scholarly journals Muscle Atrophy and Artery Shrinkage of Residual Limb After Trans-Femoral Amputation: A Morphological Study

2021 ◽  
Author(s):  
RUI-QI DONG ◽  
TAO-PING BAI ◽  
YANG LIU
Keyword(s):  
Muscle Atrophy ◽  
Physiological State ◽  
Gait Pattern ◽  
Vascular Lesions ◽  
Limb Amputation ◽  
Residual Limb ◽  
Supply Relationship ◽  
Morphological Index ◽  
Postoperative Problems

Abstract Aim: After limb amputation, patients will face many complex postoperative problems. The pathogeny of these problems usually involves blood circulation disorders, vascular lesions and other angioneurotic issues. The correlation between blood flow/vessels and those residual limb problems like the most prevalent muscle atrophy is very importent. Method: Through the case study of eight unilateral trans-femoral amputees, this research performed the morphological index analysis of residual limb muscle atrophy, arterial shrinkage and their potential correlations. Results: The atrophy level of muscles and the shrinkage level of arteries were different. Overall, Different muscles have different atrophy. Compared with the prosthesis users, those cases without using prosthesis exhibited more severe muscle atrophy and arterial shrinkage in their residual limbs. For the correlation between muscle atrophy and arterial shrinkage on the basis of blood supply relationship, there was a positive correlation expressed only in the cases using prosthesis. Conclusion: Using a prosthesis could not only effectively achieve the functional compensation for residual limb, but also promote a joint adaptation of the muscular and arterial physiological state of both the sound and amputated limbs to the new gait pattern and body balance, as well as rehabilitation process.

A Case Study Demonstrating the Utility of Surveillance Video in Assessing Gait Dynamics and Behavior During a Slip and Fall

2020 ◽  
Vol 64 (1) ◽  
pp. 550-554
Author(s):  
Leah S. Hartman ◽  
Stephanie A. Whetsel Borzendowski ◽  
Alan O. Campbell
Keyword(s):  
Human Factors ◽  
Gait Pattern ◽  
Personal Injury ◽  
Objective Data ◽  
Surveillance Video ◽  
Gait Dynamics ◽  
Fall Incident ◽  
The Individual ◽  
And Behavior

As the use of surveillance video at commercial properties becomes more prevalent, it is more likely an incident involving a personal injury will be captured on film. This provides a unique opportunity for Human Factors practitioners involved in forensic investigations to analyze the behavior of the individual prior to, during, and after the event in question. It also provides an opportunity to gather unique and objective data. The present work describes a case study of a slip and fall where surveillance video and onsite measurements were combined and analyzed to quantify a plaintiff’s gait pattern. Using this type of analysis, we were able to determine that the plaintiff was likely aware that the floor was slippery and adjusted her gait and behavior prior to the slip and fall incident.

Clinical overlap of functional neurologic symptom disorder and complex regional pain syndrome in pediatrics: A case report

2021 ◽  
pp. 1-8
Author(s):  
Heidi Kempert
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Gait Pattern ◽  
Rehabilitation Program ◽  
Neurologic Symptom ◽  
Physical Mobility ◽  
Unsteady Gait ◽  
Full Day

This case study documents a 13-year-old female who presented to our intensive inpatient chronic pain rehabilitation program with complex regional pain syndrome (CRPS) of her left leg, which was significantly interfering with her normal daily functioning. She participated in a full day of traditional interdisciplinary therapies, including physical and occupational therapy for 3 hours daily. As assistive equipment was altered or weaned her physical mobility, balance, and tremors worsened and/or increased. As she began advancing her legs more independently (versus requiring physical assist), she demonstrated more variable functional strength and stability, inconsistent balance reactions, and a more unsteady gait pattern. The team was treating her according to her incoming CRPS diagnosis; however, as treatment progressed, her physical and psychological presentation seemed more aligned with diagnostic criteria of functional neurologic symptom disorder (FND). Staff then treated according to the FND diagnosis resulting in successful long-term outcomes. The clinical impact from this case study includes highlighting the commonalities between CPRS and FND clinically, discussing differentiating treatment suggestions depending on the diagnosis, and emphasizing key components of family/patient education.

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

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.

Metabolic Power and Efficiency for an Amputee Cyclist: Implications for Cycling Technique

2020 ◽  
Author(s):  
Steven J. Elmer ◽  
James C. Martin
Keyword(s):  
Scientific Evidence ◽  
Mechanical Power ◽  
Limb Amputation ◽  
Sufficient Time ◽  
Metabolic Power ◽  
Gross Efficiency ◽  
Leg Cycling ◽  
Leg Flexion ◽  
Delta Efficiency

Cycling technique is steeped in cultural lore. One deeply held belief is that "pulling-up" to lift the leg (increased muscular leg flexion) will optimize technique and improve efficiency. In contrast, scientific evidence suggests that when cyclists are instructed to pull-up efficiency decreases. However, such interventions may not have allowed sufficient time for cyclists to adapt and refine their technique. This case study documented how a cyclist with a complete unilateral limb amputation consumed metabolic power to produce mechanical power during single-leg cycling. The cyclist was a 4-time U.S. National Paralympic Champion who performed single-leg cycling for 7yrs and thus was fully adapted to pull-up. We hypothesized that a counterweight system, which reduced the requirement to pull-up, would decrease metabolic power and increase efficiency for this cyclist. The cyclist performed submaximal cycling (100, 135, 170, 205W, 80rpm, 5min) with and without a counterweight (10kg) on the unused crank. Expired gasses were measured, and metabolic power and gross efficiency were calculated. Metabolic power decreased on average by 87±7W (p<0.001) and gross efficiency increased from 16.3±1.9 to 18.0±1.8% (p<0.001) when cycling with the counterweight. During counterweighted single-leg cycling, the metabolic power of unloaded cycling decreased (317 vs. 238W) and delta efficiency was similar (25.2 vs. 25.5%). Results demonstrated that significant metabolic power was associated with pulling-up to produce muscular leg flexion power even in a cyclist who pulled-up substantially during cycling. Our findings confirm observations from previous studies that altered pedaling technique acutely and indicate that pulling-up during cycling is less efficient.

scholarly journals Effects of elevated vacuum on in-socket residual limb fluid volume: Case study results using bioimpedance analysis

2011 ◽  
Vol 48 (10) ◽  
pp. 1231 ◽  
Author(s):  
Joan E. Sanders ◽  
Daniel S. Harrison ◽  
Timothy R. Myers ◽  
Katheryn J. Allyn
Keyword(s):  
Fluid Volume ◽  
Residual Limb ◽  
Bioimpedance Analysis ◽  
Study Results

scholarly journals Osteoporosis: A factor on residual limb pain in traumatic trans-tibial amputations

2008 ◽  
Vol 32 (2) ◽  
pp. 172-178 ◽  
Author(s):  
Kamil Yazicioglu ◽  
Ilknur Tugcu ◽  
Bilge Yilmaz ◽  
Ahmet Salim Goktepe ◽  
Haydar Mohur
Keyword(s):  
Bone Loss ◽  
Lower Limb ◽  
Gait Pattern ◽  
Residual Limb ◽  
Disuse Atrophy ◽  
Mineral Density ◽  
Limb Pain ◽  
Local Bone ◽  
Painful Sensation ◽  
Residual Limb Pain

Residual limb pain is defined as a painful sensation or feeling from the remaining part of the leg. Aggressive bone edge, bone spur formation, neuroma, abscess or bursitis are common causes of residual limb pain. On the other hand, regional osteoporosis on femur and tibia is an inevitable consequence in patients with lower limb amputations. The etiology of bone loss is uncertain but it is likely to be a local phenomenon in lower limb amputees. Altered gait pattern, decreased weight load, disuse atrophy and lack of muscular action at the limb seem to be important causal factors in the development of both local and generalized osteoporosis. The aims of this study are: (i) To determine if there is significant bone mineral density (BMD) difference at proximal tibias and femurs between intact and amputated limbs, (ii) to investigate the factors affecting bone loss in these areas and (iii) to investigate the possible relationship between residual limb pain and local bone loss. The 36 men who participated in this study had amputations due to land-mine injuries. Dual energy X-ray absorptiometry was used to determine BMD of the proximal femur and proximal tibia. The non-amputated limb was used as a control for the amputated side. BMD values on the amputated side were significantly lower than non-amputated side. In addition, BMD values on the amputated limbs with residual limb pain were significantly less than in those without residual limb pain. Insufficient mechanical loading leads to bone loss in patients with trans-tibial amputations. Furthermore, bone loss at tibia may be a cause of residual limb pain. However, this needs to be confirmed with more specific studies in the future.

scholarly journals Design & Development of a Trans Tibial Socket Stabilized by Alternating Areas of Tissue Compression and Release - A Case Study

2021 ◽  
Vol 11 (7) ◽  
pp. 317-321
Author(s):  
Prachi Prava Pattnaik ◽  
Jonathan T
Keyword(s):  
Single Case ◽  
Weight Bearing ◽  
Gait Pattern ◽  
Extensive Study ◽  
Adaptation Period ◽  
Design Development ◽  
Transtibial Amputation ◽  
Prosthetic Socket ◽  
Tissue Compression

The socket is the most important aspect of the artificial limb, constituting the critical interface between the amputee’s stump and prosthesis. The design and fitting of the socket is also the most difficult procedure due to the uniqueness of each amputee’s stump. An uncomfortable socket fit is the most common complaint from lower limb amputees with surveys revealing that amputees believe comfort are the most important aspects of the prosthesis and over half of all wearers are in moderate to severe pain for most of the time whilst wearing the prosthesis. Kristinsson argued that a transtibial socket can be designed to transfer loads primarily to limited areas of the limb such as the patella tendon and the medial flare, which in most cases found both ineffective and uncomfortable. There were inconsistencies in producing satisfactory PTB sockets because of inadequate training of prosthetist in the PTB technique. However, the TSB silicon liner socket has problems such as causing excessive perspiration, heating and odor etc. Therefore, a new socket is designed following the principle of alternative pressure and release to overcome the disadvantages and to check the socket with regard to stability, comfort and satisfaction. Method: A single case study of a person 37-year-old, with transtibial amputation population took part in this study and was selected according to the inclusion criteria. The participant was provided patient information sheet and after taking the informed consent, the assessment and fabrication of the new socket were being proceeded, taking the cast on the first day. On the third day the newly designed socket along with prosthesis was provided with an adaptation period of 7 days. After 7 days the patient was called to check the stability with standing, comfort and satisfaction with a prosthetic socket comfort score. Results and Discussion: The present socket is well suitable for transtibial patient in weight bearing position. It fits well to the contour of the adult patient. The socket was adjusted manually during rectification phase providing respective pressure in areas required. Conclusion: The developed socket had a great effect on gait pattern of transtibial amputee. This socket provides adjustment for pressure, anterior, posterior, medial and lateral of the stump. It also creates surface for the placement of bony prominences. As it is a complex casting procedure, proper care should be taken to fabricate the casting of socket with minimal error. Further, innovative inventions will be required to refine more products and extensive study has to be carried out on the existing mode. Key words: transtibial amputation, transtibial socket, tissue compression and release.

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

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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