In the United States, the number of major limb amputees is predicted to exceed several million in the coming decades. For those amputees using a prosthesis, their quality of life (QoL) is often modulated by residuum limb problems resultant from its use. Multiple factors preclude quality evidence-based medicine (EBM) research in the field of prosthetics, leading to greater health risk from prosthetic prescription ambiguity. Positive social change is integral to good QoL; studies support administrative healthcare (AHc) as useful to support such, especially in the absence of EBM. This study utilized Veterans Healthcare Administration (VHA) AHc data to discriminate determinants of residual limb skin problem severity (RLSPS), relative to the artificial limb configuration (ALC) used through a retrospective, longitudinal study of a cohort of U.S.Veteran dysvascular amputees. The dataset was derived from multiple archival VHA AHc databases from which 279 Cohort members were identified who underwent amputation surgery during the fiscal year (FY) 2007 were dispensed a prosthesis, and had clinical records through FY 2011. ICD-9-CM and HCPCS codes were used to identify categories of RLSPS and ALC, respectively, with generalized estimating equations modeling to identify likelihood associations of parameters. Derivation of the study cohort dataset was encumbered by data integrity issues and coding system limitations; significant associations were detected for RLSPS with chronic obstructive pulmonary disease, substance use disorder, and major depressive disorder, regardless of the ALC dispensed. The findings support the utility of an amputee-prosthesis AHc database to drive product, policy, and medical decisions toward an improved QoL for this vulnerable population.

Motor control of any movement task involves the integration of neural, muscular and skeletal systems. This integration must occur throughout the sensorimotor system and focus its efforts on controlling the system endpoint, e.g. the foot during locomotion. A person with a uni-lateral trans-tibial amputation has lost the foot, ankle joint, and muscles crossing those joints, hence the residuum becomes the new terminus of the motor system. The amputee must now adjust to the additional challenges of utilizing a compromised motor system as well as the challenges of controlling an external device, i.e. prosthesis, through the mechanical interface between the residuum and prosthetic socket. The obvious physical and physiologic asymmetries between the sound and amputated limbs are also involved in strategies for locomotion involving kinematic and kinetic asymmetries (Winter&Sienko, 1988). There are many questions as to why these asymmetric locomotor strategies are selected and what factors may be influencing that strategy. Factors influencing a change in locomotor strategy could be related to 1) the central nervous system accounting for the loss of sensorimotor feedback, 2) the altered mechanics of this new human/prosthetic system, or some combination of these factors. Understanding how the human motor system adjusts to the amputation and to the addition of an external mechanical device can provide useful insight into how robust the human control system may be and to adaptations in human motor control. This research uses a group of individuals with a uni-lateral trans-tibial amputation and a group of intact individuals using an Ankle Foot Orthosis (AFO) performing a cycling task to understand the "motor adjustments" necessary to utilize an external device for locomotion. Results of these experiments suggest 1) the motor system does account for the activation-contraction dynamics when coordinating muscle activity post amputation, 2) the motor system also changes joint kinetics and muscle activity, 3) these changes are related to control of the interface between the limb and the external device, and 4) the motor system does not alter kinetic asymmetries when kinematic asymmetries are minimized, contrary to a common practice in rehabilitation (Kapp, 2004). Results suggest that control of the external device, i.e. prosthesis or AFO, via the interface between the limb and the device reflect "motor adjustments" made by the nervous system and may be viewed in the context of tool use. Clinical goals in rehabilitation currently focus on minimizing gait deviations whereas the clinical application of these results suggest these deviations from normal locomotion are motor adjustments necessary to control a tool, i.e. prosthesis, by the motor system. Examining amputee locomotion in the context of tool use changes the clinical paradigm from one designed to minimize deviations to one intended to understand this behavior as related to interface control of the device thereby shifting the focus to improving function of the limb/prosthesis system. Kapp SL. (2004) Atlas amp limb def: surg pros rehab princ. 3rd ed: 385 - 394. Winter&Sienko. (1988) J Biomech, 21: 361 - 367.

Over one million amputees are living in the United States with major lower limb loss (Ziegler-Graham et al. 2008). Lower limb amputation leads to the functional loss of the ankle plantar flexor muscles, which are important contributors to body support, forward propulsion, and leg swing initiation during walking (Neptune et al. 2001; Liu et al. 2006). Effective prosthetic component design is essential for successful rehabilitation of amputees to return to an active lifestyle by partially replacing the functional role of the ankle muscles. The series of experimental and computer simulation studies presented in this research showed that design characteristics of energy storage and return prosthetic ankles, specifically the elastic stiffness, significantly influence residual and intact leg ground reaction forces, knee joint moments, and muscle activity, thus affecting muscle output. These findings highlight the importance of proper prosthetic foot stiffness prescription for amputees to assure effective rehabilitation outcomes. The research also showed that the ankle muscles serve to stabilize the body during turning the center of mass. When amputees turn while supported by their prosthetic components, they rely more on gravity to redirect the center of mass than active muscle generation. This mechanism increases the risks of falling and identifies a need for prosthetic components and rehabilitation focused on increasing amputee stability during turning. A proper understanding of the effects of prosthetic components on amputee walking mechanics is critical to decreasing complications and risks that are prevalent among lower-limb amputees. The presented research is an important step towards reaching this goal. / text

Background: Cosmesis has been found to have an impact on prosthesis users' body image. Therefore the satisfaction of the cosmesis plays an essential role in a prosthesis user perception of themselves. Most cosmeses on the market are natural-looking, although more futuristic options are coming to the market. Most of the previous evidence has been conducted using quantitative methods. There is a lack of research investigating the experiences of cosmesis in transtibial prosthesis users through qualitative methods. This is expected to elucidate potentially undiscovered areas and factors surrounding patient satisfaction.  Purpose: The aim of this thesis is to explore transtibial prosthesis user's satisfaction with the appearance of their cosmesis and gain a deeper understanding of their experiences regarding cosmeses.  Methods: The method in this thesis is a qualitative phenomenology approach with an interpretivist view. The experiences of 5 male transtibial users regarding their cosmesis and satisfaction towards it were explored. This was done by having in-depth semi-structured interviews that were analyzed with thematic analysis.  Results: The results five main themes arrived: Satisfaction, Natural-looking cosmesis, Function, Difficulties with the material, and Awareness. The results of these themes showed that the participants have different experiences regarding cosmesis.  Conclusion: This thesis found a variation regarding satisfaction of the appearance among unilateral transtibial prosthesis users. Similarities in satisfaction and experience were found in the respective age groups of the participants. However, due to saturation not being fully reached, there should be further investigations. / Bakgrund: Kosmetik har visat sig påverka protesanvändarnas kroppsuppfattning. Därför spelar tillfredsställelsen av kosmetiken en viktig roll i en protesanvändares mentala hälsa och kroppsuppfattning. Huvuddelen av den kosmetik som finns på marknaden har ett mer naturligt utseende, även om mer futuristiska alternativ har blivit mer vanliga på marknaden. De flesta av de tidigare redovisade studierna har genomförts med hjälp av kvantitativa forskningsmetoder. Det saknas ännu forskning som undersöker erfarenheterna när det gäller kosmetik hos transtibialt amputerade protesanvändare utförda med kvalitativa metoder. Studien förväntas belysa potentiellt oupptäckta områden och faktorer kring patientnöjdhet. Syfte: Syftet med denna studie är att utforska transtibialt amputerade protesanvändares tillfredsställelse med utseendet på deras kosmetik och få en djupare förståelse för deras erfarenheter av kosmetik. Metoder: I denna avhandling är ett kvalitativt fenomenologiskt tillvägagångssätt med ett interpretivistiskt förhållningssätt. Erfarenheter från 5 manliga transtibialt amputerade protesanvändare med avseende på proteskosmetik och deras tillfredsställelse med användandet kosmetik undersöktes. Detta genomfördes genom att ha djupgående halvstrukturerade intervjuer som analyserades med ett tematiskt förhållningssätt. Resultat: I resultaten framkom i huvudsak 5 huvudtema: Tillfredsställelse, kosmetik med naturligt utseende, funktion, svårigheter med material och medvetenhet. Resultaten av dessa teman visade att deltagarna har stora variationer när det gäller erfarenheter och användandet av kosmetik. Slutsats: Denna studie fann en betydande variation när det gäller tillfredsställelse av utseendet bland ensidiga användare av transtibiala proteser. Likheter inom tillfredsställelse och erfarenhet kunde noteras i deltagarnas respektive åldersgrupper. På grund av att mättnad (saturation) inte uppnåddes helt finns ett forsatt behov av ytterligare studier inom området.

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