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We usually assume that age and level of amputation are important predictors of successful prosthetic fitting. However, in a study of all non-traumatic amputations in Scotland over a three year period from 2007 to 2009, Fiona Davie-Smith and colleagues found that in people with diabetes mellitus (DM), this was not the case. In the population studied, although the group with DM was younger and had a higher proportion of transtibial amputations, the proportion of successful fittings was the same as the older, higher level, non-DM group. More research into factors influencing fit rates in people with DM is required. The results of the study are published in the current (February 2017) issues of Prosthetics and Orthotics International.
In multi-articular muscles such as the long finger flexors, the joint position at one articulation can be adjusted to compensate strength losses as a result of the position at other joints which the muscle crosses. In grasping small objects in a power grip, the shortened length of the finger flexors can be compensated by extending the wrist to put the muscles at a more favourable length for force production. After finger flexor tendon surgery, it is desirable to ensure that muscle forces are limited to minimize the risk of damage during recovery. A wrist orthosis can be used to hold the wrist in a flexed position so that the fingers can be used but force production is limited. In the current issue of POI, Arne Bursens and co-workersdocument the decrease in grip force for wrist angles ranging from 30 degrees extension to 80 degrees of flexion. A wrist position of 23 degrees flexion reduces maximum grip force by 50%.
The physical and mental health benefits of regular exercise are well known but people living with disabilities are less likely to participate due to personal physical and psychological barriers, inaccessibility of suitably modified facilities and inadequate training and preparation of exercise leadership personnel. In a study recently published in OnlineFirst, Carol Miller and colleagueshave shown that a 6-week supervised community-based exercise program significantly improved walking velocity, dynamic balance and balance confidence in a group with lower limb amputation. More carefully controlled studies in amputees and people with other physical disabilities are required but the results of this study are very encouraging.
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Prosthetics and Orthotics International (POI)
Influence of wrist position on maximum grip force in a post-operative orthosis. Burssens, A., Schelpe, N., Vanhaecke, J., Dezillie, M., & Stockmans, F. (2015)
The impact of gender, level of amputation and diabetes on prosthetic fit rates following major lower extremity amputation. Davie-Smith, F., Paul, L., Nicholls, N., Stuart, W. P., & Kennon, B. (2016)
The effect of a supervised community–based exercise program on balance, balance confidence, and gait in individuals with lower limb amputation. Miller, C. A., Williams, J. E., Durham, K. L., Hom, S. C., & Smith, J. L. (2017)