Understanding Implications of Residual Limb Length, Strength, and Range-of-Motion Impairments of Veterans With Upper Limb Amputation

Abstract

The aim of the study was to describe and quantify the relationship between limb impairment variables to key functional outcomes. Design: This was an observational study of 107 participants with unilateral above/at-elbow or below-elbow/wrist amputation. Demographics, prosthesis characteristics, residual limb length, and prevalence of passive range-of-motion restrictions, and strength impairments were described. Correlations between impairment variables were estimated. Linear regressions examined associations between impairment variables and activity performance, health-related quality of life, disability, and prosthesis satisfaction. Results: Prevalence of short/very short below-and above-elbow residua was 25.7% and 12.5%, respectively. Shorter below-elbow/wrist residual limb length was correlated with elbow flexion weakness (r = 0.30) and prevalence of passive range of motion (r = 0.25). Shoulder prevalence of passive range-of-motion restrictions were correlated with shoulder (r = 0.27-0.51) and elbow weakness (r = 0.25-0.46). In regressions, activity performance was worse for those with shoulder flexion prevalence of passive range-of-motion restrictions (B = −5.0, P = 0.03) and better for those with flexion restrictions (B = 3.3, P = 0.04) compared with normal prevalence of passive range of motion. Prosthetic satisfaction was lower for those with limited elbow prevalence of passive range of motion. Conclusions: Short below-elbow residual limb length was correlated with impairment of elbow flexion strength and prevalence of passive range of motion. Prevalence of passive range-of-motion restrictions were most prevalent at the shoulder and were strongly correlated with weakness in the same planes of motion. Few significant associations were found between impairment variables and outcomes.

Prosthesis usability experience is associated with extent of upper limb prosthesis adoption: A Structural Equation Modeling (SEM) analysis

“…Although our study was not designed to explain why TH amputation level, but not SH level, moderates the effect of Prosthesis Usability Experience on Extent of Prosthesis Adoption, we believe that this effect might be attributable to unmeasured variables that impact persons with TH amputation level, but were not well captured in our set of indicator variables. For example, we did not have an indicator measure assessing fatigue associated with prosthesis use, a common problem amongst those with shorter residual limbs due to impaired muscle strength [ 58 ].…”

“…unmeasured variables that impact persons with TH amputation level, but were not well captured in our set of indicator variables. For example, we did not have an indicator measure assessing fatigue associated with prosthesis use, a common problem amongst those with shorter residual limbs due to impaired muscle strength [58].…”

Upper limb prosthetic prescription

“…One of the most important parameters in deciding the upper limb prosthesis is the stump length and the level of amputation. [ 6 ] If supination and pronation are preserved in transradial amputations, a prosthesis capable of finger flexion and extension may be sufficient. Four-channel control may be difficult in patients with small muscle volume.…”