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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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Towards Management of Residual Limb Volume: Monitoring the Prosthetic Interface Pressure to Detect Volume Fluctuations—A Feasibility Study. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10196841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
(1) Motivation: Variations in the volume of the residual limb negatively impact various aspects of prosthesis use including the prosthetic socket fit. Although volume adjustment systems mitigate corresponding fit problems to some extent, some users still find the management of these systems challenging. With the ultimate goal of creating a feedback system that assists users with the management of their volume adjustment systems, this study demonstrates the feasibility of detecting variations in the volume of the residual limb. (2) Methods: Measurements of the interface force at the bottom of the prosthetic socket were used as indicators of variations in the volume of the residual limb. Force sensitive resistors (FSRs) were placed at the bottom of participants’ prosthetic sockets to monitor the interface limb–socket force as participants walked on a flat surface. Two phases of experiments were carried out: The first phase considered variations simulated by three prosthetic sock plies, established the feasibility of detecting variations in the volume of the limb based on the interface force, and further determined the locations at which the interface force could be used to detect variations in the limb’s volume. Having validated the effectiveness of the proposed method in the first phase, the second phase was carried out to determine the smallest detectable variation of the limb’s volume using the proposed method. In this phase, variations simulated by one and two prosthetic sock plies were considered. Four and three volunteers with transtibial amputations participated in the first and the second phases, respectively. (3) Results: Results of the first phase showed that an increase in the volume of the limb resulted in a decrease in the force measured at the distal location of the prosthetic sockets of all participants; however, the smallest detected variation could not be statistically confirmed.
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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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Naranjo-Hernández D, Reina-Tosina J, Roa LM, Barbarov-Rostán G, Aresté-Fosalba N, Lara-Ruiz A, Cejudo-Ramos P, Ortega-Ruiz F. Smart Bioimpedance Spectroscopy Device for Body Composition Estimation. SENSORS (BASEL, SWITZERLAND) 2019; 20:E70. [PMID: 31877699 PMCID: PMC6983241 DOI: 10.3390/s20010070] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/14/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
Abstract
The purpose of this work is to describe a first approach to a smart bioimpedance spectroscopy device for its application to the estimation of body composition. The proposed device is capable of carrying out bioimpedance measurements in multiple configurable frequencies, processing the data to obtain the modulus and the bioimpedance phase in each of the frequencies, and transmitting the processed information wirelessly. Another novelty of this work is a new algorithm for the identification of Cole model parameters, which is the basis of body composition estimation through bioimpedance spectroscopy analysis. Against other proposals, the main advantages of the proposed method are its robustness against parasitic effects by employing an extended version of Cole model with phase delay and three dispersions, its simplicity and low computational load. The results obtained in a validation study with respiratory patients show the accuracy and feasibility of the proposed technology for bioimpedance measurements. The precision and validity of the algorithm was also proven in a validation study with peritoneal dialysis patients. The proposed method was the most accurate compared with other existing algorithms. Moreover, in those cases affected by parasitic effects the proposed algorithm provided better approximations to the bioimpedance values than a reference device.
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Affiliation(s)
- David Naranjo-Hernández
- Biomedical Engineering Group, University of Seville, 41092 Seville, Spain; (J.R.-T.); (L.M.R.)
| | - Javier Reina-Tosina
- Biomedical Engineering Group, University of Seville, 41092 Seville, Spain; (J.R.-T.); (L.M.R.)
| | - Laura M. Roa
- Biomedical Engineering Group, University of Seville, 41092 Seville, Spain; (J.R.-T.); (L.M.R.)
| | - Gerardo Barbarov-Rostán
- Biomedical Engineering Group, University of Seville, 41092 Seville, Spain; (J.R.-T.); (L.M.R.)
| | - Nuria Aresté-Fosalba
- Nephrology Service of the Virgen Macarena University Hospital in Seville, 41009 Seville, Spain; (N.A.-F.); (A.L.-R.)
| | - Alfonso Lara-Ruiz
- Nephrology Service of the Virgen Macarena University Hospital in Seville, 41009 Seville, Spain; (N.A.-F.); (A.L.-R.)
| | - Pilar Cejudo-Ramos
- Medical-Surgical Unit of Respiratory Diseases, University Hospital Virgen del Rocío, 41013 Seville, Spain; (P.C.-R.); (F.O.-R.)
- Biomedical Research Center in Network (CIBER) of Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - Francisco Ortega-Ruiz
- Medical-Surgical Unit of Respiratory Diseases, University Hospital Virgen del Rocío, 41013 Seville, Spain; (P.C.-R.); (F.O.-R.)
- Biomedical Research Center in Network (CIBER) of Respiratory Diseases (CIBERES), 28029 Madrid, Spain
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Hinrichs P, Cagle JC, Sanders JE. A portable bioimpedance instrument for monitoring residual limb fluid volume in people with transtibial limb loss: A technical note. Med Eng Phys 2019; 68:101-107. [PMID: 31023596 DOI: 10.1016/j.medengphy.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 03/04/2019] [Accepted: 04/03/2019] [Indexed: 10/27/2022]
Abstract
People with transtibial limb loss experience daily changes in volume of their residual limb that affect the fit of their prosthetic socket. A portable instrument was developed to monitor fluid volume changes outside of the laboratory setting. The bioimpedance system applied 26 current bursts per second at frequencies between 3 kHz and 1 MHz, and sensed voltage at up to six channels. Among six voltage-controlled current source circuits and five receive-channel amplifier topologies considered, a differential Howland current pump and a single receive-channel instrumentation amplifier proved the best combination of low noise and low power consumption. Mean RMS errors were 0.07% for extracellular fluid resistance, 2.23% for intracellular fluid resistance, and 1.15% for membrane capacitance.
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Affiliation(s)
- Paul Hinrichs
- Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle WA 98195, United States
| | - John C Cagle
- Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle WA 98195, United States
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle WA 98195, United States.
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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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How Do Socket Size Adjustments during Ambulation Affect Residual Limb Fluid Volume? Case Study Results. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/jpo.0000000000000224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sanders JE, Youngblood RT, Hafner BJ, Cagle JC, McLean JB, Redd CB, Dietrich CR, Ciol MA, Allyn KJ. Effects of socket size on metrics of socket fit in trans-tibial prosthesis users. Med Eng Phys 2017; 44:32-43. [PMID: 28373013 DOI: 10.1016/j.medengphy.2017.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 02/28/2017] [Accepted: 03/05/2017] [Indexed: 11/25/2022]
Abstract
The purpose of this research was to conduct a preliminary effort to identify quantitative metrics to distinguish a good socket from an oversized socket in people with trans-tibial amputation. Results could be used to inform clinical practices related to socket replacement. A cross-over study was conducted on community ambulators (K-level 3 or 4) with good residual limb sensation. Participants were each provided with two sockets, a duplicate of their as-prescribed socket and a modified socket that was enlarged or reduced by 1.8mm (∼6% of the socket volume) based on the fit quality of the as-prescribed socket. The two sockets were termed a larger socket and a smaller socket. Activity was monitored while participants wore each socket for 4 weeks. Participants' gait; self-reported satisfaction, quality of fit, and performance; socket comfort; and morning-to-afternoon limb fluid volume changes were assessed. Visual analysis of plots and estimated effect sizes (measured as mean difference divided by standard deviation) showed largest effects for step time asymmetry, step width asymmetry, anterior and anterior-distal morning-to-afternoon fluid volume change, socket comfort score, and self-reported utility. These variables may be viable metrics for early detection of deterioration in socket fit, and should be tested in a larger clinical study.
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Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, 3720 15th Ave NE, Box 355061, University of Washington, Seattle WA 98195-5061, United States.
| | - Robert T Youngblood
- Department of Bioengineering, 3720 15th Ave NE, Box 355061, University of Washington, Seattle WA 98195-5061, United States
| | - Brian J Hafner
- Department of Rehabilitation Medicine, 1959 NE Pacific Street, Box 356490, University of Washington, Seattle, WA 98195-6490, United States
| | - John C Cagle
- Department of Bioengineering, 3720 15th Ave NE, Box 355061, University of Washington, Seattle WA 98195-5061, United States
| | - Jake B McLean
- Department of Bioengineering, 3720 15th Ave NE, Box 355061, University of Washington, Seattle WA 98195-5061, United States
| | - Christian B Redd
- Department of Bioengineering, 3720 15th Ave NE, Box 355061, University of Washington, Seattle WA 98195-5061, United States
| | - Colin R Dietrich
- Department of Bioengineering, 3720 15th Ave NE, Box 355061, University of Washington, Seattle WA 98195-5061, United States
| | - Marcia A Ciol
- Department of Rehabilitation Medicine, 1959 NE Pacific Street, Box 356490, University of Washington, Seattle, WA 98195-6490, United States
| | - Katheryn J Allyn
- Department of Bioengineering, 3720 15th Ave NE, Box 355061, University of Washington, Seattle WA 98195-5061, United States
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Sanders JE, Hartley TL, Phillips RH, Ciol MA, Hafner BJ, Allyn KJ, Harrison DS. Does temporary socket removal affect residual limb fluid volume of trans-tibial amputees? Prosthet Orthot Int 2016; 40:320-8. [PMID: 25710944 PMCID: PMC4601934 DOI: 10.1177/0309364614568413] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/03/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lower-limb prosthesis users typically experience residual limb volume losses over the course of the day that can detrimentally affect socket fit. OBJECTIVES To determine whether temporarily doffing the prosthesis encouraged residual limb fluid volume recovery and whether the recovered fluid was maintained. STUDY DESIGN Experimental design. METHODS Residual limb fluid volume was monitored on 16 participants in three test sessions each. Participants conducted six cycles of resting/standing/walking. Between the third and fourth cycles, participants sat for 30 min with the prosthesis and liner: donned (ON), the prosthesis doffed but the liner donned (LINER), or the prosthesis and liner doffed (OFF). RESULTS Percentage fluid volume gain and retention were greatest for the OFF condition followed by the LINER condition. Participants experienced fluid volume losses for the ON condition. CONCLUSION Doffing the prosthesis or both the prosthesis and liner during rest improved residual limb fluid volume retention compared with leaving the prosthesis and liner donned. CLINICAL RELEVANCE Practitioners should advise patients who undergo high daily limb volume losses to consider temporarily doffing their prosthesis. Fluid volume retention during subsequent activity will be highest if both the prosthesis and liner are doffed.
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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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