RESUMEN
The loss of a hand disrupts the sophisticated neural pathways between the brain and the hand, severely affecting the level of independence of the patient and the ability to carry out daily work and social activities. Recent years have witnessed a rapid evolution of surgical techniques and technologies aimed at restoring dexterous motor functions akin to those of the human hand through bionic solutions, mainly relying on probing of electrical signals from the residual nerves and muscles. Here, we report the clinical implementation of an interface aimed at achieving this goal by exploiting muscle deformation, sensed through passive magnetic implants: the myokinetic interface. One participant with a transradial amputation received an implantation of six permanent magnets in three muscles of the residual limb. A truly self-contained myokinetic prosthetic arm embedding all hardware components and the battery within the prosthetic socket was developed. By retrieving muscle deformation caused by voluntary contraction through magnet localization, we were able to control in real time a dexterous robotic hand following both a direct control strategy and a pattern recognition approach. In just 6 weeks, the participant successfully completed a series of functional tests, achieving scores similar to those achieved when using myoelectric controllers, a standard-of-care solution, with comparable physical and mental workloads. This experience raised conceptual and technical limits of the interface, which nevertheless pave the way for further investigations in a partially unexplored field. This study also demonstrates a viable possibility for intuitively interfacing humans with robotic technologies.
Asunto(s)
Amputados , Miembros Artificiales , Fuerza de la Mano , Imanes , Diseño de Prótesis , Robótica , Humanos , Amputados/rehabilitación , Fuerza de la Mano/fisiología , Robótica/instrumentación , Masculino , Músculo Esquelético/fisiología , Extremidad Superior , Mano/fisiología , Adulto , Electromiografía , Muñones de Amputación/fisiopatología , Contracción Muscular/fisiología , Implantación de PrótesisRESUMEN
Prosthetic hands have significant potential to restore the manipulative capabilities and self-confidence of amputees and enhance their quality of life. However, incompatibility between prosthetic devices and residual limbs can lead to secondary injuries such as skin pressure ulcers and restricted joint motion, contributing to a high prosthesis abandonment rate. To address these challenges, this study introduces a data-driven design framework (D3Frame) utilizing a multi-index optimization method. By incorporating motion/ pressure data, as well as clinical criteria such as pain threshold/ tolerance, from various anatomical sites on the residual limbs of amputees, this framework aims to optimize the structural design of the prosthetic socket, including the Antecubital Channel (AC), Lateral Epicondylar Region Contour (LC), Medial Epicondylar Region Contour (MC), Olecranon Region Contour (OC), Lateral Flexor/ Extensor Region (LR), and Medial Flexor/ Extensor Region (MR). Experiments on five forearm amputees verified the improved adaptability of the optimized socket compared to traditional sockets under three load conditions. The experimental results revealed a modest score enhancement on standard clinical scales and reduced muscle fatigue levels. Specifically, the percent effort of muscles and slope value of mean/ median frequency decreased by 19%, 70%, and 99% on average, respectively, and the average values of mean/ median frequency in the motion cycle both increased by approximately 5%. The proposed D3Frame in this study was applied to optimize the structural aspects of designated regions of the prosthetic socket, offering the potential to aid prosthetists in prosthesis design and, consequently, augmenting the adaptability of prosthetic devices.
Asunto(s)
Amputados , Miembros Artificiales , Mano , Diseño de Prótesis , Humanos , Amputados/rehabilitación , Masculino , Adulto , Algoritmos , Persona de Mediana Edad , Muñones de Amputación/fisiopatología , FemeninoRESUMEN
BACKGROUND: The company Ethnocare has developed the Overlay, a new pneumatic solution for managing volumetric variations (VVs) of the residual limb (RL) in transtibial amputees (TTAs), which improves socket fitting. However, the impact of the Overlay during functional tasks and on the comfort and pain felt in the RL is unknown. METHODS: 8 TTAs participated in two evaluations, separated by two weeks. We measured compensatory strategies (CS) using spatio-temporal parameters and three-dimensional lower limb kinematics and kinetics during gait and sit-to-stand (STS) tasks. During each visit, the participant carried out our protocol while wearing the Overlay and prosthetic folds (PFs), the most common solution to VV. Between each task, comfort and pain felt were assessed using visual analog scales. RESULTS: While walking, the cadence with the Overlay was 105 steps/min, while it was 101 steps/min with PFs (p = 0.021). During 35% and 55% of the STS cycle, less hip flexion was observed while wearing the Overlay compared to PFs (p = 0.004). We found asymmetry coefficients of 13.9% with the Overlay and 17% with PFs during the STS (p = 0.016) task. Pain (p = 0.031), comfort (p = 0.017), and satisfaction (p = 0.041) were better with the Overlay during the second visit. CONCLUSION: The Overlay's impact is similar to PFs' but provides less pain and better comfort.
Asunto(s)
Muñones de Amputación , Amputados , Miembros Artificiales , Extremidad Inferior , Diseño de Prótesis , Ajuste de Prótesis , Tibia , Humanos , Masculino , Persona de Mediana Edad , Anciano , Amputación Quirúrgica , Muñones de Amputación/fisiopatología , Extremidad Inferior/fisiopatología , Tibia/cirugía , Fenómenos Biomecánicos , Dolor/etiología , Sedestación , Posición de Pie , Marcha , Ajuste de Prótesis/efectos adversos , Miembros Artificiales/efectos adversosRESUMEN
BACKGROUND: Against the technological advances in limb salvage, below-the-knee amputation (BKA) remains a common procedure. Although most elective BKA is classified as clean operation, the reported stump complication rate is much higher than predicted. Postoperative casting (PC) may reduce the number of these complications. The aim of this study was to compare the efficacy of elastic bandage with knee immobilizer (EBKI) and PC in BKA stump complications. METHODS: Retrospective cohort comparison design identified patients who underwent BKA between 2000 and 2023 for non-correctable critical limb ischemia (CLI), or excessive tissue loss secondary to CLI, infection, severe neuropathy, or the combination of these and stratified them into 2 cohorts based on their postoperative stump dressing: EBKI and PC. BKAs that were done for trauma or neoplastic processes were excluded. The primary outcome measures: wound healing in 6 weeks and length of stay (LOS). SECONDARY OUTCOME MEASURES: stump injury, infection, dehiscence, necrosis, number of higher-level amputations, knee contracture, and post-BKA mobility with Special Interest Group of Amputee Medicine score. RESULTS: One hundred sixteen patients with 122 limbs (52 EBKI and 70 PC) were found who met inclusion criteria and analyzed. The groups were comparable in demographics and comorbidities and preoperative variables, including mobility. The primary wound healing at 6 weeks was higher (P = 0.007); wound dehiscence (P = 0.01) and LOS (P = 0.006) was lower in the PC group compared to EBKI group. The PC group achieved higher Special Interest Group of Amputee Medicine mobility score and lower number of contractures developed compared to the EBKI group. CONCLUSIONS: Applying and maintaining PC to the BKA stump during the first month of healing reduced the incidence of stump complications, shortened the LOS, and improved postrehabilitation mobility results. We found no effect of PC on postoperative infections, stump necrosis, and higher-level amputations.
Asunto(s)
Muñones de Amputación , Amputación Quirúrgica , Moldes Quirúrgicos , Cicatrización de Heridas , Humanos , Estudios Retrospectivos , Masculino , Femenino , Amputación Quirúrgica/efectos adversos , Anciano , Muñones de Amputación/fisiopatología , Persona de Mediana Edad , Resultado del Tratamiento , Factores de Tiempo , Moldes Quirúrgicos/efectos adversos , Tiempo de Internación , Factores de Riesgo , Anciano de 80 o más Años , Isquemia/fisiopatología , Isquemia/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & controlRESUMEN
BACKGROUND: Relative motion between the residual limb and socket in individuals with transtibial limb loss can lead to substantial consequences that limit mobility. Although assessments of the relative motion between the residual limb and socket have been performed, there remains a substantial gap in understanding the complex mechanics of the residual limb-socket interface during dynamic activities that limits the ability to improve socket design. However, dynamic stereo x-ray (DSX) is an advanced imaging technology that can quantify 3D bone movement and skin deformation inside a socket during dynamic activities. OBJECTIVE: This study aims to develop analytical tools using DSX to quantify the dynamic, in vivo kinematics between the residual limb and socket and the mechanism of residual tissue deformation. METHODS: A lower limb cadaver study will first be performed to optimize the placement of an array of radiopaque beads and markers on the socket, liner, and skin to simultaneously assess dynamic tibial movement and residual tissue and liner deformation. Five cadaver limbs will be used in an iterative process to develop an optimal marker setup. Stance phase gait will be simulated during each session to induce bone movement and skin and liner deformation. The number, shape, size, and placement of each marker will be evaluated after each session to refine the marker set. Once an optimal marker setup is identified, 21 participants with transtibial limb loss will be fitted with a socket capable of being suspended via both elevated vacuum and traditional suction. Participants will undergo a 4-week acclimation period and then be tested in the DSX system to track tibial, skin, and liner motion under both suspension techniques during 3 activities: treadmill walking at a self-selected speed, at a walking speed 10% faster, and during a step-down movement. The performance of the 2 suspension techniques will be evaluated by quantifying the 3D bone movement of the residual tibia with respect to the socket and quantifying liner and skin deformation at the socket-residuum interface. RESULTS: This study was funded in October 2021. Cadaver testing began in January 2023. Enrollment began in February 2024. Data collection is expected to conclude in December 2025. The initial dissemination of results is expected in November 2026. CONCLUSIONS: The successful completion of this study will help develop analytical methods for the accurate assessment of residual limb-socket motion. The results will significantly advance the understanding of the complex biomechanical interactions between the residual limb and the socket, which can aid in evidence-based clinical practice and socket prescription guidelines. This critical foundational information can aid in the development of future socket technology that has the potential to reduce secondary comorbidities that result from complications of poor prosthesis load transmission. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57329.
Asunto(s)
Extremidad Inferior , Piel , Tibia , Humanos , Muñones de Amputación/diagnóstico por imagen , Muñones de Amputación/fisiopatología , Miembros Artificiales , Fenómenos Biomecánicos/fisiología , Cadáver , Extremidad Inferior/diagnóstico por imagen , Extremidad Inferior/cirugía , Extremidad Inferior/fisiología , Movimiento/fisiología , Piel/diagnóstico por imagen , Tibia/diagnóstico por imagen , Tibia/cirugíaRESUMEN
Transtibial prosthetic users do often struggle to achieve an optimal prosthetic fit, leading to residual limb pain and stump-socket instability. Prosthetists face challenges in objectively assessing the impact of prosthetic adjustments on residual limb loading. Understanding the mechanical behaviour of the pseudo-joint formed by the residual bone and prosthesis may facilitate prosthetic adjustments and achieving optimal fit. This study aimed to assess the feasibility of using B-mode ultrasound to monitor in vivo residual bone movement within a transtibial prosthetic socket during different stepping tasks. Five transtibial prosthesis users participated, and ultrasound images were captured using a Samsung HM70A system during five dynamic conditions. Bone movement relative to the socket was quantified by tracking the bone contour using Adobe After-Effect. During the study a methodological adjustment was made to improve data quality, and the first two participants were excluded from analysis. The remaining three participants exhibited consistent range of motion, with a signal to noise ratio ranging from 1.12 to 2.59. Medial-lateral and anterior-posterior absolute range of motion varied between 0.03 to 0.88 cm and 0.14 to 0.87 cm, respectively. This study demonstrated that it is feasible to use B-mode ultrasound to monitor in vivo residual bone movement inside an intact prosthetic socket during stepping tasks.
Asunto(s)
Miembros Artificiales , Tibia , Ultrasonografía , Humanos , Masculino , Tibia/diagnóstico por imagen , Tibia/cirugía , Tibia/fisiología , Ultrasonografía/métodos , Persona de Mediana Edad , Femenino , Adulto , Rango del Movimiento Articular , Anciano , Muñones de Amputación/fisiopatología , Muñones de Amputación/diagnóstico por imagen , Movimiento/fisiología , Diseño de Prótesis , AmputadosRESUMEN
BACKGROUND AND OBJECTIVE: Jumping stump is an uncommon movement disorder characterized by involuntary movements and severe neuropathic pain in the stump. The pathophysiology and etiology of this phenomenon have not yet been clearly elucidated, and unfortunately, no proven treatment with successful recovery exists. This report aims to describe a severe painful jumping stump, possibly due to neuromas, in a traumatic transradial amputee. MATERIALS AND METHOD: We performed ultrasound examination of the painful stump depicted neuroma. Electromyographic evaluation of the stump revealed arrhythmic motor unit action potentials (MUAPs) with normal duration and amplitude; other movement disorders, such as myokymia and fasciculations, were excluded. Ultrasound should be preferred to magnetic resonance imaging (MRI) for evaluation of stumps in patients with painful stump because MRI may not be helpful due to motion artefacts. The involuntary movements ceased after surgical excision of the neuroma following failure of conservative treatments. CONCLUSION: This report confirms that neuromas are clearly associated with jumping stump. Ultrasonographic and electromyographic assessments are necessary to reveal the features of this pathology for treatment planning.
Asunto(s)
Muñones de Amputación/diagnóstico por imagen , Trastornos del Movimiento/diagnóstico por imagen , Neuralgia/diagnóstico por imagen , Neuroma/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Extremidad Superior/diagnóstico por imagen , Amputación Quirúrgica , Muñones de Amputación/fisiopatología , Amputados , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Movimiento/fisiopatología , Neuralgia/fisiopatología , Neuroma/fisiopatología , Dimensión del Dolor , Neoplasias de los Tejidos Blandos/fisiopatología , Ultrasonografía , Extremidad Superior/fisiopatologíaRESUMEN
BACKGROUND: In our clinic, a substantial number of patients present with transtibial residual limb pain of no specific somatic origin. Silicone liner induced tissue compression may reduce blood flow, possibly causing residual limb pain. Thus, as a first step we investigated if the liner itself has an effect on transcutaneous oxygen pressure (TcPO2). METHODS: Persons with unilateral transtibial amputation and residual limb pain of unknown origin were included. Medical history, including residual limb pain, was recorded, and the SF-36 administered. Resting TcPO2 levels were measured in the supine position and without a liner at 0, 10, 20 and 30 minutes using two sensors: one placed in the Transverse plane over the tip of the Tibia End (= TTE), the other placed in the Sagittal plane, distally over the Peroneal Compartment (= SPC). Measurements were repeated with specially prepared liners avoiding additional pressure due to sensor placement. Statistical analyses were performed using SPSS. RESULTS: Twenty persons (9 women, 11 men) with a mean age of 68.65 years (range 47-86 years) participated. The transtibial amputation occurred on average 43 months prior to study entry (range 3-119 months). With liner wear, both sensors measured TcPO2 levels that were significantly lower than those measured without a liner (TTE: p < 0.001; SPC: p = 0.002) after 10, 20 and 30 minutes. No significant differences were found between TcPO2 levels over time between the sensors. There were no significant associations between TcPO2 levels and pain, smoking status, age, duration of daily liner use, mobility level, and revision history. CONCLUSION: Resting TcPO2 levels decreased significantly while wearing a liner alone, without a prosthetic socket. Further studies are required to investigate the effect of liner wear on exercise TcPO2 levels.
Asunto(s)
Muñones de Amputación/fisiopatología , Amputación Quirúrgica , Monitoreo de Gas Sanguíneo Transcutáneo/métodos , Miembro Fantasma/sangre , Descanso , Tibia/cirugía , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/complicaciones , Miembro Fantasma/etiología , Factores Sexuales , SiliconasRESUMEN
BACKGROUND AND AIM: During post-amputation recovery or rapid body mass change, residual limb volume can change quickly, requiring frequent adjustments or replacement of the socket to maintain fit. The aim of this pilot test was to evaluate the feasibility of using a three-dimensional-printed insert to extend the service life of a prosthetic socket after substantial residual limb volume loss. TECHNIQUE: One research subject with a well-fitting transtibial prosthetic socket had an oversized socket fabricated to simulate substantial limb volume loss. The digital shapes of the oversized and well-fitting sockets were used to create a three-dimensional-printed insert to restore fit. DISCUSSION: Two-minute walk test distance decreased when using the oversized socket without the insert, but not when using the socket with the insert. Socket comfort score was 8+ under all conditions. These results suggest that three-dimensional-printed inserts may be an effective method of extending the service life of prosthetic sockets when rapid limb volume loss occurs. CLINICAL RELEVANCE: Three-dimensional (3D) printing gives prosthetists a new tool to manage large volume changes without refabricating entire sockets. Sockets can be fabricated in anticipation of volume gain/loss, using replaceable 3D-printed inserts to maintain fit and comfort.
Asunto(s)
Muñones de Amputación/fisiopatología , Amputados/rehabilitación , Miembros Artificiales , Impresión Tridimensional , Diseño de Prótesis , Ajuste de Prótesis , Humanos , Proyectos Piloto , Prueba de PasoRESUMEN
OBJECTIVE: To determine the effect of a removable rigid dressing (RRD) on the time to residual limb maturation compared with elastic bandage (EB) in transtibial amputees. DESIGN: Experimental single-blinded (assessor-blinded) randomized controlled trial. SETTING: Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. PARTICIPANTS: Transtibial amputees (N=25) with immature residual limb. INTERVENTION: Participants were allocated to use RRD or EB to achieve residual limb maturation, and all participants in both groups were trained with the same preprosthetic program. MAIN OUTCOME MEASURES: The time to residual limb maturation, patient satisfaction, and complications were compared between the 2 groups. RESULTS: Median time to residual limb maturation was significantly lower in the RRD group (median, 28d [interquartile range, 17-51d]) than in the EB group (median, 54d [interquartile range, 30-77d]; P=.020). After accounting for time since amputation, maturation time remained significantly lower in the RRD group (adjusted hazard ratio, 3.32; 95% CI, 1.08-10.20; P=.036). There was no significant difference in complications or patient satisfaction. CONCLUSION: In postoperative management of transtibial amputation, the use of RRD had a significantly shorter period to residual limb maturation when compared with the EB group.
Asunto(s)
Muñones de Amputación/fisiopatología , Amputación Quirúrgica/rehabilitación , Amputados/rehabilitación , Vendajes de Compresión , Cicatrización de Heridas/fisiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Miembros Artificiales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Factores Sexuales , Método Simple Ciego , Tibia/cirugíaRESUMEN
RATIONALE: Phantom limb pain (PLP) refers to a common complication following amputation, which is characterized by intractable pain in the absent limb, phantom limb sensation, and stump pain. The definitive pathogenesis of PLP has not been fully understood, and the treatment of PLP is still a great challenge. Till now, ozone injection has never been reported for the treatment of PLP. PATIENT CONCERNS: We report 3 cases: a 68-year-old man, a 48-year-old woman, and a 46-year-old man. All of them had an amputation history and presented with stump pain, phantom limb sensation, and sharp pain in the phantom limb. Oral analgesics and local blocking in stump provided no benefits. DIAGNOSIS: They were diagnosed with PLP. INTERVENTIONS: We performed selective nerve root ozone injection combined with ozone injection in the stump tenderness points. OUTCOMES: There were no adverse effects. Postoperative, PLP, and stump pain were significantly improved. During the follow-up period, the pain was well controlled. LESSONS: Selective nerve root injection of ozone is safe and the outcomes were favorable. Ozone injection may be a new promising approach for treating PLP.
Asunto(s)
Muñones de Amputación/inervación , Amputación Quirúrgica/efectos adversos , Ozono/administración & dosificación , Dolor Intratable/terapia , Miembro Fantasma/complicaciones , Anciano , Muñones de Amputación/fisiopatología , Femenino , Humanos , Inyecciones/métodos , Masculino , Persona de Mediana Edad , Ozono/uso terapéutico , Dolor Intratable/etiología , Miembro Fantasma/fisiopatología , Raíces Nerviosas Espinales/efectos de los fármacos , Resultado del TratamientoRESUMEN
BACKGROUND: Previous studies investigating limb volume change with elevated vacuum have shown inconsistent results and have been limited by out-of-socket volume measurements and short, single-activity protocols. OBJECTIVES: To evaluate the effectiveness of elevated vacuum for managing limb fluid volume compared to suction suspension with an in-socket measurement modality during many hours of activity. STUDY DESIGN: Fixed-order crossover design with a standardized out-of-laboratory activity protocol. METHODS: Transtibial electronic elevated vacuum users participated in two sessions. Elevated vacuum was used during the first session, and suction suspension in the second. Participants completed a 5.5-h protocol consisting of multiple intervals of activity. In-socket residual limb fluid volume was continuously measured using a custom portable bioimpedance analyzer. RESULTS: A total of 12 individuals participated. Overall rate of fluid volume change was not significantly different, though the rate of posterior fluid volume change during Cycle 3 was significantly lower with elevated vacuum. Although individual results varied, 11 participants experienced lower overall rates of fluid volume loss in at least one limb region using elevated vacuum. CONCLUSION: Elevated vacuum may be more effective as a volume management strategy after accumulation of activity. Individual variation suggests the potential to optimize the limb fluid volume benefits of elevated vacuum by reducing socket vacuum pressure for some users. CLINICAL RELEVANCE: A better understanding of how elevated vacuum (EV) affects residual limb fluid volume will allow prosthetists to make more informed clinical decisions regarding accommodation strategies designed to improve daily socket fit.
Asunto(s)
Muñones de Amputación/fisiopatología , Miembros Artificiales , Líquido Extracelular/fisiología , Diseño de Prótesis , Ajuste de Prótesis , Soporte de Peso , Adulto , Anciano , Estudios Cruzados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tibia/cirugíaRESUMEN
Fish have a high ability to regenerate fins, including the caudal fin. After caudal fin amputation, original bi-lobed morphology is reconstructed during its rapid regrowth. It is still controversial whether positional memory in the blastema cells regulates reconstruction of fin morphology as in amphibian limb regeneration, in which limb blastema cells located at the same proximal-distal level have the same positional identity. We investigated growth period and growth rate in zebrafish caudal fin regeneration. We found that both the growth period and growth rate differed for fin rays that were amputated at the same proximal-distal level, indicating that it takes different periods of time for fin rays to restore their original lengths after straight amputation. We also show that more proximal amputation takes longer period to reconstruct the original morphology/size than more distal amputation. Statistical analysis suggested that both the growth period/rate are determined by amputated length (depth) regardless of the fin ray identity along dorsal-ventral axis. In addition, we suggest the possibility that the structural/physical condition such as width of the fin ray at the amputation site (niche at the stump) may determine the growth period/rate.
Asunto(s)
Muñones de Amputación/patología , Muñones de Amputación/fisiopatología , Aletas de Animales/citología , Aletas de Animales/fisiología , Proliferación Celular , Regeneración , Pez Cebra/fisiología , AnimalesRESUMEN
Purpose: To gather ideas from lower-limb prosthesis users and certified prosthetists regarding possible residual limb monitoring system features and data presentation. We also gathered information on the type of residual limb problems typically encountered, how they currently manage those problems, and their ideas for methods to better manage them.Materials and methods: Two focus groups were held; one with certified prosthetists and another with lower-limb prosthesis users. Open-ended questions were used in a moderated discussion that was audio recorded, transcribed, and assessed using applied thematic analysis.Results and conclusions: Seven individuals participated in each focus group. Prosthetists came from a mix of practice settings, while prosthesis users were diverse in level of amputation, aetiology, and years of experience using lower-limb prostheses. Residual limb problems reported by participants were consistent with those in the literature. Participants suggested better managing residual limb problems through improved education, better detection of residual limb problems, and using sensor-based information to improve prosthetic technology. Participants favoured short-term use of a possible residual limb monitoring systems to troubleshoot residual limb problems, with temperature and pressure the most frequently mentioned measurements. Participants described that an ideal residual limb monitoring system would be lightweight, not interfere with prosthesis function, and result in benefits with regard to prosthetic care and socket function that outweighed inconveniences or concerns regarding system use. A potential positive of system use included having objective data for reimbursement justification, although it was pointed out that the residual limb monitoring system itself also needed to be reimbursable.Implications for RehabilitationStakeholders suggested better managing residual limb problems through improved education, better detection of residual limb problems, and using sensor-based information to improve prosthetic technology.Stakeholders favored short-term use of a possible system to troubleshoot residual limb problems, with temperature and pressure the most frequently mentioned measurements.Stakeholders described that an ideal residual limb monitoring system would be lightweight, not interfere with prosthesis function, and result in benefits with regard to prosthetic care and socket function that outweighs any inconveniences or concerns regarding system use.Stakeholders indicated that a potential positive of system use included having objective data for reimbursement justification, although it was pointed out that the residual limb monitoring system itself also needed to be reimbursable.
Asunto(s)
Muñones de Amputación/fisiopatología , Amputación Quirúrgica , Extremidad Inferior/cirugía , Monitoreo Fisiológico/métodos , Complicaciones Posoperatorias , Adulto , Amputación Quirúrgica/efectos adversos , Amputación Quirúrgica/métodos , Amputación Quirúrgica/rehabilitación , Miembros Artificiales/efectos adversos , Miembros Artificiales/normas , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/rehabilitación , Diseño de Prótesis/métodos , Diseño de Prótesis/normas , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/métodosRESUMEN
ntroduction: Lower limb amputation is a surgery performed as a last resort, when all other therapeutic options have been exhausted. The duration of treatment lasts from a few to several months and depends on the extent of amputation, the patient's overall health and the course of the stump healing process. MATERIALS AND METHODS: A retrospective analysis was performed using the database of the General and Vascular Surgery Ward of the Nikolay Pirogov Regional Specialist Hospital in Lódz. Patients who underwent lower limb amputation at the transfemoral level in 2017 were analyzed. 92 patients undergoing surgery were qualified for the study. Patients were divided into two groups: those with no healing complications and those with stump healing complications. Medical records of both groups were analyzed for risk factors for impaired healing. The obtained data were subjected to statistical analysis. RESULTS: Patients with impaired stump healing most often had minimal bleeding and higher ASA scores compared to patients without healing complications. No differences between the two groups were found for the remaining parameters. Patients with complications needed an average of 28 days to heal the wound and spent an average of 40 days in hospital, compared to 14 and 21 days, respectively, for patients without complications. The percentage of deaths in the group of patients with complications was also significantly higher (35%) than in the group of patients without complications (5%). CONCLUSIONS: Statistically significant factors increasing the risk of impaired stump healing include high ASA scale and minimal muscle bleeding during surgery. Patients who experienced this complication are at greater risk of prolonged hospitalization and death in the postoperative period. This study showed statistically significant risk factors for impaired stump healing following amputation and confirmed the negative impact of this complication on the length of hospitalization and risk of death.
Asunto(s)
Muñones de Amputación/fisiopatología , Amputación Quirúrgica/rehabilitación , Complicaciones Posoperatorias/fisiopatología , Arteriopatías Oclusivas/cirugía , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodos , Cicatrización de Heridas/fisiologíaRESUMEN
None: Ventral thigh surface electromyography may be used to assess for periodic limb movements during sleep (PLMS) in a limb with an above-the-knee amputation. Presence of PLMS in the proximal portion of an amputated lower extremity supports theories of spinal and supraspinal mechanisms in PLMS generation, and demonstrates that intact distal motor efferent pathways and distal sensory afferent pathways are not absolutely necessary for the generation of periodic limb movements. CITATION: Chada A, Hoque R. Periodic limb movements during sleep noted on ventral thigh surface electromyography in an above-the-knee amputated stump. J Clin Sleep Med. 2019;15(8):1183-1184.
Asunto(s)
Muñones de Amputación/fisiopatología , Electromiografía , Síndrome de Mioclonía Nocturna/fisiopatología , Humanos , Pierna/fisiopatología , Masculino , Persona de Mediana Edad , Polisomnografía , MusloRESUMEN
Different species respond differently to severe injury, such as limb loss. In species that regenerate, limb loss is met with complete restoration of the limbs' form and function, whereas in mammals the amputated limb's stump heals and scars. In in vitro studies, electrical stimulation (EStim) has been shown to promote cell migration, and osteo- and chondrogenesis. In in vivo studies, after limb amputation, EStim causes significant new bone, cartilage and vessel growth. Here, in a rat model, the stumps of amputated rat limbs were exposed to EStim, and we measured extracellular matrix (ECM) deposition, macrophage distribution, cell proliferation and gene expression changes at early (3 and 7 days) and later stages (28 days). We found that EStim caused differences in ECM deposition, with less condensed collagen fibrils, and modified macrophage response by changing M1 to M2 macrophage ratio. The number of proliferating cells was increased in EStim treated stumps 7 days after amputation, and transcriptome data strongly supported our histological findings, with activated gene pathways known to play key roles in embryonic development and regeneration. In conclusion, our findings support the hypothesis that EStim shifts injury response from healing/scarring towards regeneration. A better understanding of if and how EStim controls these changes, could lead to strategies that replace scarring with regeneration.
Asunto(s)
Muñones de Amputación/fisiopatología , Amputación Quirúrgica/efectos adversos , Cicatriz/prevención & control , Terapia por Estimulación Eléctrica , Cicatrización de Heridas/fisiología , Muñones de Amputación/irrigación sanguínea , Animales , Proliferación Celular , Modelos Animales de Enfermedad , Regulación de la Expresión Génica , Humanos , Masculino , Neovascularización Fisiológica , Ratas , Resultado del TratamientoRESUMEN
BACKGROUND: Thermal discomfort is prevalent among prosthesis users. This observational study of thirty unilateral lower-limb prosthesis users compared their skin temperatures and the thermal discomfort experienced during exercise between their residual and contralateral limbs. METHODS: Participants performed a 2-minute interval cycling exercise test. Skin temperature was measured at matched locations on each leg during the 1-minute rest intervals. Average rate-of-change in skin temperature was compared between legs using a repeated measures analysis of variance. Participants rated thermal discomfort on each leg before and after exercise, and a Wilcoxon signed-rank test was used to compare legs. Ordinal regression evaluated the relationship between the rate-of-change in temperature on the residual limb and the perceived thermal discomfort. FINDINGS: After exercise, thermal discomfort ranked higher on the amputated side (Pâ¯=â¯0.007). On average, both legs cooled during exercise (Pâ¯=â¯0.002), but the difference between legs was not significant. The rate-of change in skin temperature on the residual limb during exercise did not relate to the thermal discomfort experienced (odds ratio of 0.357). INTERPRETATION: These findings indicate that in this patient population, skin temperature does not explain the thermal discomfort experienced, and subjective thermal discomfort is inadequate for detecting thermoregulatory issues, with potential implications for long-term tissue health.
Asunto(s)
Miembros Artificiales , Ejercicio Físico/fisiología , Temperatura Cutánea , Adulto , Muñones de Amputación/fisiopatología , Amputados , Prueba de Esfuerzo , Femenino , Fémur , Humanos , Masculino , Persona de Mediana Edad , Descanso , Estudios Retrospectivos , Encuestas y Cuestionarios , Temperatura , Sensación Térmica , TibiaRESUMEN
BACKGROUND: Strategies to maintain prosthesis users' daily limb volume are needed. OBJECTIVES: Test how intermittent incremental socket volume adjustments affect limb fluid volume and limb-socket distance. STUDY DESIGN: Repeated measures. METHODS: People with transtibial limb loss walked on an outdoor trail wearing a motor-driven adjustable socket that they adjusted a small amount, approximately 0.3% socket volume, every 2 min using a mobile phone app. Limb fluid volume and sensed distance between the socket and a target in their elastomeric liner were monitored. A gradual socket enlargement phase was followed by a gradual socket reduction phase. RESULTS: An incremental socket enlargement significantly increased limb fluid volume (p < 0.001) but not sensed distance (p = 0.063). An incremental socket reduction significantly decreased both limb fluid volume (p < 0.001) and sensed distance (p < 0.001). CONCLUSION: Participants' residual limb fluid volume increases during ambulation compensated for incremental socket volume increases. For incremental socket volume decreases, residual limb fluid volume decreases did not compensate and the socket fit became tighter. CLINICAL RELEVANCE: Results support the hypothesis that for people without co-morbidities, intermittent incremental socket volume enlargements are an effective accommodation strategy to increase limb fluid volume while maintaining socket fit. Intermittent incremental socket volume reductions decreased limb fluid volume but also made the socket fit tighter.
Asunto(s)
Adaptación Fisiológica , Muñones de Amputación/fisiopatología , Miembros Artificiales , Líquido Extracelular , Ajuste de Prótesis , Tibia/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , CaminataRESUMEN
Reductions in sensory and motor activity following unilateral upper limb amputation during adulthood are associated with widespread, activity-dependent reorganization of the gray matter and white matter through the central nervous system. Likewise, in cases of congenital limb absence there is evidence that limited afferent or efferent activity affects the structural integrity of white matter pathways serving the affected side. Evidence that the structural integrity of mature sensory and motor tracts controlling the lost upper limb exhibits similar activity dependence is, however, sparse and inconsistent. Here we used diffusion tensor tractography to test whether amputation of the dominant right hand during adulthood (n = 16) alters the microstructural integrity of the major sensory (medial lemniscus, ML) and motor (corticospinal tract, CST) pathways controlling missing hand function. Consistent with prior findings, healthy control subjects (n = 27) exhibited higher fractional anisotropy (FA), an index of white matter microstructural integrity, within dominant left CST and nondominant right ML. Critically, in contrast to what might be expected if the microstructural organization of these tracts is activity dependent, these asymmetries persisted in amputees. Moreover, we failed to detect any differences in dominant left ML or CST between healthy control subjects and amputees. Our results are consistent with these white matter tracts being robust to changes in activity once mature or that continued use of the residual limb (in a compensatory fashion or with prosthesis) provides stimulation sufficient to maintain tract integrity. NEW & NOTEWORTHY We report that unilateral hand amputation in adults has no significant effects on the structure of major sensory or motor pathways contralateral to the amputation. Our results are consistent with the organization of these white matter tracts being robust to changes in activity once mature or that continued use of the residual limb (with or without a prosthesis) provides stimulation sufficient to maintain tract integrity.