Contralateral Acupuncture for the Treatment of Phantom Limb Pain and Phantom Limb Sensation in Oncologic Lower Limb Amputee: A Case Report

Phantom limb pain (PLP) and phantom limb sensation (PLS) are common and distressing sequelae of amputation. Current pain management following amputation is challenging and unsatisfying. In this case study, a 74-year-old woman underwent above-knee amputation because of the rhabdomyosarcoma in the right leg. Despite several analgesics, pain was poorly controlled. The phantom limb pain and sensation were immediately reduced by the contralateral acupuncture, and abolished after the third session with no side-effects, no relapse during the next 9 months. Contralateral acupuncture showed positive effect on PLP and PLS in this case, but more robust evidence would be needed to support the efficacy of this treatment technique for indication.

How Can Biomechanics Improve Physical Preparation and Performance in Paralympic Athletes? A Narrative Review

Recent research in Paralympic biomechanics has offered opportunities for coaches, athletes, and sports practitioners to optimize training and performance, and recent systematic reviews have served to summarize the state of the evidence connecting biomechanics to Paralympic performance. This narrative review serves to provide a comprehensive and critical evaluation of the evidence related to biomechanics and Paralympic performance published since 2016. The main themes within this review focus on sport-specific body posture: the standing, sitting, and horizontal positions of current summer Paralympic sports. For standing sports, sprint and jump mechanics were assessed in athletes with cerebral palsy and in lower-limb amputee athletes using running-specific prostheses. Our findings suggest that running and jumping-specific prostheses should be ‘tuned’ to each athlete depending on specific event demands to optimize performance. Standing sports were also inclusive to athletes with visual impairments. Sitting sports comprise of athletes performing on a bike, in a wheelchair (WC), or in a boat. WC configuration is deemed an important consideration for injury prevention, mobility, and performance. Other sitting sports like hand-cycling, rowing, and canoeing/kayaking should focus on specific sitting positions (e.g., arm-crank position, grip, or seat configuration) and ways to reduce aero/hydrodynamic drag. Para-swimming practitioners should consider athlete-specific impairments, including asymmetrical anthropometrics, on the swim-start and free-swim velocities, with special considerations for drag factors. Taken together, we provide practitioners working in Paralympic sport with specific considerations on disability and event-specific training modalities and equipment configurations to optimize performance from a biomechanical perspective.

Prosthetic Satisfaction and Body Image among Lower Limb Amputee: A Cross-sectional Study

Introduction: Limb amputation not only brings functional and sensory loss, but also leads to loss or change of body image. These changes have significant effect on the Quality of Life (QoL) of an individual. Amputee adaptation varies widely between individuals. For an amputee a prosthesis not only bring back near normal physical appearance but also it significantly repair his disturbed body image. There is a significant correlation between body image and life satisfaction. Aim: To investigate the correlation between body image and prosthetic satisfaction among lower limb amputee. Materials and Methods: This cross-sectional study was conducted from July 2018 to January 2020 at King George’s Medical University, Lucknow, Uttar Pradesh, India. Participants with unilateral lower limb prosthesis using amputees of either sex from Regional Artificial Limb Centre, Lucknow were included in the study. Each participant was subjected offline questionnaire based assessment of satisfaction with respect to their prosthesis related to it`s function, aesthetic (cosmesis), weight of prosthesis and general (overall) by Revised Trinity Amputation and Prosthesis Experience Scale (R-TAPES). Change in body image was assessed by Amputee Body Image Scale (ABIS). Results were analysed by computer-based software Statistical Package for the Social Sciences (SPSS) windows version 20.0. Analysis of Variance (ANOVA) t-test was used for normally distributed and Mann-Whitney U test was used for abnormally distributed variables. Results: The study enrolled 119 patients in which the most common cause of amputation was an accident (69). Statistically significant difference was found for satisfaction between males and females for weight of prosthesis (p-value=0.038). Statistically significant difference was found between male and female for amputee body image with ABIS score (p-value=0.001). Significant correlation was found between ABIS and functional satisfaction (p-value=0.001; r=-0.38)) and between ABIS and weight satisfaction (p-value=0.001; r=-0.36). Conclusion: Amputation causes significantly deterioration of body image among the amputee, with such deteriorated body image prosthetic satisfaction remains a big challenge for healthcare worker and prosthetist.

Ergonomic Assessment of Low Back Loading Pattern During Occupational Lifting Task in a Lower Limb Amputee: Minimizing Injury Risk.

While the relationship between occupational task intensity and repetitive overuse injuries have been well studied and prescription/guidelines to assess and minimize risk of such injuries well established in the general healthy population, these aspects are not well understood in individuals with disabilities. In this practice-oriented paper, we use high a resolution sensor-data driven methodology to track muscle activation patterns and joint kinematics during a common lifting task in a unilateral lower limb amputee to gain a better understanding of the risk of injury during non-optimal lifting postures. The observed data from high resolution sensors are used to recommend optimized prosthetic device tuning. Further the participant specific low back compression loads calculated using Hand-Calculation Back Compressive Force estimation model (HCBCF) and the University of Michigan 3D Static Strength Prediction Program (3DSSPP™) model is used to identify the safe zones of joint loading during the lifting task.

The Comprehensive Lower limb Amputee Socket Survey: Reliability and validity of the Persian version

Background: The Comprehensive Lower limb Amputee Socket Survey (CLASS) is a self-reported measure developed to assess prosthetic socket fit in individuals with lower limb amputation. Objective: To assess the reliability and validity of the Persian version of the CLASS. Study Design: Cross-sectional and repeated-measures. Methods: We evaluated the translation and back translation of the CLASS and made the required changes according to expert committee feedback. Then, we recruited 124 participants with unilateral lower limb amputation (89.5% men). Internal consistency was analyzed with Cronbach’s alpha and test–retest reliability using intra-class correlation coefficients. Convergent construct validity was assessed by comparing the CLASS scores with the Persian version of the Trinity Amputation and Prosthesis Experience Scales (TAPES) scores. In addition, known groups construct validity was assessed by comparing CLASS scores between groups with different causes and levels of amputation. Results: Cronbach’s alpha coefficient represented a very good internal consistency for all domains of the Persian CLASS (ranged from 0.86 to 0.92). The intra-class correlation coefficient for test–retest reliability for the Persian CLASS was good to excellent (ranged from 0.73 to 0.97). There was a significant correlation between the subscales of the Persian CLASS and satisfaction subscales of the Persian TAPES ( p < 0.001). There was no significant difference between the Persian CLASS scores by cause or level of amputation. Conclusion: The Persian CLASS is a reliable and valid measure for evaluating prosthetic socket fit.

Development of a Skateboard for a Physically Disabled Child

The aim of this paper is to present the development of a skateboard for a physically disabled child. The design presented in this study was motivated by an existing request of a local school that wanted to provide one of its students, a lower-limb amputee, with a more efficient method of transportation. Therefore, the design of an adapted skateboard, that values a healthy posture and an alternative propulsion system was proposed. For the product design, a user-centered methodology was applied based on the Project Development Orientation Guide. This methodology is divided in 8 stages and starts at the market opportunities and ends in the product testing. Hence, strategies of research and idea generation, such as articles and patents research, questionnaires, morphological matrix and SCAMPER tool, were used to develop a solution with a 3D model. With the model, a static simulation was performed through a finite element analysis method to validate the design and define the product’s dimension. The development of a product focused on the real needs of the user was highly approved. However, the user centered method presents significant challenges, especially dealing with a child and considering ethical standards in scientific research. The adapted skateboard represents a life quality improvement for the user and needs to be prototyped and tested for validation of the presented solution.