ISPO- The 13th World CongressLeipzig-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

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

Nerve transfers to restore surface EMG

Adapted from L Miller et al, 13th ISPO World Congress, 2010

Effectiveness of a Evidence Based Amputee Rehabilitation Programme

Bob 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 Components of Exercise Programme

1. Cardiopulmonary endurance2. Core strengthening & power3. Balance & co-ordination4. Weight bearing and stance control5. Prosthetic gait training

Adapted from R Gailey, 13th ISPO World Congress, 2010

Results

Adapted from R Gailey, 13th ISPO World Congress, 2010

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

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

Results

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

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

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

1. Single leg stance2. Seated medicine ball put3. Modified Edgren side-step test4. T-test5. Illinois agility test

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

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

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

Speed & agility testing of military service members with traumatic lower limb loss

I 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

Improving outcomes for bilateral trans-femoral amputees

Kevin Carroll, P&O, USA

Phases1.Building confidence2.Walking on short legs ( stubbies)3.Graduated increase in height4.Walking on full length prosthetic legs

Adapted from K Carroll, 13th ISPO World Congress, 2010

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

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

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

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.

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

Other

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

Technology, Rehabilitation, Outcomes, Sports & Specialisation

Keynote address: Bob Gailey, PT

Specialisation

Adapted from slides of R Gailey, Keynote Address, 13th ISPO World Congress, 2010