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Choi HJ, Choi J, Kim GS, Sung Kim H, Ko CY. Asymmetry of peak plantar pressure in transfemoral amputees during indoor and outdoor walking. J Biomech 2024; 170:112177. [PMID: 38838496 DOI: 10.1016/j.jbiomech.2024.112177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
This study investigates the differences in peak plantar pressure between the amputated and intact limbs of transfemoral amputees when walking outdoors. Ten non-amputees (aged 24.4 ± 2.0 years, 176.9 ± 2.5 cm, 72.3 ± 7.9 kg) and six transfemoral amputees (48.5 ± 6.3 years, 173.8 ± 4.2 cm, 82.0 ± 11.9 kg) participated in the study. Over approximately 1.6 km, the participants encountered various obstacles, including stairs, uneven surfaces, hills, and level ground, both indoors and outdoors. Throughout the walking session, the peak plantar pressure in both feet was monitored using wearable insole sensors. For all terrains, the percentage asymmetry was determined. Significant changes in peak plantar pressure asymmetry were found between the intact and amputated limbs, particularly when walking on level ground indoors, uneven terrains, descending stairs, and on steep slopes outdoors (all p < 0.05). These findings highlight the greater peak plantar pressure asymmetry in transfemoral amputees when walking outside. In addition, this study revealed that not all terrains contribute uniformly to this asymmetry.
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Affiliation(s)
- Hyuk-Jae Choi
- Rehabilitation Engineering Research Institute, Incheon, Republic of Korea.
| | - Junwon Choi
- Department of Biomedical Engineering, Yonsei University, Seoul, Republic of Korea.
| | - Gyoo-Suk Kim
- Rehabilitation Engineering Research Institute, Incheon, Republic of Korea.
| | - Han Sung Kim
- Department of Biomedical Engineering, Yonsei University, Seoul, Republic of Korea.
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Li X, Li Z, Jiang W, Wei J, Xu K, Bai T. Effect of lower extremity amputation on cardiovascular hemodynamic environment: An in vitro study. J Biomech 2022; 145:111368. [PMID: 36347116 DOI: 10.1016/j.jbiomech.2022.111368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/13/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
Lower extremity amputation (LEA) was associated with a greater risk of cardiovascular disease, but its hemodynamic mechanisms have not been fully studied. Therefore, to clarify the interrelationship between them, and figure out the potential pathogenesis, the exploration of the hemodynamic environment change of patients after LEA was premeditatedly executed. A near-physiological mock circulatory system (MCS) was employed in the present work to replicate the cardiovascular circulation after LEA in a short time and the unsteady-state numerical simulation was utilized as an auxiliary method to observe the changes of the hemodynamic environment inside the blood vessel. Higher severity of LEA leads to higher peripheral vascular impedance, higher blood pressure, and more obvious redistribution of blood perfusion volume. In addition, higher severity of LEA leads to lower wall shear stress (WSS), higher oscillatory shear index (OSI), and higher relative residence time (RRT) appeared in the infrarenal abdominal aorta and the iliac artery, while these changes are closely related to the higher probability of cardiovascular diseases. Results showed that different degrees of LEA (varying heights, unilateral/bilateral) have diverse effects on the patient's hemodynamic environment. This study explained the potential pathogenesis of cardiovascular diseases after LEA from a hemodynamic perspective and provided a certain reference value for the improvement of the cardiovascular hemodynamic environment and the prevention of cardiovascular diseases in lower extremity amputees.
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Affiliation(s)
- Xiao Li
- Department of Mechanical Science and Engineering, Sichuan University, China; Biomechanical Engineering Laboratory of Sichuan Province, Chengdu, China
| | - Zhongyou Li
- Department of Mechanical Science and Engineering, Sichuan University, China; Biomechanical Engineering Laboratory of Sichuan Province, Chengdu, China
| | - Wentao Jiang
- Department of Mechanical Science and Engineering, Sichuan University, China; Biomechanical Engineering Laboratory of Sichuan Province, Chengdu, China.
| | - Junru Wei
- Department of Mechanical Science and Engineering, Sichuan University, China; Biomechanical Engineering Laboratory of Sichuan Province, Chengdu, China
| | - Kairen Xu
- Department of Mechanical Science and Engineering, Sichuan University, China; Biomechanical Engineering Laboratory of Sichuan Province, Chengdu, China
| | - Taoping Bai
- Department of Mechanical Science and Engineering, Sichuan University, China; Biomechanical Engineering Laboratory of Sichuan Province, Chengdu, China
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3
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Akhtar MA, Hoellwarth JS, Al-Jawazneh S, Lu W, Roberts C, Al Muderis M. Transtibial Osseointegration for Patients with Peripheral Vascular Disease: A Case Series of 6 Patients with Minimum 3-Year Follow-up. JB JS Open Access 2021; 6:JBJSOA-D-20-00113. [PMID: 34235362 PMCID: PMC8238302 DOI: 10.2106/jbjs.oa.20.00113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The management of peripheral vascular disease (PVD) can require amputation. Osseointegration surgery is an emerging rehabilitation strategy for amputees. In this study, we report on 6 patients who had PVD requiring transtibial amputation (PVD-TTA) and either simultaneous or subsequent osseointegration (PVD-TTOI). Methods Six patients (aged 36 to 84 years) with transtibial amputation and preexisting PVD underwent osseointegration between 2014 and 2016 and were followed for 3 to 5 years. Pre- and postoperative clinical and functional outcomes (pain, prosthesis wear time, mobility, walking ability, and quality of life) and adverse events (infection, fracture, implant failure, revision surgery, additional amputation, and death) were prospectively recorded. Results All patients' mobility improved following osseointegration. Three patients initially had required the use of a wheelchair, precluding baseline walking tests; the other 3 were classified as K level 1 or 2, with mean baseline Timed Up and Go (TUG) test = 14.0 ± 2.2 s and 6-Minute Walk Test (6MWT) = 262 ± 75 m. At the time of the latest follow-up, all patients were K level 2 or 3; mean TUG = 12.7 ± 7.2 s and 6MWT = 353 ± 148 m. Four patients wore their prosthesis ≥16 hours daily. Three patients had superficial soft-tissue infections. One other patient experienced recurrent infections 2.8 years after osseointegration requiring debridements and transfemoral amputation; the patient died 2 days following surgery from myocardial infarction caused by coronary atherosclerosis. Conclusions All 6 patients who underwent PVD-TTOI in this case series survived through 2 years. Patients who initially had used a wheelchair achieved and maintained independent, unaided ambulation until PVD-related impairments in the contralateral leg occurred in 1 patient. Patients previously using a traditional socket prosthesis reported improvement in mobility and quality of life. One patient's death underscores the importance of careful patient selection. However, marked improvement in the other 5 patients suggests cautious optimism that PVD-TTA is not an absolute osseointegration contraindication. Conscientious further investigation seems appropriate. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Muhammad Adeel Akhtar
- Trauma and Orthopaedic Department, Victoria Hospital Kirkcaldy, NHS Fife, Kirkcaldy, Scotland, United Kingdom.,Norwest Private Hospital, Bella Vista, New South Wales, Australia.,University of Edinburgh, Edinburgh, Scotland, United Kingdom.,University of St Andrews, St. Andrews, Scotland, United Kingdom.,Australian School of Advanced Medicine, Macquarie University, North Ryde, New South Wales, Australia
| | - Jason Shih Hoellwarth
- Australian School of Advanced Medicine, Macquarie University, North Ryde, New South Wales, Australia
| | - Shakib Al-Jawazneh
- Australian School of Advanced Medicine, Macquarie University, North Ryde, New South Wales, Australia
| | - William Lu
- Biomaterials and Tissue Engineering Research Unit, School of AMME, University of Sydney, Sydney, New South Wales, Australia
| | - Claudia Roberts
- Norwest Private Hospital, Bella Vista, New South Wales, Australia.,Australian School of Advanced Medicine, Macquarie University, North Ryde, New South Wales, Australia
| | - Munjed Al Muderis
- Norwest Private Hospital, Bella Vista, New South Wales, Australia.,University of St Andrews, St. Andrews, Scotland, United Kingdom.,School of Medicine, The University of Notre Dame Australia, Auburn, New South Wales, Australia
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Diment LE, Thompson MS, Bergmann JHM. Comparing thermal discomfort with skin temperature response of lower-limb prosthesis users during exercise. Clin Biomech (Bristol, Avon) 2019; 69:148-155. [PMID: 31352255 PMCID: PMC6839397 DOI: 10.1016/j.clinbiomech.2019.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/03/2019] [Accepted: 07/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thermal discomfort is prevalent among prosthesis users. This observational study of thirty unilateral lower-limb prosthesis users compared their skin temperatures and the thermal discomfort experienced during exercise between their residual and contralateral limbs. METHODS Participants performed a 2-minute interval cycling exercise test. Skin temperature was measured at matched locations on each leg during the 1-minute rest intervals. Average rate-of-change in skin temperature was compared between legs using a repeated measures analysis of variance. Participants rated thermal discomfort on each leg before and after exercise, and a Wilcoxon signed-rank test was used to compare legs. Ordinal regression evaluated the relationship between the rate-of-change in temperature on the residual limb and the perceived thermal discomfort. FINDINGS After exercise, thermal discomfort ranked higher on the amputated side (P = 0.007). On average, both legs cooled during exercise (P = 0.002), but the difference between legs was not significant. The rate-of change in skin temperature on the residual limb during exercise did not relate to the thermal discomfort experienced (odds ratio of 0.357). INTERPRETATION These findings indicate that in this patient population, skin temperature does not explain the thermal discomfort experienced, and subjective thermal discomfort is inadequate for detecting thermoregulatory issues, with potential implications for long-term tissue health.
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Affiliation(s)
- Laura E Diment
- Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - Mark S Thompson
- Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - Jeroen H M Bergmann
- Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK.
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Kaptein S, Geertzen JHB, Dijkstra PU. Association between cardiovascular diseases and mobility in persons with lower limb amputation: a systematic review. Disabil Rehabil 2017; 40:883-888. [PMID: 28129515 DOI: 10.1080/09638288.2016.1277401] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Persons requiring a lower limb amputation often have cardiovascular diseases that reduce cardiac function, which may complicate recovery and rehabilitation after an amputation. This systematic review analysis the association between cardiovascular diseases and mobility in persons with a lower limb amputation. METHOD Four databases were searched for studies published before August 2016 using database-specific keywords and synonyms for amputation, cardiovascular diseases and mobility. Assessment of the publications was performed based on predefined criteria; first title and abstract and thereafter the full text. RESULTS Of the 1704 titles and abstracts, 51 full texts were assessed. Ten studies were included. Cardiovascular diseases were associated with cardiac complications during rehabilitation. Prosthetic training improved cardiac function. Seven studies showed that cardiovascular diseases were associated with a smaller chance of becoming a prosthetic walker, and with poorer mobility outcomes. CONCLUSION Evidence for effects of cardiovascular diseases on mobility in persons with a lower limb amputation is heterogeneous. Cardiovascular diseases reduce the chance of becoming a prosthetic walker and reduce mobility outcomes after a lower limb amputation. More research with adequate quality about cardiovascular diseases in persons requiring a lower limb amputation is needed, to enable informed choices in the pre- and post-amputation rehabilitation. Implications for rehabilitation Data about the effect of cardiovascular diseases on mobility in persons with a lower limb amputation is limited. More research about cardiovascular diseases in persons requiring a lower limb amputation is needed, to enable informed choices in the pre- and post-amputation rehabilitation.
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Affiliation(s)
- Sara Kaptein
- a Department of Rehabilitation Medicine , Center for Rehabilitation, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Jan H B Geertzen
- a Department of Rehabilitation Medicine , Center for Rehabilitation, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Pieter U Dijkstra
- a Department of Rehabilitation Medicine , Center for Rehabilitation, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands.,b Department of Oral and Maxillofacial Surgery , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
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Affiliation(s)
- JA Dormandy
- St George's Hospital Medical School, London, UK
| | - SA Ray
- St George's Hospital Medical School, London, UK
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Chamlian TR. Use of prostheses in lower limb amputee patients due to peripheral arterial disease. EINSTEIN-SAO PAULO 2014; 12:440-6. [PMID: 25628194 PMCID: PMC4879909 DOI: 10.1590/s1679-45082014ao3132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 10/30/2014] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To evaluate the indication of prosthesis during rehabilitation and the maintenance of their use or abandonment rate after discharge, as well as mortality of lower limb amputees due to peripheral arterial disease. METHODS A retrospective and cross-sectional study carried out with lower limb amputee patients, at transfemoral and transtibial levels, due to vascular conditions. The sample was composed of 310 patients (205 men, 105 women, mean age 61.8 years), transfemoral (142) and transtibial (150) levels, unilateral or bilateral (18). A total of 217 were fitted with prosthesis and 93 did not. Nonparametric statistical tests with equality of two proportions, 95% confidence interval and p value <0,05 were used. RESULTS Out of 195 patients we contacted, 151 were fitted with prosthesis and 44 not. Of those that were fitted with prosthesis, 54 still use it, 80 abandoned and 17 died. In the group without prosthesis, 27 were on wheelchair and 17 died. Mortality is statistically higher among patients who were not fitted with prosthesis and 34 death occur, on average, 3.91 years after amputation. Survival time of patients who were not fitted with prosthesis was smaller than those were fitted. CONCLUSION The use of prosthesis in lower limb amputees, due to vascular conditions, during rehabilitation is high. However, maintenance of prosthesis is not frequent after discharge. Early and high mortality is observed mainly among diabetic patients.
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Vincent C, Demers É, Moffet H, Corriveau H, Nadeau S, Mercier C. Use of an innovative model to evaluate mobility in seniors with lower-limb amputations of vascular origin: a pilot study. BMC Geriatr 2010; 10:68. [PMID: 20854684 PMCID: PMC2955596 DOI: 10.1186/1471-2318-10-68] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 09/20/2010] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The mobility of older individuals has often been only partially assessed, without considering all important aspects such as potential (available) versus effective (used) mobilities and the physical and psychosocial factors that modulate them. This study proposes a new model for evaluating mobility that considers all important aspects, applied here to lower-limb amputees with vascular origin. This model integrates the concepts of potential mobility (e.g. balance, speed of movement), effective mobility (e.g. life habits, movements in living areas) and factors that modulate these two types of mobility (e.g. strength, sensitivity, social support, depression). The main objective was to characterize potential and effective mobility as well as mobility modulators in a small sample of people with lower-limb amputations of vascular origin with different characteristics. The second objective of this pilot study was to assess the feasibility of measuring all variables in the model in a residential context. METHODS An observational and transversal design was used with a heterogeneous sample of 10 participants with a lower-limb amputation of vascular origin, aged 51 to 83, assessed between eight and 18 months after discharge from an acute care hospital. A questionnaire of participant characteristics and 16 reliable and valid measurements were used. RESULTS The results show that the potential mobility indicators do not accurately predict effective mobility, i.e., participants who perform well on traditional measures done in the laboratory or clinic are not always those who perform well in the real world. The model generated 4 different profiles (categories) of participants ranging from reduced to excellent potential mobility and low to excellent effective mobility, and characterized the modulating factors. The evaluations were acceptable in terms of the time taken (three hours) and the overall measurements, with a few exceptions, which were modified to optimize the data collected and the classification of the participants. For the population assessed, the results showed that some of the negative modulators (particularly living alone, no rehabilitation, pain, limited social support, poor muscle strength) played an important role in reducing effective mobility. CONCLUSION The first use of the model revealed interesting data that add to our understanding of important aspects linked to potential and effective mobility as well as modulators. The feasibility of measuring all variables in the model in a residential context was demonstrated. A study with a large number of participants is now warranted to rigorously characterize mobility levels of lower-limb amputees with vascular origin.
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Affiliation(s)
- Claude Vincent
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, 525, Wilfrid-Hamel Blvd East, Québec (Québec), G1M 2S8, Canada
- Département de réadaptation, Laval University, Pavillon Ferdinand-Vandry, Quebec City, Quebec, G1K 7P4, Canada
| | - Émilie Demers
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, 525, Wilfrid-Hamel Blvd East, Québec (Québec), G1M 2S8, Canada
| | - Hélène Moffet
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, 525, Wilfrid-Hamel Blvd East, Québec (Québec), G1M 2S8, Canada
- Département de réadaptation, Laval University, Pavillon Ferdinand-Vandry, Quebec City, Quebec, G1K 7P4, Canada
| | - Hélène Corriveau
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 Belvédère South, Sherbrooke, Quebec J1H 4C4, Canada
- Department of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue, Sherbrooke, Quebec, Canada
| | - Sylvie Nadeau
- Department of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue, Sherbrooke, Quebec, Canada
- École de réadaptation, Université de Montréal, c.p. 6128, succursale Centre-ville, Montréal (Québec), H3C 3J7, Canada
- Centre de recherche interdisciplinaire de réadaptation, Institut de réadaptation Gingras-Lindsay de Montréal, Canada
| | - Catherine Mercier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, 525, Wilfrid-Hamel Blvd East, Québec (Québec), G1M 2S8, Canada
- Département de réadaptation, Laval University, Pavillon Ferdinand-Vandry, Quebec City, Quebec, G1K 7P4, Canada
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Wright DA, Marks L, Payne RC. A comparative study of the physiological costs of walking in ten bilateral amputees. Prosthet Orthot Int 2008; 32:57-67. [PMID: 18330804 DOI: 10.1080/03093640701669108] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The physiological cost of walking is greater in bilateral amputees (BA) than in both unilateral amputee and non-pathological gait. The aim of this study was to describe the physiological costs and other standard gait characteristics in a sample population of BA, walking at self-selected (comfortable) speeds. Amputees had bilateral trans-tibial, bilateral trans-femoral or trans-tibial/trans-femoral amputations as a result of trauma or congenital defects. All amputees wore their own prosthetic limbs which were either full-length prostheses or short non-articulating pylon prostheses (SNAPPs). The results were compared with a base line data set collected from a non-pathological control group. It was anticipated that amputees with high-level amputations would walk at the slowest speeds, have the highest physiological costs and lowest perception of walking ability. However, varying walking speeds resulted in varying exercise intensities, exercise heart rates and perceptions of walking that could not be directly related to amputation levels. It is therefore concluded that bilateral amputee gait is complex, varied and not easily categorized.
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Affiliation(s)
- D A Wright
- School of Sport and Education, Brunel University, Uxbridge, Middlesex, UK
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Bosser G, Martinet N, Rumilly E, Paysant J, André JM. [Exercise training for lower limb amputees]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2008; 51:50-56. [PMID: 18164090 DOI: 10.1016/j.annrmp.2007.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Accepted: 09/10/2007] [Indexed: 05/25/2023]
Abstract
Lower limb amputee have lower exercise capacities, proportionally to the delay necessary to use their well-fitted prosthesis. Exercise training is a valid therapeutic to improve local factors (residual limb), muscle strength and endurance, locomotor performance and to decrease the cardiovascular risk factors. The programs for exercise training used for amputees are derivate from the vascular diseases and adapted (upper limb ergometer, cycloergometer with intact limb, pharmacological stress). Exercise training must be personalised because the population with lower limb amputation is very heterogeneous for deficiency and capacity (orthopaedic, vascular and cardiac) and for their socioprofessional project.
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Affiliation(s)
- G Bosser
- Institut régional de médecine physique et de réadaptation, 75, boulevard Lobau, CS 34209, 54042 Nancy cedex, France
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Desmond DM. Coping, affective distress, and psychosocial adjustment among people with traumatic upper limb amputations. J Psychosom Res 2007; 62:15-21. [PMID: 17188116 DOI: 10.1016/j.jpsychores.2006.07.027] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 07/27/2006] [Accepted: 07/31/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study investigated the prevalence of symptoms of depression and anxiety in a sample of predominantly elderly males with acquired upper limb amputations (n=138) and examined the contribution of coping strategies to the prediction of psychosocial adjustment. METHOD One hundred and thirty-eight men with injury-related upper limb amputations completed self-report questionnaires assessing coping strategies, symptoms of anxiety and depression, and psychosocial adaptation to prosthesis use. RESULTS Prevalence of significant depressive symptoms was 28.3% [Hospital Anxiety and Depression Scale, Depression subscale (HADS-D) score > or =8]. Prevalence of significant anxiety symptoms was 35.5% [HADS Anxiety subscale (HADS-A) score > or =8]. Coping styles emerged as important predictors of psychosocial adaptation. In particular, avoidance was strongly associated with psychological distress and poor adjustment. CONCLUSIONS These findings suggest the potential benefits of interventions to reduce reliance on avoidant coping and stimulate more problem-focused approaches to coping with difficulties and challenges in order to facilitate adaptation and prevent problems in psychosocial functioning postamputation.
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Affiliation(s)
- Deirdre M Desmond
- Department of Psychology, John Hume Building, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland; Dublin Psychoprosthetics Group, Dublin, Ireland.
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12
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DeGere MW, Grady JF. A modification of Chopart's amputation with ankle and subtalar arthrodesis by using an intramedullary nail. J Foot Ankle Surg 2005; 44:281-6. [PMID: 16012435 DOI: 10.1053/j.jfas.2005.04.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study reports on 7 patients who underwent a new technique for Chopart amputation that includes ankle and subtalar arthrodesis using an intramedullary nail. This method affords rigid control to the rearfoot and appears to avoid the most common complications historically associated with Chopart amputations. All 6 surviving patients achieved successful outcomes within 1 year of their surgery. All are community ambulators who are able to walk short distances within the home without a prosthesis. One patient, who had undergone a previous vascular bypass, died in the early postoperative period after developing an infection that required an above-knee amputation. A second patient developed an infection that resolved with intravenous antibiotics. This new technique reintroduces the Chopart-level amputation as a valuable intermediate between the transmetatarsal and below-knee amputation levels.
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Affiliation(s)
- Michael W DeGere
- VA Chicago Healthcare System-Westside Division of Podiatric Surgical Residency Program, USA.
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13
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Defrin R, Holtzman S, Katz M, Heruti R, Ohry A, Drory Y. Coronary Artery Disease and Risk Factors in People With Posttraumatic Vision Loss. Arch Phys Med Rehabil 2005; 86:968-73. [PMID: 15895343 DOI: 10.1016/j.apmr.2004.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the prevalence of coronary artery disease (CAD) and its risk factors in people with posttraumatic vision loss (PTVL). DESIGN Cross-sectional, controlled study. SETTING The general community. PARTICIPANTS Study groups included 82 subjects with PTVL, 49 siblings, 58 blind subjects with retinitis pigmentosa (RP), and the general population in Israel. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Sociodemographic and biomedical data collected by using a structured questionnaire and medical records. RESULTS The prevalence of CAD among subjects with PTVL (24%) was 2 to 3 times higher than the control groups ( P <.001). However, the prevalence of the CAD risk factors in these subjects was similar to or lower than those in the control groups. For example, significantly fewer subjects with PTVL were physically inactive (16%) than patients with RP (55%, P <.01). The only variable that was significantly associated with CAD prevalence was the cause of blindness-that is, trauma versus disease; the odds of having CAD after traumatic vision loss was 3.75 times higher than after RP. CONCLUSIONS People with PTVL exhibit elevated rates of risk for CAD similar to those of other groups with physical disability. The traumatic injury that caused vision loss might be an important factor underlying that risk.
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Affiliation(s)
- Ruth Defrin
- Department of Physical Therapy, Sackler School of Medicine, Tel-Aviv University, Israel.
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14
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Roth EJ, Park KL, Sullivan WJ. Cardiovascular disease in patients with dysvascular amputation. Arch Phys Med Rehabil 1998; 79:205-15. [PMID: 9474005 DOI: 10.1016/s0003-9993(98)90301-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cardiovascular diseases are the most common causes of morbidity and mortality in individuals with peripheral vascular disease (PVD). Among patients who have undergone lower extremity amputation as a result of PVD, the prevalence of concomitant cardiovascular disease may be as high as 75%. Comorbid heart disease may complicate the postamputation course of recovery, delay initiation of rehabilitation training, and inhibit the achievement of maximal functional independence. A variety of methods have been used to assess cardiac status and risk in amputation patients undergoing physical training; these have included clinical evaluation, resting electrocardiography, and continuous dynamic electrocardiography during either standard physical therapy exercise or adapted ergometry. Several conditioning training programs have been developed to improve the cardiovascular fitness of patients with dysvascular amputation, the results of which have been favorable. These assessment and intervention strategies have extensive applicability in the clinical management of patients with dysvascular amputation.
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Affiliation(s)
- E J Roth
- Department of Physical Medicine and Rehabilitation, Northwestern University Medical School, Chicago, IL, USA
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Uiterwijk AE, Remerie SC, Rol M, Sier JC, Stam HJ, Terburg M. Routing through the health care system and level of functioning of lower limb amputees. Clin Rehabil 1997; 11:253-62. [PMID: 9360039 DOI: 10.1177/026921559701100310] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To describe the routing through the health care system and the level of functioning of a consecutive series of lower limb amputees at a general Dutch hospital. METHODS A descriptive cohort study (medical records examination) with a follow-up interval of 11.7 months. All 124 major lower limb amputations (ankle to hip) between 1 July 1989 and 31 December 1992 are included in the study: 123 patients, average age 73.8 years, 96% vascular disease. Amputation levels are 55.3% transfemoral, 12.2% knee disarticulation and 32.5% transtibial. At follow-up two patients are missing. RESULTS Before admission to hospital 75.6% of patients are able to walk and 79.9% live independently. Discharge destinations from hospital are 22.5% home, 42.3% inpatient rehabilitation and 32.4% nursing home. At follow-up, 59% of surviving patients have a prosthesis, 47.7% are able to walk and 70.5% live independently. Mortality after one year is 28.5%. Poor preoperative walkers seem to die more often within the first year and have less chance of being fitted with a prosthesis. Poor walkers, older than 75, with diabetes mellitus and a transfemoral amputation seem to stay more often in a nursing home after one year. DISCUSSION Although the results are largely comparable with other studies, there appear to be differences in age, amputation level and course and duration of treatment. The predicting factors found here may help the rehabilitation specialist in advising on the best moment and level of amputation and course of treatment.
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Bailey MJ, MacWhannell C. Clinical Monitoring of Dysvascular Lower Limb Amputees During Initial Gait Training. Physiotherapy 1997. [DOI: 10.1016/s0031-9406(05)66174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pernot HF, de Witte LP, Lindeman E, Cluitmans J. Daily functioning of the lower extremity amputee: an overview of the literature. Clin Rehabil 1997; 11:93-106. [PMID: 9199861 DOI: 10.1177/026921559701100202] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of this paper is to review the existing literature on the incidence, morbidity and mortality of lower limb amputation. The functional level of the lower limb amputee and the predictive factors for functioning with a prosthesis are reviewed, both for unilateral and for bilateral amputees. The reported incidence of lower extremity amputation (LEA) varies considerably between different Western countries. The mean survival of LEA patients ranges between two and five years. Assessment of functional outcome is carried out differently. Studies are not comparable and most concern selected groups of amputees. Increasing age, concurrent disease and poor compliance are prognostic factors for a low functional level. For optimal planning of rehabilitation it is necessary to study a complete cohort of amputees with respect to these prognostic factors.
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Affiliation(s)
- H F Pernot
- Rehabilitation Centre 'Hoensbroeck', The Netherlands
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