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ISPO- The 13 th World Congress Leipzig-Germany 2010

ISPO- The 13 th World Congress Leipzig-Germany 2010. + Orthopadie + Reha-technik 2010. Upper Extremity Prosthetics/ Socket Prostheses Control: Targeted Reinnervation - Surgical Outcome of 30 patients ( trans-humeral or shoulder disarticulation amputees) Dr Laura Miller, USA.

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ISPO- The 13 th World Congress Leipzig-Germany 2010

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  1. ISPO- The 13th World CongressLeipzig-Germany 2010 + Orthopadie + Reha-technik 2010

  2. Upper Extremity Prosthetics/ Socket Prostheses Control:Targeted Reinnervation- Surgical Outcome of 30 patients (trans-humeral or shoulder disarticulation amputees)Dr Laura Miller, USA Hyper- innervation (ie transfer large nerve fibres onto smaller muscles) Improved Activation ( to allow use of myo-electric prostheses) Adapted from L Miller et al, 13th ISPO World Congress, 2010

  3. Nerve transfers to restore surface EMG Adapted from L Miller et al, 13th ISPO World Congress, 2010

  4. Effectiveness of a Evidence Based Amputee Rehabilitation ProgrammeBob Gailey, PT, USA • RCT • 3 exercise sessions per week v’s waitlist control • 8 week programme • 16 subjects (of 345 amputees asked to participate) • Age (av.): 63 years • Time since amputation (av.): 8 years • 75% PVD or DM

  5. 5 Components of Exercise Programme • Cardiopulmonary endurance • Core strengthening & power • Balance & co-ordination • Weight bearing and stance control • Prosthetic gait training Adapted from R Gailey, 13th ISPO World Congress, 2010

  6. Results Adapted from R Gailey, 13th ISPO World Congress, 2010

  7. Adapted from R Gailey et al, 13th ISPO World Congress, 2010

  8. A single blind cross-over trial of hip abductor strength training to improve gait & balance in patients with unilateral, trans-femoral amputation.T Pauley, PT, Canada Method: • Cross-over design • Min 6 months post fitting • Hip abductor strengthening machine • ACSM guidelines etc • Control used arm ergometer • 14 subjects • 2 minute walk test, timed up & go, ?balance measure

  9. Results Adapted from T Pauley, 13th ISPO World Congress, 2010

  10. Adapted from T Pauley, 13th ISPO World Congress, 2010

  11. Reliability of 5 high-level activity measures established for military service members with traumatic lower limb loss.Alison Linberg, PT, USA Inter-rater & test-retest reliability of 83 amputee & 97 uninjured military personnel • Single leg stance • Seated medicine ball put • Modified Edgren side-step test • T-test • Illinois agility test

  12. Speed & Agility Measures • Modified Edgren Side Step Test: measures side stepping distance over 4 metre course in 10 seconds • T-Test: measures time negotiating a 10m forward, 10m side to side, 10m backwards. • Illinois Agility Test: From prone, measures time rapidly moving forward, diagonally and weaving along a 10m x 5m course. Adapted from I Gaunaurd, 13th ISPO World Congress, 2010

  13. Background • Ceiling effect of usual measures • Technological improvements • Return to duty • Five chosen tests commonly used in sports medicine Adapted from K Linberg et al, 13th ISPO World Congress, 2010

  14. Results • Excellent inter-rater reliability in both groups ( ie ICC > 0.9) • Moderate/ good test-retest scores in normals • Good/ excellent test-retest scores in amputees • (Nb: Still need validity studies eg correlation with job tasks etc etc) Adapted from A Linberg et al, 13th ISPO World Congress, 2010

  15. Speed & agility testing of military service members with traumatic lower limb lossI Gaunaurd et al • Edgren Side Step Test, T-Test & Illinois Agility Test. • Comparison between amputees and non-amputee service members ( control). • Non-amputees performed better than TT and TF amputees. • TT amputees performed better than TF amputees. • 51% of unilateral TT amputees performed within the range of scores for the 3 tests for the non-amputees. Adapted from I Gaunaurd et al, 13th ISPO World Congress, 2010

  16. Improving outcomes for bilateral trans-femoral amputeesKevin Carroll, P&O, USA Phases Building confidence Walking on short legs ( stubbies) Graduated increase in height Walking on full length prosthetic legs Adapted from K Carroll, 13th ISPO World Congress, 2010

  17. Improving outcomes for bilateral TF cont. • Increasing numbers • Patients have higher expectations • Teach patients how to fall and get up • Practise on grass ( patients will fall!) • Need micro-processor knees, especially on stairs and ramps ( less falls than standard knees & can walk step over step) • Peer support Adapted from K Carroll, 13th ISPO World Congress, 2010

  18. Virtual Reality (VR) Based Training and Assessment in Persons with Lower Extremity Amputation. B Darter et al Method: • Amputee on treadmill • VR goggles/ markers etc etc • 12 sessions over 3 weeks • 3 times 10 mins VR walking/ session • Standing balance & gait training using VR • Provides real time feedback, unexpected obstacles/ stumble recovery and external focus of attention

  19. Virtual Reality cont. Results: • 15 % improvement in metabolic cost • Marked improvement in trunk motion symmetry • Controlled environment gives patients licence to push themselves • Improved reaction times • Subtle differences in recovery strategy could be noted. • Study ongoing. From B Darter et al. 13th ISPO World Congress, 2010

  20. Osseointegration • Increased prosthetic use with OI. 93% use OI prosthesis. 40% use prosthesis >15 hours per day. Ongoing study.(K Hagberg) • 40% ( of 45) had some form of infection, mostly minor. Infection not an obstacle to OI. (J Tilander) • OPRA programme. Most complications can be handled without surgery. 4 of 42 implants removed because of loosening and/or deep infection. Study ongoing. (R Branemark) Adapted from 13th ISPO World Congress 2010. Symposium: Osseointegration Technique-Rehabilitation, Long-Term Results, Complication Management. Also adapted from Prosthetics poster session.

  21. Michelangelo Hand • Good for stabilising objects ( ie use other hand for fine motor tasks) • Includes pinch grip, key grip, hand flat • Wrist/ fingers/ finger tips are compliant • Good force ( > 10 kg), speed & ROM (90mm) • Good cosmetically • Thumb movement • No IP joints • Passive wrist movement (electronic movement under development) • Auto return to neutral position Adapted from 13th ISPO World Congress and Orthopadie + Reha-techik 2010

  22. Other • Wii • Deka-arm • I-limb • Pain • Surgery • Power knee • RSL Steeper hand • C-leg • Other +++

  23. Technology, Rehabilitation, Outcomes, Sports & SpecialisationKeynote address: Bob Gailey, PT Specialisation Adapted from slides of R Gailey, Keynote Address, 13th ISPO World Congress, 2010

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