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Coburn KC, Weissinger MJ, Krout AJ, Hafner BJ, Garbini JL, Allyn KJ, Sanders JE. Design and testing of a simple quick connect for a prosthetic liner tether. Prosthet Orthot Int 2024; 48:481-487. [PMID: 37708336 DOI: 10.1097/pxr.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/27/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND A limitation of tether lanyards is that fastening and unfastening the tether from the liner, which needs to be performed to clean or replace the liner, is difficult for some users. OBJECTIVE The purpose of this research was to create a quick connect that allows users to easily attach and detach the tether from the liner. STUDY DESIGN Mechanical testing and pilot study. METHODS A slide-and-lock mechanism was used. To operate the quick connect, the prosthesis user turns open the lock, slides it onto a short pin extending from the liner, and releases the mechanism, causing it to spring back to the locked position. RESULTS Mechanical tests demonstrated that the system well-tolerated tensile loads of 25,000 cycles at 100 N and single cycles at 350 N. Five transtibial users trialed the system and took between 2 and 30 s to fasten and unfasten the quick connect. They found the quick connect intuitive to use, secure, relatively quiet, and stable. However, they preferred their traditional pin lock over the quick connect system, mainly because the quick connect required a multistep procedure (twist-align-slide) that they considered more complex than operating the locking pin to which they were accustomed. CONCLUSIONS In its current form, the quick connect is likely to be used by limited community ambulators who struggle with the pin lock donning procedure. It also has potential use with powered tethers that use a motor to adjust tether length.
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Affiliation(s)
- Kendrick C Coburn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | | | - Adam J Krout
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph L Garbini
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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Hu M, He Y, Hisano G, Hobara H, Kobayashi T. Coordination of Lower Limb During Gait in Individuals With Unilateral Transfemoral Amputation. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3835-3843. [PMID: 37721878 DOI: 10.1109/tnsre.2023.3316749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Understanding the lower-limb coordination of individuals with unilateral transfemoral amputation (uTFA) while walking is essential to understand their gait mechanisms. Continuous relative phase (CRP) analysis provides insights into gait coordination patterns of the neuromusculoskeletal system based on movement kinematics. Fourteen individuals with uTFA and their age-matched non-disabled individuals participated in this study. Kinematic data of the lower limbs of the participants were collected during walking. The joint angles, segment angles, and CRP values of the thigh-shank and shank-foot couplings were investigated. The curves among the lower limbs of the participants were compared using a statistical parametric mapping test. Compensatory strategies were found in the lower limbs from coordination patterns. In thigh-shank coupling, although distinct coordination traits in stance and swing phases among the lower limbs were found, the lower limbs in both groups were discovered to remain in a similar coordination pattern during gait. For individuals with uTFA, in shank-foot coupling, intact limbs demonstrated a short period of foot-leading pattern which was significantly different from that of the other limbs during mid-stance to compensate for the weaker force generation by prosthetic limbs. The findings offer normative coordination patterns on the walking of individuals with uTFA, which could benefit prosthetic gait rehabilitation and development.
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Devin KM, Tang J, Moser D, Jiang L. Assessing Socket Fit Effects on Pressure and Shear at a Transtibial Residuum/Socket Interface. Appl Bionics Biomech 2023; 2023:3257059. [PMID: 37621485 PMCID: PMC10447010 DOI: 10.1155/2023/3257059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/29/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Fluctuations in residuum volume during daily activities are known to occur in lower-limb amputees. This can cause frequent changes to fit, which cannot be accommodated by commonly-used prosthetic sockets. The real-time effects, if any, of these minor socket fit changes on interface biomechanics have not been studied extensively. Amputees commonly use different layers of socks to accommodate frequent volume fluctuations, enabling adjustment of socket fit. We, thus, altered socket fit levels via addition/removal of sock layers to a transtibial amputee who habitually-donned two-sock layers to mimic relatively looser and tighter socket fits. Interface pressure and shear sensors were placed at known prominent load-bearing sites of the transtibial residuum/socket interface, i.e., patellar tendon (PT), popliteal fossa (PF), and anterior-distal (AD) end, to measure real-time biomechanical interactions during standing and level walking. Although socket fit level was only slightly modified, changes in interface pressure and shear across anatomical sites were still observed. Tighter fit corresponds to notable pressure reduction at AD during early stance and pressure increase at PT during terminal stance due to the residuum being pushed up. Shear-to-pressure ratios were used to assess comfort, while pressure- and shear-time integrals were used to assess tissue health. We observed more notable changes at tissue sites (e.g., AD and PF). Combined evaluation of pressure and shear, including shear-to-pressure ratio and time integrals, may offer insight for residuum care.
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Affiliation(s)
- Kirstie M. Devin
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Jinghua Tang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - David Moser
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Liudi Jiang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ, UK
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Klotz R, Emile G, Daviet JC, De Sèze M, Godet J, Urbinelli R, Krasny-Pacini A. Daily socket comfort in transtibial amputee with a vacuum-assisted suspension system: study protocol of a randomized, multicenter, double-blind multiple N-of-1 trial. BMC Sports Sci Med Rehabil 2023; 15:85. [PMID: 37452356 PMCID: PMC10347726 DOI: 10.1186/s13102-023-00694-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The main aim of this paper is to present the feasibility of rigorously designed multiple N-of-1 design in prosthetics research. While research of adequate power and high quality is often lacking in rehabilitation, N-of-1 trials can offer a feasible alternative to randomized controlled group trials, both increasing design power at group level and allowing a rigorous, statistically confirmed evaluation of effectiveness at a single patient level. The paper presents a multiple N-of-1 trial protocol, which aim is to evaluate the effectiveness of Unity, a prosthetic add-on suspension system for amputees, on patient-reported comfort during daily activities (main outcome measure), prosthesis wearing time, perception of limb-prosthesis fitting and stump volume and functional walking parameters. METHODS Multicenter, randomized, prospective, double-blind multiple N-of-1 trial using an introduction/withdrawal design alternating Unity connected/disconnected phases of randomized length on twenty patients with unilateral transtibial amputation. The primary outcome measure is the Prosthetic Socket Comfort Score (SCS), a validated measure of comfort, administered daily by an phone app designed for the study. Secondary outcomes measures will be collected during the 50 days period of the N-of-1 trial: (1) by the same app, daily for patient-reported limb-prosthesis fitting, stump volume variation, and daily wearing time of the prosthesis; (2) by a pedometer for the number of steps per day; (3) by blind assessors in the rehabilitation center during adjustment visits for functional walking parameter (L-Test, 6-minute walk test), and by the patient for the QUEST, and ABC-S. Effectiveness of the Unity system regarding SCS and daily secondary outcome measures will be tested by randomization test. The secondary outcome measures assessed during visits in the rehabilitation center will be analyzed by Non Overlap of All pairs. An estimate of the effect on the amputee population will be generated by aggregating each individual clinical trial (N-of-1 trial) by Hierarchical Bayesian methods. DISCUSSION This study protocol was designed to answer the question "which device is best for THIS patient" and to conclude at a group level on the effectiveness of a new devic, using a Multiple N-of-1 trial, which is promising but underused in prosthetics research so far. TRIAL REGISTRATION N° ID-RCB 2020-A01309-30 Clintrial.gov : NCT04804150 - Retrospectively registered March 20th 2021.
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Affiliation(s)
- Rémi Klotz
- La Tour de Gassies Centre for Physical Medicine and Rehabilitation, UGECAM, Rue de la Tour de Gassies, Bruges, 33523, France
| | - Guilhem Emile
- Department of Physical and Rehabilitation Medicine, Centre Hospitalier d'Arcachon, Avenue Jean Hameau, 33260, La Teste de Buch, France
| | - Jean-Christophe Daviet
- Department of Physical and Rehabilitation Medicine, Limoges University, Jean Rebeyrol Hospital, Avenue du Buisson, 87170, Limoges, France
| | - Mathieu De Sèze
- Physical and Rehabilitation Medicine Unit, Bordeaux University Hospital, University of Bordeaux, EA4136, Bordeaux, France
| | - Julien Godet
- Clinical Research Methods Group, Laboratory of Bioimaging and Pathologies, UMR CNRS 7021, University Hospitals of Strasbourg, Illkirch, Strasbourg, France
| | | | - Agata Krasny-Pacini
- Department of Physical and Rehabilitation Medicine, UF 4372, CHU de Strasbourg, Institut Universitaire de Réadaptation Clémenceau, 45 Boulevard Clémenceau, Strasbourg, 67000, France
- Department of Psychiatry, Hôpital civil, INSERM 1114, Strasbourg University Hospital, Strasbourg, France
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5
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Willson AM, Anderson AJ, Richburg CA, Muir BC, Czerniecki J, Steele KM, Aubin PM. Full body musculoskeletal model for simulations of gait in persons with transtibial amputation. Comput Methods Biomech Biomed Engin 2023; 26:412-423. [PMID: 35499924 PMCID: PMC9626388 DOI: 10.1080/10255842.2022.2065630] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This paper describes the development, properties, and evaluation of a musculoskeletal model that reflects the anatomical and prosthetic properties of a transtibial amputee using OpenSim. Average passive prosthesis properties were used to develop CAD models of a socket, pylon, and foot to replace the lower leg. Additional degrees of freedom (DOF) were included in each joint of the prosthesis for potential use in a range of research areas, such as socket torque and socket pistoning. The ankle has three DOFs to provide further generality to the model. Seven transtibial amputee subjects were recruited for this study. 3 D motion capture, ground reaction force, and electromyographic (EMG) data were collected while participants wore their prescribed prosthesis, and then a passive prototype prosthesis instrumented with a 6-DOF load cell in series with the pylon. The model's estimates of the ankle, knee, and hip kinematics comparable to previous studies. The load cell provided an independent experimental measure of ankle joint torque, which was compared to inverse dynamics results from the model and showed a 7.7% mean absolute error. EMG data and muscle outputs from OpenSim's Static Optimization tool were qualitatively compared and showed reasonable agreement. Further improvements to the muscle characteristics or prosthesis-specific foot models may be necessary to better characterize individual amputee gait. The model is open-source and available at (https://simtk.org/projects/biartprosthesis) for other researchers to use to advance our understanding and amputee gait and assist with the development of new lower limb prostheses.
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Affiliation(s)
- Andrea M. Willson
- Department of Mechanical Engineering, University of Washington, Seattle WA, USA,VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle WA, USA
| | - Anthony J. Anderson
- Department of Mechanical Engineering, University of Washington, Seattle WA, USA,VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle WA, USA
| | | | - Brittney C. Muir
- Department of Mechanical Engineering, University of Washington, Seattle WA, USA,VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle WA, USA
| | - Joseph Czerniecki
- VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle WA, USA,Department of Rehabilitation Medicine, University of Washington, Seattle WA, USA
| | - Katherine M. Steele
- Department of Mechanical Engineering, University of Washington, Seattle WA, USA
| | - Patrick M. Aubin
- Department of Mechanical Engineering, University of Washington, Seattle WA, USA,VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle WA, USA
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6
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Finco MG, Moudy SC, Patterson RM. Normalized kinematic walking symmetry data for individuals who use lower-limb prostheses: considerations for clinical practice and future research. JOURNAL OF PROSTHETICS AND ORTHOTICS : JPO 2023; 35:e1-e17. [PMID: 37008386 PMCID: PMC10062529 DOI: 10.1097/jpo.0000000000000435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT
Introduction
Individuals who use unilateral transtibial or transfemoral prostheses have negative secondary health effects associated with decreased kinematic (e.g., spatiotemporal and joint angle) walking symmetry between prosthetic and intact limbs. Research studies have quantified kinematic walking symmetry, but studies can be difficult to compare owing to the inclusion of small sample sizes and differences in participant demographics, biomechanical parameters, and mathematical analysis of symmetry. This review aims to normalize kinematic walking symmetry research data across studies by level of limb loss and prosthetic factors to inform considerations in clinical practice and future research.
Methods
A search was performed on March 18, 2020, in PubMed, Scopus, and Google Scholar to encompass kinematic walking symmetry literature from the year 2000. First, the most common participant demographics, kinematic parameters, and mathematical analysis of symmetry were identified across studies. Then, the most common mathematical analysis of symmetry was used to recalculate symmetry data across studies for the five most common kinematic parameters.
Results
Forty-four studies were included in this review. The most common participant demographics were younger adults with traumatic etiology who used componentry intended for higher activity levels. The most common kinematic parameters were step length, stance time, and sagittal plane ankle, knee, and hip range of motion. The most common mathematical analysis was a particular symmetry index equation.
Conclusions
Normalization of data showed that symmetry tended to decrease as level of limb loss became more proximal and to increase with prosthetic componentry intended for higher activity levels. However, most studies included 10 or fewer individuals who were active younger adults with traumatic etiologies.
Clinical Relevance
Data summarized in this review could be used as reference values for rehabilitation and payer justification. Specifically, these data can help guide expectations for magnitudes of walking symmetry throughout rehabilitation or to justify advanced prosthetic componentry for active younger adults under 65 years of age with traumatic etiologies to payers.
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Affiliation(s)
- M G Finco
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Sarah C Moudy
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Rita M Patterson
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
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Sasaki K, Guerra G, Lei Phyu W, Chaisumritchoke S, Sutdet P, Kaewtip S. Assessment of Socket Pressure during Walking in Rapid Fit Prosthetic Sockets. SENSORS 2022; 22:s22145224. [PMID: 35890905 PMCID: PMC9319515 DOI: 10.3390/s22145224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/09/2022] [Accepted: 07/10/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: A sustainable casting system that combines the use of a polystyrene bag, a prosthetic liner and a vacuum system was developed to reduce fabrication time while maintaining comfort for the trans-tibial prosthesis user. (2) Methods: Eight prosthetists (28.7 ± 8.25 years old) fit ten trans-tibial prosthesis wearers (46 ± 12.4 years old) with two types of total surface bearing (TSB) prostheses; a polystyrene bead (PS) prosthesis and a plaster of paris (POP) prosthesis. Duration of casting and combined mean peak pressure was measured at six locations on the residual limb using Force Sensing Resistors (FSR). A pressure uniformity score (%) was determined. Socket Comfort Scale (SCS) was also measured. (3) Results: Duration of casting for the POP method was 64.8 ± 9.53 min and 7.8 ± 2 min for the PS method, (p = 0.006). Pressure uniformity in the POP prosthesis was 79.3 ± 6.54 and 81.7 ± 5.83 in the PS prosthesis (p = 0.027). SCS in both prosthesis types were equivalent. (4) Conclusion: A rapid fit PS prosthesis was developed, with significantly shorter duration than the traditional POP method. Socket pressure uniformity was confirmed and improved in the PS method. Socket comfort was equal between the two prothesis types.
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Affiliation(s)
- Kazuhiko Sasaki
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.S.); (W.L.P.); (S.C.); (P.S.); (S.K.)
| | - Gary Guerra
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.S.); (W.L.P.); (S.C.); (P.S.); (S.K.)
- Department of Exercise and Sport Science, St. Mary’s University, One Camino Santa Maria, San Antonio, TX 78228, USA
- Correspondence:
| | - Win Lei Phyu
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.S.); (W.L.P.); (S.C.); (P.S.); (S.K.)
| | - Sirarat Chaisumritchoke
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.S.); (W.L.P.); (S.C.); (P.S.); (S.K.)
| | - Prawina Sutdet
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.S.); (W.L.P.); (S.C.); (P.S.); (S.K.)
| | - Sirintip Kaewtip
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.S.); (W.L.P.); (S.C.); (P.S.); (S.K.)
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8
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Tezuka Y, Chin T, Azuma Y, Miura Y. Factors related to indoor prosthetic use in individuals with unilateral lower limb amputation. Prosthet Orthot Int 2022; 46:12-18. [PMID: 34812795 DOI: 10.1097/pxr.0000000000000062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 09/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The rate of indoor prosthetic use in people with lower limb amputation (LLA) is lower than that of outdoor use. Very few studies of indoor prosthetic use have been conducted, and no studies have focused on the perspective of instrumental activities of daily living (IADLs). OBJECTIVES To assess the indoor prosthetic use of individuals with unilateral LLA from the perspective of IADLs. STUDY DESIGN Cross-sectional study. METHODS A total of 162 people with LLA participated in this study. Based on the information obtained from a questionnaire and medical records, the relationships between each outcome and indoor prosthetic use were assessed by univariate analysis and multivariate logistic regression analysis. RESULTS Of the 110 respondents (72.8%), 6 participants did not use the prosthesis or used it for cosmesis. With respect to the prosthetic users (n = 104), 74 (71.2%) used their prosthesis indoors and outdoors and 30 (28.8%) used it only outdoors, but none used it indoors only. On univariate analysis, five items were identified: household size, amputation level, domestic chores and outdoor activities of the Frenchay Activities Index, and difficulty donning/doffing the prosthesis. Small household, transtibial amputation, and a high score on the domestic chores of the Frenchay Activities Index (cutoff value 9.0 points) were independently associated with indoor prosthetic use. CONCLUSIONS Training of motions that are desirable to use the prosthesis and participation in domestic chores frequently based on IADLs before hospitalization may increase the frequency of prosthesis use in people with transfemoral amputation who use their prosthesis outdoors.
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Affiliation(s)
- Yusuke Tezuka
- Department of Physical Therapy, Hyogo Rehabilitation Center, Kobe, Japan
- Faculty of Health Science, Kobe University Graduate School of Health Science, Kobe, Japan
| | - Takaaki Chin
- Department of Physical Medicine and Rehabilitation, Hyogo Rehabilitation Center, Kobe, Japan
- Department of Rehabilitation Science, Kobe University Graduate School of Medicine in Hyogo Rehabilitation Center, Kobe, Japan
| | - Yuji Azuma
- Department of Physical Therapy, Hyogo Rehabilitation Center, Kobe, Japan
- Faculty of Health Science, Kobe University Graduate School of Health Science, Kobe, Japan
| | - Yasushi Miura
- Faculty of Health Science, Kobe University Graduate School of Health Science, Kobe, Japan
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Nizam MAM, Razak NAA, Osman NAA, Jaladin RAM. Qualitative Study of Prosthetic Liner Materials on Transtibial Amputees’ Satisfaction in Term of Positional Pain and Discomfort. 6TH KUALA LUMPUR INTERNATIONAL CONFERENCE ON BIOMEDICAL ENGINEERING 2021 2022:205-216. [DOI: 10.1007/978-3-030-90724-2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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10
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Arauz PG, Chiriboga P, García MG, Kao I, Díaz EA. New technologies applied to canine limb prostheses: A review. Vet World 2021; 14:2793-2802. [PMID: 34903941 PMCID: PMC8654758 DOI: 10.14202/vetworld.2021.2793-2802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
Although only a few studies have investigated about the development of animal prosthesis, currently, there is an increasing interest in canine limb prosthesis design and its clinical application since they offer an alternative to killing the animal in extreme situations where amputating the limb is the only option. Restoring normal function of amputated canine limbs with the use of a prosthesis is challenging. However, recent advances in surgical procedures and prosthesis design technology appear promising in developing devices that closely recreate normal canine limb function. Surgical advances such as evolution of osseointegration (bone-anchored) prostheses present great promise. Likewise, modern computer-aided design and manufacturing technology, as well as novel motion analysis systems are now providing improved prosthesis designs. Advances in patient-customized prostheses have the potential to reduce the risk of implant failure. The objective of this investigation is to present a general review of the existing literature on modern surgical approaches, design and manufacturing methods, as well as biomechanical analyses so that veterinarians can make more and better-informed decisions on the development and selection of proper canine limb prosthesis. Isolated research efforts have made possible an improvement in stability, comfort, and performance of canine limb prosthesis. However, continued multidisciplinary research collaboration and teamwork among veterinarians, engineers, designers, and industry, with supporting scientific evidence, is required to better understand the development of canine limb prosthesis designs that closely replicate the normal limb function.
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Affiliation(s)
- Paul G Arauz
- Department of Mechanical Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - Patricio Chiriboga
- Department of Mechanical Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - María-Gabriela García
- Department of Industrial Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - Imin Kao
- Department of Mechanical Engineering, Stony Brook University, Stony Brook, United States
| | - Eduardo A Díaz
- Department of Veterinary Medicine, Universidad San Francisco de Quito, Quito, Ecuador
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11
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Seth M, Beisheim EH, Spencer MT, Horne JR, Sarlo FB, Sions JM. Self-reported socket comfort, mobility, and balance-confidence of individuals with transtibial amputation using pinlock vs suction suspension. Prosthet Orthot Int 2021; 45:214-220. [PMID: 33840751 PMCID: PMC8169564 DOI: 10.1097/pxr.0000000000000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 10/10/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Improper suspension between the residual limb and prosthesis can result in pistoning, which may compromise skin integrity and reduce overall user comfort. In addition to objective measures of limb pistoning, user perspective may provide insight into suspension system effectiveness. OBJECTIVES The primary objective of this analysis was to explore differences in self-reported measures among adults with transtibial amputation (TTA) using pinlock vs suction suspension systems. STUDY DESIGN This is a secondary analysis of cross-sectional data. METHODS Participants (n = 48) were included if they (1) were ≥18 years of age, (2) were community-dwelling, (3) had a unilateral TTA of ≥6 months, and (4) were prescribed a prosthesis with either pinlock or suction suspension. Participants completed self-reported measures evaluating socket comfort (Socket Comfort Score [SCS]), prosthesis-enabled mobility (Prosthesis Evaluation Questionnaire-Mobility Section [PEQ-MS]; Locomotor Capabilities Index [LCI]), and balance-confidence (Activities-Specific Balance Confidence Scale [ABC]). RESULTS Participants using suction suspension reported significantly higher SCS as compared with participants using pinlock suspension (P ≤ .001). No differences were observed between groups for PEQ-MS, LCI, and/or ABC. CONCLUSIONS Individuals with TTA using suction suspension may report greater socket comfort than peers using pinlock suspension, but prosthesis-enabled mobility and balance-confidence may be similar. Future research is warranted to confirm these preliminary findings using a prospective, crossover study design that controls for all suspected factors that might influence socket comfort.
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Affiliation(s)
- Mayank Seth
- University of Delaware, Department of Physical Therapy, Newark, DE
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12
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Safari R. Lower limb prosthetic interfaces: Clinical and technological advancement and potential future direction. Prosthet Orthot Int 2020; 44:384-401. [PMID: 33164655 DOI: 10.1177/0309364620969226] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The human-prosthesis interface is one of the most complicated challenges facing the field of prosthetics, despite substantive investments in research and development by researchers and clinicians around the world. The journal of the International Society for Prosthetics and Orthotics, Prosthetics and Orthotics International, has contributed substantively to the growing body of knowledge on this topic. In celebrating the 50th anniversary of the International Society for Prosthetics and Orthotics, this narrative review aims to explore how human-prosthesis interfaces have changed over the last five decades; how research has contributed to an understanding of interface mechanics; how clinical practice has been informed as a result; and what might be potential future directions. Studies reporting on comparison, design, manufacturing and evaluation of lower limb prosthetic sockets, and osseointegration were considered. This review demonstrates that, over the last 50 years, clinical research has improved our understanding of socket designs and their effects; however, high-quality research is still needed. In particular, there have been advances in the development of volume and thermal control mechanisms with a few designs having the potential for clinical application. Similarly, advances in sensing technology, soft tissue quantification techniques, computing technology, and additive manufacturing are moving towards enabling automated, data-driven manufacturing of sockets. In people who are unable to use a prosthetic socket, osseointegration provides a functional solution not available 50 years ago. Furthermore, osseointegration has the potential to facilitate neuromuscular integration. Despite these advances, further improvement in mechanical features of implants, and infection control and prevention are needed.
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Affiliation(s)
- Reza Safari
- Health and Social Care Research Centre, University of Derby, Derby, UK
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13
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Miyata Y, Sasaki K, Guerra G, Rattanakoch J. Sustainable, affordable and functional: reimagining prosthetic liners in resource limited environments. Disabil Rehabil 2020; 44:2941-2947. [PMID: 33167733 DOI: 10.1080/09638288.2020.1844316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate function and performance of unilateral trans-tibial prosthesis users wearing an affordable liner in three types of socket designs. METHODS Five unilateral trans-tibial amputees participated, were provided an Affordable Ethyl-Vinyl-Acetate Roll-On liner (AERO) roll-on liner with patella tendon bearing (PTB) prosthesis, PE-Lite liner with PTB prosthesis, and an (AERO) liner with total-surface bearing (TSB) prosthesis. A battery of outcome measures; step-counts, socket comfort score (SCS), orthotics prosthetics user survey (OPUS) and socket pressure measurement during walking were administered. RESULTS Comparisons of step-counts indicated that PTB-AERO (3604 ± 815) was not significantly different than PTB-PE-Lite (3386 ± 942). Mean SCS was 9.2 ± .83 and 7.2 ± 2.1 for PTB-AERO and PTB-PE-Lite. A 6.6% decrease in mean peak pressure was observed between PTB-PE-Lite and TSB-AERO, and 3.2% difference between PTB-PE-Lite and PTB-AERO. CONCLUSION An affordable ($20 USD) and sustainably fabricated prosthesis liner was created and evaluated in trans-tibial prosthesis users. These initial results garner preliminary support for use of the AERO prosthetic liner and continued research.Implications for rehabilitationLower limb prosthetics in less-resourced settings can leverage locally sourced and affordable materials to fabricate roll-on liners for use in modern prosthetic sockets.The cost of the AERO liner is markedly lower than current standard of care gel liners, yet still facilitates use of current prosthetic sockets.
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Affiliation(s)
- Yusuke Miyata
- Faculty of Medicine, Sirindhorn School of Prosthetics and Orthotics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kazuhiko Sasaki
- Faculty of Medicine, Sirindhorn School of Prosthetics and Orthotics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Gary Guerra
- Faculty of Medicine, Sirindhorn School of Prosthetics and Orthotics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jutima Rattanakoch
- Faculty of Medicine, Sirindhorn School of Prosthetics and Orthotics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Abstract
BACKGROUND Strength deficits may play a central role in the severity of balance, mobility, and endurance impairments in lower limb prosthesis users. A body of literature detailing the scope and specifics of muscle weakness in lower limb prosthesis users is emerging, but has yet to be summarized. A synopsis of strength deficits, and their impact on functional abilities in lower limb prosthesis users, may inform rehabilitation and research needs. OBJECTIVES Synthesize reported strength deficits in lower limb prosthesis users, and discuss possible causes, consequences, and solutions. STUDY DESIGN Scoping review. METHODS A search of biomedical databases was performed, and inclusion/exclusion criteria were applied to identify publications relevant to the purpose of the review. RESULTS In all, 377 publications were identified, of which 12 met the inclusion/exclusion criteria. When compared with the controls and the intact limb, the primary strength outcome, peak torque, was lower in transtibial residual limb knee flexors and extensors, as well as transfemoral residual limb hip muscles. CONCLUSIONS The reviewed studies provide evidence of strength deficits in lower limb prosthesis users. These deficits appear to be consequential, as they may contribute to balance, mobility, and endurance impairments. Additional research exploring alternative strength metrics, clinical tests, and causal links to functional impairments is required. CLINICAL RELEVANCE Evidence of muscle weakness among lower limb prosthesis users, and its influence on balance, mobility, and endurance, suggests that greater clinical attention and scientific inquiry into physical conditioning of lower limb prosthesis users is merited and required.
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Affiliation(s)
- Alex Hewson
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Shaquitta Dent
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Andrew Sawers
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
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15
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Breuer R, Trieb K. Silicone soft socket system for the treatment of geriatric transtibial amputees. Wien Klin Wochenschr 2020; 133:216-221. [PMID: 32300882 PMCID: PMC7969543 DOI: 10.1007/s00508-020-01643-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/20/2020] [Indexed: 11/23/2022]
Abstract
Background Outfitting geriatric amputees with a suitable prosthesis is a demanding task. The aim of this study was to determine the effect of prostheses outfitted with a silicone suspension interface system on a large group of transtibial amputees regarding walking distance, satisfaction of use and duration of daily use. Methods The study included 75 mostly geriatric transtibial amputees fitted with a rigid total contact socket with a silicone interface system called an Icelandic roll-on silicone socket (ICEROSS, Ossur, Reykjavik, Iceland). At follow-up 54 patients remained for assessment. Ambulatory performance was measured by first categorizing the patients into four subgroups regarding their walking capacity: 0–50 m, 50–100 m, 100–500 m and >500 m. The alteration in patient mobility was measured at admission, discharge and follow-up. Satisfaction and duration of daily use as well as use of walking aids were collated with a standard questionnaire. Results Between admission and discharge, patients showed significant improvement (p = <0.001) in walking distances. The walking distance diminished again between time of discharge and follow-up (p = <0.001). The parameters satisfaction with device and duration of daily use showed no significant differences and the same applied to male and female subjects. Conclusions Geriatric transtibial amputees fitted with prostheses attached via a silicone suction socket system showed significant improvements in walking distances and a high rate of satisfaction with the device. There were no statistically significant gender-specific differences among users of the ICEROSS system.
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Affiliation(s)
- Robert Breuer
- Department of Orthopedics and Trauma Surgery, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Klemens Trieb
- Computed Tomography Research Group, University of Applied Sciences Upper Austria, Stelzhamerstraße 23, 4600, Wels, Austria
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16
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Sasaki K, Guerra G, Rattanakoch J, Miyata Y, Suntharalingam S. Sustainable Development: A Below-Knee Prostheses Liner for Resource Limited Environments. J Med Device 2020. [DOI: 10.1115/1.4045835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AbstractThis research sought to develop a fabricable prosthetic liner that could be fabricable, intuitive, and a cost-effective means of providing advanced prosthetics in developing settings. An affordable ethyl-vinyl-acetate roll-on (AERO) liner for permitting a total surface bearing suction socket design was created and provided to a single participant for in vivo outcome measurements. The liner was fabricated from locally produced low-density ethyl-vinyl-acetate (EVA) foam. A liner fabrication process was developed and described, and one participant was provided 3 mm and 6 mm AERO liner variants for outcome evaluations. Six-minute walk test, residual limb temperature, and socket comfort score (SCS) while in AERO liner were collected. Thirty-day step counts of AERO liner with prosthesis and thermoplastic elastomer (TPE) liner with prosthesis were collected. The results of in vivo evaluations indicate increased speed, slightly higher residuum temperature, and increased comfort of the 6 mm AERO liner. Pedometer tallied step counts for the AERO liner and TPE liner prostheses were similar. The 6 mm AERO liner provided the best comfort and function of the two thicknesses in liners, and step count data indicated that the volume of patient activity was similar to when wearing the TPE liner prosthesis. Roll-on fabricable low-cost liners offer an affordable means of providing total surface bearing suction prostheses for resource limited environments (RLE). A prosthetist or technician can use the existing skills and lab to create liners.
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Affiliation(s)
- Kazuhiko Sasaki
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10100, Thailand
| | - Gary Guerra
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10100, Thailand
| | - Jutima Rattanakoch
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10100, Thailand
| | - Yusuke Miyata
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10100, Thailand
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18
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Çalışkan Uçkun A, Yurdakul FG, Almaz ŞE, Yavuz K, Koçak Ulucaköy R, Sivas F, Bodur H. Reported physical activity and quality of life in people with lower limb amputation using two types of prosthetic suspension systems. Prosthet Orthot Int 2019; 43:519-527. [PMID: 31423938 DOI: 10.1177/0309364619869783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vacuum-assisted suspension systems provide better suspension than non-vacuum systems, but data are limited on whether they improve physical activity levels and quality of life for people with amputation. OBJECTIVES To compare the physical activity and quality of life levels of people with transtibial amputation using PIN/LOCK suspension system or vacuum-assisted suspension systems with those of able-bodied controls and to investigate parameters associated with physical activity levels. STUDY DESIGN A cross-sectional observational study. METHODS Fifty-one people with amputation and 51 controls participated. The International Physical Activity Questionnaire Short Form and Short Form 36 were used to measure the physical activity and quality of life, respectively. RESULTS The total physical activity and Short Form 36 scores were significantly lower in the participants with amputation than the controls. There were no significant differences between the two types of suspension systems in terms of physical activity levels and quality of life. The vacuum-assisted suspension system users reported significantly more bodily pain on the Short Form 36 questionnaire than the controls (p = 0.003). The only parameter that correlated significantly with the total physical activity was the Short Form 36 physical functioning subscale (r = 0.302, p = 0.031). CONCLUSION Contrary to our expectations, vacuum-assisted suspension system users compared to PIN/LOCK users did not report greater levels of physical activity or improved quality of life or levels closer to comparable controls. CLINICAL RELEVANCE A better understanding of the effects of different prosthetic suspension systems on physical activity and quality of life may help clinicians when prescribing prostheses, as well as setting appropriate prosthetic expectations. This study suggests that vacuum-assisted suspension systems and PIN/LOCK suspension systems provide equal benefit to users with regards to physical activity and quality of life.
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Affiliation(s)
- Aslı Çalışkan Uçkun
- Department of Physical Medicine and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Fatma Gül Yurdakul
- Department of Physical Medicine and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Şahide Eda Almaz
- Department of Physical Medicine and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Kaan Yavuz
- Department of Physical Medicine and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Rezan Koçak Ulucaköy
- Department of Physical Medicine and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Filiz Sivas
- Department of Physical Medicine and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Hatice Bodur
- Department of Physical Medicine and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
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19
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Evaluating shear and normal force with the use of an instrumented transtibial socket: A case study. Med Eng Phys 2019; 71:102-107. [PMID: 31331756 DOI: 10.1016/j.medengphy.2019.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 11/21/2022]
Abstract
Patients with transtibial amputation experience ulcers on their residual limb. The loading between the device and underlying material plays a role in loads transmitted to the skin. The objective was to evaluate normal and shear forces at the socket/liner interface during walking. A 53 year old male (85.45 kg and 177.8 cm) with a transtibial amputation participated in this case study. A transtibial prosthesis was instrumented with a load cell to measure normal and shear forces at the socket interface. Three conditions were evaluated during walking: gel liner, additional three ply sock and a hole in the gel liner. Shear and normal forces were highest with the addition of a three ply. Longitudinal shear stresses ranged from 0.4-7.66 kPa, transverse shear stresses ranged from 0.01-7.79 kPa and normal stresses ranged from 2.7-61.9 kPa. Increased shear and normal forces can cause a significant decrease in blood perfusion, linked to an increased risk of ulcer formation. Experimental force results are also important for future work involving finite element modeling of the skin/liner/device interface.
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20
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Gholizadeh H, Lemaire E, Sinitski E, Nielen D, Lebel P. Transtibial amputee gait with the unity suspension system. Disabil Rehabil Assist Technol 2019; 15:350-356. [DOI: 10.1080/17483107.2019.1579000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- H. Gholizadeh
- Centre for Rehabilitation Research and Development, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Prosthetics & Orthotics, Ottawa Hospital Rehabilitation Centre, Ottawa, Canada
| | - E.D. Lemaire
- Centre for Rehabilitation Research and Development, Ottawa Hospital Research Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - E.H. Sinitski
- Centre for Rehabilitation Research and Development, Ottawa Hospital Research Institute, Ottawa, Canada
- Canadian Forces Health Services, Ottawa, Canada
| | - D. Nielen
- Department of Prosthetics & Orthotics, Ottawa Hospital Rehabilitation Centre, Ottawa, Canada
| | - P. Lebel
- Department of Prosthetics & Orthotics, Ottawa Hospital Rehabilitation Centre, Ottawa, Canada
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21
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Gailey R, Kristal A, Lucarevic J, Harris S, Applegate B, Gaunaurd I. The development and internal consistency of the comprehensive lower limb amputee socket survey in active lower limb amputees. Prosthet Orthot Int 2019; 43:80-87. [PMID: 30095355 DOI: 10.1177/0309364618791620] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: Prosthetic socket fit is an important element associated with successful ambulation and use of a prosthesis. Prosthetists and rehabilitation clinicians would benefit from an assessment tool that discriminates between and quantifies the multiple determinants that influence the lower limb amputee's performance and satisfaction of a prosthetic socket. OBJECTIVES: To determine the internal consistency of the comprehensive lower limb amputee socket survey, a new self-report measure of prosthetic socket satisfaction that quantifies suspension, stability, comfort, and appearance. STUDY DESIGN: Cross-sectional sample of active amputees. METHODS: Interviews were conducted with prosthetists, physical therapists, and lower limb amputees to identify clinical concerns and common activities influencing socket fit. An expert panel of five clinicians reviewed the items and constructed the original version of the comprehensive lower limb amputee socket survey which was then administered to a convenience sample of 47 active lower limb amputees. Item analysis and Cronbach's alpha were used to determine the final version of the comprehensive lower limb amputee socket survey. RESULTS: Following item raw score-to-total score correlation with Cronbach's alpha for comprehensive lower limb amputee socket survey determinants, internal consistency improved when nine questions were eliminated. CONCLUSION: The comprehensive lower limb amputee socket survey is a self-report measure of prosthetic socket satisfaction with very good internal consistency. CLINICAL RELEVANCE When socket problems occur, the ability to determine the specific cause can reduce modification time, enhance socket fit, and promote patient satisfaction. A standardized multi-dimensional assessment measure of socket satisfaction enables prosthetists to quantify the multiple determinants of socket satisfaction, improve patient communication, and demonstrate the value of socket interventions.
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Affiliation(s)
- Robert Gailey
- 1 Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Anat Kristal
- 1 Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Jennifer Lucarevic
- 1 Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Shane Harris
- 1 Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | | | - Ignacio Gaunaurd
- 1 Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,3 Department of Veterans Affairs Medical Center, Miami VA Healthcare System, Miami, FL, USA
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22
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Guerra-Farfán E, Nuñez JH, Sanchez-Raya J, Crespo-Fresno A, Anglés F, Minguell J. Prosthetic Limb Options for Below and Above Knee Amputations: Making the Correct Choice for the Right Patient. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0149-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Lenz AL, Johnson KA, Tamara Reid B. Understanding Displacements of the Gel Liner for Below Knee Prosthetic Users. J Biomech Eng 2018; 140:2681001. [PMID: 29801173 DOI: 10.1115/1.4040125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Indexed: 11/08/2022]
Abstract
Many people with amputation utilize a prosthetic device to maintain function and ambulation. During the use of the prosthetic device, their residual limbs can develop wounds called pressure ulcers. The formation of these wounds has been linked to deformation and loading conditions of the skin and deeper tissues. Our research objective was to develop a complete profile of displacements on the gel liner at the interface with the socket during walking in transtibial amputees. Displacements for seven regions along the limb were quantified in addition to six calculations of displacement and three rotations relative to the prosthetic socket. The largest displacements were observed in the distal region of the gel liner, near the pin locking mechanism on the gel liner. Displacements were uneven throughout the liner with distal regions showing higher displacements. This mechanics-based information, combined with clinical information, will allow us to understand the local skin and muscle displacements, and will provide insights regarding localized tissue breakdown. Knowledge of how the liner displaces within the prosthetic socket can also help prosthetists modify designs to reduce these displacements, and reduce the potential for shear on the skin and in deeper tissues.
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Affiliation(s)
- Amy L Lenz
- Mem. ASME Department of Mechanical Engineering, Michigan State University, 428 S. Shaw Lane, East Lansing, MI 48824 e-mail:
| | - Katie A Johnson
- Mary Free Bed Rehabilitation Hospital Prosthetics, 235 Wealthy Street SE, Grand Rapids, MI 49503 e-mail:
| | - Bush Tamara Reid
- Fellow ASME Department of Mechanical Engineering, Michigan State University, 428 S. Shaw Lane 2555, East Lansing, MI 48824.,Chair of Dynamics, Design and Rehabilitation Committee, East Lansing, MI 48823 e-mail:
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Gholizadeh H, Lemaire ED, Sinitski EH. Transtibial amputee gait during slope walking with the unity suspension system. Gait Posture 2018; 65:205-212. [PMID: 30558933 DOI: 10.1016/j.gaitpost.2018.07.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 07/05/2018] [Accepted: 07/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND People with lower limb amputation may experience walking limitations on slopes because of missing musculoskeletal and neuromuscular systems. Elevated vacuum suspension could benefit transtibial amputee gait for slope walking, but research is lacking to inform clinical practice. METHODS Twelve people with unilateral transtibial amputation were fitted with the Unity elevated vacuum suspension system (Össur) and Pro-Flex XC foot. 3D motion analysis was performed for 7° incline, 7° decline, and level walking within a CAREN-Extended system virtual Park environment. Randomized and blinded walking trials were completed with the vacuum active or inactive. RESULTS Statistically significant differences (p < 0.05) were found between vacuum conditions when walking uphill or downhill for temporal spatial, kinematic, and kinetic gait parameters; however, effect sizes were small (r≤0.35). Prosthetic step length decreased for both vacuum conditions on downhill compared to uphill walking. Symmetry index was <10% for step length, step time, and stance time for both vacuum condition during downhill walking, indicating acceptable symmetry. During incline walking, step length was only symmetrical with active vacuum. Knee range of motion was not restricted, for both conditions. CONCLUSION Active vacuum improved gait symmetry for incline walking, but the other differences between vacuum conditions were small and may not be clinically significant. Therefore, the Unity system approach for elevated vacuum suspension had a positive, but small, effect on walking and should maintain appropriate walking even with vacuum failure, until limb volume changes adversely affect socket fit (i.e., elevated vacuum helps control limb volume fluctuations over time).
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Affiliation(s)
- Hossein Gholizadeh
- Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada; Prosthetics & Orthotics, Ottawa Hospital Rehabilitation Centre, Ottawa, Canada.
| | - Edward D Lemaire
- Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Canada.
| | - Emily H Sinitski
- Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada; Canadian Forces Health Services, Ottawa, Canada.
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25
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Thibault G, Gholizadeh H, Sinitski E, Baddour N, Lemaire ED. Effects of the unity vacuum suspension system on transtibial gait for simulated non-level surfaces. PLoS One 2018; 13:e0199181. [PMID: 29902256 PMCID: PMC6002056 DOI: 10.1371/journal.pone.0199181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/01/2018] [Indexed: 11/19/2022] Open
Abstract
Walking on various surfaces encountered in everyday life requires lower limb prosthesis users to continually adapt their movement patterns. Elevated vacuum suspension systems could improve transtibial amputee gait on non-level surfaces; however, research is lacking to guide clinical practice. Twelve transtibial amputees were fitted with the Össur sleeveless vacuum suspension system (Unity). After a one month accommodation period, the CAREN-Extended system was used to evaluate gait on a self-paced treadmill when walking with continuous perturbations (medial-lateral translations, rolling hills, simulated uneven ground) with an active or inactive vacuum suspension system. Significant differences between active and inactive vacuum conditions (p<0.05) were found for some temporal-spatial and kinematic gait parameters, but the differences were small and not considered clinically significant. Our findings suggest that potential vacuum pump failures would not immediately affect gait performance in a moderately high functioning amputee population. However, residual limb volume changes over time due to the removal of elevated vacuum may adversely affect socket fit, leading to greater gait differences and reduced quality of life.
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Affiliation(s)
- Gabrielle Thibault
- The Ottawa Hospital Rehabilitation Centre, Centre for Rehabilitation Research and Development, Ottawa, Canada
| | - Hossein Gholizadeh
- The Ottawa Hospital Rehabilitation Centre, Centre for Rehabilitation Research and Development, Ottawa, Canada
- * E-mail: ,
| | - Emily Sinitski
- The Ottawa Hospital Rehabilitation Centre, Centre for Rehabilitation Research and Development, Ottawa, Canada
- Canadian Forces Health Services, Ottawa, Canada
| | - Natalie Baddour
- Faculty of Engineering, Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada
| | - Edward D. Lemaire
- The Ottawa Hospital Rehabilitation Centre, Centre for Rehabilitation Research and Development, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Lenz AL, Johnson KA, Bush TR. A new method to quantify liner deformation within a prosthetic socket for below knee amputees. J Biomech 2018; 74:213-219. [PMID: 29678418 DOI: 10.1016/j.jbiomech.2018.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 02/28/2018] [Accepted: 04/01/2018] [Indexed: 10/17/2022]
Abstract
Many amputees who wear a leg prosthesis develop significant skin wounds on their residual limb. The exact cause of these wounds is unclear as little work has studied the interface between the prosthetic device and user. Our research objective was to develop a quantitative method for assessing displacement patterns of the gel liner during walking for patients with transtibial amputation. Using a reflective marker system and a custom clear socket, evaluations were conducted with a clear transparent test socket mounted over a plaster limb model and a deformable limb model. Distances between markers placed on the limb were measured with a digital caliper and then compared with data from the motion capture system. Additionally, the rigid plaster set-up was moved in the capture volume to simulate walking and evaluate if inter-marker distances changed in comparison to static data. Dynamic displacement trials were then collected to measure changes in inter-marker distance due to vertical elongation of the gel liner. Static and dynamic inter-marker distances within day and across days confirmed the ability to accurately capture displacements using this new approach. These results encourage this novel method to be applied to a sample of amputee patients during walking to assess displacements and the distribution of the liner deformation within the socket. The ability to capture changes in deformation of the gel liner will provide new data that will enable clinicians and researchers to improve design and fit of the prosthesis so the incidence of pressure ulcers can be reduced.
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Affiliation(s)
- Amy L Lenz
- Michigan State University, Department of Mechanical Engineering, United States; Mary Free Bed Rehabilitation Hospital, Motion Analysis Center, United States
| | - Katie A Johnson
- Mary Free Bed Rehabilitation Hospital, Department of Prosthetics, United States
| | - Tamara Reid Bush
- Michigan State University, Department of Mechanical Engineering, United States.
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27
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Shimizu Y, Mutsuzaki H, Torishima H, Yoshikawa K, Katane D, Takeuchi R, Mataki Y, Tokeji K, Wadano Y. Spiral sockets for various types of stumps in transhumeral amputees: a case series. Eur J Phys Rehabil Med 2018; 54:752-756. [PMID: 29422484 DOI: 10.23736/s1973-9087.18.04847-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fitting a stump prosthesis is difficult in transhumeral amputees because of the stump's conical form. Shoulder harnesses for suspension can cause neck and shoulder pain. We developed a novel spiral socket transhumeral prosthesis to overcome these difficulties. We investigated its safety and effects in transhumeral amputees. CASE REPORT Five transhumeral amputees with a mean age of 50.8±23.8 (range, 19-75 years) were fitted with the spiral socket between April 2013 and February 2017. Spiral sockets can adapt to changes in the shape of the stump, even in early stages when stump shape can change. It can also adapt to an hourglass-shaped stump. CLINICAL REHABILITATION IMPACT The novel spiral socket transhumeral prosthesis might be useful for socket-stump adaptation at various stages after amputation. It may also be used for irregularly shaped stumps and can possibly prevent secondary complications, including neck and shoulder pain and skin disorders.
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Affiliation(s)
- Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan - .,Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami-machi, Japan -
| | - Hirotaka Mutsuzaki
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami-machi, Japan
| | | | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami-machi, Japan
| | - Daisuke Katane
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami-machi, Japan
| | - Ryoko Takeuchi
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami-machi, Japan
| | - Yuki Mataki
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami-machi, Japan
| | - Kayo Tokeji
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences Hospital, Ami-machi, Japan
| | - Yasuyoshi Wadano
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences Hospital, Ami-machi, Japan
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Abu Osman NA, Eshraghi A, Gholizadeh H, Wan Abas WAB, Lechler K. Prosthesis donning and doffing questionnaire: Development and validation. Prosthet Orthot Int 2017; 41:571-578. [PMID: 28190376 DOI: 10.1177/0309364617690397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To develop a questionnaire that specifically evaluates the ability of trans-tibial amputees to don and doff a prosthesis and to investigate the psychometric properties of the newly developed questionnaire. BACKGROUND Prosthesis should be donned and doffed few times during the day and night; thus, it is important to measure ease of donning and doffing. STUDY DESIGN A cross-sectional study. METHODS The questionnaire was designed and evaluated by a group of experts. The final questionnaire was administered to 50 individuals with trans-tibial amputation. A test-retest study was also conducted on 20 amputees to assess the repeatability of questionnaire items. RESULTS The prosthesis donning and doffing questionnaire was developed and tested through a pilot study. Based on Kappa index, the questionnaire items showed correlation coefficients greater than 0.7, which indicate good reliability and repeatability. The majority of the participants had good hand dexterity (80%) and could perform all types of grasps. The mean satisfaction scores with donning and doffing were 69.9 and 81.4, respectively. Most of the respondents needed to don and doff the prosthesis 3.44 times per day. Based on a 7-point score, the total scores ranged between 3 and 7. CONCLUSION The prosthesis donning and doffing questionnaire items showed good psychometric properties. A scoring method was suggested based on the pilot sample, which requires further evaluation to be able to differentiate between more suspension types. A larger international multicenter evaluation is required in the future to measure the responsiveness of the scales. This questionnaire will be useful in the evaluation of the ability of amputees to don and doff a trans-tibial limb prosthesis. Clinical relevance Donning and doffing of prostheses are challenging tasks for many lower limb amputees. The prosthesis donning and doffing questionnaire, on its own or combined with other prosthetic evaluation questionnaires, has the potential to help manufacturers, clinicians, and researchers gain knowledge and improve the donning and doffing qualities of prostheses.
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Affiliation(s)
- Noor Azuan Abu Osman
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Arezoo Eshraghi
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,2 Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Hossein Gholizadeh
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,3 Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada
| | - Wan Abu Bakar Wan Abas
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Knut Lechler
- 4 Ossur ehf, R&D Medical Office, Reykjavik, Iceland
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Abu Osman NA, Gholizadeh H, Eshraghi A, Wan Abas WAB. Clinical evaluation of a prosthetic suspension system: Looped silicone liner. Prosthet Orthot Int 2017; 41:476-483. [PMID: 28946824 DOI: 10.1177/0309364616670396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study aimed to evaluate and compare a newly designed suspension system with a common suspension in the market. STUDY DESIGN Prospective study. METHODS Looped liners with hook fastener and Iceross Dermo Liner with pin/lock system were mechanically tested using a tensile testing machine in terms of system safety. A total of 10 transtibial amputees participated in this study and were asked to use these two different suspension systems. The pistoning was measured between the liner and socket through a photographic method. Three static axial loading conditions were implemented, namely, 30, 60, and 90 N. Furthermore, subjective feedback was obtained. RESULTS Tensile test results showed that both systems could safely tolerate the load applied to the prosthesis during ambulation. Clinical evaluation confirmed extremely low pistoning in both systems (i.e. less than 0.4 cm after adding 90 N traction load to the prosthesis). Subjective feedback also showed satisfaction with both systems. However, less traction at the end of the residual limb was reported while looped liner was used. CONCLUSION The looped liner with hook fastener is safe and a good alternative for individuals with transtibial amputation as this system could solve some problems with the current systems. Clinical relevance The looped liner and hook fastener were shown to be good alternative suspension for people with lower limb amputation especially those who have difficulty to use and align the pin/lock systems. This system could safely tolerate centrifugal forces applied to the prosthesis during normal and fast walking.
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Affiliation(s)
- Noor Azuan Abu Osman
- 1 BioApps Sdn Bhd, PlatCOM Ventures Sdn Bhd, Centre for Applied Biomechanics, Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Hossein Gholizadeh
- 2 Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada.,3 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Arezoo Eshraghi
- 4 Bloorview Research Institute, Holland Bloorview Kid's Rehabilitation Hospital, Toronto, Canada.,5 Centre for Applied Biomechanics, Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Abu Bakar Wan Abas
- 1 BioApps Sdn Bhd, PlatCOM Ventures Sdn Bhd, Centre for Applied Biomechanics, Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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Major MJ, Fey NP. Considering passive mechanical properties and patient user motor performance in lower limb prosthesis design optimization to enhance rehabilitation outcomes. PHYSICAL THERAPY REVIEWS 2017; 22:1-15. [PMID: 29170616 DOI: 10.1080/10833196.2017.1346033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Selection of prosthesis mechanical characteristics to restore function of persons with lower-limb loss can be framed as an optimization problem to satisfy a given performance objective. However, the choice of a particular objective is critical, and considering only device and generalizable outcomes across users without accounting for inherent motor performance likely restricts a given patient from fully realizing the benefits of a prosthetic intervention. Objectives This review presents methods for optimizing passive below-knee prosthesis designs to maximize rehabilitation outcomes and how considerations on patient motor performance may enhance these outcomes. Major Findings Available literature supports that considering patient-specific variables pertaining to motor performance permits a multidimensional landscape relating device characteristics and user function, which may yield more accurate predictions of rehabilitation outcomes for individual patients. Moreover, the addition of targeted physical therapeutic interventions that encourage user self-organization may further improve these outcomes. We note the potential of existing paradigms to address these additional dimensions, and we encourage investigators to consider the many different performance objectives available for prosthesis optimization. Conclusions By considering user motor performance in combination with prosthesis mechanical characteristics, a staged optimization approach can be formulated which acknowledges that device modifications may only improve outcomes to a certain extent and user self-organization is a critical component to complete rehabilitation. An iterative process that can be integrated within existing rehabilitative practices accounts for changes in patient status through combined targeted prosthetic solutions and physical therapeutic techniques, and embodies the concept of personalized intervention for patients with lower limb-loss.
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Affiliation(s)
- Matthew J Major
- Jesse Brown VA Medical Center, Chicago IL, USA.,Northwestern University Prosthetics Orthotics Center, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago IL, USA
| | - Nicholas P Fey
- University of Texas at Dallas, Departments of Bioengineering and Mechanical Engineering, Richardson TX, USA.,UT Southwestern Medical Center, Department of Physical Medicine and Rehabilitation, Dallas TX, USA
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Lee DJ, Veneri DA. Development and acceptability testing of decision trees for self-management of prosthetic socket fit in adults with lower limb amputation. Disabil Rehabil 2017. [DOI: 10.1080/09638288.2017.1286694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Daniel Joseph Lee
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| | - Diana A. Veneri
- Department of Physical Therapy, Sacred Heart University, Fairfield, CT, USA
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Abstract
BACKGROUND The liner is an integral part of a transtibial prosthesis designed to protect the residual limb, enhance comfort and provide suspension. Literature is difficult to interpret and use given the variety of interventions, outcome measures and method designs. Critical appraisal and synthesis of the evidence is needed to help inform decisions about liner prescription based on the user experience. OBJECTIVES To critically appraise and synthesise research describing the user experience of transtibial prosthetic liners. STUDY DESIGN Systematic review. METHODS A comprehensive suite of databases were searched using terms related to amputation level, liner type and user experience. Included studies were in English and measured the first-person experience of using a transtibial liner. Studies were appraised using the McMaster University Critical Review Forms. RESULTS A total of 18 articles met the inclusion criteria. While the quality of the evidence has improved over time, a number of common issues (e.g. sampling bias, validity of outcome measures, incorrect inferential analysis) reduce our ability to differentiate between the user experience of different transtibial liners. CONCLUSION There is insufficient research to differentiate between the user experience of different transtibial liners. High-quality research is needed to inform decisions about liner prescription based on the user experience. Clinical relevance The available evidence suggests that the user experience of commonly reported problems (e.g. sweating) may be very similar between different liners. Aspects of the user experience that differ most between liners (e.g. unwanted noises, rotation within the socket) can help focus attention on what matters most when discussing prescription.
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Klute GK, Bates KJ, Berge JS, Biggs W, King C. Prosthesis management of residual-limb perspiration with subatmospheric vacuum pressure. ACTA ACUST UNITED AC 2016; 53:721-728. [PMID: 27997669 DOI: 10.1682/jrrd.2015.06.0121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 12/17/2015] [Indexed: 11/05/2022]
Abstract
For the ambulatory person with lower-limb amputation, insufficient management of perspiration can result in inadequate prosthesis adherence, reduced mobility, and discomfort. This study compared a dynamic air exchange (DAE) prosthesis designed to expel accumulated perspiration with a total surface bearing suction socket (Suction) that cannot. Five people with unilateral transtibial amputation participated in a randomized, crossover experiment. All subjects were given a 1 wk acclimation to each study prosthesis while we measured their step activity levels. A rest-walk-rest protocol, including a 30 min treadmill walk at a self-selected speed while wearing thermally insulative garments, was then used to observe residual-limb skin temperatures and perspiration. Afterward, subject opinions about the prostheses were assessed with questionnaires. During the week-long acclimation period, no statistical difference in step activity levels were detected between prostheses (p = 0.22), but this may have been due to self-reported behavioral modifications. During the rest-walk-rest protocol, no differences in skin temperatures were observed (p = 0.37). The DAE prosthesis accumulated 1.09 +/- 0.90 g and expelled 0.67 +/- 0.38 g of perspiration, while the Suction prosthesis accumulated 0.97 +/- 0.75 g. The questionnaire results suggest that participants were receptive to both prostheses. The DAE prosthesis was able to expel more than a third of the total perspiration, suggesting it may enable longer uninterrupted periods of perspiration-inducing activity.
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Affiliation(s)
- Glenn K Klute
- Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA.,Department of Mechanical Engineering, University of Washington, Seattle, WA
| | - Katherine J Bates
- Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA
| | - Jocelyn S Berge
- Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA
| | - Wayne Biggs
- Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA
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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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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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Al-Fakih EA, Abu Osman NA, Mahmad Adikan FR. Techniques for Interface Stress Measurements within Prosthetic Sockets of Transtibial Amputees: A Review of the Past 50 Years of Research. SENSORS 2016; 16:s16071119. [PMID: 27447646 PMCID: PMC4970162 DOI: 10.3390/s16071119] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/12/2016] [Accepted: 06/02/2016] [Indexed: 11/18/2022]
Abstract
The distribution of interface stresses between the residual limb and prosthetic socket of a transtibial amputee has been considered as a direct indicator of the socket quality fit and comfort. Therefore, researchers have been very interested in quantifying these interface stresses in order to evaluate the extent of any potential damage caused by the socket to the residual limb tissues. During the past 50 years a variety of measurement techniques have been employed in an effort to identify sites of excessive stresses which may lead to skin breakdown, compare stress distributions in various socket designs, and evaluate interface cushioning and suspension systems, among others. The outcomes of such measurement techniques have contributed to improving the design and fitting of transtibial sockets. This article aims to review the operating principles, advantages, and disadvantages of conventional and emerging techniques used for interface stress measurements inside transtibial sockets. It also reviews and discusses the evolution of different socket concepts and interface stress investigations conducted in the past five decades, providing valuable insights into the latest trends in socket designs and the crucial considerations for effective stress measurement tools that lead to a functional prosthetic socket.
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Affiliation(s)
- Ebrahim A Al-Fakih
- 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.
| | - Faisal Rafiq Mahmad Adikan
- Department of Electrical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
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Khemka A, Frossard L, Lord SJ, Bosley B, Al Muderis M. Osseointegrated total knee replacement connected to a lower limb prosthesis: 4 cases. Acta Orthop 2015; 86:740-4. [PMID: 26145721 PMCID: PMC4750776 DOI: 10.3109/17453674.2015.1068635] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Osseointegrated implants are an alternative for prosthetic attachment in individuals with amputation who are unable to wear a socket. However, the load transmitted through the osseointegrated fixation to the residual tibia and knee joint can be unbearable for those with transtibial amputation and knee arthritis. We report on the feasibility of combining total knee replacement (TKR) with an osseointegrated implant for prosthetic attachment. PATIENTS AND METHODS We retrospectively reviewed all 4 cases (aged 38-77 years) of transtibial amputations managed with osseointegration and TKR in 2012-2014. The below-the-knee prosthesis was connected to the tibial base plate of a TKR, enabling the tibial residuum and knee joint to act as weight-sharing structures. A 2-stage procedure involved connecting a standard hinged TKR to custom-made implants and creation of a skin-implant interface. Clinical outcomes were assessed at baseline and after 1-3 years of follow-up using standard measures of health-related quality of life, ambulation, and activity level including the questionnaire for transfemoral amputees (Q-TFA) and the 6-minute walk test. RESULTS There were no major complications, and there was 1 case of superficial infection. All patients showed improved clinical outcomes, with a Q-TFA improvement range of 29-52 and a 6-minute walk test improvement range of 37-84 meters. INTERPRETATION It is possible to combine TKR with osseointegrated implants.
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Safari MR, Meier MR. Systematic review of effects of current transtibial prosthetic socket designs--Part 2: Quantitative outcomes. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2015; 52:509-26. [PMID: 26436733 DOI: 10.1682/jrrd.2014.08.0184] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [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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Gholizadeh H, Osman NAA, Eshraghi A, Abd Razak NA. Clinical implication of interface pressure for a new prosthetic suspension system. Biomed Eng Online 2014; 13:89. [PMID: 24981801 PMCID: PMC4090423 DOI: 10.1186/1475-925x-13-89] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 06/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prosthesis suspension systems can alter the distribution of pressure within the prosthetic socket. This study evaluates a new suspension system for lower limb prostheses, and aims to compare the interface pressure and amputees' satisfaction with the new system compared with a common prosthetic suspension system (pin/lock). METHODS Ten transtibial amputees walked at a self-selected speed on a level ground with two different suspension systems, namely the pin/lock and HOLO system. The interface pressure was measured using the F-socket transducers at the proximal, middle and distal sites of residual limb. Furthermore, subjective feedback was logged to compare two systems. RESULTS The pressure was significantly higher at the proximal and distal areas with the pin/lock suspension system during the swing phase of gait (P<0.05). Subjective feedback also showed traction at the stump with the pin/lock system. There were no significant differences in the pressure applied to the mid-anterior and mid posterior stump for both suspension systems. However, the lateral and medial sides exhibited higher pressure with the new system during stance phase. CONCLUSIONS The intention of this study was to deepen understanding on the effect of suspension system on the load distribution over the residual limb. The new coupling system was proved compatible with the pin/lock system in terms of suspending the leg and amputee's satisfaction. On the other hand, the HOLO system could distribute the pressure more uniformly over the residual limb.
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Affiliation(s)
- Hossein Gholizadeh
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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