A low-cost easily implementable physiotherapy intervention clinically improves gait implying better adaptation to lower limb prosthesis: a randomized clinical trial.

Lower limb amputation highly impacts the lives of individuals. The inability to walk due to difficulties in adapting to wearing prosthesis can potentially result in physical degeneration and comorbidity in this population. In this randomized clinical trial study, we investigated if a low-cost and easily implementable physiotherapy intervention was effective in improving gait performance and adaptation to lower limb prosthesis in individuals with an amputation. A total of 26 individuals participated in the study, 16 with lower limb amputation and 10 without amputation. Participants with amputation were further divided in intervention and control groups. The intervention group underwent a rehabilitation protocol aimed at strengthening muscles and improving prosthesis adaptation. Muscle strengthening targeted the hip segment, prioritizing the abdominal muscles, hip flexors, extensors, adductors and abductors, followed by cicatricial mobilization and weight-bearing on the stump for desensitization. Assessment and measures were performed across the kinetic and kinematic parameters of gait. In the comparison between pre-and post-intervention, a significant increase in gait speed (0.68-2.98, 95% CI, 1.83, effect size ES) and cadence (0.56-2.69, 95% CI, 1.63, ES) was found between groups and time points. Step (0.73-3.11, 95% CI, 1.92, ES) and stride length (0.62-2.84, 95% CI, 1.73) increased between pre- and post-intervention, while in the control group both variables remained smaller. The intervention group decreased stance phase as a percentage of gait cycle between pre- and post-intervention (- 1.33-0.62, 95% CI, - 36, ES), while it increased in the control group. Improvement in a combination of important gait parameters indicates that the intervention protocol promoted the adaptation to prosthesis and the functional independence of individuals with lower limb amputation. It is recommended that the participants continue receiving follow-up assessments and rehabilitation interventions.

Heterotopic ossification in civilians with lower limb amputations.

OBJECTIVES: To report the incidence of symptomatic heterotopic ossification (HO) in a defined civilian amputee population, describe its characteristics, and compare these findings to published data in military amputees. DESIGN: Retrospective chart analysis from July 1998 to July 2009. SETTING: Ambulatory amputee clinic within a large university medical center. PARTICIPANTS: Adults with lower limb amputation (N=158). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Patients with symptomatic HO confirmed by radiographs. RESULTS: A total of 261 patients were evaluated; 158 met inclusion criteria, with 59% having traumatic etiology, 18% vascular etiology, 22% infection, and 1% tumor. Symptomatic HO was diagnosed in 36 (22.8%) patients, and 94% patients had mild HO on radiographic scoring. Rate of HO in amputations related to trauma was not increased compared with those of other etiologies. Surgical resection of the ectopic bone was required in 4 (11%) patients. CONCLUSIONS: HO is seen commonly after civilian lower limb amputation regardless of etiology. The prevalence was less than that observed in previous reports from military populations. This is the first report estimating the prevalence of HO in adult civilian amputees.

Analysis of bone demineralization due to the use of exoprosthesis by comparing Young's modulus of the femur in unilateral transfemoral amputees.

BACKGROUND: There is a relation between Hounsfield units obtained from computed tomography (CT) scans and bone density. The density of the bones can be used to establish its mechanical properties and therefore to assess the bone mechanical condition using CT images. OBJECTIVES: To identify the effect of the transfemoral amputation and the use of external lower limb prosthesis in the bone properties, by comparing Young's modulus. STUDY DESIGN: Young's modulus comparison. METHODS: Comparison of bone density between the healthy femur and the amputated bone of 20 unilateral transfemoral amputees was done by generating three histograms of the Hounsfield units at different parts of the femur. The histograms were created based on images obtained by CT and the Hounsfield units were translated to Young's modulus to establish the comparison. RESULTS: The results show a significant difference (p-value <0.05) between the mean value of Young's modulus of healthy and amputated bone. CONCLUSIONS: There is clearly a direct association between the use of external prosthesis and the bone demineralization due the stress shielding phenomenon. The Young's modulus comparison using information from CT images can be a suitable tool to analyze the bone demineralization due to the use of exoprosthesis.