Vocational end results following rehabilitation of upper-extremity amputees

The long-term outcome of upper limb amputees treated at a rehabilitation centre in Sydney, Australia

A follow-up study by questionnaire or interview has been made of the 27 respondents of 41 upper limb amputees (66%) treated at the Royal South Sydney Hospital between 1981 and 1990. Prosthetic use of 8 h/day or more was 37% and occasional use was 18.5%. The prosthetic users were more likely to be distal amputees. The reason for the low level of prosthetic use is not known. The majority of non-users discarded prostheses after leaving their rehabilitation programme. Occupational changes were made by 72% of the amputees. The unemployment rate at follow-up was similar to the rest of the community, which is a better outcome than 25 years ago. Activities of daily living had been affected in all patients, but to a lesser extent in prosthetic users. Leisure pursuits were changed in 70% of patients, with these activities being more sedentary and indoor in nature. Of the 18 car drivers, 15 drove automatic cars with modifications. Phantom pain was experienced by 16 of the respondents (59%) and stump pain was experienced by seven. Only 26% used medication or alcohol for the pain. Pain did not affect prosthetic use or functional ability.

Prosthetic usage in major upper extremity amputations

Patterns of use of contemporary prostheses by 135 patients with major upper extremity amputations were evaluated by questionnaire. Eighty-four percent of the patients were male and 16% were female. Amputation levels represented were below elbow, 44%; above elbow, 40%; and shoulder disarticulations or forequarter amputations, 16%. The follow-up interval averaged 12 years (range, 1-67 years). One hundred and thirteen patients were fitted with either a myoelectric or body-powered prosthesis. The overall rejection rate was 38%. Thirty-nine of 42 in the below-elbow amputation group used the prosthesis and appeared to benefit the most. Eight of 141 in the wrist disarticulation group used the prosthesis: as did 9 of 21 in the above-elbow amputation group. In contrast, all bilateral amputees used their prostheses. Stiff shoulders and brachial plexus injury were both predictors for poor prosthetic usage.