Standing sway and weight-bearing distribution in people with below-knee amputations.

Upright stability in humans has been found to decrease with age, certain diseases, or trauma. We investigated stability of standing in people with below-knee amputations (BKA) and in able-bodied controls. Body sway was evaluated during standing on a set of two Kistler force plates, first with eyes open and then with eyes closed. People with BKA were tested twice--first, one to two days after receiving their prostheses, and second, on completing their prosthetic rehabilitation. The results indicate that both able-bodied people and those with BKA sway more with their eyes closed. However, people with BKA are significantly less stable when they stand with either closed eyes or open eyes. We demonstrated that the differences between the groups studied are due to a proprioceptive deficit as a result of partial limb loss. We also found that there was a gradual process of compensation and adaptation, as some people with BKA sway less at the end of the rehabilitation period.     

心脏瓣膜置换术后80例护理体会

心脏瓣膜置换术是治疗心脏瓣膜病变所致心功能不全的重要手段[1-7]。由于术后患者管道多,手术创伤大,病情变化迅速,易发生各种并发症。所以,术后监护要分清主次,同时又要注意联系整体。现就我院2007年3月～2009年6月80例心脏换瓣术后监护体会总结如下。1临床资料本组80例,男32例,女48例。年龄5～64岁。单纯二尖瓣病变22例,主动脉瓣病变17例,二尖瓣及主动脉联合病变20例,二尖瓣或主动脉瓣联合三尖瓣病变21例。术前心功能二级15例,三级53例,四级12例。行二尖瓣置换术28例,主动脉瓣置换术15例,双瓣置换术18例,二尖瓣或主动脉瓣置换联合三尖瓣成形术19例。2结果术后呼吸机辅助时间1     

Bilateral changes in somatosensory sensibility after unilateral below-knee amputation

OBJECTIVE: To evaluate possible alteration in proprioceptive and cutaneous sensibility in the nonamputated leg of unilateral transtibial amputees. DESIGN: Cross-sectional study with between-subjects (amputees vs controls) and within-subjects (nonamputated vs amputated leg) comparisons. SETTING: Canadian rehabilitation hospital research laboratory. PARTICIPANTS: Two groups of amputees (34 due to traumatic causes, 14 due to vascular causes), recruited more than 1 year after their prosthetic training; and 2 groups (n=34, n=14) of age-matched control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Threshold of movement detection and touch-pressure perception at the knee and foot levels. RESULTS: In the traumatic group, the sensory thresholds of the nonamputated leg were significantly higher than the control values in the 2 modalities tested. The movement detection was reduced at the knee and ankle levels, whereas a decrease in touch-pressure sensibility was observed only at the plantar site. As expected, a large proportion of the vascular amputees presented with severe sensory deficits in the nonamputated leg, particularly a loss in touch-pressure perception at the foot. The thresholds of movement detection were similar and correlated at both knees in the 2 groups of amputees. For the touch-pressure thresholds, no significant relationship was found between sides at the knee level. CONCLUSIONS: Sensory changes observed in the nonamputated leg suggest that central sensory adaptations occur after amputation. For movement detection, they were marked by a matching of perception on both sides of the body. Functional significance of these changes remains to be determined.     

Acute renal failure in patients over 80 years old: 25-years' experience

Objective: To determine the epidemiological trends, spectrum of etiologies, morbidity and mortality of acute renal failure (ARF) in patients over 80 years old.¶Design: Historical cohort analysis.¶Setting: Intensive care unit (ICU) of nephrology, Tenon Hospital, Paris.¶Patients and participants: The criteria of inclusion was ARF, defined on the basis of a creatinine value over 120 μmol/l, in patients over 80 years of age admitted between October 1971 and September 1996. When moderate chronic nephropathy was pre-existing, ARF was defined by the increase of at least 50 % over the basal creatininemia.¶Measurements and results: Three hundred and eighty-one patients over 80 years of age were included. The etiology and mechanism of ARF are detailed. 29 % of the patients received dialysis. Global mortality at the hospital was 40 %. Factors significantly associated with a poor prognosis are identified. Mean survival after hospitalization was 19 months.¶Conclusion: The frequency of admission to ICUs for ARF in patients older than 80 years seems to be on the increase. Mortality is less severe than expected. These patients could benefit from the renal replacement therapy of modern intensive care medicine.     

Arm ergometry exercise testing in patients with dysvascular amputations

The purpose of this study was to test the agreement between the heart rate (HR) response and rating of perceived exertion (RPE) on an arm ergometry graded exercise test (GXT) in deconditioned persons with acute dysvascular amputations before and after an inpatient rehabilitation program. Twenty-six men were studied at admission, and 11 were retested after completion of the program. After obtaining resting measurements of HR and systolic and diastolic blood pressures, each patient performed the GXT using an arm ergometer. Patients maintained a cranking rate of 50rpm, which was monitored electronically. The workloads started with a warm-up period of 0 watts (stage 1) and increased by increments of 5 watts. Each stage lasted three minutes-2.5 minutes of exercise and 30 seconds of rest. The RPE was taken five seconds before the end of each exercise stage. During the rest period, HR and blood pressures were recorded. Scatter plots and linear regression analyses revealed no statistically significant relationship, either at early stages of GXT or at peak work, between HR and RPE. The results suggest that RPE cannot be used reliably as a surrogate for direct pulse measurement in exercise training of persons with acute dysvascular amputations.     

Walker inlet-closure strap for unsteady patients with lower-extremity amputations.

Some patients with lower-extremity amputations who use a walker fall backwards after advancing too far forward into the walker's base of support. In a pilot study of 14 patients with unilateral lower-extremity amputations who stepped into the forward two thirds of the walker base, this problem was corrected by using a knee-high elastic strap to close the open posterior "inlet" of the walker. Without the strap, the stance-phase position of the leading ankle was in the forward third of the walker base for 8 subjects and in the middle third for 6. With the walker strap, the ankle position was in the middle third for one subject, in the posterior third for 6, and at or behind the walker inlet for 7 (p < .0002). This simple intervention appears to correct the potentially dangerous behavior of stepping too far into the walker base.     

骨科截肢患者的护理和心理疏导

目的：总结骨科施行截肢（指）术患者的护理方法。方法：对2008年1月—2011年12月34例接受截肢（指）术患者的临床资料和护理方法进行总结。结果：住院9～18 d,平均14 d。无感染和压疮等并发症发生,均康复出院。结论：施行截肢（指）术患者的心理护理十分必要。正确的心理疏导和采取相应的康复措施,有利于患者疾病康复。     

Prosthetic use in patients with burns and associated limb amputations

A review of 11 patients who sustained burns that were complicated by limb amputation was completed to determine their eventual ability to use prosthesis. Amputations included six below-elbow, four above-elbow, three below-knee, and three above-knee amputations. Ten of the 11 patients (91%) had open wounds on the stump limbs and nine patients (82%) required skin grafting procedures on the amputated limbs. Delays in prosthetic fitting because of continued surgeries, open wounds, skin grafts on the stump limb, and breakdown of the stump were identified. However, eight of these patients (73%) were eventually able to wear prosthetic devices. Fisher's exact test was used to test the influence of the number and site of the amputations and skin grafting on the stump on successful prosthesis use. None of these tested items were found to be significant. The results demonstrate that most patients with burns who require limb amputation can achieve successful prosthesis use.     

The "Z" strap: harnessing modification for patients with upper extremity amputations

High level, upper extremity amputees have been observed to have problems affecting overall prosthetic function. These include: tendency of the Northwestern Ring to ride upward and difficulty with terminal device function above 90 degrees of elbow flexion. A simple modification of the control strap was tried to resolve these problems of function. The control strap was attached across the back to a buckle on the unamputated side at the shoulder to provide a more efficient anchor. This created more body contact across the back and formed a type of "Z" strap allowing full freedom of movement in any direction. Less forward shoulder flexion was necessary due to decreased cable travel and because the strap was not sliding up and over the shoulder. A single case study is described and the successful outcome for the amputee.     

Prosthetic use in elderly patients with dysvascular above-knee and through-knee amputations

Fifty-five patients with vascular insufficiency resulting in above-knee (AK) and through-knee (TK) amputations were studied to determine factors related to prosthetic candidacy and functional outcome. Chart review showed that the only difference between patients who were fitted with prostheses and those who were not fitted with prostheses was their respective number of medical complications. Twenty-three of 31 patients with prostheses were evaluated 7 to 35 months after receiving the prostheses. Ten (44%) of these patients wore their prostheses all day every day and used wheelchairs minimally or not at all. Over half of the patients evaluated used their wheelchairs most of the time. Two (9%) of the 23 patients had stopped wearing their prostheses. Patients who demonstrated increased walking distances and velocities at follow-up used their prostheses more and their wheelchairs less than did the other patients. Neither gait factors nor hip range of motion at discharge was predictive of continued prosthetic use. Functional outcome and prosthetic use were limited in this group of elderly patients with dysvascular AK and TK amputations. The results of this study may serve as a basis for clinical determination of prosthetic candidacy and functional goals.     

Joint kinetics in unilateral below-knee amputee patients during running

Objective: To explore the nature of the accommodations in running gait that persons with below-knee amputations make in response to the limb segment loss.Patients: Two groups of volunteer subjects (n = 6 in each group). Individuals in one group had below-knee amputations; the second group had intact lower limbs.Design: Individuals ran at two nominal speeds, 2.7m/sec and 3.5m/sec, over a flush-mounted force platform. Ground reaction force data were combined with simultaneously recorded and subsequently digitized video data of coordinate motion to calculate joint and segment motion and net joint moment data.Results: The degree of left-to-right asymmetry for the amputee group was dependent on the variable of interest. There was symmetry in stride frequency and support moment and a marked asymmetry in ankle, knee, and hip moments. In response to increased running speed, both groups increased the amplitude of each joint moment. The nonamputee group appeared to increase the gain uniformly across the three joints, whereas the intact and prosthetic limbs were not uniformly increased. The temporal sequencing of the components for the intact and prosthetic limbs did not appear to differ from the nonamputee limb. This similarity in timing was unaffected by speed increases.Conclusion: There was no need to develop completely new patterns of joint moments; rather, it was sufficient to retune the current moment patterns to account for new segmental properties and thus retain the internal timing characteristics.     

Goal attainment scaling in the rehabilitation of patients with lower-extremity amputations: a pilot study

OBJECTIVE: To assess the interrater reliability, construct validity, and responsiveness of Goal Attainment Scaling (GAS) among patients who have had lower-extremity amputations. DESIGN: Pilot study comparing GAS with 2 functional measures with established reliability, validity, and responsiveness values. SETTING: Regional amputee program in southwestern Ontario. PARTICIPANTS: Ten patients (6 women, 4 men; mean age +/- standard deviation, 72.3+/-10.7 y) with unilateral lower-extremity amputations who were consecutively admitted to a regional amputee program. The ratio of transtibial to transfemoral amputations was 6:4. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects were assessed by using GAS, the Barthel Index, and the Locomotor Capabilities Index (LCI) of the Prosthetic Profile of the Amputee. RESULTS: The interrater reliability of GAS was r=.67, and 63% of goals developed were identified independently by both investigators. The construct validity between GAS and the Barthel Index and the LCI was r=.44 and r=.35, respectively. GAS was more responsive than both the Barthel Index and the LCI, as indicated by the calculation of effect sizes and relative efficiencies. CONCLUSION: This pilot study suggests that GAS is a promising outcome measure for the rehabilitation of patients with lower-extremity amputations.     

80例缺铁性贫血孕产妇围产期护理体会

目的从护理角度探讨做好围产期护理干预对孕产妇缺铁性贫血及并发症的预防、治疗效果的影响。方法通过从确诊早孕开始,根据孕产妇的实际健康状况,建立孕产妇保健手册,对患缺铁性贫血的80例孕产妇实施从孕期到分娩期、产褥期的有针对性的分阶段护理干预,观察采取护理干预措施后缺铁性贫血孕产妇的治疗效果,探讨缺铁性贫血孕产妇有效的围产期护理措施。结果80例缺铁性贫血孕产妇经围产期护理措施干预后,无1例发生产后出血及感染。经产后跟踪随访,孕产妇的血红蛋白稳定在100-120g／L;红细胞计数均达到正常值。结论有效的预防及治疗妊娠合并缺铁性贫血,提高母体的抵抗力,有利于母婴的健康,有效改善了孕产妇的生活质量。