Comparison of removable rigid dressing and elastic bandage in reducing the residual limb volume of below knee amputees.

OBJECTIVE: Compare the reducing volumes of the residual limbs between the removable rigid dressing method and the elastic bandaging technique. STUDY DESIGN: Randomized controlled trial. Setting: Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: Twenty-six below-the-knee amputees (11 men (42.3%) and 15 women (57.69%)) who were informed and gave written consents were included in this study. The mean age was 68.19 +/- 10.83 years. The patients who met the eligible criteria were randomized into two groups. Fourteen subjects (53.8%) were in the EB group and 12 (46.2%) in the RRD group. The first group was taught to use a removable rigid dressing (RRD) while the second group was taught to use an elastic bandage (EB) for stump shaping and volume reduction. Both groups were trained with the same pre-prosthetic program. The circumference of the stump was measured and calculated for volume at the beginning, 2 weeks, and 4 weeks. The volume reduction was compared between the two groups. RESULTS: Twenty subjects were amputated on the right side (76.92%). The majority underlying was diabetes mellitus (80.77%). Fifteen cases of amputation were peripheral vascular disease (57.69%). The stump volume reduction of the RRD group at 2 and 4 weeks were 42.73 +/- 62.70 and 79.9 +/- 103.33 cm3, respectively. The stump volume reduction of the EB group were 21.89 +/- 118.49 and 83.03 +/- 113.05 cm3, respectively. There were no statistically significant differences of volume reduction between the two groups at 4 weeks. CONCLUSION: Removable rigid dressing had a tendency to reduce residual limb volume of below knee amputees faster than elastic bandage at 2 weeks but the decreasing volumes were not different at 4 weeks.

Common foot problems in diabetic foot clinic.

OBJECTIVE: To study common foot problems presented in diabetic foot clinic. MATERIAL AND METHOD: A retrospectively review of out patient department records and diabetic foot evaluation forms of patients who visited the diabetic foot clinic at King Chulalongkorn Memorial Hospital between 2004 and 2006. RESULTS: Of all diabetic patients, 70 men and 80 women with the average age of 63.8 years were included in this study. About 32% of all reported cases had lower extremity amputation in which the toe was the most common level. Foot problems were evaluated and categorized in four aspects, dermatological, neurological, musculoskeletal, and vascular, which were 67.30%, 79.3%, 74.0%, and 39.3% respectively. More than half of the patients had skin dryness, nail problem and callus formation. Fifty six percent had the abnormal plantar pressure area, which was presented as callus. The great toe was the most common site of callus formation, which was correlated with gait cycle. The current ulcer was 18.8%, which was presented mostly at heel and great toe. Three-fourth of the patients (75.3%) had lost protective sensation, measured by the 5.07 monofilament testing. The most common problem found in musculoskeletal system was limited motion of the joint (44.0%). Claw toe or hammer toe were reported as 32.0% whereas the other deformities were bunnion (12.0%), charcot joint (6.0%) and flat feet (5.3%). The authors classified patients based on category risk to further lower extremity amputation into four groups. Forty-seven percent had highest risk for having further amputation because they had lost protective sensation from monofilament testing, previous current ulcer, or history of amputation. Only half of the patients had previous foot care education. CONCLUSION: Multidisciplinary diabetic foot care including patient education (proper foot care and footwear), early detection, effective management of foot problems, and scheduled follow-up must be emphasized to prevent diabetes-related lower extremities amputation.

Effects of imagery-weight exercise.

OBJECTIVE: To study the effects of imagery-weight exercise on muscle strength. MATERIAL AND METHOD: Preliminary study of a before and after designed experiment was conducted at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok, from June to September 2004. Fifteen healthy sedentary volunteers: 5 males, 10 females, mean age 28.7 +/- 3.5 years were enrolled The participants were instructed to perform imagery-weight exercise training with their non-dominant arms. The program consisted of 3 sets of 10 repetitions of elbow flexion, 3 days/week, for 8 weeks. The arm muscles strength were assessed with computerized isotonic machine. One-Repetition Maximum (1-RM) at before and after the training program, was compared RESULTS: The mean 1-RM of elbow flexors increased by 44.9% (from 6.78 +/- 2.10 kg to 9.83 +/- 2.32 kg, p = 0.000). The mean 1-RM of elbow extensors increased by 32.0% (from 4.03 +/- 1.98 kg to 5.33 +/- 2.32 kg, p = 0.000). CONCLUSION: Imagery-weight exercise is another effective technique of low impact strength training.

Effects of shoe lift on weight bearing in stroke patients.

OBJECTIVES: To determine the effect of shoe lift, cueing and cueing with shoe lift on weight bearing in paretic leg of stroke hemiparetic patients and compare the effect between each condition. DESIGN: Cross-sectional experimental study. SETTING: Department of Rehabilitation Medicine and Department of Ear Nose and Throat, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University. SUBJECT: Ten hemiparetic patients as a result of unilateral stroke. MATERIAL AND METHOD: Weight symmetry of each patient was measured by posturography during quiet stance and in conditions of compelled weight shift. Each patient was started with quiet standing, standing with shoe lift under the sound leg; cueing and cueing with shoe lift under the sound leg respectively. Weight symmetry scores were recorded for comparing the weight distribution between each foot. RESULTS: There were 10 hemiparetic patients. Seven were male. The average age was 53.4 +/- 8.45 years. There were 5 right hemiparesis and 5 left hemiparesis. The average onset was 12.3 +/- 15.73 months. In the right hemiparetic patients, weight bearing in the paretic leg was significantly improved when cueing with shoe lift compared with quiet standing and with shoe lift (Backward p = 0.012, Forward p = 0.011 and Backward p = 0.001, Forward p = 0.036 respectively). In the left hemiparetic patients, weight bearing in the paretic leg was significantly improved when cueing compared with quiet standing (Backward p = 0.046), and when using the shoe lift (Backward p = 0.016). Cueing with shoe lift could significantly improve weight bearing in the paretic leg when compared with shoe lift alone (Backward p = 0.015). Shoe lift alone could improve weight bearing in the paretic leg of the right and left hemiparetic patients but was not statistically significant (p > 0.05). CONCLUSION: Cueing with shoe lift under the sound leg can significantly improve weight bearing of the paretic leg of the right and left stroke hemiparetic patients.

Reliability of foot caliper.

OBJECTIVES: To determine the reliability of foot caliper DESIGN: Descriptive study. SETTING: Rehabilitation Medicine Outpatient Department, King Chulalongkorn Memorial Hospital. SUBJECT: Fifteen volunteers were recruited from Rehabilitation residents and health care professionals of Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: The authors created 3 sets of simple Foot Caliper and measured foot dimension including foot width, foot length and toe depth while subjects stood with equal weight bearing to both feet. The authors set 3 examiners to measure foot dimension by the same method. To determine reliability of 3 sets of foot caliper, one examiner was assigned to measure foot dimension of 30 feet with all calipers. To determine the reliability of examiners, all examiners measured foot dimension of the same 30 feet. All parameters were recorded in millimeters. The data was analyzed and presented as intraclass correlation coefficients (ICC) with 95% CI. RESULTS: There were fifteen volunteers (8 men and 7 women). The average age was 28.6 +/- 4.11 years (range 22-39). Average foot width,length and great toe depth (millimeters) were 9.64 +/- 0.63, 24.17 +/- 1.10 and 1.91 +/- 0.24 respectively. For reliability analysis of 3 sets off foot caliper, the intraclass correlation coefficients (ICC) with 95% CI were 0.985 (0.972-0.992), 0.996 (0.992-0.998) and 0.982 (0.968-991) for foot width, length and great toe depth, respectively. For Inter-examiner reliability, intraclass correlation coefficients (ICC) were 0.941 (0.864-0.969), 0.850 (0.46-0.920) and 0.834 (0.721-0.910) for foot width, length and great toe depth, respectively. These results showed high agreement of data. CONCLUSION: These simple foot calipers have high reliability forf oot measurement. These devices are appropriate for clinical use.