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Youngblood RT, Hafner BJ, Czerniecki JM, Larsen BG, Allyn KJ, Sanders JE. Mechanically and physiologically optimizing prosthetic elevated vacuum systems in people with transtibial amputation: a pilot study. JOURNAL OF PROSTHETICS AND ORTHOTICS : JPO 2022; 34:194-201. [PMID: 36582938 PMCID: PMC9793861 DOI: 10.1097/jpo.0000000000000396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction The most suitable elevated vacuum (EV) pressure may differ for each individual prosthesis user depending on suspension needs, socket fit, prosthetic components, and health. Mechanical and physiological effects of EV were evaluated in an effort to determine the optimal vacuum pressure for three individuals. Methods Instrumented EV sockets were created based on the participants' regular EV sockets. Inductive distance sensors were embedded into the wall of the socket at select locations to measure limb movement relative to the socket. Each participant conducted an activity protocol while limb movement, limb fluid volume, and user-reported comfort were measured at various socket vacuum pressure settings. Results Increased socket vacuum pressure resulted in reduced limb-socket displacement for each participant; however, 81-93% of limb movement was eliminated by a vacuum pressure setting of 12 (approximately -9 inHg). Relative limb-socket displacement by sensor location varied for each participant, suggesting distinct differences related to socket fit or residual limb tissue content. The rate of limb fluid volume change and the change in socket comfort did not consistently differ with socket vacuum pressure, suggesting a more complex relationship unique to each individual. Conclusions Practitioners may use individual responses to optimize socket vacuum pressure settings, balancing mechanical and physiological effects of EV for improved clinical outcomes.
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Affiliation(s)
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Czerniecki
- VA Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Brian G Larsen
- Department of Bioengineering, 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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2
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Ballesteros D, Youngblood RT, Vamos AC, Garbini JL, Allyn KJ, Hafner BJ, Larsen BG, Ciol MA, Friedly JL, Sanders JE. Cyclic socket enlargement and reduction during walking to minimize limb fluid volume loss in transtibial prosthesis users. Med Eng Phys 2022; 103:103787. [DOI: 10.1016/j.medengphy.2022.103787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/14/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
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Scoping review to evaluate existing measurement parameters and clinical outcomes of transtibial prosthetic alignment and socket fit. Prosthet Orthot Int 2022; 46:95-107. [PMID: 35412519 DOI: 10.1097/pxr.0000000000000061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Fit and alignment are observable objectives of the prosthesis rendering process for individuals with lower limb amputation. Nevertheless, there is a dearth of validated measures to directly assess the quality of this clinical procedure. OBJECTIVES The objectives of this scoping review are to evaluate existing measurement parameters and clinical outcomes used in investigations of transtibial socket fit or prosthetic alignment and to identify gaps in the literature regarding tools for evaluation of prosthetic fitting. STUDY DESIGN Scoping literature review. METHODS A comprehensive search was conducted in the following databases: MEDLINE (through PubMed), Embase (through Elsevier), Scopus (through Elsevier), and Engineering Village (through Elsevier), resulting in 6107 studies to be screened. RESULTS Sixty-three studies were included in the review. When measuring fit, studies most frequently reported on patient-reported comfort (n = 22) and socket size compared with the residual limb volume (n = 9). Alignment was most frequently measured by the prosthetists' judgment and/or use of an alignment jig (n = 34). The measurement parameters used to determine alignment or fit varied greatly among the included studies. CONCLUSION This review demonstrated that most measures of socket fit rely on a patient's self-report and may vary with biopsychosocial factors unrelated to the socket fitting process. Meanwhile, alignment is determined mostly by the prosthetist's judgment, paired with objective measurements, such as alignment jigs and gait analysis. Efforts to standardize and validate measures of these parameters of prosthetic fitting are vital to improving clinical practice and reporting outcomes.
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Knight AD, Dearth CL, Hendershot BD. Deleterious Musculoskeletal Conditions Secondary to Lower Limb Loss: Considerations for Prosthesis-Related Factors. Adv Wound Care (New Rochelle) 2021; 10:671-684. [PMID: 32320367 PMCID: PMC8568798 DOI: 10.1089/wound.2019.1079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/23/2020] [Indexed: 11/13/2022] Open
Abstract
Significance: The intent of this work was to summarize the existing evidence of, and highlight knowledge gaps specific to, prosthetic devices/componentry and training regimes, particularly in the context of the human-device interaction and deleterious musculoskeletal conditions secondary to lower limb loss. Recent Advances: With the recent and evolving technological advancements in prostheses, there are numerous devices available to individuals with lower limb loss. Current literature demonstrates the importance of expanding the knowledge of all prosthetic device-specific factors and the significance of proper prescription, fit, and alignment, along with adequate device-/activity-specific training, to enhance human-device interaction, reduce gait abnormalities and compensatory motions, and as a result, mitigate risk for secondary musculoskeletal conditions. Critical Issues: Inadequate device prescription, fit, alignment, and training are evident owing to the lack of knowledge or awareness of the many device-specific properties and factors, leading to suboptimal use, as well as, biomechanical compensations, which collectively and adversely affect the function, activity level, and overall health of the prosthesis user. Future Directions: To maximize optimal outcomes after lower limb loss, it is essential to better appreciate the factors that affect both prosthesis use and satisfaction, particularly any modifiable factors that might be targeted in rehabilitation interventions such as device prescription, fit/alignment, and training regimes. A better understanding of such device-specific factors will help enhance the human-device interaction and resulting functional performance, thereby reducing secondary musculoskeletal conditions, allowing for the readiness of the fighting force (return-to-duty/redeployment) and/or improved reintegration into civilian society/work, and overall enhancing quality of life after lower limb loss.
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Affiliation(s)
- Ashley D. Knight
- DoD-VA Extremity Trauma & Amputation Center of Excellence, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christopher L. Dearth
- DoD-VA Extremity Trauma & Amputation Center of Excellence, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Brad D. Hendershot
- DoD-VA Extremity Trauma & Amputation Center of Excellence, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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5
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Rosenblatt NJ, Stachowiak A, Reddin C. Prosthetic Disuse Leads to Lower Balance Confidence in a Long-Term User of a Transtibial Prosthesis. Adv Wound Care (New Rochelle) 2021; 10:529-533. [PMID: 34232743 PMCID: PMC8260888 DOI: 10.1089/wound.2019.1086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/29/2019] [Indexed: 11/12/2022] Open
Abstract
Residual limb wounds or ulcers are one of the most frequent skin problems reported by lower extremity prosthesis users. Healing often requires prosthesis disuse, which can logically impair physical functioning. However, there are limited data available to support this idea. We report the impact of prosthesis disuse by presenting assessments of balance, gait, physical activity, and balance confidence obtained on a case subject before experiencing a wound and following reintroduction to a well-fit prosthesis after wound-related prosthesis disuse. The case subject was a 76-year-old male who suffered a unilateral, transtibial amputation due to synovial sarcoma 13 years before. After presenting with a history of pain in the area of a chronic skin plaque, he received a punch biopsy, which resulted in 4 weeks of prosthesis disuse followed by 12 weeks of limited use before a final well-fitting socket was received. The following data were collected 24 weeks before the biopsy and 4 weeks after receiving the final well-fitting socket: Berg Balance Scale, L-test of walking, quantitative gait analysis, Activity-specific Balance Confidence Scale, and 1 week of community-based activity. Balance confidence decreased nearly 19%, walking speed decreased by 12%, and steps/day decreased by 19% following ∼4 months of prosthesis disuse/limited use; functional measures were not impacted. Lower balance confidence is not trivial as it can lead to activity avoidance and increased fall risk. Interventions to target balance confidence changes following prosthesis disuses may be important to minimize the impact of disuse on physical and mental well-being.
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Affiliation(s)
- Noah J. Rosenblatt
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Aaron Stachowiak
- Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois
| | - Christopher Reddin
- Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois
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6
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Paternò L, Ibrahimi M, Rosini E, Menfi G, Monaco V, Gruppioni E, Ricotti L, Menciassi A. Residual limb volume fluctuations in transfemoral amputees. Sci Rep 2021; 11:12273. [PMID: 34112873 PMCID: PMC8192500 DOI: 10.1038/s41598-021-91647-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/31/2021] [Indexed: 11/08/2022] Open
Abstract
This study constitutes the first attempt to systematically quantify residual limb volume fluctuations in transfemoral amputees. The study was carried out on 24 amputees to investigate variations due to prosthesis doffing, physical activity, and testing time. A proper experimental set-up was designed, including a 3D optical scanner to improve precision and acceptability by amputees. The first test session aimed at measuring residual limb volume at 7 time-points, with 10 min intervals, after prosthesis doffing. This allowed for evaluating the time required for volume stabilization after prosthesis removal, for each amputee. In subsequent sessions, 16 residual limb scans in a day for each amputee were captured to evaluate volume fluctuations due to prosthesis removal and physical activity, in two times per day (morning and afternoon). These measurements were repeated in three different days, a week apart from each other, for a total of 48 scans for each amputee. Volume fluctuations over time after prosthesis doffing showed a two-term decay exponential trend (R2 = 0.97), with the highest variation in the initial 10 min and an average stabilization time of 30 min. A statistically significant increase in residual limb volume following both prosthesis removal and physical activity was verified. No differences were observed between measures collected in the morning and in the afternoon.Clinical Trials.gov ID: NCT04709367.
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Affiliation(s)
- Linda Paternò
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Michele Ibrahimi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Elisa Rosini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giuseppe Menfi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- IRCCS Fondazione Don Carlo Gnocchi, 20148, Milan, Italy
| | | | - Leonardo Ricotti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
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7
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Abstract
In the original edition of Prosthetics and Orthotics International, Dr Sidney Fishman identified what he anticipated as foundational educational needs for the emerging field of clinical prosthetics and orthotics. Within the broader construct of the physical sciences, this included mathematics, physics, chemistry, biomechanics, and material sciences. The clinical application of these disciplines to expanding the collective understanding within the field is described, including the biomechanics of able-bodied and prosthetic gait, the material science of socket construction, the physics of suspension and load distribution, and the engineering of prosthetic components to mimic human biomechanics. Additional applications of the physical sciences to upper limb prosthetics and lower limb orthotics are also described. In contemplating the continued growth and maturation of the field in the years to come, mechatronics and statistics are suggested as future areas where clinical proficiency will be required.
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Affiliation(s)
- Phillip M Stevens
- Department of Clinical and Scientific Affairs, Hanger Clinic, Salt Lake City, UT, USA.,Division of Physical Medicine and Rehabilitation, University of Utah Healthcare, Salt Lake City, UT, USA
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8
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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: 19] [Impact Index Per Article: 4.8] [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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9
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Youngblood RT, Hafner BJ, Czerniecki JM, Brzostowski JT, Allyn KJ, Sanders JE. Modeling the mechanics of elevated vacuum systems in prosthetic sockets. Med Eng Phys 2020; 84:75-83. [PMID: 32977925 DOI: 10.1016/j.medengphy.2020.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
Elevated vacuum (EV) is suggested to improve suspension and limb volume management for lower limb prosthesis users. However, few guidelines have been established to facilitate configuration of EV sockets to ensure their safe and proper function. A benchtop model of an EV socket was created to study how prosthetic liner tensile elasticity, socket fit, and socket vacuum pressure affect liner displacement and subsequent pressure on the residual limb. A domed carbon fiber layup was used to represent an EV socket. Inserts were used to simulate various air gaps between the socket and liner. Various prosthetic liner samples were placed under the carbon fiber layup. Liner displacement and the corresponding pressure change underneath the liner were measured as vacuum was applied between the liner sample and socket wall. Tissue vacuum pressure increased linearly with socket vacuum pressure until the liner contacted the socket wall. Predicted tissue vacuum pressure matched well with experimental results. Findings suggest that the effect of vacuum pressure on the residual limb is primarily determined by air gap distance. The developed model may be used to assess effects of EV on residual limb tissues based on an individual's socket fit, liner characteristics, and applied vacuum. Understanding the physiological effects of EV on the residual limb could help practitioners avoid blister formation and improve EV implementation.
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Affiliation(s)
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Czerniecki
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; VA Center for Limb Loss and Mobility, VA Puget Sound Health Care System, 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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10
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Larsen BG, McLean JB, Brzostowski JT, Carter R, Allyn KJ, Hafner BJ, Garbini JL, Sanders JE. Does actively enlarging socket volume during resting facilitate residual limb fluid volume recovery in trans-tibial prosthesis users? Clin Biomech (Bristol, Avon) 2020; 78:105001. [PMID: 32619870 DOI: 10.1016/j.clinbiomech.2020.105001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Residual limb volume loss is a source of prosthetic socket fit problems in people with lower-limb amputation. The aim of this study was to investigate a novel volume recovery strategy for people with trans-tibial amputation. METHODS Test sockets for people with trans-tibial amputation were created that allowed panels of an adjustable socket and the underlying elastomeric liner to be pulled radially outward, using small motors mounted to the socket. One Control and one Intervention session were conducted with each participant. During Intervention sessions, panel-pull was executed during the sits of a multi-cycle sit/walk protocol. No panel-pull was executed during the Control sessions. Residual limb fluid volume was monitored in anterior and posterior regions using bioimpedance analysis. FINDINGS Results from 12 participants demonstrated that short-term (12 min after the intervention was applied) median posterior residual limb fluid volume change for Intervention (0.44%) was higher than that for Control (-0.02%) (P = .015). Long-term (40 min after the intervention was applied) median posterior residual limb fluid volume change for Intervention (0.95%) was higher than that for Control (-0.26%) (P = .002). INTERPRETATION If a panel-pull mechanism that was easy to assemble and operate could be created, then panel-pull may be an effective accommodation strategy to reduce daily limb volume loss in trans-tibial prosthesis users.
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Affiliation(s)
- Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Jake B McLean
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | | | - Ryan Carter
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Katheryn J Allyn
- 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
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, USA.
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11
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Youngblood RT, Brzostowski JT, Hafner BJ, Czerniecki JM, Allyn KJ, Foster RL, Sanders JE. Effectiveness of elevated vacuum and suction prosthetic suspension systems in managing daily residual limb fluid volume change in people with transtibial amputation. Prosthet Orthot Int 2020; 44:155-163. [PMID: 32186238 PMCID: PMC7443051 DOI: 10.1177/0309364620909044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Previous studies investigating limb volume change with elevated vacuum have shown inconsistent results and have been limited by out-of-socket volume measurements and short, single-activity protocols. OBJECTIVES To evaluate the effectiveness of elevated vacuum for managing limb fluid volume compared to suction suspension with an in-socket measurement modality during many hours of activity. STUDY DESIGN Fixed-order crossover design with a standardized out-of-laboratory activity protocol. METHODS Transtibial electronic elevated vacuum users participated in two sessions. Elevated vacuum was used during the first session, and suction suspension in the second. Participants completed a 5.5-h protocol consisting of multiple intervals of activity. In-socket residual limb fluid volume was continuously measured using a custom portable bioimpedance analyzer. RESULTS A total of 12 individuals participated. Overall rate of fluid volume change was not significantly different, though the rate of posterior fluid volume change during Cycle 3 was significantly lower with elevated vacuum. Although individual results varied, 11 participants experienced lower overall rates of fluid volume loss in at least one limb region using elevated vacuum. CONCLUSION Elevated vacuum may be more effective as a volume management strategy after accumulation of activity. Individual variation suggests the potential to optimize the limb fluid volume benefits of elevated vacuum by reducing socket vacuum pressure for some users. CLINICAL RELEVANCE A better understanding of how elevated vacuum (EV) affects residual limb fluid volume will allow prosthetists to make more informed clinical decisions regarding accommodation strategies designed to improve daily socket fit.
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Affiliation(s)
| | | | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Czerniecki
- VA Center for Limb Loss and Mobility, VA Puget Sound Health Care System, 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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12
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McLean JB, Larsen BG, Weathersby EJ, Carter Bs RV, Allyn KJ, Garbini JL, Sanders JE. Fluid Volume Management in Prosthesis Users: Augmenting Panel Release with Pin Release. PM R 2020; 12:1236-1243. [PMID: 32103634 DOI: 10.1002/pmrj.12349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/03/2020] [Accepted: 02/12/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Management of fluid in the limbs is a challenge faced by people with disabilities. In prosthetics, a means for transtibial prosthesis users to stabilize their residual limb fluid volume during the day may improve socket fit. OBJECTIVE To determine if releasing the panels and locking pin of a cabled-panel adjustable socket during socket release significantly improved limb fluid volume recovery and retention over releasing the panels alone. DESIGN Repeated-measures experiment to assess the effects on limb fluid volume retention. SETTING Participants were tested in a laboratory setting while walking on a treadmill. INTERVENTION Release of a locking pin tether during sitting as a limb volume accommodation strategy. MAIN OUTCOME MEASURE Percent limb fluid volume retention for panel and pin release compared with panel release alone at 2 minutes (short term) and 50 minutes (long term) after subsequent activity. Limb fluid volume was monitored using bioimpedance analysis. RESULTS Median percent limb fluid volume retention for the panel and pin release was significantly greater than panel release alone for both anterior and posterior regions for the long term (P = .0499 and .0096, respectively) but not the short term (P = .0712 and .1580, respectively). CONCLUSION Augmenting panel release with pin release may be an effective accommodation strategy for prosthesis users with transtibial amputation to better retain limb fluid volume.
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Affiliation(s)
- Jake B McLean
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Ethan J Weathersby
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Ryan V Carter Bs
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Joseph L Garbini
- 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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13
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Larsen BG, McLean JB, Allyn KJ, Brzostowski JT, Garbini JL, Sanders JE. How do transtibial residual limbs adjust to intermittent incremental socket volume changes? Prosthet Orthot Int 2019; 43:528-539. [PMID: 31339448 DOI: 10.1177/0309364619864771] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Strategies to maintain prosthesis users' daily limb volume are needed. OBJECTIVES Test how intermittent incremental socket volume adjustments affect limb fluid volume and limb-socket distance. STUDY DESIGN Repeated measures. METHODS People with transtibial limb loss walked on an outdoor trail wearing a motor-driven adjustable socket that they adjusted a small amount, approximately 0.3% socket volume, every 2 min using a mobile phone app. Limb fluid volume and sensed distance between the socket and a target in their elastomeric liner were monitored. A gradual socket enlargement phase was followed by a gradual socket reduction phase. RESULTS An incremental socket enlargement significantly increased limb fluid volume (p < 0.001) but not sensed distance (p = 0.063). An incremental socket reduction significantly decreased both limb fluid volume (p < 0.001) and sensed distance (p < 0.001). CONCLUSION Participants' residual limb fluid volume increases during ambulation compensated for incremental socket volume increases. For incremental socket volume decreases, residual limb fluid volume decreases did not compensate and the socket fit became tighter. CLINICAL RELEVANCE Results support the hypothesis that for people without co-morbidities, intermittent incremental socket volume enlargements are an effective accommodation strategy to increase limb fluid volume while maintaining socket fit. Intermittent incremental socket volume reductions decreased limb fluid volume but also made the socket fit tighter.
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Affiliation(s)
- Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Jake B McLean
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | | | - Joseph L Garbini
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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14
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Youngblood RT, Hafner BJ, Allyn KJ, Cagle JC, Hinrichs P, Redd CB, Vamos AC, Ciol MA, Bean N, Sanders JE. Effects of activity intensity, time, and intermittent doffing on daily limb fluid volume change in people with transtibial amputation. Prosthet Orthot Int 2019; 43:28-38. [PMID: 30010494 PMCID: PMC7447527 DOI: 10.1177/0309364618785729] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: The volume of a prosthesis user's residual limb changes during the day and may affect the fit of the prosthesis. These changes must be managed by the user to prevent discomfort, skin breakdown, and falls. OBJECTIVES: The objectives were to test how activity, time of day, and intermittent doffing affected residual limb fluid volume in people with transtibial amputation. STUDY DESIGN: Standardized, repeated measure (A-B-A) out-of-laboratory protocol. METHODS: Participants with transtibial amputation completed three 6-h test sessions. Two sessions served as controls (A protocol) during which participants left their prosthesis donned, and one session was an intervention (B protocol) where participants doffed their prosthesis twice for 20 min during the 6 h of testing. Within-socket fluid volume was measured using a custom portable bioimpedance analysis system. RESULTS: A total of 13 participants completed the study. The rate of limb fluid volume loss was higher early in the session compared with late in the session. Participants experienced less fluid volume loss during high activity than low activity. Socket users with pin suspension experienced less posterior fluid volume loss when they intermittently doffed their prosthesis. Intermittent doffing did not benefit limb fluid volume of mechanical vacuum and suction suspension users. CONCLUSION: High activity may reduce fluid volume loss compared with low activity. Intermittent doffing may provide volume accommodation for transtibial prosthesis users with pin suspension. CLINICAL RELEVANCE Prosthetists should query their patients about the intensity of activity they conduct when advising them on limb volume management. Patients using sockets with pin suspension may be able to offset limb fluid volume loss by periodically doffing the prosthesis.
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Affiliation(s)
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of
Washington
| | | | - John C Cagle
- Department of Bioengineering, University of Washington
| | - Paul Hinrichs
- Department of Bioengineering, University of Washington
| | | | | | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of
Washington
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15
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Schoepp KR, Schofield JS, Home D, Dawson MR, Lou E, Keri M, Marasco PD, Hebert JS. Real time monitoring of transtibial elevated vacuum prostheses: A case series on socket air pressure. PLoS One 2018; 13:e0202716. [PMID: 30346953 PMCID: PMC6197629 DOI: 10.1371/journal.pone.0202716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/09/2018] [Indexed: 12/03/2022] Open
Abstract
Prosthetic elevated vacuum is a suspension method used to reduce daily volume changes of the residual limb. Evaluation of the effectiveness of these systems is limited due to a lack of correlation to actual socket air pressure, particularly during unconstrained movements. This may explain some of the variability in functional outcomes reported in the literature. Our objective was to develop a light-weight portable socket measurement system to quantify internal socket air pressure, temperature, and acceleration; and to present preliminary results from implementation with three transtibial prosthesis users with mechanical elevated vacuum pumps. Participants completed five functional tasks with and without the vacuum pumps actively connected, including the 2-Minute Walk test, 5-Times Sit-to-Stand test, 4-Square Step test, L-Test, and Figure-8 test. Results demonstrated different gait profiles and pressure ranges for each user. Two of the participants demonstrated substantially lower air pressure (higher vacuum) over time while the pump was active compared to inactive. The minimum air pressure measured for all participants was -34.6 ± 7.7 kPa. One participant did not show substantial changes in pressure over time for either pump condition. Functional task performance was not significantly different between pump conditions. Correlation with accelerometer readings indicated peak positive pressures occurred just following initial contact of the foot in early stance, and the most negative pressures (highest vacuum) were observed throughout swing. This study has demonstrated the use of a portable data logging tool that may serve the clinical and research communities to quantify the operation of elevated vacuum systems, and better understand the variability of mechanical pump operation and overall system performance.
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Affiliation(s)
- Katherine R. Schoepp
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathon S. Schofield
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland, Ohio, United States of America
| | - David Home
- Prosthetics and Orthotics Department, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Michael R. Dawson
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Edmond Lou
- Department of Electrical & Computer Engineering, Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - McNiel Keri
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Paul D. Marasco
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland, Ohio, United States of America
- Advanced Platform Technology Center of Excellence, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Jacqueline S. Hebert
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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16
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Rink C, Wernke MM, Powell HM, Gynawali S, Schroeder RM, Kim JY, Denune JA, Gordillo GM, Colvin JM, Sen CK. Elevated vacuum suspension preserves residual-limb skin health in people with lower-limb amputation: Randomized clinical trial. ACTA ACUST UNITED AC 2018; 53:1121-1132. [PMID: 28355039 DOI: 10.1682/jrrd.2015.07.0145] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 04/13/2016] [Indexed: 11/05/2022]
Abstract
A growing number of clinical trials and case reports support qualitative claims that use of an elevated vacuum suspension (EVS) prosthesis improves residual-limb health on the basis of self-reported questionnaires, clinical outcomes scales, and wound closure studies. Here, we report first efforts to quantitatively assess residual-limb circulation in response to EVS. Residual-limb skin health and perfusion of people with lower-limb amputation (N = 10) were assessed during a randomized crossover study comparing EVS with nonelevated vacuum suspension (control) over a 32 wk period using noninvasive probes (transepidermal water loss, laser speckle imaging, transcutaneous oxygen measurement) and functional hyperspectral imaging approaches. Regardless of the suspension system, prosthesis donning decreased perfusion in the residual limb under resting conditions. After 16 wk of use, EVS improved residual-limb oxygenation during treadmill walking. Likewise, prosthesis-induced reactive hyperemia was attenuated with EVS following 16 wk of use. Skin barrier function was preserved with EVS but disrupted after control socket use. Taken together, outcomes suggest chronic EVS use improves perfusion and preserves skin barrier function in people with lower-limb amputation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; "Evaluation of limb health associated with a prosthetic vacuum socket system": NCT01839123; https://clinicaltrials.gov/ct2/show/NCT01839123?term=NCT01839123&rank=1.
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Affiliation(s)
- Cameron Rink
- Department of Surgery, Comprehensive Wound Center, and Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Heather M Powell
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH
| | - Surya Gynawali
- Department of Surgery, Comprehensive Wound Center, and Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Jayne Y Kim
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH
| | | | - Gayle M Gordillo
- Department of Surgery, Comprehensive Wound Center, and Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH.,Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Chandan K Sen
- Department of Surgery, Comprehensive Wound Center, and Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
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17
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Paterno L, Ibrahimi M, Gruppioni E, Menciassi A, Ricotti L. Sockets for Limb Prostheses: A Review of Existing Technologies and Open Challenges. IEEE Trans Biomed Eng 2018; 65:1996-2010. [PMID: 29993506 DOI: 10.1109/tbme.2017.2775100] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the prosthetics field, one of the most important bottlenecks is still the human-machine interface, namely the socket. Indeed, a large number of amputees still rejects prostheses or points out a low satisfaction level, due to a sub-optimal interaction between the socket and the residual limb tissues. The aim of this paper is to describe the main parameters (displacements, stress, volume fluctuations and temperature) affecting the stump-socket interface and reducing the comfort/stability of limb prostheses. In this review, a classification of the different socket types proposed in the literature is reported, together with an analysis of advantages and disadvantages of the different solutions, from multiple viewpoints. The paper then describes the technological solutions available to face an altered distribution of stresses on the residual limb tissues, volume fluctuations affecting the stump overtime and temperature variations affecting the residual tissues within the socket. The open challenges in this research field are highlighted and the possible future routes are discussed, towards the ambitious objective of achieving an advanced socket able to self-adapt in real-time to the complex interplay of factors affecting the stump, during both static and dynamic tasks.
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18
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Wernke MM, Schroeder RM, Haynes ML, Nolt LL, Albury AW, Colvin JM. Progress Toward Optimizing Prosthetic Socket Fit and Suspension Using Elevated Vacuum to Promote Residual Limb Health. Adv Wound Care (New Rochelle) 2017; 6:233-239. [PMID: 28736683 DOI: 10.1089/wound.2016.0719] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/07/2017] [Indexed: 11/13/2022] Open
Abstract
Objective: Prosthetic sockets are custom made for each amputee, yet there are no quantitative tools to determine the appropriateness of socket fit. Ensuring a proper socket fit can have significant effects on the health of residual limb soft tissues and overall function and acceptance of the prosthetic limb. Previous work found that elevated vacuum pressure data can detect movement between the residual limb and the prosthetic socket; however, the correlation between the two was specific to each user. The overall objective of this work is to determine the relationship between elevated vacuum pressure deviations and prosthetic socket fit. Approach: A tension compression machine was used to apply repeated controlled forces onto a residual limb model with sockets of different internal volume. Results: The vacuum pressure-displacement relationship was dependent on socket fit. The vacuum pressure data were sensitive enough to detect differences of 1.5% global volume and can likely detect differences even smaller. Limb motion was reduced as surface area of contact between the limb model and socket was maximized. Innovation: The results suggest that elevated vacuum pressure data provide information to quantify socket fit. Conclusions: This study provides evidence that the use of elevated vacuum pressure data may provide a method for prosthetists to quantify and monitor socket fit. Future studies should investigate the relationship between socket fit, limb motion, and limb health to define optimal socket fit parameters.
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19
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Vacuum level effects on knee contact force for unilateral transtibial amputees with elevated vacuum suspension. J Biomech 2017; 57:110-116. [PMID: 28476209 DOI: 10.1016/j.jbiomech.2017.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 02/17/2017] [Accepted: 04/09/2017] [Indexed: 11/22/2022]
Abstract
The elevated vacuum suspension system (EVSS) has demonstrated unique health benefits for amputees, but the effect of vacuum pressure values on knee contact force (KCF) is still unclear. The objective of this study was to investigate the effect of vacuum levels on KCF for unilateral transtibial amputees (UTA) using the EVSS. Three-dimensional gait was modeled for 9 UTA with five vacuum levels (0-20inHg [67.73kPa], 5inHg [16.93kPa] increments) and 9 non-amputees based on kinematic and ground reaction force data. The results showed that the vacuum level effects were significant for peak axial KCF, which had a relatively large value at 0 and 20inHg (67.73kPa). The intact limb exhibited a comparable peak axial KCF to the non-amputees at 15inHg (50.79kPa). At moderate vacuum levels (5inHg [16.93kPa] to 15inHg [50.79kPa]), co-contraction of quadriceps and hamstrings at peak axial KCF was similar for the intact limb, but was smaller for the residual limb comparing with the non-amputees. The intact limb showed a similar magnitude of quadriceps and hamstrings force at 15inHg (50.79kPa) to the non-amputees, but the muscle coordination patterns varied between the residual and intact limbs. These findings indicate that a proper vacuum level may partially compensate for the lack of ankle plantarflexor and reduce the knee loading. Of the tested vacuum levels, 15inHg (50.79kPa) appears most favorable, although additional analyses with more amputees are suggested to confirm these results prior to establishing clinical guidelines.
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20
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Rosenblatt NJ, Ehrhardt T, Fergus R, Bauer A, Caldwell R. Effects of Vacuum-Assisted Socket Suspension on Energetic Costs of Walking, Functional Mobility, and Prosthesis-Related Quality of Life. ACTA ACUST UNITED AC 2017. [DOI: 10.1097/jpo.0000000000000127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Xu H, Greenland K, Bloswick D, Zhao J, Merryweather A. Vacuum level effects on gait characteristics for unilateral transtibial amputees with elevated vacuum suspension. Clin Biomech (Bristol, Avon) 2017; 43:95-101. [PMID: 28232236 PMCID: PMC5404825 DOI: 10.1016/j.clinbiomech.2017.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The elevated vacuum suspension system has demonstrated unique health benefits for amputees, but the effect of vacuum pressure values on gait characteristics is still unclear. The purpose of this study was to investigate the effects of elevated vacuum levels on temporal parameters, kinematics and kinetics for unilateral transtibial amputees. METHODS Three-dimensional gait analysis was conducted in 9 unilateral transtibial amputees walking at a controlled speed with five vacuum levels ranging from 0 to 20inHg, and also in 9 able-bodied subjects walking at self-preferred speed. Repeated ANOVA and Dunnett's t-test were performed to determine the effect of vacuum level and limb for within subject and between groups. FINDINGS The effect of vacuum level significantly affected peak hip external rotation and external knee adduction moment. Maximum braking and propulsive ground reaction forces generally increased for the residual limb and decreased for the intact limb with increasing vacuum. Additionally, the intact limb experienced an increased loading due to gait asymmetry for several variables. INTERPRETATION There was no systematic vacuum level effect on gait. Higher vacuum levels, such as 15 and 20inHg, were more comfortable and provided some relief to the intact limb, but may also increase the risk of osteoarthritis of the residual limb due to the increased peak external hip and knee adduction moments. Very low vacuum should be avoided because of the negative effects on gait symmetry. A moderate vacuum level at 15inHg is suggested for unilateral transtibial amputees with elevated vacuum suspension.
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Affiliation(s)
- Hang Xu
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Kasey Greenland
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Donald Bloswick
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Jie Zhao
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
| | - Andrew Merryweather
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA.
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22
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Darter BJ, Sinitski K, Wilken JM. Axial bone-socket displacement for persons with a traumatic transtibial amputation: The effect of elevated vacuum suspension at progressive body-weight loads. Prosthet Orthot Int 2016; 40:552-7. [PMID: 26423107 DOI: 10.1177/0309364615605372] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 07/27/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Elevated vacuum suspension systems use a pump to draw air from the socket with the intent of reducing bone-socket motion as compared to passive suction systems. However, it remains unknown if elevated vacuum suspension systems decrease limb displacement uniformly during transitions from unloaded to full-body-weight support. OBJECTIVES To compare limb-socket motion between elevated vacuum and passive suction suspension sockets using a controlled loading paradigm. STUDY DESIGN Comparative analysis. METHODS Persons with transtibial amputation were assessed while wearing either an elevated vacuum or passive suction suspension socket. Digital video fluoroscopy was used to measure axial bone-socket motion while the limb was loaded in 20% body-weight increments. An analysis of variance model was used to compare between suspension types. RESULTS Total axial displacement (0%-100% body weight) was significantly lower using the elevated vacuum (vacuum: 1.3 cm, passive suction: 1.8 cm; p < 0.0001). Total displacement decreased primarily due to decreased motion during initial loading (0%-20%; p < 0.0001). Other body-weight intervals were not significantly different between systems. CONCLUSION Elevated vacuum suspension reduced axial limb-socket motion by maintaining position of the limb within the socket during unloaded conditions. Elevated vacuum provided no meaningful improvement in limb-socket motion past initial loading. CLINICAL RELEVANCE Excessive bone-socket motion contributes to poor residual limb health. Our results suggest elevated vacuum suspensions can reduce this axial displacement. Visual assessment of the images suggests that this occurs through the reduction or elimination of the air pocket between the liner and socket wall while the limb is unloaded.
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Affiliation(s)
- Benjamin J Darter
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, USA
| | - Kirill Sinitski
- Center for the Intrepid, Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, JBSA, Fort Sam Houston, TX, USA
| | - Jason M Wilken
- Center for the Intrepid, Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, JBSA, Fort Sam Houston, TX, USA
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23
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Safari MR, Meier MR. Systematic review of effects of current transtibial prosthetic socket designs--Part 2: Quantitative outcomes. ACTA ACUST UNITED AC 2016; 52:509-26. [PMID: 26436733 DOI: 10.1682/jrrd.2014.08.0184] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 04/14/2015] [Indexed: 11/05/2022]
Abstract
This review is an attempt to untangle the complexity of transtibial prosthetic socket fit and perhaps find some indication of whether a particular prosthetic socket type might be best for a given situation. In addition, we identified knowledge gaps, thus providing direction for possible future research. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using medical subject headings and standard key words to search for articles in relevant databases. No restrictions were made on study design and type of outcome measure used. From the obtained search results (n = 1,863), 35 articles were included. The relevant data were entered into a predefined data form that included the Downs and Black risk of bias assessment checklist. This article presents the results from the systematic review of the quantitative outcomes (n = 27 articles). Trends indicate that vacuum-assisted suction sockets improve gait symmetry, volume control, and residual limb health more than other socket designs. Hydrostatic sockets seem to create less inconsistent socket fittings, reducing a problem that greatly influences outcome measures. Knowledge gaps exist in the understanding of clinically meaningful changes in socket fit and its effect on biomechanical outcomes. Further, safe and comfortable pressure thresholds under various conditions should be determined through a systematic approach.
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Affiliation(s)
- Mohammad Reza Safari
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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24
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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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25
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Major MJ, Caldwell R, Fatone S. Evaluation of a Prototype Hybrid Vacuum Pump to Provide Vacuum-Assisted Suspension for Above-Knee Prostheses. J Med Device 2016; 9:0445041-445044. [PMID: 27462383 DOI: 10.1115/1.4030507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/03/2015] [Indexed: 11/08/2022] Open
Abstract
Vacuum-assisted suspension (VAS) of prosthetic sockets utilizes a pump to evacuate air from between the prosthetic liner and socket, and are available as mechanical or electric systems. This technical note describes a hybrid pump that benefits from the advantages of mechanical and electric systems, and evaluates a prototype as proof-of-concept. Cyclical bench testing of the hybrid pump mechanical system was performed using a materials testing system to assess the relationship between compression cycles and vacuum pressure. Phase 1 in vivo testing of the hybrid pump was performed by an able-bodied individual using prosthesis simulator boots walking on a treadmill, and phase 2 involved an above-knee prosthesis user walking with the hybrid pump and a commercial electric pump for comparison. Bench testing of 300 compression cycles produced a maximum vacuum of 24 in-Hg. In vivo testing demonstrated that the hybrid pump continued to pull vacuum during walking, and as opposed to the commercial electric pump, did not require reactivation of the electric system during phase 2 testing. The novelty of the hybrid pump is that while the electric system provides rapid, initial vacuum suspension, the mechanical system provides continuous air evacuation while walking to maintain suspension without reactivation of the electric system, thereby allowing battery power to be reserved for monitoring vacuum levels.
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Affiliation(s)
- Matthew J Major
- Jesse Brown VA Medical Center, Northwestern University Prosthetics-Orthotics Center, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611 e-mail:
| | - Ryan Caldwell
- Scheck and Siress Orthotics and Prosthetics, Northwestern University Prosthetics-Orthotics Center, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611 e-mail:
| | - Stefania Fatone
- Northwestern University Prosthetics-Orthotics Center, 680 North Lake Shore Drive, Suite 1100, Chicago, IL 60611 e-mail:
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26
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Samitier CB, Guirao L, Costea M, Camós JM, Pleguezuelos E. The benefits of using a vacuum-assisted socket system to improve balance and gait in elderly transtibial amputees. Prosthet Orthot Int 2016; 40:83-8. [PMID: 25261489 DOI: 10.1177/0309364614546927] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/15/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lower limb amputation leads to impaired balance, ambulation, and transfers. Proper fit of the prosthesis is a determining factor for successful ambulation. Vacuum-assisted socket systems extract air from the socket, which decreases pistoning and probability of soft-tissue injuries and increases proprioception and socket comfort. OBJECTIVES To investigate the effect of vacuum-assisted socket system on transtibial amputees' performance-based and perceived balance, transfers, and gait. STUDY DESIGN Quasi-experimental before-and-after study. METHODS Subjects were initially assessed using their prosthesis with the regular socket and re-evaluated 4 weeks after fitting including the vacuum-assisted socket system. We evaluated the mobility grade using Medicare Functional Classification Level, Berg Balance Scale, Four Square Step Test, Timed Up and Go Test, the 6-Min Walk Test, the Locomotor Capabilities Index, Satisfaction with Prosthesis (SAT-PRO questionnaire), and Houghton Scale. RESULTS A total of 16 unilateral transtibial dysvascular amputees, mean age 65.12 (standard deviation = 10.15) years. Using the vacuum-assisted socket system, the patients significantly improved in balance, gait, and transfers: scores of the Berg Balance Scale increased from 45.75 (standard deviation = 6.91) to 49.06 (standard deviation = 5.62) (p < 0.01), Four Square Step Test decreased from 18.18 (standard deviation = 3.84) s to 14.97 (3.9) s (p < 0.01), Timed Up and Go Test decreased from 14.3 (standard deviation = 3.29) s to 11.56 (2.46) s (p < 0.01). The distance walked in the 6-Min Walk Test increased from 288.53 (standard deviation = 59.57) m to 321.38 (standard deviation = 72.81) m (p < 0.01). CONCLUSION Vacuum-assisted socket systems are useful for improving balance, gait, and transfers in over-50-year-old dysvascular transtibial amputees. CLINICAL RELEVANCE This study gives more insight into the use of vacuum-assisted socket systems to improve elderly transtibial dysvascular amputees' functionality and decrease their risk of falls. The use of an additional distal valve in the socket should be considered in patients with a lower activity level.
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Affiliation(s)
| | | | | | | | - Eulogio Pleguezuelos
- Hospital de Mataró, Mataró, Barcelona, Spain Department of Experimental Science and Healthcare, Faculty of Health Sciences Universitat Pompeu Fabra, Barcelona, Spain Faculty of Health Sciences Blanquerna, Universitat Ramón Llull, Barcelona, Spain
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27
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Sanders JE, Redd CB, Cagle JC, Hafner BJ, Gardner D, Allyn KJ, Harrison DS, Ciol MA. Preliminary evaluation of a novel bladder-liner for facilitating residual limb fluid volume recovery without doffing. ACTA ACUST UNITED AC 2016; 53:1107-1120. [PMID: 28355030 DOI: 10.1682/jrrd.2014.12.0316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 01/25/2016] [Indexed: 11/05/2022]
Abstract
For people who wear a prosthetic limb, residual-limb fluid volume loss during the day may be problematic and detrimentally affect socket fit. The purpose of this research was to test the capability of a novel liner with adjustable bladders positioned within its wall to mitigate volume loss and facilitate limb fluid volume recovery and retention. Bioimpedance analysis was used to monitor fluid volume changes in the anterior and posterior residual limb of participants with transtibial amputation. Participants underwent six cycles of sitting for 90 s, standing for 90 s, and walking for 5 min with liquid within the bladder-liners. Between the third and fourth cycles, participants sat for 10 min with liquid left within the bladders (Liquid-In) or removed (Liquid-Out). Results showed that participants recovered more fluid volume during the 10 min of sitting with Liquid-Out than Liquid-In (p = 0.09 for anterior and p = 0.04 for posterior). However, those fluid volume recoveries were not well retained in the short term (after the fourth cycle) or the long term (after the sixth cycle). Physiologic differences between sessions, reflected in the rates of fluid volume change at the outset of the session, and excessive stiffness of the bladder-liners may have affected fluid volume retentions.
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Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA
| | - Christian B Redd
- Department of Bioengineering, University of Washington, Seattle, WA
| | | | - Brian J Hafner
- Department of Bioengineering, University of Washington, Seattle, WA
| | - David Gardner
- Department of Bioengineering, University of Washington, Seattle, WA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA
| | | | - Marcia A Ciol
- Department of Bioengineering, University of Washington, Seattle, WA
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Major MJ, Caldwell R, Fatone S. Comparative Effectiveness of Electric Vacuum Pumps for Creating Suspension in Transfemoral Sockets. ACTA ACUST UNITED AC 2015. [DOI: 10.1097/jpo.0000000000000073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kuntze Ferreira AE, Neves EB. A comparison of vacuum and KBM prosthetic fitting for unilateral transtibial amputees using the Gait Profile Score. Gait Posture 2015; 41:683-7. [PMID: 25684145 DOI: 10.1016/j.gaitpost.2015.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to compare gait deviations between Kondylen Bettung Münster (KBM) and vacuum prosthetic fitting using the Gait Profile Score (GPS), the Movement Analysis Profile (MAP) and temporal-spatial parameters. Seventeen transtibial amputees that received their prosthesis from the Brazilian governmental health system participated in this study. Twelve of them used KBM prosthetic fitting on their prosthesis and five used vacuum prosthetic fitting. Kinematic and temporal-spatial parameters data were captured by a six-camera Motion Analysis system (Santa Rosa, CA). The results showed that the vacuum group walked faster than the KBM group but the differences in temporal-spatial parameters between them were not significant. The GPS for the intact limb (IL) and the overall GPS differentiated between the groups of prosthetic fitting. Hip flexion/extension and knee flexion/extension were higher in KBM group than in the vacuum group, although only knee flexion/extension for the intact limb revealed significant difference between the groups. In KBM group, the major deviations were in hip flexion/extension for both limbs, knee flexion/extension for both limbs and ankle dorsi/plantar flexion for the prosthetic limb. The vacuum group showed deviations especially in ankle dorsi/plantar flexion for both limbs, knee flexion/extension for the prosthetic limb and hip rotation for the prosthetic limb. Besides, the vacuum group was more symmetrical than the KBM group. This study concluded that subjects who used vacuum prosthetic fitting presented smaller gait deviations and a more symmetrical gait than those who used KBM prosthetic fitting.
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Affiliation(s)
- Alana Elisabeth Kuntze Ferreira
- Federal Technological University of Paraná, Graduate Program in Biomedical Engineering, Curitiba, Brazil; Paraná Rehabilitation Center, Curitiba, Brazil.
| | - Eduardo Borba Neves
- Federal Technological University of Paraná, Graduate Program in Biomedical Engineering, Curitiba, Brazil.
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Pirouzi G, Abu Osman NA, Oshkour AA, Ali S, Gholizadeh H, Abas WABW. Development of an air pneumatic suspension system for transtibial prostheses. SENSORS 2014; 14:16754-65. [PMID: 25207872 PMCID: PMC4208197 DOI: 10.3390/s140916754] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/25/2014] [Accepted: 07/28/2014] [Indexed: 11/16/2022]
Abstract
The suspension system and socket fitting of artificial limbs have major roles and vital effects on the comfort, mobility, and satisfaction of amputees. This paper introduces a new pneumatic suspension system that overcomes the drawbacks of current suspension systems in donning and doffing, change in volume during daily activities, and pressure distribution in the socket-stump interface. An air pneumatic suspension system (APSS) for total-contact sockets was designed and developed. Pistoning and pressure distribution in the socket-stump interface were tested for the new APSS. More than 95% of the area between each prosthetic socket and liner was measured using a Tekscan F-Scan pressure measurement which has developed matrix-based pressure sensing systems. The variance in pressure around the stump was 8.76 kPa. APSS exhibits less pressure concentration around the stump, improved pressure distribution, easy donning and doffing, adjustability to remain fitted to the socket during daily activities, and more adaptability to the changes in stump volume. The volume changes were adjusted by utility of air pressure sensor. The vertical displacement point and reliability of suspension were assessed using a photographic method. The optimum pressure in every level of loading weight was 55 kPa, and the maximum displacement was 6 mm when 90 N of weight was loaded.
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Affiliation(s)
- Gholamhossein Pirouzi
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Noor Azuan Abu Osman
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Azim Ataollahi Oshkour
- Department of Mechanical Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Sadeeq Ali
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Hossein Gholizadeh
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Wan A B Wan Abas
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
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Hoskins RD, Sutton EE, Kinor D, Schaeffer JM, Fatone S. Using vacuum-assisted suspension to manage residual limb wounds in persons with transtibial amputation: a case series. Prosthet Orthot Int 2014; 38:68-74. [PMID: 23685916 DOI: 10.1177/0309364613487547] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Persons with amputation and residual limb wounds would benefit from the ability to continue wearing a prosthesis while healing. Sockets with vacuum-assisted suspension may reduce intra-socket motion and be less disruptive to wound healing. The purpose of this case series was to measure residual limb wound size over time in persons with transtibial amputation while using prostheses with vacuum-assisted suspension. CASE DESCRIPTION AND METHODS Six subjects with residual limb wounds were fit with vacuum-assisted suspension sockets. Wound surface area was calculated using ImageJ software at the time of fit and each subsequent visit until closure. FINDINGS AND OUTCOME: Average wound surface area at initial measurement was 2.17 ± 0.65 cm(2). All subjects were instructed to continue their normal activity level while wounds healed, with a mean of 177.6 ± 113 days to wound closure. CONCLUSION Results suggest that well-fitting sockets with vacuum-assisted suspension in compliant individuals did not preclude wound healing. Further research is required to substantiate these case-based observations. CLINICAL RELEVANCE Residual limb wounds are typically treated by suspension of prosthetic use until healing occurs, increasing the risk of long-term prosthesis nonuse. Our results suggest that vacuum-assisted suspension sockets may be used while healing occurs.
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Sanders JE, Severance MR, Swartzendruber DL, Allyn KJ, Ciol MA. Influence of prior activity on residual limb volume and shape measured using plaster casting: results from individuals with transtibial limb loss. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2013; 50:1007-16. [PMID: 24301437 DOI: 10.1682/jrrd.2012.10.0195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 03/07/2013] [Indexed: 11/05/2022]
Abstract
The purpose of this research was to determine whether prior activity affected the shape of a plaster cast taken of a transtibial residual limb. Plaster casts were taken twice on one day in 24 participants with transtibial limb loss, with 5 s between doffing and casting in one trial (PDI-5s) and 20 min in the other trial (PDI-20m). The ordering of the trials was randomized. The mean +/- standard deviation radial difference between PDI-20m and PDI-5s was 0.34 +/- 0.21 mm when PDI-5s was conducted first and -0.02 +/- 0.20 mm when PDI-20m was conducted first. Ordering of the trials had a statistically significant influence on the mean radial difference between the two shapes (p = 0.008). The result shows that prior activity influenced the residual limb cast shape. Practitioners should be mindful of prior activity and doffing history when casting an individual's limb for socket design and prosthetic fitting.
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Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, University of Washington, 355061, Foege N430J, 3720 15th Ave NE, Seattle, Washington 98195.
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Komolafe O, Wood S, Caldwell R, Hansen A, Fatone S. Methods for characterization of mechanical and electrical prosthetic vacuum pumps. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2013; 50:1069-78. [PMID: 24458892 DOI: 10.1682/jrrd.2012.11.0204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 03/11/2013] [Indexed: 11/05/2022]
Affiliation(s)
| | - Sean Wood
- Northwestern University Prosthetics-Orthotics Center, Chicago IL
| | | | - Andrew Hansen
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, MN
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Sanders JE, Harrison DS, Myers TR, Allyn KJ. Effects of elevated vacuum on in-socket residual limb fluid volume: case study results using bioimpedance analysis. ACTA ACUST UNITED AC 2012; 48:1231-48. [PMID: 22234667 DOI: 10.1682/jrrd.2010.11.0219] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bioimpedance analysis was used to measure the residual limb fluid volume of seven transtibial amputee subjects using elevated vacuum sockets and nonelevated vacuum sockets. Fluid volume changes were assessed during sessions with the subjects sitting, standing, and walking. In general, fluid volume losses during 3 or 5 min walks and losses over the course of the 30 min test session were less for elevated vacuum than for suction. Numerous variables, including the time of day that data were collected, soft tissue consistency, socket-to-limb size and shape differences, and subject health, may have affected the results and had an equivalent or greater effect on limb fluid volume compared with elevated vacuum. Researchers should well consider these variables in the study design of future investigations on the effects of elevated vacuum on residual limb volume.
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Affiliation(s)
- Joan E Sanders
- University of Washington-Bioengineering, 3720 15th Ave NE, University of Washington, Seattle, WA 98195, USA.
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Sanders JE, Fatone S. Residual limb volume change: systematic review of measurement and management. ACTA ACUST UNITED AC 2012; 48:949-86. [PMID: 22068373 DOI: 10.1682/jrrd.2010.09.0189] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Management of residual limb volume affects decisions regarding timing of fit of the first prosthesis, when a new prosthetic socket is needed, design of a prosthetic socket, and prescription of accommodation strategies for daily volume fluctuations. This systematic review assesses what is known about measurement and management of residual limb volume change in persons with lower-limb amputation. Publications that met inclusion criteria were grouped into three categories: group I: descriptions of residual limb volume measurement techniques; group II: studies investigating the effect of residual limb volume change on clinical care in people with lower-limb amputation; and group III: studies of residual limb volume management techniques or descriptions of techniques for accommodating or controlling residual limb volume. We found that many techniques for the measurement of residual limb volume have been described but clinical use is limited largely because current techniques lack adequate resolution and in-socket measurement capability. Overall, limited evidence exists regarding the management of residual limb volume, and the evidence available focuses primarily on adults with transtibial amputation in the early postoperative phase. While we can draw some insights from the available research about residual limb volume measurement and management, further research is required.
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Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, Box 355061, Foege N430J, 3720 15th Ave NE, University of Washington, Seattle, WA 98195-5061, USA.
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Eshraghi A, Osman NAA, Gholizadeh H, Karimi M, Ali S. Pistoning assessment in lower limb prosthetic sockets. Prosthet Orthot Int 2012; 36:15-24. [PMID: 22269941 DOI: 10.1177/0309364611431625] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND One of the main indicators of the suspension system efficiency in lower limb prostheses is vertical displacement or pistoning within the socket. Decreasing pistoning and introducing an effective system for evaluating pistoning could contribute to the amputees' rehabilitation process. OBJECTIVES The main objective of this study was to review existing research studies that examine the occurrence of pistoning in lower limb prosthesis with different techniques in static (standing) and dynamic (walking and jumping) positions. STUDY DESIGN Literature review. METHODS Keywords related to slippage, suspension, pistoning and vertical movement in lower limb prosthetics were used to search the literature available in PubMed, ScienceDirect, Web of Science and Google Scholar databases. Sixteen articles were selected for further analysis according to the selection criteria. RESULTS The following methods have been used to measure the occurrence of pistoning in prosthetic limbs: radiological methods, photographic technique, motion analysis system, sensor and spiral computerized tomography (CT). Pistoning was measured both in standing and walking. CONCLUSIONS The results of this review reveal that further research is needed to develop and evaluate easy, accurate and safe methods of measuring pistoning. Future studies should provide a gold standard for the acceptable range of pistoning in a prosthetic socket.
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Andrysek J, Klejman S, Steinnagel B, Torres-Moreno R, Zabjek KF, Salbach NM, Moody K. Preliminary Evaluation of a Commercially Available Videogame System as an Adjunct Therapeutic Intervention for Improving Balance Among Children and Adolescents With Lower Limb Amputations. Arch Phys Med Rehabil 2012; 93:358-66. [PMID: 22289250 DOI: 10.1016/j.apmr.2011.08.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 08/17/2011] [Accepted: 08/29/2011] [Indexed: 11/18/2022]
Affiliation(s)
- Jan Andrysek
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.
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Klute GK, Berge JS, Biggs W, Pongnumkul S, Popovic Z, Curless B. Vacuum-assisted socket suspension compared with pin suspension for lower extremity amputees: effect on fit, activity, and limb volume. Arch Phys Med Rehabil 2011; 92:1570-5. [PMID: 21963124 DOI: 10.1016/j.apmr.2011.05.019] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/24/2011] [Accepted: 05/26/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effect of a vacuum-assisted socket suspension system as compared with pin suspension on lower extremity amputees. DESIGN Randomized crossover with 3-week acclimation. SETTING Household, community, and laboratory environments. PARTICIPANTS Unilateral, transtibial amputees (N=20 enrolled, N=5 completed). INTERVENTIONS (1) Total surface-bearing socket with a vacuum-assisted suspension system (VASS), and (2) modified patellar tendon-bearing socket with a pin lock suspension system. MAIN OUTCOME MEASURES Activity level, residual limb volume before and after a 30-minute treadmill walk, residual limb pistoning, and Prosthesis Evaluation Questionnaire. RESULTS Activity levels were significantly lower while wearing the vacuum-assisted socket suspension system than the pin suspension (P=.0056; 38,000 ± 9,000 steps per 2 wk vs 73,000 ± 18,000 steps per 2 wk, respectively). Residual limb pistoning was significantly less while wearing the vacuum-assisted socket suspension system than the pin suspension (P=.0021; 1 ± 3mm vs 6 ± 4mm, respectively). Treadmill walking had no effect on residual limb volume. In general, participants ranked their residual limb health higher, were less frustrated, and claimed it was easier to ambulate while wearing a pin suspension compared with the VASS. CONCLUSIONS The VASS resulted in a better fitting socket as measured by limb movement relative to the prosthetic socket (pistoning), although the clinical relevance of the small but statistically significant difference is difficult to discern. Treadmill walking had no effect, suggesting that a skilled prosthetist can control for daily limb volume fluctuations by using conventional, nonvacuum systems. Participants took approximately half as many steps while wearing the VASS which, when coupled with their subjective responses, suggests a preference for the pin suspension system.
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Affiliation(s)
- Glenn K Klute
- Department of Veterans Affairs Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Seattle, WA, USA.
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Outcomes Study of Transtibial Amputees Using Elevated Vacuum Suspension in Comparison With Pin Suspension. ACTA ACUST UNITED AC 2011. [DOI: 10.1097/jpo.0b013e3182173b83] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Elevated Vacuum Suspension Influence on Lower Limb Amputee's Residual Limb Volume at Different Vacuum Pressure Settings. ACTA ACUST UNITED AC 2010. [DOI: 10.1097/jpo.0b013e3181f903df] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A Vacuum Suspension Measurement Tool for Use in Prosthetic Research and Clinical Outcomes: Validation and Analysis of Vacuum Pressure in a Prosthetic Socket. ACTA ACUST UNITED AC 2010. [DOI: 10.1097/jpo.0b013e3181e8feaa] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fergason J, Keeling JJ, Bluman EM. Recent advances in lower extremity amputations and prosthetics for the combat injured patient. Foot Ankle Clin 2010; 15:151-74. [PMID: 20189122 DOI: 10.1016/j.fcl.2009.10.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Blast-related extremity trauma represents a serious challenge because of the extent of bone and soft tissue damage. Fragmentation and blast injuries account for 56% of all injuries produced within the Iraqi and Afghan theaters where, as of July 2009, 723 combatants have sustained lower extremity limb loss. If limb salvage is not practical, or fails, then amputation should be considered. Amputation can be a reliable means toward pain relief and improvement of function. Optimizing functional outcome is paramount when deciding on definitive amputation level. Preservation of joint function improves limb biomechanics in many cases. Increased limb length also allows for the benefits associated with articular and distal limb proprioception. Amputees with improved lower extremity function also usually exhibit less energy consumption. Function and length are generally directly correlated, whereas energy consumption and length are inversely related. This article discusses the surgical principles of lower extremity amputation and postoperative management of amputees, and the various prosthetic options available.
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Affiliation(s)
- John Fergason
- Brooke Army Medical Centre, 3851 Roger Brooke Drive, DOR, Fort Sam Houston, TX 48234, USA.
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Sanders JE, Jacobsen AK, Fergason JR. Effects of fluid insert volume changes on socket pressures and shear stresses: case studies from two trans-tibial amputee subjects. Prosthet Orthot Int 2006; 30:257-69. [PMID: 17162516 DOI: 10.1080/03093640600810266] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Fluid inserts potentially help to overcome prosthetic fit problems resulting from stump volume change. The purpose of this investigation was to add fluid to fluid inserts positioned on the inner socket walls of trans-tibial prostheses and to assess their influence on socket stresses. Pressures and shear stresses were measured at 13 sites on the sockets of two trans-tibial amputee subjects while they ambulated at their self-selected walking speeds. Stresses at the transducer sites generally increased with greater fluid addition and, interestingly, both subjects found relatively high fluid insert volumes most comfortable. The magnitudes of stress change were larger than those resulting from alignment, cadence, and componentry changes as reported in the literature. Possible explanations for why subjects found settings that induced higher measured socket stresses more comfortable than those that induced lower measured stresses include: A reduced shear: pressure ratio; the short duration of the study; and reduced stresses at sites not monitored with transducers.
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Affiliation(s)
- J E Sanders
- Department of Bioengineering, University of Washington, Seattle, Washington, USA.
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