfemoral amputees (N=12).

Interventions

Participants were asked to stand upright, as immobile as possible, in 2 Eyes-open and Mirror-feedback experimental conditions. The latter experimental condition consisted of supplying the participants with their frontal reflection by positioning a mirror in front of them.

Main Outcome Measures

Weight-bearing symmetry and the displacements of the center of foot pressure under the nonaffected limb and the prosthetic limb.

Results

Mirror feedback did not modify weight-bearing symmetry and had different effects on the center of foot pressure displacements under the nonaffected limb and prosthetic limb: a decreased center of foot pressure surface area was observed in the Mirror-feedback condition relative to the Eyes-open condition under the nonaffected limb, whereas no significant difference between the Eyes-open condition and the Mirror-feedback condition was observed under the prosthetic limb.

Conclusions

Results suggest that elderly transfemoral amputees were able to integrate augmented visual biofeedback through the use of mirror-reflected body image to improve their upright stance control. The present findings could have implications for clinical practice and rehabilitation.     

Effects of Electrical Stimulation on Muscle Trophism in Patients With Hemophilic Arthropathy

Gomis M, González L-M, Querol F, Gallach JE, Toca-Herrera J-L. Effects of electrical stimulation on muscle trophism in patients with hemophilic arthropathy.

Objective

To determine changes occurring in the cross-sectional area, electromyography (EMG) activity, and the strength of the biceps brachii after an 8-week period of bilateral training with surface muscle electrical stimulation in patients with hemophilic arthropathy.

Design

Controlled trial.

Setting

Coagulopathy unit, university hospital.

Participants

Volunteer subjects (N=30) participated in this study: 15 with severe hemophilia A (hemophilic group) and 15 nonhemophilic control subjects (control group).

Interventions

The hemophilic group followed a surface electrical stimulation program (frequency 45Hz, impulse 200μs, 10s on/10s off) over an 8-week period on the biceps brachii of both arms. The control group did no training of any kind.

Main Outcome Measures

The cross-sectional area, maximum voluntary isometric contraction, and EMG activity of the biceps brachii in both arms were determined before and after the 8-week-long task.

Results

The results of the hemophilic group showed significant increases in the diameter (15.8%, P<.001), isometric force (4.6%, P<.05), and EMG activity (37.6%, P<.05) of the biceps brachii muscles in both arms. No significant changes were observed for the control group.

Conclusions

Our findings confirm the efficacy of muscle electrical stimulation in causing muscles to hypertrophy in patients with hemophilia, thereby improving their muscular strength. In addition, these results may also be clinically applicable in the rehabilitation of patients who have similar deficiencies in the locomotor system.