Can PC-9 Zhong chong replace K-1 Yong quan for the acupunctural resuscitation of a bilateral double-amputee? Stating the “random criterion problem” in its statistical analysis

AIM: To present an inclusion criterion for patients who have suffered bilateral amputation in order to be treated with the supplementary resuscitation treatment which is hereby proposed by the author.METHODS: This work is based on a Retrospective Cohort model so that a certainly lethal risk to the control group is avoided.RESULTS: This paper presents a hypothesis on acupunctural PC-9 Zhong chong point, further supported by previous statistical work recorded for the K-1 Yong quan resuscitation point.CONCLUSION: Thanks to the application of the resuscitation maneuver herein proposed on the previously mentioned point, patients with bilateral amputation would have another alternative treatment available in case basic and advanced CPR should fail.

Neuromorphic transcutaneous electrical nerve stimulation(nTENS)induces efficient tactile-related cortical networks in forearm amputees

Conventional transcutaneous electrical nerve stimulation(cTENS),which uses a modulated square waveform as stimuli,has been generally used in testing and eliciting artificial tactile perception in forearm amputees.However,a novel neuromorphic TENS(nTENS)model based on neural signals has been largely ignored.In this study,we further explore the effect of nTENS patterns to elicit tactile perception in forearm amputees.Four forearm amputees were recruited to test discriminate tactile perception elicited by different TENS patterns with electroencephalography(EEG)recording at the following four stimulated sites:the index finger and the little finger on both phantom and real sides.Finally,we compared the results of cortical networks in six frequency bands at different stimulated sites between forearm amputees and able-bodied subjects.Behavioral results suggested that n TENS patterns required a lower electric charge at each stimulated site than cTENS patterns.And forearm amputees required a higher intensity in each TENS pattern than able-bodied subjects.Moreover,amputees showed a lower clustering coefficient(aCP),global efficiency(aEG),local efficiency(aEL),and a longer path length(aLP)than able-bodied subjects in all six frequency bands when stimulation was accessed.Specifically,the SMU pattern showed a higher functional network efficiency in real fingers than at phantom sites in theta,alpha,and high gamma bands.This study highlighted the characteristics of n TENS patterns in eliciting tactile perception among forearm amputees,which provided insights into evaluating the neural mechanism of tactile information processing in forearm amputees and building tactile perceptual systems for sensory rehabilitation.

Reconstructive surgery for phantom and residual limb pain in post-conflict settings

Traumatic amputations remain one of the most frequent and disturbing wounds of armed conflict.In this scenario,most amputees develop residual and phantom limb pain,impacting their quality of life.There are several elective surgical procedures available for both conditions,such as neuroma excision followed by nerve reconstruction,nerve relocation,e.g.,surgically implanting a transected nerve into a muscle,nerve transfers in cases of associated paralysis,and most recently,regenerative peripheral nerve interface surgery.Whenever possible in the post-conflict phase,a coordinated effort between traveling humanitarian surgeons specializing in reconstructive microsurgery and local healthcare providers is essential for successfully treating phantom and chronic residual limb pain in post-conflict amputees.While providing a detailed logistical framework for global humanitarian missions is beyond the scope of this article,we provide a brief perspective on a topic of utmost importance for reconstructive surgeons worldwide:the high-quality care and treatment of refugees and those whose lives have been impacted by conflict,disaster,or displacement.

Intracapsular fracture of the proximal femur in a bilateral above-knee amputee: A case report with technical tips for intraoperative positioning and literature review

Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which requires customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.

Influence of Prosthetic Sagittal Alignment on Trans-Tibial Amputee Gait and Compensating Pattern:A Case Study

This study relates the gait asymmetry, residual limb comfort, and energy cost during walking and identifies a compensating pattern for the trans-tibial amputees when the prostheses are misaligned. One male subject with a trans-tibial amputation volunteered for the study. The knee joint moments at the prosthetic side, the phase symmetry index, and the interface pressures were discussed under three sagittal alignment settings. The results show that the subject changes the knee joint moment, gait symmetry, and interface pressure with a misaligned prosthesis to improve his comfort and movement during walking. A high-quality liner reduces the gait sensitivity to misalignment and enhances the amputee＇s ability to compensate for misalignment. Since different people have different compensation patterns, more cases will be studied in future work.

Assistive technologies for pain management in people with amputation: a literature review

The prevalence of limb amputation is increasing globally as a devastating experience that can physically and psychologically affect the lifestyle of a person. The residual limb pain and phantom limb pain are common disabling sequelae after amputation surgery. Assistive devices/technologies can be used to relieve pain in people with amputation. The existing assistive devices/technologies for pain management in people with amputation include electrical nerve block devices/technologies, TENS units, elastomeric pumps and catheters, residual limb covers, laser systems, myoelectric prostheses and virtual reality systems, etc. There is a great potential to design, fabricate, and manufacture some portable, wireless, smart, and thin devices/technologies to stimulate the spinal cord or peripheral nerves by electrical, thermal, mechanical, and pharmaceutical stimulus. Although some preliminary efforts have been done, more attention must be paid by researchers, clinicians, designers, engineers, and manufacturers to the post amputation pain and its treatment methods.

Shoulder girdle recognition using electrophysiological and low frequency anatomical contraction signals for prosthesis control

Shoulder disarticulation amputees account for a small portion of upper-limb amputees,thus little emphasis has been devoted to developing functional prosthesis for this cohort of amputees.In this study,shoulder girdle recognition was investigated with acquired data from electrophysiological(electromyography[EMG])and low frequency contraction(accelerometer[Acc])signals from both amputee and non-amputee participants.The contribution of this study is based around the contrast of the classification accuracy(CA)for different sensor configurations using a unique set of signal features.It was seen that the fusion of the EMG-Acc produced an enhancement in the CA in the range of 10%-20%,depending on which windowing parameters were considered.From this,it was seen that the best combination of a windowing scheme and classifier would likely be for the 350 ms and spectral regression discriminant analysis,with a fusion of the EMG-Acc information.The results have thus provided evidence that the two sensors can be combined and used in practice for prosthesis control.Taking a holistic view on the study,the authors conclude by providing a framework on how the shoulder motion recognition could be combined with neuromuscular reprogramming to contribute towards easing the cognitive burden of amputees during the prosthesis control process.

Amputation stump management:A narrative review

In this review intended for medical staff involved in patient rehabilitation,we provided an overview of the basic methods for managing amputation stumps.After the amputation surgery,it is imperative to optimize the remaining physical abilities of the amputee through rehabilitation processes,including postoperative rehabilitation,desensitization,and continuous application of soft or rigid dressings for pain reduction and shaping of the stump.Depending on the situation,a prosthesis may be worn in the early stage of recovery or an immediate postoperative prosthesis may be applied to promote stump maturation.Subsequently,to maintain the range of motion of the stump and to prevent deformation,the remaining portion of the limb should be positioned to prevent contracture.Continuous exercises should also be performed to improve muscle strength to ensure that the amputee is able to perform activities of daily living,independently.Additionally,clean wound or edema management of the stump is necessary to prevent problems associated with wearing the prosthesis.Our review is expected to contribute to the establishment of basic protocols that will be useful for stump management from the time of completion of amputation surgery to the fitting of a prosthesis to optimize patient recovery.

Principles and Precautions of Nursing for Post-amputation Residual Limbs in an Earthquake

Nursing plays an important part in the rehabilitation of residual limbs and the utilization of artificial limbs after the attack of the earthquake,which also prevent and reduce the damage severity,supplement and improve functional state,increase quality of life and strengthen the social life participating capacity of the amputees. According to the Guiding Principles for Adaptation and Utilization of Common Assistive Devices for Injury of the Wounded in Earthquake [1]compiled jointly by CDPF and Ministry of Health,to further promote the development of scientific work for rehabilitation of the wounded in the earthquake,improve the whole level and efficacy of medical remedy and rehabilitation,and maximally reduce the severity of disability,this study mainly interpreted the precautions to the post-amputation nursing for residual limbs of the wounded,hoping to provide reference for medical staff who will receive patients for amputation to implement rehabilitation therapy.

How should we assess the mechanical properties of lower-limb prosthesis technology used in elite sport?—An initial investigation

Despite recent controversy, it is not yet formally recognised how lower-limb prosthesis should be assessed for their performance. To assist in this process, experiments are undertaken to investigate the linearity, stiffness and assessment of feet based energy return prosthesis technology typically used for elite level high speed running. Through initial investigations, it is concluded that static load testing would not be recommended to specify or regulate energy return prostheses for athletes with a lower-limb amputation. Furthermore, an assessment of energy return technology when loaded under dynamic conditions demonstrates changes in mechanical stiffness due to bending and effective blade length variation during motion. Such radical changes of boundary conditions due to loading suggest that any assessment of lower-limb prosthesis technology in the future should use methods that do not assume linear mechanical stiffness. The research into such effects warrants further investigation in the future.

A Case Study of a Force-myography Controlled Bionic Hand Mitigating Limb Position Effect

Force Myography （FMG）, which monitors pressure or radial deformation of a limb, has recently been proposed as a po- tential alternative for naturally controlling bionic robotic prostheses. This paper presents an exploratory case study aimed at evaluating how FMG behaves when a person with amputation uses a hand prosthetic prototype. One volunteer （transradial amputation） participated in this study, which investigated two experimental cases： static and dynamic. The static case considered forearm muscle contractions in a fixed elbow and shoulder positions whereas the dynamic case included movements of the elbow and shoulder. When considering eleven different hand grips, static data showed an accuracy over 99%, and dynamic data over 86% （within-trial analysis）. The across-trial analysis, that takes into account multiple trials in the same data collection set, showed a meaningful accuracy respectively of 81% and 75% only for the reduced six grips setup. While further research is needed to increase these accuracies, the obtained results provided initial evidence that this technology could represent an in- teresting alternative that is worth exploring for controlling prosthesis.

Associations between partial foot amputation level,gait parameters,and minimum impairment criteria in para-sport:A research study protocol

Altered biomechanics due to amputation can contribute to substantial limitations,influencing sporting activities.Individuals with lower extremity amputations or congenital lower limb deficiency are encouraged to participate in para-sports.However,to compete in Paralympic sports,the candidate must have an impairment that results in lower extremity loss of function and meets or exceeds the sport's minimum impairment criteria(MIC).This review will focus on the MIC for competitive wheelchair tennis.Limb deficiency is known as one of the MIC used to regulate participation in competitive para-sports since it impacts gait,kinematics,and biomechanics of both the upper and lower body.Notwithstanding,it is questionable whether the MIC concerning limb deficiency is set at the correct level for determining eligibility for participating in Paralympic sports.This study aims to provide an overview of the evidence examining the impact of different partial foot amputation(PFA)levels on gait as a proxy for sporting performance.This scoping review will be based on a 6-step methodological framework and Preferred Reporting Items for Systematic Reviews and Meta-Analysis,extension for scoping reviews(PRISMA-ScR).Studies will be selected from PubMed,Embase,CINAHL,and SPORTDiscus.Two authors will screen the titles/abstracts independently.Selected studies will be scrutinised,and the same authors will extract data.Findings will be relevant to informing the evidence-based development of MIC for lower limb impairment after PFA and may be extrapolated to specific Paralympic sports,including wheelchair tennis.Results will be disseminated through scientific publications and conferences to audiences interested in Paralympic sports.

Finite Element Modeling of Cutaneous Electrical Stimulation for Sensory Feedback

It is currently difficult for the amputee to perceive environmental information such as tactile pressure on the fingertip of the present upper limb prostheses.Sensory feedback induced by cutaneous electrical stimulation can be used to transmit tactile information from hand prostheses to sensory nerve of intact upper arm, thus producing the corresponding perceptions in human brain. In order to have a deeper understanding on the distribution of stimulation current within the limb, and find a better placement of the stimulating and reference electrodes, we constructed a three-dimensional upper-limb model to systematically study the effect of electrode placement on current distribution based on finite element analysis. In these simulations, the reference electrode is positioned at four different locations around and on the axial direction of the arm. The results show that with the increase of distance between reference electrode and stimulating electrode, the current density increases in the skin layer of the upper limb.When the reference electrode is on the opposite side of stimulating electrode around the arm, the current is more concentrated in the skin layer, which is in line with recent findings in psychophysiological experiments. But better spatial selectivity could be achieved when the reference electrode is closer to the stimulating electrode around the arm, and it is more obvious in comparison with that on the axial direction. These findings will provide insights for the design of electrode array used for evoking cutaneous sensory afferents.