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Sturma A, Boesendorfer A, Gstoettner C, Baumgartner B, Salminger S, Farina D, Brånemark R, Vujaklija I, Hobusch G, Aszmann O. Long-term functional and clinical outcome of combined targeted muscle reinnervation and osseointegration for functional bionic reconstruction in transhumeral amputees: a case series. J Rehabil Med 2024; 56:jrm34141. [PMID: 38770700 PMCID: PMC11135336 DOI: 10.2340/jrm.v56.34141] [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: 12/04/2023] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE To describe and evaluate the combination of osseointegration and nerve transfers in 3 transhumeral amputees. DESIGN Case series. PATIENTS Three male patients with a unilateral traumatic transhumeral amputation. METHODS Patients received a combination of osseointegration and targeted muscle reinnervation surgery. Rehabilitation included graded weight training, range of motion exercises, biofeedback, table-top prosthesis training, and controlling the actual device. The impairment in daily life, health-related quality of life, and pain before and after the intervention was evaluated in these patients. Their shoulder range of motion, prosthesis embodiment, and function were documented at a 2- to 5-year follow-up. RESULTS All 3 patients attended rehabilitation and used their myoelectric prosthesis on a daily basis. Two patients had full shoulder range of motion with the prosthesis, while the other patient had 55° of abduction and 45° of anteversion. They became more independent in their daily life activities after the intervention and incorporated their prosthesis into their body scheme to a high extent. CONCLUSION These results indicate that patients can benefit from the combined procedure. However, the patients' perspective, risks of the surgical procedures, and the relatively long rehabilitation procedure need to be incorporated in the decision-making.
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Affiliation(s)
- Agnes Sturma
- Degree Program Physiotherapy, Department of Health Sciences, University of Applied Sciences FH Campus Vienna, Vienna, Austria; Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Anna Boesendorfer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria; Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Benedikt Baumgartner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Stefan Salminger
- AUVA Trauma Hospital Lorenz Böhler-European Hand Trauma Center, Vienna, Austria.
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, UK.
| | - Rickard Brånemark
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; K. Lisa Yang Center for Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, USA.
| | - Ivan Vujaklija
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland.
| | - Gerhard Hobusch
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
| | - Oskar Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria; Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
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Hutchison A, D'Cruz K, Keeves J, Ross P, Anderson S. Barriers and facilitators to community reintegration in adults following traumatic upper limb amputation: an exploratory study. Disabil Rehabil 2023:1-11. [PMID: 37723859 DOI: 10.1080/09638288.2023.2256667] [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: 02/14/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE To explore barriers and facilitators to community reintegration experienced by people following traumatic upper limb amputation (ULA). METHODS An exploratory qualitative study was conducted with ten adults with major ULA due to trauma. Data from individual, semi-structured interviews was analysed using Braun and Clarke's reflexive thematic analysis. RESULTS Underlying and influencing community reintegration for participants, was a process of adjustment to the impacts of amputation on everyday function and re-establishing their identity. Participants felt social networks and peer support facilitated the return to social and community activities, as did drawing on personal attributes such as positivity, resilience and self-belief. Prosthetic devices were facilitative for community reintegration by minimising visible differences and unwanted attention through restored cosmesis and in the performance of functional tasks to fulfil social norms and meaningful roles despite issues with comfort and function. Despite the adaptation and evolution of abilities, perspectives and identities, the functional impact of ULA on everyday community activities was an ongoing challenge for all participants. CONCLUSION ULA has a significant and lifelong impact on an individual's ability to complete tasks and fulfil meaningful roles in the community. Recommendations based on the study's findings will inform clinicians to support community reintegration for people following traumatic ULA.
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Affiliation(s)
- Abby Hutchison
- La Trobe University, Melbourne, Victoria, Australia
- Epworth Healthcare, Melbourne, Victoria, Australia
| | - Kate D'Cruz
- La Trobe University, Melbourne, Victoria, Australia
| | - Jemma Keeves
- Epworth Healthcare, Melbourne, Victoria, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
- Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Pamela Ross
- Epworth Healthcare, Melbourne, Victoria, Australia
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Marneweck M, Gardner C, Dundon NM, Smith J, Frey SH. Reorganization of sensorimotor representations of the intact limb after upper but not lower limb traumatic amputation. Neuroimage Clin 2023; 39:103499. [PMID: 37634375 PMCID: PMC10470418 DOI: 10.1016/j.nicl.2023.103499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
It is becoming increasingly clear that limb loss induces wider spread reorganization of representations of the body that are nonadjacent to the affected cortical territory. Data from upper extremity amputees reveal intrusion of the representation of the ipsilateral intact limb into the former hand territory. Here we test for the first time whether this reorganization of the intact limb into the deprived cortex is specific to the neurological organization of the upper limbs or reflects large scale adaptation that is triggered by any unilateral amputation. BOLD activity was measured as human subjects with upper limb and lower limb traumatic amputation and their controls moved the toes on each foot, open and closed each hand and pursed their lips. Subjects with amputation were asked to imagine moving the missing limb while remaining still. Bayesian pattern component modeling of fMRI data showed that intact ipsilateral movements and contralateral movements of the hand and foot were distinctly represented in the deprived sensorimotor cortex years after upper limb amputation. In contrast, there was evidence reminiscent of contralateral specificity for hand and foot movements following lower limb amputation, like that seen in controls. We propose the cortical reorganization of the intact limb to be a function of use-dependent plasticity that is more specific to the consequence of upper limb loss of forcing an asymmetric reliance on the intact hand and arm. The contribution of this reorganization to phantom pain or a heightened risk of overuse and resultant maladaptive plasticity needs investigating before targeting such reorganization in intervention.
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Affiliation(s)
| | - Cooper Gardner
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Neil M Dundon
- Department of Brain and Psychological Sciences, University of California Santa Barbara, Santa Barbara, CA, USA; Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Freiburg, 79104 Freiburg, Germany
| | - Jolinda Smith
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Scott H Frey
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
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4
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Lai WC, Pham C, Chan JP, Lung BE, Rafijah GH. Hand Replantation With Dorsal Spanning Plate Following a Self-Inflicted Radiocarpal Amputation. Cureus 2023; 15:e36656. [PMID: 37102009 PMCID: PMC10123377 DOI: 10.7759/cureus.36656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/28/2023] Open
Abstract
Upper extremity amputations represent a prime opportunity to restore function through replantation. There are a variety of options that treating surgeons use to protect neurovascular repairs and restore function including Kirschner wire fixation, external fixation, wrist arthrodesis, and proximal row carpectomy. Additionally, the dorsal spanning plate may be a valuable tool for protecting neurovascular repairs. Compared to temporary immobilization with Kirschner wire fixation, which has previously been described in conjunction with upper extremity replantation, dorsal spanning plates can be left in place for longer durations with a lower risk of loosening and loss of fixation and for preventing postoperative sabotage or repeat amputation of the replant by the patient. In this article, we describe a unique case of a patient with acute psychiatric illness that presented with a self-inflicted amputation through the radiocarpal joint and was initially treated with emergent replantation and application of a dorsal spanning plate to protect the neurovascular repair from patient sabotage and allow for early rehabilitation. We found the dorsal spanning plate to be an effective option in this complex clinical scenario. This case illustrates the utility of the dorsal spanning plate in protecting complex neurovascular repairs in the setting of severe skeletal and psychiatric instability.
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Affiliation(s)
- Wilson C Lai
- Orthopaedic Surgery, University of California Irvine Health, Orange, USA
| | - Cory Pham
- Orthopaedic Surgery, University of California Irvine Health, Orange, USA
| | - Justin P Chan
- Orthopaedic Surgery, University of California Irvine Health, Orange, USA
| | - Brandon E Lung
- Orthopaedic Surgery, University of California Irvine Health, Orange, USA
| | - Gregory H Rafijah
- Orthopaedic Surgery, University of California Irvine Health, Orange, USA
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Parr JVV, Wright DJ, Uiga L, Marshall B, Mohamed MO, Wood G. A scoping review of the application of motor learning principles to optimize myoelectric prosthetic hand control. Prosthet Orthot Int 2022; 46:274-281. [PMID: 34932512 DOI: 10.1097/pxr.0000000000000083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
Although prosthetic hand rejection rates remain high, evidence suggests that effective training plays a major role in device acceptance. Receiving training early in the rehabilitation process also enhances functional prosthetic use, decreases the likelihood of developing an overreliance on the intact limb, and reduces amputation-related pain. Despite these obvious benefits, there is a current lack of evidence regarding the most effective training techniques to facilitate myoelectric prosthetic hand control, and it remains unknown whether training is effective in facilitating the acquisition and transfer of prosthetic skill. In this scoping review, we introduced and summarized key motor learning principles related to attentional focus, implicit motor learning, training eye-hand coordination, practice variability, motor imagery, and action observation, and virtual training and biofeedback. We then reviewed the existing literature that has applied these principles for training prosthetic hand control before outlining future avenues for further research. The importance of optimizing early and appropriate training cannot be overlooked. While the intuition and experience of clinicians holds enormous value, evidence-based guidelines based on well-established motor learning principles will also be crucial for training effective prosthetic hand control. While it is clear that more research is needed to form the basis of such guidelines, it is hoped that this review highlights the potential avenues for this work.
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Affiliation(s)
- Johnny V V Parr
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester UK
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - David J Wright
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester UK
- Research Centre for Health, Psychology and Communities, Department of Psychology, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Liis Uiga
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester UK
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Ben Marshall
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester UK
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Mohamed Omar Mohamed
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester UK
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Greg Wood
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester UK
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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Jo YH, Lee BG, Lee CH, Lee KH, Kim DH, Kim DS, Kim SJ. Radiocapitellar joint pressures following transradial amputation increase during elbow motion. Sci Rep 2021; 11:13897. [PMID: 34230504 PMCID: PMC8260786 DOI: 10.1038/s41598-021-92743-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to compare the contact area, mean pressure, and peak pressure of the radiocapitellar joint (RCJ) in the upper limb after transradial amputation with those of the normal upper limb during elbow flexion and forearm rotation. Testing was performed using ten fresh-frozen upper limbs, and the transradial amputation was performed 5 cm proximal to the radial styloid process. The specimens were connected to a custom-designed apparatus for testing. A pressure sensor was inserted into the RCJ. The biomechanical indices of the RCJ were measured during elbow flexion and forearm rotation in all specimens. There was no significant difference in the contact area between the normal and transradial amputated upper limbs. However, in the upper limbs after transradial amputation, the mean pressure was higher than that in the normal upper limbs at all positions of elbow flexion and forearm rotation. The peak pressure was significantly higher in the upper limbs after transradial amputation than in the normal upper limbs, and was especially increased during pronation at 45° of elbow flexion. In conclusion, these results could cause cartilage erosion in the RCJ of transradial amputees. Thus, methods to reduce the pressure of the RCJ should be considered when a myoelectric prosthesis is developed.
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Affiliation(s)
- Young-Hoon Jo
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Bong-Gun Lee
- Department of Orthopedic Surgery, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Chang-Hun Lee
- Department of Orthopedic Surgery, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Kwang-Hyun Lee
- Department of Orthopedic Surgery, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Dong-Hong Kim
- Department of Orthopedic Surgery, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Doo-Sup Kim
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, South Korea.
| | - Sung Jae Kim
- Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea.
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McDonagh STJ, Sheppard JP, Warren FC, Boddy K, Farmer L, Shore H, Williams P, Lewis PS, Baumber R, Fordham J, Martin U, Aboyans V, Clark CE. Arm Based on LEg blood pressures (ABLE-BP): can systolic leg blood pressure measurements predict systolic brachial blood pressure? Protocol for an individual participant data meta-analysis from the INTERPRESS-IPD Collaboration. BMJ Open 2021; 11:e040481. [PMID: 33741659 PMCID: PMC7986760 DOI: 10.1136/bmjopen-2020-040481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/13/2020] [Accepted: 01/09/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Blood pressure (BP) is normally measured on the upper arm, and guidelines for the diagnosis and treatment of high BP are based on such measurements. Leg BP measurement can be an alternative when brachial BP measurement is impractical, due to injury or disability. Limited data exist to guide interpretation of leg BP values for hypertension management; study-level systematic review findings suggest that systolic BP (SBP) is 17 mm Hg higher in the leg than the arm. However, uncertainty remains about the applicability of this figure in clinical practice due to substantial heterogeneity. AIMS To examine the relationship between arm and leg SBP, develop and validate a multivariable model predicting arm SBP from leg SBP and investigate the prognostic association between leg SBP and cardiovascular disease and mortality. METHODS AND ANALYSIS Individual participant data (IPD) meta-analyses using arm and leg SBP measurements for 33 710 individuals from 14 studies within the Inter-arm blood pressure difference IPD (INTERPRESS-IPD) Collaboration. We will explore cross-sectional relationships between arm and leg SBP using hierarchical linear regression with participants nested by study, in multivariable models. Prognostic models will be derived for all-cause and cardiovascular mortality and cardiovascular events. ETHICS AND DISSEMINATION Data originate from studies with prior ethical approval and consent, and data sharing agreements are in place-no further approvals are required to undertake the secondary analyses proposed in this protocol. Findings will be published in peer-reviewed journal articles and presented at conferences. A comprehensive dissemination strategy is in place, integrated with patient and public involvement. PROSPERO REGISTRATION NUMBER CRD42015031227.
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Affiliation(s)
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fiona C Warren
- Primary Care Research Group, University of Exeter, Exeter, UK
| | - Kate Boddy
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, Exeter, UK
| | - Leon Farmer
- Patient and Public Involvement Advisor, Exeter, UK
| | - Helen Shore
- Patient and Public Involvement Advisor, Exeter, UK
| | | | - Philip S Lewis
- Department of Cardiology, Stockport NHS Foundation Trust, Stockport, UK
| | - Rachel Baumber
- Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
| | | | - Una Martin
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Victor Aboyans
- Department of Cardiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
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8
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Rosa S, Freitas M, Pegado A, Martins D, Moura M. Rehabilitation after forearm/hand replantation. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2021. [DOI: 10.4103/jisprm.jisprm_59_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Salminger S, Stino H, Pichler LH, Gstoettner C, Sturma A, Mayer JA, Szivak M, Aszmann OC. Current rates of prosthetic usage in upper-limb amputees - have innovations had an impact on device acceptance? Disabil Rehabil 2020; 44:3708-3713. [PMID: 33377803 DOI: 10.1080/09638288.2020.1866684] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE There is a large body of evidence demonstrating high rates of prosthesis abandonment in the upper extremity. However, these surveys were conducted years ago, thus the influence of recent refinements in prosthetic technology on acceptance is unknown. This study aims to gather current data on prosthetic usage, to assess the effects of these advancements. MATERIALS AND METHODS A questionnaire was sent to 68 traumatic upper limb amputees treated within the Austrian Trauma Insurance Agency between the years 1996 and 2016. Responses were grouped by the year of amputation to assess the effect of time. RESULTS The rejection rate at all levels of amputation was 44%. There was no significant difference in acceptance between responders amputated before or after 2006 (p = 0.939). Among users, 92.86% (n = 13) used a myoelectric, while only one amputee (7.14%, n = 1) used a body-powered device. Most responders complained about the comfort (60.87%, n = 14) as well as the weight of the device (52.17%, n = 12). CONCLUSIONS The advancements of the last decade in the arena of upper limb prosthetics have not yet achieved a significant change in prosthetic abandonment within this study cohort. Although academic solutions have been presented to tackle patient's complaints, clinical reality still shows high rejection rates of cost-intensive prosthetic devices.Implications for rehabilitationAbandonment rates in prosthetic rehabilitation after upper limb amputation have shown to be 50% and higher.The advancements of the last decade in the arena of upper limb prosthetics have not yet achieved a significant change in prosthetic abandonment.Well-structured and patient-tailored prosthetic training as well as ensuring the amputee's active participation in the decision making process will most likely improve prosthetic acceptance.
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Affiliation(s)
- Stefan Salminger
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria.,Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
| | - Heiko Stino
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
| | | | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
| | - Agnes Sturma
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria.,Department of Bioengineering, Imperial College London, London, UK
| | - Johannes A Mayer
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
| | - Michael Szivak
- Department of Medical Documentation and Statistics, Austrian Trauma Insurance Agency (AUVA), Vienna, Austria
| | - Oskar C Aszmann
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria.,Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
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10
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Prosthetic Rehabilitation and Vascularized Composite Allotransplantation following Upper Limb Loss. Plast Reconstr Surg 2019; 143:1688-1701. [PMID: 31136485 DOI: 10.1097/prs.0000000000005638] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Upper limb loss is a devastating condition with dramatic physical, psychological, financial, and social consequences. Improvements in the fields of prosthetics and vascularized composite allotransplantation have opened exciting new frontiers for treatment and rehabilitation following upper limb loss. Each modality offers a unique set of advantages and limitations with regard to the restoration of hand function following amputation. METHODS Presented in this article is a discussion outlining the complex considerations and decisions encountered when determining patient appropriateness for either prosthetic rehabilitation or vascularized composite allotransplantation following upper limb loss. In this review, the authors examine how psychosocial factors, nature of injury, rehabilitation course, functional outcomes, and risks and benefits may affect overall patient selection for either rehabilitative approach. RESULTS This review summarizes the current state of the literature. Advancements in both prosthetic and biological strategies demonstrate promise with regard to facilitating rehabilitation following upper limb loss. However, there remains a dearth of research directly comparing outcomes in prosthetic rehabilitation to that following upper extremity transplantation. CONCLUSIONS Few studies have performed a direct comparison between patients undergoing vascularized composite allotransplantation and those undergoing prosthetic rehabilitation. Upper extremity transplantation and prosthetic reconstruction should not be viewed as competing options, but rather as two treatment modalities with different risk-to-benefit profiles and indications.
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Boni I, Millenaar J, Controzzi M, Ortiz-Catalan M. Restoring Natural Forearm Rotation in Transradial Osseointegrated Amputees. IEEE Trans Neural Syst Rehabil Eng 2018; 26:2333-2341. [DOI: 10.1109/tnsre.2018.2880948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Widehammar C, Pettersson I, Janeslätt G, Hermansson L. The influence of environment: Experiences of users of myoelectric arm prosthesis-a qualitative study. Prosthet Orthot Int 2018; 42:28-36. [PMID: 28470129 PMCID: PMC5808811 DOI: 10.1177/0309364617704801] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prostheses are used to varying degrees; however, little is known about how environmental aspects influence this use. OBJECTIVES To describe users' experiences of how environmental factors influence their use of a myoelectric arm prosthesis. STUDY DESIGN Qualitative and descriptive. METHODS A total of 13 patients previously provided with a myoelectric prosthetic hand participated. Their age, sex, deficiency level, etiology, current prosthesis use, and experience varied. Semi-structured interviews were audiotaped, transcribed, and analyzed through inductive content analysis. RESULTS Four categories were created from the data: "Prosthesis function," "Other people's attitudes," "Support from family and healthcare," and "Individual's attitude and strategies." The overarching theme, "Various degrees of embodiment lead to different experiences of environmental barriers and facilitators," emerged from differences in individual responses depending on whether the individual was a daily or a non-daily prosthesis user. Environmental facilitators such as support from family and healthcare and good function and fit of the prosthesis seemed to help the embodiment of the prosthesis, leading to daily use. This embodiment seemed to reduce the influence of environmental barriers, for example, climate, attitudes, and technical shortcomings. CONCLUSION Embodiment of prostheses seems to reduce the impact of environmental barriers. Support and training may facilitate the embodiment of myoelectric prosthesis use. Clinical relevance For successful prosthetic rehabilitation, environmental factors such as support and information to the patient and their social network about the benefits of prosthesis use are important. Local access to training in myoelectric control gives more people the opportunity to adapt to prosthesis use and experience less environmental barriers.
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Affiliation(s)
- Cathrine Widehammar
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden,Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,Department of Prosthetics and Orthotics, Faculty of Medicicne and Health, Örebro University, Örebro, Sweden,Cathrine Widehammar, Faculty of Medicine and Health, Örebro University, Örebro 70281, Sweden.
| | | | | | - Liselotte Hermansson
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden,Department of Prosthetics and Orthotics, Faculty of Medicicne and Health, Örebro University, Örebro, Sweden
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Mattiassich G, Rittenschober F, Dorninger L, Rois J, Mittermayr R, Ortmaier R, Ponschab M, Katzensteiner K, Larcher L. Long-term outcome following upper extremity replantation after major traumatic amputation. BMC Musculoskelet Disord 2017; 18:77. [PMID: 28187720 PMCID: PMC5303287 DOI: 10.1186/s12891-017-1442-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/03/2017] [Indexed: 11/30/2022] Open
Abstract
Background Amputations in general and amputations of upper extremities, in particular, have a major impact on patients’ lives. There are only a few long-term follow-up reports of patients after macro-replantation. We present our findings in contrast with the existing literature. Methods Sixteen patients with traumatic macro-amputation of an upper extremity were eligible for inclusion in this study. Altogether, the patients underwent replantation in 3 institutions between 1983 and 2011. Results Twelve male and four female patients with an average age at injury of 40.6 years (range, 14–61 years) were included in this study. The mean follow-up period was 13.5 years (range, 4.4–32.6 years; SD, 5.7 years). The mean disabilities of the arm, shoulder and hand (DASH) outcome measure was 41 (range, 5.2–94.8; SD, 18.2), functional independence measurement (FIM) was 125 (range, 120–126; SD, 1.8). Chen I representing very good function was accounted in six, Chen II representing good function in eight, Chen III (fair) in one and Chen IV (bad function) in one patient. Conclusions We found that while the majority of the included patients exhibited good or very good function of the extremity, none of the replanted appendages regained normal levels of functionality. In addition, all participants were very satisfied with their outcomes. Positive long-term results with high rates of subjective satisfaction are possible after replantation of upper extremities.
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Affiliation(s)
- G Mattiassich
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria. .,Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. .,Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern - Teaching hospital of the Paracelcus Medical University Salzburg, Linz, Austria.
| | - F Rittenschober
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria
| | - L Dorninger
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria
| | - J Rois
- Trauma Center Vienna Meidling, Vienna, Austria
| | - R Mittermayr
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Trauma Center Vienna Meidling, Vienna, Austria
| | - R Ortmaier
- Department of Trauma Surgery, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria
| | - M Ponschab
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria.,Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - K Katzensteiner
- Trauma Center, Unfallkrankenhaus Linz-Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, 4010, Linz, Austria
| | - L Larcher
- Trauma Center Salzburg, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.,Plastic, Aesthetic and Reconstructive Surgery Sanitaetsbetrieb South Tyrol (SABES), Bolzano, Italy
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Østlie K, Granan LP. [Guidelines for rehabilitation after acquired upper limb amputation]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:15. [PMID: 28073222 DOI: 10.4045/tidsskr.16.1025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Wijk U, Carlsson I. Forearm amputees' views of prosthesis use and sensory feedback. J Hand Ther 2016; 28:269-77; quiz 278. [PMID: 25990442 DOI: 10.1016/j.jht.2015.01.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 01/20/2015] [Accepted: 01/30/2015] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Qualitative descriptive. INTRODUCTION The lack of sensory feedback in today's hand prostheses has been in focus recently but the amputees' experiences need to be further investigated. PURPOSE To explore forearm amputees' views of prosthesis use and sensory feedback. METHODS Thirteen unilateral congenital or traumatic forearm amputees were interviewed. The transcribed text was subjected to content analysis. RESULTS Prostheses both facilitate and limit occupational performance. Appearance is important for identity and blending into society. The feeling of agency regarding the prostheses is present but not that of body ownership. Future expectations concerned improved mobility, cosmetics, and sensory feedback. CONCLUSIONS This study allows a deeper understanding of the complex relationship between a prosthetic device and the wearer. Today's prostheses allow the wearer to feel agency concerning the artificial limb but the lack of sensory feedback seems to be an important factor still blocking the achievement of body ownership of the prosthesis. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Ulrika Wijk
- Department of Translational Medicine - Hand Surgery, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| | - Ingela Carlsson
- Department of Translational Medicine - Hand Surgery, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
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Patel AA, Blount AL, Owens PW, Askari M. Functional outcomes of replantation following radiocarpal amputation. J Hand Surg Am 2015; 40:266-70. [PMID: 25499843 DOI: 10.1016/j.jhsa.2014.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the long-term functional and clinical outcomes of patients who have undergone replantation after radiocarpal amputation. METHODS We performed a retrospective review of radiocarpal joint amputations at a level 1 trauma center over a 13-year period. Medical records of patients treated with replantation were queried for injury data, operative reports, complications, and clinical progress. Patients who met inclusion criteria were contacted for long-term follow-up. We measured total active motion of each digit, strength (grip and pinch), and 2-point discrimination. Functional outcomes were assessed with Disabilities of Arm, Shoulder, and Hand score, Mayo Wrist Score, Patient-Rated Wrist Evaluation, and Michigan Hand Questionnaire. Descriptive statistics were calculated, including frequencies for categorical variables and means and ranges for continuous variables. RESULTS Six patients met the inclusion criteria. The mean age was 36 years (range, 26-50 y). Five patients were available at a mean follow-up of 3.9 years (range, 1.0-6.9 y). Compared with the contralateral uninjured extremity, total active motion of the hand was 38% (range, 26% to 59%) and grip strength was 9% (range, 0% to 18%). Neither tip nor key pinch was present. Mean 2-point discrimination was 10.6 mm (range, 8-12 mm). All mean outcome scores indicated moderate disability, including Disabilities of Arm, Shoulder, and Hand (76; range, 45-82), Mayo Wrist Score (23; range, 5-50), Patient-Rated Wrist Evaluation (86; range, 56-98), and Michigan Hand Questionnaire (27; range, 15-55). Two patients were able to return to work and 3 were permanently disabled. All patients were satisfied with the hand function. CONCLUSIONS Successful replantation for a radiocarpal joint amputation is associated with major restriction of motion, decreased strength, and moderate disability on functional outcome assessments. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Amar Arun Patel
- Department of Orthopaedics, Hand, and Microvascular Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL
| | - Andrew L Blount
- Department of Orthopaedics, Hand, and Microvascular Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL
| | - Patrick W Owens
- Department of Orthopaedics, Hand, and Microvascular Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL
| | - Morad Askari
- Department of Orthopaedics, Hand, and Microvascular Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL.
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Johansen H, Østlie K, Andersen LØ, Rand-Hendriksen S. Adults with congenital limb deficiency in Norway: demographic and clinical features, pain and the use of health care and welfare services. A cross-sectional study. Disabil Rehabil 2015; 37:2076-82. [DOI: 10.3109/09638288.2014.998781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Clinical Factors Associated with Replantation after Traumatic Major Upper Extremity Amputation. Plast Reconstr Surg 2013; 132:911-919. [DOI: 10.1097/prs.0b013e31829f4a49] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Samant Y, Parker D, Wergeland E, Westin S. Work-related upper-extremity amputations in Norway. Am J Ind Med 2012; 55:241-9. [PMID: 22068965 DOI: 10.1002/ajim.21026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2011] [Indexed: 11/11/2022]
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Østlie K, Lesjø IM, Franklin RJ, Garfelt B, Skjeldal OH, Magnus P. Prosthesis use in adult acquired major upper-limb amputees: patterns of wear, prosthetic skills and the actual use of prostheses in activities of daily life. Disabil Rehabil Assist Technol 2012; 7:479-93. [PMID: 22315926 DOI: 10.3109/17483107.2011.653296] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe patterns of prosthesis wear and perceived prosthetic usefulness in adult acquired upper-limb amputees (ULAs). To describe prosthetic skills in activities of daily life (ADL) and the actual use of prostheses in the performance of ADL tasks. To estimate the influence of prosthetic skills on actual prosthesis use and the influence of background factors on prosthetic skills and actual prosthesis use. METHOD Cross-sectional study analysing population-based questionnaire data (n = 224) and data from interviews and clinical testing in a referred/convenience sample of prosthesis-wearing ULAs (n = 50). Effects were analysed using linear regression. RESULTS 80.8% wore prostheses. 90.3% reported their most worn prosthesis as useful. Prosthetic usefulness profiles varied with prosthetic type. Despite demonstrating good prosthetic skills, the amputees reported actual prosthesis use in only about half of the ADL tasks performed in everyday life. In unilateral amputees, increased actual use was associated with sufficient prosthetic training and with the use of myoelectric vs cosmetic prostheses, regardless of amputation level. Prosthetic skills did not affect actual prosthesis use. No background factors showed significant effect on prosthetic skills. CONCLUSIONS Most major ULAs wear prostheses. Individualised prosthetic training and fitting of myoelectric rather than passive prostheses may increase actual prosthesis use in ADL.
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Affiliation(s)
- Kristin Østlie
- Innlandet Hospital Trust, Department of Physical Medicine and Rehabilitation, Ottestad, Norway.
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Ostlie K, Franklin RJ, Skjeldal OH, Skrondal A, Magnus P. Musculoskeletal pain and overuse syndromes in adult acquired major upper-limb amputees. Arch Phys Med Rehabil 2012; 92:1967-1973.e1. [PMID: 22133243 DOI: 10.1016/j.apmr.2011.06.026] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 06/21/2011] [Accepted: 06/28/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES (1) To compare the prevalence of self-reported musculoskeletal pain in upper-limb amputees (ULAs) in Norway with that of a control group drawn from the Norwegian general population; (2) to describe musculoskeletal pain bothersomeness in ULAs; (3) to estimate the association between prosthesis wear and self-reported musculoskeletal pain in ULAs; and (4) to describe the occurrence of musculoskeletal overuse syndromes in a sample of ULAs. DESIGN Cross-sectional study: postal questionnaires and clinical examinations. SETTING Norwegian ULA population. Clinical examinations performed at 3 clinics. PARTICIPANTS Questionnaires: population-based amputee sample (n=224; 57.4% response rate). Random control sample (n=318; 33.1% response rate). Clinical examinations: combined referred sample and convenience sample (n=70; 83.3% of those invited). Survey inclusion criteria: adult, resident in Norway and mastering Norwegian (amputees and controls), acquired major upper-limb amputation (amputees only). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-reported musculoskeletal pain and pain bothersomeness. Self-reported pain in prosthesis wearers and nonwearers. Clinically assessed diagnoses of musculoskeletal overuse syndromes. RESULTS Self-reported musculoskeletal pain was more frequent in ULAs than in the control group except for lower back pain. In ULAs, 57.0% reported neck/upper back pain (odds ratio [OR]=2.56; 95% confidence interval [CI], 1.64-3.98), and 58.9% reported shoulder pain (OR=4.00; 95% CI, 2.51-6.36). The percentage difference for arm pain was 24.8% (P<.001). All pain was reported as bothersome. We found no difference in pain prevalence between prosthesis wearers and nonwearers. Musculoskeletal overuse syndromes were found in 6.1% to 24.2% of ULAs, depending on diagnosis and case-definition criteria. CONCLUSIONS Upper-limb loss increases the risk of self-reported musculoskeletal pain in the neck/upper back, shoulders, and in the remaining arm. Prosthesis wear does not prevent musculoskeletal pain. Further studies should be conducted to investigate the effects of prosthesis wear and possible preventive measures, and to ascertain our preliminary prevalence estimates of overuse syndromes.
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Affiliation(s)
- Kristin Ostlie
- Department of Physical Medicine and Rehabilitation, Innlandet Hospital Trust, Ottestad, Norway.
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e3182434f58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Østlie K, Lesjø IM, Franklin RJ, Garfelt B, Skjeldal OH, Magnus P. Prosthesis rejection in acquired major upper-limb amputees: a population-based survey. Disabil Rehabil Assist Technol 2011; 7:294-303. [PMID: 22112174 DOI: 10.3109/17483107.2011.635405] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To estimate the rates of primary and secondary prosthesis rejection in acquired major upper-limb amputees (ULAs), to describe the most frequently reported reasons for rejection and to estimate the influence of background factors on the risk of rejection. METHOD Cross-sectional study analysing population-based questionnaire data (n = 224). Effects were analysed by logistic regression analyses and Cox regression analyses. RESULTS Primary prosthesis rejection was found in 4.5% whereas 13.4% had discontinued prosthesis use. The main reasons reported for primary non-wear were a perceived lack of need and discrepancies between perceived need and the prostheses available. The main reasons reported for secondary prosthesis rejection were dissatisfaction with prosthetic comfort, function and control. Primary prosthesis rejection was more likely in ULAs amputated at high age and in ULAs with proximal amputations. Secondary prosthesis rejection was more likely in proximal ULAs and in women. CONCLUSIONS Clinicians should be aware of the increased risk of rejection in proximal ULAs, elderly ULAs and in women. Emphasising individual needs will probably facilitate successful prosthetic fitting. Improved prosthesis quality and individualised prosthetic training may increase long-term prosthesis use. Further studies of the effect of prosthetic training and of the reasons for rejection of different prosthetic types are suggested.
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Affiliation(s)
- Kristin Østlie
- Innlandet Hospital Trust, Department of Physical Medicine and Rehabilitation, Ottestad, Norway.
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