BACKGROUND:Amputation leads not only to limb loss but also to alterations in body representation, motor planning, and sensorimotor integration. Prosthesis use may help preserve these representations; however, its influence on cognitive motor processes such as laterality judgment and motor imagery remains unclear. OBJECTIVES:This study aimed to examine the effects of lower limb amputation (LLA) and prosthesis use on laterality judgment performance and motor imagery ability compared with able-bodied individuals. METHODS:Three groups participated: prosthesis users (PU) and nonprosthesis users (N-PU) with acquired unilateral LLA at or above the below-knee level, and normally limbed controls. Participants completed a laterality judgment task (reaction time and accuracy), the Vividness of Movement Imagery Questionnaire-2 (VMIQ-2), and the imagined Timed Up and Go (iTUG) test. Repeated measures ANOVAs, one-way ANOVAs, and independent samples t-test were conducted to analyze group differences. RESULTS:In the laterality task, N-PU participants demonstrated significantly longer reaction times than controls in the abstract condition for both the nonamputated (p = 0.001) and amputated sides (p = 0.004), along with lower overall accuracy (p = 0.035), whereas PU participants performed comparably with controls (p > 0.05). In the VMIQ-2, both amputee groups showed significantly reduced imagery vividness across all subscales compared with controls (p < 0.05); however, PU participants exhibited significantly greater kinesthetic imagery vividness than N-PU participants (p = 0.001). No significant difference was found between PU and controls in iTUG performance (p = 0.051). CONCLUSIONS:Prosthesis use appears to support the preservation of motor imagery ability and spatial representation in individuals with LLA. These findings emphasize the potential cognitive-motor benefits of prosthetic integration and support the inclusion of imagery-based assessments in rehabilitation programs.
Background Individuals with unilateral transfemoral amputation (TFA) commonly experience gait-related loading asymmetries, elevating their risks of lower limb injuries and degenerative changes. To evaluate the effects of interventions on these asymmetries, it is crucial to assess test-retest reliability and establish minimum detectable changes (MDCs) for loading-related measures. Determining them for these measures would help distinguish meaningful interventional effects from daily variability. This study evaluated test-retest reliability and established MDC values for ground reaction force (GRF) during treadmill walking in individuals with TFA and compared GRF outcomes between the amputated and intact limbs. Methods Ten participants underwent 2 study visits, 1 month apart. Ground reaction force data were collected during treadmill walking at a self-selected speed. Outcome measures included loading rates, unloading rates, braking impulses, and propulsive impulses, normalized by body weight. Intersession reliability and MDC values were computed with intraclass correlation analysis. Side-to-side differences were analyzed using repeated-measures ANOVAs. Ground reaction force time series were compared using statistical parametric mapping (SPM-1d). Results Braking and propulsion impulses demonstrated good-to-excellent reliability (intraclass correlation coefficients >0.82) in both limbs, whereas intact limb loading rates showed poor reliability. Higher loading rate but lower propulsion impulses were detected in the amputated limb, with differences in propulsion impulses exceeding MDC values. SPM-1d analyses detected side-to-side differences in GRF waveforms at the beginning and the end of the stance phase in superior-inferior and anterior-posterior directions. Conclusion Impulse outcomes are reliable measures, promising for future investigation of treatment effectiveness in longitudinal gait studies in individuals with TFA.
Background: Stubby prostheses are nonarticulated prostheses used by persons with bilateral transfemoral/through-knee amputations (BTF) either exclusively or alongside full-length articulated prostheses. The implications of stubby prosthesis use on musculoskeletal function and movement patterns are unclear. This study aims to provide insights into the biomechanics of walking with stubbies. Methods: Gait data were collected using a 10-camera motion capture system from 4 male traumatic BTF who exclusively use stubbies and 4 male traumatic BTF who use multiple prostheses, including stubbies and full-length articulated prostheses. Both cohorts completed level-ground walking trials wearing stubby prostheses. Muscle parameters were quantified through high-resolution magnetic resonance imaging scans. Results: Compared with BTF who use multiple prostheses, stubbies-only users showed lower walking speeds by 15% (0.79 vs 0.93 m/s), lower cadence by 20% (91.2 vs 114.7 steps/min), lower peak hip flexion angles by 45% (19.7° vs 35.9°), and larger peak-to-peak anterior pelvic tilt by 103% (15.8° vs 7.8°). Stubbies-only users presented lower overall muscle volume and physiological cross-sectional area. Conclusion: In this small cohort, full-time stubby users presented signs of muscle weakness that were not observed in those using full-length articulated prostheses. This may affect current and future functional abilities.
Introduction: Ankle-foot orthosis (AFO) is the most common orthotic device for children with cerebral palsy (CP), improving stride length, walking speed, and stability. Although AFO use is highest in children ages 6-12 years, it often decreases with age, and little is known about how youth and parents perceive AFO use in daily life, particularly regarding activity and participation. Aim: To explore the perceptions and experiences of AFO use in daily life among youth with CP and their parents, with a focus on activity and participation. Method: This qualitative study included 18 interviews with 9 AFO users with CP (8-15 years) and their parents. Data were analyzed using a descriptive phenomenological approach. Results: Four closely related themes emerged. The first, “AFO use evokes emotions and feelings,” captured positive and negative emotional responses to wearing AFOs. The second, “AFO use requires adaptation in everyday life,” described practical adjustments needed to integrate AFOs into daily routines. The third, “Experience creates awareness of autonomy and usefulness,” reflected how youth and parents gradually develop focused knowledge of when and how AFOs support daily functioning. Finally, “Participation in the AFO provision process” highlighted the role of communication and collaboration between families and professionals. Conclusion: AFO use in youth with CP involves complex emotional, practical, and participatory dimensions. Active inclusion of families through collaborative goal-setting from the outset of the orthotic process, and throughout follow-up, alongside consideration of emotional and social factors, can optimize orthotic outcomes and psychosocial well-being.
This scoping review aims to establish an understanding of existing tools or methodologies to grade referral quality or appropriateness published in an orthotics, Allied Health Profession (AHP), or AHP-involved setting. All patients deserve equal access to NHS services, but without knowing if services accept and triage referrals in the same way, it is not possible to. The PRISMA (ScR) checklist was used to structure this scoping review. The search was performed on March 04th, 2025, and was restricted to publications in the English Language only. Publications were screened and extracted by a single reviewer. Further to the literature search a call for gray literature, unpublished service evaluations, or audits through the British Association of Prosthetists and Orthotists, 71 publications were found, and 19 of these were included in the review. No publications focused on an orthotics setting, and only 3 publications centered on AHP specific services. Large variations exist in the methodology used and the purpose of evaluating referrals, with the 2 key tests of appropriateness appearing to be clinicians’ judgment or on the outcome after a referral. There is a gap that appears to exist wider than the orthotics profession in what is considered an appropriate referral and an agreed upon methodology for measuring appropriateness. This could be a valuable topic for further research and consideration, with the initial steps being to establish an understanding of how orthotic departments receive and evaluate referrals and understanding if there are differences in experience or common problems that services face.
