Deirdre Desmond

Psychosocial adjustment to diabetes‐related lower limb amputation

Aim  To examine psychosocial adjustment in persons with lower limb amputations related to diabetes.

Psychological correlates of illusory body experiences.

Postamputation phantom sensations and phantom pain, i.e., sensation or pain in the amputated limb, can be extremely distressing for people who have had amputations. Recent research on treating phantom phenomena has used the experimental induction of illusory body experiences. Although the suggestion has been that such experiences may influence the cortical remapping that occurs after amputation, the role of psychological factors in these experimental inductions has not been addressed. We used an able-bodied sample to investigate whether a common underlying propensity exists for illusory body experiences and whether the occurrence of these experiences is associated with previously neglected psychological variables. Psychometric measures of body plasticity, somatic preoccupation, and creative imagination were significantly and differentially associated with the occurrence of illusory body experiences. Hence, these measures have potential use in identifying patients most likely to benefit from treatment interventions using the induction of illusory body experiences.

Factor structure of the Trinity Amputation and Prosthesis Experience Scales (TAPES) with individuals with acquired upper limb amputations.

Desmond DM, MacLachlan M: Factor structure of the Trinity Amputation and Prosthesis Experience Scales (TAPES) with individuals with acquired upper limb amputations. Am J Phys Med Rehabil 2005;84:506–513. Objectives:To investigate the factorial composition of the Trinity Amputation and Prosthesis Experience Scales (TAPES), a multidimensional assessment of adaptation to amputation and prosthesis, for use with individuals with acquired upper limb amputations. Design:Cross-sectional survey of members of the British Limbless Ex-Service Men’s Association. Results:A total of 101 individuals (men, 100; mean age, 73.8 yrs, SD 11.94) with acquired upper limb amputations (98 traumatic cases) completed the TAPES. Principal components analyses with varimax rotation revealed four psychosocial subscales (general adjustment, social adjustment, optimal adjustment, and adjustment to limitation), four activity-restriction subscales (restriction of lifestyle, social restriction, occupational restriction, and restriction of mobility), and a single prosthesis-satisfaction subscale. Each of these subscales had high internal reliability. Conclusions:The TAPES structure can be meaningfully represented in terms of nine internally consistent subscales. Additional research needs to be done on the TAPES for use with individuals with upper limb amputations. In particular studies of the scales, predictive validity is warranted.

Environmental barriers, activity limitations and participation restrictions experienced by people with major limb amputation

Background: Limited research is available that explores major limb amputation and the World Health Organization’s International Classification of Functioning, Disability and Health (ICF). Objectives: To investigate the barriers, participation restriction and functioning levels experienced by people with a major limb amputation. Study design: Secondary data analysis. Method: Relevant data for 148 people with major limb amputation were extracted from the National Physical and Sensory Disability Database in Ireland. Results: The most common environmental barriers encountered were climate, physical environment and income. Participation restriction was most commonly experienced in sports/physical recreation, leisure/cultural activity and employment/job-seeking. For daily activities and functioning, the most common difficulties were with standing for long periods, walking long distances and the emotional effects of disability. Differences were found between people with an upper limb or lower limb prosthesis. Conclusion: This paper addresses the limited information available on environmental barriers, activity limitation and participation restriction of people with a major limb amputation. Greater understanding of the impact of amputation andprosthesis type on activity, participation and environmental barriers is important to facilitate improved management and planning at the individual, service and societal level. Clinical relevance Improved understanding of environmental barriers and challenges, activity limitations and participation restrictions experienced by individuals with major limb amputation is a critical step in informing evidence-based service delivery, intervention and policy in order to improve outcomes for this group.

Prevalence and Characteristics of Phantom Limb Pain and Residual Limb Pain in the Long Term after Upper Limb Amputation.

This study aims to describe the prevalence and characteristics of phantom limb pain and residual limb pain after upper limb amputation. One-hundred and forty-one participants (139 males; mean age 74.8 years; mean time since amputation 50.1 years) completed a self-report questionnaire assessing residual and phantom limb pain experience. Prevalence of phantom limb pain during the week preceding assessment was 42.6% (60 of 141). Prevalence of residual limb pain was 43.3% (61 of 141). More than one third of these had some pain constantly or most days. Phantom limb pain was commonly described as ‘discomforting’ (31 of 60) and associated with ‘a little bit’ of lifestyle interference (23 of 60). Residual limb pain was most often described as ‘discomforting’ (27 of 61) or ‘distressing’ (19 of 61) and was typically associated with low to moderate levels of lifestyle interference. Assessment of multiple dimensions of postamputation pain in the long term after upper limb amputation is warranted.

Augmenting the Reality of Phantom Limbs: Three Case Studies Using an Augmented Mirror Box Procedure

Phantom sensation and phantom pain are common after limb amputation. Previous research documents increased motor control of phantom limbs and alleviation of phantom limb pain through exposure to the “mirror box illusion.” This approach centers on the potential for vision and sensorimotor interactions to alter phantom limb perception. The applicability and flexibility of this intervention is limited by methodological constraints inherent in the use of conventional mirrors. This article reports the application of an “augmented reality” intervention that seeks to overcome these constraints. Three case studies are presented, and it is argued that augmented reality technology offers a promising new approach to the investigation of phantom experience and potentially to the treatment of phantom pain.

Psychosocial Issues in the Field of Prosthetics and Orthotics

The involvement of psychologists in medical settings has grown at a tremendous rate in recent years, with an ever-increasing number of medical environments developing and promoting interdisciplinary collaboration, and thus enabling psychologists to extend their practice beyond the traditional mental

Measuring quality of life in prosthetic practice: benefits and challenges

There is an increasing awareness that the inclusion of quality of life as an outcome measure is important in ensuring a client-centred and holistic assessment. This review outlines the benefits of quality of life as an outcome measurement in the field of prosthetics. It introduces the key concepts and challenges in the definition and assessment of quality of life post-amputation, including the relative advantages and disadvantages of adopting generic, disease/condition specific, dimension specific and individualized measures of quality of life. In conclusion, the review delineates and recommends issues and guidelines for consideration when undertaking quality of life research and assessment. A co-ordinated approach by practitioners in the field of prosthetics is necessary to ensure the inclusion of quality of life as an outcome measure and to ensure its measurement in a standardized and rigorous manner.

Psychological issues in prosthetic and orthotic practice: A 25 year review of psychology in Prosthetics and Orthotics International

In the inaugural edition of Prosthetics and Orthotics International, Fishman identified the psychological sciences as one of six indispensable areas of skill and knowledge in professional prosthetic-orthotic practice. Given the journals significant role in reporting and developing pertinent research and practice, this review assesses the profile of psychology in prosthetic and orthotic research, as evidenced by the content of Prosthetics and Orthotics International since its inception. A MEDLINE search of the journals abstracts over a twenty-five year period was conducted using the search terms: ‘psychology’, ‘psychosocial’, ‘quality of life’, ‘developmental’ and ‘coping’. Results of this search are summarised under the following headings: (a) body image; (b) coping and adjustment; (c) developmental issues; (d) psychosocial well-being; (e) quality of life; and (f) psychological factors leading to amputation. On the basis of this review, the authors conclude by highlighting a number of key areas where the psychological aspects of prosthetics and orthotics warrant further investigation and dissemination.

Cognitive functioning in persons with lower limb amputations: a review

Purpose: To review the literature on cognitive functioning in persons with lower limb amputations. Method: A search of the MEDLINE, PsycINFO and Web of Science databases was carried out. Results: Thirty papers were found that met the inclusion criteria. The studies were characterised by heterogeneity of design, methodological quality, sample characteristics, assessment of cognitive functioning, and outcomes examined. The research published to date suggests that cognitive impairment is more prevalent among persons with lower limb amputations than in the general population, and is linked with a number of important outcomes in this patient group, including mobility, prosthesis use, and maintenance of independence following amputation. Conclusions: These findings highlight the importance of assessing the cognitive abilities of persons with lower limb amputations. An understanding of the cognitive profile of these patients could assist rehabilitation teams in determining their suitability for prosthetic or wheelchair rehabilitation, ascertaining appropriate and realistic goals for rehabilitation, and tailoring rehabilitation programmes to patients’ strengths so that maximal mobility and independence is achieved. Implications for Rehabilitation Cognitive impairment appears to be more prevalent among persons with lower limb amputations than in the general population. Cognitive impairment is negatively associated with mobility, prosthesis use, and maintenance of independence following amputation. Cognitive screening prior to rehabilitation could assist in determining patients’ suitability for prosthetic or wheelchair use, ascertaining appropriate goals, and tailoring rehabilitation to patients’ strengths so as to optimise their mobility and independence.