IMMEDIATE POST-OPERATIVE ISCHIAL WEIGHT BEARING PROSTHESIS
Madan M. Telikicherla (Rehabilitation Institute of Michigan, Detroit, U.S.A.)
Purpose: To design a safe, prefabricated immediate post-operative lower limb prosthesis.
Method: A pre-fabricated prosthesis with a quadrilateral, ischial weight bearing socket, open distally, attached to the prosthetic foot through metal bars, to bypass weight bearing through the stump, with size and length adjustable features, along with a manual locking and unlocking knee was designed. We fitted this device, 1 to 14 days post amputation (mean 6.6 days) on 22 amputees, 17 below knee (1 bilateral) and 5 above knee, 21 closed, 1 open, 16 to 90 years old (mean 51.5years), performed for peripheral vascular disease in-11, trauma in 4, infection in 5, frost bite in 1 (who underwent bilateral below knee amputations on the same day) and congenital local gigantism in 1.
Results: At discharge, 10 to 27 days post amputation (mean 17 days) all patients were independent with self care, 17 walked independently with the prosthesis and walker, 2 with contact guarding and 1 with standby assistance over household distances and they were sent home with the prosthesis and walker.
Conclusions: Our results are quite promising and we plan a controlled study in future.
COGNITIVE DEMANDS AND DYNAMIC COSMESIS OF WALKING OF AMPUTEES USING INTELLIGENT KNEE
- A COMPARATIVE EVALUATION
DIPAK DATTA, JOHN HOWITT, BENJAMIN HELLER, GEOFF BILLINGHAM
NORTHERN GENERAL HOSPITAL NHS TRUST, SHEFFIELD, ENGLAND
Aim: To evaluate if the micro-processor controlled intelligent knee prosthesis (IP) (a) reduces the cognitive demand of walking for TF amputees (b) produces an subjective improvement in gait pattern.
Method: Prospective experimental cross-over trial comparing the IP with the standard Pneumatic Swing Phase Control (PSPC) knee. Ten fit unilateral amputees using the PSPC were firstly video-recorded whilst walking in the laboratory. They then walked on a treadmill at various speeds whilst performing a simple control visual-verbal task and then a more cognitively demanding one (the Stroop test). The 3D movement of a head-mounted marker measured by an Elite motion analysis system assessed gait quality. The PSPC knee joint was converted to IP and after 6 weeks of use the tests were repeated. A panel of 6 experts and 4 lay members assessed the videos for dynamic cosmesis; knee type was not revealed.
Results: IP gait was rated significantly better by the panel (95%) for 2 subjects. From analysis of 9 cognitive tests, there was a non-significant (84%) trend showing that the IP is less-cognitively demanding.
Conclusion: Gait pattern improved for only 2 patients. There is a trend for reduced cognitive demand, if it is confirmed by a larger study it would provide a significant benefit to TF amputees.