Often encountered in traditional transtibial amputation is a condition that constitutes pain, swelling, sense of instability, bone and soft tissue atrophy, and prosthetic difficulties, resulting in decreased function. One innovative method for maximizing the rehabilitation capability after amputation surgical reconstruction is osteomyoplastic transtibial amputation, commonly called the "Ertl procedure" (Ertl and Ertl, Prosthetics and Patient Management: A Comprehensive Clinical Approach. 2006). A standard for physical therapy management of those with osteomyoplastic transtibial amputation needs to be described for future controlled study. To describe the typical clinical presentation and current physical therapy management practiced in patients with osteomyoplastic transtibial amputation. Standardized physical therapy management of primary and secondary osteomyoplastic transtibial amputation from initial status through discharge is described. During the rehabilitation process after the Ertl procedure, residual limb compression hose is usually not applied. Progressive residual limb end bearing is encouraged. Muscle hypertrophy of all residual limb muscles because of strengthening exercise can occur, thus permanent prosthesis use may be delayed. Patient goals for normal gait and return-to-previous function can be achieved. Patients, who undergo an osteomyoplastic transtibial procedure, the Ertl procedure, may benefit from standardized physical therapy management guidelines to facilitate recovery time and maximize function. Setting a standard for care will allow outcomes to be measured and generalized more broadly, allowing future study of the effectiveness of care for patients with transtibial Ertl procedure. (J Prosthet Orthot. 2009;21:64 -70.)

In the transtibial osteomyoplastic amputation (TOA) technique, the distal ends of the tibia and fibula are surgically joined to form a ''bone bridge'' to stabilize the bony anatomy of the distal residuum. The distal-most muscles also are secured to reestablish a length-tension relationship. Unlike conventional amputation techniques in which the muscles are not secured and do not retain length-tension relationship, the TOA procedure is anticipated to allow muscles to actively contract and retain normal physiological function. In this case series, outcomes of the TOA procedure were investigated by measuring electromyography signals from the tibialis anterior and gastrocnemius muscles in the residuum and forces at the residuum socket interface (RSI) in unilateral transtibial amputees with TOA during three types of gait activities (self-paced walking, brisk 2-minute walking, and walking over a distance of 25 ft while carrying various loads). Results confirmed the presence of loadings at the distal residuum and the activity in the residuum muscles during these gaits. Furthermore, statistical analysis showed that when the distal RSI force variation was higher, the residual tibialis anterior muscle was more active compared with its activity at lower distal RSI force variation. (J Prosthet Orthot. 2013;25:151Y158.)

Azuma, H.Comparison of a correlational with a probabilistic approach to concept learning.Unpublished doctoral dissertation. University of Illinois, 1960, Bartlett ? M. S 3 Some examples of statistical methods of research in agriculture and applied biology.

Background Lower-limb amputation (LLA) results in participation restrictions in major life activities in personal, work, and leisure environments. By participating in significantly less physical activity (PA) than those who are otherwise healthy, people with LLA are at risk for developing secondary chronic health conditions. Barriers and facilitators to PA participation for those with conventional LLA are well documented. However, these factors are not well understood for those with transtibial osteomyoplastic amputation (TOA). Purpose The aim of this study was to qualitatively investigate the barriers and facilitators to PA participation in the TOA population. Design This study is an observational, qualitative research using thematic analysis. Methods Semistructured interviews were utilized to collect information-rich data from nine men with TOA. Results The participants reported minimal body structure impairments but still experience impairment to body functions. Participants reported that they were limited during running and resistance exercises during before and after the actual amputation surgery. The majority of participants value PA benefits as they relate to prevention of chronic disease but fail to recognize potential benefits on function. An individual's motivation to participate can serve as both a facilitator and barrier to PA. Having the opportunity to socialize during PA is important to these participants. The quality of postoperative care program has a direct influence on the long-term PA participation for these participants. Conclusions People with TOA continue to experience body function impairment, activity limitations, and participation restrictions. The health care team can play a significant role in the adoption of a physically active lifestyle for people with TOA.