- Implications for rehabilitation
Even with recent developments and advances in prosthetic design, the needs and desires of prosthetic users are not being met with current products.
The desires and needs of those with upper limb difference are diverse.
Using additive manufacturing to produce prosthetics allows for mass customization of prosthetics to meet these diverse needs while reducing costs.
A soft robotic approach to prosthetics can help meet the desires of reducing weight and costs, while maintaining functionality.
- Implications for rehabilitation
Research into prosthetic and orthotic interventions has grown substantially in the last 20 years, with most of this research conducted in a small number of countries and focusing on the use of lower limb orthotics in adult populations.
Research to date has utilized an extensive range of outcome measures, the development of agreed standardized sets of outcomes would allow comparison and combination of results in future research.
This study highlights the need for further research in this area, especially studies which examine the cost-effectiveness of prosthetic and orthotic provision.
- Implications for Rehabilitation
??Over one third of people with upper limb amputations do not use a prosthesis because prosthetic devices do not meet their needs.??The number of motions possible in state of the art prosthetic devices is limited by the small number of control sites available.??The Dart Thrower?s Motion is a wrist motion used for many activities of daily living but unavailable in commercial prosthetics leading many prosthetics users to have difficulty with these tasks.??Prosthetic use, and therefore quality of life, could be improved by including the Dart Thrower’s Motion in a prosthesis.
- Implications for rehabilitation
Adjustment to amputation and prosthesis use involves both physical and psychosocial issues, it is important that besides physical rehabilitation, psychological interventions and education and communication activities between the patient and the health professionals are carried out.
The adaptation to the prosthesis and the recovery of walking capacity are important goals in the rehabilitation process and the knowledge of the physical and psychosocial factors associated with amputation and the use of the prosthesis can help the health team to provide better care to these subjects.
Well-adjusted, comfortable and easy-to-use prostheses are of great importance as they enable the patient to perform their daily activities and maintain their independence.
It is important to encourage the participation of the individual in both rehabilitation and choice of prosthesis.
Methods: A retrospective review of 338 patients who had undergone lower limb amputation was conducted to identify characteristics that affected the success of rehabilitation with a prosthetic limb. These data were used to devise an assessment tool (the BLARt score), which was then tested and validated in 199 patients planned to undergo lower limb amputation in two UK regional centers. Functional rehabilitation outcomes were recorded at 12?months after surgery using the SIGAM mobility grading.
Results: No patient with a BLARt score?≥13 achieved good functional outcome (defined as independent mobility, SIGAM grade E or F) and only 6 patients with a BLARt score?≥17 achieved any functional outcome (defined as any ability to walk unaided, SIGAM grade C or greater).
Conclusions: In the patient cohorts studied, the BLARt assessment tool was a strong predictor of whether or not patients would be able to walk with a prosthetic limb after surgery. It is simple to administer and could be useful in clinical practice to inform expectations for patients and clinicians.
- Implications for rehabilitation
Patients undergoing lower limb amputation face major physical and psychological challenges after surgery that have a considerable impact on rehabilitation and their ability to walk independently.
Many amputees are unable to walk with a prosthetic limb, but there are no validated tools to predict this before surgery.
The BLARt is a potentially valuable measure that can predict the likelihood of being unable to walk after amputation.
It is simple to use and could be useful to inform patients’ and clinicians’ expectations before surgery.
- Implications for rehabilitation
Whilst the formal characteristics of product attachment were not broadly identified in this study, some indications may give credence for prosthetists to consider an “appearance follows performance” approach to sports prostheses design. This may improve end-user satisfaction with their assistive technology.
The inclusion of prosthetic post-manufacture decoration and personalization would seem to be desirable to the end-user.
By adopting the feedback given in this study, undertaking trials conducted at a race-specific intensity of the athlete end-user may reduce the need to perform post-manufacture ad-hoc prostheses modifications.
Methods: This case series includes three women with transradial amputation. Structured surveys and semi-guided interviews were administered after completion of in-laboratory training and a home trial of the DEKA Arm. A constant comparative method with a grounded theory approach was used to generate a model describing women’s decision-making related to the DEKA Arm. Quantitative data on prosthetic satisfaction was used to triangulate findings.
Results: Factors that enhanced desirability of the DEKA Arm were improved functionality, increased abilities and the availability of someone to service the prosthesis. Factors that detracted from desirability of the device were its appearance, conspicuousness, lifestyle incompatibility, weight, need for service and difficulty of use. Each woman weighted these factors within the larger context of the capabilities of and satisfaction with her personal prostheses, her self-concept and lifestyle needs. Situational demands, particularly the desire to appear feminine and professional or need to perform certain activities, also altered the valuation of these priorities.
Conclusion: Findings strongly suggest that advanced upper limb prosthetic technologies, like the DEKA Arm, will be better accepted by women if appropriately gendered in appearance and designed with women’s priorities in mind.
- Implications for Rehabilitation
Women should be able to derive the functional benefits of advances in upper limb technology without needing to compromise their feminine identity and lifestyle preferences.
Advanced upper limb prosthetic technologies will be better accepted by women if they are appropriately gendered.
- Implications for Rehabilitation
Exoskeletons offer the promise of allowing individuals with neurological injury to reengage in everyday activities from a standing position.
Several exoskeleton devices are currently available for use in the United States.
Weight of exoskeleton devices, the need for upper extremity supports, supervision requirements of hone units, and a limited range of movements are issues that restrict opportunities for using such devices in real-world contexts.
Further development of exoskeleton technologies is warranted to improve the devices for real-world use.
- Implications for Rehabilitation
Small changes in form made to a cycling prostheses design can potentially deliver worthwhile performance enhancement.
Prosthetists may obtain greater end-user satisfaction by taking a broader approach to sports prostheses design than just fit and biomechanical function alone.
This study indicates that other regions of the cycling prosthesis could now benefit from aerodynamic optimization with the aim to further improve paracycling performance.
Methods: We included 42 patients with partial or complete single or multiple finger amputation of one hand who visited the outpatient clinic for prosthetics and orthotics at our institute and received a silicone prosthesis. We assessed their adjustment to amputation and prosthesis with the Trinity Amputation and Prosthesis Experience Scales (TAPES).
Results: Most of the patients (28, 67%) had a single finger amputated. The average scores on all TAPES subscales (except adjustment to limitation) were above 50% of the maximum possible score. On average, the scores were the highest on the general adjustment and satisfaction with the prosthesis subscales.
Conclusions: Silicone prostheses for finger amputation of upper limb play an important role in the process of adaptation to amputation. They offer aesthetically satisfying results and alleviate social interactions, which influences overall quality of life.
- Implications for Rehabilitation
Silicone prostheses for finger amputation of upper limb offer an aesthetically satisfying result and alleviate problems with social interactions.
Their influence on hand function is not optimal, but the prosthesis improves the amputee's quality of life.
Material and methods: We investigated 32 patients at six months after stroke with the Fugl-Meyer Assessment (observed function) and hand subscale of the Stroke Impact Scale (perceived function). Spearman correlation was calculated to relate observed and perceived function. Through cut-off scores, we divided our sample in low (Fugl-Meyer Assessment <31/66) and good observed function, and low (hand subscale of Stroke Impact Scale <61/100) and good perceived function. Scatterplot and hierarchical clustering analysis was conducted to detect distinct groups.
Results: A strong positive relation was found between observed and perceived function (r?=?0.84). Three groups could be identified; a “low match group” of patients with low observed and low perceived function (n?=?11, 34%), a “good match group” containing patients with good observed and good perceived function (n?=?15, 47%), and a “mismatch group” comprising patients with good observed but low perceived function (n?=?6, 19%).
Conclusions: In our chronic sample, one in five patients showed good upper limb observed but low perceived function. Measuring both observed and perceived arm and hand function seems warranted together with considering a differential therapy approach for the distinct groups.
- Implications for rehabilitation
A considerable group of patients in the chronic phase post-stroke have good motor function in their affected upper limb, but nevertheless perceive a restricted ability.
In order to identify a mismatch in people with chronic stroke, both observed and perceived upper limb motor function should be assessed.
Besides common measurement tools for observed function like the Fugl-Meyer Assessment, perceived function can be evaluated by means of the hand function section of the Stroke Impact Scale.
For patients with good observed but low perceived function, an additional rehabilitation strategy should be considered, potentially including awareness of ability and a self-efficacy approach.
Method: A rigorous literature review was undertaken using several technical and clinical databases using a variety of key words pertinent to maxillofacial prosthetic rehabilitation and resource-limited areas. In addition, interviews were conducted with researchers, clinicians and prosthetists that had direct experience of volunteering or working in resource-limited countries.
Results: Results from the review and interviews suggest rehabilitating patients in resource-limited countries remains challenging and efforts to improve the situation requires a multifactorial approach.
Conclusions: In conclusion, public health awareness programmes to reduce the causation of injuries and bespoke maxillofacial prosthetics training programmes to suit these countries, as opposed to attempting to replicate Western training programmes. It is also possible that usage of locally sourced and cheaper materials and the use of low-cost technologies could greatly improve maxillofacial rehabilitation efforts in these localities.
- Implications for Rehabilitation
More information and support needs to be provided to maxillofacial defect/injuries patients and to their families or guardians in a culturally sensitive manner by governments.
The health needs, economic and psychological needs of the patients need to be taken into account during the rehabilitation process by clinicians and healthcare organizations.
The possibility of developing training programs to suit these resource limited countries and not necessarily follow conventional fabrication methods must be looked into further by educational entities.
- Implications for rehabilitation
Upper limb deficiency is a condition in which a part of the upper limb is missing as a result of a congenital limb deficiency of as a result of an amputation.
A prosthetic hand can restore some of the functions of a missing limb and help the user in performing activities of daily living.
Using 3D-printing technology is one of the solutions to manufacture hand prostheses.
This overview provides information about the general, mechanical and kinematic specifications of all the devices and it provides the information about the 3D-printing technology used to print the hands.
- Implications for rehabilitation
There is wide variety of tasks and performance-based outcomes for PW driving.
Results showed that available assessment measures are not commonly used in research and that tasks used often lacked consistency across studies.
New methods to measure the interaction of speed and accuracy are needed.
The contents of this review could be used by researchers as a starting point when designing a PW task and selecting appropriate performance-based outcomes.
- KEY MESSAGES
The cornerstones for the treatment of CDI are vancomycin and fidaxomicin. Metronidazole should be used only in mild-to-moderate disease in younger patients who have no or only few risk factors for recurrence.
In recurrent CDI, bezlotoxumab infusion (a monoclonal antibody against C. difficile toxin B) may be considered as an adjunctive therapeutic strategy in addition to the standard care provided to patients with several risk factors for recurrence.
Faecal microbiota transplantation (FMT) should be offered to patients with frequently recurring CDI.
Methods: Ten TFA and ten matched people without amputations (NA) walked in a virtual environment with level, sloped and simulated uneven surfaces on a self-paced treadmill. Stability was quantified using medial-lateral margin of stability (ML-MoS), step parameters, and gait variability (standard deviations for speed, temporal-spatial parameters, foot clearance and root-mean-square of medial-lateral trunk acceleration).
Results and conclusions: TFA and NA adapted to non-level conditions by changing their walking speed, step width, and foot clearance. Variability for most parameters increased across conditions, compared to level. TFA walked slower than NA with shorter, wider and longer duration steps (most differences related to speed). ML-MoS did not change compared to level; however, ML-MoS was greater on the prosthetic side than both intact side and NA limbs. Foot clearance and root-mean-square of medial-lateral trunk acceleration were greater on the prosthetic side than the intact side and NA limbs. This research provides a comprehensive analysis of the different adaptations made by people without amputations compared to people with transfemoral amputations over non-level conditions and establishes significant differences between slopes and simulated uneven surfaces for TFA.
- Implications for Rehabilitation
Transfemoral amputation and no amputation groups adapted walking biomechanics when traversing non-level surfaces.
Greatest temporal-spatial gait adaptations were walking speed, step width and foot clearance.
Gait parameter variability typically increased from the level condition in both groups.
Transfemoral amputation group walked slower than no amputation group with shorter, wider steps and longer duration steps. This was related to speed.
Transfemoral amputation group had more trunk motion variability on the prosthetic side than no amputation group; could be related to prosthetic fit.
- Implications for rehabilitation
Proactive assessment for assistive products by health professionals is rare and the vast majority of people with intellectual disabilities depend on carers to signal the need .
A lack of education for carers around available assistive products and the benefits of assistive products for people with intellectual disabilities may lead to an underutilization for this group.
The paternalistic attitude of care providers towards people with intellectual disabilities limits access and use to certain (high-tech) assistive products.
The segmented and disjointed aspect of public funding to support assistive products found in this study is a key issue for policymakers who aspire to adhere to implementing the UNCRPD equally in all areas of their country.
- Implications for rehabilitation
Step length symmetry between intact and prosthetic limbs improved with an active vacuum system.
Differences between vacuum conditions on most gait parameters were small during level walking.
Subjective feedback showed improved proprioception and comfort with an active vacuum system.
Methods: Using information on the symptoms, diagnosis, rehabilitation and outcome of a young patient with complex regional pain syndrome type II.
Results: A 9-year -old girl had severe pain in the region of the left foot, signs of a common fibular nerve entrapment, hyperalgesia not limited to the distribution of the injured nerve, weakness and temperature asymmetry unknown origin. She consulted few doctor’s before she was given the right diagnosis of complex regional pain syndrome type II. Following the diagnosis the treatment started, it included intensive physiotherapy, electrical therapy and also supportive psychological therapy. Half a year later, the patient was free of the daily pain and returned to all physical activity without any restrictions.
Conclusions: The case report illustrates that peripheral nerve compression or injuries specifically, complex regional pain syndrome type II, should be taken into consideration when evaluating children with weakness and pain of the lower or upper limb.
- Implication of rehabilitation
Raising the awareness of complex regional pain syndrome in the childhood is essential for an early diagnosis and appropriate treatment.
The treatment options include early and adequate pain management inclusive electrical therapy and physiotherapy.
Psychological therapy helps to avoid psychological stress reaction and the disease negative impact on the child’s education and sports and the family social life.