Demography and function of children with limb loss

This retrospective study was designed for the period 1982-2002 to collect the basic data on the demography, level and side of the amputation, involved limbs, age, gender, and prosthetic functional level in children with limb loss. A total of 232 children were assessed through their prosthetic records. Seventy-two percent (195 children) presented lower-limb involvement, and 28% (77 children) had upper-limb loss. The age of the children varied between 1 and 15 years with a mean age of 9.90 +/- 2.32 years. Results of the study revealed that the leading amputation cause in children was congenital limb absence. The most frequent levels were determined as trans-tibial and trans-radial in lower and upper limbs, respectively. Findings showed that more boys (60%) were affected, and 84% of all amputations were found to be unilateral. It was also seen that right-side amputations (54%) were more common than left-side amputations (46%). The outcome of the study showed that 96% of children with lower-limb loss reached a functional gait pattern without any aids, while the percentage of independence in activities of daily living was found to be 88% in upper-limb loss.

The short -term effects of an exercise programme as an adjunct to an orthosis in neuromuscular scoliosis

The purpose of this study was to investigate the effects of a 4 week physiotherapy programme on patients who were given a spinal orthosis for neuromuscular scoliosis. This study was planned as a single group pre- and post-intervention repeated measures design. All patients were given a polyethylene spinal orthosis with an anterior opening. Fifteen (15) patients with neuromuscular diseases and a mean age of 12.46 years were evaluated. An exercises programme consisting of postural training, muscle strengthening and stretching exercises with special emphasis on respiratory exercises was given as an adjunct to orthotic treatment. The degree of impairment in forced vital capacity was 17.56% upon wearing an orthosis, it decreased to 9.28% following therapy (p < 0.05). There was also a statistically significant increase in muscle strength, balance duration and a significant decrease in limitation of range of motion. The results of the study imply that the conservative treatment of neuromuscular scoliosis should include an exercise programme as an adjunct to an orthosis, both to reduce the compromising effect of an orthosis on respiratory function and to support the patient's physical capacities.

Intra- and interspecific molecular polymorphism of thrips species

Molecular polymorphism of six species of Thysanoptera of both sexes, collected from different locations and host plants in Hungary was studied by using RAPD-PCR technique. The specimens were classified according to sampling sites (Gödöllö, Nagykovácsi and Valkó), host plants (Lathyrus tuberosus, Medicago sativa, Taraxacum officinale, Trifolium pratense), sexes, and larvae in case of Aeolothrips intermedius. On the basis of the total of 103 fragments generated by 15 RAPD primers the genetic distances were calculated by cluster analysis using simple matching method. The dendrogram resulted in two main groups: Aeolothripidae (Aeolothrips intermedius) and Thripidae (Frankliniella intonsa, Kakothrips robustus, Odontothrips confusus, Thrips dilatatus and T. tabaci). Within the family Thripidae two subgroups were observed including (i) F. intonsa, T. dilatatus and T. tabaci, and (ii) K. robustus and O. confusus. Two population-specific and one sex-linked fragments were identified by the RAPD primers, OPQ 14, NO11 and OPA08, respectively.

Comparison of the effects of patellar tendon bearing and total surface bearing sockets on prosthetic fitting and rehabilitation

Patellar tendon bearing (PTB) and total surface bearing (TSB) sockets have been used respectively in the prosthetic treatment of 20 trans-tibial amputees to investigate the effectiveness of both sockets on prosthetic fitting and rehabilitation. Data analysis showed that prostheses with TSB sockets were lighter than the prostheses with PTB sockets and better suspension was obtained from TSB prosthetic socket (p<0.05). It was also found that weight acceptance on the amputated side advanced to a more normal value with TSB prostheses (p<0.05). There was a statistically significant difference between the two socket types in walking and in other ambulation activities except sitting and standing up from a chair, in favour of the TSB socket (p<0.05). Consequently, due to the outcome of this study it can be said that TSB prosthetic sockets can be used effectively in the rehabilitation of trans-tibial amputees.

A comparison of traditional prosthetic training versus proprioceptive neuromuscular facilitation resistive gait training with trans-femoral amputees

Reports in the rehabilitation literature suggest that patients with trans-femoral amputation ambulate well after suitable prosthetic treatment. The effects of exercise protocols on function, however, have not been documented in this population. This study was conducted to compare the outcome of traditional and proprioceptive neuromuscular facilitation (PNF) techniques on weight bearing and gait. Fifty unilateral trans-femoral amputees who were attending for their first prosthesis, participated in this study. Amputees were randomly assigned into groups receiving the traditional training or PNF. Traditional treatment was consisted of weight-shifting, balancing, stool-stepping and gait exercises. In the other group the same activities were given by PNF. Amputees were trained 30 minutes daily, for a total of 10 treatments. Pre- and post-training assessment included weight bearing measurements by using two bathroom scales and time-distance characteristics of gait from footprints. A statistically significant difference was found in all parameters within the groups due to pre- and post-training evaluation data (p<0.05), but more obvious improvement was observed in the group who received PNF (p<0.05). The results of the study suggest that the prosthetic training based on proprioceptive feedback was more effective to improve weight bearing and gait when compared with a traditional programme.

Effectiveness of prosthetic rehabilitation of children with limb deficiencies present at birth

This study was performed to investigate the efficacy of prosthetic rehabilitation in children with congenital malformations, also to determine whether there were any factors related to family history and pregnancy which could have affected the formation of such deficiencies. Twenty-five (25) limb deficient children were provided with prostheses and received rehabilitation. A detailed family and pregnancy history was researched through the records. The ability of performing activities of daily living was scored on a four point scale. Thirteen (13) lower and 12 upper limb deficient children with a mean age of 4.88+/-2.52 years were included in the study. Ten (10) children had longitudinal and 15 transverse deficiencies. Traditional marriages amongst close cousins were observed in 31%. Five (5) mothers used medications, 2 received radiodiagnostic tests and 2 had bleedings during pregnancy. Some 84.7% of the lower limb group became independent walkers without requiring walking aids while 15.3% of them required Canadian crutches for independent ambulation. A total of 61.5% of these children actively participated in recreation with peers. In the upper limb group 41.6% were completely independent in self-care, feeding and hand skills; 33.3% showed independence with self-help devices while 25% tended to use the prostheses for assistive purposes. Participation in recreational activities was 58.2%. The author's results have shown that the children gained a functional activity level although the prostheses were provided in a late period. It can be concluded that success in rehabilitating these children is a true challenge.