Action and Non-Action Oriented Body Representations: Insight from Behavioural and Grey Matter Modifications in Individuals with Lower Limb Amputation

Objective. Following current model of body representations, we aimed to systematically investigate the association between brain modifications, in terms of grey matter loss, and body representation deficits, in terms of alterations of the body schema (BS) and of non-action oriented body representations (NA), in individuals with lower limb amputation (LLA). Method. BS and NA (both semantic and visuospatial NA) were evaluated in 11 healthy controls and in 14 LLA, considering the impact of clinical variables such as prosthesis use. The association between BS and NA deficits and grey matter loss was also explored in LLA by using Voxel Based Morphometry analysis. Results. LLA's performance was fine in terms of semantic NA, while it showed behavioural impairments both in BS and visuospatial NA as compared to healthy controls. Interestingly the visuospatial NA performance was related to the amount of prosthesis use. NA deficits in terms of visuospatial body map processing were associated with grey matter reduction in left (lobule VIII) and right (crus II) cerebellum, while BS deficits were associated with grey matter reduction in right anterior cingulate cortex and the bilateral cuneus. No significant association was detected for semantic NA. Conclusion. The study of BS and NA representations after limb loss has informed our understanding of the different dynamics (i.e., adjustments to body change) of such representations, supporting current cognitive models of body representation. The clinical relevance of present findings is also discussed.

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Obesity and Skin Problems in Persons With a Lower Limb Amputation: An Observational Study

10.21203/rs.3.rs-332506/v1 ◽

2021 ◽

Author(s):

Terezka S. Mollee ◽

Pieter U. Dijkstra ◽

Rienk Dekker ◽

Jan H.B. Geertzen

Keyword(s):

Body Mass Index ◽

Body Weight ◽

Confidence Interval ◽

Body Mass ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Residual Limb ◽

Prevalence Of Obesity ◽

The Impact

Abstract Background: A lower limb amputation can lead to weight gain and obesity. However, data regarding the prevalence of obesity in the Dutch population with a lower limb amputation are lacking. Furthermore, the impact of obesity on skin problems of the residual limb and the need of prosthetic repairs is unknown. The aim of this study was to determine the prevalence of obesity in Dutch persons with a lower limb amputation and to investigate the relationship between body weight, body mass index and skin problems of the residual limb and the frequency of prosthetic repairs. Methods: A survey was performed among adults with a unilateral lower limb amputation due to any cause, and who are user of a prosthesis. The survey consisted of measurement of the subjects’ body height and weight, a questionnaire which assessed self-reported skin problems in the previous month and factors potentially associated with these skin problems, and assessment of the frequency of visits to the orthopedic workshop. Results: In total, 413 persons were enrolled. Of them, 39% (95% confidence interval 35%−44%) was overweight and 28% (95% confidence interval 24%−33%) was obese. A total of 77% (95% confidence interval 73%−81%) reported one or more skin problems in the past month. Body weight and body mass index were neither associated with the presence of skin problems in general nor with the number of prosthetic repairs. Persons with severe skin problems had a slightly lower body mass index (26.6 kg/m2 vs. 28.0 kg/m2, p = 0.012). Persons with skin problems were younger than those without (difference in means 6.0 years (95% confidence interval 3.0−8.9)). Conclusion: Our findings show that obesity is common in the ambulant population with a lower limb amputation, with a prevalence being higher than in the general Dutch adult population. However, its negative impact on the presence of skin problems and the frequency of prosthetic repairs may be limited.

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Factors associated with mobility apprehension in persons with lower limb amputation

Prosthetics and Orthotics International ◽

10.1177/0309364620915017 ◽

2020 ◽

Vol 44 (4) ◽

pp. 208-214

Author(s):

Shannon L Mathis

Keyword(s):

Standard Deviation ◽

Lower Limb ◽

Avoidance Behavior ◽

Pain Catastrophizing ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Walking Ability ◽

Factors Associated ◽

The Mean ◽

The Impact

Background: Factors that are related to mobility apprehension were measured in a sample of persons with lower-limb amputation. Objectives: The purpose was to determine whether intensity, interference, or catastrophizing are associated with mobility apprehension. Study design: Cross-sectional study. Methods: Persons with amputation of a lower limb who were attending a national limb loss conference were recruited to complete a survey. Subjects were administered the Tampa Scale for Kinesiophobia to measure mobility apprehension. The Brief Pain Inventory was administered to quantify the affect of pain on general activity, walking ability, and enjoyment of life. The Pain Catastrophizing Scale was administered to assess the tendency to ruminate and magnify pain sensations. A multivariable linear regression was performed to determine factors associated with mobility apprehension. Results: Fifty-three people with lower-limb amputation participated in the study. The mean (standard deviation) score for mobility apprehension was 34.2 (6.0). Mean (standard deviation) pain intensity and interference scores were 1.6 (1.7) and 2.5 (2.6), respectively. The mean (standard deviation) pain catastrophizing score was 9.1 (10). Pain catastrophizing was the only variable associated with higher mobility apprehension ( β = 0.31, p < 0.001, R2 = 0.32). Results suggest that for every one-point increase in the pain catastrophizing score, mobility apprehension will increase by 0.3 of a point. Conclusion: These preliminary results suggest that pain catastrophizing was related to mobility apprehension in this cohort of persons with lower-limb amputation. This relationship indicates that the exploration of avoidance behaviors, such as pain catastrophizing, may be useful when developing a program for physical rehabilitation. Clinical relevance Pain catastrophizing, an avoidance behavior, may be associated with higher levels of mobility apprehension in persons with major lower-limb amputation. Understanding the impact of fear-avoidance behavior will allow clinicians to identify individuals at risk for poor outcomes following amputation surgery and to develop psychological strategies to complement treatment.

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Beyond the body image: a qualitative study on how adults experience lower limb amputation

Clinical Rehabilitation ◽

10.1177/0269215511410731 ◽

2011 ◽

Vol 26 (2) ◽

pp. 180-191 ◽

Cited By ~ 49

Author(s):

Hugo Senra ◽

Rui Aragão Oliveira ◽

Isabel Leal ◽

Cristina Vieira

Keyword(s):

Body Image ◽

Qualitative Study ◽

Lower Limb ◽

The Body ◽

Lower Limb Amputation ◽

Limb Amputation

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The Impact of Comorbidities on Rehabilitation and Functional Outcomes Following Lower Limb Amputation

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2017.08.380 ◽

2017 ◽

Vol 98 (10) ◽

pp. e118

Author(s):

Michael Juszczak ◽

Leif Nelson ◽

Jason Maikos ◽

Jeffrey Cohen ◽

Jeffrey Heckman ◽

...

Keyword(s):

Lower Limb ◽

Functional Outcomes ◽

Lower Limb Amputation ◽

Limb Amputation ◽

The Impact

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The association between body mass index and skin problems in persons with a lower limb amputation: an observational study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04646-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Terezka S. Mollee ◽

Pieter U. Dijkstra ◽

Rienk Dekker ◽

Jan H.B. Geertzen

Keyword(s):

Body Mass Index ◽

Body Weight ◽

Confidence Interval ◽

Body Mass ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Residual Limb ◽

Prevalence Of Obesity ◽

The Impact

Abstract Background Obesity is common in persons with a lower limb amputation, an amputation can also lead to further weight gain. Data regarding the prevalence of obesity in the Dutch population with a lower limb amputation are lacking. Furthermore, the impact of obesity on skin problems of the residual limb and the need of prosthetic repairs is unknown. The aim of this study was to determine the prevalence of obesity in Dutch persons with a lower limb amputation and to investigate the relationship between body weight, body mass index and skin problems of the residual limb and the frequency of prosthetic repairs. Methods A survey was performed among adults with a unilateral lower limb amputation due to any cause, and who are user of a prosthesis. The survey consisted of measurement of the subjects’ body height and weight, a questionnaire which assessed self-reported skin problems in the previous month and factors potentially associated with these skin problems, and assessment of the frequency of visits to the orthopedic workshop. Results In total, 413 persons were enrolled. Of them, 39% (95 % confidence interval 35;44) were overweight and 28% (95% confidence interval 24;33) were obese. A total of 77% (95% confidence interval 73;81) reported one or more skin problems in the past month. Body weight and body mass index were neither associated with the presence of skin problems in general nor with the number of prosthetic repairs. Persons with severe skin problems had a slightly lower body mass index (26.6 kg/m2 vs. 28.0 kg/m2, p = 0.012). Persons with skin problems were younger than those without (difference in means 6.0 years (95% confidence interval 3.0;8.9)). Conclusions Our findings show that obesity is common in the Dutch ambulant population with a lower limb amputation, with a prevalence being higher than in the general Dutch adult population. However, its negative impact on the presence of skin problems and the frequency of prosthetic repairs may be limited.

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Disability, economic and work-role status of individuals and their families in Bangladesh, post-unilateral lower-limb amputation (LLA) and pre-rehabilitation: a cross-sectional study

10.21203/rs.3.rs-489964/v1 ◽

2021 ◽

Author(s):

Md Shapin Ibne Sayeed ◽

Jodi Oakman ◽

Michael P. Dillon ◽

Rwth Stuckey

Keyword(s):

Lower Limb ◽

Rural Areas ◽

Cross Sectional Study ◽

Lower Limb Amputation ◽

World Health ◽

Limb Amputation ◽

Mobility Impairment ◽

Cross Sectional ◽

Gendered Roles ◽

The Impact

Abstract Background To quantify disability, occupation and socioeconomic status of individuals and their families in Bangladesh, post-unilateral lower-limb amputation (LLA) and pre-rehabilitation. Methods Between November 2017 and February 2018, people with unilateral LLA attending two XXX prosthetic rehabilitation centres were surveyed prior to rehabilitation, using the World Health Organization Disability Assessment Schedule (WHODAS-2.0) with additional socio-economic questions. Data was analysed descriptively, and cross-tabulation conducted with Chi-square test and Fisher’s exact tests. Results Seventy-six individuals participated. The majority had transtibial amputation (61.8%) from trauma (64.5%), were young adults (37.92 ± 12.35 years), in paid work prior to LLA (80%), married (63.2%), male (81.6%), from rural areas (78.9%), with primary/no education (72.4%). After LLA, mobility (WHODAS score 74.61 ± 13.19) was the most negatively affected domain. Most (60.5%) participants did not return to a paid or unpaid occupation. Acute healthcare costs negatively impacted most families (89.5%), and over 80% became impoverished. Nearly 70% of previous income-earners became economically dependent resulting in changes to traditional family roles. Conclusions Following LLA, most participants experienced significant mobility impairment, were unable to return to paid occupation and became economically dependent. The study population presents with many different characteristics from other people with LLA globally, which suggest with timely rehabilitation a return to paid employment is possible. The impact of LLA extends beyond the individual, including to families, many of whom face challenges with changes to traditional primary earner gendered roles. Improved access to timely and affordable rehabilitation is required to reduce the significant personal and societal costs of disability after LLA.

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The Impact of Previous Surgery and Revisions on Outcome after Major Lower Limb Amputation

Annals of Vascular Surgery ◽

10.1016/j.avsg.2013.10.017 ◽

2014 ◽

Vol 28 (5) ◽

pp. 1166-1171 ◽

Cited By ~ 4

Author(s):

Rachel Barnes ◽

Panos Souroullas ◽

Risha A. Lane ◽

Ian Chetter

Keyword(s):

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Previous Surgery ◽

The Impact

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Analysis of selected factors determining quality of life in patients after lower limb amputation- a review article

Polish Journal of Surgery ◽

10.5604/01.3001.0009.8980 ◽

2017 ◽

Vol 89 (2) ◽

pp. 57-61 ◽

Cited By ~ 3

Author(s):

Anna Grzebień ◽

Mariusz Chabowski ◽

Maciej Malinowski ◽

Izabella Uchmanowicz ◽

Magdalena Milan ◽

...

Keyword(s):

Quality Of Life ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Occupational Activity ◽

Social Aspect ◽

Phantom Pain ◽

Comprehensive Health ◽

The Impact

The amputation of the lower limb is a crippling procedure, which impairs both physical and mental aspect of the patient’s life and therefore, it is important to provide these patients with comprehensive health care. Patients and their families must change their lives and reorganize them, which is undoubtedly associated with a decrease in the quality of life. The aim of this study was to analyze various determinants of quality of life in patients after lower limb amputation and their impact on the physical, mental and social aspect of life. Based on the available literature, this paper discusses certain factors determining quality of life, including the presence of phantom pain and stump pain, the way patients move, independence in daily activity, occupational activity, and access to rehabilitation. Analysis of the impact of particular factors on quality of life in people after lower limb amputation may contribute to the improvement and introduction of new paradigms regarding care provided for amputees.

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