Outcomes of Artificial Lower-Limb Fitting in Scotland

Background: There is a known shortage of rehabilitation staff in rural settings and a sharp increase in the number of lower limb amputations being performed. A lack of adequate pre-prosthetic rehabilitation will result in worse physical and psychological outcomes for a person with a lower limb amputation, and they will not be eligible to be fitted with a prosthesis. Objective: To explore therapists’ experiences with providing pre-prosthetic rehabilitation in a rural setting. Study design: A qualitative descriptive approach was used to collect and analyse data. Methods: Data were collected from 17 purposively sampled therapists in five district hospitals in a rural community in South Africa. Data were collected in two rounds of focus groups to explore the challenges of providing pre-prosthetic rehabilitation in rural South Africa. Results: The main themes identified in the study were (1) a lack of government health system support, (2) poor socioeconomic circumstances of patients and (3) cultural factors that influence rehabilitation. These themes all negatively influence the therapists’ ability to follow up patients for pre-prosthetic rehabilitation after discharge from hospital. A lack of adequate pre-prosthetic rehabilitation is a substantial barrier to prosthetic fitting in rural South Africa. Patients who do not receive pre-prosthetic rehabilitation have a poorly shaped residuum or other complications such as knee or hip joint contractures which disqualifies them from being referred to prosthetic services. Conclusion: Therapists involved in this study identified the most important barriers to patients having access to prosthetic services. Clinical relevance Pre-prosthetic rehabilitation provides care of the residuum; maintenance or improvement of physical strength, joint range of motion and referral to a prosthetist. By exploring the challenges known to exist in this service, we can identify potential ways to reduce these barriers and improve the lives of those who use it.

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The value of stump split skin grafting following amputation for trauma in adult upper and lower limb amputees

Prosthetics and Orthotics International ◽

10.3109/03093648709078181 ◽

1987 ◽

Vol 11 (2) ◽

pp. 71-74 ◽

Cited By ~ 20

Author(s):

M. R. Wood ◽

G. A. Hunter ◽

S. G. Millstein

Keyword(s):

Revision Surgery ◽

Lower Limb ◽

Skin Grafting ◽

Limb Amputation ◽

Skin Grafts ◽

Early Management ◽

Split Skin Grafting ◽

Prosthetic Fitting ◽

Fitting In ◽

Split Skin

One hundred and twenty adult patients were reviewed in whom split skin grafts were applied to the stump following traumatic amputation of the upper limb (44 amputees) or lower limb (76 amputees). The average follow-up period was seven and a half years after initial amputation. There was delay in prosthetic fitting in all patients. Approximately one third of patients complained of occasional minor ulceration, controlled by removing the prosthesis for a few days or modification of the prosthesis. Further revision surgery, including excision of the grafted skin often combined with proximal bone resection, but not removal of the proximal joint, was necessary in 29% of below-elbow amputees and approximately 50% of below and above-knee amputees. At the above-elbow level, use of skin grafts allowed prosthetic fitting because of preservation of sufficient length of the stump. Despite the fact that revision surgery may often be necessary, split skin grafting has a definite place in the early management of the stump following traumatic limb amputation in the adult. Preservation of stump length with the knee or elbow joint allows easier rehabilitation and lower energy expenditure when using the prosthesis. Partial foot amputation, when combined with skin grafting usually requires subsequent revision to a more proximal level to obtain a satisfactory result.

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Outcomes of Artificial Lower Limb Fitting in Scot-land???A Survey of New Patients Referred to theLimb Fitting Servic

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/00002060-198912000-00013 ◽

1989 ◽

Vol 68 (6) ◽

pp. 303

Author(s):

Madan M. Telikicherla

Keyword(s):

Lower Limb ◽

Fitting In

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Below-knee amputation in patients with yascular disease and prosthetic fitting problems

Prosthetics and Orthotics International ◽

10.3109/03093648609164515 ◽

1986 ◽

Vol 10 (3) ◽

pp. 125-128 ◽

Cited By ~ 2

Author(s):

D. Yaramenko ◽

R. V. Andruhova

Keyword(s):

Lower Limb ◽

Collateral Circulation ◽

The Other ◽

Posterior Flap ◽

Productive Work ◽

Knee Amputation ◽

Prosthetic Fitting ◽

Cutaneous Flap ◽

Fitting In ◽

Limb Deficiencies

A study was made of 544 cases with lower limb deficiencies caused by obliterative diseases; 262 cases were below-knee amputees. Of these, 106 (40%) were amputees transferred from other clinics for prosthetic fitting; in 156 cases (60%) the amputations were performed in the Institute. Amputations were carried out using one of two techniques according to the state of arterial and collateral circulation. The posterior flap below-knee amputation (Burgess, 1969) was employed in 94 cases, the other 62 amputations were carried out using a modification of that technique which was characterized by the formation of a musculo-fascia-cutaneous flap. The stump wound healed by first intention in 127 patients (81.4%), by second intention in 18 (11.5%) and in 11 cases (7.1%) the wounds failed to heal. Successful prosthetic fitting and walking training was achieved in 91.3% of amputees and 67.2% were returned to productive work.

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Prosthetic Fitting in Lower Limb Amputees

Acta Orthopaedica Scandinavica ◽

10.3109/17453678308992877 ◽

1983 ◽

Vol 54 (1) ◽

pp. 101-103 ◽

Cited By ~ 8

Author(s):

J. Steen Jensen ◽

T. Mandrup-Poulsen ◽

M. Krasnik

Keyword(s):

Lower Limb ◽

Prosthetic Fitting ◽

Fitting In ◽

Lower Limb Amputees

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Background Fitting in the Low-Loss Region of Electron Energy Loss Spectra

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100133874 ◽

1990 ◽

Vol 48 (2) ◽

pp. 56-57

Author(s):

C P Scott ◽

A J Craven ◽

C J Gilmore ◽

A W Bowen

Keyword(s):

Energy Loss ◽

Multiple Scattering ◽

Simple Form ◽

Single Scattering ◽

Low Loss ◽

Characteristic Energy ◽

Normal Method ◽

Fitting In ◽

Electron Energy Loss ◽

Electron Energy Loss Spectra

The normal method of background subtraction in quantitative EELS analysis involves fitting an expression of the form I=AE-r to an energy window preceding the edge of interest; E is energy loss, A and r are fitting parameters. The calculated fit is then extrapolated under the edge, allowing the required signal to be extracted. In the case where the characteristic energy loss is small (E < 100eV), the background does not approximate to this simple form. One cause of this is multiple scattering. Even if the effects of multiple scattering are removed by deconvolution, it is not clear that the background from the recovered single scattering distribution follows this simple form, and, in any case, deconvolution can introduce artefacts.The above difficulties are particularly severe in the case of Al-Li alloys, where the Li K edge at ~52eV overlaps the Al L2,3 edge at ~72eV, and sharp plasmon peaks occur at intervals of ~15eV in the low loss region. An alternative background fitting technique, based on the work of Zanchi et al, has been tested on spectra taken from pure Al films, with a view to extending the analysis to Al-Li alloys.

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