Functional outcome after prosthetic rehabilitation of children with acquired and congenital lower limb loss

Background: Body composition is important for health screening, but appropriate methods for unilateral lower extremity amputees have not been validated. Objectives: To compare body mass index adjusted using Amputee Coalition equations (body mass index–Amputee Coalition) to dual-energy X-ray absorptiometry in unilateral lower limb amputees. Study design: Cross-sectional, experimental. Methods: Thirty-eight men and women with lower limb amputations (transfemoral, transtibial, hip disarticulation, Symes) participated. Body mass index (mass/height2) was compared to body mass index corrected for limb loss (body mass index–Amputee Coalition). Accuracy of classification and extrapolation of percent body fat with body mass index was compared to dual-energy X-ray absorptiometry. Results: Body mass index–Amputee Coalition increased body mass index (by ~ 1.1 kg/m2) but underestimated and mis-classified 60% of obese and overestimated 100% of lean individuals according to dual-energy X-ray absorptiometry. Estimated mean percent body fat (95% confidence interval) from body mass index–Amputee Coalition (28.3% (24.9%, 31.7%)) was similar to dual-energy X-ray absorptiometry percent body fat (29.5% (25.2%, 33.7%)) but both were significantly higher ( p < 0.05) than percent body fat estimated from uncorrected body mass index (23.6% (20.4%, 26.8%)). However, total errors for body mass index and body mass index–Amputee Coalition converted to percent body fat were unacceptably large (standard error of the estimate = 6.8%, 6.2% body fat) and the discrepancy between both methods and dual-energy X-ray absorptiometry was inversely related ( r = −0.59 and r = −0.66, p < 0.05) to the individual’s level of body fatness. Conclusions: Body mass index (despite correction) underestimates health risk for obese patients and overestimates lean, muscular individuals with lower limb amputation. Clinical relevance Clinical recommendations for an ideal body mass based on body mass index–Amputee Coalition should not be relied upon in lower extremity amputees. This is of particular concern for obese lower extremity amputees whose health risk might be significantly underestimated based on body mass index despite a “correction” formula for limb loss.

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Influence of Health Beliefs on Self-Management in Persons with Lower Limb Loss

10.26226/morressier.614ca2d987a68d83cb5d5d39 ◽

2021 ◽

Author(s):

Daniel Lee

Keyword(s):

Health Beliefs ◽

Lower Limb ◽

Limb Loss ◽

Self Management

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Toward improving residual limb climate within prostheses for persons with lower limb loss

Prosthetics and Orthotics International ◽

10.1097/pxr.0000000000000085 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Ashley D Knight ◽

Brad D Hendershot ◽

Todd J Sleeman ◽

Christopher L Dearth ◽

Felix Starker ◽

...

Keyword(s):

Lower Limb ◽

Limb Loss ◽

Residual Limb

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Effects of the acetabular fracture index and other factors of posterior wall acetabular fracture on functional outcome

Journal of International Medical Research ◽

10.1177/0300060517709816 ◽

2017 ◽

Vol 45 (4) ◽

pp. 1394-1405 ◽

Cited By ~ 2

Author(s):

Hai-Tao Long ◽

Zhen-Han Deng ◽

Min Zou ◽

Zhang-Yuan Lin ◽

Jian-Xi Zhu ◽

...

Keyword(s):

Physical Therapy ◽

Femoral Head ◽

Functional Outcome ◽

Avascular Necrosis ◽

Lower Limb ◽

Acetabular Fracture ◽

Posterior Wall ◽

Functional Score ◽

Related Data ◽

Limb Fracture

Objective To analyze the effects of the acetabular fracture index (AFI) and other factors on the functional outcome of patients with acetabular fractures involving the posterior wall. Methods Forty-eight patients who underwent surgery in our department were reviewed. According to the AFI, which indicates the percentage of remaining intact posterior acetabular arc, the patients were divided into Group A (AFI ≤ 25%, 11 patients), Group B (25% < AFI ≤ 50%, 23 patients), Group C (50% < AFI ≤ 75%, 7 patients), and Group D (75% < AFI ≤ 100%, 7 patients). The AFI was measured with a computed tomography picture archiving and communication system or calculated with the cosine theorem. A nonparametric test and ordinal regression were used to determine the role of the AFI and other factors on the functional outcome. Perioperative information, including demographic and fracture-related data, reduction quality, physical therapy duration, association with a lower limb fracture and avascular necrosis of the femoral head were prospectively gathered. Results The mean AFIs of A, B, C, and D groups were 14.3%, 35.9%, 59.5%, and 81.2%, respectively. No statistically significant differences were observed among the groups for demographic and fracture-related data. A better reduction quality (OR = 4.21, 95%CI 1.42 ∼ 12.43, χ2 = 6.781, P = 0.009) and a larger value of AFI (OR = 2.56, 95%CI 1.18 ∼ 5.55, χ2 = 5.648, P = 0.017) result in a higher functional score. The functional outcome of a physical therapy duration of more than 12 months (OR = 0.15, 95%CI 0.02 ∼ 0.90, χ2 = 4.324, P = 0.038) was better than that of less than 12 months. Lower limb fracture (OR = 0.13, 95%CI 0.02 ∼ 0.74, χ2 = 5.235, P = 0.022) and avascular necrosis of femoral head (OR = 0.02, 95%CI 0.00 ∼ 0.87, χ2 = 4.127, P = 0.042) were found to correlate with a lower functional score. Conclusion With a greater of AFI, the functional outcome score would be better. Other factors, including reduction quality, physical therapy duration, association with a lower limb fracture, and avascular necrosis of the femoral head, most likely also affect hip functional recovery.

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A qualitative study of the challenges of providing pre-prosthetic rehabilitation in rural South Africa

Prosthetics and Orthotics International ◽

10.1177/0309364617698520 ◽

2017 ◽

Vol 42 (2) ◽

pp. 179-186 ◽

Cited By ~ 5

Author(s):

Liezel Ennion ◽

Anton Johannesson

Keyword(s):

South Africa ◽

Lower Limb ◽

Rural Setting ◽

Limb Amputation ◽

Prosthetic Rehabilitation ◽

Rural South ◽

Physical Strength ◽

District Hospitals ◽

Fitting In ◽

Rural South Africa

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 Self-Management Assessment for the Residuum and prosThesis (S.M.A.R.T.): A Novel Knowledge Assessment for Persons with Lower Limb Loss

10.26226/morressier.614ca2d987a68d83cb5d5dd0 ◽

2021 ◽

Author(s):

Daniel Lee

Keyword(s):

Lower Limb ◽

The Self ◽

Limb Loss ◽

Knowledge Assessment ◽

Self Management

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Differences in Measures of Strength and Dynamic Balance Among Individuals With Lower-Limb Loss Classified as Functional Level K3 Versus K4

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/phm.0000000000001183 ◽

2019 ◽

Vol 98 (9) ◽

pp. 745-750 ◽

Cited By ~ 1

Author(s):

Emma Haldane Beisheim ◽

John Robert Horne ◽

Ryan Todd Pohlig ◽

Jaclyn Megan Sions

Keyword(s):

Lower Limb ◽

Dynamic Balance ◽

Limb Loss ◽

Functional Level

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Successful prosthetic rehabilitation and gait analysis of individual with bilateral transtibial amputation: A case study with comparison to able-bodied gait

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491719893071 ◽

2020 ◽

Vol 27 (1) ◽

pp. 93-100

Author(s):

Rajesh Kumar Mohanty ◽

Jay Prakash Kumar ◽

Somanath Rout ◽

Sakti Prasad Das

Keyword(s):

Muscle Power ◽

Real Life ◽

Limb Loss ◽

Prosthetic Rehabilitation ◽

Phase Duration ◽

Transtibial Amputation ◽

Rehabilitation Team ◽

Gait Characteristics ◽

Ankle Muscle ◽

The Individual

Background: Intensive rehabilitation of individuals with bilateral lower limb loss poses a great challenge to both rehabilitation team and amputees themselves due to unavailability of a sound leg to provide stability in standing and gait. Although gait characteristics of individuals with unilateral transtibial amputations are well documented in the literature, very less is known about those with bilateral limb loss. Aim: To examine the gait characteristics of an individual with bilateral transtibial amputation (BTA) and its comparison with an able-bodied (AB). This study also provides a real-life presentation of successful prosthetic rehabilitation. Case content and methodology: Temporal–spatial, kinematic and kinetic gait parameters were analysed for a 45-year-old male individual with traumatic BTA using prosthesis in a motion analysis laboratory setting with force platform (BTS P-6000) and cameras with reflective markers (BTS SMART-DX6000). Findings and conclusion: Variances in many temporal–spatial, kinematic and kinetic parameters were observed. The findings of temporal–spatial parameters revealed that the individual with BTA walked with slower speed, lower cadence, shorter step lengths and wider step width compared to that of AB. Ankle dorsiflexion, stance knee flexion and swing hip hiking were reduced in an individual with BTA compared to AB. In kinetics, he demonstrated low peak ankle muscle power, increased muscle power amplitudes and phase duration at the hip and knee joints compared to AB individual. The combination of an intensive prosthetic rehabilitation led to completely independent and remarkable degree of functional ambulation.

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