ABSTRACT
Forequarter amputation is a rare procedure, performed mainly for patients with malignant bone and soft tissue tumors. The present case involved a 59-year-old man with left scapula chondrosarcoma. Rehabilitation began on the second day after amputation for a left shoulder chondrosarcoma. We performed early mobilization, wound management, mirror therapy for phantom pain, strength training for the remaining muscles, and activities of daily living (ADL)/instrumental ADL (IADL) training for only the remaining upper limb. In addition, we made a shoulder disarticulation prosthesis. Six months after the operation, the International Society of Limb Salvage-Musculoskeletal Tumor Society functional score was 36.7％ for 6 items and 73.3％ for 3 items, while the Disability of Arm, Shoulder and Hand score was 31.7. The patient-reported outcome had a low score because of the lack of an upper limb, including the scapula. However, when he was discharged from the hospital, he gained self-care independence with only the remaining upper limb and resumed fishing as a hobby. We suggest that rehabilitation after forequarter amputation requires careful intervention based on a deep evaluation of the patient's ADL/IADL, hobbies, and quality of life, in accordance with the patient's lifestyle.
ABSTRACT
Forequarter amputation is a rare procedure, performed mainly for patients with malignant bone and soft tissue tumors. The present case involved a 59-year-old man with left scapula chondrosarcoma. Rehabilitation began on the second day after amputation for a left shoulder chondrosarcoma. We performed early mobilization, wound management, mirror therapy for phantom pain, strength training for the remaining muscles, and activities of daily living (ADL)/instrumental ADL (IADL) training for only the remaining upper limb. In addition, we made a shoulder disarticulation prosthesis. Six months after the operation, the International Society of Limb Salvage-Musculoskeletal Tumor Society functional score was 36.7％ for 6 items and 73.3％ for 3 items, while the Disability of Arm, Shoulder and Hand score was 31.7. The patient-reported outcome had a low score because of the lack of an upper limb, including the scapula. However, when he was discharged from the hospital, he gained self-care independence with only the remaining upper limb and resumed fishing as a hobby. We suggest that rehabilitation after forequarter amputation requires careful intervention based on a deep evaluation of the patient's ADL/IADL, hobbies, and quality of life, in accordance with the patient's lifestyle.
ABSTRACT
Abstract Introduction Intuitive prosthesis control is one of the most important challenges in order to reduce the user effort in learning how to use an artificial hand. This work presents the development of a novel method for pattern recognition of sEMG signals able to discriminate, in a very accurate way, dexterous hand and fingers movements using a reduced number of electrodes, which implies more confidence and usability for amputees. Methods The system was evaluated for ten forearm amputees and the results were compared with the performance of able-bodied subjects. Multiple sEMG features based on fractal analysis (detrended fluctuation analysis and Higuchi's fractal dimension) combined with traditional magnitude-based features were analyzed. Genetic algorithms and sequential forward selection were used to select the best set of features. Support vector machine (SVM), K-nearest neighbors (KNN) and linear discriminant analysis (LDA) were analyzed to classify individual finger flexion, hand gestures and different grasps using four electrodes, performing contractions in a natural way to accomplish these tasks. Statistical significance was computed for all the methods using different set of features, for both groups of subjects (able-bodied and amputees). Results The results showed average accuracy up to 99.2% for able-bodied subjects and 98.94% for amputees using SVM, followed very closely by KNN. However, KNN also produces a good performance, as it has a lower computational complexity, which implies an advantage for real-time applications. Conclusion The results show that the method proposed is promising for accurately controlling dexterous prosthetic hands, providing more functionality and better acceptance for amputees.