Thermographic Evaluation, Residual Limb Skin Sensitivity, and Adaptation to the Prosthesis of Individuals with Lower-Limb Amputation with Prosthesis Provided by the Universal Health System
Authors: Vieira Rafael Isac , da Silva Honório Gesilani Júlia , Bender dos Santos Kadine Priscila , Lorenzetti Branco Ruy Luiz , Lorenzetti Branco Joaquim Henrique , Tonon da Luz Soraia Cristina 
Published: July 2023

ABSTRACT

Introduction
Prosthesis fixation is considered the central point for functionality, which promotes social reintegration of the individual with amputation. The deficits in the making of the prosthetic socket may trigger excessive friction on the residual limb and socket discomfort, possibly leading to a poor adaptation and consequent reduction of activity. Thermography is an evaluation and diagnostic method that may aid in the verification of the functionality of the prosthesis. The objective of the study was to analyze the superficial thermal distribution characteristics, the skin sensitivity of the residual limb, and the adaptation to the prosthesis of individuals with lower-limb amputation with prostheses provided by the Universal Health System.

Materials and Methods
Sixteen individuals of both genders with unilateral lower-limb amputation with ages between 18 and 64 years were recruited. The data collection protocol was composed of completing the physiotherapeutic evaluation form, assessment of residual limb skin sensitivity, application of the Prosthesis Evaluation Questionnaire (PEQ), treadmill walk for 10 minutes, thermographic evaluation immediately after the removal of the prosthesis, and lastly postacclimatization thermographic assessment.

Results
Before the acclimatization, the region of the L3 dermatome of those who had altered sensitivity, the maximum (31.43°C), mean (28.97°C), and minimum (28.27°C) temperatures were significantly lower compared with those who had normal sensitivity (32.81°C, 29.68°C, and 28.91°C, respectively) (P < 0.05). Regarding the period after the acclimatization, there was no significant difference in the comparison performed between temperature and sensitivity. The individuals with transtibial amputation obtained results above the overall median for the PEQ items, whereas the individuals with transfemoral amputation obtained results above the overall median for the “total score.” There is a strong negative relationship between the mean temperature of the residual limb extremity with item “utility” in the preacclimatization moment and a strong negative relationship between the mean and minimum temperatures at the residual limb extremity with the “residual limb health” item at the moment after the acclimatization. There is no association between the PEQ items and residual limb sensitivity.

Conclusions
One may conclude that high temperatures at the postacclimatization moment indicate areas of friction that trigger a poor adaptation of the residual limb with the prosthetic socket, in which case the development of new strategies for improving the quality of the prostheses supplied is suggested.

Clinical Relevance
Thermography helps in evaluating the residual limb and adapting the prosthesis, as it is a noninvasive clinical assessment tool. Thermography aids health professionals for management of the patient with amputation in the preprosthesis and postprosthesis phases.