which measure function by ambu- of an upper-limb prosthesis ..

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The social and economic outcome after upper limb amputation

Dealing with limb loss is difficult in and of itself without having to deal with the complications and routine of using a prosthetic device. In contrast to people with lower-limb loss, a significant proportion of people with upper-limb loss completely abandon use of all prostheses and rely upon their nonamputated upper limb to perform daily tasks. Unfortunately, reliance upon the uninjured arm often results in CTD or fatigue due to overuse. Of 60 people with upper-limb loss surveyed in the United Kingdom, 45 percent developed shoulder pain in the contralateral upper limb and 35 percent abandoned using their prosthetic devices [12]. In another study of 242 people with upper-limb loss, 20 percent abandoned prosthetic devices [11]. In our study, 30 percent of the Vietnam group and 22 percent of the OIF/OEF group completely abandoned upper-limb prostheses. Although the Vietnam group used prosthetic devices for a longer time (average 4 years) before abandonment than the OIF/OEF group (average 8 months), the reasons were similar (pain, weight, fuss), and most of those who abandoned prosthetic devices had other comorbid complications. More research is needed to elucidate preventable reasons for upper-limb prostheses abandonment and policies to correct deficiencies.

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The social and economic outcome after upper limb amputation ..

A recent Department of Defense (DOD) Rehabilitation Directive aims to restore wounded servicemembers from OIF/OEF to the highest possible functional level so the loss of a limb does not prevent a return to Active Duty [14-16]. Factors predicting continued use of and satisfaction with prosthetic devices in these servicemembers and veterans have not been fully explored [17-18]. Our study explores the effect of this rehabilitation paradigm shift by comparing the prosthesis use of veterans with combat-associated unilateral upper-limb loss from the Vietnam group (predirective) with that of the OIF/OEF group (postdirective). The purpose of this study was to describe prosthetic-device use patterns in two large groups of servicemembers and veterans with combat-associated upper-limb loss.

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"A Self-energizing System for Above-Knee Prosthesis," J

When survey participants were asked to rank how their upper-limb loss affected their current quality of life, the average combat injury impact rank for the Vietnam group was 7 ± 3 versus 8 ± 2 for the OIF/OEF group ( = 0.04). In the Vietnam group, those with transhumeral limb loss reported their limb loss had the greatest effect on their current life, while in the OIF/OEF group, through-the-hand limb loss had the greatest effect on quality of life.

"A Self-energizing System for Above-Knee Prosthesis ..

The upper-limb activity scores were also associated with the level of limb loss, with a trend for activity to increase the more distal the limb-loss level (). In both groups, higher upper-limb activity scores were found for the wrist and transradial limb-loss levels (), whereas lower activity scores were found in the elbow, transhumeral, and shoulder limb-loss levels. We did not find a significant difference in upper-limb activity measure by group: the mean activity score was 0.6 ± 2 for the Vietnam group and 0.7 ± 2 for the OIF/OEF group ( = 0.83).

The Analysis of Upper Limb Movement ..

Forty-seven Vietnam veterans and fifty servicemembers wounded in the OIF/OEF conflict with unilateral upper-limb loss were enrolled in our study. The mean (± standard deviation) age of the Vietnam group was 60 ± 2 years, and the mean age of the OIF/OEF group was 30 ± 6 years. Seven (14%) of the OIF/OEF participants returned to Active Duty after rehabilitation. Surprisingly, more than half those returning to Active Duty had transhumeral limb loss. A comparison of the health status of the Vietnam and OIF/OEF groups is shown by level of limb loss in . The level of limb loss was diverse for both groups; transradial and transhumeral limb loss being the most frequent for both the Vietnam (32% and 43%, respectively) and OIF/OEF groups (40% and 28%, respectively). A detailed description of the demographic characteristics of the Vietnam and OIF/OEF groups with unilateral upper-limb loss can be found in another article in this issue [19].


The total number of upper-limb prosthetic devices ever received by type of device and level of limb loss is provided in for the Vietnam and OIF/OEF groups. As the mean time since limb loss to survey date was significantly longer for the Vietnam group (39.1 ± 2.3 years) than the OIF/OEF group (3.4 ± 1.0 years), the different time periods at risk were adjusted by using person-years as the denominator. In the first year after limb loss, the Vietnam group received a mean of 1.2 ± 0.5 devices (usually mechanical/body-powered), while the OIF/OEF group received a mean of 3.0 ± 1.6 devices ( . Little effect of limb-loss level was noted, except for a higher annual rate (3.3/person-year) for those with an elbow disarticulation in the OIF/OEF group.