5 December 2003

Ossur Scientific E-letter #2

I detta e-brev ingår fyra nya vetenskapliga artiklar.Dessa tar upp allt ifrån fotens konfiguration under olika belastningar till rehabilitering och träningsresultat hos transfemuralt amputerade. Artiklar från föregående e-brev finns arkiverade under respektive rubrik. Ha en trevlig läsning och god fortsättning på detta året.

Hälsningar
Magnus Lilja

Proteser (Nedre Extremiteterna)

Pelvic motion in trans-femoral amputees in the frontal and transverse plane before and after special gait re-education.

Sjodahl C, Jarnlo GB, Soderberg B, Persson BM. Prosthet Orthot Int. 2003 Dec;27(3):227-37.

Abstract-Using a special gait re-education programme, combining methods in physiotherapy with a psychological therapeutic approach to integrate the prosthesis with normal movements and to increase body awareness, the authors studied unilateral trans-femoral amputees aged 16-60 years with trauma or tumour as causes. In their service area they found 16 such current prosthetic users with at least 2 years of prosthetic experience and 9 who could complete the programme. Gait was measured before and after treatment and at 6 months follow-up with a three-dimensional motion analysis system and was compared to a reference group of 18 healthy volunteers of similar age. Results showed normalised gait speed and increased symmetry in step length after treatment, but reduced symmetry in pelvic motion. The reference group had a pelvic rotation of + 4 degrees both in the frontal and transverse planes. In the frontal plane, pelvic obliquity increased after treatment to a similar amplitude to the reference group, but with a different timing. Pelvic internal rotation on the amputated side increased to about 8 degrees in the beginning of stance. The amputated and the intact side before treatment were more symmetrical than afterwards and also when compared with the reference group. In spite of this, gait appeared to be more symmetrical, probably due to more efficient pelvic motion and more symmetrical upper-body movements. This was probably an effect of increased work with the intact side to compensate for the lack of power on the amputated side. These results remained at follow-up.

Custom Removable Immediate Postoperative Prosthesis

Thomas L. Walsh, BS, CPO J Prosthet Orthot 2003, 15 (4):158-161

Abstract- Many postoperative treatment modalities for the transtibial amputee are in current use. A simple gauze dressing is the treatment of choice for many surgeons. Another option is compression therapy using an ace bandage or stump shrinker. A more aggressive approach would include the use of a rigid dressing or an immediate postoperative prosthesis (IPOP). The latter modality, although documented to offer the highest rate of healing, is possibly the least used because of many factors, including lack of familiarity with the treatment, a fear of placing a hard cast on a vascularly compromised limb, and the need to frequently monitor the wound. The traditional IPOP is a nonremovable cylinder cast. When the residual limb needs to be inspected, the cast is cut off using a cast saw. Another cast is then fabricated if the IPOP continues to be used. This article presents a removable IPOP, designed for the diabetic, peripheral vascular disease amputee, that specifically addresses the needs of the surgeon. In addition, the design permits a proactive clinical team approach, enhancing the treatment of the prosthetist and the physical therapist.

Ortoser (Nedre Extremiteterna)

Quantitative comparison of plantar foot shapes under different weight-bearing conditions

Bonnie Yuk San Tsung, MPhil; Ming Zhang, PhD; Yu Bo Fan, PhD; David Alan Boone, CP, MPhil J Rehabil Res Dev 2003 40, 6, 517-526.

Abstract Knowledge of the plantar foot shape alteration under weight bearing can offer implications for the design and construction of a comfortable and functional foot support. The purpose of this study was to quantify the change in three-dimensional foot shape under different weight-bearing conditions. The plantar foot shapes of 16 normal feet were collected by an impression casting method under three weight-bearing conditions: non-weight bearing, semi-weight bearing, and full-weight bearing. An optical digitizing system was used to capture the three-dimensional plantar surface shape of the foot cast. Measurements and comparisons from the digitized shapes were conducted for the whole foot and regions of the foot. The data showed that increased weight bearing significantly increased the contact area, foot length, foot width, and rearfoot width, while it decreased average height, arch height, and arch angle. Compared with the non-weight-bearing foot shape, the semi-weight-bearing condition would produce increases in the contact area of 35.1% ± 21.6 %, foot length of 2.7% ± 1.2%, foot width of 2.9% ± 2.4%, and rearfoot width of 5.9% ± 4.8%, and decreases in the arch height of 15.4% ± 7.8% and arch angle of 21.7% ± 17.2%. The full-weight-bearing condition would produce increases in the contact area of 60.4% ± 33.2%, foot length of 3.4% ± 1.3%, foot width of 6.0% ± 2.1%, and rearfoot width of 8.7% ± 4.9%, and decreases in the arch height of 20.0% ± 9.2% and arch angle of 41.2% ± 16.2%. The findings may be useful for considering the change of foot shape in the selection of shoe size and shoe or insole design.

HELA ARTIKELN

Spinala Ortoser Critical review on non-operative management of adolescent idiopathic scoliosis.

Wong MS, Liu WC. Prosthet Orthot Int. 2003 Dec;27(3):242-53.

Abstract There are a number of different non-operative interventions which aim to control moderate adolescent idiopathic scoliosis (AIS) from progression. Clinicians may find difficulties in the selection of appropriate interventions for AIS. A comprehensive literature review was carried out to study all contemporary non-operative interventions, it was noted that rigid spinal orthoses apparently give more curve control; however, it would compromise the patient's quality of life via those inevitable factors--physical constraint, poor acceptance and psychological disturbance. There is a trend to develop more effective, acceptable and user-friendly interventions. Under such an aspiration, the theories and clinical evidence of different interventions should be developed along the clinical pathway of early intervention with reliable indicators/predictors, patient's active participation, dynamic control mechanism, holistic psychological and psychosocial considerations, and effective and long-lasting outcome.