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Abstract: Shapiro LT, Huang ME. Inpatient rehabilitation of survivors of purpura fulminans with multiple limb amputations: a case series. Purpura fulminans (PF) is a rare, rapidly progressive syndrome characterized by intravascular thrombosis and necrosis of the skin and subcutaneous tissues. Survivors are often left with considerable impairments, including organ dysfunction, adjustment disorder, extensive wounds, and amputations. This retrospective case series presents 4 adult patients who underwent multiple limb amputations secondary to acute infectious PF. All patients underwent acute inpatient rehabilitation, were fitted with prostheses during their stay, and achieved a minimal assistance level for most of their self-care and mobility skills. Rehabilitation management is discussed, including common medical issues, complications, and prosthetic considerations. [Copyright &y& Elsevier]

Abstract: Pasquina PF, Bryant PR, Huang ME, Roberts TL, Nelson VS, Flood KM. Advances in amputee care. This self-directed learning module highlights the recent innovations in amputee care. It is part of the study guide on limb deficiency in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This focused review article describes the key elements of a successful comprehensive amputee program, the basic surgical considerations for upper- and lower-extremity amputation, and some of the more recent advances in prosthetic components. Further, an update is given on issues such as hand transplantation and the integration of robotics and artificial muscles for people with limb loss. Overall Article Objective: (a) To discuss current issues and advances in the care of patients with amputation, (b) to describe the key elements in designing a comprehensive amputee care program, and (c) to discuss surgical considerations of limb preservation and amputation levels. [Copyright &y& Elsevier]

Abstract: Roberts TL, Pasquina PF, Nelson VS, Flood KM, Bryant PR, Huang ME. Limb deficiency and prosthetic management. 4. Comorbidities associated with limb loss. This self-directed learning module highlights common comorbidities found in people with amputations and their impact on functional outcome. It is part of the study guide on limb deficiency and vascular rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on prosthetic considerations, functional outcome, and potential complications for a woman with the comorbidities of stroke and diabetes who experiences a dysvascular amputation. Formulation of the differential diagnosis, management of limb pain, and evaluation of the potential psychosocial issues arising after amputation are also discussed. Overall Article Objective: To analyze common comorbidities of people with amputations and to delineate their impact on functional outcome. [Copyright &y& Elsevier]

Abstract: Huang ME, Nelson VS, Flood KM, Roberts TL, Bryant PR, Pasquina PF. Limb deficiency and prosthetic management. 3. Complex limb deficiency. This self-directed learning module highlights rehabilitation and prosthetic issues associated with complex limb deficiencies. It is part of the chapter on acquired limb deficiencies in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses rehabilitation and prosthetic management of patients with amputations for complex limb deficiencies secondary to trauma. Mechanisms of injury, prosthetic issues, prosthetic components, and potential problems in prosthetic fitting will be discussed. Overall Article Objective: To evaluate common problems associated with complex limb deficiency. [Copyright &y& Elsevier]

Abstract: Flood KM, Huang ME, Roberts TL, Pasquina PF, Nelson VS, Bryant PR. Limb deficiency and prosthetic management. 2. Aging with limb loss. This self-directed learning module highlights the issues faced by people aging with limb loss. It is part of the study guide on limb deficiency and vascular rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the impact that limb loss has on health and physical function throughout the life span. Case examples are used to illustrate what effect limb loss in childhood or young adulthood has on the incidence and management of new impairments or disease processes commonly associated with aging. Overall Article Objective: To discuss the impact of early-life limb loss on the incidence and management of physiologic and functional changes associated with aging. [Copyright &y& Elsevier]

Abstract: Nelson VS, Flood KM, Bryant PR, Huang ME, Pasquina PF, Roberts TL. Limb deficiency and prosthetic management. 1. Decision making in prosthetic prescription and management. This self-directed learning module highlights decision making in prosthetic management in pediatric and adult patients. This chapter reviews classification of congenital limb deficiency and management of congenital pediatric upper-extremity amputees. Differences in management of amputees of various ages from infancy to old age is discussed. Case examples are used to formulate prosthetic prescriptions for transradial limb deficiency as well as knee disarticulation and transtibial level amputations. Common prosthetic gait deviations and anticipated functional levels are evaluated. Overall Article Objective: To discuss prosthetic prescription and management in congenital limb deficiency and acquired amputations for patients of various ages. [Copyright &y& Elsevier]

Introduction: Exercise habits and return to exercise in individuals with lower-limb amputation (LLA) have been reported in up to 11% to 61% of individuals with amputation, but it is unclear if these individuals meet American College of Sports Medicine (ACSM) exercise guidelines and if there are any negative consequences associated with exercise. This pilot study investigated the exercise habits of individuals with unilateral nonvascular LLA to ascertain adherence to ACSM exercise guidelines and any relationships to contralateral (intact)-limb limb knee injuries. Methods: A telephone survey was conducted with 25 individuals (n = 7, female) 22 to 90 years of age (M = 47) with nonvascular unilateral LLAs (2 transmetatarsal/Syme [TM], 13 transtibial [TT], 7 transfemoral [TF], 3 hip disarticulation [HD]) from a university hospital population. Weekly reported exercise before and after amputation (including type, frequency, duration and intensity, based on talk test correlating to intensity) as well as any history of intact-limb knee injuries was obtained. Data were analyzed using χ2 and one-way analysis of variance tests. Results: Sixty-eight percent met the recommended ACSM guidelines for cardiorespiratory (CR) exercise before amputation and 48% of individuals met CR guidelines after amputation, and, of those, 41.7% reported sustaining intact-limb knee injuries (there were no injuries in those not meeting CR guidelines; P = 0.009). Respondents who met CR guidelines were at significantly higher risk of knee injury (P = 0.05). Also, those engaged in greater than moderate intensity CR exercise had significantly higher rates of intact knee injury compared with those exercising at low or moderate intensities (P = 0.01). Conclusions: This pilot study suggests that engaging in an exercise routine at greater than moderate intensity may significantly increase the risk of intact-limb knee injury in individuals with unilateral LLAs. A larger study involving more subjects would be beneficial in clarifying the risk of knee injury from exercise in patients with amputation. [ABSTRACT FROM AUTHOR]