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van der Stelt M, Grobusch MP, Koroma AR, Papenburg M, Kebbie I, Slump CH, Maal TJ, Brouwers L. Pioneering low-cost 3D-printed transtibial prosthetics to serve a rural population in Sierra Leone - an observational cohort study. EClinicalMedicine 2021; 35:100874. [PMID: 34027333 PMCID: PMC8129890 DOI: 10.1016/j.eclinm.2021.100874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is a huge unmet global need for affordable prostheses. Amputations often happen in Sierra Leone due to serious infections, complex wounds, traffic accidents and delayed patient presentation to the hospital. However, purchasing a prosthesis is still beyond reach for most Sierra Leonean amputees. METHOD We applied computer-aided design (CAD) and computer-aided manufacturing (CAM) to produce low-cost transtibial prosthetic sockets. In February and March 2020, eight participants received a 3D printed transtibial prosthesis in the village of Masanga in Tonkolili district, Sierra Leone. Research was performed using questionnaires to investigate the use, participants' satisfaction, and possible complications related to the prostheses. Questionnaires were conducted prior to production of the prosthesis and five to six weeks after fitting the prosthesis. A personal short-term goal was set by the participants. FINDINGS Competitively priced and fully functional prostheses were produced locally. After six weeks, all participants were still wearing the prosthesis and six of the eight participants reached their personal rehabilitation goals. Using their prostheses, all participants were no longer in need of their crutches. INTERPRETATION We have come a step closer to the production of low-cost prostheses for low-and middle-income countries (LMICs). The goal of our project is to perform long-term follow-up and to refine our concept of 3D printed prostheses for LMICs to provide practical solutions for a global health need unmet to date. FUNDING € 15,000 was collected during a crowdfunding campaign in collaboration with the Dutch Albert Schweitzer Fund. Internship allowance for MvdS was obtained from the University of Twente. 3D-scanner, 3D-printer, and printing material were donated by Ultimaker BV and Shining 3D.
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Affiliation(s)
- Merel van der Stelt
- Masanga Medical Research Unit, Masanga Hospital, Masanga, Sierra Leone
- Masanga Hospital, Masanga, Sierra Leone
- Technical Medicine, University of Twente, Enschede, The Netherlands
- Radboudumc 3D lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin. P. Grobusch
- Masanga Medical Research Unit, Masanga Hospital, Masanga, Sierra Leone
- Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Abdul. R. Koroma
- Masanga Medical Research Unit, Masanga Hospital, Masanga, Sierra Leone
| | | | - Ismaila Kebbie
- National Rehabilitation Programme/Centre, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Thomas J.J. Maal
- Radboudumc 3D lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lars Brouwers
- Masanga Hospital, Masanga, Sierra Leone
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Surgery, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
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Ramstrand N, Maddock A, Johansson M, Felixon L. The lived experience of people who require prostheses or orthoses in the Kingdom of Cambodia: A qualitative study. Disabil Health J 2021; 14:101071. [PMID: 33583726 DOI: 10.1016/j.dhjo.2021.101071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/20/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is an assumption that provision of assistive technologies, such as prostheses and orthoses, will improve the life situation of people with disabilities; however, this issue has been poorly addressed in low- and middle-income country settings. OBJECTIVE The objective of this qualitative study was to explore the life experience of people who use lower-limb prosthetic or orthotic devices in Cambodia, with a view to identifying areas in which developments can be made to improve the life experiences for prosthesis and orthosis users. METHODS Participants were recruited from 1/urban and 2/rural prosthetic and orthotic clinics, run by the same non-governmental organisation. Individual interviews were conducted in 2019 with 15 users of prosthetic or orthotic devices. Interviews were transcribed and analysed using a thematic analysis approach. RESULTS Three themes were identified: 1) A more positive outlook with an assistive device; 2) assistive devices reduce barriers but do not eliminate them and 3) disability creates social exclusion while assistive devices facilitate inclusion. For participants in this study, life without a prosthesis or orthosis was characterised by financial insecurity and a sense of hopelessness. After receiving an assistive device, participants experienced a greater sense of self-worth and empowerment as well as improved functional performance and social interactions. CONCLUSIONS Disability was found to affect multiple facets of participants' lives including physical and psychosocial factors. Prosthetic and orthotic devices were experienced as being enablers of social inclusion and generally improved the life situation for individuals with disabilities in The Kingdom of Cambodia. Attention should be directed towards improving knowledge of, and access to prosthetic and orthotic services, securing a stable income for users and addressing device related problems.
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Affiliation(s)
- Nerrolyn Ramstrand
- CHILD Research Group, Jönköping University, Sweden; Department of Rehabilitation, Jönköping University, Sweden; Exceed Research Network, Exceed Worldwide, Lisburn, UK.
| | - Alan Maddock
- School of Social Sciences, Education and Social Work, Queen's University, Belfast, Northern, Ireland; Exceed Research Network, Exceed Worldwide, Lisburn, UK.
| | | | - Lisa Felixon
- Department of Rehabilitation, Jönköping University, Sweden.
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Laing S, Lythgo N, Lavranos J, Lee PVS. Transtibial Prosthetic Socket Shape in a Developing Country: A study to compare initial outcomes in Pressure Cast hydrostatic and Patella Tendon Bearing designs. Gait Posture 2017; 58:363-368. [PMID: 28869901 DOI: 10.1016/j.gaitpost.2017.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 07/06/2017] [Accepted: 08/11/2017] [Indexed: 02/02/2023]
Abstract
This study compared the physical function and comfort level of patients with unilateral transtibial amputation after being fitted with a hand-cast Patella Tendon Bearing (PTB) socket and a pressure-cast (PCAST) hydrocast socket. The latter technique aims to reduce the skill dependency currently required for socket manufacture and fit. The study was conducted at the Vietnamese Training Centre for Orthopaedic Technologies and involved seventeen Vietnamese participants with unilateral transtibial amputation, all of whom were long term users of prosthetics. All participants were fitted with two sockets manufactured using both hand-cast and PCAST techniques with International Committee of the Red Cross components. Walking tests (timed up and go test and six-minute-walk-test), spatio-temporal gait analyses and subjective comfort assessments were completed after a short acclimatisation period with each socket. The participant-preferred socket was also noted. No significant differences were found for the measures of mobility, functional capacity, spatio-temporal gait parameters, gait symmetry, perceived comfort or participant socket preference. The results show the initial patient outcomes are similar when participants are fitted with a hand-cast PTB socket and a PCAST hydrocast sockets. Future work should confirm these findings in a longer trial.
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Affiliation(s)
- Sheridan Laing
- The Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Noel Lythgo
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Jim Lavranos
- Department of Prosthetics and Orthotics, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Peter Vee Sin Lee
- The Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia.
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Magnusson L, Ahlström G. Patients' Satisfaction with Lower-limb Prosthetic and Orthotic Devices and Service delivery in Sierra Leone and Malawi. BMC Health Serv Res 2017; 17:102. [PMID: 28143549 PMCID: PMC5286686 DOI: 10.1186/s12913-017-2044-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 01/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with disabilities have the right to personal mobility and available and affordable assistive technology, according to the Convention of Rights of Persons with Disabilities. The aims were to investigate similarities and differences between Sierra Leone and Malawi concerning participants' mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery, and to identify variables associated with patients' satisfaction with assistive devices and associated services in the entire study group from these two low-income countries. METHODS Questionnaires, including QUEST, were answered by 222 patients in Sierra Leone and Malawi. RESULTS Eighty-six per cent of assistive devices were in use, but half needed repair. One third of participants reported pain when using their assistive device. A higher percentage (66%) of participants in Sierra Leone had difficulties or could not walk at all on uneven ground compared with 42% in Malawi. The majority in both countries had difficulties or could not walk at all up and down hills, or on stairs. Participants in both countries were quite satisfied (mean 3.7-3.9 of 5) with their assistive device. Participants were most dissatisfied with: comfort (46%), dimensions (39%), and safety (38%) of their assistive device. In Sierra Leone participants were less satisfied than in Malawi with service delivery (mean 3.7; 4.4, p < .001). Access to repairs and servicing of their assistive device was considered the most important item. In Sierra Leone patients were less satisfied with follow-up services (41%) than patients in Malawi were (22%). The strongest association with satisfaction with assistive device was pain, and for satisfaction with service, country. The general condition of devices and the ability to walk on uneven ground were associated with both satisfaction with assistive devices and service received. CONCLUSIONS Participants reported high levels of use and mobility with their assistive device, in spite of pain and difficulties walking on uneven ground, which were also associated with the level of satisfaction with the assistive device. Access to repairs and follow-up services were the most important to patients, and should be addressed. Country was associated with satisfaction with service, with participants in Sierra Leone significantly less satisfied.
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Affiliation(s)
- Lina Magnusson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O Box 187, SE, 221 00, Lund, Sweden.
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O Box 187, SE, 221 00, Lund, Sweden
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Ikeda AJ, Grabowski AM, Lindsley A, Sadeghi-Demneh E, Reisinger KD. A scoping literature review of the provision of orthoses and prostheses in resource-limited environments 2000-2010. Part two: research and outcomes. Prosthet Orthot Int 2014; 38:343-62. [PMID: 23942758 DOI: 10.1177/0309364613490443] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite the activities of many orthotic and prosthetic provision organizations in resource-limited environments, there is still a great need and there are several areas for improvement, as identified in Part One of this series. OBJECTIVES Our goal was to examine outcomes and conclusions of research studies to produce an evidence base for determining factors that may lead to successful provision of orthoses and prostheses in resource-limited environments. STUDY DESIGN Literature review. METHODS We conducted a scoping literature review of all information related to orthotic and prosthetic provision in resource-limited environments published from 2000 to 2010. We extracted measured outcomes reported in all types of articles and analyzed conclusions from research studies. RESULTS Reported outcomes included durability, cost, satisfaction, use/nonuse of device, amount of utilization, walking speed, discomfort, pain, fit, misalignment, capacity for service provision, number of devices produced or delivered, and number of graduates from training programs. CONCLUSIONS There are many gaps in the evidence base, notably in measuring inclusion, participation, and quality of life for orthosis and prosthesis users in resource-limited environments. There is a paucity of reported outcomes for orthotics. Valid, reliable, and standard methods of data collection and reporting are needed to advance the field and enhance the evidence base.
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Affiliation(s)
- Andrea J Ikeda
- Whirlwind Wheelchair International, San Francisco State University, San Francisco, CA, USA
| | - Alena M Grabowski
- Department of Integrative Physiology University of Colorado Boulder, Boulder, CO, USA Eastern Colorado Healthcare System, U.S. Department of Veterans Affairs, Denver, CO, USA
| | - Alida Lindsley
- Whirlwind Wheelchair International, San Francisco State University, San Francisco, CA, USA
| | - Ebrahim Sadeghi-Demneh
- Musculoskeletal Research Center, Orthotics and Prosthetics Department, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran
| | - Kim D Reisinger
- Whirlwind Wheelchair International, San Francisco State University, San Francisco, CA, USA
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Borg J, Lindström A, Larsson S. Assistive technology in developing countries: a review from the perspective of the Convention on the Rights of Persons with Disabilities. Prosthet Orthot Int 2011; 35:20-9. [PMID: 21515886 DOI: 10.1177/0309364610389351] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The 'Convention on the Rights of Persons with Disabilities' (CRPD) requires governments to meet the assistive technology needs of citizens. However, the access to assistive technology in developing countries is severely limited, which is aggravated by a lack of related services. OBJECTIVES To summarize current knowledge on assistive technology for low- and lower-middle-income countries published in 1995 or later, and to provide recommendations that facilitate implementation of the CRPD. STUDY DESIGN Literature review. METHODS Literature was searched in web-based databases and reference lists. Studies carried out in low- and lower-middle-income countries, or addressing assistive technology for such countries, were included. RESULTS The 52 included articles are dominated by product oriented research on leg prostheses and manual wheelchairs. Less has been published on hearing aids and virtually nothing on the broad range of other types of assistive technology. CONCLUSIONS To support effective implementation of the CRPD in these countries, there is a need for actions and research related particularly to policies, service delivery, outcomes and international cooperation, but also to product development and production. CLINICAL RELEVANCE The article has a potential to contribute to CRPD compliant developments in the provision of assistive technology in developing countries by providing practitioners with an overview of published knowledge and researchers with identified research needs.
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Affiliation(s)
- Johan Borg
- Department of Health Sciences, Lund University, Malmö, Sweden.
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Andrysek J. Lower-limb prosthetic technologies in the developing world: A review of literature from 1994-2010. Prosthet Orthot Int 2010; 34:378-98. [PMID: 21083505 DOI: 10.3109/03093646.2010.520060] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In the mid-1990s, a number of key publications and meetings of experts identified major technical issues associated with prosthetic technologies intended for developing countries. These included inadequate durability of prosthetic feet, poor socket quality and prosthetic fit, improper alignment of prostheses, and inferior function of components. To examine the progress that has been made since then in addressing these issues, a comprehensive review of literature was performed. In total, 106 articles were selected and included in the review. The review examined prosthetic technologies categorized into feet and ankles, knees, sockets and suspension, and materials, structures, and alignment methods. Moreover, publications were categorized as technical development, clinical (lab-based) testing, or clinical field testing studies. The results reveal important work that has been carried out to develop and implement standardized outcome measures during field testing, allowing various existing prosthetic technologies to be evaluated in terms of their use, function, durability, and other factors. Progress has also been made toward addressing the aforementioned limitations of prosthetic technologies, however, more research and development is required. This includes improving the durability of the external cosmetic features of prosthetic feet, developing more functional prosthetic knee joints, and simplifying fabrication techniques to further improve outcomes associated with socket fit and prosthetic alignment. Research and development collaborations between developed and developing countries, and the dissemination of ongoing research, development, and evaluation activities are essential to the advancement of prosthetic technologies in these regions.
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Affiliation(s)
- Jan Andrysek
- Bloorview Kids Rehab, Research Institute, Toronto, Ontario, Canada.
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Jensen JS, Raab W. Clinical field testing of vulcanized Jaipur rubber feet for trans-tibial amputees in low-income countries. Prosthet Orthot Int 2007; 31:105-15. [PMID: 17365891 DOI: 10.1080/03093640701321411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to check out the performance and durability of vulcanized Jaipur rubber feet in tropical areas of the developing world. Forty-one MUKTI and 40 NISHA feet were followed for 16 (8-17) months. The user compliance was high and nearly all were satisfied. Failure of the prosthetic foot with the need for exchange at the end of the study amounted to 27% (22/81), which is equivalent to a mixed series of rubber feet previously reported (Jansen et al. 2006b). Failures were mostly related to skin fracture and gliding between sponge rubber layers of the heel block.
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Affiliation(s)
- J Steen Jensen
- International Society for Prosthetics and Orthotics, Copenhagen, Denmark.
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Jensen JS, Raab W. Clinical field testing of vulcanized Jaipur rubber feet for trans-tibial amputees in low-income countries. Prosthet Orthot Int 2006; 30:225-36. [PMID: 17162513 DOI: 10.1080/03093640600867233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to check out the performance and durability of vulcanized Jaipur rubber feet in tropical areas of the developing world. Forty-one MUKTI and 40 NISHA feet were followed for 16 (8 - 17) months. The user compliance was high and nearly all were satisfied. Failure of the prosthetic foot with the need for exchange at the end of the study amounted to 27% (22/81), which is equivalent to a mixed series of rubber feet previously reported (Jensen et al. 2006b). Failures were mostly related to skin fracture and gliding between sponge rubber layers of the heel block.
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Affiliation(s)
- J Steen Jensen
- International Society for Prosthetics and Orthotics, Copenhagen, Denmark.
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