Total surface bearing below-knee prosthesis: advantages, disadvantages, and clinical implications.

OBJECTIVE: To investigate the total surface bearing (TSB) prosthesis for below-knee amputee patients and to determine its clinical indications. DESIGN: Case series. SETTING: University hospital and the Welfare Center for the Disabled. PATIENTS: Thirty-two subjects who could walk with the TSB prosthesis and had already used the patellar-tendon bearing (or Kondylen-Bettung Münster) socket. MAIN OUTCOME MEASURE: Subjective assessment of the TSB socket, consisting of an overall rating and ratings of 13 individual items, was performed, and results were analyzed with Fisher's exact test. RESULTS: Seventy-five percent of the subjects were satisfied overall with the TSB socket. Of the 13 items, comfort, ease to swing, pain, piston movement, tightness, skin irritation, appearance, and durability were regarded as good by more than 75% of the patients. Donning, perspiration, odor, and staining were regarded as poor by more than 20%. Items that were significantly related with overall satisfaction with the TSB socket were comfort, ease to swing, and piston movement, while donning was significantly related to dissatisfaction. CONCLUSION: The TSB socket is suitable for and preferred by many amputee subjects, but some problems remain to be solved.

The role of weakness of triceps surae muscles in astasia without abasia.

OBJECTIVE: To investigate the role of weakness of the bilateral triceps surae muscles-the gastrocnemius and soleus muscles-in astasia without abasia and whether compensating for muscle weakness with ankle-foot orthoses improves this disability. DESIGN: Case-control study of clinical findings and before and after trial of ankle-foot orthoses. SETTING: Clinics of the departments of rehabilitation medicine of two university hospitals. PATIENTS: A stilts group consisting of 23 patients with astasia without abasia, and a non-stilts group without this phenomenon consisting of 12 patients with hereditary motor sensory neuropathy, 15 patients with lumbosacral spondylotic radiculopathy or spondylolisthesis, and 20 healthy volunteers. MAIN OUTCOME MEASURE: Clinical findings of the stilts and non-stilts groups were compared and the sensitivity and specificity of each clinical finding was calculated. The length of the centre of foot pressure (COP) while standing was measured in a bilateral below knee amputee and 16 consecutive patients in the stilts group with and without ankle-foot orthoses. RESULTS: Weakness of the triceps surae muscles was the only finding that differed significantly between the two groups and was both sensitive and specific. The amputee was unable to stand in place without dorsiflexion bumpers, which functioned similarly to the triceps surae muscle. Bilateral ankle-foot orthoses improved the COPs of 14 out of 16 patients. CONCLUSION: The main cause of astasia without abasia is weakness of the triceps surae muscles, and this disability is improved by bilateral ankle-foot orthoses.

Test-retest and inter-method reliability of the self-rating Barthel Index.

OBJECTIVE: To develop a self-rating Barthel Index questionnaire (SB) for assessing stroke patients living at home, the test-retest reliability of SB versions 1 and 2 and the inter-method reliability of SB version 3 were examined. DESIGN: Case series. SETTING: Clinics of the Department of Rehabilitation Medicine at the University Hospital and two affiliated hospitals. PATIENTS: Thirty-one, 140 and 65 chronic stroke patients living at home, being seen for regular follow-up, and having no severe aphasia for SB versions 1, 2 and 3, respectively. MAIN OUTCOME MEASURE: Kappa coefficients of items in SB versions 1 and 2 for test-retest reliability, intra-class correlation coefficients of the self-care index, mobility index and total score, kappa coefficients of items and Friedman's two-way ANOVAs of ranking in SB version 3 among the self-ratings, family ratings and occupational therapist (OT) ratings; a regression analysis of age, gender, duration, time for filling in the SB, OT ratings, Mini-Mental State score and aphasia. RESULTS: Kappa coefficients in SB version 2 were higher than those in version 1. Intra-class correlation coefficients in SB version 3 among the three ratings were good, and kappa coefficients in each item were also good or excellent. By Friedman's two-way ANOVA, all the items except walking up/down stairs had no significant difference in ranking. Regression analysis revealed that OT ratings and time for filling in the SB affected the absolute difference of scores between the self-ratings and OT ratings. CONCLUSIONS: SB version 3 is sufficiently reliable for practical use.

Peripheral neuropathies in the upper extremities of paraplegic wheelchair marathon racers.

In order to know if peripheral neoropathies in the upper extremities of paraplegic individuals are induced by participating in wheelchair marathon races, we performed nerve conduction studies bilaterally on the median, ulnar, and radial nerves of 10 male wheelchair marathon racers, and on 10 male sedentary paraplegic individuals. In five of 10 paraplegic racers, and in nine of 10 sedentary paraplegics there was a decrease of motor nerve conduction velocities and/or prolongation of motor or sensory nerve distal latencies. Abnormal results in all of the nerve conduction studies were 3.2% and 13.6% in paraplegic racers and sedentary paraplegics, respectively. Although paraplegic racers had fewer peripheral neuropathies in the upper extremities than did sedentary paraplegics, ulnar lesions due to involvement of the deep motor branch and at the elbow were a characteristic feature of nerve injuries, presumably caused by wheelchair marathon racing. It is suggested that although a wheelchair marathon is generally a safe sport, wearing gloves and handling a wheelchair in the correct way during the race are necessary to prevent nerve injuries.

An autopsy study of the incidence of lacunes in relation to age, hypertension, and arteriosclerosis.

We investigated selected features of lacunes in 1,086 necropsy cases. Lacunes were found in brains from patients above the age of 40 years and were most common in brains from persons in their sixties but decreased in number in brains from older persons. The most common site of lacunes was the frontal lobe white matter, followed by the putamen, pons, parietal lobe white matter, thalamus, and caudate nucleus in descending order of frequency. By dividing the 1,086 cases into three groups according to blood pressure, we found more lacunes in the hypertensive and borderline hypertensive groups than in the normotensive group; the average number of lacunes per brain in each group was 3.61, 2.77, and 1.15, respectively. Diastolic hypertension was more closely related to the number of lacunes than was systolic hypertension. The extent of arteriolosclerosis of the medullary arteries in the frontal lobe white matter was measured and compared with the number of lacunes. There was a close correlation between lacunes and arterioloslerosis in all age groups.