scholarly journals A low-cost easily implementable physiotherapy intervention clinically improves gait implying better adaptation to lower limb prosthesis: a randomized clinical trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Leticia Vargas Almeida ◽  
Claudiane Arakaki Fukuchi ◽  
Tania Emi Sakanaka ◽  
Alberto Cliquet
Keyword(s):  
Lower Limb ◽  
Low Cost ◽  
Intervention Group ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Control Group ◽  
Post Intervention ◽  
Physiotherapy Intervention ◽  
Lower Limb Prosthesis ◽  
Limb Prosthesis

AbstractLower limb amputation highly impacts the lives of individuals. The inability to walk due to difficulties in adapting to wearing prosthesis can potentially result in physical degeneration and comorbidity in this population. In this randomized clinical trial study, we investigated if a low-cost and easily implementable physiotherapy intervention was effective in improving gait performance and adaptation to lower limb prosthesis in individuals with an amputation. A total of 26 individuals participated in the study, 16 with lower limb amputation and 10 without amputation. Participants with amputation were further divided in intervention and control groups. The intervention group underwent a rehabilitation protocol aimed at strengthening muscles and improving prosthesis adaptation. Muscle strengthening targeted the hip segment, prioritizing the abdominal muscles, hip flexors, extensors, adductors and abductors, followed by cicatricial mobilization and weight-bearing on the stump for desensitization. Assessment and measures were performed across the kinetic and kinematic parameters of gait. In the comparison between pre-and post-intervention, a significant increase in gait speed (0.68—2.98, 95% CI, 1.83, effect size ES) and cadence (0.56—2.69, 95% CI, 1.63, ES) was found between groups and time points. Step (0.73—3.11, 95% CI, 1.92, ES) and stride length (0.62—2.84, 95% CI, 1.73) increased between pre- and post-intervention, while in the control group both variables remained smaller. The intervention group decreased stance phase as a percentage of gait cycle between pre- and post-intervention (− 1.33—0.62, 95% CI, − 36, ES), while it increased in the control group. Improvement in a combination of important gait parameters indicates that the intervention protocol promoted the adaptation to prosthesis and the functional independence of individuals with lower limb amputation. It is recommended that the participants continue receiving follow-up assessments and rehabilitation interventions.

scholarly journals Prosthetics for Lower Limb Amputation

2021 ◽  
Author(s):  
P. Senthil Selvam ◽  
M. Sandhiya ◽  
K. Chandrasekaran ◽  
D. Hepzibah Rubella ◽  
S. Karthikeyan
Keyword(s):  
Gait Analysis ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Complete Picture ◽  
Limb Amputation ◽  
Advantages And Disadvantages ◽  
Diagrammatic Representation ◽  
Mechanical Component ◽  
Lower Limb Prosthesis ◽  
Limb Prosthesis

The Chapter will include a brief note on Amputation, Particularly Lower Limb Amputation (LLA), Levels and Causes of LLA. Importance of Prosthetics for LLA are explained in detail. The types of Prosthesis, Application (Donning & Doffing) of prosthesis are included in this chapter. Diagrammatic representation of the prosthesis are added too. Bio mechanical component is explained in detail within this chapter. The advantages and disadvantages of each and every Lower limb Prosthesis are clearly mentioned. Moreover, the Gait analysis & Training after the application of prosthesis are discussed. The reader will get a complete picture of Prosthetics for Lower limb Amputation by going through this chapter for lower limb prosthesis.

scholarly journals Feasibility and Validity of a Graded One-Legged Cycle Exercise Test to Determine Peak Aerobic Capacity in Older People With a Lower-Limb Amputation

2012 ◽  
Vol 92 (2) ◽  
pp. 329-338 ◽  
Author(s):  
Daphne Wezenberg ◽  
Arnold de Haan ◽  
Lucas H. van der Woude ◽  
Han Houdijk
Keyword(s):  
Older People ◽  
Aerobic Capacity ◽  
Exercise Test ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Lower Limb Prosthesis ◽  
Valid Assessment ◽  
Peak Aerobic Capacity ◽  
Limb Prosthesis

BackgroundInformation concerning exercise tolerance and aerobic capacity is imperative for generating effective and safe exercise programs. However, for older people with a lower-limb amputation, a standard exercise test is not available.ObjectiveThe primary aim of the present study was to determine whether a graded 1-legged peak exercise test is feasible and provides a valid assessment of peak aerobic capacity in older people walking with a lower-limb prosthesis.DesignThis was a quasi-experimental case-control study.MethodsA total of 36 older people with a lower-limb prosthesis and 21 people who were able-bodied (controls) (overall mean age=61.7 years, SD=6.1) performed a discontinuous graded 1-legged exercise test. The peak respiratory exchange ratio was used as an indicator of maximal effort. The controls performed an additional 2-legged exercise test to provide insight into differences between the testing modes.ResultsAll participants were able to perform the exercise test. Electrocardiographic tracings and blood pressure were adequately monitored. The controls and the people with a lower-limb amputation were able to stress the cardiovascular system to a similar extent. Analyses of construct validity revealed that the peak aerobic capacity measured with the 1-legged exercise test was able to distinguish between participants on the basis of age, body mass index, and sex to a similar extent as the conventional 2-legged exercise test.LimitationsThe results can be generalized only to people who are able to ambulate with their prosthesis.ConclusionsThe graded 1-legged exercise test was feasible and provided a valid assessment of peak aerobic capacity and exercise tolerance in older people walking with a lower-limb prosthesis.

scholarly journals USING PERFORATED LINERS TO COMBAT THE DETRIMENTAL EFFECTS OF EXCESSIVE SWEATING IN LOWER LIMB PROSTHESIS USERS

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Katherine C. Davies ◽  
Mike McGrath ◽  
Alison Stenson ◽  
Zoe Savage ◽  
David Moser ◽  
...  
Keyword(s):  
Lower Limb ◽  
The Body ◽  
Limb Amputation ◽  
Control Group ◽  
Residual Limb ◽  
Excessive Sweating ◽  
Lower Limb Prosthesis ◽  
Skin Conditions ◽  
The Impact ◽  
Limb Prosthesis

BACKGROUND: Excessive sweating of the residual limb has a substantial effect on the daily activities of people with lower limb amputation. Prosthetic liners offer protection and comfort to sensitive areas but often exacerbate perspiration. They act as insulators, trapping sweat on the skin’s surface to the detriment of skin health. Recently, liners with perforations have been developed, allowing the moisture to escape. The goal of this study was to assess the impact of such liners. METHODS: A sample group of 13 patients with unilateral transtibial amputation, who wore a perforated liner (PL) as part of their current prescription, was compared to 20 control patients who wore non-perforated liners (NPL). During their routine appointments, they completed a survey of scientifically validated outcome measures relating to their limb health, pain and the impact on daily life over a 12-month period. RESULTS: Patients using the PL had healthier residual limbs, reporting higher scores on questions relating to limb health, experiencing fewer skin issues (p<0.001) and estimating a 61.8% lower rating in perceived sweat (p=0.004). Perhaps consequentially, there was a lower incidence of residual (p=0.012) and phantom (p=0.001) limb pain when compared to the control group. The prevalence of individual issues affecting the residual limbs of PL users was also lower. Of the issues that remained, only 23% were attributed to sweating in PL users, compared to 49% for the NPL group (p=0.066). PL users missed fewer days of work in the year (2.4 vs 11.6, p=0.267) and were also limited on fewer days (1.4 vs 75.4, p=0.009). CONCLUSION: The use of perforated liners shows much promise within prosthetic care, significantly improving the health of the residual limb. The observed effects on perceived sweat reduction, residual skin health, pain levels and patient limitation suggest that perforated liners are highly beneficial to patients. Layman's Abstract Individuals with amputation often find that they sweat more as they exert more energy when walking and because the total surface area of their body is reduced. Silicone liners are used to cushion the residual limb and as a way of attaching a prosthetic leg, but they act as insulators causing the residual limb to get hot and sweaty. The material isn’t breathable, so the sweat is not able to escape, instead staying on the skin’s surface and causing discomfort or leading to the development of skin conditions. Liners that have small holes in them allow sweat to travel away from the body and preserve skin health. Patients who wore a perforated liner, as well as patients who wore a liner without holes, filled in questionnaires about their experience, the results of which were compared. Generally, patients who wore the perforated liner had healthier skin on their residual limbs and experienced fewer skin conditions than the other patient group. Out of the issues they did experience, fewer were attributed to sweating. The study group experienced less frequent pain both in their physical and phantom limbs. They also considered themselves less limited by their prosthetic device and missed fewer days of work. These observations suggest that perforated liners are highly beneficial to patients within the prosthetic field. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/34610/26579 How To Cite: Davies K.C, McGrath M, Savage Z, Stenson A, Moser D, Zahedi S. Using perforated liners to combat the detrimental effects of excessive sweating in lower limb prosthesis users. Canadian Prosthetics & Orthotics Journal. 2020;Volume 3, Issue 2, No.1. https://doi.org/10.33137/cpoj.v3i2.34610 Corresponding Author: K.C Davies, Blatchford Group, Unit D Antura, Bond Close, Basingstoke, RG24 8PZ, UK.E-mail: [email protected]: https://orcid.org/0000-0003-2933-4365

Group-based telerehabilitation intervention using Wii Fit to improve walking in older adults with lower limb amputation (WiiNWalk): A randomized control trial

2021 ◽  
pp. 026921552110612
Author(s):  
Gordon Tao ◽  
William C. Miller ◽  
Janice J. Eng ◽  
Elham Esfandiari ◽  
Bita Imam ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Performance ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Walk Test ◽  
Balance Confidence ◽  
Wii Fit ◽  
Lower Limb Prosthesis ◽  
Limb Prosthesis

Objective Determine efficacy of the novel WiiNWalk intervention on walking-related outcomes in older adults with lower limb amputation. Design Multi-site, parallel, evaluator-masked randomized controlled trial. Setting Home-setting in three Canadian cities. Participants Community-dwelling lower limb prosthesis users over 50 years of age. Interventions The WiiNWalk group (n = 38) used modified Wii Fit activities for prosthetic rehabilitation. The attention control group (n = 33) used Big Brain Academy: Wii Degree, comprising of cognitive activities. Both groups completed a 4-week supervised phase with three 1-h sessions/week in groups of three overseen by a clinician via videoconferencing and a 4-week unstructured and unsupervised phase. Main Measures Primary outcome was walking capacity (2 min walk test); secondary outcomes were balance confidence (activities-specific balance confidence scale), dynamic balance (four-step square test), and lower limb functioning (short physical performance battery). Outcomes were compared across time points with repeated measures analysis of covariance, adjusting for baseline and age. Results Mean age was 65.0 (8.4) years, with 179.5 (223.5) months post-amputation and 80% transtibial amputation. No group difference in a 2 min walk test with an effect size: 1.53 95% CI [−3.17, 6.23] m. Activities balance confidence was greater in the WiiNWalk group by 5.53 [2.53, 8.52]%. No group difference in the four-step square test −0.16 [−1.25, 0.92] s, nor short physical performance battery 0.48 [−0.65, 1.61]. A post-hoc analysis showed the greatest difference in balance confidence immediately after an unsupervised phase. Conclusions The WiiNWalk intervention improved balance confidence, but not walking-related physical function in older adult lower limb prosthesis users. Future rehabilitation games should be specific to the amputation context. Clinical Trial Registration number, NCT 01942798.

Reduced cortical brain activity with the use of microprocessor-controlled prosthetic knees during walking

2018 ◽  
Vol 43 (3) ◽  
pp. 257-265 ◽  
Author(s):  
Saffran Möller ◽  
David Rusaw ◽  
Kerstin Hagberg ◽  
Nerrolyn Ramstrand
Keyword(s):  
Cognitive Processes ◽  
Lower Limb ◽  
Brain Activity ◽  
Control Group ◽  
Healthy Controls ◽  
Prosthetic Knee ◽  
Level Walking ◽  
Lower Limb Prosthesis ◽  
Prosthetic Knees ◽  
Limb Prosthesis

Background: Individuals using a lower-limb prosthesis indicate that they need to concentrate on every step they take. Despite self-reports of increased cognitive demand, there is limited understanding of the link between cognitive processes and walking when using a lower-limb prosthesis. Objective: The objective was to assess cortical brain activity during level walking in individuals using different prosthetic knee components and compare them to healthy controls. It was hypothesized that the least activity would be observed in the healthy control group, followed by individuals using a microprocessor-controlled prosthetic knee and finally individuals using a non-microprocessor-controlled prosthetic knee. Study design: Cross-sectional study. Methods: An optical brain imaging system was used to measure relative changes in concentration of oxygenated and de-oxygenated haemoglobin in the frontal and motor cortices during level walking. The number of steps and time to walk 10 m was also recorded. The 6-min walk test was assessed as a measure of functional capacity. Results: Individuals with a transfemoral or knee-disarticulation amputation, using non-microprocessor-controlled prosthetic knee ( n = 14) or microprocessor-controlled prosthetic knee ( n = 15) joints and healthy controls ( n = 16) participated in the study. A significant increase was observed in cortical brain activity of individuals walking with a non-microprocessor-controlled prosthetic knee when compared to healthy controls ( p < 0.05) and individuals walking with an microprocessor-controlled prosthetic knee joint ( p < 0.05). Conclusion: Individuals walking with a non-microprocessor-controlled prosthetic knee demonstrated an increase in cortical brain activity compared to healthy individuals. Use of a microprocessor-controlled prosthetic knee was associated with less cortical brain activity than use of a non-microprocessor-controlled prosthetic knee. Clinical relevance Increased understanding of cognitive processes underlying walking when using different types of prosthetic knees can help to optimize selection of prosthetic components and provide an opportunity to enhance functioning with a prosthesis.

scholarly journals The reversible adjustable coupling: A lightweight and low-cost alignment component for the lower limb prosthesis

2017 ◽  
Vol 4 ◽  
pp. 205566831770642
Author(s):  
Kazuhiko Sasaki ◽  
Jutamat Pinitlertsakun ◽  
Pakwan Nualnim ◽  
Gary Guerra ◽  
Yuttapichai Sansook ◽  
...  
Keyword(s):  
Low Income ◽  
Lower Limb ◽  
External Rotation ◽  
Low Cost ◽  
Low Income Countries ◽  
Strength Tests ◽  
Lower Limb Prosthesis ◽  
Repetitive Loading ◽  
Limb Prosthesis ◽  
Anterior Posterior

Background The alignment of the lower limb prosthesis is an integral part of the prosthetic fitting. A properly aligned prosthesis contributes to optimal gait and overall function of the patient. The current offering of alignment componentry is expensive for low-income countries. The purpose of this study was to develop a lightweight and low-cost alignment coupler for the lower limb prosthesis. Methods An alignment coupler called the reversible adjustable coupling was designed and manufactured. Measurements of total anterior/posterior and medial/lateral and rotation in prostheses were recorded and mechanical testing performed. Swiftness and difficulty of use was also recorded. Results The reversible adjustable coupling permitted acceptable ranges of anterior/posterior and medial/lateral translation and 30° of internal and external rotation of prosthetic componentry. Repetitive loading of the coupling at a speed of 1 Hz under 1.28 kN load for 2000 cycles was successful, as were static and strength tests. Discussion The coupler provided acceptable ranges of anterior/posterior and medial/lateral and rotation adjustment and is acceptable for potential use in the alignment of both exoskeletal and endoskeletal prosthesis. The final weight of the component was 166 g and cost of $55.00 USD is affordable for low-income countries for use in clinical and educational settings.

scholarly journals Towards an estimation of 3D efforts in lower limb prosthesis socket using low-cost, gauge-based acquisition system

2020 ◽  
Vol 23 (sup1) ◽  
pp. S7-S9
Author(s):  
A. Altamirano ◽  
D. Jacquot ◽  
D. Mangenot ◽  
C. Villa ◽  
E. Vacherand ◽  
...  
Keyword(s):  
Lower Limb ◽  
Low Cost ◽  
Acquisition System ◽  
Lower Limb Prosthesis ◽  
Limb Prosthesis

Patient’s satisfaction with a lower limb prosthesis: a longitudinal study

2021 ◽  
Vol 28 (3) ◽  
pp. 276-283
Author(s):  
Isaias Pimentel dos Santos ◽  
Alana das Mercês Silva ◽  
Graziella Santos Furtado ◽  
Rosarly Maria Marques de Menezes ◽  
Kionna Oliveira Bernardes dos Santos ◽  
...  
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Lower Limb ◽  
Limb Amputation ◽  
Patient’S Satisfaction ◽  
Lower Limb Prosthesis ◽  
Level Of Significance ◽  
Ambulatory Rehabilitation ◽  
Limb Prosthesis ◽  
Over Time

ABSTRACT This is a descriptive longitudinal study that aimed to verify prosthesis satisfaction of older adults with lower-limb amputation (LLA). In total, This study was composed of 34 older adults with LLA participated of this study. Participant’s satisfaction about the lower-limb prosthesis (LLP), the discomforts, and the embarrassment when use it were evaluated through an interview composed of five questions. The occurrence of falls and the independence in prosthesis management were also evaluated. All variables were collected at the last week of ambulatory rehabilitation discharge and after one and three months. A descriptive and inferential statistical analysis was performed. The level of significance was set at 5% (p <0.05). In total, 80% of participants with transtibial amputation and 78.6% of participants with transfemoral amputation were satisfied with the LLP after three months. Tight prosthesis, walking pain, the embarrassment of using LLP, and the occurrence of falls decreased over time. The independence in prosthesis handling did not change significantly after three months. Participants that used manual locking knee (p=0.040) and/or Solid-Ankle Cushion Heel foot (p=0.017) were more satisfied with LLP. The occurrence of falls reduced (p=0.039) after transfemoral participants started to use the prosthesis. Participant’s satisfaction with the LLP was high and did not change significantly over time.

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