Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventive surgery for such problems. A special case is that of congenital amputation, a congenital disorder, where fetal limbs have been cut off by constrictive bands. In some countries, judicial amputation is currently used to punish people who commit crimes. Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury. In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment. When done by a person, the person executing the amputation is an amputator. The oldest evidence of this practice comes from a skeleton found buried in Liang Tebo cave, East Kalimantan, Indonesian Borneo dating back to at least 31,000 years ago, where it was done when the amputee was a young child.
In medicine, a prosthesis, or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through physical trauma, disease, or a condition present at birth. Prostheses are intended to restore the normal functions of the missing body part. Amputee rehabilitation is primarily coordinated by a physiatrist as part of an inter-disciplinary team consisting of physiatrists, prosthetists, nurses, physical therapists, and occupational therapists. Prostheses can be created by hand or with computer-aided design (CAD), a software interface that helps creators design and analyze the creation with computer-generated 2-D and 3-D graphics as well as analysis and optimization tools.
A phantom limb is the sensation that an amputated or missing limb is still attached. It is a chronic condition which is often resistant to treatment. When the cut ends of sensory fibres are stimulated during thigh movements, the patient feels as if the sensation is arising from the non-existent limb. Sometimes the patient might feel pain in the non-existent limb. Approximately 80–100% of individuals with an amputation experience sensations in their amputated limb. However, only a small percentage will experience painful phantom limb sensation. These sensations are relatively common in amputees and usually resolve within two to three years without treatment. Research continues to explore the underlying mechanisms of phantom limb pain (PLP) and effective treatment options.
Mirror therapy (MT) or mirror visual feedback (MVF) is a therapy for pain or disability that affects one side of the patient more than the other side. It was invented by Vilayanur S. Ramachandran to treat post-amputation patients who had phantom limb pain (PLP). Ramachandran created a visual illusion of two intact limbs by putting the patient's affected limb into a "mirror box," with a mirror down the center.
Phantom pain is a painful perception that an individual experiences relating to a limb or an organ that is not physically part of the body, either because it was removed or was never there in the first place.
Neuroprosthetics is a discipline related to neuroscience and biomedical engineering concerned with developing neural prostheses. They are sometimes contrasted with a brain–computer interface, which connects the brain to a computer rather than a device meant to replace missing biological functionality.
Extended physiological proprioception (EPP) is a concept pioneered by D.C. Simpson (1972) to describe the ability to perceive at the tip of a tool. Proprioception is the concept is that proprioceptors in the muscles and joints, couple with cutaneous receptors to identify and manage contacts between the body and the world. Extended physiological proprioception allows for this same process to apply to contacts between a tool that is being held and the world. The work was based on prostheses developed at the time in response to disabilities incurred by infants as the result of use of the drug thalidomide by mothers from 1957 to 1962, with the tool in this case simply being the prosthesis itself. How a person identifies with themself changes after a lower limb amputation affects body image, functioning, awareness, and future projections.
A traumatic neuroma is a type of neuroma which results from trauma to a nerve, usually during a surgical procedure. The most common oral locations are on the tongue and near the mental foramen of the mouth. They are relatively rare on the head and neck.
Dysesthesia is an unpleasant, abnormal sense of touch. Its etymology comes from the Greek word "dys," meaning "bad," and "aesthesis," which means "sensation". It often presents as pain but may also present as an inappropriate, but not discomforting, sensation. It is caused by lesions of the nervous system, peripheral or central, and it involves sensations, whether spontaneous or evoked, such as burning, wetness, itching, electric shock, and pins and needles. Dysesthesia can include sensations in any bodily tissue, including most often the mouth, scalp, skin, or legs.
The Krukenberg procedure, also known as the Krukenberg operation, is a surgical technique that converts a forearm stump into a pincer. It was first described in 1917 by the German army surgeon Hermann Krukenberg. It remains in use today for certain special cases but is considered controversial and some surgeons refuse to perform it.
Targeted reinnervation enables amputees to control motorized prosthetic devices and to regain sensory feedback. The method was developed by Dr. Todd Kuiken at Northwestern University and Rehabilitation Institute of Chicago and Dr. Gregory Dumanian at Northwestern University Division of Plastic Surgery.
Össur hf. is a company based in Iceland that develops, manufactures and sells non-invasive equipment for orthopaedics, including bracing and support products, compression therapy, and prosthetics. The company is headquartered in Reykjavík, with offices in the Americas, Europe, and Asia, and distributors in other markets.
T42 is a disability sport classification for disability athletics, applying to athletes with single above the knee amputations or a disability that is comparable. This class includes ISOD classified A2 and A9 competitors.
T43 is a disability sport classification for disability athletics, applying to athletes with "Double below knee amputation or similar disability." It includes ISOD classified athletes from the A4 and A9 classes.
T44 is a disability sport classification for disability athletics, applying to "Single below knee amputation or an athlete who can walk with moderately reduced function in one or both legs." It includes ISOD A4 and A9 classes.
Cortical remapping, also referred to as cortical reorganization, is the process by which an existing cortical map is affected by a stimulus resulting in the creating of a 'new' cortical map. Every part of the body is connected to a corresponding area in the brain which creates a cortical map. When something happens to disrupt the cortical maps such as an amputation or a change in neuronal characteristics, the map is no longer relevant. The part of the brain that is in charge of the amputated limb or neuronal change will be dominated by adjacent cortical regions that are still receiving input, thus creating a remapped area. Remapping can occur in the sensory or motor system. The mechanism for each system may be quite different. Cortical remapping in the somatosensory system happens when there has been a decrease in sensory input to the brain due to deafferentation or amputation, as well as a sensory input increase to an area of the brain. Motor system remapping receives more limited feedback that can be difficult to interpret.
A2 is an amputee sport classification used by the International Sports Organization for the Disabled (ISOD).for people with acquired or congenital amputations. A2 sportspeople have one leg amputated above the knee. Their amputations impact their sport performance, including having balance issues, increased energy costs, higher rates of oxygen consumption, and issues with their gait.
A1 is an amputee sport classification used by the International Sports Organization for the Disabled (ISOD) for people with acquired or congenital amputations. This class is for sportspeople who have both legs amputated above the knee. Their amputations impact their sport performance, including having balance issues, increased energy costs, higher rates of oxygen consumption, and issues with their gait. Sports people in this class are eligible to participate in include athletics, swimming, sitting volleyball, archery, weightlifting, badminton, lawn bowls, sitzball and wheelchair basketball.
Gait deviations are nominally referred to as any variation of standard human gait, typically manifesting as a coping mechanism in response to an anatomical impairment. Lower-limb amputees are unable to maintain the characteristic walking patterns of an able-bodied individual due to the removal of some portion of the impaired leg. Without the anatomical structure and neuromechanical control of the removed leg segment, amputees must use alternative compensatory strategies to walk efficiently. Prosthetic limbs provide support to the user and more advanced models attempt to mimic the function of the missing anatomy, including biomechanically controlled ankle and knee joints. However, amputees still display quantifiable differences in many measures of ambulation when compared to able-bodied individuals. Several common observations are whole-body movements, slower and wider steps, shorter strides, and increased sway.
Limb telescoping is the progressive shortening of a phantom limb as the cortical regions are reorganized following an amputation. During this reorganization, proximal portions of the residual limb are perceived as more distal parts of the phantom limb. Such effect is responsible for increased phantom pain due to the discrepancy between the patient’s body perception and their actual body. This effect may last from weeks up to years after post-amputation.
