Unna and elastic postoperative dressings: comparison of their effects on function of adults with amputation and vascular disease.

OBJECTIVES: To compare the functional outcome associated with the use of Unna semirigid dressings (SRD) and elastic bandage soft dressings (ED) for adults with lower limb amputation. DESIGN: Experimental design. SETTING: Inpatient rehabilitation unit of an urban academic medical center. PARTICIPANTS: A successive series of adults with vascular disease who had lower limb amputation surgery. Subjects were randomly assigned to the SRD (12 patients with 12 recent amputations) or the ED (9 patients with 10 recent amputations) group. Subjects in each group were not significantly different except for age; those in the SRD group were somewhat older. INTERVENTION: Subjects in the SRD group had Unna dressings applied to the amputation limb by physical therapists trained in the technique. Those in the ED group had elastic bandaging by therapists, nurses, family, and themselves, all of whom were trained in the technique. RESULTS: Sixty-seven percent of the SRD group and 20% of those in the ED group were discharged from the rehabilitation unit ambulating with prostheses. Of those who received prostheses, time from admission to the rehabilitation unit to readiness for fitting averaged 20.8 days for the SRD group and 28.7 days for the ED group. Comparison of survival curves shows that the time from surgery to fitting in the SRD group was almost half that of the ED group; 30% of the SRD group was fitted within 34 days, whereas it took 64 days for the same percentage of the ED group to be fitted. CONCLUSIONS: Unna semirigid dressings are more effective in fostering amputation limb wound healing and preparing the amputation limb for prosthetic fitting. Subjects treated with SRDs were more likely to be fitted with prostheses and to return home walking with a prosthesis.

Performance comparison among children fitted with myoelectric and body-powered hands.

Seventy-six children with unilateral below-elbow amputation were fitted in random sequence with a myoelectric (MYO) and a body-powered (BP) prosthetic hand of identical size, shape, and glove color. Subjects ranged from six to 17 years, nine months and included 67 children with congenital limb deficiency and nine who sustained traumatic amputation. After training, each child wore each hand for three months. On the form board test requiring only prosthetic use, subjects took 13.7% longer with the MYO and committed more errors with the MYO, specifically in dropping objects and delaying their grasp and release. Object displacement, the most common error, occurred nearly as often with BP as MYO. MYO was minimally faster on a test of ten practical activities designed for bimanual prehension. Card playing was 39.8% faster with BP, whereas donning socks, cutting paper, and bandage application were 27.8%, 12.5%, and 10.9% faster with MYO. Performance with both hands was rated as decidedly poorer than normal quality. No major clinically important differences were found in the comparison of performance.

Prosthetic management of children with limb deficiencies.

Children with amputations present challenging management problems. Surgical management, prosthetic fitting options, and training regimens have progressed substantially over the past several decades. Clinicians should be familiar with the available technological options to provide children with amputations the best possible care. The plethora of small components available for lower- and upper-limb prostheses indicates the desirability of managing juvenile patients in an interdisciplinary, specialized clinical setting where the advantages and disadvantages of prosthetic options can be related to the particular needs and wishes of each young client and the client's family. Although prostheses are not anatomical avatars, careful appliance prescription and training, coordinated with the child's growth and developmental changes, can optimize the benefits the child derives from the prosthesis.

Foot care for the aging.

Age-related changes in the feet include alterations in the skin, which becomes dry, inelastic, and cool and often exhibits hyperkeratoses. Thickened and brittle toenails complicate pedicure. The contour of the foot widens with age and may have increased forefoot height in the presence of toe deformities. Sensory acuity diminishes, as does joint mobility, muscle-force production, and ability to withstand stress. The elderly person's gait is slower and less forceful, with shorter strides. Visual loss affects footwear donning and toenail trimming. Older individuals on a limited income are less likely to have appropriate shoes and hose. Preventive care begins with good hygiene and continues with selection of suitable hosiery and shoes. Conservative management of the podiatric conditions most often seen in geriatric patients (eg, metatarsalgia and hallux valgus) should be based on relating the pathomechanics of the disorder to the options available in shoe selection, modification, and insert design.

Prosthetic feet. State of the Art.

Familiarity with the characteristics of current prosthetic foot-ankle assemblies will enable physical therapists to participate more effectively in the management of individuals with lower limb amputation. The purpose of this article is to inform therapists of the distinctions among various prosthetic devices, including their advantages and disadvantages. All foot-ankle prosthetic, components support the wearer, absorb shock, and simulate toe extension passively. Articulated assemblies, such as the single-axis and multiple-axis feet, plantar flex easily after heel-strike; however, they have an unattractive gap at the ankle. Nonarticulated components, such as the solid-ankle cushion heel foot, have various keel designs; energy-storing variants provide springiness for walking and running. Foot selection should reflect consideration of the patient's physical and psychological attributes and financial resources. Training should be structured to enable the wearer to make use of all features of the component. More laboratory and clinical research on prosthetic feet should be conducted to provide objective data on foot function.

Comparison of plastic/metal and leather/metal knee-ankle-foot orthoses.

Fifteen children with bilateral lower limb disability were fit alternately with plastic/metal (PM) and leather/metal (LM) knee-ankle-foot orthoses. Fit was maintained by periodic growth adjustments. Gait, activities of daily living, and subjective reactions were gathered for each orthosis type. Despite previous anecdotal reports and expert opinion to the contrary, no overall differences were found between the two types of orthoses. Several specific differences were revealed, however; most children preferred the PM orthoses, saying they were lighter and more easily donned and doffed; the PM orthoses also controlled hip and knee sagittal motion and foot valgus/varus during gait more effectively. Individual biomechanical, neuromuscular and psychologic attributes of the disabled child must be carefully matched with the technical attributes of each orthotic option to effect an optimal prescription.

Icelandic-Swedish-New York above-knee prosthetic sockets: pediatric experience.

The Icelandic-Swedish-New York (ISNY) above-knee prosthetic socket affords juvenile amputees improved comfort, function, and appearance. The flexible polyethylene socket and rigid frame facilitate accommodation to longitudinal and circumferential limb growth. Review of 10 subjects revealed that all who had worn pelvic band suspension with prior prosthesis having rigid sockets could use total or partial suction to suspend prostheses having ISNY sockets.

Reliability of observational kinematic gait analysis.

Gait analysis, like all clinical assessments, is subject to measurement error. Specification of the extent of measurement error is imperative before drawing conclusions from any test. The purpose of this study was to determine the within-rater and between-rater reliability of observational gait analysis in a pediatric sample wearing knee-ankle-foot orthoses. Three expert observers, using a 3-point scale, rated videotaped gait kinematics of 15 children who had lower limb disability and who wore braces. The rating sessions were then repeated, with one month between sessions. Total agreement (identical ratings), both between-raters and within-raters, occurred in two-thirds of the observations, and an additional 29% of the observations differed by one point. Between-rater intraclass correlation coefficient type 2, 1 was .73; within-rater Pearson product-moment correlation averaged .60. Observational kinematic gait analysis appears to be a convenient, but only moderately reliable, technique.