A systematic review in prosthetics and orthotics education research

Vision-based motion capture for the gait analysis of neurodegenerative diseases: A review

BACKGROUND

Developments in vision-based systems and human pose estimation algorithms have the potential to detect, monitor and intervene early on neurodegenerative diseases through gait analysis. However, the gap between the technology available and actual clinical practice is evident as most clinicians still rely on subjective observational gait analysis or objective marker-based analysis that is time-consuming.

RESEARCH QUESTION

This paper aims to examine the main developments of vision-based motion capture and how such advances may be integrated into clinical practice.

METHODS

The literature review was conducted in six online databases using Boolean search terms. A commercial system search was also included. A predetermined methodological criterion was then used to assess the quality of the selected articles.

RESULTS

A total of seventeen studies were evaluated, with thirteen studies focusing on gait classification systems and four studies on gait measurement systems. Of the gait classification systems, nine studies utilized artificial intelligence-assisted techniques, while four studies employed statistical techniques. The results revealed high correlations of gait features identified by classifier models with existing clinical rating scales. These systems demonstrated generally high classification accuracies and were effective in diagnosing disease severity levels. Gait measurement systems that extract spatiotemporal and kinematic joint information from video data generally found accurate measurements of gait parameters with low mean absolute errors, high intra- and inter-rater reliability.

SIGNIFICANCE

Low cost, portable vision-based systems can provide proof of concept for the quantification of gait, expansion of gait assessment tools, remote gait analysis of neurodegenerative diseases and a point of care system for orthotic evaluation. However, certain challenges, including small sample sizes, occlusion risks, and selection bias in training models, need to be addressed. Nevertheless, these systems can serve as complementary tools, equipping clinicians with essential gait information to objectively assess disease severity and tailor personalized treatment for enhanced patient care.

Experiences of persons with lower limb amputation after prosthetic rehabilitation in Ghana: A qualitative inquiry

BACKGROUND

Lower limb amputations (LLAs) have long been associated with physical, social, and psychological consequences. Individuals with LLAs have challenges with mobility and often become isolated from their social networks. Disability rehabilitation technologies such as prosthetic devices are used to improve the mobility capabilities of lower limb amputees. To improve clinical outcomes, feedback from the prosthetic users is a key element to consider.

OBJECTIVES

The study sort to explore the experiences of lower-limb prosthetic users after prosthetic rehabilitation in a prosthetic and orthotic rehabilitation center in the Eastern Region of Ghana.

STUDY DESIGN

This study adopted an exploratory descriptive qualitative study design.

METHODS

A purposive sampling technique and semistructured interview guide was used to interview 17 participants by the first author. The social model of disability underpinned the study. Lower-limb prosthetic users (≥18 years) with unilateral LLA attending outpatient follow-up at a prosthetic and orthotic rehabilitation center were recruited. The interviews were audio recoded, transcribed verbatim, and analyzed using the procedure for thematic content analysis by Braun and Clarke (2013).

RESULTS

Participants reported injuries and tingling in their residual limb. Internal stigma resulting from negative comments and labeling from the public were reported. Prosthetic users experienced empathy and being treated as weaklings by their family/peers. Participants avoided relationships because of recurrent rejection, embarrassment, fear of sexual abuse, and exploitation. As a coping method, some participants chose to isolate themselves to avoid humiliation and public disgrace. Other coping mechanisms included watching television, listening to music, conversing with others, ignoring criticism, and having faith in God.

CONCLUSION

Participants' narrative in this study gave insight into the varied lived experiences on the individual level, family/peer level, and the coping mechanisms used. Challenges relating to discomfort from the prosthesis, internal stigma, relationship avoidance, and altered sexual life should be given much attention and used in implementing initiatives to improve clinical outcomes.

Development of a proposed organizational framework for undergraduate research training in prosthetics and orthotics education

BACKGROUND

An undergraduate research project gives prosthetic and orthotic (P&O) students the chance to acquire both foundational research knowledge and in-depth knowledge in a specific area of interest in P&O research. Undergraduates frequently enter the field of research with less experience or understanding of research instruments, presenting them with significant obstacles when conducting research.

OBJECTIVE

This study's objective was to establish a framework for undergraduate research training in prosthetics and orthotics education.

METHODS

Using narrative qualitative methodology, 4 successive phases of research were conducted. Phase I: A document analysis was conducted to determine the presence of research training in Thailand's undergraduate P&O curriculum taught in 2021; phase II: document analysis of student P&O program feedback reports using manifest content analysis; phase III: strengths, weaknesses, opportunities, and threats analysis of lecturer P&O program feedback reports; and phase IV: data sets from phases I, II, and III were applied to the formulation of a unifying framework. Using grounded theory's three-stage thematic analysis-open, axial, and selective coding-data were analyzed.

CONCLUSIONS

The novel organizational research framework is presented as the result and conclusion of the study. The framework for enhancing this important foundational research program at the undergraduate level was derived through discussion with colleagues and based on the results and discussion from this investigation. Although the framework for undergraduate research training was designed for use by the undergraduate prosthetics and orthotics program in Thailand, it is believed to be applicable and relevant to P&O education worldwide.

Determining educational assessment criteria for patellar-tendon-bearing impressions for transtibial prosthetic sockets: A Delphi study

BACKGROUND

Validated criteria to guide assessment of student performance in clinical tasks in prosthetics and orthotics education have not been established. Lack of established criteria and assessment methods presents challenges in evaluating student performance on clinical tasks, such as taking impressions for patellar-tendon-bearing (PTB) sockets.

OBJECTIVES

To establish assessment criteria for the PTB impression process for use in educational settings.

STUDY DESIGN

Delphi consensus process.

METHODS

Initial Delphi survey items were based on interviews with prosthetic instructors and focus groups with prosthetic students. Expert prosthetic educators were then identified by purposive sampling to complete multiple-round Internet-based Delphi surveys. The Delphi surveys asked experts to indicate their level of agreement on various assessment methods and criteria in PTB education. Consensus for survey items was reviewed after each survey round and used to determine the content of and need for subsequent rounds.

RESULTS

Fourteen experts completed two Delphi survey rounds. Items were categorized into educational materials/strategies, impression stages/materials, measurement tools, measurements taken, assessment during impression, assessment after impression, feedback, student self-assessment, and grading. In two survey rounds, 40 items guiding assessment methods and criteria for PTB impressions achieved 80% consensus.

CONCLUSIONS

A high level of consensus was achieved in two survey rounds. Lower levels of consensus were reached on specific objective criteria, such as use of measurement thresholds when evaluating student impressions. Standardized assessment of student performance on PTB impression-taking instead relies primarily on qualitative assessments based on instructor expertise.

Understanding the adoption of digital workflows in orthotic & prosthetic practice from practitioner perspectives: a qualitative descriptive study

BACKGROUND

The implementation of digital technology (DT) in orthotics and prosthetics (O&P) has been slow despite recent research suggesting that the use of DT will continue to grow and become more prevalent within the industry. There is a need to further investigate DT in O&P practice and the current state of its use in the field.

OBJECTIVE

This study aimed to explore the views and experiences of practitioners using DT workflows in their O&P practice.

METHODS

In this qualitative descriptive study, 10 in-depth, semistructured interviews with O&P practitioners were conducted. A content analysis was performed to analyze the transcripts and identify key themes from the data.

RESULTS

The study examined the experiences of practitioners using or trying to use DT in their practices, and three key themes were identified on the implementation of digital practice: 1) technological advancement and scientific evidence; 2) marketplace, economic, and operational factors; and 3) industry mindset shift in embracing DT practice.

CONCLUSION

A collaborative effort involving academia, healthcare institutions, vendors, and individual practitioners will be required to facilitate the widespread adoption of DT in O&P. More work is required to overcome challenges from the technical, logistical, and cultural aspects.

An insight into Transfemoral Prostheses: Materials, modelling, simulation, fabrication, testing, clinical evaluation and performance perspectives

INTRODUCTION

A Transfemoral prosthesis restores any limb amputated above the knee. Designing and developing a transfemoral prosthesis that is consistent with human performance is a tough task. While prosthetic components are widely available in the market, ongoing research is being conducted to develop parts that would restore the lost capability, taking into account numerous social, economic and technological considerations.

AREAS COVERED

The present paper provides a comprehensive review about the mechanical aspects and performance of transfemoral prosthesis in recent years based on the research findings on materials, manufacturing methods and evaluations for suitability of the prostheses. The fundamental terminologies as well as technical advancements are covered in order to impart a better knowledge in the area of Lower Limb prostheses. This review also provides a concise description on the role of computers, advanced software packages, sensors and other hardware components for the design, fabrication and testing of transfemoral prosthetic devices in the current environment.

EXPERT OPINION

The current state of lower limb prostheses and future research opportunities are summarised to address upcoming challenges. Based on survey of various research works, adapting modern technology may aid in the development of functional and cost-efficient prosthetic components with superior safety, comfort and quality.

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Education in prosthetic and orthotic training: Looking back 50 years and moving forward

There is a long history of prosthetic and orthotic services helping to mitigate the impact of physical impairment by restoring function, and enabling and equipping the user. The training of health professionals who design, fit, and maintain prosthetic and orthotic devices has evolved over the centuries, reflecting an increase in knowledge, technology, understanding, and social attitudes in each era. Improvements in pedagogical thinking and biomechanical understanding, as well as the advent of new integrated technologies, have driven the profession over the past 50 years to modernize, evolve training and service delivery models in line with new attitudes toward clients, and search for new ways to improve users' quality of life. In this narrative review, the authors examined the evolution of prosthetic and orthotic education, the impact of changing educational techniques and technologies, and the impact of the International Society for Prosthetics and Orthotics in that process. Through conversations with experts and review of peer-reviewed literature, accreditation documents, and the International Society for Prosthetics and Orthotics records and databases, the authors identified three areas of change in prosthetics and orthotics education over the past 50 years: (1) prosthetic/orthotic curriculum content, (2) pedagogy and course delivery, and (3) internships/residencies. This narrative review is a snapshot of a growing profession and we can only speculate where the next 50 years will lead us as we strive to serve patients, ever placing their needs and aspirations at the center of this professional service.