ISPO- The 13 th World Congress Leipzig-Germany 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 vs 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 endurance 2.Core strengthening & power 3.Balance & co-ordination 4.Weight bearing and stance control 5.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

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 stance 2.Seated medicine ball put 3.Modified Edgren side-step test 4.T-test 5.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 Phases 1.Building confidence 2.Walking on short legs ( stubbies) 3.Graduated increase in height 4.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 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