ACADEMY ANNUAL ASSEMBLY ABSTRACTS
Prosthetics, Orthotics, Assistive Devices
Poster 296
A Flexion Reminder Device to Discourage Recurrent Positional
Posterior Dislocation of Total Hip Replacement: A Case Report.
Manoj Sivan (Wycombe General Hospital, High Wycombe, United
Kingdom); Michael G. Matthews, MA, MBBS, FRCS; King Wong.
Disclosure: M.G. Matthews, none; M. Sivan, none; K. Wong, none.
Setting: Orthopaedic outpatient clinc and orthotic department of a
tertiary care district hospital. Patient: A 64-year-old fit and healthy
woman had a left cemented total hip replacement for primary osteo-
arthritis of the hip by anterolateral approach. 6 weeks later she was
bending down to pick up an object from the floor and dislocated her
operated hip. Relocation was done under general anaesthesia. Post-
reduction examination under anaesthesia showed the hip was stable
within the safe range of movements. X-rays did not show any com-
ponent malposition. She received comprehensive physiotherapy and
advice on avoiding unsafe positions. She eventually had 3 more
dislocations in 2 years time (when getting into bath tub and sitting on
a low sofa). She admitted the precipitating cause for each dislocation
being an unguarded flexion of the hip. An abduction brace was
prescribed but she could not tolerate wearing it all the time. Case
Description: We designed a simple padded plastic device that sits in
a slot of an elastic strap strapped to the upper thigh. Beyond 70° of
flexion, the padded top portion of the device hitches against the groin
crease and reminds the patient not to flex further. This device can be
worn either under or over clothing. It can be worn continuously for the
whole day, including while sleeping. It can be removed while bathing,
or if worn, the sponge padded top of the device can be easily dried. The
device can be worn while sitting in high chairs. As long as there is no
flexion beyond 70°, it is not uncomfortable while sitting. It is very
secure when worn and does not loosen even if worn continuously for
the whole day. It is lightweight and cheap to manufacture. Assess-
ment/Results: She has been using this device for the last 2 years and
has not had any further dislocation. She is very comfortable using it
and has now learned her limitations in terms of hip movements and life
style. Conclusions: The flexion reminder device acts as a physical
reminder when the hip is flexed beyond safe limits. This may prevent
recurrent positional posterior dislocation after total hip arthroplasty,
particularly when the precipitating factor is unsafe flexion of the
operated hip. Key Words: Arthroplasty; Rehabilitation.
Poster 297
How Successful is the Workers Compensation Board in Returning
Work-Related Traumatic Amputations to Employment? David
Berbrayer, MD, FRCPC, DABPMR (University of Toronto, To-
ronto, ON, Canada).
Disclosure: D. Berbrayer, none.
Objective: Hypothesis: To determine return-to-work rate in work-
ers compensation traumatic amputations. Design: Retrospective cohort
design reviewed medical records of outpatients with traumatic ampu-
tations. Records were reviewed from 2000 through May 31, 2006; 75
charts were reviewed, 3 were excluded (2 misfiled and 1 not traumatic)
Setting: Tertiary rehabilitation hospital. Participants: 72 amputees;
50 upper-limb amputations, 28 lower-limb amputations, 78 total am-
putations. Interventions: All amputees: average age 35 years, men/
women 96/4, returned to work, 34%, deemed fit to work, 31%, retired
4 %, did not return to work, 31%. Main Outcome Measures: Upper
limb dominant (n⫽30): average age 35 years, men/women 90/10,
returned to work, 40%, deemed fit return to work, 30%, retired 0%, did
not return to work, 30%. Lower limb dominant (n⫽18): average age
35 years, men/women 100/0, returned to work, 17%, deemed fit return
to work, 34%, retired, 6%, did not return to work, 43%. Results:
E119
Occupations: agriculture, 6%, labor/heavy machine operator, 77%,
truck driver, 4%, railway, 3%, firefighter, 1%, butcher, 6%, welder,
3%. 80% returned to work at same company, 8% opened own busi-
ness. Conclusions: Barriers to return to work were phantom and
residual pain and psychiatric comorbidities. Earlier studies suggested
higher return to work (89%). Is there an increase in incidence of
phantom limb and residual limb pain and is the pain adequately
treated? Key Words: Rehabilitation; Traumatic amputation; Workers
compensation.
Poster 298
Low Back Pain in Transfemoral Amputees: Is There a Correlation
With Leg-Length Discrepancy? David C. Morgenroth, MD (Uni-
versity of Washington, Seattle, WA); Joseph Czerniecki, MD;
Michael Orendurff; Ali Shakir, MD.
Disclosure: J. Czerniecki, none; D.C. Morgenroth, none; M. Oren-
durff, none; A. Shakir, none.
Objective: To test the hypothesis that either static or dynamic leg
length discrepancy (LLD) is associated with low back pain (LBP) in
transfemoral amputees. Design: A cross-sectional cohort study. Set-
ting: A tertiary care Veteran’s Administration medical center. Partic-
ipants: A volunteer sample of 9 transfemoral amputees with LBP and
8 transfemoral amputees without LBP. Interventions: None. Main
Outcome Measures: Static leg length was measured while the subject
stood in a comfortable position. Dynamic leg length was measured
both during the single limb support (SLS) and double-limb support
(DLS) phases of the gait cycle. Results: The pain and no-pain groups
were essentially the same in terms of all demographic and potentially
confounding variable measures. The mean of the absolute value ⫾ SD
of LLD was as follows: Measured statically: 8.4⫾7.5mm in the NP
group and 8.3⫾5.5mm in the P group (P⫽1.0, 95% confidence inter-
val [CI]⫺6.8 to 6.6mm). Measured dynamically during SLS: 28.4
⫾20.5mm in the NP group and 18.4⫾12.4mm in the P group (P⫽0.3,
95% CI⫺27.3 to 7.3mm). Measured dynamically during prosthetic
limb leading DLS: 11.0⫾6.3mm in the NP group and 15.1⫾9.0mm in
the P group (P⫽0.3, 95% CI⫺4.0 to 12.2mm). Measured dynamically
during intact limb leading DLS: 15.1⫾5.3mm in the NP group and
15.8⫾7.9mm in the P group (P⫽0.8, 95% CI⫺6.4 to 7.8mm). LLDs
of less than 8mm are unlikely to be clinically relevant. Conclusions:
This study calls into question whether LLD plays a significant role in
persistence of LBP in transfemoral amputees. Further study of the
effects of LLD and its possible relationship to causation of LBP in
amputees is needed. Key Words: Amputation; Low back pain; Reha-
bilitation.
Poster 299
Off-Loading Effect of Patella-Tendon-Bearing Ankle Foot Ortho-
sis in Patients With Diabetic Charcot Neuroarthropathic Foot: A
Pilot Study With 12 Months Follow-Up. Moo-Yeon Oh-Park, MD
(Montefiore Medical Center, Albert Einstein College of Medicine,
New York, NY); Jeffrey Chacko, MD; Dennis D. Kim, MD.
Disclosure: J. Chacko, none; D.D. Kim, none; M. Oh-Park, none.
Objective: To evaluate the off-loading effect of patella-tendon-
bearing ankle foot orthosis (PTB/AFO) in patients with diabetic Char-
cot neuroarthropathic foot (DCNA) over 12 months. Design: Retro-
spective review of serial pedobarometric measurement in 6 patients
with diabetic Charcot neuroarthropathic foot wearing PTB/AFO over
12 months. Setting: Diabetic foot and ankle clinic in tertiary hospital.
Participants: 6 patients with DCNA treated with PTB/AFO (anterior
and posterior shells encompassing the calf muscles with double up-
rights attached to custom made shoe). Interventions: Not applicable.
Main Outcome Measures: Serial measurement of pedobarometric
Arch Phys Med Rehabil Vol 89, November 2008
E120 ACADEMY ANNUAL ASSEMBLY ABSTRACTS
parameters, peak plantar pressure (PPPr) and force-time integral (FTI),
at 2 weeks, 3, 6, and 12 months after application of PTB/AFO.
Wilcoxon matched-pairs signed-rank test was used for analysis.
Results: The median PPPr on the entire foot was reduced from
312.2kPa with Darco shoe to 140.7kPa with PTB/AFO at 2 weeks
(54.9% reduction), 174.5kPa at 3 months, 175.8kPa at 6 months, and
175.5kPa at 12 months (43.7% reduction) after application. The dif-
ference in median PPPr at 2 weeks and 12 months approached statis-
tical significance (P⫽0.0625). The median FTI of the entire foot was
reduced from 636.2 newton seconds (Nsec) with Darco shoe to
469.9Nsec with PTB AFO at 2 weeks (26.1% reduction), 548.2Nsec at
3 months (13.8% reduction), 555.9Nsec at 6 months (12.6% reduction)
and 570.1Nsec at 12 months (10.4% reduction). The median FTI at 12
months was significantly different from that at 2 weeks for hindfoot
(P⫽0.031). The largest reduction in off-loading effect was seen be-
tween 2 weeks and 3 months. Conclusions: The initial off-loading
ability of PTB/AFO in patients with DCNA foot is not maintained with
substantial reduction over 12 months. Considering the largest reduc-
tion was observed during the first 3 months, adjustment of fitting is
recommended during this period. Key Words: Arthropathy, neuro-
genic; Diabetes Mellitus; Rehabilitation.
Poster 300
Pertinent Abduction Angle for Reduction of Shoulder Subluxation
in the Hemiplegic Patients. Jong Moon Kim, MD, PhD (Konkuk
Medical School, Chungju, South Korea); Soo Kyung Bok, MD,
PhD; Kang Hee Cho, MD, PhD; Bum Sun Kwon, MD, PhD; Ho
Lee; Su Young Lee, MD, PhD; Hyun Joon Shin, MD, PhD.
Disclosure: S. Bok, none; K. Cho, none; J. Kim, Konkuk University
research grants; B.S. Kwon, none; H. Lee, none; S. Lee, none; H. Shin,
none.
Objective: To investigate the proper abduction angle for reduction
of shoulder subluxation in hemiplegic patients. Design: Nonrandom-
ized, controlled trial. Setting: Tertiary care hospital. Participants: 13
hemiplegic patients (mean age, 58.8⫾8.0, 10 men, 3 women) who had
subluxated shoulder more than 1 finger breadth were enrolled. Inter-
ventions: 6 pairs of isosceles triangle with 15, 30, 45, 60, 75, and 90
degrees were made for holding the shoulders in abducted position.
Both shoulder radiographs were taken at each angle with upright
position. Main Outcome Measures: All parameters were measured
bilaterally. (1) Vertical distance (VD): distance between acromion and
humeral head (VC1), and between humeral head and lower margin of
glenoid fossa (VD2). (2) V-shape angle (VS): angles between glenoid
fossa and humeral head (VS1), and glenoid fossa and humerus (VS2).
(3) Joint distance (JD): the shortest distance between lower margin of
glenoid and humeral head. (4) VAS at each angle. Results: VAS was
increased with increments of abducted angles (r⫽0.982, P⬍0.05).
VS1, VS1, and JD were decreased on the contrary to VD2 with
increments of abducted angles (P⬍0.05). These values were changed
prominently between 30° and 45°. Conclusions: The more abduction
of shoulder helps, the better reduction of shoulder subluxation, but it
may be more painful and may disturb rehababilitation programs. We
concluded that 30° was the pertinent abduction angle for shoulder
subluxation. Key Words: Hemiplegia; Rehabilitation; Subluxation.
Poster 301
Phantom Pain, Phantom Sensation, and Spine Pain in Bilateral
Lower Limb Amputees. Seyedmansoor Rayegani, MD (Shahid
Beheshti University, Tehran, Iran); Batol Mousavi; Abbas Aryan-
mehr, Chief resident of physical medicine and rehabilitation.
Disclosure: B. Mousavi, none; A. Aryanmehr, none; S. Rayegani,
none.
Arch Phys Med Rehabil Vol 89, November 2008
Objective: To determine the prevalence and characteristics of phan-
tom limb pain, phantom limb sensation, and spine pain, and evaluate
their relevance to the various levels of amputation. Design: Retrospec-
tive, cross-sectional survey. Setting: All war-related bilateral lower
limb amputees from 1980 to 2006 were invited by Janbazan Medical
and Engineering Research Center. More than half of them participated
(N⫽335) and underwent thorough assessment and examination by 3
physiatrists after giving consent, and detailed questionnaire was com-
pleted. Participants: Participants were recruited from the pool of war
victims who had undergone bilateral lower limb amputations from
1980 to 2006. In this study 335 bilateral lower limb amputees were
visited by 3 physiatrists in same setting. Inclusion criteria were: (1) 6
or more months since lower limb amputation; (2) at or over the age of
18 years; (3) war-related bilateral lower limb amputation. Exclusion
criterion was perceptual and cognitive impairments making the an-
swers unreliable. Interventions: All war-related bilateral lower limp
amputees throughout the country were invited by Janbazan Medical
and Engineering Center. Of 578 amputees, 335 amputees participated
in our study. 3 physiatrists interviewed, examined, and completed the
detailed questionnaire. Main Outcome Measures: Prevalence, inten-
sity, bothersomeness of phantom pain, phantom sensation, prevalence
of various levels of spine pain (neck, back, low back), characteristics
of amputation, and prosthetic use. Results: The majority of partici-
pants were men (97.6%), aged from 18 to 70 years (mean⫽42), 97.6%
were married, and 73.1% had a job. The most common level of
amputation was transtibial (53%), for which 94% of patients wore
prosthesis. Low back pain was the most common complaint (53%) of
spine involvement. The overall prevalence of phantom limb pain and
nonpainful phantom sensation was 64% and 83%, respectively. Con-
clusions: Phantom limb pain/sensation is highly prevalent in war-
related amputees, but a minor proportion of them were bothered with
severe pain or sensation (rating 7–10). There was no relevance of
phantom limb pain/sensation with level of limb amputation. Key
Words: Amputation; Phantom pain; Rehabilitation.
Poster 302
Pressure Variation Under the Buttock During a Push Cycle.
Dong-A Kim, (Korean National Rehabilitation Center, Seoul,
South Korea); Mira Ahn; Bumsuk Lee; Sukhee Lee; Munhee Lim.
Disclosure: M. Ahn, none; D. Kim, none; B. Lee, none; S. Lee, none;
M. Lim, none.
Objective: The purpose of this study was to measure pressure
variation under the buttock during a push cycle, and to compare these
results with pressure under the static sitting condition. Design: A
repeated measures design was used to test the changes thine pressure
variation. Setting: Seating and positioning clinic. Participants:
Wheelchair-bound patients with spinal cord injury (N⫽20) were se-
lected. All subjects could push a wheelchair independently. Interven-
tions: All subjects were seated at 5cm height on air-filled cushions
(ROHO) on their wheelchairs. Main Outcome Measures: Maximal
pressures and average pressures under the buttock were measured at a
static condition and during a push cycle in various situations (different
speed—slow, medium, fast— on even surface, 90° curve, and 5° ramp)
The parameters were measured by Xsensor Pressure Mapping System
(Xsensor Technology Cooperation, Canada). Results: Maximal and
average pressure of buttock during propelling at a different speed were
significantly higher than pressure under the static seating condition
(P⬍0.05). There is no difference of maximal and average pressure
according to various speeds (P⬎0.05). Maximal and average pressure
of buttock during propelling up 5° ramp were significantly higher than
pressure under the static seating condition (P⬍0.05). Maximal and
average pressure of butock during propelling through a 90° curve were
significantly higher than pressure under the static sitting condition