Advances in Prosthetics and Rehabilitation of Individuals with Limb Loss

Prevalence of secondary prosthesis use in lower limb prosthesis users

PURPOSE

Prostheses designed for daily use are often inappropriate for high-level activities and/or are susceptible to water damage and mechanical failure. Secondary prostheses, such as activity-specific or back-up prostheses, are typically required to facilitate uninterrupted participation in desired life pursuits. This study estimated the prevalence of secondary prosthesis use in a large, national sample of lower limb prosthesis users (LLPUs).

METHODS

We conducted a secondary analysis of survey data from three cross-sectional studies that assessed mobility in LLPUs. Descriptive statistics were used to determine the percentage of secondary prosthesis users and percentages of LLPUs that used different type(s) of secondary prosthesis(es). Secondary prosthesis users and non-users were compared to identify differences in participant characteristics between groups.

RESULTS

Of participants in the analysis (n = 1566), most (65.8%) did not use a secondary prosthesis. The most common secondary prosthesis types were back-up (19.2%) and activity-specific prostheses (13.5%). Secondary prosthesis users differed significantly from non-users with respect to gender, race, and other characteristics.

CONCLUSIONS

Results suggest that secondary prosthesis use for most LLPUs is limited and may differ based on users' demographic and clinical characteristics. Future research should determine how LLPUs' health-related quality-of-life outcomes are affected by access to and use of secondary prostheses.Implications for RehabilitationSecondary prostheses, including activity-specific, back-up, and shower prostheses, have the potential to improve function, mobility, and participation for people who use lower limb prostheses.Most lower limb prosthesis users do not use secondary prostheses, and access to these devices may be related to users' demographic and clinical characteristics.Rehabilitation professionals play a key role in facilitating prosthesis users' access to secondary prostheses and should advocate for those who need them.

Surface profile analysis of laminated transfemoral prosthetic socket fabricated with different ratios of epoxy resin and acrylic resin

Acrylic and epoxy are common types of resin used in fabricating sockets. Different types of resin will affect the internal surface of a laminated socket. This paper is to determine the best combination of ratio for epoxy and acrylic resin for a laminated prosthesis socket and to evaluate the surface profile analysis of different combinations of laminated prosthetic sockets for surface roughness. Transfemoral sockets were created using various resin-to-hardener ratios of 2:1, 3:1, 3:2, 2:3, and 1:3 for epoxy resin and 100:1, 100:2, 100:3, 100:4, and 100:5 for acrylic resin. Eight layers of stockinette consisting of four elastic stockinette and four Perlon stockinette were used. A sample with a size of 4 cm × 6 cm was cut out from the socket on the lateral side below the Greater Trochanter area. The Mitutoyo Sj-210 Surface Tester stylus was run through the sample and gave the Average Surface Roughness value (Ra), Root Mean Square Roughness value (Rq), and Ten-Point Mean Roughness value (Rz). Epoxy resin shows a smoother surface compared to acrylic resin with Ra values of is 0.766 µm, 0.9716 µm, 0.9847 µm and 1.5461 µm with 3:2, 3:1, 2:1 and 2:3 ratio respectively. However, for epoxy resin with ratio 1:3, the resin does not cure with the hardener. As for acrylic resin the Ra values are 1.0086 µm, 2.362 µm, 3.372 µm, 4.762 µm and 6.074 µm with 100: 1, 100:2, 100:5, 100:4 and 100:3 ratios, respectively. Epoxy resin is a better choice in fabricating a laminated socket considering the surface produced is smoother.

Muscle as a tunable material: implications for achieving muscle-like function in robotic prosthetic devices

An ideal prosthesis should perform as well as or better than the missing limb it was designed to replace. Although this ideal is currently unattainable, recent advances in design have significantly improved the function of prosthetic devices. For the lower extremity, both passive prostheses (which provide no added power) and active prostheses (which add propulsive power) aim to emulate the dynamic function of the ankle joint, whose adaptive, time-varying resistance to applied forces is essential for walking and running. Passive prostheses fail to normalize energetics because they lack variable ankle impedance that is actively controlled within each gait cycle. By contrast, robotic prostheses can normalize energetics for some users under some conditions. However, the problem of adaptive and versatile control remains a significant issue. Current prosthesis-control algorithms fail to adapt to changes in gait required for walking on level ground at different speeds or on ramps and stairs. A new paradigm of 'muscle as a tunable material' versus 'muscle as a motor' offers insights into the adaptability and versatility of biological muscles, which may provide inspiration for prosthesis design and control. In this new paradigm, neural activation tunes muscle stiffness and damping, adapting the response to applied forces rather than instructing the timing and amplitude of muscle force. A mechanistic understanding of muscle function is incomplete and would benefit from collaboration between biologists and engineers. An improved understanding of the adaptability of muscle may yield better models as well as inspiration for developing prostheses that equal or surpass the functional capabilities of biological limbs across a wide range of conditions.

RESEARCH ON KINECT BASED TRAINING SYSTEM FOR SPORTS OBSTACLE ASSESSMENT

ABSTRACT Objective: The study draws attention to designing a dyskinesia assessment system using a Kinect sensor to improve the efficiency of rehabilitation training. Methods: The login page design. Step 2: System functions setting. Relevant movement guidance content and rehabilitation evaluation content are incorporated in the system to make rehabilitation training efficient and orderly. Comprehensive data processing, evaluation, and export functions are necessary to reference rehabilitation physicians in diagnosis and treatment. Step 3: System modules design. Based on the system settings, corresponding functional modules have been designed and developed. With each module realizing its specific functions, it must be ensured that there is a certain degree of correlation between the modules. Step 4: The system function framework design. Results: A simple and comfortable login page is designed; 2. The system is capable of rehabilitation training and data management; 3. Specifically designed modules include sports collection module, rehabilitation training module, rehabilitation evaluation module, and information management module; 4. After logging in, the patient should first search for the rehabilitation plan in the rehabilitation training function module and then perform rehabilitation training regarding the rehabilitation plan. Kinect synchronously obtains patient sports information throughout the training process, and patients can obtain rehabilitation assessment information and automatically save it in the information management module. Conclusions: The Kinect-based dyskinesia assessment and training system designed in this study can heighten the efficiency of rehabilitation training for patients with dyskinesia, and it is highly suggested in clinical practice. Level of evidence II; Therapeutic studies - investigation of treatment results.

Effects of prosthetic feet on metabolic energy expenditure in people with transtibial amputation: a systematic review and meta-analysis

OBJECTIVE

To assess the effects of different prosthetic feet on energy costs associated with walking and running in people with transtibial amputation.

LITERATURE SURVEY

The Pubmed, CINAHL, and Web-of-Science bibliographic databases were searched for original research published through June 30, 2018. References from identified articles were also reviewed.

METHODOLOGY

Two reviewers screened titles, abstracts, and articles for pertinent studies. Details were extracted with a standardized template. Risk of bias was assessed using domain-based methods. Prosthetic feet were grouped into categories, and compared according to energy costs associated with walking or running over various terrain conditions. Meta-analyses were conducted when data quantity and homogeneity permitted. Evidence statements were formed when results were consistent or undisputed.

SYNTHESIS

15 studies were included. Participants (n = 144) were predominantly male (88.2%), had unilateral amputation (95.8%) from non-dysvascular causes (87.5%), and were classified as unlimited community ambulators or active adults (56.9%). Participants were often young, but varied in age (mean age 24.8-66.6 years). Available evidence indicates that feet with powered dorsiflexion reduce energy costs relative to dynamic response feet in unlimited community ambulators or active adults when walking on level or declined surfaces. Dynamic response feet do not significantly reduce energy costs compared to energy storing, flexible keel, or solid ankle feet when walking on level terrain. Running feet do not reduce energy costs relative to dynamic response in active adults when running. Select feet may reduce energy costs under specific conditions, but additional research is needed to confirm preliminary results.

CONCLUSIONS

The overall body of evidence is based on small samples, comprised mostly of participants who may not well represent the population of prosthesis users, and test conditions that may not well reflect how prostheses are used in daily life. However, evidence suggests energy costs are affected by prosthetic foot type, but only under select conditions. This article is protected by copyright. All rights reserved.

Exploring the perspectives of prosthetic and orthotic users: past and present experiences and insights for the future

PURPOSE

The aim of this work was to qualitatively explore the personal perspectives of prosthetic and orthotic users, in the context of their past and present experiences and understand their insights for the future.

MATERIALS AND METHODS

A narrative exploration study design, employing a phenomenological approach was used. Semi-structured interviews were conducted with three female and two male prosthetic and orthotic users from Australia and the United Kingdom. Interviews were analysed, coded and key themes and sub-themes identified.

RESULTS

Three themes were identified. The Maximising Opportunity theme linked sub-themes of recreation and pushing boundaries. The Health Care Network theme included sub-themes of communication, peer support and building a team. The final theme, Changes over time, included sub-themes of disability perception, advice and advancements over time.

CONCLUSION

Prosthetic and orthotic users identified that there had been vast changes in disability perception, disability rights, and their role in the health care system, along with the variety of technology and materials available. Key findings were that prosthetic and orthotic users want to be listened to, considered central to the health care team, and had a deep understanding of their own health care needs.Implications for rehabilitationProsthesis and orthosis users want to be listened to and considered central within the health care team.Attending medical and allied health teams must recognise that prosthesis and orthosis users have a fundamental understanding of their own health care needs.Themes, whilst potentially generalisable, are derived from specific individuals and may particularly relate to these individuals.