Özlem Ülger

A comparison of traditional prosthetic training versus proprioceptive neuromuscular facilitation resistive gait training with trans-femoral amputees

Reports in the rehabilitation literature suggest that patients with trans-femoral amputation ambulate well after suitable prosthetic treatment. The effects of exercise protocols on function, however, have not been documented in this population. This study was conducted to compare the outcome of traditional and proprioceptive neuromuscular facilitation (PNF) techniques on weight bearing and gait. Fifty unilateral trans-femoral amputees who were attending for their first prosthesis, participated in this study. Amputees were randomly assigned into groups receiving the traditional training or PNF. Traditional treatment was consisted of weight-shifting, balancing, stool-stepping and gait exercises. In the other group the same activities were given by PNF. Amputees were trained 30 minutes daily, for a total of 10 treatments. Pre- and post-training assessment included weight bearing measurements by using two bathroom scales and time-distance characteristics of gait from footprints. A statistically significant difference was found in all parameters within the groups due to pre- and post-training evaluation data (p<0.05), but more obvious improvement was observed in the group who received PNF (p<0.05). The results of the study suggest that the prosthetic training based on proprioceptive feedback was more effective to improve weight bearing and gait when compared with a traditional programme.

Demography and function of children with limb loss

This retrospective study was designed for the period 1982 – 2002 to collect the basic data on the demography, level and side of the amputation, involved limbs, age, gender, and prosthetic functional level in children with limb loss. A total of 232 children were assessed through their prosthetic records. Seventy-two percent (195 children) presented lower-limb involvement, and 28% (77 children) had upper-limb loss. The age of the children varied between 1 and 15 years with a mean age of 9.90 ± 2.32 years. Results of the study revealed that the leading amputation cause in children was congenital limb absence. The most frequent levels were determined as trans-tibial and trans-radial in lower and upper limbs, respectively. Findings showed that more boys (60%) were affected, and 84% of all amputations were found to be unilateral. It was also seen that right-side amputations (54%) were more common than left-side amputations (46%). The outcome of the study showed that 96% of children with lower-limb loss reached a functional gait pattern without any aids, while the percentage of independence in activities of daily living was found to be 88% in upper-limb loss.

Risk Factors, Frequency, and Causes of Falling in Geriatric Persons Who Has Had a Limb Removed by Amputation

Purpose This study was planned to investigate falls, their frequency, reasons, and consequences in the older patient with lower limb amputations. Methods Twenty-five patients with lower limb amputations were included in the study. A questionnaire for falling was applied. Functional levels of these patients were determined according to the Medicare Functional Level System. Results The falling questionnaire revealed that except for 5 patients with amputations, the subjects had experienced an incident of falling once or more than once. The common reasons for falls turned out to be losing balance, stumbling on the prosthesis, and colliding with someone. Conclusions It was concluded that performing comprehensive evaluations in which falling histories were assessed before planning rehabilitation programs enriched the rehabilitation programs by suggesting different types of activities.

Reliability and construct validity of the Turkish version of the Trinity Amputation and Prosthetic Experience Scales (TAPES) in lower limb amputees

Background: In Turkey there is no amputee-specific instrument to measure health-related quality of life in lower limb amputees. Objectives: To evaluate the validity and reliability of a Turkish version of the Trinity Amputation and Prosthesis Experience Scales (TAPES). Study design: Outcome study to determine test–retest reliability and construct validity of the adapted Turkish version of the TAPES. Methods: After translation/retranslation of the TAPES, the Turkish version of the TAPES was applied to 47 amputees. A quality of life evaluation (Nottingham Health Profile), a satisfaction evaluation (Satisfaction with Prosthesis), and a functional assessment tool (Amputee Mobility Predictor) were also performed and analysed. Results: On the basis of retesting, the Turkish version of the TAPES was observed to be reliable. The first domain of the Turkish version, which includes psychosocial adjustment, activity restriction and satisfaction with the prosthesis, was found to be valid. However, the validity of the second domain could not be analysed. Conclusions: The Turkish version of the multidimensional TAPES survey is valid and reliable in Turkish unilateral lower limb amputees and may be used in clinical situations to assess the needs of amputees. Clinical relevance The Turkish version of the TAPES quality-of-life measurement tool for amputees is a valid instrument for assessing the effectiveness of rehabilitation and clinical applications.

Evaluation of functionality in acquired and congenital upper extremity child amputees

OBJECTIVE The aim of this study was to evaluate the functional level of children with congenital and acquired upper limb loss after a rehabilitation program. METHODS This study included a total of 40 children, aged 8 to 17 years with upper limb loss. Children were divided into two groups; congenital amputees (n=20) and acquired amputees (n=20). The children underwent prosthetic fitting, prosthetic training and rehabilitation. The Child Amputee Prosthetics Project - Functional Status Inventory (CAPP-FSI) and Prosthetic Upper Extremity Functional Index (PUFI) were used at the initial visit to the prosthetic unit without prosthesis, 3 weeks after the prosthetic training and 6 months after discharge with and without prosthesis. The results with and without the prosthesis were compared between the acquired and congenital amputee groups. RESULTS There were significant differences in all tests performed at the baseline, at the 3rd week, and at the 6th month without prosthesis and at the 3rd week and at the 6th month with prosthesis (p<0.05). The congenital group received higher scores in the CAPP-FSI and PUFI at the baseline, at the 3rd week and at the 6th month (p<0.05). Patients in the congenital group used their prostheses for 8 hours a day and the acquired group for 4 to 8 hours. CONCLUSION Daily prosthesis usage time and the childs experience with the prosthesis during daily activities are the determining factors for the functional level in upper limb child amputees. Functionality may improve based on these factors.

The effect of visceral osteopathic manual therapy applications on pain, quality of life and function in patients with chronic nonspecific low back pain

BACKGROUND The efficacy of osteopathic manual therapy (OMT) applications on chronic nonspecific low back pain (LBP) has been demonstrated. However, visceral applications, which are an important part of OMT techniques, have not been included in those studies. OBJECTIVE The studys objective was to determine the effect of OMT including visceral applications on the function and quality of life (QoL) in patients with chronic nonspecific LBP. DESIGN The study was designed with a simple method of block randomization. METHODS Thirty-nine patients with chronic nonspecific LBP were included in the study. OMT group consisted of 19 patients to whom OMT and exercise methods were applied. The visceral osteopathic manual therapy (vOMT) group consisted of 20 patients to whom visceral applications were applied in addition to the applications carried out in the other group. Ten sessions were performed over a two-week period. Pain (VAS), function (Oswestry Index) and QoL (SF-36) assessments were carried out before the treatment and on the sixth week of treatment. RESULTS Both of the treatments were found to be effective on pain and function, physical function, pain, general health, social function of the QoL sub-parameter. vOMT was effective on all sub-QoL parameters (p<0.05). Comparing the groups, it was determined that the energy and physical limitations of the QoL scores in vOMT were higher (p< 0.05). CONCLUSION Visceral applications on patients with non-specific LBP gave positive results together with OMT and exercise methods. We believe that visceral fascial limitations, which we think cause limitations and pain in the lumbar segment, should be taken into consideration.

The effect of physiotherapy approaches on the pain patterns of amputees for Buerger's disease

AbstractThis study was carried out on 34 lower limb amputees in order to investigate the effect of three different physiotherapy approaches on pain patterns of amputees for Buergers disease. Amputees were divided into three groups. Connective tissue manipulation (CTM) and interferential therapy (IT) were applied to the first and second groups combined with an exercise programme and prosthetic training. The third group followed only the exercise programme and prosthetic training. Amputees underwent pain assessments before and after the treatment including intensity, quality and localisation of pain. Significant differences were found between pre- and post-treatment pain values of all groups (p < 0.05) but especially in the groups treated by CTM and IT.

Comparison of the Effects of Complex Decongestive Physiotherapy and Conventional Bandaging on Edema of Geriatric Amputees: A Pilot Study

Objective: The aim of this study is to compare the effects of complex decongestive physiotherapy (CDP) and conventional bandaging (CB) on the postamputation edema of geriatric transtibial amputees. Material and Methods: Eleven geriatric transtibial amputees were included in the study. Randomized controlled study started on the first postoperative day with the amputees who are appropriate for CB and CDP. Before and after application, all the participants underwent circumferential assessments both amputated and intact side in each session. The period between the first session and the last session (transition to permanent prostheses) were recorded in days. The hospitalization period of the cases were also recorded. Results: There was not any significant difference between the groups when the duration of stay at the hospital was evaluated (P > 0.05). The period of transition to permanent prostheses was found to be shorter in CDP group (P < 0.05). When the first and last session values of both groups were analyzed, significant differences were determined (P < 0.05). The difference between the last circumferential measurements of the stump was observed to be more obvious in the CDP group than in the CB group (P < 0.05). Conclusion: To conclude, it can be postulated that CDP could be preferred in the treatment of postamputation stump edema to shape the stump effectively, which is the basic cardinal requirement of prosthetic fitting after surgery.

A systematic literature review of physiotherapy and rehabilitation approaches to lower-limb amputation

ABSTRACT Background: Successful use of prostheses after lower-limb amputation (LLA) depends on undergoing physiotherapy and rehabilitation both physically and psychologically. The aim of this systematic literature review is to systematically review the scientific evidence regarding prosthetic rehabilitation and physiotherapy after LLA. Methods: A systematic literature search was conducted using PubMed, Web of Science, Cochrane, CINAHL, EMBASE, SCOPUS, and EMB Reviews databases on December 31, 2015. Studies with the search keywords were identified and independently assessed by reviewers. The search yielded 403 potentially relevant articles after the removal of duplicates. Of these, only nine articles met the inclusion criteria. All studies were original articles, one of which was a randomized controlled study. Different measurement methods were used and positive results in terms of functional status, weight-lifting capacity with prosthesis, walking and balance ability, and acute care process were gained with a physiotherapy program. Conventional methods still possess high importance; however, it is safe to say that virtual reality and software-based programs for rehabilitation are increasingly being developed and getting more and more support. Discussion: LLA rehabilitation is a topic that requires the focus of current and future studies; evidence-based studies are required on the approaches to rehabilitation for specific LLA groups.

The effect of minimal invasive techniques and physiotherapy on pain and disability in elderly: A retrospective study

BACKGROUND Low back pain is one of the major musculoskeletal problems seen in elderly, and its the fifth common cause for hospitalization. OBJECTIVE This retrospective study has determined whether minimal invasive techniques or physiotherapy methods are effective for decreasing pain and improving functions in the geriatric population. METHODS A retrospective design was used in this study. Sixty-one patients aged ⩾ 65, who were referred to physiotherapy enrolled in the study. The patients were divided into 2 groups; Group 1 received minimal invasive techniques, whereas Group 2 had no surgery or no minimal invasive application. Pressure Pain Threshold (PPT) was used for perceived pain intensity, Semmes Weinstein Monofilaments (SWM) was used to assess tactile sensitivity, and Oswestry Disability Index (ODI) was used to determine perceived functional disability. Physiotherapy methods including soft tissue mobilizations, muscle-energy techniques and spinal stabilization exercises were used in the treatment of all patients. The outcomes were evaluated pre- and post-physiotherapy applications. RESULTS Significant improvements in PPT were shown in both groups after physiotherapy treatment as to baseline (p< 0.05). Despite the significant improvements in PPT values of all muscles in Group 1, Group 2 had significant improvements in PPT except Hamstring muscles (p< 0.05). Functional disability levels of both groups reduced acc. to ODI, improvement in disability scores was only significant in Group 1 (p< 0.05). CONCLUSION Although both treatments showed pain relief, functional restoration and improvement in hypoesthesia existence; there was no superiority of physiotherapy alone over physiotherapy added minimal invasive treatments in terms of parameters.