Do chronic pain syndromes in lower limb amputees have an effect on the use of prostheses?

BACKGROUND: The use of a prosthesis is critical to regain the ability to walk in lower limb amputees but the relationship between the use of a prosthesis and chronic pain syndromes (PLS, PLP, RLP), common in amputees patients, is still poorly understood. OBJECTIVE: This long-term follow-up study investigates the possible correlation between prosthesis use and the presence of PLP, PLS and RLP in lower limb amputees. METHODS: Patients undergoing transtibial, transfemoral or hemipelvectomy amputation of any aetiology at the Rizzoli Orthopaedic Institute from 2008 to 2018 were included. The Houghton scale was used to assess functional use of the prosthesis. RESULTS: The results show that, in lower limb amputees, prosthesis use is greater in individuals with below-the-knee amputation and in those who were younger at the time of amputation. No significant correlation between the presence of pain syndromes (PLS, PLP, RLP) and the various items on the Houghton scale was found. CONCLUSIONS: The study found no significant correlation indicating that phantom limb pain syndromes affect amputee use of a prosthesis.

Characterisation of Phantom Limb Pain in Traumatic Lower-Limb Amputees

Introduction. There is no diagnosis for phantom limb pain (PLP), and its investigation is based on anamnesis, which is subject to several biases. Therefore, it is important to describe and standardize the diagnostic methodology for PLP. Objective. To characterise PLP and, secondarily, to determine predictors for its diagnosis. Methodology. This is a cross-sectional study involving patients with unilateral traumatic lower-limb amputation aged over 18 years. Those with clinical decompensation or evidence of disease, trauma, or surgery in the central or peripheral nervous system were excluded. Sociodemographic and rehabilitative data were collected; PLP was characterised using the visual analogue scale (VAS), pain descriptors, and weekly frequency. Results. A total of 55 eligible patients participated in the study; most were male, young, above-knee amputees in the preprosthetic phase of the rehabilitation. The median PLP VAS was 60 (50–79.3) mm characterised by 13 (6–20) different descriptors in the same patient, which coexist, alternate, and add up to a frequency of 3.94 (2.5–4.38) times per week. The most frequent descriptor was movement of the phantom limb (70.91%). Tingling, numbness, flushing, itchiness, spasm, tremor, and throbbing are statistically significant PLP descriptor numbers per patient predicted by above-knee amputation, prosthetic phase, higher education level, and greater PLP intensity by VAS ( p < 0.05 ). Conclusion. PLP is not a single symptom, but a set with different sensations and perceptions that need directed and guided anamnesis for proper diagnosis.

Walking Practice Combined with Virtual Reality Contributes to Early Acquisition of Symmetry Prosthetic Walking: An Experimental Study Using Simulated Prosthesis

Virtual reality (VR)-based rehabilitation has been used in lower limb amputees; however, the extent to which VR is effective in reacquiring symmetrical gait in lower limb amputees is unclear. The purpose of this study was to confirm whether a VR intervention is effective in obtaining a simulated prosthetic gait. The participants were 24 healthy males who had never worn a simulated prosthesis. They were divided into three groups: VR, tablet, and control groups. The intervention consisted of 5 min of in situ stepping on parallel bars and watching a video of a simulated prosthetic leg walker on a head-mounted display or a tablet. Measurements included Gait Up parameters during a 10-m walk and immersion scores. After the intervention, there was a significant interaction between walking speed and leg swing speed in the VR group. The rate of improvement in walking speed and immersion scores was significantly higher in the VR group than in the other two groups, and there was a significant positive correlation between the rate of improvement and immersion scores. Compared to the tablet and control groups, the VR group showed the highest rate of immersion and improvement in walking speed.

Gait and rehabilitation in lower limb amputees: a narrative review v1

Introduction:Even if gait analysis is a validated outcome measure to assess the effects of a rehabilitation program on gait performance, few articles have been produced about the evaluation of a rehabilitation program in lower limb amputees using the gait analysis as a measure of outcome. Inclusion criteria:The inclusion criteria of the following narrative review is to investigate all the studies, without year limitations but only in English, whose population was lower limb adult amputees that underwent a rehabilitation process evaluated through the use of the gait analysis as a measure of outcome. Methods:Three databases will be investigated: Scopus, Pubmed and Embase, without year limitations but only in English. Study selection will be done following the inclusion and exclusion criteria, data extraction will follow the review’s objectives. Agree II scale will be used to assess the quality of guidelines, Amstar 2 scale will be used to evaluate systematic review, Pedro scale will be used to assess quality of randomized controlled trial, Stard-2015 scale will be used to assess observational studies. Two reviewers will screen the articles in blind and a third reviewer will solve the conflicts raised. Objective:The aim of this narrative review will be the investigation of the extent, type and results of evidence in relation to gait and rehabilitation in lower limb amputees.

Para-Sports can Promote Functional Reorganization in the Ipsilateral Primary Motor Cortex of Lower Limbs Amputee

Background. Drastic functional reorganization was observed in the ipsilateral primary motor cortex (M1) of a Paralympic long jumper with a unilateral below-knee amputation in our previous study. However, it remains unclear whether long-term para-sports are associated with ipsilateral M1 reorganization since only 1 athlete with amputation was investigated. Objective. This study aimed to investigate the relationship between the long-term para-sports and ipsilateral M1 reorganization after lower limb amputation. Methods. Lower limb rhythmic muscle contraction tasks with functional magnetic resonance imaging and T1-weighted structural imaging were performed in 30 lower limb amputees with different para-sports experiences in the chronic phase. Results. Brain activity in the ipsilateral primary motor and somatosensory areas (SM1) as well as the contralateral dorsolateral prefrontal cortex, SM1, and inferior temporal gyrus showed a positive correlation with the years of routine para-sports participation (sports years) during contraction of the amputated knee. Indeed, twelve of the 30 participants who exhibited significant ipsilateral M1 activation during amputated knee contraction had a relatively longer history of para-sports participation. No significant correlation was found in the structural analysis. Conclusions. Long-term para-sports could lead to extensive reorganization at the brain network level, not only bilateral M1 reorganization but also reorganization of the frontal lobe and visual pathways. These results suggest that the interaction of injury-induced and use-dependent cortical plasticity might bring about drastic reorganization in lower limb amputees.

Effects of phantom exercises on pain, mobility, and quality of life among lower limb amputees; a randomized controlled trial

Background The objective of the current study is to evaluate the effects of phantom exercises on phantom limb pain, mobility status, and quality of life in lower limb amputees treated with mirror therapy and routine physiotherapy. Methods It is a randomized controlled trial in which 24 unilateral lower limb amputees (above and below the knee) were randomly assigned to two equal groups i.e., control group (mirror therapy and conventional physical therapy) and experimental group in which, phantom exercises were given, additionally. Physical therapy included conventional therapeutic exercises while phantom exercises include imagining the movement of the phantom limb and attempting to execute these movements Data were collected at baseline, after 2 and 4 weeks of intervention using VAS (pain), AMP (mobility) and RAND SF-36 Version 1.0 (QOL) questionnaires. All statistical analyses were done with IBM SPSS 25.0 with 95% CI. Results Twenty-four amputees (17 males and 7 females) participated in this trial. The Mean age of the participants in experimental and control groups was 45.3 ± 11.1 years and 40.5 ± 12.5 years respectively. After the intervention, the pain (VAS score) was significantly lower in the experimental group (p = 0.003). Similarly, the experimental group demonstrated a significantly better score in the “bodily pain” domain of SF-36 (p = 0.012). Both groups significantly (p < 0.05) improved in other domains of SF-36 and ambulatory potential with no significant (p > 0.05) between-group differences. Conclusions The Addition of phantom exercises resulted in significantly better pain management in lower limb amputees treated with mirror therapy and routine physiotherapy. Trial registration This study is registered in the U.S National Library of Medicine. The clinical trials registration number for this study is NCT04285138 (ClinicalTrials.gov Identifier) (Date: 26/02/2020).