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Laing S, Lythgo N, Lavranos J, Lee PVS. Transtibial Prosthetic Socket Shape in a Developing Country: A study to compare initial outcomes in Pressure Cast hydrostatic and Patella Tendon Bearing designs. Gait Posture 2017; 58:363-368. [PMID: 28869901 DOI: 10.1016/j.gaitpost.2017.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 07/06/2017] [Accepted: 08/11/2017] [Indexed: 02/02/2023]
Abstract
This study compared the physical function and comfort level of patients with unilateral transtibial amputation after being fitted with a hand-cast Patella Tendon Bearing (PTB) socket and a pressure-cast (PCAST) hydrocast socket. The latter technique aims to reduce the skill dependency currently required for socket manufacture and fit. The study was conducted at the Vietnamese Training Centre for Orthopaedic Technologies and involved seventeen Vietnamese participants with unilateral transtibial amputation, all of whom were long term users of prosthetics. All participants were fitted with two sockets manufactured using both hand-cast and PCAST techniques with International Committee of the Red Cross components. Walking tests (timed up and go test and six-minute-walk-test), spatio-temporal gait analyses and subjective comfort assessments were completed after a short acclimatisation period with each socket. The participant-preferred socket was also noted. No significant differences were found for the measures of mobility, functional capacity, spatio-temporal gait parameters, gait symmetry, perceived comfort or participant socket preference. The results show the initial patient outcomes are similar when participants are fitted with a hand-cast PTB socket and a PCAST hydrocast sockets. Future work should confirm these findings in a longer trial.
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Affiliation(s)
- Sheridan Laing
- The Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Noel Lythgo
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Jim Lavranos
- Department of Prosthetics and Orthotics, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Peter Vee Sin Lee
- The Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia.
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Wernke MM, Schroeder RM, Haynes ML, Nolt LL, Albury AW, Colvin JM. Progress Toward Optimizing Prosthetic Socket Fit and Suspension Using Elevated Vacuum to Promote Residual Limb Health. Adv Wound Care (New Rochelle) 2017; 6:233-239. [PMID: 28736683 DOI: 10.1089/wound.2016.0719] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/07/2017] [Indexed: 11/13/2022] Open
Abstract
Objective: Prosthetic sockets are custom made for each amputee, yet there are no quantitative tools to determine the appropriateness of socket fit. Ensuring a proper socket fit can have significant effects on the health of residual limb soft tissues and overall function and acceptance of the prosthetic limb. Previous work found that elevated vacuum pressure data can detect movement between the residual limb and the prosthetic socket; however, the correlation between the two was specific to each user. The overall objective of this work is to determine the relationship between elevated vacuum pressure deviations and prosthetic socket fit. Approach: A tension compression machine was used to apply repeated controlled forces onto a residual limb model with sockets of different internal volume. Results: The vacuum pressure-displacement relationship was dependent on socket fit. The vacuum pressure data were sensitive enough to detect differences of 1.5% global volume and can likely detect differences even smaller. Limb motion was reduced as surface area of contact between the limb model and socket was maximized. Innovation: The results suggest that elevated vacuum pressure data provide information to quantify socket fit. Conclusions: This study provides evidence that the use of elevated vacuum pressure data may provide a method for prosthetists to quantify and monitor socket fit. Future studies should investigate the relationship between socket fit, limb motion, and limb health to define optimal socket fit parameters.
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Fatone S, Caldwell R. Northwestern University Flexible Subischial Vacuum Socket for persons with transfemoral amputation: Part 2 Description and Preliminary evaluation. Prosthet Orthot Int 2017; 41:246-250. [PMID: 28132589 PMCID: PMC5423530 DOI: 10.1177/0309364616685230] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Current transfemoral prosthetic sockets are problematic as they restrict function, lack comfort, and cause residual limb problems. Development of a subischial socket with lower proximal trim lines is an appealing way to address this problem and may contribute to improving quality of life of persons with transfemoral amputation. OBJECTIVES The purpose of this study was to illustrate the use of a new subischial socket in two subjects. STUDY DESIGN Case series. METHODS Two unilateral transfemoral prosthesis users participated in preliminary socket evaluations comparing functional performance of the new subischial socket to ischial containment sockets. Testing included gait analysis, socket comfort score, and performance-based clinical outcome measures (Rapid-Sit-To-Stand, Four-Square-Step-Test, and Agility T-Test). RESULTS For both subjects, comfort was better in the subischial socket, while gait and clinical outcomes were generally comparable between sockets. CONCLUSION While these evaluations are promising regarding the ability to function in this new socket design, more definitive evaluation is needed. Clinical relevance Using gait analysis, socket comfort score and performance-based outcome measures, use of the Northwestern University Flexible Subischial Vaccum Socket was evaluated in two transfemoral prosthesis users. Socket comfort improved for both subjects with comparable function compared to ischial containment sockets.
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Affiliation(s)
- Stefania Fatone
- Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA,Stefania Fatone, Northwestern University Prosthetics-Orthotics Center, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611, USA.
| | - Ryan Caldwell
- Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA,Scheck & Siress, Schaumburg, IL, USA
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Fatone S, Caldwell R. Northwestern University Flexible Subischial Vacuum Socket for persons with transfemoral amputation-Part 1: Description of technique. Prosthet Orthot Int 2017; 41:237-245. [PMID: 28094686 PMCID: PMC5423533 DOI: 10.1177/0309364616685229] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Current transfemoral prosthetic sockets restrict function, lack comfort, and cause residual limb problems. Lower proximal trim lines are an appealing way to address this problem. Development of a more comfortable and possibly functional subischial socket may contribute to improving quality of life of persons with transfemoral amputation. OBJECTIVES The purpose of this study was to (1) describe the design and fabrication of a new subischial socket and (2) describe efforts to teach this technique. STUDY DESIGN Development project. METHODS Socket development involved defining the following: subject and liner selection, residual limb evaluation, casting, positive mold rectification, check socket fitting, definitive socket fabrication, and troubleshooting of socket fit. Three hands-on workshops to teach the socket were piloted and attended by 30 certified prosthetists and their patient models. RESULTS Patient models responded positively to the comfort, range of motion, and stability of the new socket while prosthetists described the technique as "straight forward, reproducible." CONCLUSION To our knowledge, this is the first attempt to create a teachable subischial socket, and while it appears promising, more definitive evaluation is needed. Clinical relevance We developed the Northwestern University Flexible Subischial Vacuum (NU-FlexSIV) Socket as a more comfortable alternative to current transfemoral sockets and demonstrated that it could be taught successfully to prosthetists.
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Affiliation(s)
- Stefania Fatone
- Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA,Stefania Fatone, Northwestern University Prosthetics-Orthotics Center, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611, USA.
| | - Ryan Caldwell
- Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA,Scheck & Siress, Schaumburg, IL, USA
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Vacuum level effects on knee contact force for unilateral transtibial amputees with elevated vacuum suspension. J Biomech 2017; 57:110-116. [PMID: 28476209 DOI: 10.1016/j.jbiomech.2017.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 02/17/2017] [Accepted: 04/09/2017] [Indexed: 11/22/2022]
Abstract
The elevated vacuum suspension system (EVSS) has demonstrated unique health benefits for amputees, but the effect of vacuum pressure values on knee contact force (KCF) is still unclear. The objective of this study was to investigate the effect of vacuum levels on KCF for unilateral transtibial amputees (UTA) using the EVSS. Three-dimensional gait was modeled for 9 UTA with five vacuum levels (0-20inHg [67.73kPa], 5inHg [16.93kPa] increments) and 9 non-amputees based on kinematic and ground reaction force data. The results showed that the vacuum level effects were significant for peak axial KCF, which had a relatively large value at 0 and 20inHg (67.73kPa). The intact limb exhibited a comparable peak axial KCF to the non-amputees at 15inHg (50.79kPa). At moderate vacuum levels (5inHg [16.93kPa] to 15inHg [50.79kPa]), co-contraction of quadriceps and hamstrings at peak axial KCF was similar for the intact limb, but was smaller for the residual limb comparing with the non-amputees. The intact limb showed a similar magnitude of quadriceps and hamstrings force at 15inHg (50.79kPa) to the non-amputees, but the muscle coordination patterns varied between the residual and intact limbs. These findings indicate that a proper vacuum level may partially compensate for the lack of ankle plantarflexor and reduce the knee loading. Of the tested vacuum levels, 15inHg (50.79kPa) appears most favorable, although additional analyses with more amputees are suggested to confirm these results prior to establishing clinical guidelines.
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56
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Rosenblatt NJ, Ehrhardt T, Fergus R, Bauer A, Caldwell R. Effects of Vacuum-Assisted Socket Suspension on Energetic Costs of Walking, Functional Mobility, and Prosthesis-Related Quality of Life. ACTA ACUST UNITED AC 2017. [DOI: 10.1097/jpo.0000000000000127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Xu H, Greenland K, Bloswick D, Zhao J, Merryweather A. Vacuum level effects on gait characteristics for unilateral transtibial amputees with elevated vacuum suspension. Clin Biomech (Bristol, Avon) 2017; 43:95-101. [PMID: 28232236 PMCID: PMC5404825 DOI: 10.1016/j.clinbiomech.2017.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The elevated vacuum suspension system has demonstrated unique health benefits for amputees, but the effect of vacuum pressure values on gait characteristics is still unclear. The purpose of this study was to investigate the effects of elevated vacuum levels on temporal parameters, kinematics and kinetics for unilateral transtibial amputees. METHODS Three-dimensional gait analysis was conducted in 9 unilateral transtibial amputees walking at a controlled speed with five vacuum levels ranging from 0 to 20inHg, and also in 9 able-bodied subjects walking at self-preferred speed. Repeated ANOVA and Dunnett's t-test were performed to determine the effect of vacuum level and limb for within subject and between groups. FINDINGS The effect of vacuum level significantly affected peak hip external rotation and external knee adduction moment. Maximum braking and propulsive ground reaction forces generally increased for the residual limb and decreased for the intact limb with increasing vacuum. Additionally, the intact limb experienced an increased loading due to gait asymmetry for several variables. INTERPRETATION There was no systematic vacuum level effect on gait. Higher vacuum levels, such as 15 and 20inHg, were more comfortable and provided some relief to the intact limb, but may also increase the risk of osteoarthritis of the residual limb due to the increased peak external hip and knee adduction moments. Very low vacuum should be avoided because of the negative effects on gait symmetry. A moderate vacuum level at 15inHg is suggested for unilateral transtibial amputees with elevated vacuum suspension.
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Affiliation(s)
- Hang Xu
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Kasey Greenland
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Donald Bloswick
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Jie Zhao
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
| | - Andrew Merryweather
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA.
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58
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Childers WL, Siebert S. Marker-based method to measure movement between the residual limb and a transtibial prosthetic socket. Prosthet Orthot Int 2016; 40:720-728. [PMID: 26527758 DOI: 10.1177/0309364615610660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 08/31/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Limb movement between the residuum and socket continues to be an underlying factor in limb health, prosthetic comfort, and gait performance yet techniques to measure this have been underdeveloped. OBJECTIVES Develop a method to measure motion between the residual limb and a transtibial prosthetic socket. STUDY DESIGN Single subject, repeated measures with mathematical modeling. METHODS The gait of a participant with transtibial amputation was recorded using a motion capture system using a marker set that included arrays on the anterior distal tibia and the lateral epicondyle of the femur. The proximal or distal translation, anterior or posterior translation, and angular movements were quantified. A random Monte Carlo simulation based on the precision of the motion capture system and a model of the bone moving under the skin explored the technique's accuracy. Residual limb tissue stiffness was modeled as a linear spring based on data from Papaioannou et al. RESULTS Residuum movement relative to the socket went through ~30 mm, 18 mm, and 15° range of motion. Root mean squared errors were 5.47 mm, 1.86 mm, and 0.75° when considering the modeled bone-skin movement in the proximal or distal, anterior or posterior, and angular directions, respectively. CONCLUSION The measured movement was greater than the root mean squared error, indicating that this method can measure motion between the residuum and socket. CLINICAL RELEVANCE The ability to quantify movement between the residual limb and the prosthetic socket will improve prosthetic treatment through the evaluation of different prosthetic suspensions, socket designs, and motor control of the prosthetic interface.
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59
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Darter BJ, Sinitski K, Wilken JM. Axial bone-socket displacement for persons with a traumatic transtibial amputation: The effect of elevated vacuum suspension at progressive body-weight loads. Prosthet Orthot Int 2016; 40:552-7. [PMID: 26423107 DOI: 10.1177/0309364615605372] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 07/27/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Elevated vacuum suspension systems use a pump to draw air from the socket with the intent of reducing bone-socket motion as compared to passive suction systems. However, it remains unknown if elevated vacuum suspension systems decrease limb displacement uniformly during transitions from unloaded to full-body-weight support. OBJECTIVES To compare limb-socket motion between elevated vacuum and passive suction suspension sockets using a controlled loading paradigm. STUDY DESIGN Comparative analysis. METHODS Persons with transtibial amputation were assessed while wearing either an elevated vacuum or passive suction suspension socket. Digital video fluoroscopy was used to measure axial bone-socket motion while the limb was loaded in 20% body-weight increments. An analysis of variance model was used to compare between suspension types. RESULTS Total axial displacement (0%-100% body weight) was significantly lower using the elevated vacuum (vacuum: 1.3 cm, passive suction: 1.8 cm; p < 0.0001). Total displacement decreased primarily due to decreased motion during initial loading (0%-20%; p < 0.0001). Other body-weight intervals were not significantly different between systems. CONCLUSION Elevated vacuum suspension reduced axial limb-socket motion by maintaining position of the limb within the socket during unloaded conditions. Elevated vacuum provided no meaningful improvement in limb-socket motion past initial loading. CLINICAL RELEVANCE Excessive bone-socket motion contributes to poor residual limb health. Our results suggest elevated vacuum suspensions can reduce this axial displacement. Visual assessment of the images suggests that this occurs through the reduction or elimination of the air pocket between the liner and socket wall while the limb is unloaded.
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Affiliation(s)
- Benjamin J Darter
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, USA
| | - Kirill Sinitski
- Center for the Intrepid, Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, JBSA, Fort Sam Houston, TX, USA
| | - Jason M Wilken
- Center for the Intrepid, Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, JBSA, Fort Sam Houston, TX, USA
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Safari MR, Meier MR. Systematic review of effects of current transtibial prosthetic socket designs--Part 2: Quantitative outcomes. ACTA ACUST UNITED AC 2016; 52:509-26. [PMID: 26436733 DOI: 10.1682/jrrd.2014.08.0184] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 04/14/2015] [Indexed: 11/05/2022]
Abstract
This review is an attempt to untangle the complexity of transtibial prosthetic socket fit and perhaps find some indication of whether a particular prosthetic socket type might be best for a given situation. In addition, we identified knowledge gaps, thus providing direction for possible future research. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using medical subject headings and standard key words to search for articles in relevant databases. No restrictions were made on study design and type of outcome measure used. From the obtained search results (n = 1,863), 35 articles were included. The relevant data were entered into a predefined data form that included the Downs and Black risk of bias assessment checklist. This article presents the results from the systematic review of the quantitative outcomes (n = 27 articles). Trends indicate that vacuum-assisted suction sockets improve gait symmetry, volume control, and residual limb health more than other socket designs. Hydrostatic sockets seem to create less inconsistent socket fittings, reducing a problem that greatly influences outcome measures. Knowledge gaps exist in the understanding of clinically meaningful changes in socket fit and its effect on biomechanical outcomes. Further, safe and comfortable pressure thresholds under various conditions should be determined through a systematic approach.
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Affiliation(s)
- Mohammad Reza Safari
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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61
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Gholizadeh H, Lemaire ED, Eshraghi A. The evidence-base for elevated vacuum in lower limb prosthetics: Literature review and professional feedback. Clin Biomech (Bristol, Avon) 2016; 37:108-116. [PMID: 27423025 DOI: 10.1016/j.clinbiomech.2016.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 06/17/2016] [Accepted: 06/21/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND An optimal suspension system can improve comfort and quality of life in people with limb loss. To guide practice on prosthetic vacuum suspension systems, assessment of the current evidence and professional opinion are required. METHODS PubMed, Web of Science, and Google Scholar databases were explored to find related articles. Search terms were amputees, artificial limb, prosthetic suspension, prosthetic liner, vacuum, and prosthesis. The results were refined by vacuum socket or vacuum assisted suspension or sub-atmospheric suspension. Study design, research instrument, sample size, and outcome measures were reviewed. An online questionnaire was also designed and distributed worldwide among professionals and prosthetists (www.ispoint.org, OANDP-L, LinkedIn, personal email). FINDINGS 26 articles were published from 2001 to March 2016. The number of participants averaged 7 (SD=4) for transtibial and 6 (SD=6) for transfemoral amputees. Most studies evaluated the short-term effects of vacuum systems by measuring stump volume changes, gait parameters, pistoning, interface pressures, satisfaction, balance, and wound healing. 155 professionals replied to the questionnaire and supported results from the literature. Elevated vacuum systems may have some advantages over the other suspension systems, but may not be appropriate for all people with limb loss. INTERPRETATION Elevated vacuum suspension could improve comfort and quality of life for people with limb loss. However, future investigations with larger sample sizes are needed to provide strong statistical conclusions and to evaluate long-term effects of these systems.
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Affiliation(s)
- H Gholizadeh
- Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada; Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.
| | - E D Lemaire
- Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Canada.
| | - A Eshraghi
- Bloorview Research Institute, Holland Bloorview Kid's Rehabilitation Hospital, Toronto, Canada.
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Major MJ, Caldwell R, Fatone S. Evaluation of a Prototype Hybrid Vacuum Pump to Provide Vacuum-Assisted Suspension for Above-Knee Prostheses. J Med Device 2016; 9:0445041-445044. [PMID: 27462383 DOI: 10.1115/1.4030507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/03/2015] [Indexed: 11/08/2022] Open
Abstract
Vacuum-assisted suspension (VAS) of prosthetic sockets utilizes a pump to evacuate air from between the prosthetic liner and socket, and are available as mechanical or electric systems. This technical note describes a hybrid pump that benefits from the advantages of mechanical and electric systems, and evaluates a prototype as proof-of-concept. Cyclical bench testing of the hybrid pump mechanical system was performed using a materials testing system to assess the relationship between compression cycles and vacuum pressure. Phase 1 in vivo testing of the hybrid pump was performed by an able-bodied individual using prosthesis simulator boots walking on a treadmill, and phase 2 involved an above-knee prosthesis user walking with the hybrid pump and a commercial electric pump for comparison. Bench testing of 300 compression cycles produced a maximum vacuum of 24 in-Hg. In vivo testing demonstrated that the hybrid pump continued to pull vacuum during walking, and as opposed to the commercial electric pump, did not require reactivation of the electric system during phase 2 testing. The novelty of the hybrid pump is that while the electric system provides rapid, initial vacuum suspension, the mechanical system provides continuous air evacuation while walking to maintain suspension without reactivation of the electric system, thereby allowing battery power to be reserved for monitoring vacuum levels.
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Affiliation(s)
- Matthew J Major
- Jesse Brown VA Medical Center, Northwestern University Prosthetics-Orthotics Center, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611 e-mail:
| | - Ryan Caldwell
- Scheck and Siress Orthotics and Prosthetics, Northwestern University Prosthetics-Orthotics Center, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611 e-mail:
| | - Stefania Fatone
- Northwestern University Prosthetics-Orthotics Center, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611 e-mail:
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63
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Sanders JE, Redd CB, Cagle JC, Hafner BJ, Gardner D, Allyn KJ, Harrison DS, Ciol MA. Preliminary evaluation of a novel bladder-liner for facilitating residual limb fluid volume recovery without doffing. ACTA ACUST UNITED AC 2016; 53:1107-1120. [PMID: 28355030 DOI: 10.1682/jrrd.2014.12.0316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 01/25/2016] [Indexed: 11/05/2022]
Abstract
For people who wear a prosthetic limb, residual-limb fluid volume loss during the day may be problematic and detrimentally affect socket fit. The purpose of this research was to test the capability of a novel liner with adjustable bladders positioned within its wall to mitigate volume loss and facilitate limb fluid volume recovery and retention. Bioimpedance analysis was used to monitor fluid volume changes in the anterior and posterior residual limb of participants with transtibial amputation. Participants underwent six cycles of sitting for 90 s, standing for 90 s, and walking for 5 min with liquid within the bladder-liners. Between the third and fourth cycles, participants sat for 10 min with liquid left within the bladders (Liquid-In) or removed (Liquid-Out). Results showed that participants recovered more fluid volume during the 10 min of sitting with Liquid-Out than Liquid-In (p = 0.09 for anterior and p = 0.04 for posterior). However, those fluid volume recoveries were not well retained in the short term (after the fourth cycle) or the long term (after the sixth cycle). Physiologic differences between sessions, reflected in the rates of fluid volume change at the outset of the session, and excessive stiffness of the bladder-liners may have affected fluid volume retentions.
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Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA
| | - Christian B Redd
- Department of Bioengineering, University of Washington, Seattle, WA
| | | | - Brian J Hafner
- Department of Bioengineering, University of Washington, Seattle, WA
| | - David Gardner
- Department of Bioengineering, University of Washington, Seattle, WA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA
| | | | - Marcia A Ciol
- Department of Bioengineering, University of Washington, Seattle, WA
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64
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Major MJ, Caldwell R, Fatone S. Comparative Effectiveness of Electric Vacuum Pumps for Creating Suspension in Transfemoral Sockets. ACTA ACUST UNITED AC 2015. [DOI: 10.1097/jpo.0000000000000073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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65
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Safari MR, Meier MR. Systematic review of effects of current transtibial prosthetic socket designs—Part 1: Qualitative outcomes. ACTA ACUST UNITED AC 2015; 52:491-508. [DOI: 10.1682/jrrd.2014.08.0183] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 04/23/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Mohammad Reza Safari
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Margrit Regula Meier
- Department for Occupational Therapy, Prosthetics, and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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66
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Kahle JT, Highsmith MJ. Transfemoral sockets with vacuum-assisted suspension comparison of hip kinematics, socket position, contact pressure, and preference: ischial containment versus brimless. ACTA ACUST UNITED AC 2014; 50:1241-52. [PMID: 24458964 DOI: 10.1682/jrrd.2013.01.0003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/20/2013] [Indexed: 11/05/2022]
Abstract
The objective of this study was to investigate the effect of brimless compared with ischial ramus containment (IRC) prosthetic sockets when using vacuum-assisted suspension (VAS) on persons with a unilateral transfemoral amputation (TFA). A randomized crossover design with a 2 d accommodation was used. People with unilateral TFA (n = 9 analyzed) were enrolled. Interventions were IRC VAS and brimless VAS sockets. Main outcome measures included coronal hip angle and vertical and lateral socket movement as measured by X-ray, skin pressure measured by Tekscan, and preference measured subjectively. The brimless design was statistically equivalent to IRC in all measured coronal hip angles and vertical and lateral socket displacement. The peak/stance mean pressure in the medial proximal aspect of the socket was 322 mmHg in the IRC compared with 190 mmHg in the brimless condition. Except for medial proximal pressure, no other measures reached statistical significance. All subjects reported the brimless design to be more comfortable than the IRC in short-term preference. Brimless VAS socket design may be a clinically viable choice for people with TFA.
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Affiliation(s)
- Jason T Kahle
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, 3515 East Fletcher Ave, Tampa, FL 33612.
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Abd Razak NA, Abu Osman NA, Gholizadeh H, Ali S. Biomechanics principle of elbow joint for transhumeral prostheses: comparison of normal hand, body-powered, myoelectric & air splint prostheses. Biomed Eng Online 2014; 13:134. [PMID: 25208636 PMCID: PMC4228154 DOI: 10.1186/1475-925x-13-134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 09/04/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Understanding of kinematics force applied at the elbow is important in many fields, including biomechanics, biomedical engineering and rehabilitation. This paper provides a comparison of a mathematical model of elbow joint using three different types of prosthetics for transhumeral user, and characterizes the forces required to overcome the passive mechanical of the prosthetics at the residual limb. METHODS The study modeled the elbow as a universal joint with intersecting axes of x-axis and y-axis in a plain of upper arm and lower arm. The equations of force applied, torque, weight and length of different type of prosthetics and the anthropometry of prosthetics hand are discussed in this study. The study also compares the force, torque and pressure while using all three types of prosthetics with the normal hand. RESULTS The result was measured from the elbow kinematics of seven amputees, using three different types of prosthetics. The F-Scan sensor used in the study is to determine the pressure applied at the residual limb while wearing different type of prostheses. CONCLUSION These technological advances in assessment the biomechanics of an elbow joint for three different type of prosthetics with the normal hand bring the new information for the amputees and prosthetist to choose the most suitable device to be worn daily.
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Affiliation(s)
- Nasrul Anuar Abd Razak
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, 50603 Malaysia
| | - Noor Azuan Abu Osman
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, 50603 Malaysia
| | - Hossein Gholizadeh
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, 50603 Malaysia
| | - Sadeeq Ali
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, 50603 Malaysia
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Razak NAA, Osman NAA, Gholizadeh H, Ali S. Prosthetics socket that incorporates an air splint system focusing on dynamic interface pressure. Biomed Eng Online 2014; 13:108. [PMID: 25085005 PMCID: PMC4120006 DOI: 10.1186/1475-925x-13-108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 07/22/2014] [Indexed: 11/18/2022] Open
Abstract
Background The interface pressure between the residual limb and prosthetic socket has a significant effect on an amputee’s satisfaction and comfort. This paper presents the design and performance of a new prosthetic socket that uses an air splint system. Methods The air splint prosthetic socket system was implemented by combining the air splint with a pressure sensor that the transhumeral user controls through the use of a microcontroller. The modular construction of the system developed allows the FSR pressure sensors that are placed inside the air splint socket to determine the required size and fitting for the socket used. Fifteen transhumeral amputees participated in the study. Results The subject’s dynamic pressure on the socket that’s applied while wearing the air splint systems was recorded using F-socket transducers and microcontroller analysis. The values collected by the F-socket sensor for the air splint prosthetic socket system were determined accordingly by comparing the dynamic pressure applied using statically socket. The pressure volume of the air splint fluctuated and was recorded at an average of 38 kPa (2.5) to 41 kPa (1.3) over three hours. Conclusion The air splint socket might reduce the pressure within the interface of residual limb. This is particularly important during the daily life activities and may reduce the pain and discomfort at the residual limb in comparison to the static socket. The potential development of an auto-adjusted socket that uses an air splint system as the prosthetic socket will be of interest to researchers involved in rehabilitation engineering, prosthetics and orthotics.
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Affiliation(s)
- Nasrul Anuar Abd Razak
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Sanders JE, Cagle JC, Allyn KJ, Harrison DS, Ciol MA. How do walking, standing, and resting influence transtibial amputee residual limb fluid volume? JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2014; 51:201-12. [PMID: 24933719 DOI: 10.1682/jrrd.2013.04.0085] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 09/17/2013] [Indexed: 11/05/2022]
Abstract
The purpose of this research was to determine how fluid volume changes in the residual limbs of people with transtibial amputation were affected by activity during test sessions with equal durations of resting, standing, and walking. Residual limb extracellular fluid volume was measured using biompedance analysis in 24 participants. Results showed that all subjects lost fluid volume during standing with equal weight-bearing, averaging a loss rate of -0.4%/min and a mean loss over the 25 min test session of 2.6% (standard deviation [SD] 1.1). Sixteen subjects gained limb fluid volume during walking (mean gain of 1.0% [SD 2.5]), and fifteen gained fluid volume during rest (mean gain of 1.0% [SD 2.2]). Walking explained only 39.3% of the total session fluid volume change. There was a strong correlation between walk and rest fluid volume changes (-0.81). Subjects with peripheral arterial disease experienced relatively high fluid volume gains during sitting but minimal changes or losses during sit-to-stand and stand-to-sit transitioning. Healthy female subjects experienced high fluid volume changes during transitioning from sit-to-stand and stand-to-sit. The differences in fluid volume response among subjects suggest that volume accommodation technologies should be matched to the activity-dependent fluid transport characteristics of the individual prosthesis user.
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Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, University of Washington, Box 355061, William H. Foege Bldg, 3720 15th Ave NE, Seattle, WA 98195.
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Kahle JT, Highsmith MJ. Transfemoral interfaces with vacuum assisted suspension comparison of gait, balance, and subjective analysis: ischial containment versus brimless. Gait Posture 2014; 40:315-20. [PMID: 24852508 DOI: 10.1016/j.gaitpost.2014.04.206] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 04/08/2014] [Accepted: 04/27/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Investigate the effect of a brimless interface design compared with ischial ramus containment (IRC) of interfaces when using vacuum-assisted suspension (VAS) on transfemoral amputees (TFAs). DESIGN Randomized experimental crossover. SETTING Household, community, and clinic. PARTICIPANTS Unilateral TFAs (N=12 enrolled, N=10 analyzed). Mean age: 42.9 years. Mean residual limb length: 60.3% of the sound side femur length. Participants' mean time as an amputee: 8.3 years and median AMP score: 43. INTERVENTIONS (1) IRC VAS interface, and (2) brimless VAS interface. Average medial wall height for IRC interfaces was 0.7cm proximal to the distal-most aspect of the ischial tuberosity (IT). The medial wall on the brimless design was an average of 3.3cm distal to the distal-most aspect of the IT. MAIN OUTCOME MEASURES Spatiotemporal gait parameters, limits of stability, four square step test, and subjective perception using the prosthetic evaluation questionnaire (PEQ). RESULTS Step length was significantly improved towards the IRC (p=0.04), when calculating degree of asymmetry. Base of support was significantly narrowed toward the brimless (p=0.03). All subjective measures reached statistical significance in favor of improvement with the brimless design, compared to the IRC. CONCLUSIONS The brimless design was equivalent to IRC in most gait and balance outcome measures. However, step length was more symmetrical toward the IRC while base of support was narrowed toward the brimless demonstrating mixed inconsistent performance changes. Further, the PEQ demonstrated significant subjective improvements in prosthetic related function and quality of life when participants used the brimless design. Brimless interface design may be a clinically viable choice.
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Affiliation(s)
- Jason T Kahle
- The University of South Florida, 3515 E. Fletcher Avenue, Tampa, FL 33612, United States.
| | - M Jason Highsmith
- The University of South Florida, 3515 E. Fletcher Avenue, Tampa, FL 33612, United States.
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Ali S, Abu Osman NA, Eshraghi A, Gholizadeh H, Abd Razak NAB, Wan Abas WABB. Interface pressure in transtibial socket during ascent and descent on stairs and its effect on patient satisfaction. Clin Biomech (Bristol, Avon) 2014; 28:994-9. [PMID: 24161521 DOI: 10.1016/j.clinbiomech.2013.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 09/06/2013] [Accepted: 09/09/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transtibial amputees encounter stairs and steps during their daily activities. The excessive pressure between residual limb/socket may reduce the walking capability of transtibial prosthetic users during ascent and descent on stairs. The purposes of the research were to evaluate the interface pressure between Dermo (shuttle lock) and Seal-In X5 (prosthetic valve) interface systems during stair ascent and descent, and to determine their satisfaction effects on users. METHODS Ten amputees with unilateral transtibial amputation participated in the study. Interface pressure was recorded with F-socket transducer (9811E) during stair ascent and descent at self-selected speed. Each participant filled in a questionnaire about satisfaction and problems encountered with the use of the two interface systems. FINDINGS The resultant mean peak pressure (kPa) was significantly lower for the Dermo interface system compared to that of the Seal-In X5 interface system at the anterior, posterior and medial regions during stair ascent (63.14 vs. 80.14, 63.14 vs. 90.44, 49.21 vs. 66.04, respectively) and descent (67.11 vs. 80.41, 64.12 vs. 88.24, 47.33 vs. 65.11, respectively). Significant statistical difference existed between the two interface systems in terms of satisfaction and problems encountered (P<0.05). INTERPRETATION The Dermo interface system caused less pressure within the prosthetic socket compared to the Seal-In X5 interface system during stair negotiation. The qualitative survey also showed that the prosthesis users experienced fewer problems and increased satisfaction with the Dermo interface system.
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Affiliation(s)
- Sadeeq Ali
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia.
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The effects of suction and pin/lock suspension systems on transtibial amputees' gait performance. PLoS One 2014; 9:e94520. [PMID: 24827560 PMCID: PMC4021017 DOI: 10.1371/journal.pone.0094520] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 03/14/2014] [Indexed: 11/20/2022] Open
Abstract
Background The suction sockets that are commonly prescribed for transtibial amputees are believed to provide a better suspension than the pin/lock systems. Nevertheless, their effect on amputees’ gait performance has not yet been fully investigated. The main intention of this study was to understand the potential effects of the Seal-in (suction) and the Dermo (pin/lock) suspension systems on amputees’ gait performance. Methodology/Principal Findings Ten unilateral transtibial amputees participated in this prospective study, and two prostheses were fabricated for each of them. A three-dimensional motion analysis system was used to evaluate the temporal-spatial, kinematics and kinetics variables during normal walking. We also asked the participants to complete some part of Prosthesis Evaluation Questionnaire (PEQ) regarding their satisfaction and problems with both systems. The results revealed that there was more symmetry in temporal-spatial parameters between the prosthetic and sound limbs using the suction system. However, the difference between two systems was not significant (p<0.05). Evaluation of kinetic data and the subjects’ feedback showed that the participants had more confidence using the suction socket and the sockets were more fit for walking. Nevertheless, the participants had more complaints with this system due to the difficulty in donning and doffing. Conclusion It can be concluded that even though the suction socket could create better suspension, fit, and gait performance, overall satisfaction was higher with the pin/lock system due to easy donning and doffing of the prosthesis. Trial Registration irct.ir IRCT2014012816395N1
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Hoskins RD, Sutton EE, Kinor D, Schaeffer JM, Fatone S. Using vacuum-assisted suspension to manage residual limb wounds in persons with transtibial amputation: a case series. Prosthet Orthot Int 2014; 38:68-74. [PMID: 23685916 DOI: 10.1177/0309364613487547] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Persons with amputation and residual limb wounds would benefit from the ability to continue wearing a prosthesis while healing. Sockets with vacuum-assisted suspension may reduce intra-socket motion and be less disruptive to wound healing. The purpose of this case series was to measure residual limb wound size over time in persons with transtibial amputation while using prostheses with vacuum-assisted suspension. CASE DESCRIPTION AND METHODS Six subjects with residual limb wounds were fit with vacuum-assisted suspension sockets. Wound surface area was calculated using ImageJ software at the time of fit and each subsequent visit until closure. FINDINGS AND OUTCOME: Average wound surface area at initial measurement was 2.17 ± 0.65 cm(2). All subjects were instructed to continue their normal activity level while wounds healed, with a mean of 177.6 ± 113 days to wound closure. CONCLUSION Results suggest that well-fitting sockets with vacuum-assisted suspension in compliant individuals did not preclude wound healing. Further research is required to substantiate these case-based observations. CLINICAL RELEVANCE Residual limb wounds are typically treated by suspension of prosthetic use until healing occurs, increasing the risk of long-term prosthesis nonuse. Our results suggest that vacuum-assisted suspension sockets may be used while healing occurs.
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Gholizadeh H, Abu Osman NA, Eshraghi A, Ali S, Razak NA. Transtibial prosthesis suspension systems: systematic review of literature. Clin Biomech (Bristol, Avon) 2014; 29:87-97. [PMID: 24315710 DOI: 10.1016/j.clinbiomech.2013.10.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 10/18/2013] [Accepted: 10/21/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Today a number of prosthetic suspension systems are available for transtibial amputees. Consideration of an appropriate suspension system can ensure that amputee's functional needs are satisfied. The higher the insight to suspension systems, the easier would be the selection for prosthetists. This review attempted to find scientific evidence pertaining to various transtibial suspension systems to provide selection criteria for clinicians. METHODS Databases of PubMed, Web of Science, and ScienceDirect were explored to find related articles. Search terms were as follows: "Transtibial prosthesis (32), prosthetic suspension (48), lower limb prosthesis (54), below-knee prosthesis (58), prosthetic liner (20), transtibial (193), and prosthetic socket (111)". Two reviewers separately examined the papers. Study design (case series of five or more subjects, retrospective or prospective), research instrument, sampling method, outcome measures and protocols were reviewed. FINDINGS Based on the selection criteria, 22 articles (15 prospective studies, and 7 surveys) remained. Sweat control was found to be a major concern with the available suspension liners. Donning and doffing procedures for soft liners are also problematic for some users, particularly those with upper limb weakness. Moreover, the total surface bearing (TSB) socket with pin/lock system is favored by the majority of amputees. INTERPRETATION In summary, no clinical evidence is available to suggest what kind of suspension system could have an influential effect as a "standard" system for all transtibial amputees. However, among various suspension systems for transtibial amputees, the Iceross system was favored by the majority of users in terms of function and comfort.
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Affiliation(s)
- H Gholizadeh
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia.
| | - N A Abu Osman
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia
| | - A Eshraghi
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia
| | - S Ali
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia
| | - N A Razak
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia
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Sanders JE, Severance MR, Swartzendruber DL, Allyn KJ, Ciol MA. Influence of prior activity on residual limb volume and shape measured using plaster casting: results from individuals with transtibial limb loss. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2013; 50:1007-16. [PMID: 24301437 DOI: 10.1682/jrrd.2012.10.0195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 03/07/2013] [Indexed: 11/05/2022]
Abstract
The purpose of this research was to determine whether prior activity affected the shape of a plaster cast taken of a transtibial residual limb. Plaster casts were taken twice on one day in 24 participants with transtibial limb loss, with 5 s between doffing and casting in one trial (PDI-5s) and 20 min in the other trial (PDI-20m). The ordering of the trials was randomized. The mean +/- standard deviation radial difference between PDI-20m and PDI-5s was 0.34 +/- 0.21 mm when PDI-5s was conducted first and -0.02 +/- 0.20 mm when PDI-20m was conducted first. Ordering of the trials had a statistically significant influence on the mean radial difference between the two shapes (p = 0.008). The result shows that prior activity influenced the residual limb cast shape. Practitioners should be mindful of prior activity and doffing history when casting an individual's limb for socket design and prosthetic fitting.
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Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, University of Washington, 355061, Foege N430J, 3720 15th Ave NE, Seattle, Washington 98195.
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Brunelli S, Delussu AS, Paradisi F, Pellegrini R, Traballesi M. A comparison between the suction suspension system and the hypobaric Iceross Seal-In® X5 in transtibial amputees. Prosthet Orthot Int 2013; 37:436-44. [PMID: 23436696 DOI: 10.1177/0309364613476531] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The two passive vacuum suspension systems currently available in total surface-bearing sockets are the hypobaric Iceross Seal-In(®) and the suction suspension system. OBJECTIVES The purpose of this study was to compare the effect of the hypobaric Iceross Seal-In(®) liner with that of the suction suspension system for quality of life, pistoning, and prosthesis efficiency in unilateral transtibial amputees. STUDY DESIGN Single-group repeated measures. METHODS Ten amputees were enrolled. The pistoning test, used to compare vertical movement of the stump within the socket, and the energy cost of walking test were carried out when the amputees were wearing the suction suspension system and after 2, 5, and 7 weeks of Seal-In® X5 use. The Prosthesis Evaluation Questionnaire and the Houghton Scale Questionnaire of perceived mobility and quality of life with the prosthesis, and the Timed Up&Go Test and the Locomotor Capability Index for functional mobility were also administered at the beginning and end of the study. RESULTS The hypobaric Iceross Seal-In® X5 led to significant pistoning reduction and improvement on the Houghton Scale Questionnaire and 3 of 9 domains of the Prosthesis Evaluation Questionnaire. No statistical changes were observed in functional mobility or the energy cost of walking tests. CONCLUSION Replacing the suction suspension system with the hypobaric Iceross Seal-In® X5 improves quality of life in transtibial amputees.
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Affiliation(s)
- Stefano Brunelli
- 1Fondazione Santa Lucia, Scientific Institute for Research, Hospitalization and Health Care, Operative Unit D, Rome, Italy
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Delussu AS, Brunelli S, Paradisi F, Iosa M, Pellegrini R, Zenardi D, Traballesi M. Assessment of the effects of carbon fiber and bionic foot during overground and treadmill walking in transtibial amputees. Gait Posture 2013; 38:876-82. [PMID: 23702342 DOI: 10.1016/j.gaitpost.2013.04.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 03/30/2013] [Accepted: 04/17/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the energy cost of walking (ECW) of a bionic foot (Proprio-Foot®) during ambulation on floor and on treadmill (at different slopes) compared to walking with a dynamic carbon fiber foot (DCF). We evaluated transtibial amputees (TTAs) perceived mobility with the prosthesis and their walking ability on stairs and ramps. METHOD TTAs were enrolled. The ECW tests were conducted on a regular floor surface and on treadmill with -5%, 0% and 12% slopes. In all conditions, TTAs were asked to walk at their own self-selected speed. Metabolic and cardiac data were collected using a portable gas analyzer. Tests were performed at six data collection points: first with a standard suction system (SSS) and the DCF; second, with the DCF after 7 weeks of using a hypobaric suspension system (HSS) with the DCF; third, after 1 h of Proprio-Foot® use together with the HSS; three more testing sessions were carried out at 30-day intervals, i.e., after 30, 60 and 90 days of Proprio-Foot® use together with the HSS. TTAs perceived mobility using the prosthesis and walking ability on stairs and ramps were assessed. RESULTS Ten TTAs completed the measurements. ECW with the Proprio-Foot® obtained in the final floor-walking test was significantly lower than ECW with the DCF (p=0.002). No significant improvements were observed for perceived mobility or walking ability. CONCLUSIONS Results suggest that use of the Proprio-Foot® can lower the ECW for TTAs in spite of its added weight compared to DCF.
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Affiliation(s)
- Anna Sofia Delussu
- Fondazione Santa Lucia IRCCS - Scientific Institute for Research, Hospitalization and Healthcare, via Ardeatina, 306, 00179 Rome, Italy.
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Quantitative and qualitative comparison of a new prosthetic suspension system with two existing suspension systems for lower limb amputees. Am J Phys Med Rehabil 2013; 91:1028-38. [PMID: 23168378 DOI: 10.1097/phm.0b013e318269d82a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objectives of this study were to compare the effects of a newly designed magnetic suspension system with that of two existing suspension methods on pistoning inside the prosthetic socket and to compare satisfaction and perceived problems among transtibial amputees. DESIGN In this prospective study, three lower limb prostheses with three different suspension systems were fabricated for ten transtibial amputees. The participants used each of the three prostheses for 1 mo in random order. Pistoning inside the prosthetic socket was measured by motion analysis system. The Prosthesis Evaluation Questionnaire was used to evaluate satisfaction and perceived problems with each suspension system. RESULTS The lowest pistoning motion was found with the suction system compared with the other two suspension systems (P < 0.05). The new suspension system showed peak pistoning values similar to that of the pin lock system (P = 0.086). The results of the questionnaire survey revealed significantly higher satisfaction rates with the new system than with the other two systems in donning and doffing, walking, uneven walking, stair negotiation, and overall satisfaction (P < 0.05). CONCLUSIONS The new suspension system has the potential to be used as an alternative to the available suspension systems. The pistoning motion was comparable to that of the other two systems. The new system showed compatible prosthetic suspension with the other two systems (suction and pin lock). The satisfaction with donning and doffing was high with the magnetic system. Moreover, the subjects reported fewer problems with the new system.
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Eshraghi A, Abu Osman NA, Gholizadeh H, Ali S, Sævarsson SK, Wan Abas WAB. An experimental study of the interface pressure profile during level walking of a new suspension system for lower limb amputees. Clin Biomech (Bristol, Avon) 2013; 28:55-60. [PMID: 23157843 DOI: 10.1016/j.clinbiomech.2012.10.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 10/05/2012] [Accepted: 10/08/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Different suspension systems that are used within prosthetic devices may alter the distribution of pressure inside the prosthetic socket in lower limb amputees. This study aimed to compare the interface pressure of a new magnetic suspension system with the pin/lock and Seal-In suspension systems. METHODS Twelve unilateral transtibial amputees participated in the study. The subjects walked on a level walkway at a self-selected speed. The resultant peak pressure with the three different suspension systems was recorded using F-socket transducers. FINDINGS There were significant statistical differences between the three studied suspension systems. Pair-wise analyses revealed that the mean peak pressure (kPa) was lower with the magnetic system than it was with the pin/lock system over the anterior and posterior aspects during one gait cycle (89.89 vs. 79.26 and 47.22 vs. 26.01, respectively). Overall, the average peak pressure values were higher with the Seal-In system than they were with the new magnetic lock and pin/lock system. INTERPRETATION The new magnetic system might reduce the pressure within the prosthetic socket in comparison to the pin/lock and Seal-In system during one gait cycle. This is particularly important during the swing phase of gait and may reduce the pain and discomfort at the distal residual limb in comparison to the pin/lock system.
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Affiliation(s)
- Arezoo Eshraghi
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Komolafe O, Wood S, Caldwell R, Hansen A, Fatone S. Methods for characterization of mechanical and electrical prosthetic vacuum pumps. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2013; 50:1069-78. [PMID: 24458892 DOI: 10.1682/jrrd.2012.11.0204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 03/11/2013] [Indexed: 11/05/2022]
Affiliation(s)
| | - Sean Wood
- Northwestern University Prosthetics-Orthotics Center, Chicago IL
| | | | - Andrew Hansen
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, MN
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Gholizadeh H, Abu Osman NA, Kamyab M, Eshraghi A, Lúvíksdóttir ÁG, Wan Abas WAB. Clinical Evaluation of Two Prosthetic Suspension Systems in a Bilateral Transtibial Amputee. Am J Phys Med Rehabil 2012; 91:894-8. [DOI: 10.1097/phm.0b013e31823c74d7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yeung LF, Leung AKL, Zhang M, Lee WCC. Effects of long-distance walking on socket-limb interface pressure, tactile sensitivity and subjective perceptions of trans-tibial amputees. Disabil Rehabil 2012; 35:888-93. [PMID: 22992201 DOI: 10.3109/09638288.2012.712197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Many trans-tibial amputees could not tolerate long-distance walking. Lack of walking could explain for the increased cardiovascular diseases mortality rate. This study investigated the effects of long-distance walking (LDW) on socket-limb interface pressure, tactile sensitivity of the residual limb, and subjective feedbacks, which potentially identified the difficulties in LDW. METHOD Five male unilateral trans-tibial amputees walked on a level treadmill for a total of one hour at comfortable speed. Tactile sensitivity of the residual limb and socket-limb interface pressure during over-ground walking were measured before and after the treadmill walking. Modified Prosthesis Evaluation Questionnaires were also administered. RESULTS After the treadmill walking, the socket-limb interface pressure and the tactile sensitivity at the popliteal depression area were significantly reduced. This corresponds well with the questionnaire results showing that the level of discomfort and pain of the residual limb did not increase. The questionnaire revealed that there were significant increases in fatigue level at the sound-side plantar flexors, which could lead to impaired dynamic stability. CONCLUSIONS Fatigue of sound-side plantar-flexor was the main difficulty faced by the five subjects when walking long-distances. This finding might imply the importance of refining prosthetic components and rehabilitation protocols in reducing the muscle fatigue. IMPLICATIONS FOR REHABILITATION • After long-distance walking (LDW) of the trans-tibal amputee subjects, there were significant increases in fatigue level at the plantar flexors. These might explain the reduced walking stability as perceived by the subjects. • LDW did not produce any problems in residual-limb comfort and pain feeling. These were in line with the significant reductions of socket-limb interface pressure and the tactile sensitivity at the popliteal depression after LDW. • Refinements of prosthetic components and rehabilitation protocols should be attempted to reduce the fatigue of the plantar flexors and facilitate LDW.
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Affiliation(s)
- L F Yeung
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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84
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Gholizadeh H, Abu Osman NA, Eshraghi A. Effect of vacuum-assisted socket and pin suspensions on socket fit. Arch Phys Med Rehabil 2012; 93:921. [PMID: 22541316 DOI: 10.1016/j.apmr.2011.11.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 11/28/2011] [Indexed: 11/18/2022]
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85
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Sanders JE, Harrison DS, Myers TR, Allyn KJ. Effects of elevated vacuum on in-socket residual limb fluid volume: case study results using bioimpedance analysis. ACTA ACUST UNITED AC 2012; 48:1231-48. [PMID: 22234667 DOI: 10.1682/jrrd.2010.11.0219] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bioimpedance analysis was used to measure the residual limb fluid volume of seven transtibial amputee subjects using elevated vacuum sockets and nonelevated vacuum sockets. Fluid volume changes were assessed during sessions with the subjects sitting, standing, and walking. In general, fluid volume losses during 3 or 5 min walks and losses over the course of the 30 min test session were less for elevated vacuum than for suction. Numerous variables, including the time of day that data were collected, soft tissue consistency, socket-to-limb size and shape differences, and subject health, may have affected the results and had an equivalent or greater effect on limb fluid volume compared with elevated vacuum. Researchers should well consider these variables in the study design of future investigations on the effects of elevated vacuum on residual limb volume.
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Affiliation(s)
- Joan E Sanders
- University of Washington-Bioengineering, 3720 15th Ave NE, University of Washington, Seattle, WA 98195, USA.
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86
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Klute GK, Berge JS, Biggs W, Pongnumkul S, Popovic Z, Curless B. The authors respond: vacuum-assisted socket suspension systems for lower extremity amputees: effect on fit, activity, and limb volume. Arch Phys Med Rehabil 2012; 93:922-3. [PMID: 22541317 DOI: 10.1016/j.apmr.2012.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/12/2012] [Indexed: 11/18/2022]
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87
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Sanders JE, Fatone S. Residual limb volume change: systematic review of measurement and management. ACTA ACUST UNITED AC 2012; 48:949-86. [PMID: 22068373 DOI: 10.1682/jrrd.2010.09.0189] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Management of residual limb volume affects decisions regarding timing of fit of the first prosthesis, when a new prosthetic socket is needed, design of a prosthetic socket, and prescription of accommodation strategies for daily volume fluctuations. This systematic review assesses what is known about measurement and management of residual limb volume change in persons with lower-limb amputation. Publications that met inclusion criteria were grouped into three categories: group I: descriptions of residual limb volume measurement techniques; group II: studies investigating the effect of residual limb volume change on clinical care in people with lower-limb amputation; and group III: studies of residual limb volume management techniques or descriptions of techniques for accommodating or controlling residual limb volume. We found that many techniques for the measurement of residual limb volume have been described but clinical use is limited largely because current techniques lack adequate resolution and in-socket measurement capability. Overall, limited evidence exists regarding the management of residual limb volume, and the evidence available focuses primarily on adults with transtibial amputation in the early postoperative phase. While we can draw some insights from the available research about residual limb volume measurement and management, further research is required.
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Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, Box 355061, Foege N430J, 3720 15th Ave NE, University of Washington, Seattle, WA 98195-5061, USA.
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88
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Eshraghi A, Osman NAA, Gholizadeh H, Karimi M, Ali S. Pistoning assessment in lower limb prosthetic sockets. Prosthet Orthot Int 2012; 36:15-24. [PMID: 22269941 DOI: 10.1177/0309364611431625] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND One of the main indicators of the suspension system efficiency in lower limb prostheses is vertical displacement or pistoning within the socket. Decreasing pistoning and introducing an effective system for evaluating pistoning could contribute to the amputees' rehabilitation process. OBJECTIVES The main objective of this study was to review existing research studies that examine the occurrence of pistoning in lower limb prosthesis with different techniques in static (standing) and dynamic (walking and jumping) positions. STUDY DESIGN Literature review. METHODS Keywords related to slippage, suspension, pistoning and vertical movement in lower limb prosthetics were used to search the literature available in PubMed, ScienceDirect, Web of Science and Google Scholar databases. Sixteen articles were selected for further analysis according to the selection criteria. RESULTS The following methods have been used to measure the occurrence of pistoning in prosthetic limbs: radiological methods, photographic technique, motion analysis system, sensor and spiral computerized tomography (CT). Pistoning was measured both in standing and walking. CONCLUSIONS The results of this review reveal that further research is needed to develop and evaluate easy, accurate and safe methods of measuring pistoning. Future studies should provide a gold standard for the acceptable range of pistoning in a prosthetic socket.
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89
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Gholizadeh H, Osman NAA, Kamyab M, Eshraghi A, Abas WABW, Azam MN. Transtibial prosthetic socket pistoning: static evaluation of Seal-In(®) X5 and Dermo(®) Liner using motion analysis system. Clin Biomech (Bristol, Avon) 2012; 27:34-9. [PMID: 21794965 DOI: 10.1016/j.clinbiomech.2011.07.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 07/05/2011] [Accepted: 07/05/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND The method of attachment of prosthesis to the residual limb (suspension) and socket fitting is a critical issue in the process of providing an amputee with prosthesis. Different suspension methods try to minimize the pistoning movement inside the socket. The Seal-In(®) X5 and Dermo(®) Liner by Ossur are new suspension liners that intend to reduce pistoning between the socket and liner. Since the effects of these new liners on suspension are unclear, the objective of this study was to compare the pistoning effect of Seal-In(®) X5 and Dermo(®) Liner by using Vicon Motion System. METHODS Six transtibial amputees, using both the Iceross Seal-In(®) X5 and the Iceross Dermo(®) Liner, participated in the study. The vertical displacement (pistoning) was measured between the liner and socket in single limb support on the prosthetic limb (full-weight bearing), double limb support (semi-weight bearing), and non-weight bearing on the prosthetic limb, and also under three static vertical loading conditions (30 N, 60 N, and 90 N). FINDINGS The results demonstrated that the pistoning within the socket when Seal-In(®) X5 was used, decreased by 71% in comparison to the Iceross Dermo(®) Liner. In addition, a significant difference between the two liners under different static conditions was found (p<0.05). INTERPRETATION Participants needed to put in extra effort for donning and doffing the prosthesis with Seal-In(®) X5; however, this type of liner provided less pistoning. The new approach that uses the motion analysis system in this study might be an alternative for measuring the pistoning effect in the prosthetic socket.
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Affiliation(s)
- H Gholizadeh
- Department of Biomedical Engineering, University of Malaya, Malaysia.
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90
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Klute GK, Berge JS, Biggs W, Pongnumkul S, Popovic Z, Curless B. Vacuum-assisted socket suspension compared with pin suspension for lower extremity amputees: effect on fit, activity, and limb volume. Arch Phys Med Rehabil 2011; 92:1570-5. [PMID: 21963124 DOI: 10.1016/j.apmr.2011.05.019] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/24/2011] [Accepted: 05/26/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effect of a vacuum-assisted socket suspension system as compared with pin suspension on lower extremity amputees. DESIGN Randomized crossover with 3-week acclimation. SETTING Household, community, and laboratory environments. PARTICIPANTS Unilateral, transtibial amputees (N=20 enrolled, N=5 completed). INTERVENTIONS (1) Total surface-bearing socket with a vacuum-assisted suspension system (VASS), and (2) modified patellar tendon-bearing socket with a pin lock suspension system. MAIN OUTCOME MEASURES Activity level, residual limb volume before and after a 30-minute treadmill walk, residual limb pistoning, and Prosthesis Evaluation Questionnaire. RESULTS Activity levels were significantly lower while wearing the vacuum-assisted socket suspension system than the pin suspension (P=.0056; 38,000 ± 9,000 steps per 2 wk vs 73,000 ± 18,000 steps per 2 wk, respectively). Residual limb pistoning was significantly less while wearing the vacuum-assisted socket suspension system than the pin suspension (P=.0021; 1 ± 3mm vs 6 ± 4mm, respectively). Treadmill walking had no effect on residual limb volume. In general, participants ranked their residual limb health higher, were less frustrated, and claimed it was easier to ambulate while wearing a pin suspension compared with the VASS. CONCLUSIONS The VASS resulted in a better fitting socket as measured by limb movement relative to the prosthetic socket (pistoning), although the clinical relevance of the small but statistically significant difference is difficult to discern. Treadmill walking had no effect, suggesting that a skilled prosthetist can control for daily limb volume fluctuations by using conventional, nonvacuum systems. Participants took approximately half as many steps while wearing the VASS which, when coupled with their subjective responses, suggests a preference for the pin suspension system.
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Affiliation(s)
- Glenn K Klute
- Department of Veterans Affairs Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Seattle, WA, USA.
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Sagawa Y, Turcot K, Armand S, Thevenon A, Vuillerme N, Watelain E. Biomechanics and physiological parameters during gait in lower-limb amputees: a systematic review. Gait Posture 2011; 33:511-26. [PMID: 21392998 DOI: 10.1016/j.gaitpost.2011.02.003] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 02/03/2011] [Accepted: 02/06/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to identify which biomechanical and physiological parameters are the most relevant, commonly used, able to discriminate and/or have specific clinical relevance for the gait analysis of lower-limb amputees (LLA). METHODS We performed an electronic search via the PubMed, EMBASE and ISI Web of Knowledge databases from 1979 to May 2009. Two independent reviewers assessed the title and abstract of each identified study. The quality assessment of the full text was undertaken using a 13-item checklist divided into three levels: A, B, and C. RESULTS The literature search identified 584 abstracts to be considered. After applying the inclusion criteria, we reviewed the full text of a total of 89 articles. The mean article quality was 8±2. No A-level article was found; the primary reason was a negative score in blinded outcome assessment. Sixty-six articles (74%) corresponded to a B-level, and two articles (2%) corresponded to a C-level. Twenty-one articles (24%) did not acquire enough points to be assigned to any level. In this study, we present and discuss the most commonly used and most relevant 32 parameters. Many of the parameters found were not reported in enough studies or in enough detail to allow a useful evaluation. CONCLUSION This systematic review can help researchers compare, choose and develop the most appropriate gait evaluation protocol for their field of study, based on the articles with best scores on the criteria list and the relevance of specific biomechanical and physiological parameters.
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Outcomes Study of Transtibial Amputees Using Elevated Vacuum Suspension in Comparison With Pin Suspension. ACTA ACUST UNITED AC 2011. [DOI: 10.1097/jpo.0b013e3182173b83] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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95
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Elevated Vacuum Suspension Influence on Lower Limb Amputee's Residual Limb Volume at Different Vacuum Pressure Settings. ACTA ACUST UNITED AC 2010. [DOI: 10.1097/jpo.0b013e3181f903df] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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96
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A Vacuum Suspension Measurement Tool for Use in Prosthetic Research and Clinical Outcomes: Validation and Analysis of Vacuum Pressure in a Prosthetic Socket. ACTA ACUST UNITED AC 2010. [DOI: 10.1097/jpo.0b013e3181e8feaa] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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97
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Fergason J, Keeling JJ, Bluman EM. Recent advances in lower extremity amputations and prosthetics for the combat injured patient. Foot Ankle Clin 2010; 15:151-74. [PMID: 20189122 DOI: 10.1016/j.fcl.2009.10.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Blast-related extremity trauma represents a serious challenge because of the extent of bone and soft tissue damage. Fragmentation and blast injuries account for 56% of all injuries produced within the Iraqi and Afghan theaters where, as of July 2009, 723 combatants have sustained lower extremity limb loss. If limb salvage is not practical, or fails, then amputation should be considered. Amputation can be a reliable means toward pain relief and improvement of function. Optimizing functional outcome is paramount when deciding on definitive amputation level. Preservation of joint function improves limb biomechanics in many cases. Increased limb length also allows for the benefits associated with articular and distal limb proprioception. Amputees with improved lower extremity function also usually exhibit less energy consumption. Function and length are generally directly correlated, whereas energy consumption and length are inversely related. This article discusses the surgical principles of lower extremity amputation and postoperative management of amputees, and the various prosthetic options available.
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Affiliation(s)
- John Fergason
- Brooke Army Medical Centre, 3851 Roger Brooke Drive, DOR, Fort Sam Houston, TX 48234, USA.
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98
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Laferrier JZ, Gailey R. Advances in Lower-limb Prosthetic Technology. Phys Med Rehabil Clin N Am 2010; 21:87-110. [DOI: 10.1016/j.pmr.2009.08.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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99
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Traballesi M, Averna T, Delussu AS, Brunelli S. Trans-tibial prosthesization in large area of residual limb wound: Is it possible? A case report. Disabil Rehabil Assist Technol 2009; 4:373-5. [DOI: 10.1080/17483100903038568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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100
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Sanders JE, Lee GS. A means to accommodate residual limb movement during optical scanning: a technical note. IEEE Trans Neural Syst Rehabil Eng 2009; 16:505-9. [PMID: 18990654 DOI: 10.1109/tnsre.2008.2003388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A technique is described for correcting for subject movement while imaging the residual limb of a person with a transtibial amputation. Small reflective markers were placed on the residual limb, and then their motions tracked during scanning using two stationary cameras. The marker position measurements were used to generate appropriate translational and rotational transformation matrices so that limb motion could be corrected for during the 1.5-s scan interval. Evaluation tests showed good performance for moderate (2-4 mm) to high (5-8 mm) motion cases. The difference in mean absolute cross-sectional area between the test scan and a stationary reference scan was reduced by approximately one half when motion correction was used compared with when motion correction was not used. The algorithm broke down for exaggerated motion ( >or= 9 mm) cases, particularly in areas outside the region encompassed by the markers. The developed method is useful in prosthetics research where high resolution shape measurement is needed, for example in cases where residual limb shape or volume change is of interest.
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Affiliation(s)
- Joan E Sanders
- Bioengineering Department, University of Washington, Seattle, WA 98195, USA.
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