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Atallah H, Qureshi AZ, Nawaz S, Wani T. Complications of major lower limb amputations before prosthetic provision at a tertiary care rehabilitation facility. Prosthet Orthot Int 2024:00006479-990000000-00215. [PMID: 38227682 DOI: 10.1097/pxr.0000000000000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 11/17/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Although postoperative complications of lower limb amputations and complications related to prosthetics are well known, complications before prosthetic fitting are less often emphasized in literature. There are no Saudi studies documenting the complications before prosthetic fitting where there is high rise in dysvascular amputation, and early prosthetic provision remains a challenge. OBJECTIVES To investigate the complications following major lower limb amputations (MLLAs). STUDY DESIGN Retrospective study. METHODS One hundred thirty-six electronic files for individuals with major lower limb amputations were reviewed. Individuals visiting the primary limb loss clinic for the first time, who have not been fitted with a prosthesis before, were included. RESULTS Muscle weakness was the most common complication (55.1%), followed by edema (52.9%), while infection was found to be the least frequent (5.1%). Age was significantly associated with etiology ( p value < 0.001), usage of assistive device ( p value = 0.002), and complications ( p value = 0.013). Complications were also significantly associated with time since amputation ( p value = 0.001). In addition, etiology was significantly associated with the usage of assistive device ( p value = 0.012). CONCLUSIONS Muscle weakness and edema were the most common complications after MLLA in a cohort of patients with median onset of 8.5 ± 6.8 months since amputation. Presence of various complications in MLLAs before prosthetic evaluation reflect gaps of care including delayed prosthetic evaluation. National strategies need to be introduced to promote early rehabilitation interventions, prevent complications, and improve quality of life of individuals with MLLAs.
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Affiliation(s)
- Huthaifa Atallah
- Prosthetics and Orthotics Department, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Ahmad Zaheer Qureshi
- Physical Medicine and Rehabilitation Department, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shah Nawaz
- Rehabilitation Technology Department, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tariq Wani
- Biostatistics Department, King Fahad Medical City, Riyadh, Saudi Arabia
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Biyani AM, Arya N, Deshpande M, Baheti NC. Physiotherapy Rehabilitation for Above-Knee Amputation Secondary to Infected External Fixation: A Case Report. Cureus 2024; 16:e51689. [PMID: 38313920 PMCID: PMC10838395 DOI: 10.7759/cureus.51689] [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] [Received: 11/09/2023] [Accepted: 01/05/2024] [Indexed: 02/06/2024] Open
Abstract
This case study examines the total physiotherapy care of a 50-year-old male patient, who had a right-sided displaced distal tibia and fibula fracture, a talus fracture due to a road traffic accident, and an above-knee amputation due to a serious infection. Enhancing muscle strength, reducing pain from phantom limbs, avoiding problems, maintaining range of motion, increasing endurance, and promoting functional independence in the postoperative period were the main goals of the patient's rehabilitation. The recovery plan included an intensive four-week program of physiotherapy care. The regimen included a variety of interventions, such as pain management, edema control, wound healing techniques, range of motion (ROM) exercises, muscle strengthening activities, mobility and transfer exercises, cardiovascular endurance training, psychosocial support, education on prosthetic use, and independence in daily living activities. ROM measures, manual muscle testing, and functional independence measure scores were used to evaluate the patient's improvement. The patient's physical health and level of functional independence both exhibited significant improvements, according to the statistics. Following treatment, the patient's ROM, muscle strength, and overall functional independence all improved. The study highlights the positive impacts of physical therapy interventions on the patient's quality of life, mobility, and self-sufficiency following the amputation and subsequent recovery. These findings support the patient's transition to a more self-sufficient and active lifestyle by providing valuable insights into the efficient use of physiotherapy and the comprehensive post-amputation treatment plan.
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Affiliation(s)
- Anushka M Biyani
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neha Arya
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Maithili Deshpande
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nandini C Baheti
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Kabir MR, Mahmud H, Hasan MK. Acceptability of a head-mounted assistive mouse controller for people with upper limb disability: An empirical study using the technology acceptance model. PLoS One 2023; 18:e0293608. [PMID: 37906562 PMCID: PMC10617718 DOI: 10.1371/journal.pone.0293608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
Due to limited motor capabilities, people with upper limb disabilities have trouble utilizing a typical mouse while operating a computer. Different wearable Assistive Mouse Controllers (AMCs) have been developed to overcome their challenges. However, these people may not be able to realize the importance, ease of use, and social approval of these AMCs due to their fear of new technology, lack of confidence, and lack of ingenuity. These may negatively affect their attitude and intention toward accepting AMCs for equitable human-computer interaction. This study presents the development of a sensor-based head-mounted AMC, followed by an empirical analysis of its acceptance using the Technology Acceptance Model (TAM) from the socioeconomic perspective of Bangladesh. In a similar vein, we examined the effects of three additional psychological constructs-technology anxiety, confidence, and innovation, on its acceptance along with the original components of the TAM. A total of 150 individuals with stroke-induced upper limb disability participated in an online survey, and their responses were analyzed using confirmatory factor analysis and structural equation modeling, following the general least square method. Analysis revealed, about 96.44% of the participants had positive attitude towards the AMC, and almost 88.56% of them had positive intentions to accept it. Furthermore, about 68.61% of them expressed signs of anxiety, 96.35% were confident, and 94.16% of them had an innovative mindset in terms of device usage. The findings imply that individuals with an innovative mentality are more capable of comprehending the practical implications of a new technology than those without one. It is also feasible to reduce technological anxiety and boost a user's confidence while using an AMC by combining an innovative mentality with straightforward device interaction techniques. Additionally, peer encouragement and motivation can significantly enhance their positive attitude towards accepting the AMC for facilitating their interaction with a computer.
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Affiliation(s)
- Mohammad Ridwan Kabir
- Systems and Software Lab (SSL), Islamic University of Technology (IUT), Boardbazar, Gazipur, Bangladesh.
- Department of Computer Science and Engineering, Islamic University of Technology (IUT), Boardbazar, Gazipur, Bangladesh.
| | - Hasan Mahmud
- Systems and Software Lab (SSL), Islamic University of Technology (IUT), Boardbazar, Gazipur, Bangladesh.
- Department of Computer Science and Engineering, Islamic University of Technology (IUT), Boardbazar, Gazipur, Bangladesh.
| | - Md. Kamrul Hasan
- Systems and Software Lab (SSL), Islamic University of Technology (IUT), Boardbazar, Gazipur, Bangladesh.
- Department of Computer Science and Engineering, Islamic University of Technology (IUT), Boardbazar, Gazipur, Bangladesh.
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DadeMatthews OO, Roper JA, Vazquez A, Shannon DM, Sefton JM. Prosthetic device and service satisfaction, quality of life, and functional performance in lower limb prosthesis clients. Prosthet Orthot Int 2023:00006479-990000000-00189. [PMID: 37870367 DOI: 10.1097/pxr.0000000000000285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 07/20/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE The aim of this study was to characterize the relationship between prosthetic device and service satisfaction, health-related quality of life (HRQOL), and functional movement in a diverse population of lower limb prosthesis users. METHODS An online survey was conducted on individuals with lower limb amputation between September and October 2021. Sample validated questionnaires assessing demographic and clinical features, satisfaction, functional outcomes, and quality of life were analyzed using path analysis. RESULTS Participants were 1736 individuals with lower limb amputation. Overall, 44% of participants reported dissatisfaction with prosthetic device, whereas 37% were dissatisfied with prosthetic service. Low functional mobility was reported by 58% of participants and 61% reported low HRQOL. Lower extremity functional status (β = 0.55), HRQOL (β = 0.08), Activities-specific Balance Scale (β = 0.22), and modified fall efficacy scale (β = -0.07) are significantly associated with prosthetic device satisfaction (P < 0.0005, R2 = 0.47). Satisfaction with provider service was significantly associated with lower extremity functional status (β = 0.44) and balance confidence (β = 0.18) (P < 0.0005, R2 = 0.34). CONCLUSION AND CLINICAL RELEVANCE Civilians, veterans, and service members reported low functional mobility, low quality of life, and moderate levels of dissatisfaction with their lower extremity prosthetic device and provider service. Improvements in mobility, balance, quality of life, and fall efficacy may enhance device satisfaction. Functional mobility and balance improvements may increase ratings of provider service. This study provides feedback that may improve clinical decisions on lower limb prosthesis patient care.
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Affiliation(s)
- Oluwagbemiga O DadeMatthews
- Warrior Research Center, School of Kinesiology, Auburn University, Auburn, AL
- Department of Educational Foundations, Leadership, and Technology, Auburn University, Auburn, AL
| | - Jaimie A Roper
- School of Kinesiology, Louisiana State University, Baton Rouge, LA
| | - Adan Vazquez
- Locomotor and Movement Control Laboratory, School of Kinesiology, Auburn University, Auburn, AL
| | - David M Shannon
- Department of Prosthetics and Orthotics, Alabama State University, Montgomery, AL
| | - JoEllen M Sefton
- Warrior Research Center, School of Kinesiology, Auburn University, Auburn, AL
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Gane E, Petersen P, Killalea T, Glavinovic P, Nash I, Batten H. The effect of rehabilitation therapies on quality of life and function in individuals with phantom limb pain after lower-limb amputation: A systematic review. Prosthet Orthot Int 2023:00006479-990000000-00178. [PMID: 37708332 DOI: 10.1097/pxr.0000000000000288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 07/30/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE To evaluate the existing evidence surrounding the effect of rehabilitation therapies on quality of life (QOL) and function of individuals with a lower-limb amputation and experiencing phantom limb pain (PLP). METHODS This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses methodology. Four databases were searched with key terms that covered 4 broad areas: phantom limb, lower-limb amputation, rehabilitation interventions, and randomized controlled trial (no date limits). Outcomes of either function or QOL in people receiving rehabilitation for PLP were included. The RoB2.0 risk-of-bias tool was used to rate quality. RESULTS Five studies were included, reporting on QOL (n = 5) and function (n = 3), using interventions including mirror therapy, phantom exercises, and muscle relaxation. The evidence was mixed in direction and significance, and this was likely attributed to by the heterogeneity of interventions and types of outcomes as well as incomplete reporting. There was very low certainty in the effect of these rehabilitation interventions to affect QOL or function. CONCLUSION The overall effect of rehabilitation interventions on QOL and function is inconclusive because of the variable results across the included randomized controlled trials. More research is needed to explore the impact of interventions beyond the outcome of pain and to establish a clearer conclusion. Including measures of QOL and function as well as pain in studies with people with PLP is encouraged.
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Affiliation(s)
- Elise Gane
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Physiotherapy Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Phoebe Petersen
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Taylor Killalea
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Paige Glavinovic
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Isabel Nash
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Heather Batten
- Physiotherapy Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Essien SK, Zucker-Levin A. The impact of the demographic shift on limb amputation incidence in Saskatchewan, Canada, 2006–2019. PLoS One 2022; 17:e0274037. [PMID: 36054197 PMCID: PMC9439249 DOI: 10.1371/journal.pone.0274037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Changing demographics in a population may have an inevitable influence on disease incidence including limb amputation. However, the extent to which these changes affect limb amputation (LA) is unknown. Understanding the impact of changing demographics on LA would provide the best opportunity to plan for the future. We assessed the impact of changes in age and sex on limb amputation in Saskatchewan between 2006 and 2019. Methods Retrospective linked Saskatchewan’s LA cases, and demographic characteristics and residents population from 2006–2019 was used. The amputation rate was calculated by dividing the total number of LA cases recorded each year by the annual Saskatchewan resident population and the results expressed per 100,000 populations. Furthermore, decomposition analysis was used to assess the impact of changes in age and sex on LA in a decade (2008–2017) and the Generalized Additive Model (GAM) was employed to examine the linear and non-linear effect of age. Results We found that in the ten years (2008–2017), the absolute LA rate difference was 9.0 per 100,000 population. Changes in age structure alone contributed 7.7% to the LA rate increase and 92.3% to changes in age-specific LA rates. The decade witnessed a marginal population difference between males and females, but the LA rate was 2.1–2.2 times higher in males than in females. The GAM revealed a non-linear relationship between LA and age, and further indicates that the risk of LA significantly increased as age increases. Conclusions In a decade, we found that changes in age distribution and age-specific rate substantially impacted the increase in the LA rate observed in the province. This highlights the urgent need for strategized programs to respond to these changes as both the population and diabetes, which is age-dependent and a leading cause of LA, are expected to increase in the province by 2030. As changes in population and demographic factors are inevitable, this study provides data for policy makers on the need for continuous incorporation of the shift in population in the design of future health services.
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Affiliation(s)
- Samuel Kwaku Essien
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
- * E-mail:
| | - Audrey Zucker-Levin
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
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England DL, Miller TA, Stevens PM, Campbell JH, Wurdeman SR. Mobility Analysis of AmpuTees (MAAT 7): Normative Mobility Values for Lower Limb Prosthesis Users of Varying Age, Etiology, and Amputation Level. Am J Phys Med Rehabil 2022; 101:850-858. [PMID: 34864771 PMCID: PMC9377488 DOI: 10.1097/phm.0000000000001925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to establish normative values of lower limb amputation mobility across primary etiologies based on age and amputation level. DESIGN This study is a cross-sectional observational analysis of outcomes. A total of 11,995 lower limb prosthesis users were included in the analysis. Participants were grouped by etiology into four categories: cancer, congenital, trauma, and diabetes/dysvascular. Mobility was assessed by using the Prosthetic Limb Users Survey of Mobility. RESULTS Mobility across seven age groups for the four etiologies was established for both above-the-knee amputation and below-the-knee amputation. Differences were found between age groups for individuals: above-the-knee amputation: cancer (χ 2 (6) = 40.97, P < 0.001), congenital (χ 2 (3) = 9.41, P = 0.024), trauma (χ 2 (6) = 18.89, P = 0.004), and dysvascular (χ 2 (5) = 39.73, P < 0.001; below-the-knee amputation: cancer (χ 2 (6) = 29.77, P < 0.001), trauma (χ 2 (6) = 28.22, P < 0.001), and dysvascular (χ 2 (6) = 144.66, P < 0.001). CONCLUSIONS The awareness of differences across amputation etiologies extending across the lifespan of ages can assist the goal-setting process as part of prosthetic rehabilitation. In addition, refined normative values provide the ability to benchmark new and innovative changes in clinical practice.
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Pathophysiological and Neuroplastic Changes in Postamputation and Neuropathic Pain: Review of the Literature. Plast Reconstr Surg Glob Open 2022; 10:e4549. [PMID: 36187278 PMCID: PMC9521753 DOI: 10.1097/gox.0000000000004549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/05/2022] [Indexed: 10/24/2022]
Abstract
Despite advancements in surgical and rehabilitation strategies, extremity amputations are frequently associated with disability, phantom limb sensations, and chronic pain. Investigation into potential treatment modalities has focused on the pathophysiological changes in both the peripheral and central nervous systems to better understand the underlying mechanism in the development of chronic pain in persons with amputations. Methods Presented in this article is a discussion outlining the physiological changes that occur in the peripheral and central nervous systems following amputation. In this review, the authors examine the molecular and neuroplastic changes occurring in the nervous system, as well as the state-of-the-art treatment to help reduce the development of postamputation pain. Results This review summarizes the current literature regarding neurological changes following amputation. Development of both central sensitization and neuronal remodeling in the spinal cord and cerebral cortex allows for the development of neuropathic and phantom limb pain postamputation. Recently developed treatments targeting these pathophysiological changes have enabled a reduction in the severity of pain; however, complete resolution remains elusive. Conclusions Changes in the peripheral and central nervous systems following amputation should not be viewed as separate pathologies, but rather two interdependent mechanisms that underlie the development of pathological pain. A better understanding of the physiological changes following amputation will allow for improvements in therapeutic treatments to minimize pathological pain caused by amputation.
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Ruggieri P, Angelini A. CORR Insights®: Feasibility of a Wireless Implantable Multi-electrode System for High-bandwidth Prosthetic Interfacing: Animal and Cadaver Study. Clin Orthop Relat Res 2022; 480:1205-1207. [PMID: 35420548 PMCID: PMC9263472 DOI: 10.1097/corr.0000000000002213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/24/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
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Dhillon MS, Saini UC, Rana A, Aggarwal S, Srivastava A, Hooda A. The burden of post-traumatic amputations in a developing country - An epidemiological study from a level I trauma centre. Injury 2022; 53:1416-1421. [PMID: 35180999 DOI: 10.1016/j.injury.2022.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 02/02/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND With the rapidly growing population and expanding vehicle density on the roads, there has been an upsurge in road accidents in developing countries. Knowledge about the causes and patterns of trauma-related amputations helps in the formulation of strategies for limb savage, timely management, and effective rehabilitation. OBJECTIVE To study the epidemiology, demographic profile, and outcomes of post-trauma amputations at a level I tertiary care centre in North India. METHODS Retrospective evaluation of the amputee data from 1st January 2018 to 31st December 2019, focusing on demographic details, injury mechanisms, surgical delays, hospital stay, and complications. RESULTS A total of 17,445 trauma cases were seen in our trauma centre during the study period. Of these, 442 patients (2.5%) underwent major limb amputation. The hospital-based prevalence of traumatic limb amputation was 2.5%. The mean age of the amputees was 35.6years (range 1-75), and the majority were males (n = 369, 83.5%). The lower to upper limb involvement ratio was 3:1 (n = 338:105). A road traffic accident was the most common mode of injury (77.4%), followed by machine-cut injuries (16.1%). On-site traumatic amputation was seen in 23.1% (n = 102), while 43.5% had a mangled limb amputated in the hospital (mean MESS score 9.53). Overall, 27% of cases had a vascular injury after trauma, ultimately ending in limb amputation. The in-hospital mortality was 2% (n = 9/442). 43.7% of patients with a single limb amputation were discharged within 48 h. Extended hospital stay was noted in cases with associated fractures in the other limbs (28.5%), head or facial injury (9.9%), and with or without a combination of chest, abdomen, pelvic, or spine injury (7.2%). CONCLUSION A 2.5% incidence of post-trauma amputation reflects on the severity of injury related to road and industrial accidents which predominantly affect the lower limbs at the peak of productive work life. In the absence of national amputation registries, the results underscore the need to focus on road safety protocols, patient transfer methods, and the up-gradation of local hospitals.
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Affiliation(s)
- Mandeep Singh Dhillon
- Department of Orthopaedics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Uttam Chand Saini
- Department of Orthopaedics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
| | - Anurag Rana
- Department of Orthopaedics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Sameer Aggarwal
- Department of Orthopaedics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Akshat Srivastava
- Department of Orthopaedics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Aman Hooda
- Department of Orthopaedics, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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Asirdizer M, Hekimoğlu Y, Keskin S. Investigation of effective factors on traumatic amputations due to road traffic accidents. Injury 2022; 53:966-971. [PMID: 34852919 DOI: 10.1016/j.injury.2021.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 02/02/2023]
Abstract
AIM To determine factors associated with the locations, types and levels of traumatic limb amputations caused by road traffic accidents. MATERIALS AND METHODS The files sent by the courts to the expert committee chaired by the authors for the determination of applicants' disability rate over the 10-year period between 2011 and 2020 were examined retrospectively. RESULTS Of the 27 cases with traumatic amputations caused by road traffic accidents, 63% of them were male and the mean age of the cases was 29.0 ± 20.0 years. The cases comprised 12 passengers, 10 pedestrians, and 5 drivers. Of all, 66.7% of the amputations were caused by automobile accidents, 59.3% of them were in lower limbs, 51.9% of them were on the right side, and most of them occurred below the elbow/knee levels. Amputations occurred more frequently in lower limbs that are contralateral to the side of the traffic flow, in drivers, and in front seat passengers. CONCLUSION The findings in this preliminary study need to be confirmed in studies to be conducted in larger series. The findings of these studies will shed light on technological developments that can be used in the prevention of serious injuries that lead to post-accident traumatic amputations.
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Affiliation(s)
- Mahmut Asirdizer
- Forensic Medicine Department, Medical School of Bahcesehir University, Sahrayı Cedit, Batman Sk. No:66, 34734 Kadıköy, Istanbul, Turkey.
| | - Yavuz Hekimoğlu
- Ankara City Hospital of Health Sciences University, Ankara, Turkey
| | - Sıddık Keskin
- Biostatistics Department, Medical School of Van Yuzuncu Yil University, Van, Turkey
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12
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Seth M, Beisheim EH, Pohlig RT, Horne JR, Sarlo FB, Sions JM. Time Since Lower-Limb Amputation: An Important Consideration in Mobility Outcomes. Am J Phys Med Rehabil 2022; 101:32-39. [PMID: 34915544 PMCID: PMC8678402 DOI: 10.1097/phm.0000000000001736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate associations between time since amputation (TSAmp) and mobility outcomes of adults with lower-limb amputation. DESIGN A secondary analysis of a cross-sectional dataset, including 109 community-dwelling adults, 1 yr or more after unilateral transfemoral (n = 39; mean age, 54 ± 15 yrs) or transtibial (n = 70; mean age = 58 ± 14 yrs) amputation, was conducted. Participants attended standardized clinical evaluations and completed mobility-related outcome measures: Prosthesis Evaluation Questionnaire-Mobility Subscale, timed up and go, 10-m walk test, and 6-min walk test. RESULTS After controlling for age, sex, amputation level, and etiology, TSAmp was significantly associated with each mobility outcome. Prosthesis Evaluation Questionnaire-Mobility Subscale and TSAmp were linearly associated, with TSAmp explaining 10.6% of the overall variance. Timed up and go test time and TSAmp were linearly associated, with TSAmp and an interaction term (LevelxTSAmp) explaining 8.4% of the overall variance; 10-m walk test speed and 6-min walk test distance had nonlinear associations with TSAmp, with TSAmp and nonlinear terms (TSAmp2) explaining 12.1% and 13.2% of the overall variance, respectively. CONCLUSIONS Based on the findings, longer TSAmp may be associated with better Prosthesis Evaluation Questionnaire-Mobility Subscale score and timed up and go test time, whereas longer TSAmp may be associated with better or worse 10-m walk test speed and 6-min walk test distance depending upon time elapsed since lower-limb amputation. Estimations of postamputation mobility among adults with lower-limb amputation should consider TSAmp.
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Affiliation(s)
- Mayank Seth
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, Newark, Delaware, USA
| | - Emma Haldane Beisheim
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, Newark, Delaware, USA
| | - Ryan Todd Pohlig
- University of Delaware, Biostatistics Core Facility, Newark, Delaware, USA
| | | | | | - Jaclyn Megan Sions
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, Newark, Delaware, USA
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Rydland J, Spiegel S, Wolfe O, Alterman B, Johnson JT, Wheaton LA. Neurorehabilitation in Adults With Traumatic Upper Extremity Amputation: A Scoping Review. Neurorehabil Neural Repair 2021; 36:208-216. [PMID: 34967259 DOI: 10.1177/15459683211070277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most of the current literature around amputation focuses on lower extremity amputation or engineering aspects of prosthetic devices. There is a need to more clearly understand neurobehavioral mechanisms related to upper extremity amputation and how such mechanisms might influence recovery and utilization of prostheses. OBJECTIVE This scoping review aims to identify and summarize the current literature on adult traumatic upper limb amputation in regard to recovery and functional outcomes and how neuroplasticity might influence these findings. METHODS We identified appropriate articles using Academic Search Complete EBSCO, OVID Medline, and Cochrane databases. The resulting articles were then exported, screened, and reviewed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. RESULTS Eleven (11) studies met the study criteria. Of these studies, 7 focused on sensory involvement, 3 focused on neuroplastic changes post-amputation related to functional impact, and 1 study focused on motor control and learning post-amputation. Overall, these studies revealed an incomplete understanding of the neural mechanisms involved in motor rehabilitation in the central and peripheral nervous systems, while also demonstrating the value of an individualized approach to neurorehabilitation in upper limb loss. CONCLUSIONS There is a gap in our understanding of the role of neurorehabilitation following amputation. Overall, focused rehabilitation parameters, demographic information, and clarity around central and peripheral neural mechanisms are needed in future research to address neurobehavioral mechanisms to promote functional recovery following traumatic upper extremity amputation.
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Affiliation(s)
- Jake Rydland
- Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie Spiegel
- Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Olivia Wolfe
- Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | | | - John T Johnson
- School of Biological Sciences, Georgia Tech, Atlanta, GA, USA
| | - Lewis A Wheaton
- School of Biological Sciences, Georgia Tech, Atlanta, GA, USA
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Donnelley CA, Shirley C, von Kaeppler EP, Hetherington A, Albright PD, Morshed S, Shearer DW. Cost Analyses of Prosthetic Devices: A Systematic Review. Arch Phys Med Rehabil 2021; 102:1404-1415.e2. [PMID: 33711275 DOI: 10.1016/j.apmr.2021.02.010] [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: 08/31/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To synthesize extant literature on the cost-effectiveness of prosthetic interventions and explore applicability to low- and middle-income country (LMIC) settings. DATA SOURCES A systematic literature review using subject headings including "prosthetics," "amputation," and "cost analysis" was performed with PubMed, Embase, and Web of Science search engines, yielding 1194 articles. An additional 22 articles were identified via backward citation searching for 1144 total after duplicate removal. The search was last run in May of 2019. STUDY SELECTION Studies were included if they conducted an economic analysis of an upper or lower extremity prosthetic device. Studies were excluded if (1) full text was unavailable in English; (2) study was a systematic review or meta-analysis; or (3) study did not have a prosthetic comparison group. Using DistillerSR software, 2 authors independently conducted title and abstract screening. One author conducted full-text screening. The proportion of initially identified studies that met final inclusion criteria was 1% (12 of 1144). DATA EXTRACTION Data were dually extracted by 2 authors and reviewed by 3 additional authors. DATA SYNTHESIS All included studies (N=12) examined lower extremity amputations comparing advanced technology. No studies were conducted in LMICs. Comparable data between studies demonstrated (1) the cost-effectiveness of microprocessor- over nonmicroprocessor-controlled knees for transfemoral amputation in high-income settings; (2) equivocal findings regarding osseointegrated vs socket-suspended prostheses; and (3) increased cost for ICEX and modular socket systems over patellar tendon-bearing socket systems with no functional improvement. CONCLUSIONS There are few prosthetic cost analyses in the literature. Additional analyses are needed to determine the direct and indirect costs associated with prosthetic acquisition, fitting, and maintenance; the costs of amputee rehabilitation; and long-term economic and quality-of-life benefits. Such studies may guide future prosthetic and rehabilitative care, especially in resource-austere settings where prosthetic needs are greatest.
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Affiliation(s)
- Claire A Donnelley
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA
| | - Corin Shirley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - Ericka P von Kaeppler
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA
| | - Alexander Hetherington
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | | | - Saam Morshed
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA
| | - David W Shearer
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA.
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Phantom pain decreases with vibrating silicone liner in lower limb amputee: a prospective study. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000000970] [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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Mallik AK, Pandey SK, Srivastava A, Kumar S, Kumar A. Comparison of Relative Benefits of Mirror Therapy and Mental Imagery in Phantom Limb Pain in Amputee Patients at a Tertiary Care Center. Arch Rehabil Res Clin Transl 2020; 2:100081. [PMID: 33543104 PMCID: PMC7853377 DOI: 10.1016/j.arrct.2020.100081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the relative benefit of mirror therapy and mental imagery in phantom limb pain. DESIGN Prospective randomized controlled trial. SETTING Physical Medicine and Rehabilitation Department, All India Institute of Medical Sciences, Patna. PARTICIPANTS Amputees (N=92) with no significant difference in baseline characteristics. There was a male predominance in both groups (mirror therapy: 36 men, 10 women; mental imagery: 37 men, 9 women). INTERVENTION Patients of both groups underwent a conventional amputee rehabilitation program and daily treatment of either mirror therapy or mental imagery on a regular basis, first in a rehabilitation care unit and later at home. MAIN OUTCOME MEASURES Phantom limb pain (PLP) was measured by visual analog scale (VAS) score at baseline (0) and at 4, 8, and 12 months. RESULTS This study included 92 patients ranging in age from 12 to 75 years (average, 34.79y). There was no significant difference in VAS score between the groups at baseline, but we found a significant reduction of pain in both groups at follow-up. However, upon comparing the improvement in both groups, we determined that the mirror therapy group had better improvement (from 7.07±1.74 to 2.74±0.77) compared with the mental imagery group (from 7.85±0.76 to 5.87±1.41). CONCLUSIONS Mirror therapy and mental imagery are both good and cost-effective rehabilitation aids for amputee patients to reduce PLP, but mirror therapy appears to be more effective than mental imagery.
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Affiliation(s)
- Amit Kumar Mallik
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Sanjay Kumar Pandey
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ashish Srivastava
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Sanyal Kumar
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Anjani Kumar
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Patna, Bihar, India
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Abstract
Osseointegration is a surgical approach that permitted the direct attachment of an external prosthesis to the skeleton in some select patients with amputation, who had failed to tolerate conventional sockets, thereby obviating related issues such as discomfort, skin breakdown, and poor fit. In this specific population, osseointegration offers the potential for enhanced biomechanical advantage and rehabilitative potential. Multiple percutaneous implant systems exist for clinical use internationally, each attempting to create a stable bone-implant interface while avoiding complications such as infection and loosening. Prospective clinical trials are now underway in the United States. This article will review the history and biology of osseointegration, indications and contraindications for use of currently available implant systems, and reported outcomes. Future directions of orthopaedic osseointegration technology, including electronic systems capable of biomimetic bidirectional volitional motor control of, and sensory/proprioceptive feedback from, external prosthetic devices, will also be discussed.
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Ali Y, Halvorson J, Nunn A, Miller P. Delayed Closure is Associated with Decreased Infection Rate in Amputations after Trauma. Am Surg 2019. [DOI: 10.1177/000313481908500527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Amputations associated with trauma carry significant morbidity in addition to risk of limb loss due to tissue damage, contamination, and risk of infection. The timing of formal amputation closure in this situation varies among surgeons, with some allowing the wound to remain open for some time after debridement, whereas others perform formal amputation and closure at the index operation if debridement is adequate. The presence of infection after closure of an amputation has the potential to result in a higher amputation ( i.e., a below-knee amputation to an above-knee amputation). Our goal was to examine the relationship of timing of closure to stump infection and eventual level of amputation. A review was performed of all patients admitted to a Level I trauma center over a six-year period with amputations during the initial admission after trauma. Amputations of either an arm (above or below the elbow) or a leg (above or below the knee) were included. The number of days between adequate debridement as judged by the operating surgeon and closure of the amputation and whether there was an infection after closure were evaluated. Also investigated was the relationship between infection after closure and a higher level of amputation. Between January 1, 2010, and December 31, 2015, 63 patients (ages 15–81 years, mean age 45.1 ± 18.4) underwent an amputation of a leg or an arm. Fifty-four were male, nine were female, the mean injury severity score was 20.9 ± 10.4, and the mean lactate level at admission was 3.4 ± 1.7. Of the 63 patients, 53 patients had an amputation of a leg and 10 had an amputation of an arm. The overall infection rate was 32 per cent, and the mean time until closure was 6.7 ± 11.1 days. Comparing closure times in those with and without infection after closure, the mean intervals were 3.1 ± 9.7 and 8.4 ± 11.4 days, respectively ( P = 0.01). The receiver operating characteristic curve c-statistic was 0.69 ( P = 0.04). Sensitivity of various times to closure for avoiding infection was examined and was optimized at five days with infection rates above five days of 5.3 per cent versus at or below five days to closure of 43.2 per cent ( P = 0.0029). Infection resulted in a higher level of amputation in 40 per cent of those who had an infection. Based on these data, delay in closure of an amputation even after debridement appears adequate was associated with a lower rate of infection and the presence of infection resulted in a higher amputation level in more than a third of studied patients. Delay of formal amputation closure for at least five days after adequate debridement is acheived is associated with a significantly reduced rate of infection.
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Affiliation(s)
- Yasmin Ali
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jason Halvorson
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Andrew Nunn
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Preston Miller
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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19
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Das N, Nagpal N, Bankura SS. A review on the advancements in the field of upper limb prosthesis. J Med Eng Technol 2019; 42:532-545. [PMID: 30875266 DOI: 10.1080/03091902.2019.1576793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Amputation is one of the serious issue across the globe which is mainly caused by trauma, medical illness or congenital condition. Because of steep increase in amputation incidences, the need for progress in technicality of prosthesis is becoming imperative. In this article, the journey of advancements in upper arm prosthesis has been discussed step by step. Moreover, it has also been enunciated that how from a simple replacement for an arm it now has reached the mark of giving a patient a fully functional limb with the help of sensors and myoelectric transducers that are able to translate the remaining muscle signals into full movement of the prosthesis. However, researches are still going on to make the design of the prosthetic more impressive having better range of movement, to establish its interface with brain more efficiently and to make the control of prosthetic more user friendly. In this review, a special emphasis has also been given to myoelectric prosthesis as this prosthetic system possesses a decisive influence on rehabilitation results. Moreover, this prosthetic system is extremely elegant and cutting-edge in both design and technology and offers a great wearer comfort.
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Affiliation(s)
- Nilanjan Das
- a Accendere, CL Educate Ltd. , New Delhi , India
| | - Nikita Nagpal
- b Department of Biotechnology , Manav Rachna International Institute of Research and Studies , Faridabad , India
| | - Shailee Singh Bankura
- b Department of Biotechnology , Manav Rachna International Institute of Research and Studies , Faridabad , India
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Outcomes of lower limb amputees at Cotonou. J Clin Orthop Trauma 2019; 10:191-194. [PMID: 30705558 PMCID: PMC6349679 DOI: 10.1016/j.jcot.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Limb amputations are responsible for disability. We studied the outcomes of lower limb amputees in our daily practice. METHODS This prospective analytical study over 7 years (January 2009-December 2015) included 70 amputees of lower limb. They were mainly male (73%), aged on average of 42.4 ± 18.8 years. The mean time of follow- up was 3.2 ± 1.9 years. We assessed disability on balance, walking, disability in daily life for patients with prosthesis, and the socio-economic impact of the amputation. Statistical analysis was performed with Chi2 and Mann-Whitney tests; a p-value ≤ 0.05 was considered statistically significant. RESULTS The average Timed Up and Go Test was 18.5 s. Class II of Pohjolainen subjects were the most recovered (37%). The mean Houghton score in the 17 fitted patients was 6.2 ± 2.0. Socially, 90% of the patients no longer practiced leisure activities, and 4/53 patients were no longer in a couple. At the economic level, 87% of patients had a decreased monthly income. Factors that bear direct correlation to functional outcome of patients were the level of amputation, and the prosthesis fitting. CONCLUSION Lower limbs amputations entail adverse consequences at the functional and socio-economic level. Our country must review its policy on prosthetic fittings for amputees, and vote laws that involve private firms and government in socio-economic reintegration, and empowerment of these subjects.
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Gebreslassie B, Gebreselassie K, Esayas R. Patterns and Causes of Amputation in Ayder Referral Hospital, Mekelle, Ethiopia: A Three-Year Experience. Ethiop J Health Sci 2018; 28:31-36. [PMID: 29622905 PMCID: PMC5866287 DOI: 10.4314/ejhs.v28i1.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Amputation is a surgical procedure for the removal of a limb which is indicated when limb recovery is impossible. There are different types of amputation, and their causes can vary from one area to the other. Therefor, the aim of this study is to find out the patterns and causes of amputations in patients presented to Ayder Referral Hospital, Mekelle, Ethiopia. Methods the record of 87 patients who had amputation at different sites after admission to Ayder referral hospital, Mekelle, Ethiopia in three years period were reviewed retrospectively. Result A total of 87 patients had amputation of which 78.2% were males. The age range was from 3 to 95 years, and the mean age was 40.6 in years. The most common indications were trauma (37.7%), tumor (24.1%), and peripheral arterial disease (PAD) (20.7%). The commonest type of amputation was major lower limb amputation (58.6%) which includes above knee amputation (35.6%)and below knee amputation (23%) followed by digital amputation (17.2%). There was 11.4% major upper limb amputation of which there was one patient who had re-amputation. Conclusion Most of the indications for amputations in our setup are potentially preventable by increasing awareness in the society on safety measures both at home and at work and early presentation to health facilities.
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Affiliation(s)
| | | | - Reiye Esayas
- Department of Surgery, College of Health Sciences, Mekelle University
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Delgado F, Currlin S, Kundu A, Patrick EE, Otto KJ. Effect of Asymmetric, Charge Balanced Stimuli on Elicited Compound Neural Action Potentials. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:3370-3373. [PMID: 30441110 DOI: 10.1109/embc.2018.8513057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Whether via cuff or intrafascicular electrode, peripheral neural stimulations often rely on symmetric, charge balanced paradigms. To date, few investigations have been carried out which systematically decompose the features of a stimulus waveform. Factors such as pulse-width, amplitude, and the timing with which they are presented may have significant effects on the quality of the stimuli. This work seeks to fill this gap in knowledge and share insight into how selection of electrical stimuli may affect the resultant neural activation in peripheral nerves. In particular, we found that, although there is some variance, over the parameter range tested there was not a significant effect on neural fiber recruitment percent due to waveform selection.
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23
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Ghoseiri K, Allami M, Soroush MR, Rastkhadiv MY. Assistive technologies for pain management in people with amputation: a literature review. Mil Med Res 2018; 5:1. [PMID: 29502531 PMCID: PMC5778696 DOI: 10.1186/s40779-018-0151-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/08/2018] [Indexed: 11/13/2022] Open
Abstract
The prevalence of limb amputation is increasing globally as a devastating experience that can physically and psychologically affect the lifestyle of a person. The residual limb pain and phantom limb pain are common disabling sequelae after amputation surgery. Assistive devices/technologies can be used to relieve pain in people with amputation. The existing assistive devices/technologies for pain management in people with amputation include electrical nerve block devices/technologies, TENS units, elastomeric pumps and catheters, residual limb covers, laser systems, myoelectric prostheses and virtual reality systems, etc. There is a great potential to design, fabricate, and manufacture some portable, wireless, smart, and thin devices/technologies to stimulate the spinal cord or peripheral nerves by electrical, thermal, mechanical, and pharmaceutical stimulus. Although some preliminary efforts have been done, more attention must be paid by researchers, clinicians, designers, engineers, and manufacturers to the post amputation pain and its treatment methods.
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Affiliation(s)
- Kamiar Ghoseiri
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mostafa Allami
- Janbazan Medical and Engineering Research Center (JMERC), Farrokh Ave, Velenjak, Tehran, Iran.
| | - Mohammad Reza Soroush
- Janbazan Medical and Engineering Research Center (JMERC), Farrokh Ave, Velenjak, Tehran, Iran
| | - Mohammad Yusuf Rastkhadiv
- Department of Occupational Therapy, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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Farsi Z, Azarmi S. Effect of Roy's Adaptation Model-Guided Education on Coping Strategies of the Veterans with Lower Extremities Amputation: A Double-Blind Randomized Controlled Clinical Trial. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2016; 4:127-36. [PMID: 27218110 PMCID: PMC4876781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Any defect in the extremities of the body can affect different life aspects. The purpose of this study was to investigate the effect of Roy's adaptation model-guided education on coping strategies of the veterans with lower extremities amputation. METHODS In a double-blind randomized controlled clinical trial, 60 veterans with lower extremities amputation referring to Kowsar Orthotics and Prosthetics Center of Veterans Clinic in Tehran, Iran were recruited using convenience method and randomly assigned to intervention and control groups in 2013-2014. Lazarus and Folkman coping strategies questionnaire was used to collect the data. After completing the questionnaires in both groups, maladaptive behaviours were determined in the intervention group and an education program based on Roy's adaptation model was implemented. After 2 months, both groups completed the questionnaires again. Data were analyzed using SPSS software. RESULTS Independent T-test showed that the score of the dimensions of coping strategies did not have a statistically significant difference between the intervention and control groups in the pre-intervention stage (P>0.05). This test showed a statistically significant difference between the two groups in the post-intervention stage in terms of the scores of different dimensions of coping strategies (P>0.05), except in dimensions of social support seeking and positive appraisal (P>0.05). CONCLUSION The findings of this research indicated that the Roy's adaptation model-guided education improved the majority of coping strategies in veterans with lower extremities amputation. It is recommended that further interventions based on Roy's adaptation model should be performed to improve the coping of the veterans with lower extremities amputation. TRIAL REGISTRATION NUMBER IRCT2014081118763N1.
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Affiliation(s)
- Zahra Farsi
- Department of Community Health, AJA University of Medical Sciences, Tehran, Iran,Corresponding author: Zahra Farsi, PhD; Department of Community Health, AJA University of Medical Sciences, Kaj St, Shariati St, Tehran, Iran Tel: +98 21 77500404; Fax: +98 21 77500929;
| | - Somayeh Azarmi
- Department of Military Nursing, AJA University of Medical Sciences, Tehran, Iran
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Allami M, Mousavi B, Masoumi M, Modirian E, Shojaei H, Mirsalimi F, Hosseini M, Pirouzi P. A comprehensive musculoskeletal and peripheral nervous system assessment of war-related bilateral upper extremity amputees. Mil Med Res 2016; 3:34. [PMID: 27891243 PMCID: PMC5111189 DOI: 10.1186/s40779-016-0102-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 10/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation. METHODS The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees (206 amputations) from the Iran-Iraq war were evaluated, and a detailed questionnaire was also administered. RESULTS The most common level of amputation was the finger or wrist level (108, 52.4 %). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis (65, 31.6 %), rotator cuff injury (24, 11.7 %), bicipital tendonitis (69, 33.5 %), shoulder drop (42, 20.4 %) and muscle atrophy (19, 9.2 %). Peripheral nerve disorders included carpal tunnel syndrome in 13 (6.3 %) and unilateral brachial plexus injury in 1 (1 %). Fifty-three (51.5 %) were diagnosed with facet joint syndrome at the level of the cervical spine (the most frequent site). Using a prosthesis was reported by 65 (63.1 %), both left and right sides. The back was the most common site of pain (71.8 %). CONCLUSION The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.
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Affiliation(s)
- Mostafa Allami
- Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
| | - Batool Mousavi
- Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
| | - Mehdi Masoumi
- Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
| | - Ehsan Modirian
- Emergency Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hadi Shojaei
- Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
| | - Fatemeh Mirsalimi
- Candidate of Health Education and Promotion, Department of Health Education and Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Maryam Hosseini
- Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
| | - Pirouz Pirouzi
- Department of Radiology, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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