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Purpose: Core strength is vital for athletic performance, and many more exercises that involve the kinetic chain have been designed for able-bodied athletes. Disabilities that impair the kinetic chain can reduce the effectiveness of strength training. However, the impact of amputation on core strength training of people with disabilities and its underlying mechanism remains unclear. This study aimed to evaluate the muscle activation patterns and levels in athletes with amputation during 4 basic and modified weight-bearing core strength-training exercises. Methods: Fifteen elite athletes with unilateral amputation (170.6 [7.3] cm; 63.9 [11.9] kg; 25.9 [5.3] y) volunteered for this study. Surface electromyography was used to measure the muscle activity mainly in the lumbopelvic–hip complex-stabilizing muscles during 4 kinetic chain trunk exercises with and without modifications. Results: The significance level was set at α =.05. The results showed a significant difference in muscle activation between different body sides (P <.05). Specifically, amputation on the support position resulted in a diagonal pattern of muscle activation, and amputation on the free distal segments resulted in a unilateral dominant pattern with higher activation in muscles on the nonamputated side (P <.05). Modifications led to significant decreases in muscle activation asymmetry index (P <.05). Conclusions: Amputation caused muscle activation asymmetry and 2 activation patterns. Modifications by enhancing proximal stability and adjusting distal loading effectively reduced the asymmetry of muscle activation. Coaches and clinicians can use these results to tailor exercises for athletes with disabilities in training and rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to compare the effects of home exercise alone and telerehabilitation combined with home exercise in individuals with transtibial amputation. Materials and methods: The telerehabilitation group (n = 24) received telerehabilitation combined with home exercise, while the control group (n = 24) received home exercise alone. Outcomes included the timed up-and-go (TUG) test and the 30-second chair-stand test (30CST), the Activities-specific Balance Confidence (ABC) Scale, the Trinity Amputation and Prosthesis Experience Scales (TAPES), the Amputee Body Image Scale (ABIS), and the Nottingham Health Profile (NHP). The analysis used a 2 × 2 mixed repeated measures ANOVA. Results: The group-by-time interactions were significant for TUG (p = 0.002, F[1;41] = 10.74) and 30CST (p = 0.001, F[1;41] = 11.48). The mean difference (6th week-baseline) was −0.49 for TUG and 0.95 for 30CST in the telerehabilitation group and −0.14 for TUG and 0.13 for 30CST in the control group. There were statistically meaningful group-by-time interactions on the ABC (p = 0.0004, F[1;41] = 14.47), the TAPES-activity restriction (p = 0.0001, F[1;41] = 28.96), TAPES-prosthesis satisfaction (p = 0.004, F[1;41] = 9.19), and the NHP (p = 0.0002, F[1;41] = 16.07) favoring the telerehabilitation group. Conclusions: Telerehabilitation combined with home exercise can offer greater benefits in improving gait, muscle strength, balance confidence, activity restriction, prosthesis satisfaction, and quality of life compared to home exercise alone for individuals with transtibial amputation. Implications for rehabilitation: Exercise helps individuals with lower limb amputation overcome their physical limitations and enables them to use their prostheses effectively. Physiotherapy and rehabilitation after amputation are not at the desired level, and individuals with lower limb amputation encounter various difficulties in accessing physiotherapy. Telerehabilitation has great potential to facilitate access to physiotherapy for individuals with amputation and reduce resource utilization. In a relatively small sample of amputees, this study shows that telerehabilitation-based exercise improves physical health and quality of life. [ABSTRACT FROM AUTHOR]

Introduction Contemporary advances in combat medicine have allowed greater numbers of wounded service members to survive their injuries. An estimated 1,705 combat veterans sustained major lower or upper extremity amputations between 2001 and 2017 during the Global War on Terror. This study intends to answer the following question utilizing a qualitative study design: What were the common and abnormal experiences of the Global War on Terror combat amputees relative to their mechanism of injury, perception of injury, and systems of care utilized during their recovery and rehabilitation process?. Methods During the months of December 2022 and January 2023, individual semi-structured interviews were conducted with U.S. Marines that served in the Global War on Terror (total n  = 10). Deductive and inductive approaches were employed to identify codes, themes, and meta-themes in the data. Results All participants deployed to Afghanistan between the years 2010 and 2014 and were assigned to the following military occupational specialties: Explosive Ordnance Disposal technicians (total n  = 2); combat engineers (total n  = 2); and infantrymen (total n  = 6). Analysis of data collected from interviews highlighted these key observations: (1) Themes in the combat amputee experience include support, systems of care, and mindset and (2) the themes synergistically contribute to the meta-themes mental health and pain and vice versa. As all participants were subjected to a blast mechanism of injury, it is difficult to determine if this played a role in deviating rehabilitation and recovery processes. Perception of injury and how well participants adapted to their new lifestyle, meaning how optimistic they were, appeared to play a significant role in recovery. Participants had mixed feelings about the care they had received but generally spoke favorably of military hospitals and were frustrated with the Veteran Affairs, and there was no clear consensus on their relationship with civilian health care, though most participants chose to seek most of their care through the Veteran Affairs. Conclusion Based on the research question, this study found an intricate relationship between mental health, pain, and the experiences of the participants regarding their care and rehabilitation. However, the nature of qualitative research makes it impossible to determine generalizations that can be used to create meaningful change to address improving combat amputee veteran care. Further research into long-term health outcomes based on hypotheses not evaluated in existing literature would further improve the ability of health care providers to care for this unique patient population. [ABSTRACT FROM AUTHOR]

Purpose: To explore health care providers' (HCP) experiences related to transitions in care from inpatient rehabilitation to the community for patients with limb loss. Materials and Methods: A qualitative study was conducted using semi-structured interviews. Participants were eligible if they were HCPs currently working in amputation rehabilitation at a rehabilitation hospital in Ontario, Canada, with at least 1-year experience in this setting, and could speak and understand English. Data were analyzed thematically using the six-step process of the DEPICT model dynamic reading, engaged codebook development, participatory coding, inclusive reviewing and summarizing of categories, collaborative analyzing and translating. Results: Fourteen HCPs from a variety of health care professions participated in this study. Five key themes describe participants' perspectives on the factors impacting patients' transition in care following limb loss. Specifically, participants emphasized patient preparedness, HCP follow-up, finances and funding, patient self-management skills, and psychosocial support as factors that could influence the transition in care. Conclusion: This study identified challenges to transitions in care for people with limb loss. Future research is needed to evaluate solutions to address these challenges in transitions in care. IMPLICATIONS FOR REHABILITATION: Suboptimal transitions in care can result in readmission to the hospital, emergency department visits, and increased health care costs. Patient preparedness, follow-up, finances and funding, patient self-management skills, and psychosocial support are perceived to influence transitions in care from inpatient rehabilitation to the community. Improved access to follow-up and supports in the community and improved communication across the continuum of care could improve transitions for people with limb loss. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this review is to synthesise the experiences and needs of people who had undergone dysvascular lower extremity amputations. Given the increasing global prevalence of vascular diseases like diabetes mellitus and peripheral arterial disease, the risk of requiring an amputation remains high. Materials and methods: This systematic review follows the PRISMA and ENTREQ reporting guidelines. Seven databases were searched for qualitative studies from January 2011 to October 2023. In total 6435 studies were obtained, where 1146 were duplicates and 5271 studies failed to meet the eligibility criteria. The remaining 18 studies were synthesised using Sandelowski and Barroso's approach and appraised using the CASP checklist. Results: Four themes emerged from the meta-synthesis: (1) making the decision to amputate, (2) difficulties in the physical adaptation to limb loss, (3) psychosocial consequences of living with an amputation, and (4) regaining control and building hope. Conclusions: Having dysvascular lower extremity amputations is a complicated experience as not only was the pre-amputation pain relieved, but a new set of physical, emotional and social challenges would surface after the amputation. These synthesised findings serve as a platform to explore the factors behind the various experiences faced by these people and how healthcare professionals can help them in their adjustment. IMPLICATIONS FOR REHABILITATION: Dysvascular lower extremity amputations can affect the physical and mental well-being of people who have experienced them. Healthcare professionals (HCPs) are encouraged to individualise care that meets the physical and emotional needs of patients. Sufficient time and information should be provided before the operation for these people to be better prepared for the changes following the amputation. Physical support by HCPs should include physical rehabilitation, checking on the wound healing and managing any existing co-morbidities. Emotional support can be given through additional referral to medical social workers or psychologists and the involvement of support groups. [ABSTRACT FROM AUTHOR]

Background: It has been reported that 43.6% of ankle fractures are accompanied by posterior malleolus fractures. The aim of this study is to define a safe zone for posterior malleolus fractures by determining the locations of the important anatomical structures in this region. Additionally, it aims to identify the trans-Achilles passage line for Kirschner wire insertion through a posteroanterior approach for posterior malleolus fragments. Methods: Six below-knee amputee fresh-frozen leg cadavers were used in this study. A trans-Achilles Kirschner wire was applied to the cadavers in the posteroanterior direction under the guidance of fluoroscopy. The areas where the Kirschner wire passed were dissected, and their proximity to vital anatomical structures was measured. Results: In all cadavers, the transverse thickness of the Achilles tendon at the level of the trans-Achilles Kirschner wire was 15.5 mm and the trans-Achilles Kirschner wire application was 18.6 mm from the sural nerve, 16 mm from the posterior tibial tendon, and 12.16 mm from the flexor digitorum longus muscle. It was performed 15.16 and 14.6 mm from the posterior tibial artery and vein, 12.3 mm from the tibial nerve, 13.6 mm from the tibiofibular joint, and 55.5 mm from the insertion site of the Achilles tendon to the calcaneus and at a sufficient distance from vital anatomical structures. Conclusions: The proposed trans-Achilles percutaneous surgical technique is safe from neurovascular structures for fixing posterior malleolar fractures. However, the long-term clinical outcomes of this technique need to be explored. Level of evidence: Level III, A cadaveric study. [ABSTRACT FROM AUTHOR]

Objective: To gather preliminary evidence on short- and long-term care priorities for people with lower extremity amputations. Design: A three-round modified Delphi study using semi-structured interviews. Participants: A convenience sample of 20 adult participants who had undergone lower extremity amputations at a tertiary public hospital. Main Measure: Consensus on each care priority was defined a priori as an agreement of more than 50%. Semi-structured interviews were conducted to understand the rationales for endorsing the care priorities. Results: Consensus was reached on 24 short-term care priorities and 12 long-term care priorities in the biomedical, practical and psychological and spiritual domains. The rationales for endorsing each of the care priorities generated three themes: preparedness; mental health, psychological and spiritual well-being; and participating in life, with respect and dignity. Conclusions: Our results highlight the substantial need to improve patient access to education and planning support prior to undergoing limb amputation, and optimising post-amputation rehabilitation programmes, enabling people with amputations to participate in meaningful life roles that provide them with purpose, dignity, and self-respect. The knowledge of care priorities revealed in this study may promote effective patient-centred care and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: A systematic review and meta-analysis investigating the duration and frequency of lower extremity prosthesis use and what factors were associated with changes in their use. Materials and methods: A search of PubMed, CINAHL, and Scopus over 20 years revealed 2409 articles. After review, 29 studies remained, representing 4814 participants with lower limb loss. Quality, funding, publication, and quantitative analyses were addressed. Results: The mean prosthesis use was 9.6 (5.3) hours/day and 6.4 (1.9) days/week. Distal amputation sites averaged more hours/day of prostheses use than proximal amputations (13.2 [3.2] vs. 10.8 [5.0], p <.001). After hemipelvectomy or hip dislocations, average prostheses use was less hours/day (6.0 [4.7]) than after transfemoral (12.9 [4.8]) or transtibial amputations (14.0 [4.5]) (p <.05). Pooled effects revealed an association between comorbidities and abandonment (OR 0.35, p =.03). The data supported six empirical evidence statements concerning age, sex, social support, amputation proximity, balance, skin condition, comorbidities, pain, falls, and fitness in association with changes in prosthesis utilization. Conclusions: The study provided systematic data on lower-extremity prosthesis use, thus helping to inform clinical decision-making and patient education. It also elucidated a path for future studies focused on modifiable factors related to prosthesis use and related outcomes. Implications for rehabilitation: Lower limb loss can trigger costly and debilitating sequela, which could be mitigated by increased prosthesis use and functionality, but there is no consensus on how often prostheses are being used and what affects changes in their use. When counseling patients on what they can expect after a lower extremity amputation and to set goals, the aggregated means of 9.6 (5.3) hours per day and 6.4 (1.9) days per week can be informative. Individuals who use a lower extremity prosthesis or may have to use one in the future can increase their prosthesis use and mobility by limiting further health deterioration. Rehabilitative care involving the multidisciplinary prioritization of proper socket fit, fitness training, gait training, and social support is associated with increased prosthetic device usage. [ABSTRACT FROM AUTHOR]

Targeted muscle reinnervation (TMR) is an established modality for the surgical management of neuropathic pain. Although the preventive effect of primary (acute) TMR at the time of amputation has been demonstrated previously, it remains unclear how many and which patients benefit most. Therefore, this study investigated the proportion of patients achieving sustained pain prophylaxis following amputation, as well as factors associated with its efficacy. Primary patients who underwent TMR with a minimum follow-up of 6 months between 2018 and 2023 were enrolled. Pain outcomes (numeric rating scale [NRS], 0–10), comorbidities, and surgical factors were collected from chart review. Patients achieving sustained pain prophylaxis (NRS of ≤3 for ≥3 months until final follow-up) were identified. Multilevel mixed-effect models and multivariable regression were used to visualize pain courses and identify associated factors. Seventy-five patients who underwent primary TMR were included (median follow-up: 2.0 years), of whom 57.3% achieved sustained pain prophylaxis whereas 26.7% reported pain disappearance. Distal amputation levels (p = 0.036), a lower Elixhauser Comorbidity Index (p = 0.001), and the absence of psychiatric comorbidities (p = 0.039) were associated with pain prophylaxis. This study demonstrates that more than half of all patients undergoing primary TMR achieved sustained pain prophylaxis, and approximately a quarter of patients achieved sustained pain disappearance. Several factors associated with these favorable outcomes are described. These results will aid in preoperative counseling, managing patient expectations, and selecting patients who may benefit most from primary TMR surgery. IV – Therapeutic [ABSTRACT FROM AUTHOR]

Dissatisfaction among upper limb prosthetic users is high, reaching over 70%, and 52% of upper limb amputees abandon their prosthetic devices due to limitations such as limited functionality, poor design/aesthetic, and improper fit. The conventional procedure of making prosthetics is time-consuming and expensive. This study was conducted to provide an alternative solution for the several issues of current prosthetic devices. 3D printing technology offers a promising alternative, providing greater accuracy, reduced labor time, and improved fit and comfort. This research explores the application of 3D printing for creating custom silicone prosthetic fingers, using Fused Deposition Modelling (FDM) for the mold. A high-resolution 3D scanner was employed to capture the precise anatomy of the patient's hand, and CAD software was used to design molds that satisfied the patient preference and were reusable. The resulting prosthetics demonstrated good fit and patient satisfaction, though exact color matching remains a challenge, but still, it did demonstrate that it is possible to fabricate colored prosthetics. Performance tests, such as the Jebsen–Taylor Hand Function Test, indicated that while initial performance with the prosthetic was slightly lower, patient satisfaction and potential for improved functionality over time were high. This study underscores the potential of 3D printing to enhance the customization, cost-effectiveness, and overall quality of prosthetic devices, contributing to Sustainable Development Goals related to health and industry innovation. [ABSTRACT FROM AUTHOR]

Purpose: Use of a lower limb prosthesis generally requires increased cognitive effort to compensate for missing motor and sensory inputs. This study sought to examine how lower limb prosthesis users perceive paying attention to their prosthesis(es) in daily life. Materials and methods: Focus groups with lower limb prosthesis users were conducted virtually using semi-structured questions. Verbatim transcripts were excerpted, coded, and reconciled. Inductive thematic analysis was undertaken to identify experiences shared by participants. Results: Five themes emerged from five focus groups conducted with thirty individuals: Paying attention to my prosthesis is just what I have to do; I pay attention to how my prosthetic socket fits and feels every day; I pay attention because I don't want to fall; I pay attention because I have to learn to do things in a new way; and If I can trust that my prosthesis will do what I want, I can pay less attention to it. Conclusions: Prosthetic attention, including both background and foreground attention, is a shared experience among lower limb prosthesis users. The amount and frequency of prosthetic attention fluctuates throughout the day and changes over time. Measuring attention could inform the evaluation and prescription of technology intended to reduce cognitive effort. IMPLICATIONS FOR REHABILITATION: Walking or performing mobility tasks with a prosthesis requires increased attention and may limit the cognitive resources available for other important activities. Lower limb prosthesis users report paying attention to their prosthesis(ses) to avoid falling, to maintain the fit of their prosthetic socket, and to learn to complete mobility tasks with a prosthesis. Clinicians should discuss prosthetic attention with new prosthesis users and explain how it is expected to decrease over time. Prosthetic technology may affect prosthetic attention but development of a measure to assess prosthetic attention is needed to accurately evaluate this relationship. [ABSTRACT FROM AUTHOR]

Purpose: Life after any amputation can be significantly altered and can have a significant impact on quality of life (QoL). However, most of the evidence base involves older aged amputees, therefore there is a lack of understanding about the impact of amputation on QoL and the factors that predict QoL in younger amputees. The aim of this review is to identify the factors that predict QoL in young amputees. Methods: MEDLINE, CINAHL, EMBASE, PsycINFO, Web of Science were searched to identify articles that measured QoL in young amputees. Articles were independently assessed by two assessors. Data was extracted from the selected articles and a narrative synthesis performed. Results: 18 articles were included in this review. QoL outcome measures varied between studies. The quality of evidence was generally low. This review identified, gender, age, cause of amputation, level of amputation, phantom pain, ability to use a prosthesis, physical function, depression, anxiety, body image, type of prosthesis as predictors of QoL. Conclusion: This review identified modifiable and non-modifiable predictors of QoL in young amputees. Future research needs to focus on exploring the modifiable predictors of QoL as these are the aspects that can be improved to enhance QoL. IMPLICATIONS FOR REHABILITATION: Life after any amputation can be significantly altered and can have a significant impact on quality of life (QoL). Gender, age, cause of amputation, level of amputation, phantom pain, ability to use a prosthesis, physical function, depression and anxiety, body image and type of prosthesis were identified as predictors of QoL. The ability to use a prosthesis and access to advanced prosthetic technology are important predictors of QoL as they allow for improved mobility, which in turn increases independence and therefore QoL. [ABSTRACT FROM AUTHOR]

Introduction: Muscle activity patterns in the residual arm are systematically present during phantom hand movements (PHM) in transhumeral amputees. However, their characteristics have not been directly investigated yet, leaving their neurophysiological origin poorly understood. This study pioneers a neurophysiological perspective in examining PHM-related muscle activity patterns by characterizing and comparing them with those in the arm, forearm, and hand muscles of control participants executing intact hand movements (IHM) of similar types. Methods: To enable rigorous comparison, we developed meta-variables independent of electrode placement, quantifying the phasic profile of recorded surface EMG signals and the specificity of their patterns across electrode sites and movement types. Results: Similar to the forearm and hand muscles during IHM, each signal recorded from the residual upper arm during PHM displays a phasic profile, synchronized with the onset and offset of each movement repetition. Furthermore, the PHM-related patterns of phasic muscle activity are specific not only to the type of movement but also to the electrode site, even within the same upper arm muscle, while these muscles exhibit homogeneous activities in intact arms. Discussion: Our results suggest the existence of peripheral reorganization, eventually leading to the emergence of independently controlled muscular sub-volumes. This reorganization potentially occurs through the sprouting of severed axons and the recapture of muscle fibers in the residual limb. Further research is imperative to comprehend this mechanism and its relationship with PHM, holding significant implications for the rehabilitation process and myoelectric prosthesis control. [ABSTRACT FROM AUTHOR]

Pain assessment is key in deciding whether amputee patients are fit to receive a prosthesis, but its interactional accomplishment is still underexplored. This study adopts multimodal conversation analysis to investigate how pain assessment is carried out during medical visits at an Italian prosthetic clinic involving 77 patients and 24 health professionals. In the analyzed data, doctors carry out pain assessment by asking patients whether they feel pain during palpation of the stump, and patients respond by elaborating on their sensations and using touch in turn. The analysis focuses on a collection of 10 cases in which patients use response expansions and self-touch to reorient doctors’ ongoing inquiry by specifying the type of sensation they experience and its location or to correct doctors’ previous inquiry. The analysis illuminates how the patient’s body becomes a resource for tactile practices that are shared between doctors and patients in the service of a common understanding of patients’ pain. This analysis provides new knowledge of a practice patients use to redirect doctors’ attention and understandings. [ABSTRACT FROM AUTHOR]

Introduction Approximately 89% of all service members with amputations do not return to duty. Restoring intuitive neural control with somatosensory sensation is a key to improving the safety and efficacy of prosthetic locomotion. However, natural somatosensory feedback from lower-limb prostheses has not yet been incorporated into any commercial prostheses Materials and Methods We developed a neuroprosthesis with intuitive bidirectional control and somatosensation and evoking phase-dependent locomotor reflexes, we aspire to significantly improve the prosthetic rehabilitation and long-term functional outcomes of U.S. amputees. We implanted the skin and bone integrated pylon with peripheral neural interface pylon into the cat distal tibia, electromyographic electrodes into the residual gastrocnemius muscle, and nerve cuff electrodes on the distal tibial and sciatic nerves. Results. The bidirectional neural interface that was developed was integrated into the existing passive Free-Flow Foot and Ankle prosthesis, WillowWood, Mount Sterling, OH. The Free-Flow Foot was chosen because it had the highest Index of Anthropomorphicity among lower-limb prostheses and was the first anthropomorphic prosthesis brought to market. Conclusion. The cats walked on a treadmill with no cutaneous feedback from the foot in the control condition and with their residual distal tibial nerve stimulated during the stance phase of walking [ABSTRACT FROM AUTHOR]

Elastomeric interphases (liners) protect the residual limb and distribute mass bearing to the prosthetic socket. However, discomfort due to excessive sweat and heat in the residual limb is the most relevant factor that negatively affects the quality of life in transfemoral prosthetics users. Additionally, a warm and humid environment and the non-uniform mass distribution can compromise blood flow in the residual limb; these factors favor the development of skin lesions, the dropout rate of prosthetic use, and subsequent amputations. Previous mathematical models that predict skin temperature distribution based on Pennes' model and explain the Fourier and non-Fourier thermic response are available. However, these models require knowledge of difficult parameters to obtain in conditions that lead to amputation. Therefore, the current study aims to propose an experimentally based method to design a personalized liner with areas of different diffusivity rates by using perforations according to thermal needs, preserving the mechanical properties of the liner. After thermal and mechanical characterization, we elaborated a personalized plane liner according to the thermal expression of the anterior thigh using infrared analysis. We tested the liner to probe its ability to dissipate heat. [ABSTRACT FROM AUTHOR]

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Background: The knee joint must adapt to the changes in walking speed to stabilize the stance phase and provide fluency in the swing phase.Objective: This study aimed to report a comparison of the gait patterns of transfemoral amputees using a novel mechanical prosthetic knee that can adapt automatically to different walking speeds with 3R60 and 3R15 knee prostheses.Material and Methods: In this experimental study, biomechanical data were collected from six unilateral trans-femoral amputees walking with three knee prostheses. Gait data were gathered at slow, normal, and fast walking speeds across a 7-meter walkway using the Vicon motion system.Results: The results revealed a significant difference in knee angular velocity during the swing phase between prosthetic knees across three walking speeds (P-value=0.002). Prosthetic knee flexion decreased significantly by increasing walking speed for the novel mechanical auto-adaptive prosthetic knee (P-value

Introduction: While each of the 44 National Health Service commissioned artificial limb clinics in the United Kingdom record information about their own prosthetic limb users, these are not collated to give a national picture of amputee epidemiology. The requirement to respond to Freedom of Information (FoI) requests within 20 working days offers another way of extracting data from all centres, and this study describes a first attempt to use this method to update national epidemiological data. Methods: Questions were sent to the FoI email addresses of all 44 centres, requesting numbers of adult unilateral below-knee amputees, adult unilateral above or through-knee amputees and child unilateral above or through-knee amputees (all of K2 level mobility), numbers of people consistently using a prosthesis with a single axis myoelectric hand, and access to an occupational therapist with skills to teach someone to use a myoelectric hand. A FoI request was sent to NHS England seeking release of data that they collect every month from all the prosthetic services which they commission in England. Results: All but one of the UK centres responded, the great majority within 31 days. Incomplete results were generally due to centres finding the questions ambiguous and many did not record mobility levels consistently. While 33 centres had access to skilled occupational therapy, only 4 reported more than 10 patients who constantly used a single axis myoelectric hand. Eighteen centres were unable to provide complete data, and the remainder reported a ranges of 5 to 992 below-knee amputees, 7 to 574 adult above-knee amputees and 0 to 137 child above-knee amputees, suggesting different approaches to managing missing mobility level data. Conclusions: Freedom of Information requests are an inexpensive way of gathering data from NHS prosthetic clinics, which can identify age, sex, level of amputation but not activity levels or use of a prosthesis and hence only gives limited demographic information of the amputee cohort. [ABSTRACT FROM AUTHOR]

Objective: Acute trauma care has significantly reduced mortality over the last two decades. The last study to examine the epidemiology of traumatic amputees predates these gains. The majority of those who sustain traumatic amputation are male; therefore, limited data exist on female amputees. This study aimed to (1) provide a current epidemiological analysis of traumatic amputees and (2) compare male and female amputees. Design: All patients sustaining a major limb amputation in the National Trauma Data Bank from 2013 to 2017 were identified. First, descriptive analyses of patient demographics and injury characteristics were performed and compared with a previous 2000-2004 National Trauma Data Bank study. Second, female and male traumatic amputees were compared in this study. Results: From2013 to 2017, we identified 7016 patientswho underwent major limb amputation. Compared with previous years, the current amputees were older and more severely injured. Mortality was 6.3% in the current years compared with 13.4% in the previous years (odds ratio, 0.44, 95% CI = 0.37-0.51, P < 0.001). After multivariable analysis, mortality remained significantly decreased, with no difference in hospital length of stay. Conclusions: Contemporary National Trauma Data Bank analysis demonstrated that patients with traumatic amputations, regardless of sex, often survive until hospital discharge, despite more severe injuries. [ABSTRACT FROM AUTHOR]

Functional mobility tests, such as the L test of functional mobility, are recommended to provide clinicians with information regarding the mobility progress of lower-limb amputees. Smartphone inertial sensors have been used to perform subtask segmentation on functional mobility tests, providing further clinically useful measures such as fall risk. However, L test subtask segmentation rule-based algorithms developed for able-bodied individuals have not produced sufficiently acceptable results when tested with lower-limb amputee data. In this paper, a random forest machine learning model was trained to segment subtasks of the L test for application to lower-limb amputees. The model was trained with 105 trials completed by able-bodied participants and 25 trials completed by lower-limb amputee participants and tested using a leave-one-out method with lower-limb amputees. This algorithm successfully classified subtasks within a one-foot strike for most lower-limb amputee participants. The algorithm produced acceptable results to enhance clinician understanding of a person's mobility status (>85% accuracy, >75% sensitivity, >95% specificity). [ABSTRACT FROM AUTHOR]

Purpose: The linear encoder and the Calf Raise App have been shown to be valid for measurements of plantar flexor muscular endurance in the heel raise test when compared with gold standard equipment. However, the validity of the Calf Raise App has not yet been compared with a linear encoder, an instrument commonly used in clinical and research settings. The purpose of this study was to determine the concurrent validity of the Calf Raise App compared with a linear encoder for the measurement of average heel raise height and total concentric work in the heel raise test. Methods: Fifty TeamGym athletes (82% females) from an on‐going prospective study were included (mean [SD] age: 20 [7] years; body mass index (BMI) = 21.3 [2.5]). Concurrent validity was analysed with single measures intraclass correlation coefficient (ICC) using a two‐way mixed effects, consistency model. Results: Ninety‐eight samples were included in the analysis. The mean (SD) average heel raise height and total concentric work measured by the linear encoder and Calf Raise App were 9.9 (1.4) and 7.5 (1.2) cm, and 1728 (584) and 1291 (450) J, respectively. The mean (SD) number of unilateral heel raises was 30 (7.5). The results showed poor to moderate concurrent validity for the measurement of average heel raise height (ICC: 0.62; 95% confidence interval [CI]: 0.48–0.73). Good to excellent concurrent validity was shown for the measurement of total concentric work (ICC: 0.89; 95% CI: 0.84–0.93). Conclusion: The Calf Raise App shows good concurrent validity in the heel raise test compared with a linear encoder in measuring total concentric work but not average height. While caution is recommended when comparing results from the different instruments, each instrument can be used separately to compare between‐limb differences or changes over time in plantar flexor muscular endurance in clinical and research settings. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Studies suggest that ambulation after major lower extremity amputation (LEA) is low and mortality after LEA is high. Successful prosthetic fitting after LEA has a significant quality of life benefit; however, it is unclear if there are benefits in post-LEA mortality. Our objective was to examine a contemporary cohort of patients who underwent LEA and determine if there is an association between fitting for a prosthetic and mortality. We reviewed all patients who underwent LEA between 2015 and 2022 at two academic health care systems in a large metropolitan city. The exposure of interest was prosthetic fitting after LEA. The primary outcomes were mortality within 1 and 3 years of follow-up. Ambulation after LEA was defined as being ambulatory with or without an assistive device. Patients with prior LEA were excluded. Extended Cox models with time-dependent exposure were used to evaluate the association between prosthetic fitting and mortality at 1 and 3 years of follow-up. Among 702 patients who underwent LEA, the mean (SD) age was 64.3 (12.6) years and 329 (46.6%) were fitted for prosthetic. The study population was mostly male (n = 488, 69.5%), predominantly non-Hispanic Black (n = 410, 58.4%), and nearly one-fifth were non-ambulatory before LEA (n = 139 [19.8%]). Of note, 14.3% of all subjects who were nonambulatory at some point after LEA, and 28.5% of patients not ambulatory preoperatively were eventually ambulatory after LEA. The rate of death among those fitted for a prosthetic was 12.0/100 person-years at 1 year and 5.8/100 person-years at 3 years of follow-up; among those not fitted for a prosthetic, the rate of death was 55.7/100 person-years and 50.7/100 person-years at 1 and 3 years of follow-up, respectively. After adjusting for several sociodemographic data points, comorbidities, pre- or post- coronavirus disease 2019 pandemic timeframe, and procedural factors, prosthetic fitting is associated with decreased likelihood of mortality within 1 year of follow-up (adjusted hazard ratio, 0.24; 95% confidence interval, 0.14-0.40) as well as within 3 years (adjusted hazard ratio, 0.40; 95% confidence interval, 0.29-0.55). Prosthetic fitting is associated with improved survival, and preoperative functional status does not always predict postoperative functional status. Characterizing patient, surgical, and rehabilitation factors associated with receipt of prosthetic after LEA may improve long-term survival in these patients. Process measures employed by the Department of Veterans Affairs, such as prosthetic department evaluation of all amputees, may represent a best practice. [ABSTRACT FROM AUTHOR]

Purpose: To compare the outcomes of distal neurotomy (DN) versus proximal neurotomy (PN) for the surgical management of painful neuromas in amputees and non-amputees, whether used in passive or active treatment. Methods: A retrospective study was conducted on patients who underwent surgery for painful traumatic neuromas between 2019 and 2022. DN with neuroma excision was performed at the level of the injury or amputation. PN was performed using a separate proximal approach without neuroma excision. Outcomes included a Numerical Rating Scale (NRS) score and Patient-Reported Outcomes Measurement Information System (PROMIS) scores, as well as patients' subjective assessments. Results: A total of 33 patients were included: 17 amputees and 16 non-amputees. They totalized 43 neuromas treated by DN in 21 cases and PN in 22 cases. At the median follow-up time of 13 months, there were significant decreases in all NRS and PROMIS scores in the whole series. The decrease in limb pain scores was not significantly different between groups, except for the decrease in pain interference and patient satisfaction which were higher in the DN group. Sub-group analyses found the same significant differences in amputees. Targeted muscle reinnervation (TMR) was associated with a higher decrease in PROMIS scores. Conclusion: DN seemed to give better results in amputees but there were confusing factors related to associated lesions. In other situations, the non-inferiority of PN was demonstrated. PN could be of interest for treating neuromas of superficial sensory nerves, for avoiding direct revision of a well-fitted stump and in conjunction with TMR. [ABSTRACT FROM AUTHOR]

Changes in limb volume and shape among transtibial amputees affects socket fit and comfort. The ability to accurately measure residual limb volume and shape and relate it to comfort could contribute to advances in socket design and overall care. This work designed and validated a novel 3D laser scanner that measures the volume and shape of residual limbs. The system was designed to provide accurate and repeatable scans, minimize scan duration, and account for limb motion during scans. The scanner was first validated using a cylindrical body with a known shape. Mean volumetric errors of 0.17% were found under static conditions, corresponding to a radial spatial resolution of 0.1 mm. Limb scans were also performed on a transtibial amputee and yielded a standard deviation of 8.1 ml (0.7%) across five scans, and a 46 ml (4%) change in limb volume when the socket was doffed after 15 minutes of standing. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusions\nImplications for rehabilitationTo develop and administer an assessment tool for facilitating patient–clinician discussions regarding amputation-related pain and sensation.An assessment tool was developed to measure the impact of different types of amputation-related pain and sensation on a patient’s life. The tool first provides patients with written descriptions and images of three common types of amputation-related pain or sensations: residual limb pain, phantom limb sensation, and phantom limb pain. The tool then asks them to rate the frequency, intensity, and interference of each experience. Participants were also asked to provide qualitative descriptions of these experiences.Fifty Veterans with lower limb amputation participated in the study. In the past month, 74% reported experiencing residual limb pain, 76% reported phantom limb sensation, and 84% reported phantom limb pain, with 52% reporting all three. Participants’ descriptions of some experiences were distinct, while others (e.g., “tingling”) were common between experiences. Phantom limb pain had the most varied descriptions.The amputation-related pain and sensation assessment tool can be used to identify and measure the effects of different experiences on patients’ lives, thereby improving the specificity of diagnosis and informing clinical treatment recommendations. Further development of this tool should include evaluating its psychometric properties.The amputation-related pain and sensation assessment tool was developed for use in patient–clinician discussions to identify and measure residual limb pain, phantom limb sensation, and phantom limb pain.In our sample, participants used common words to describe all three experiences.The use of illustrations in combination with descriptions may aid in differentiating these distinct experiences.Next steps for this assessment tool include further development of illustrations to represent patient diversity as well as evaluation of psychometric properties.The amputation-related pain and sensation assessment tool was developed for use in patient–clinician discussions to identify and measure residual limb pain, phantom limb sensation, and phantom limb pain.In our sample, participants used common words to describe all three experiences.The use of illustrations in combination with descriptions may aid in differentiating these distinct experiences.Next steps for this assessment tool include further development of illustrations to represent patient diversity as well as evaluation of psychometric properties. [ABSTRACT FROM AUTHOR]

Objective: To determine predictive factors of successful rehabilitation in patients with lower limb amputation who use a prosthetic device. Methods: A retrospective observational and non-probabilistic study was carried out among 70 patients who underwent transfemoral (AK) or transtibial amputation (BK) of vascular, oncologic, or traumatic origin at the Instituto Nacional de Rehabilitación "Dra. Adriana Rebaza Flores" AMISTAD PERU-JAPON, Lima-Peru, from 2018 and 2019. Patients were interviewed, and clinical charts were reviewed. Successful rehabilitation was evaluated using Houghton's instrument. Results: 81.42% were males; the mean age was 48.76 ± 15.19 years; 35.71% had between 48 and 57 years of age. Successful rehabilitation was associated with age (p<0.01), BK amputation (p<0.001), traumatic origin (p=0.014), and absence of comorbidities (p<0.04). The only predictive factor of successful rehabilitation was BK amputation [OR=2.84, p<0.02). Conclusions: Factors associated with successful rehabilitation were age below 48 years, BK amputation, traumatic origin, and fewer comorbidities, but the only determinant was the level of amputation. [ABSTRACT FROM AUTHOR]

Objective: To identify the region of interest (ROI) to represent injury and observe between-limb diffusion tensor imaging (DTI) microstructural differences in muscle following hamstring strain injury. Materials and methods: Participants who sustained a hamstring strain injury prospectively underwent 3T-MRI of bilateral thighs using T1, T2, and diffusion-weighted imaging at time of injury (TOI), return to sport (RTS), and 12 weeks after RTS (12wks). ROIs were using the hyperintense region on a T2-weighted sequence: edema, focused edema, and primary muscle injured excluding edema (no edema). Linear mixed-effects models were used to compare diffusion parameters between ROIs and timepoints and limbs and timepoints. Results: Twenty-four participants (29 injuries) were included. A significant ROI-by-timepoint interaction was detected for all diffusivity measures. The edema and focused edema ROIs demonstrated increased diffusion at TOI compared to RTS for all diffusivity measures (p-values < 0.006), except λ1 (p-values = 0.058–0.12), and compared to 12wks (p-values < 0.02). In the no edema ROI, differences in diffusivity measures were not observed (p-values > 0.82). At TOI, no edema ROI diffusivity measures were lower than the edema ROI (p-values < 0.001) but not at RTS or 12wks (p-values > 0.69). A significant limb-by-timepoint interaction was detected for all diffusivity measures with increased diffusion in the involved limb at TOI (p-values < 0.001) but not at RTS or 12wks (p-values > 0.42). Significant differences in fractional anisotropy over time or between limbs were not detected. Conclusion: Hyperintensity on T2-weighted imaging used to define the injured region holds promise in describing muscle microstructure following hamstring strain injury by demonstrating between-limb differences at TOI but not at follow-up timepoints. [ABSTRACT FROM AUTHOR]

Various techniques have been proposed to manufacture prosthetic sockets, which are essential in improving the quality of life among amputees and individuals with special needs. However, the fabrication of prosthetics using the available approaches is uneconomical due to the type of materials utilized during the production, as well as the direct methods that use expensive materials to produce prosthetic parts. Considering this, it is crucial to enhance the direct methods by exploiting cost-effective materials to produce prosthetic parts with desirable behaviors. Therefore, this study aimed to compare the fatigue performance of below-knee (BK) prosthetic sockets manufactured using three different techniques: laminate, direct, and novel. The three sockets specimens were first manufactured. Specimen A was made via the direct method using 4 layers of carbon fiber as the reinforcement and AX140401 as the matrix. Specimen B was also fabricated via the lamination method using 4 layers of carbon fiber as the reinforcement and lamination resin + hardener acrylic as the matrix. Finally, specimen C was made via the direct novel method using 4 layers of carbon as the reinforcement, and the matrix was composed of 20% polyurethane resin (part A: resin, part B: hardener) + 80% acrylic. Subsequently, the pressure distribution at the contact point between the socket and the residual limb was analyzed using the FSOCKET device. Furthermore, the numerical analysis included the distribution of the stress and the highest internal pressure, the number of cycles ascertained through the utilization of the SOLIDWORKS software. Based on the results, the S-N curves for each specimen show that all three specimens behaved similarly. Using the F-socket, the pressure during the patient's walking cycle reached its highest point at 190 kPa. In addition, applying ground reaction force from the bottom of the direct, lamination, and novel BK prosthetic sockets demonstrated the pressure distribution of the part that reacts to the loading condition. The SOLIDWORKS program revealed from the pressure distribution of the three sockets measured a maximum internal pressure of 191 kPa, 193 kPa, and 191 kPa sequentially, which was close to the pressure within the F-socket. Besides, the number of cycles for the direct, lamination, and novel BK prosthetic sockets was 1,332,345, 1,202,345, and 1,203,567 cycles. In summary, all three specimens fabricated via the direct, lamination, and novel methods achieved similar fatigue performance of BK prosthetic sockets. So, the novel BK prosthetic socket wad designed in which fabricated using a new matrix material was considered acceptable, similar to specimens A and B. [ABSTRACT FROM AUTHOR]

Introduction: Electronic versions of patient-reported outcome measures (PROMs) seem to have a clear administrative logging advantage to traditional paper versions. However, most of them have not been formally evaluated for their suitability to replace paper outcome measures for assessment of individuals with lower-limb amputations. The aim of this study is to examine the usability and equivalence of electronic to paper versions of PROMs suitable for use in prosthetic clinical care and research for persons with lower-limb loss. Methods: In this cross-sectional study, 10 participants remotely completed the following PROMs online and then on paper: Orthotic and Prosthetic User Survey (OPUS), Modified Falls Efficacy Scale (MFES), Prosthetic Evaluation Questionnaire (PEQ), Patient Health Questionnaire–9 (PHQ-9), and Community Participation Indicators (CPI). Participants also answered open-ended and standardized questions regarding the usability of the electronic surveys. Wilcoxon signed rank tests, comparisons to minimum detectable change, intraclass correlation coefficients, and Bland-Altman plots were used to evaluate differences between the two survey versions, meaningful changes in scores, reliability, and systematic biases, respectively. Results: Electronic surveys had fewer missing or ambiguous responses than paper surveys; however, the PEQ Social Burdens subscale could not be evaluated due to error in the creation of the electronic survey. No significant differences were found between scores of the two versions for any of the measures, but multiple participants had meaningful changes in the Appearance and Sounds PEQ subscales. All measures demonstrated acceptable reliability between versions, except the Appearance, Perceived Response, and Sounds subscales of the PEQ. No systematic biases in scores or usability concerns were found for any measures. Conclusions: This study analysis showed that most of the electronic PROMs studied are easily used and demonstrate equivalence to the paper versions. However, the PEQ Appearance, Perceived Response, Sounds, and Social Burden subscales require further evaluation. [ABSTRACT FROM AUTHOR]

Background The development of disability related to activities of daily living (ADL) is of great concern in the aging population, particularly for Hispanic and Non-Hispanic (NH) Black older adults, where disability prevalence is greater compared to NH Whites. ADL-disability is typically measured across many functional tasks without differentiating upper- versus lower-limb limitations, hindering our understanding of disability burden. Despite the importance of the upper limbs for completing ADL and known age-related declines in function, racial/ethnic differences in upper limb function remain largely unknown. Methods We identified 4 292 NH White, NH Black, and Mexican American older adults (≥65) from the 2011–2018 waves of the National Health and Nutrition Examination Survey (NHANES). We classified participants as having a limitation based on their ability to complete 5 upper-limb tasks (preparing meals, eating, dressing, reaching overhead, and grasping small objects) and compared limitation rates across racial/ethnic groups. Results Compared to NH Whites, NH Black older adults had significantly greater odds of reporting difficulties preparing meals (odds ratio [OR]: 1.36, 95% confidence interval [95% CI]: 1.01, 1.86) and dressing (OR: 1.55, 95% CI: 1.19, 2.02), while Mexican Americans had greater difficulty preparing meals (OR: 1.70, 95% CI: 1.12, 2.58), dressing (OR: 1.63, 95% CI: 1.12, 2.36), and grasping small objects (OR: 1.48, 95% CI: 1.06, 2.07). Conclusions Our results demonstrate differences in self-reported upper limb ADL-disability across racial/ethnic groups, particularly for Mexican American older adults. Such findings underscore the need for routine monitoring of upper limb function throughout adulthood to identify limitations and target therapeutic interventions before independence is compromised. [ABSTRACT FROM AUTHOR]

To describe admission and discharge characteristics of participants admitted to prosthetic rehabilitation following a lower limb amputation and determine changes in participant characteristics including if the population has gotten older over time at admission. A retrospective chart audit of consecutive admissions to an amputee rehabilitation program. Study criteria were transtibial level LLA and above and ≥ 18 years old. Admission characteristics included: age, Montreal Cognitive Assessment (MoCA), Functional Comorbidity Index (FCI) and days between amputation surgery and admission. Discharge characteristics included the L -Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence (ABC) scale. Multivariable linear regression modelling quantified the association between participant characteristics and admission time. A total of 601 participants (62.3 ± 14.1 years) were included, 63 were (84.9 ± 3.7 years) aged 80 and over. FCI scores [β = 70.34, (95% CI: 20.93, 119.74), p = 0.005] and days between amputation surgery [β = −0.08, (95% CI: −0.13, −0.02), p = 0.011] were independently associated with admission time. People with an LLA are presenting with a higher number of comorbidities at admission over time while being admitted faster from amputation surgery. Future research should investigate the impact of these changing characteristics on rehabilitation outcomes to better assist this population. It is expected that the rate of inpatient prosthetic rehabilitation admissions due to lower limb amputations will increase amongst those over eighty. An analysis of participant characteristics of people admitted to inpatient prosthetic rehabilitation over time will inform modification and developments to future programs. Future prosthetic rehabilitation programs should consider an increased number of comorbidities when developing prognostic expectations for participants. A shortened interval between amputation surgery and admission should be considered when developing prosthetic rehabilitation programs. [ABSTRACT FROM AUTHOR]

Similar to nonamputees, female athletes with unilateral transtibial amputation (TTA) using running-specific leg prostheses (RSPs) may have worse running economy and higher rates of running-related injury than male athletes. Optimizing RSP configuration for female athletes could improve running economy and minimize biomechanical asymmetry, which has been associated with running-related injury. Nine females with a TTA ran at 2.5 m/s while we measured metabolic rates and ground reaction forces. Subjects used an RSP with a manufacturer-recommended stiffness category, one category less stiff and two categories less stiff than recommended. Use of an RSP two categories less stiff resulted in 3.0% lower net metabolic power (P = 0.04), 7.8% lower affected leg stiffness (P = 6.01 × 10−4), increased contact time asymmetry (P = 0.04), and decreased stance average vertical ground reaction force asymmetry (P = 0.04) compared with a recommended stiffness category RSP. Lower RSP stiffness (kN/m) values were associated with lower net metabolic power (P = 0.02), lower affected leg stiffness (P = 1.36 × 10−4), longer affected leg contact time (P = 1.46 × 10−4), and similar affected leg peak and stance-average vertical ground reaction force compared with higher RSP stiffness values. Subjects then used the RSP stiffness category that elicited the lowest net metabolic power with 100 g, 200 g, and 300 g added distally. We found no significant effects of added mass on net metabolic power, biomechanics, or asymmetry. These results suggest that female runners with a TTA could decrease metabolic power during running while minimizing biomechanical asymmetries, which have been associated with running-related injury, by using an RSP two categories less stiff than manufacturer recommended. NEW & NOTEWORTHY: Females with unilateral transtibial amputation can improve running performance through reductions in net metabolic power by using a running-specific prosthesis (RSP) that is less stiff than manufacturer-recommended. Lower RSP stiffness values are associated with greater leg stiffness and contact time asymmetry, and lower stance-average vertical ground reaction force asymmetry. However, we found that adding mass to the RSP did not affect net metabolic power and stance-phase biomechanical asymmetries during running. [ABSTRACT FROM AUTHOR]

The physiological changes and alterations in gait following amputation may increase the risk of fractures. However, there is insufficient research on fracture risk in amputees. Therefore, this study intended to analyze whether the risk of new fractures increases after traumatic amputations. This population-based, retrospective cohort study used data from the Korean National Health Insurance System database. The study included 19,586 participants who had undergone an amputation and 76,645 matched controls. The incidence of any fracture and site-specific fractures (vertebral, hip, and others) according to amputation site(s) and severity of disability due to amputation were evaluated using Cox proportional hazard regression analysis. During the mean follow-up of 4.2 years, amputees had a higher incidence rate (IR) of any fracture (adjusted HR [aHR] 1.47, 95% CI 1.36–1.60), vertebral fracture (aHR 1.63, 95% CI 1.44–1.85), hip fracture (aHR 1.85, 95% CI 1.39–2.46), and other fracture (aHR 1.34, 95% CI 1.20–1.49) compared to that of controls. In the presence of disability, the risks were further increased and were highest among amputees with severe disabilities. All fracture risks were higher in amputees than they were in controls, regardless of lower limb or upper limb amputation. This cohort study demonstrated that traumatic amputees experienced higher incidence of all fractures than did individuals without amputations, and this risk increases with severity of disability. This finding underscores the importance of early screening and lifestyle interventions to address fracture risk in traumatic amputees. [ABSTRACT FROM AUTHOR]

Background: After anterior cruciate ligament reconstruction (ACLR), single-leg horizontal hop distance limb symmetry index (LSI) >90% is recommended as a cutoff point for safe return to sport (RTS). However, athletes after ACLR have abnormal lower limb biomechanics despite an adequate single-leg hop distance LSI, implying that athletes are at high risk of reinjury. Symmetry of single-leg vertical jump height appears to be more difficult to achieve and can be a better representation of knee function than single-leg horizontal hop distance. Hypothesis: Athletes after ACLR with single-leg jump height LSI >90% had similar biomechanical characteristics to healthy athletes. Study Design: Controlled laboratory study. Level of Evidence: Level 3. Methods: A total of 46 athletes after ACLR were divided into low jump height (LJH, jump height LSI <90%, n = 23) and high jump height (HJH, jump height LSI >90%, n = 23) groups according to symmetry of single-leg vertical jump height, while 24 healthy athletes acted as a control (CONT) group. One-way analysis of variance was used to compare the kinematic and kinetic characteristics of the LJH, HJH, and CONT groups during single-leg vertical jump. Results: Both the LJH and HJH groups demonstrated greater limb asymmetry (lower LSI) during landing compared with the CONT group in knee extension moment (P < 0.05), peak knee flexion angle (P < 0.05), and knee power (P < 0.05). Conclusion: Symmetry in single-leg vertical jump height does not represent normal lower limb biomechanics in athletes after ACLR. Clinical Relevance: Symmetrical jump height may not signify ideal biomechanical or RTS readiness, but single-leg vertical jump test can be used as a supplement to horizontal hop test or other functional tests to reduce the likelihood of false-negative results in the absence of detailed biomechanical evaluation. [ABSTRACT FROM AUTHOR]

Background: The knee joint must adapt to the changes in walking speed to stabilize the stance phase and provide fluency in the swing phase. Objective: This study aimed to report a comparison of the gait patterns of transfemoral amputees using a novel mechanical prosthetic knee that can adapt automatically to different walking speeds with 3R60 and 3R15 knee prostheses. Material and Methods: In this experimental study, biomechanical data were collected from six unilateral trans-femoral amputees walking with three knee prostheses. Gait data were gathered at slow, normal, and fast walking speeds across a 7-meter walkway using the Vicon motion system. Results: The results revealed a significant difference in knee angular velocity during the swing phase between prosthetic knees across three walking speeds (P-value=0.002). Prosthetic knee flexion decreased significantly by increasing walking speed for the novel mechanical auto-adaptive prosthetic knee (P-value<0.001). A lower value of hip power during early swing was considered when amputees walked with novel knee prosthesis (P-value<0.00). The intact leg ankle plantar flexion angle or vaulting did not significantly change while walking speed increased in the novel knee prostheses compared to walking with the 3R60 and 3R15 knee prostheses (P-value=0.002 and P-value<0.06, respectively). Conclusion: Based on the results, a novel mechanical auto-adaptive knee prosthesis has advantages compared to the other conventional designs for unilateral trans-femoral amputees walking at different speeds. [ABSTRACT FROM AUTHOR]

Aim: This study was undertaken to evaluate the risk factors and associated pathways for unmet dental prosthetic needs among older adult population in Central India. Methods: A total of 11,145 randomly selected older adults participated in the study; 4613 from urban region and 6532 form rural region. Oral examinations were conducted at individual households for recording dental caries, periodontal disease, prosthetic status and needs. Structural Equation Modelling (SEM) was used to examine relationship between a set of exogenous variables and unmet dental prosthetic needs with variables that remained significant in the adjusted multilevel logistic model. Path coefficients were calculated for all variables with 95% confidence interval. Goodness of fit of the model was assessed by several indices. Results: A total of 8433 (75.7%) participants had never visited a dentist and 9139 (82%) had unmet dental prosthetic needs. Dental caries was observed among 3207 (69.5%) and 4644 (71.1%) study participants from urban and rural regions respectively (p <.05). Low utilization of dental services was associated with high dental prosthetic needs in upper arch and lower arch (PC = −0.05, 0.001) and DMFT was associated with lower utilization of dental services (PC = −0.09, 0.001). DMFT was also associated with age, annual income, level of education, paternal education, type of family, tobacco consumption and CPI score in the hypothesized model. The fit indices used indicated that the model was adequate. Conclusions: Dental prosthetic needs in the proposed pathway model was associated with low utilization of dental services, dental caries, periodontal disease and other socio‐demographic factors. [ABSTRACT FROM AUTHOR]

Treatment with autologous chimeric antigen receptor (CAR) T cells has emerged as a highly effective approach in neuroimmunological disorders such as myasthenia gravis. We report a case of successful anti-CD 19 CAR T cell use in treatment-refractory stiff-person syndrome (SPS). To investigate clinical and immunological effects of anti-CD19 CAR T cell use in treatment-refractory SPS, a 69-y-old female with a 9-y history of treatment-refractory SPS with deteriorating episodes of stiffness received an infusion of autologous anti-CD19 CAR T cells (KYV-101) and was monitored clinically and immunologically for more than 6 mo. CAR T cell infusion resulted in reduced leg stiffness, drastic improvement in gait, walking speed increase over 100%, and daily walking distance improvement from less than 50 m to over 6 km within 3 mo. GABAergic medication (benzodiazepines) was reduced by 40%. KYV-101 CAR T cells were well tolerated with only low-grade cytokine release syndrome. This report of successful use of anti-CD19 CAR T cells in treatment-refractory SPS supports continued exploration of this approach in SPS and other B cell--related autoimmune disorders. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed to identify clinical measures that have been used to evaluate function, health related quality of life (HRQoL), and/or satisfaction in children who use lower limb prostheses (LLP). The data reported on psychometric properties for children who use LLP were collected for each measure. METHODS: First, PubMed, CINAHL, and Web of Science databases were searched using broad search terms to identify standardized outcome measures of function, HRQoL, and/or satisfaction with treatment used in pediatric LLP research published in 2001 or after. For each of the eligible measures found, a second search was performed to identify psychometric properties (e.g., validity, reliability) assessed with children who use LLP. RESULTS: Forty-four standardized outcome measures were identified from 41 pediatric LLP research articles. Five measures (i.e., Gait Outcomes Assessment for Lower Limb Differences, Functional Mobility Assessment, Child Amputee Prosthetics Project- Prosthesis Satisfaction Inventory, Child Amputee Prosthetics Project- Functional Scale Index, and Lower Limb Function Questionnaire) had data on psychometric properties for children who use LLP. CONCLUSIONS: Few studies report psychometric data for assessing the overall HRQoL, function, and/or satisfaction for children who use LLP. Further research is needed to validate or create new outcome measures that assess the HRQoL, satisfaction, and/or function of children who use LLP. [ABSTRACT FROM AUTHOR]

• One to three sessions of 20-60 minutes of exercise per week of mixed exercise programs, ie, programs combining aerobic exercise with strengthening or balance exercise improves balance, walking speed, walking endurance, and transfer ability in adults with lower limb amputation. • Further high-quality studies are needed to increase confidence on the effect of exercise training programs to improve cardiorespiratory health, muscle strength, flexibility, and functional status in adults with lower limb amputation. • There is a need to develop guidelines specific to people with physical disabilities, and extrapolating guidelines from the able-bodied population may be inappropriate or even potentially harmful. • The results of this review and the exercise descriptions will provide the basis for the development of physical activity guidelines for adults with lower limb amputation. To answer the following questions: (1) Do physical activity (PA) and exercise improve fitness, mobility, and functional capacity among adults with lower limb amputation (LLA) and (2) What is the type and minimum dose of PA (frequency, intensity and duration) needed? Systematic review. Outpatient intervention, outside of the prosthetic rehabilitation phase. Adults with lower limb amputation living in the community. Any physical activity or exercise intervention. Any fitness, mobility, or functional capacity indicators and measurements. Twenty-three studies were included, totaling 408 adults with LLA. Studies evaluated the effect of structured PA sessions on fitness, mobility, and functional capacity. The highest evidence is for mixed exercise programs, that is, programs combining aerobic exercise with strengthening or balance exercise. There is moderate confidence that 1-3 sessions of 20-60 minutes of exercise per week improves balance, walking speed, walking endurance, and transfer ability in adults with LLA above the ankle. As for flexibility, cardiorespiratory health, lower-limb muscles strength, and functional capacity, there was low confidence that exercise improves these fitness components because of the lack of studies. Exercise 1-3 times per week may improve balance, walking speed, walking endurance, and transfer ability in adults with LLA, especially when combining aerobic exercises with lower limb strengthening or balance exercises. There is a need for most robust studies focusing on the effect of PA on cardiorespiratory health, muscles strength, flexibility, and functional status. [ABSTRACT FROM AUTHOR]

Prosthetic socket manufacturing is experiencing a revolutionary shift towards using digital methods, such as 3D scanning and 3D printing. However, using digital methods requires the clinician to transfer their skills from making sockets by hand to making sockets with a computer. This shift in practice may change the socket geometry and fit; however, to what extent is unknown. Thus, the aim of this study was to explore the feasibility of analyzing geometric and clinical differences between digitally- and manually-designed sockets. Nine adult inpatients with below-knee amputation were recruited. Two sockets were 3D printed for each participant from 3D socket models that were developed from: (1) 3D scanning a manually-modified hand-casted positive mold of the residuum; and (2) a digitally-modified 3D scan of the residuum. Manual and digital procedures were compared for three measures: final socket geometry, the Socket Comfort Score, and a patient experience survey. Feasibility data were collected to measure protocol implementation fidelity to inform a future larger study. These data revealed that 89% of participants followed the intended protocol, no participants dropped out, and only one adverse event was report. As no significant geometric differences were found and participants experienced similar comfort scores between manually- and digitally-designed sockets, study feasibility was determined to be successful. Thus, a randomized control trial study will be conducted to draw statistically relevant conclusions from these outcome measures that may provide meaningful information for improving digital design procedures. [ABSTRACT FROM AUTHOR]

The demand for affordable prostheses, particularly in low- and middle-income countries (LMICs), is significant. Currently, the majority of prosthetic sockets are manufactured using monolithic thermoplastic polymers such as PP (polypropylene), which lack durability, strength, and exhibit creep. Alternatively, they are reinforced with consumptive thermoset resin and expensive composite fillers such as carbon, glass, or Kevlar fibres. However, there are unmet needs that amputees face in obtaining affordable prosthetic sockets, demanding a solution. This study utilises self-reinforced PET (polyethylene terephthalate), an affordable and sustainable composite material, to produce custom-made sockets. Advancing the development of a unique socket manufacturing technique employing a reusable vacuum bag and a purpose-built curing oven, we tested fabricated sockets for maximum strength. Subsequently, a prosthetic device was created and assessed for its performance during ambulation. The mechanical and structural strength of PET materials for sockets reached a maximum strength of 132 MPa and 5686 N. Findings indicate that the material has the potential to serve as a viable substitute for manufacturing functional sockets. Additionally, TOPSIS analysis was conducted to compare the performance index of sockets, considering decision criteria such as material cost, socket weight, and strength. The results showed that PET sockets outperformed other materials in affordability, durability, and strength. The methodology successfully fabricated complex-shaped patient sockets in under two hours. Additionally, walking tests demonstrated that amputees could perform daily activities without interruptions. This research makes significant progress towards realising affordable prostheses for LMICs, aiming to provide patient-specific affordable prostheses tailored for LMICs. [ABSTRACT FROM AUTHOR]

Problem: We aimed to explore the potential association between sprint running horizontal force production capacities (the theoretical maximum horizontal force that the lower limbs can produce at zero velocity: FH0, and the theoretical maximum velocity until which they can produce force (velocity at zero force): v0) and occurrence of lower limb injuries (LLI) in athletics (track and field) athletes through a season. Methods: We performed a prospective cohort study with data collection of FH0 and v0 and their week-to-week changes (dFH0 and dv0, respectively) and LLI in 16 athletes practicing sprints, jumps or combined events in the same training group during the 2021/2022 season (37 weeks). We performed a multivariable binomial logistic regression with LLI (yes/no) as the dependent variable, and FH0 and v0, dFH0 and dv0 as explanatory variables, adjusted for individual athletes and LLI during the previous week (yes/no). Risk indicators were presented as odd ratios (OR) and 95% confidence intervals (95% CI). Results: The multivariable binomial logistic regression showed that a higher FH0 was associated with lower LLI risk (OR=0.12 (95%CI: 0.00-0.89). Conclusion: Lower FH0 was associated with higher risk of sustaining a new lower limb injury during the next week. Although caution should be taken on these preliminary results (e.g., small athletes' sample, missing measurements, few confounding factors included), monitoring the FH0 could be one additional relevant approach to detect LLI in athletics. [ABSTRACT FROM AUTHOR]

As one of the basic activities of human beings, the analysis of walking is of great significance in clinical research. In this paper, we analyzed the published plantar pressure dataset Gait in Parkinson's Disease, designed a method to divide the gait period, and extracted the characteristic parameters of gait. A hybrid neural network (GRU-DNN) was applied to classify Parkinson's disease by combining the gated circulation unit (GRU) and the deep neural network (DNN). Data analysis provided more objective basis for clinical diagnosis, thereby assisting doctors in diagnosing the disease. To verify the effectiveness of the method, the network was used to classify and predict gait information with disease labels in the dataset. In Parkinson's disease diagnosis experiment, the recognition accuracy of this network was 98.7%. In the Parkinson's severity diagnosis experiment, the network achieved 100% recognition accuracy for severity level 2, and 98% for the rest of the severity level. [ABSTRACT FROM AUTHOR]