- Email: [email protected]
**Poster 467 Long-Term Prosthetic Outcome of Bilateral Lower Limb Amputees: A Case Series
PM&R
Conclusions: Based on preliminary analysis it appears that BWSTT can improve functional abilities and gait in individuals living with a LLA. However, the results suggest the use of a safety harness during treadmill training may be as effective as BWSTT at improving walking endurance and functional gait speed. Poster 465 Functional Gains of Physical Therapy Following Prosthetic Component Changes: A Case Report. Helena Lax, MD (Magee Rehabilitation Hosp, Philadelphia, PA, United States); Lynn Cunningham, DPT; Mark Nielsen, CP; Kevin Towers, BS. Disclosures: H. Lax, No Disclosures. Case Description: The objective of this case study was to report the functional gains found following physical therapy intervention in an independent individual who received new prosthetic components. The subject was a 54-year-old man with a 32-year history of left hip disarticulation secondary to trauma. The subject had utilized his previous prosthesis at a K3 modified independent level. The components were as follows: Canadian hip disarticulation hard socket, Otto Bock 7E7 hip joint, Otto Bock 3R60 knee joint, and Otto Bock Axtion LP energy storing foot. The subject was deemed appropriate for, prescribed, and issued a new prosthesis consisting of the following components: Ischial containment hip disarticulation socket with a flexible inner liner and micro carbon fiber frame, Otto Bock Helix hip joint, Otto Bock C-Leg knee joint with Otto Bock 4R57 axial rotator, and Ossur LP Variflex foot. Setting: Hospital based outpatient rehabilitation center. Interventions: The subject underwent 11 physical therapy treatment sessions focusing on prosthetic training. Main Outcome Measures: Subjective and objective measurements were recorded on initial evaluation and at discharge. Subjective measurements included: pain, Activities-Specific Balance Scale (ABC), and RAND medical outcomes study: 36-item short form survey instrument (SF-36). Objective measurements included: gait analysis, standing balance (single limb stance and Sharpened Romberg positions), 6 and 12 minute walk tests, and timed stair mobility. Results or Clinical Course: By discharge, pain was eliminated, the ABC score was improved, the SF-36 score was improved, standing balance was improved, the 6 and 12 minute walk test distances were improved, and the time to ascend and descend steps was decreased. Discussion: This case study justifies the need for physical therapy interventions throughout an amputee patient’s life. Conclusions: While a good prosthetic design is essential, physical therapy treatment may be required to help the amputee patient learn to utilize the components appropriately and help the patient achieve their highest functional and social outcomes. Poster 466 Hyperhidrosis in Amputee Populations: SelfReported Incidence and Impact on Prosthetic Use and Function. Jody Q. Wixom, MD (University of Utah, Salt Lake City, UT, United States); Bradeigh S. Godfrey, DO; Colby R. Hansen, MD. Disclosures: J. Q. Wixom, No Disclosures. Objective: To assess the incidence and severity of self-reported
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hyperhidrosis in patients with amputation. To understand the effects of self-reported hyperhidrosis on prosthetic fit or function. Design: Cross-sectional survey. Setting: Outpatient amputee clinics at an academic medical center and Veterans Affairs medical center (VAMC). Participants: 86 subjects who responded to a mail survey. Subjects included had their amputation at least 6 months prior to the time of completing the survey. Interventions: Not applicable. Main Outcome Measures: Self-reported severity of hyperhidrosis as it affects daily activities, prosthetic fit, and function on a 6-point Likert scale. Results: 86 subjects (65 M, 21 F) responded to the survey. The majority of the subjects had a below the knee amputation (67.4%) or above the knee amputation (18%). 51.7% of subjects reported tolerable sweating, with 4.6% reporting intolerable sweating. 54.1% of subjects reported that sweating interfered mildly with prosthesis fit, while 15.3% reported sweating interfered severely with prosthesis fit. 21.8% of subjects reported severe interference with prosthetic function and 24.1 % reported moderate interference with prosthesis function. 33% of subjects had not tried any interventions for sweating, while common treatment approaches included socks (36%) and anti-perspirants (58%). Conclusions: Hyperhidrosis is a common problem in amputation and varies in severity. Patients with amputations may try various interventions to manage sweating. Prosthetic fit and function may be impaired, which can negatively impact overall function. Future analysis will entail correlations of self-reported hyperhidrosis, prosthetic use, and functional mobility using the Locomotor Capabilities Index. Attempts will be made to delineate factors such as age, level of amputation, or etiology, which may correlate with greater risk of moderate to severe hyperhidrosis. **Poster 467 Long-Term Prosthetic Outcome of Bilateral Lower Limb Amputees: A Case Series. Maria Lucia Guarita, MD (AACD - Association of Assitance to the Disabled Child, San Paulo, Brazil); Alexandra P. Gaspar, MD; Sheila Inghan, MD. Disclosures: M. Guarita, No Disclosures. Objective: The first aim of this study was to determine the percentage of patients with bilateral lower limb amputations who continued to use prostheses after successfully prosthetic rehabilitation discharge. The second aim of this study was to investigate possible predictive factors related to continued prosthetic lower limb use. Design: Retrospective and sectional study. Setting: Tertiary care rehabilitation institute. Participants: Data were collected from 113 patients with bilateral lower limb amputations; 59 of these had complete data, successfully completed prosthetic rehabilitation and could be contacted by telephone. Interventions: First, this study collected data (gender, age, number of complications, etiology of the amputation, amputation level, presence of diabetes, hypertension, visual deficit, depression and obesity) from patients who had undergone bilateral lower limb amputation and that received prostheses between December of 1999 and December of 2009 at our institution. Second, these patients were contacted by telephone and questioned about prosthetic use. Data from these patients were analyzed together and
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divided into two categories depending on the nature of their amputation into vascular and non-vascular etiologies. Partial foot and Syme amputations were excluded. In order to verify possible predictive factors related to continued prosthetic lower limb use, Fisher‘s exact test and regression test were performed. Main Outcome Measures: 1. Prosthetic use or abandonment; 2. Prosthetic use x collected data (gender, age, number of complications, etiology of the amputation, amputation level, presence of diabetes, hypertension, visual deficit, depression and obesity). Results: The percentage of bilateral lower limb amputees who continue to use prostheses is 37.28% (17.64% among the vascular group and 64% among non-vascular amputees group). The total mean period of prosthesis use was 6.20 years (3.24 years in the vascular group and 10.12 years in non-vascular group). A correlation between abandoning the prosthesis and the presence of DM, hypertension, depression, visual deficit, obesity, number of complications, etiology of the amputation, amputation level and age was found. However, after a regression was performed, only age and the number of residual limb complications were correlated with the use of prostheses. Conclusions: The percentage of bilateral lower limb amputees who continue to use prostheses is 37.28%. The factors that correlated with long-term prosthetic abandonment were age and number of residual limb complications. Younger individuals, with less residual limb complications were more likely to continue using the prostheses. Poster 468 The Effects of Two Different Ankle-Foot Orthoses on the Gait of Acute Stroke Patients With Hemiplegia. Noel Rao, MD (Marianjoy Rehabilitation Hospital, Wheaton, IL, United States); Alexander S. Aruin, PhD; Daniel Hasso, CPO; Priyan Perera, MD; Jason Wening, MS, CPO. Disclosures: N. Rao, No Disclosures. Objective: To compare the effects of an off-the-shelf carbon-fiber ankle-foot orthosis (CF-AFO) to a custom fabricated polymer anklefoot orthosis (P-AFO) on the gait of acute stroke patients with hemiplegia. Design: Prospective, case-controlled study. Setting: Prosthetic/orthotics clinic in freestanding rehabilitation hospital. Participants: Acute stroke patients with hemiplegia (n⫽27) were tested with no ankle-foot orthosis (AFO), and then with an off-theshelf carbon AFO (CF-AFO) and a custom polymer AFO (P-AFO) in random order at the time of initial orthosis fitting. Interventions: Gait parameters such as velocity, cadence, stride length and step length were collected using an electronic walkway under the no-AFO, P-AFO, and CF-AFO conditions. Main Outcome Measures: All the data were subjected to a Shapiro-Wilk test for normality. A one-way repeated measures analysis of variance (ANOVA) was performed with AFO factors (3 levels: No AFO, CF-AFO, P-AFO) separately for velocity, cadence and stride length. Split-Plot ANOVA was performed with AFO factors (3 levels: No AFO, CF-AFO, P-AFO) and side (involved and uninvolved) to analyze the differences in step length. Pairwise comparisons with Bonferroni corrections were used for further analysis of significant effects. For all tests, statistical significance was set at P⬍.05. Results: Subjects walked significantly faster, with a higher ca-
PRESENTATIONS
dence, longer stride and longer step length (involved and uninvolved side) when using either the P- AFO or CF-AFO as compared to no AFO. Although the P-AFO did show more effect on all parameters than the CF-AFO, the difference between the two AFOs was never statistically significant. Conclusions: Acute stroke patients with hemiplegia will benefit from either a carbon or polymer AFO as opposed to no AFO. There is, however, no significant difference between the two AFOs in this population. **Poster 469 Effect of Lower Limb End-Effector Robot-Assisted Therapy With Body Weight-Support vs Treadmill Gait Training in Parkinson’s Patients. Patrizio Sale (IRCCS San Raffaele Pisana, Rome, Italy); Maria Francesca De Pandis, MD; Palma Enzo, MD; Marco Franceschini, MD; Vacca Laura, MD; Domenica; Le Pera, MD; Franceschini Marco, MD; Grassini Paola, MD; Fabrizio Stocchi, MD, PhD. Disclosures: P. Sale, No Disclosures. Objective: PD is characterized by a progressive decline of locomotor abilities of lower limb so that gait rehabilitation is an essential, but often frustrated, aim of the treatment. Recent studies demonstrated a major efficacy of physical rehabilitation therapy associated with treadmill training compared with physical therapy alone. The aim of the study is to validate the efficacy of a robotic system specific for lower limb (G-EO) compared with training on treadmill. Design: Randomized clinical trial. Setting: Gait analysis evaluation 3D-GA was conducted using the following equipment: a 12-camera optoelectronic system with passive markers (ELITE2002, BTS, Italy) to measure the kinematic of movement; 2 force platforms (Kistler, CH) to obtain the kinetic data of movement (ie, ground reaction forces); and 2 TV camera video system (BTS, Italy) synchronized with the optoelectronic and force platform systems for videorecording. To evaluate the kinematics of each body segment, markers were positioned as described by Davis et al (Davis, 1991). Subjects were asked to walk barefoot at their own natural pace (self-selected and comfortable speed) along a (10 m long) walkway where the two force platforms were placed. At least seven trials were collected for each subject in order to ensure the consistency of the data. All graphs obtained from GA were normalized as % of gait cycle and kinetic data were normalized for individual body weight. Using specific software (Smartanalyser, BTS, Italy) from these data some indices (time/distance parameters, angles joint values in specific gait cycle instant, peak values in ankle power graph) were calculated in order to quantify the gait pattern of participants involved in this study. Participants: Diagnosis of idiopathic Parkinson’s Disease by UK Brain Bank criteria. Inclusion criteria: evidence of motor deficit in one lower limb, age between 18 and 79 years. Exclusion criteria: association of neurological, orthopaedic or cardiopulmonary pathologies. Psychiatric disorders reducing patient collaboration. Interventions: If eligible, the patients were assigned to one of the two study arms (GEO o TREADMILL) by means of a computed randomization. Rehabilitation Treatment: 20 sessions of 45’. Ten subjects underwent lower limb rehabilitation consisting of a treatment cycle using the GE-O system device, according to individually tailored exercise scheduling. The practice included an add-on robot-assisted walking therapy at variable speeds for 40 min with a
Conclusions: Based on preliminary analysis it appears that BWSTT can improve functional abilities and gait in individuals living with a LLA. However, the results suggest the use of a safety harness during treadmill training may be as effective as BWSTT at improving walking endurance and functional gait speed. Poster 465 Functional Gains of Physical Therapy Following Prosthetic Component Changes: A Case Report. Helena Lax, MD (Magee Rehabilitation Hosp, Philadelphia, PA, United States); Lynn Cunningham, DPT; Mark Nielsen, CP; Kevin Towers, BS. Disclosures: H. Lax, No Disclosures. Case Description: The objective of this case study was to report the functional gains found following physical therapy intervention in an independent individual who received new prosthetic components. The subject was a 54-year-old man with a 32-year history of left hip disarticulation secondary to trauma. The subject had utilized his previous prosthesis at a K3 modified independent level. The components were as follows: Canadian hip disarticulation hard socket, Otto Bock 7E7 hip joint, Otto Bock 3R60 knee joint, and Otto Bock Axtion LP energy storing foot. The subject was deemed appropriate for, prescribed, and issued a new prosthesis consisting of the following components: Ischial containment hip disarticulation socket with a flexible inner liner and micro carbon fiber frame, Otto Bock Helix hip joint, Otto Bock C-Leg knee joint with Otto Bock 4R57 axial rotator, and Ossur LP Variflex foot. Setting: Hospital based outpatient rehabilitation center. Interventions: The subject underwent 11 physical therapy treatment sessions focusing on prosthetic training. Main Outcome Measures: Subjective and objective measurements were recorded on initial evaluation and at discharge. Subjective measurements included: pain, Activities-Specific Balance Scale (ABC), and RAND medical outcomes study: 36-item short form survey instrument (SF-36). Objective measurements included: gait analysis, standing balance (single limb stance and Sharpened Romberg positions), 6 and 12 minute walk tests, and timed stair mobility. Results or Clinical Course: By discharge, pain was eliminated, the ABC score was improved, the SF-36 score was improved, standing balance was improved, the 6 and 12 minute walk test distances were improved, and the time to ascend and descend steps was decreased. Discussion: This case study justifies the need for physical therapy interventions throughout an amputee patient’s life. Conclusions: While a good prosthetic design is essential, physical therapy treatment may be required to help the amputee patient learn to utilize the components appropriately and help the patient achieve their highest functional and social outcomes. Poster 466 Hyperhidrosis in Amputee Populations: SelfReported Incidence and Impact on Prosthetic Use and Function. Jody Q. Wixom, MD (University of Utah, Salt Lake City, UT, United States); Bradeigh S. Godfrey, DO; Colby R. Hansen, MD. Disclosures: J. Q. Wixom, No Disclosures. Objective: To assess the incidence and severity of self-reported
Vol. 4, Iss. 10S, 2012
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hyperhidrosis in patients with amputation. To understand the effects of self-reported hyperhidrosis on prosthetic fit or function. Design: Cross-sectional survey. Setting: Outpatient amputee clinics at an academic medical center and Veterans Affairs medical center (VAMC). Participants: 86 subjects who responded to a mail survey. Subjects included had their amputation at least 6 months prior to the time of completing the survey. Interventions: Not applicable. Main Outcome Measures: Self-reported severity of hyperhidrosis as it affects daily activities, prosthetic fit, and function on a 6-point Likert scale. Results: 86 subjects (65 M, 21 F) responded to the survey. The majority of the subjects had a below the knee amputation (67.4%) or above the knee amputation (18%). 51.7% of subjects reported tolerable sweating, with 4.6% reporting intolerable sweating. 54.1% of subjects reported that sweating interfered mildly with prosthesis fit, while 15.3% reported sweating interfered severely with prosthesis fit. 21.8% of subjects reported severe interference with prosthetic function and 24.1 % reported moderate interference with prosthesis function. 33% of subjects had not tried any interventions for sweating, while common treatment approaches included socks (36%) and anti-perspirants (58%). Conclusions: Hyperhidrosis is a common problem in amputation and varies in severity. Patients with amputations may try various interventions to manage sweating. Prosthetic fit and function may be impaired, which can negatively impact overall function. Future analysis will entail correlations of self-reported hyperhidrosis, prosthetic use, and functional mobility using the Locomotor Capabilities Index. Attempts will be made to delineate factors such as age, level of amputation, or etiology, which may correlate with greater risk of moderate to severe hyperhidrosis. **Poster 467 Long-Term Prosthetic Outcome of Bilateral Lower Limb Amputees: A Case Series. Maria Lucia Guarita, MD (AACD - Association of Assitance to the Disabled Child, San Paulo, Brazil); Alexandra P. Gaspar, MD; Sheila Inghan, MD. Disclosures: M. Guarita, No Disclosures. Objective: The first aim of this study was to determine the percentage of patients with bilateral lower limb amputations who continued to use prostheses after successfully prosthetic rehabilitation discharge. The second aim of this study was to investigate possible predictive factors related to continued prosthetic lower limb use. Design: Retrospective and sectional study. Setting: Tertiary care rehabilitation institute. Participants: Data were collected from 113 patients with bilateral lower limb amputations; 59 of these had complete data, successfully completed prosthetic rehabilitation and could be contacted by telephone. Interventions: First, this study collected data (gender, age, number of complications, etiology of the amputation, amputation level, presence of diabetes, hypertension, visual deficit, depression and obesity) from patients who had undergone bilateral lower limb amputation and that received prostheses between December of 1999 and December of 2009 at our institution. Second, these patients were contacted by telephone and questioned about prosthetic use. Data from these patients were analyzed together and
S350
divided into two categories depending on the nature of their amputation into vascular and non-vascular etiologies. Partial foot and Syme amputations were excluded. In order to verify possible predictive factors related to continued prosthetic lower limb use, Fisher‘s exact test and regression test were performed. Main Outcome Measures: 1. Prosthetic use or abandonment; 2. Prosthetic use x collected data (gender, age, number of complications, etiology of the amputation, amputation level, presence of diabetes, hypertension, visual deficit, depression and obesity). Results: The percentage of bilateral lower limb amputees who continue to use prostheses is 37.28% (17.64% among the vascular group and 64% among non-vascular amputees group). The total mean period of prosthesis use was 6.20 years (3.24 years in the vascular group and 10.12 years in non-vascular group). A correlation between abandoning the prosthesis and the presence of DM, hypertension, depression, visual deficit, obesity, number of complications, etiology of the amputation, amputation level and age was found. However, after a regression was performed, only age and the number of residual limb complications were correlated with the use of prostheses. Conclusions: The percentage of bilateral lower limb amputees who continue to use prostheses is 37.28%. The factors that correlated with long-term prosthetic abandonment were age and number of residual limb complications. Younger individuals, with less residual limb complications were more likely to continue using the prostheses. Poster 468 The Effects of Two Different Ankle-Foot Orthoses on the Gait of Acute Stroke Patients With Hemiplegia. Noel Rao, MD (Marianjoy Rehabilitation Hospital, Wheaton, IL, United States); Alexander S. Aruin, PhD; Daniel Hasso, CPO; Priyan Perera, MD; Jason Wening, MS, CPO. Disclosures: N. Rao, No Disclosures. Objective: To compare the effects of an off-the-shelf carbon-fiber ankle-foot orthosis (CF-AFO) to a custom fabricated polymer anklefoot orthosis (P-AFO) on the gait of acute stroke patients with hemiplegia. Design: Prospective, case-controlled study. Setting: Prosthetic/orthotics clinic in freestanding rehabilitation hospital. Participants: Acute stroke patients with hemiplegia (n⫽27) were tested with no ankle-foot orthosis (AFO), and then with an off-theshelf carbon AFO (CF-AFO) and a custom polymer AFO (P-AFO) in random order at the time of initial orthosis fitting. Interventions: Gait parameters such as velocity, cadence, stride length and step length were collected using an electronic walkway under the no-AFO, P-AFO, and CF-AFO conditions. Main Outcome Measures: All the data were subjected to a Shapiro-Wilk test for normality. A one-way repeated measures analysis of variance (ANOVA) was performed with AFO factors (3 levels: No AFO, CF-AFO, P-AFO) separately for velocity, cadence and stride length. Split-Plot ANOVA was performed with AFO factors (3 levels: No AFO, CF-AFO, P-AFO) and side (involved and uninvolved) to analyze the differences in step length. Pairwise comparisons with Bonferroni corrections were used for further analysis of significant effects. For all tests, statistical significance was set at P⬍.05. Results: Subjects walked significantly faster, with a higher ca-
PRESENTATIONS
dence, longer stride and longer step length (involved and uninvolved side) when using either the P- AFO or CF-AFO as compared to no AFO. Although the P-AFO did show more effect on all parameters than the CF-AFO, the difference between the two AFOs was never statistically significant. Conclusions: Acute stroke patients with hemiplegia will benefit from either a carbon or polymer AFO as opposed to no AFO. There is, however, no significant difference between the two AFOs in this population. **Poster 469 Effect of Lower Limb End-Effector Robot-Assisted Therapy With Body Weight-Support vs Treadmill Gait Training in Parkinson’s Patients. Patrizio Sale (IRCCS San Raffaele Pisana, Rome, Italy); Maria Francesca De Pandis, MD; Palma Enzo, MD; Marco Franceschini, MD; Vacca Laura, MD; Domenica; Le Pera, MD; Franceschini Marco, MD; Grassini Paola, MD; Fabrizio Stocchi, MD, PhD. Disclosures: P. Sale, No Disclosures. Objective: PD is characterized by a progressive decline of locomotor abilities of lower limb so that gait rehabilitation is an essential, but often frustrated, aim of the treatment. Recent studies demonstrated a major efficacy of physical rehabilitation therapy associated with treadmill training compared with physical therapy alone. The aim of the study is to validate the efficacy of a robotic system specific for lower limb (G-EO) compared with training on treadmill. Design: Randomized clinical trial. Setting: Gait analysis evaluation 3D-GA was conducted using the following equipment: a 12-camera optoelectronic system with passive markers (ELITE2002, BTS, Italy) to measure the kinematic of movement; 2 force platforms (Kistler, CH) to obtain the kinetic data of movement (ie, ground reaction forces); and 2 TV camera video system (BTS, Italy) synchronized with the optoelectronic and force platform systems for videorecording. To evaluate the kinematics of each body segment, markers were positioned as described by Davis et al (Davis, 1991). Subjects were asked to walk barefoot at their own natural pace (self-selected and comfortable speed) along a (10 m long) walkway where the two force platforms were placed. At least seven trials were collected for each subject in order to ensure the consistency of the data. All graphs obtained from GA were normalized as % of gait cycle and kinetic data were normalized for individual body weight. Using specific software (Smartanalyser, BTS, Italy) from these data some indices (time/distance parameters, angles joint values in specific gait cycle instant, peak values in ankle power graph) were calculated in order to quantify the gait pattern of participants involved in this study. Participants: Diagnosis of idiopathic Parkinson’s Disease by UK Brain Bank criteria. Inclusion criteria: evidence of motor deficit in one lower limb, age between 18 and 79 years. Exclusion criteria: association of neurological, orthopaedic or cardiopulmonary pathologies. Psychiatric disorders reducing patient collaboration. Interventions: If eligible, the patients were assigned to one of the two study arms (GEO o TREADMILL) by means of a computed randomization. Rehabilitation Treatment: 20 sessions of 45’. Ten subjects underwent lower limb rehabilitation consisting of a treatment cycle using the GE-O system device, according to individually tailored exercise scheduling. The practice included an add-on robot-assisted walking therapy at variable speeds for 40 min with a