Amputee Rehabilitation

BACKGROUND: The upper extremity and particularly the hands are crucial for patients in interacting with their environment, therefore amputations or severe damage with loss of hand function significantly impact their quality of life. In cases where biological reconstruction is not feasible or does not lead to sufficient success, bionic reconstruction plays a key role in patient care. Classical myoelectric prostheses are controlled using two signals derived from surface electrodes in the area of the stump muscles...

INTRODUCTION: Patients with above-knee amputations (AKA) are normally treated with the traditional socket-mounted prosthesis (SMP), which is associated with a high incidence of problems. Osseointegration has been proposed as a promising option for avoiding many common SMP drawbacks. Several concerns have arisen regarding amputee osseointegration, however, mainly with respect to infection. We report on the safety of a single-stage osseointegration protocol using an antibiotic-loaded hydrogel to coat the intramedullary implant...

BACKGROUND: This study explored how inpatient exercise rehabilitation affected prosthetic mobility, function, and ambulation in persons with lower limb loss. METHODS: In this explorative prospective nonrandomized intervention study, experienced (EXP-INT, n = 20) and new prosthetic users (NEW-INT, n = 18) completed a 4-week rehabilitation intervention. A control group of experienced prosthetic users (n = 19) received no intervention. Tests were performed at baseline (pretest) and after 4 weeks (posttest)...

In this study, a minimal setup for the ankle joint kinematics estimation is proposed relying only on proximal information of the lower-limb, i.e. thigh muscles activity and joint kinematics. To this purpose, myoelectric activity of Rectus Femoris (RF), Biceps Femoris (BF), and Vastus Medialis (VM) were recorded by surface electromyography (sEMG) from six healthy subjects during unconstrained walking task. For each subject, the angular kinematics of hip and ankle joints were synchronously recorded with sEMG signal for a total of 288 gait cycles...

PURPOSE: The study aimed to compare the effects of home exercise alone and telerehabilitation combined with home exercise in individuals with transtibial amputation. MATERIALS AND METHODS: The telerehabilitation group ( n  = 24) received telerehabilitation combined with home exercise, while the control group ( n  = 24) received home exercise alone. Outcomes included the timed up-and-go (TUG) test and the 30-second chair-stand test (30CST), the Activities-specific Balance Confidence (ABC) Scale, the Trinity Amputation and Prosthesis Experience Scales (TAPES), the Amputee Body Image Scale (ABIS), and the Nottingham Health Profile (NHP)...

BACKGROUND: Superficial infection is a common minor complication of transcutaneous implants that can be challenging to predict or diagnose. Although it remains unclear whether superficial infections progress to deep infections (which may require implant removal), predicting and treating any infection in these patients is important. Given that flap thinning during stage II surgery requires compromising vascularity for stability of the skin penetration aperture, we hypothesized that early skin temperature changes predict long-term superficial infection risk...

Background: Lower limb amputation is an emotionally devastating condition that causes a complete change in the quality of life, may lead to phantom limb pain in most of the cases, and puts the individual in a high risk of developing psychological disorders. The objective of this study is to evaluate the consequence of adding virtual reality (VR) to a traditional exercise program on pain, mental status, and psychological status in traumatic unilateral lower limb amputees (LLAs). Methods: Thirty-two traumatic LLAs were randomly assigned into two equal groups in this randomized control trial...

This study focuses on novel design and evaluation of Elastic 50A (EL50) mechanical metamaterials with open-cell patterns for its potential application to lower limb residuum/socket interfaces, specifically that of a transtibial (TT) amputee. Mechanical characteristics, that is, effective Young's modulus ( E ), was tuned by altering metamaterial porosity, which was experimentally verified. Specifically, pore radius of the unit cell was varied to achieve a range of E -values (0.05-1.71 MPa) for these 3D printed metamaterials...

BACKGROUND: The biology of osseointegration of any intramedullary implant depends on the design, the press-fit anchoring, and the loading history of the endoprosthesis. In particular, the material and surface of the endoprosthetic stem are designed to stimulate on- and in-growth of bone as the prerequisite for stable and long-lasting integration1-8 . Relative movement between a metal stem and the bone wall may stimulate the formation of a connective-tissue interface, thereby increasing the risk of peri-implant infections and implant loss9-12 ...

Gait coordination (GC), meaning that one leg moves in the same pattern but with a specific phase lag to the other, is a spontaneous behavior in the walking of a healthy person. It is also crucial for unilateral amputees with the robotic leg prosthesis to perform ambulation cooperatively in the real world. However, achieving the GC for amputees poses significant challenges to the prostheses' dynamic modeling and control design. Still, there has not been a clear survey on the initiation and evolution of the detailed solutions, hindering the precise decision of future explorations...

Peripheral nerve interfaces (PNI) are electrical systems designed to integrate with peripheral nerves in patients, such as following central nervous system (CNS) injuries to augment or replace CNS control and restore function. We review the literature for clinical trials and studies containing clinical outcome measures to explore the utility of human applications of PNIs. We discuss the various types of electrodes currently used for PNI systems and their functionalities and limitations. We discuss important design characteristics of PNI systems, including biocompatibility, resolution and specificity, efficacy, and longevity, to highlight their importance in the current and future development of PNIs...

CASE SUMMARY: A domestic shorthair cat presented to the Animal Referral Hospital (Brisbane, Australia) after having the left pelvic limb incorrectly amputated. The cat was unable to ambulate on the remaining right pelvic limb due to a chronically subluxated stifle. A stifle arthrodesis was performed on the right pelvic limb to manage the injury. Follow-up radiographs performed 5 months postoperatively demonstrated stifle arthrodesis with no detectable complications. The owner reported that aside from some difficulties in toileting, the cat had a good quality of life and was capable of performing the majority of daily activities...

Oral cancer is a type of malignant neoplasia that develops in the oral cavity or lips and is commonly referred to as squamous cell carcinoma (SCC) because of its histopathology. In this report, we present to you a case of a 35-year-old male patient operated on for moderately differentiated SCC of the lateral border of the tongue and right buccal mucosa with a two-year-old case of trans-femoral amputation. Postoperatively, the patient faced issues with breathing, mouth opening and closing limitations, and painful movements of the neck and right shoulder...

For amputees, amputation is a devastating experience. Transfemoral amputees require an artificial lower limb prosthesis as a replacement for regaining their gait functions after amputation. Microprocessor-based transfemoral prosthesis has gained significant importance in the last two decades for the rehabilitation of lower limb amputees by assisting them in performing activities of daily living. Commercially available microprocessor-based knee joints have the needed features but are costly, making them beyond the reach of most amputees...

This paper leverages the OpenSim physics-based simulation environment for the forward dynamic simulation of an osseointegrated transfemoral amputee musculoskeletal model, wearing a generic prosthesis. A deep reinforcement learning architecture, which combines the proximal policy optimization algorithm with imitation learning, is designed to enable the model to walk by using three different observation states. The first is a complete state that includes the agent's kinematics, ground reaction forces, and muscle data; the second is a reduced state that only includes the kinematics and ground reaction forces; the third is an augmented state that combines the kinematics and ground reaction forces with a prediction of the muscle data generated by a fully-connected feed-forward neural network...

Despite the increasing incidence and prevalence of amputation across the globe, individuals with acquired limb loss continue to struggle with functional recovery and chronic pain. A more complete understanding of the motor and sensory remodeling of the peripheral and central nervous system that occurs postamputation may help advance clinical interventions to improve the quality of life for individuals with acquired limb loss. The purpose of this article is to first provide background clinical context on individuals with acquired limb loss and then to provide a comprehensive review of the known motor and sensory neural adaptations from both animal models and human clinical trials...

OBJECTIVE: The study evaluated whether pain intensity and extent, balance-confidence, functional mobility, and balance (eg, functional reach) are potential risk factors for recurrent falls among adults with a lower-limb amputation. DESIGN: Cross-sectional study. SETTING: Research laboratory. PARTICIPANTS: Eighty-three adults with unilateral lower-limb amputation that occurred >1 year prior (26 transfemoral- and 57 transtibial-level amputation; 44...

INTRODUCTION: Contemporary advances in combat medicine have allowed greater numbers of wounded service members to survive their injuries. An estimated 1,705 combat veterans sustained major lower or upper extremity amputations between 2001 and 2017 during the Global War on Terror. This study intends to answer the following question utilizing a qualitative study design: What were the common and abnormal experiences of the Global War on Terror combat amputees relative to their mechanism of injury, perception of injury, and systems of care utilized during their recovery and rehabilitation process?...

ObjectiveTo examine and compare the association between the presence of depression and anxiety symptoms and different sociodemographic and clinical factors including the adjustment to amputation and prosthesis satisfaction among Lebanese individuals with lower limb amputation (LLA). Method: This cross-sectional study was conducted between December 2022 and May 2023 among 72 participants with LLA. Participants completed a questionnaire that included sociodemographic and clinical variables, the revised Trinity Amputation and Prosthesis Experience Scale (TAPES-R), and the Hopkins Symptom Checklist (HSCL-25)...

OBJECTIVE: Acute trauma care has significantly reduced mortality over the last two decades. The last study to examine the epidemiology of traumatic amputees predates these gains. The majority of those who sustain traumatic amputation are male; therefore, limited data exist on female amputees. This study aimed to (1) provide a current epidemiological analysis of traumatic amputees, and (2) compare male and female amputees. DESIGN: All patients sustaining a major limb amputation in the National Trauma Data Bank (NTDB) from 2013 to 2017 were identified...