A comprehensive musculoskeletal and peripheral nervous system assessment of war-related bilateral upper extremity amputees

Physical therapy and occupational therapy management of a person with bilateral transradial amputations: a case report

OBJECTIVE

This longitudinal case study describes the physical and occupational therapy interventions and recommendations for treatment of a person with bilateral transradial amputations during subacute rehabilitation, as there are currently few recommendations.

MATERIALS AND METHODS

A 53-year-old female with subacute bilateral transradial amputations received inpatient rehabilitation. Impairments include decreased balance, global weakness, and need for assistance with ADLs and transfers. Physical therapy, occupational therapy, nursing, a peer mentor, and a prosthetist collaborated. Interventions included task-specific and generalized strengthening, standing balance re-education, assistive device prescription, education using body-powered prostheses, home adaption recommendations, and activities of daily living practice.

RESULTS

Patient progressed to independent functional mobility but required assist for activities of daily living and stairs negotiation due to limited caregiver support and poor prosthetic dexterity. She discharged to a skilled nursing facility.

CONCLUSION

Rehabilitation of a person with bilateral transradial amputations requires clinicians experienced with prostheses; excellent interdisciplinary coordination; early discernment of the available social support system; task-specific strengthening and coordination exercises to prepare the patient for prostheses; significant task-practice with prostheses; and a working knowledge of home modifications and adaptive equipment. This article describes recommendations, successful interventions, and lessons learned for future therapists when rehabilitating someone with bilateral transradial amputations.IMPLICATIONS FOR REHABILITATIONBilateral transradial amputations (BTAs) are a life-altering, but rare condition, meaning that literature surrounding this population is sparse and that guidelines for rehabilitation are unclear.This article provides recommendations so that clinicians can be better informed when treating BTA patients in the subacute phase and more quickly progress patients toward functional independence and discharge to the community.

A comparative study of thumb reconstruction through the transplant of the first toe compound free flap between emergency surgery and elective surgery

This study compared emergency surgery with elective surgery for thumb reconstruction to explore the advantages, safety, and clinical value of emergency reconstruction. By comparing the advantages and disadvantages of thumb reconstruction in emergency surgery and elective surgery, it provides data support for optimizing the treatment process and methods. In this study, 22 patients who underwent thumb reconstruction in Rizhao people's Hospital from January 2018 to December 2020 were randomly divided into emergency operation group and elective operation group. The differences in operation period, hospitalization time, postoperative complications, hand function score, and satisfaction score between the 2 groups were analyzed. The operation period and hospitalization time of patients in the emergency surgery group were significantly lower than those in the elective surgery group, with statistical significance (P < .05). There was no significant difference in postoperative complications between the 2 groups (P > .05). After 3 months of rehabilitation training, the 2-point discrimination, functional score, and satisfaction score of the reconstructed thumb in the emergency surgery group were higher than those in the elective surgery group, and the difference was statistically significant (P < .05). Emergency reconstruction of the thumb can reduce operation time and hospitalization time, reduce operation costs, and obtain a more ideal appearance and function.

Computational musculoskeletal modeling of compensatory movements in the upper limb

It is well documented that most upper limb amputees utilize compensatory movement strategies to accomplish everyday tasks when using a prosthetic device and that musculoskeletal complaints (MSCs) are more common in this population. However, little information is available on how the loss of distal degrees of freedom (DOFs) in the arm impact muscle force, thereby limiting our understanding of the mechanism by which these MSCs are manifesting. Knowledge of how a loss of DOFs may lead to MSCs can enable clinicians to provide more targeted guidance on how best to restore functional ability while addressing pain, and may serve as a tool for prescriptive decision-making when determining the impact of device selection on long-term clinical needs. 3D motion capture data were collected from 12 right-handed subjects with no upper limb disability using an 8-camera Vicon™ motion analysis system as they performed the targeted Box and Blocks test under normal and braced conditions to simulate a loss of DOFs in the wrist and fingers. Muscle force data were calculated using AnyBody Modeling Software™ for four different muscles: erector spinae, infraspinatus, deltoid, and trapezius. Linear mixed effects models were generated using the peak force data and mean force data for a given muscle fascicle. The fixed effect coefficient and 95% confidence intervals were reported for each muscle fascicle. Overall, a strong effect of condition on muscle force was seen for most muscles in the right side of the body (specifically deltoid and infraspinatus), with greater forces generated during the braced condition.

Health concerns of veterans with high-level lower extremity amputations

BACKGROUND

The aim of the study was to identify health concerns of veterans with high-level lower extremity amputations.

METHODS

Through a cross-sectional study, general practitioners, an orthopedic specialist, psychologists, psychiatrists, physiotherapist and prosthetists examined 100 veterans using a short-form health-related quality of life questionnaire (SF-36) that assessed their ability to perform activities of daily living (ADL), instrumental activities of daily living (IADL) and life satisfaction (SWLS) after hip disarticulation or hemi-pelvectomy amputations. The assessment tool was designed to gather statistically useful information about their health needs.

RESULTS

The means of the Physical Component Summary (PCS), Mental Component Summary (MCS), SWLS, ADL and IADL were 48.58 ± 29.6, 33.33 ± 22.0, 19.30 ± 7.7, 48.10 ± 10.5 and 5.08 ± 1.8, respectively. Somatization, depression, and anxiety were the most prevalent disorders; among the veterans who were visited by psychiatrists, 11.6% had a history of hospitalization in a psychiatry section, and 53.2% had a psychiatric visit. Regardless of their injury in battle, 34% of veterans were hospitalized. Hearing problems were common, and about four-fifths of the participants suffered from at least one orthopedic condition. Neuroma (49%) was the most common stump-related complication during orthopedic evaluations, though the prevalence of phantom pain was 81% during the pain assessment. A total of 87% of the participants had a history of wearing a prosthesis, but only 29% wore a prosthesis at the time of the present study. The Canadian-type of prosthesis was uncomfortable and not useful (27%) and excessively heavy (10%) according to the amputees.

CONCLUSIONS

Understanding veterans' characteristics and special needs are important to make sure that enough facilities and services are afforded to them. These findings emphasize the importance of paying close attention to different dimensions of health in veterans and can help health providers identify health needs and make regular assessments.