Prosthetics and Orthotics International

The length of the lower limb prosthes is was compared with the length of the contralateral lower extremity in 113 Finnish war-disabled amputees by a radiological weight bearing method developed by the author. Considering a shortening of 10 mm for above-knee prostheses and of 5 mm for below-knee prostheses as tolerance limits, the length of the prosthesis was acceptable only in 17 cases (15% of the total group). In 79 cases (70%) the prosthesis was up to 47 mm too short and in 17 cases (15%) up to 40 mm too long. Chronic pain symptoms of low back, hip and knee correlated significantly with the lateral asymmetry caused by incorrect length of the prosthesis. Independently of the side of amputation, the unilateral sciatica and chronic hip pain occurred mainly on the long leg side. Physical activity of the lower limb amputees seemed to correlate with the suitability of the length of the prosthesis, and was unrelated to the length of the amputation stump.

A number of parameters related to the position of the foot on the ground during normal level walking were analysed for a group of young and a group of old subjects, divided in two sub-groups each, according to sex.

The analysis has shown asymmetries between the left and the right side of a number of subjects, differences between sexes and differences between age groups. Changes in the parameters of gait for the old subjects served the task of providing a larger base of support and a smaller loading of the hip musculature.

The effect of oxygen inhalation at atmospheric pressure and Naftidrofuryl infusion (N) on the TC_pO² is shown.

At the central control site-5 cm below the midclavicular line-oxygen inhalation produced a significant increase in TC_pO², whereas there was no change after Naftidrofuryl infusion. At the 10 cm below-knee site, there were significant rises after oxygen inhalation alone, Naftidrofuryl alone and both combined. The study was conducted on 20 patients (23 legs).

It is suggested that this study can form the basis for a regimen to improve the viability of ischaemic limbs showing borderline TC_pO² readings, and increase the chances of a successful below-knee amputation.

The “zero-position” of the shoulder joint described by Saha (1961) is recognized as a mechanical position between scapula and humerus, and the “scapular plane” is widely accepted as a mechanical plane at the shoulder joint. On the basis of biomechanical concepts of the “zero-position” and the “scapular plane”, the authors designed the “zero-position” functional shoulder orthosis. This orthosis has been successfully fitted to more than 75 patients for the postoperative management of rotator cuff injuries, and to 3 patients for the treatment of scapular neck fractures. It is introduced here, together with biomechanical considerations, structure, functional and clinical results.

The rehabilitation of 8 cold injury lower limb amputees is described, 7 of whom were alcoholic and had significant personality disorders. Delayed wound healing was the only common physical problem but the psychosocial difficulties were substantial and were the principal determinant of outcome following rehabilitation.

A review of prosthetic prescription practice reveals that in the United Kingdom about 85% of below and above-knee amputees are fitted with uniaxial feet, whereas in the United States about 80% are fitted with SACH feet. An evaluation method was developed to assess the performance of these two different types of feet. This included a subjective assessment procedure and a biomechanical evaluation of the function of the two feet and their effects on whole body gait kinematics and lower limb kinetics.

Data were acquired by three Bolex H16 cine cameras and two Kistler force plates. This set-up allowed three-dimensional analysis on the prosthetic and contralateral sides of the subject. Investigations were undertaken in which an experimental prosthesis permitted the interchange of the ankle/foot while keeping the rest of the components the same. Altogether, six below knee and five above knee amputees were tested. No clear trend for preference for either type of foot was evident from the subjective survey; in general the patients showed a preference for the foot that they were accustomed to. Kinematic and kinetic analysis showed some differences in the function between the two prosthetic feet. It is the purpose of this paper to discuss these differences and their significance.

A 24-year retrospective study of amputees was conducted at the Prosthetic and Orthotic Unit of the Kowloon Rehabilitation Centre, the first and largest rehabilitation centre in Hong Kong. A review was made of 1821 patients and a rising trend of amputee population was demonstrated probably related to the population growth. The ratio of lower limb to upper limb amputees was 1.83 to 1. The mean age of the amputees was 39 years. The commonest cause of upper limb amputation was trauma (89%) and of lower limb amputation was infection (35%). Vascular diseases were not as common in Chinese as in Caucasian communities. These patterns of amputee population indicate the demand for prosthetic service and provide guide-lines for future development.

A survey has been carried out to establish information on foot loading in amputee stance. The parameters measured are percentage body weight and the positions of the centres of pressure under each foot.

The data was collected in a clinical environment by the use of a Double Video Forceplate (DVF), a tool developed at the Bioengineering Centre. The objective of the survey is to provide background information for the use of the DVF in static alignment of lower-limb prostheses.

Results are presented from a number of patients attending the Roehampton Walking Training School, and for a small group of patients attending the Bioengineering Centre for delivery of an experimental below-knee prosthesis. Scattergrams and averaged results provide normative data which can assist in interpretation of DVF displays during individual alignment.