The aim was to review the literature on factors affecting prosthetic rehabilitation of older vascular lower extremity amputees. A search of the literature was carried out using the MEDLINE, EMBASE and CINAHL databases up to September 2010. Only original English language articles were accepted. Relevant studies were reviewed and selected based on prespecified inclusion criteria namely: age more than 65 years; vascular cause for the amputation; amputation level of below knee, through-the-knee or above knee; and discussed factors affecting rehabilitation. Age alone is not an absolute contraindication to prosthetic limb prescription; however, it does influence the potential success of gait retraining. Other factors influencing prosthetic fitting and use include comorbidities, premorbid function, level of amputation, status of the remaining limb and patient motivation. Prosthetic gait retraining is not possible in every older dysvascular amputee; however, almost all amputees will benefit from a rehabilitation program to increase independence in transfers and learn wheelchair skills. The MESH key words were: "aged" "diabetes complications" "peripheral vascular diseases" "amputees" "amputation" "rehabilitation" and "artificial limbs".

Purpose Due to limited accuracy of self-reported activities of lower limb prosthetic users, there is increasing interest in providing accurate walking time for those who are mobilising using their prosthesis in the rehabilitation ward. The aim of this study was to test the accuracy of a tri axial accelerometer (ActivPAL) in measuring walking activity of amputee patients while using their prosthetic limb. Method For the study, 21 subjects wore accelerometer devices taped to the thigh on both the amputated and non-amputated side. Each subject was asked to perform a set of activity routines: walking with prosthesis for 5 minutes, self-propelling in a wheel chair for 3 minutes and being pushed in a wheel chair for 3 minutes. Each activity was observed and timed by a physiotherapist and the observed times were compared with the output from accelerometer monitoring. Results Using the Bland–Altman method, the mean difference between observed and ActivPal monitor for total time spent walking for the non-amputated side was 0.004 seconds (limits of agreement −0.09 to 0.10 seconds) and for amputated side was 0.11 seconds (limits of agreement −0.43 to 0.66 seconds). An analysis between monitored and observed time found the sensitivity for the non-amputated side was 90.5% and 86% for the amputated side. Conclusion The use of ActivPAL accelerometers in measuring walking time for an individual using a prosthesis is within acceptable levels of accuracy for continuous ambulation monitoring. It has potentially important clinical application for prescribing prostheses.

The interRAI AC delirium screening strategy is a valid measure of delirium in older subjects in acute medical wards.

We investigated the accuracy and validity of clinical gait assessment, performed by experienced geriatricians viewing video clips of 10 s duration. Nineteen patients with normal or characteristic abnormal gait patterns were studied. The treating physician's diagnosis served as the gold standard. Another live assessment was then performed by a geriatrician blinded to the medical record to establish inter-rater reliability of live assessments. Subsequently, each gait video clip was examined by two independent geriatricians without any background clinical documentation. Diagnostic accuracy was tested at two levels -- whether the gait was abnormal, and the specific gait diagnosis. The agreement of the video clip examination with the gold standard to identify abnormal gait from normal gait ranged from substantial to excellent among assessors (kappa = 0.68-0.85), although low agreement with the gold standard was achieved in the detection of specific gait diagnosis (average agreement between both viewing geriatricians 50%). The technique appears to be a valid screening procedure for detecting gait abnormalities (average sensitivity 100%, specificity 70%).