Effectiveness of an Evidence-Based Amputee Rehabilitation Program: A Pilot Randomized Controlled Trial

Background Despite the prevalence of lower limb amputation (LLA), only a small percentage of people with LLA actually receive physical therapy post amputation and are rehabilitated to their full potential level of function. There is a need for the development of a rehabilitation program that targets impairments and limitations specific to people with LLA. Objective The objective of this study was to determine whether the Evidence-Based Amputee Rehabilitation program would improve functional mobility of people with unilateral transtibial amputation (TTA) who have already completed physical therapy and prosthetic training. Design This study was a randomized, wait-list control, single-blinded pilot clinical trial. Setting This study researched participants who had received postamputation rehabilitation to varying degrees, either in an inpatient and/or outpatient settings. Participants The participants in this study included veterans and nonveterans with unilateral TTA due to dysvascular disease and trauma. Intervention This study included a prescription-based rehabilitation program for people with amputations. Measurements Results were measured with The Amputee Mobility Predictor with (AMPPro) and without a prosthesis (AMPnoPro) and 6-Minute Walk Test (6MWT) at baseline and at the end of the 8-week intervention. Results The intervention group improved on the AMPPro scores (36.4 to 41.7), AMPnoro scores (23.2 to 27.1), and 6MWT distance (313.6 to 387.7 m). The effect size for the intervention was very large (1.32). In contrast, the wait-list control group demonstrated no change in AMPPro scores (35.3 to 35.6), AMPnoPro scores (24.7 to 25.0), and 6MWT distance (262.6 m to 268.8 m). Limitations The sample size was small. A total 326 potential candidates were screened with 306 unable to meet inclusion criteria or unwilling to participate. Conclusion People with unilateral TTA who received Evidence-Based Amputee Rehabilitation program demonstrated significant improvement in functional mobility, with most participants (66.7%) improved at least 1 K-level (58.3%) and greater than the minimal detectable change (66.7%).

Video games towards Rehabilitation: Video Games based Rehabilitation Approach for Upper Limb Amputee Patients (Preprint)

BACKGROUND Prepared residual muscles and induced specific brain plasticity are very important before wearing a myoelectric prosthetic hand. They can be achieved through exhausting and tedious muscle training. Conservative physiotherapeutic exercise often results in significant reduction in patient motivation. Motivation is a key factor for effective rehabilitation and is frequently used to determine rehabilitation outcome. While a few systems for upper limb amputee rehabilitation are available, playful concept in rehabilitation that usually increase patient engagement and perseverance through the use of video games is often unanalyzed in the upper limb amputee population. OBJECTIVE This study investigated whether the inclusion of video games in the upper limb amputee rehabilitation protocol could have a beneficial impact for muscle preparation before wearing myoelectric prosthesis, coordination and patient motivation. METHODS Ten participants, 5 amputee and 5 able-bodied, enrolled in ten 1-hour sessions within a 4-week rehabilitation program. In order to investigate the effect of the rehabilitation protocol used in this study, a virtual reality box and block test and electromyography assessment was performed. Maximum voluntary contraction was measured before, after, and two days after interacting with four different EMG-controlled computer games. Participants completed user evaluation survey and their motivation was assessed using the Intrinsic Motivation Inventory (IMI) questionnaire. RESULTS Muscle strength and coordination increased at the end of training for all the participants. The result of the Pearson correlation indicated that there was a significant positive association between the training period and the Box and Block Test score (r(8): 0.95, p < 0.001). The percentage of Maximum Voluntary Contraction increment value is greater before training (6.84%) and in follow up session (7.14%) but was very small (2.11%) shortly after the training was conducted. The IMI assessed showed high scores for subscales of interest, perceived competence, choice and usefulness but low values for pressure and tension. CONCLUSIONS This study demonstrates that videogames enhance motivation and adherence in upper limb amputee rehabilitation programs. The use of videogames could be seen as complementary methods for physical training in upper limb amputee rehabilitation. CLINICALTRIAL The test was approved by the Medical Research Ethics Committee (MREC) and the Ministry of Health (MOH) Malaysia, Approval ID: NMRR-16-2106-32880.