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To analyze the effect of lumbar strengthening exercise in lower-limb amputees with chronic low back pain.
We included in this prospective study 19 lower-limb amputees who had experienced low back pain for longer than 6 months. Participants were treated with 30-minute lumbar strengthening exercises, twice weekly, for 8 weeks. We used the visual analog scale (VAS), and Oswestry low back pain disability questionnaire, and measured parameters such as iliopsoas length, abdominal muscle strength, back extensor strength, and back extensor endurance. In addition, we assessed the isometric peak torque and total work of the trunk flexors and extensors using isokinetic dynamometer. The pre- and post-exercise measurements were compared.
Compared with the baseline, abdominal muscle strength (from 4.4±0.7 to 4.8±0.6), back extensor strength (from 2.6±0.6 to 3.5±1.2), and back extensor endurance (from 22.3±10.7 to 46.8±35.1) improved significantly after 8 weeks. The VAS decreased significantly from 4.6±2.2 to 2.6±1.6 after treatment. Furthermore, the peak torque and total work of the trunk flexors and extensors increased significantly (p<0.05).
Lumbar strengthening exercise in lower-limb amputees with chronic low back pain resulted in decreased pain and increased lumbar extensor strength. The lumbar strengthening exercise program is very effective for lower-limb amputees with chronic low back pain.
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The loss of an upper limb significantly limits the functional activities of daily living. A huge emphasis is placed on the manipulation, shape, weight, and comfort of a prosthesis, to enable its use as an inherent body part. Even with technological advances, customized upper-extremity myoelectric prosthesis remain heavy and expensive. The high cost of upper-extremity prosthesis is an especially steep economic barrier for patients. Three-dimensional (3D) printing is a promising avenue for reducing the cost of prosthesis. We applied 3D-printed pressure-sensored prosthetics to a traumatic transradial amputee, and compared the hand functions with a customized myoelectric prosthesis. The 3D-printed pressure-sensored prosthetics showed low grip strength and decreased dexterity compared to the conventional myoelectric prosthesis. Although there were a few limitations, the fabrication of prosthesis with 3D printing technology can overcome previous problems such as high production cost, long fabrication period and heavy weight.
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To investigate the effect of extracorporeal shock wave therapy (ESWT) on painful stump neuroma.
Thirty patients with stump neuroma at the distal end of an amputation site were assigned randomly to the ESWT group (n=15) and the transcutaneous electrical nerve stimulation (TENS)+desensitization+pharmacological treatment group (n=15). For 3 weeks, the ESWT group received a weekly session involving 1,500 pulses at 0.10 mJ/mm2, while the control group was treated 10 times each, 40 minutes per day with TENS and desensitization treatment, and daily medication for 3 weeks. ESWT stimulation was given by focusing on the area at the neuroma site clearly identified by ultrasound.
The changes in the McGill pain questionnaire were 38.8±9.0 prior to treatment and 11.8±3.1 following the treatment. The corresponding values for the control group were 37.2±7.7 and 28.5±10.3. The changes between groups were significantly different (p=0.035). The change in visual analog scale prior to and after treatment was 7.0±1.5 and 2.8±0.8 in the ESWT group, respectively, and 7.2±1.4 and 5.8±2.0 in the control group. These changes between the groups were also significantly different (p=0.010). The outcome in the pain rating scale also showed significant differences between groups (p<0.001). Changes in neuroma size and pain pressure threshold (lb/cm2) were not significantly different between groups (p>0.05).
The study findings imply that ESWT for stump neuroma is superior to conventional therapy.
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To find a multiple amputee more severe than a triple amputee is not easy. This is a report of a 36-year-old patient with right knee disarticulation, left trans-femoral amputation and right elbow disarticulation due to peripheral ischemic necrosis, when he was applied vasopressor in septic shock condition. His left hand was also 2nd, 3rd, 4th, and 5th distal interphalangeal joint disarticulation status, and it was more difficult for him to do rehabilitation program, such as donning and doffing the prostheses. For more efficient rehabilitation training program, we first focused on upper extremities function, since we believed that he might need a walking aid for gait training later. After 13 weeks of rehabilitation program, he has become sit to stand and walk short distance independently with an anterior walker. Although he still needs some assistance with activities of daily living, his Functional Independence Measure score improved from 48 to 90 during the course of 13 weeks.
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Protein S is a vitamin K-dependent coagulation factor that acts as an anticoagulant. Deficiency of protein S increases the risk of thromboembolic events. We report a case of isolated protein S deficiency in a 39-year-old woman suffering arterial occlusion in both lower legs. She underwent a surgical procedure using thrombectomy and balloon angioplasty of her left lower extremity. Later, she had right trans-tibial amputation because of the reperfusion injury. Throughout the evaluation of thromboembolic events, we diagnosed a large thrombus in the right atrium and an asymptomatic pulmonary thromboembolism. The patient was successfully treated with right atrial thrombectomy and systemic anticoagulation. Careful evaluation for protein S levels may be necessary in patients with arterial thromboembolic events, especially young adults.
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Objective: The aims of this study were to evaluate gait patterns in transtibial amputees with the barefeet relative to the shoe and also to identify the differences between their gait patterns of two different types of prosthetic feet.
Method: An optoelectronic motion analysis of gait was done in six transtibial amputees using both the SACH foot and the single axis foot. In both cases we compared the state of the barefeet with the shod.
Results: The gait abnormalities which were observed during the barefeet gait with the SACH foot showed knee joint hyperextension of 9.9±2.0o and the loss of ankle plantar flexion at the early stance phase. When the single axis foot was used, there was a reduction in knee flexion thrust from 9.9±3.7o to 7.2±3.8o and also in plantar flexion from 9.9±2.8o to 7.0±2.1o during the early stance phase.
Conclusion: There were significant gait abnormalities during the barefoot walking state in transtibial amputees with the SACH foot. We observed that gait patterns have been improved when the single axis prosthetic foot was used.
Rehabilitation in patients with bilateral upper extremity amputation presents a considerable problem for prosthetic training. This is a report of a bilateral transhumeral amputee and a bilateral transradial amputee admitted for intensive prosthetic rehabilitation. They underwent bilateral upper extremity amputation due to electric burn. They were successfully fitted with conventional body-powered prostheses. The problems in rehabilitation of adult bilateral upper extremity amputees were discussed and the patients' compliance was assessed. In our two cases, good acceptance and functional benefit were noted. Thus, we suggest that multidisciplinary approach including prosthetists with full discussion should be a very important factor for specialized comprehensive prosthetic training of multiple complexed amputee.
Objective: Many amputees do not use their prostheses consistently because of the unhelpfulness or discomfort. In this point, this survey was to assess the prosthetic problems in their function and willingness to use.
Method: We investigated the 18 burn induced upper extremity amputees of Hankang Sacred Heart Hospital Burn Center with the questionnaire or interview.
Results: The mean age was 39.6 years at the time of amputation & 43.3 years at the time of survey. Their amputation levels were composed of 72.2% of below elbow and 27.8% of above elbow. The using time of prosthesis was revealed that 'all day long' use in 50%, 'going out' use in 33.3% and 'living activity' use in 11.1%. Their complaint for prosthetic problems were discoloration (38.9%), poor appearance (27.8%), sweating (27.8%) and inadequate function (22.2%). Considerable number of them suffered from residual burn wound or scar in contact with a socket (27.8%) and itching and tingling sensation (22.2%). Employment was not accomplished in 61.1% of the amputees.
Conclusion: The information thus obtained in this investigation would be expected to be helpful in the prosthetic prescription and rehabilitation training of upper extremity amputees for their welfare.
Hand rehabilitation is essential to restore the maximal functional capacity of a patient after the injuries of hand or upper extremity, such as a fracture, tendon tear, crushing, or amputation. To achieve the purpose, hand rehabilitation should begin shortly after the completion of surgery. Especially after the replantation, functional recovery can be achieved by a careful inpatient evaluation providing a proper treatment, detecting problems, and updating treatment programs, and arranging discharge and follow-up cares by a hand rehabilitation team.
We report our experience of a successful hand rehabilitation of patient with a replantation surgery after the complete right forearm amputation. A comprehensive approach and systematized treatment programs are important for a hand rehabilitation.
Partial hand amputation may leave a significant functional limitations for amputee that are difficult to ameliorate by either orthoses or prostheses. Many kinds of devices have been tried to promote the function and cosmesis. Cosmetic hand was the best answer to the person with first and second metacarpophalangeal joint disarticulation and the strength and range of motion of remaining three fingers were not in optimal status till now. We applied a new device of wrist driven prehension prosthesis consist of forearm stabilizer, short opponens, actuator rod, artificial thumb, artificial index and attached 2 rings was designed and fabricated. As a result, it is possible to provide considerable improvement in function and cosmesis with this new device.
Burn patients with associated limb amputations present demanding rehabilitation problems, many of which might lead them to chronic issues. The authors studied 77 male and 9 female burn patients with amputations. Most amputations occurred with high voltage electrical burns. The fingers were the most frequent target for amputations. The most frequent site of amputation was the entrance at the right side and multiple amputation in nature.
The prosthetic fittings were delayed because of burn wounds and grafts and fragile skin at the stump. Also, limited range of motion, decreased strength, hypertrophic scar contracture, heterotopic ossification and bony overgrowth were additional limiting factors.
We conclude that early rehabilitation intervention would be critical to prevent complications and to improve rehabilitation outcome of burn amputee patients.
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