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van der Stelt M, Berends B, Papenburg M, Langenhuyzen T, Maal T, Brouwers L, de Jong G, Leijendekkers R. Evaluating the Effectiveness of Transtibial Prosthetic Socket Shape Design using Artificial Intelligence: A Clinical Comparison with Traditional Plaster Cast Socket Designs. Arch Phys Med Rehabil 2024:S0003-9993(24)01233-4. [PMID: 39304077 DOI: 10.1016/j.apmr.2024.08.026] [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: 12/12/2023] [Revised: 06/10/2024] [Accepted: 08/20/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE This study investigates the feasibility of creating an AI algorithm to enhance prosthetic socket shapes for transtibial prostheses, aiming for a less operator-dependent, standardized approach. DESIGN The study comprised two phases: first, developing an AI algorithm in a cross-sectional study to predict prosthetic socket shapes. Second, testing the AI-predicted Digitally Measured and Standardized Designed (DMSD-)prosthetic socket against a Manually Measured and Designed (MMD-)prosthetic socket in a two-week within-subject cross-sectional study. SETTING The study was done at the rehabilitation department of the Radboud University Medical Center in Nijmegen, the Netherlands. PARTICIPANTS The AI algorithm was developed using retrospective data from 116 patients from a Dutch orthopedic company: OIM Orthopedie, and tested on ten randomly selected participants from Papenburg Orthopedie. INTERVENTIONS Utilization of an AI algorithm to enhance the shape of a transtibial prosthetic socket. MAIN OUTCOME MEASURES The algorithm was optimized to minimize the error in the test set. Participants' Socket Comfort Score (SCS) and fitting ratings from an independent physiotherapist and prosthetist were collected. RESULTS Predicted prosthetic shapes deviated by 2.51 mm from the actual designs. 8/10 DMSD and all 10 MMD-prosthetic sockets were satisfactory for home testing. Participants rated DMSD prosthetic sockets at 7.1 ± 2.2 (n=8) and MMD prosthetic sockets at 6.6 ± 1.2 (n=10) on average. CONCLUSION The study demonstrates promising results for using an AI algorithm in prosthetic socket design, but long-term effectiveness and refinement for improved comfort and fit in more deviant cases are necessary.
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Affiliation(s)
- Merel van der Stelt
- 3D Lab Radboudumc, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Bo Berends
- 3D Lab Radboudumc, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Thomas Maal
- 3D Lab Radboudumc, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lars Brouwers
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido de Jong
- 3D Lab Radboudumc, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruud Leijendekkers
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Plesec V, Harih G. Bioinspired Design of 3D-Printed Cellular Metamaterial Prosthetic Liners for Enhanced Comfort and Stability. Biomimetics (Basel) 2024; 9:540. [PMID: 39329562 PMCID: PMC11430568 DOI: 10.3390/biomimetics9090540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/29/2024] [Accepted: 09/04/2024] [Indexed: 09/28/2024] Open
Abstract
Traditional prosthetic liners are often limited in customization due to constraints in manufacturing processes and materials. Typically made from non-compressible elastomers, these liners can cause discomfort through uneven contact pressures and inadequate adaptation to the complex shape of the residual limb. This study explores the development of bioinspired cellular metamaterial prosthetic liners, designed using additive manufacturing techniques to improve comfort by reducing contact pressure and redistributing deformation at the limb-prosthesis interface. The gyroid unit cell was selected due to its favorable isotropic properties, ease of manufacturing, and ability to distribute loads efficiently. Following the initial unit cell identification analysis, the results from the uniaxial compression test on the metamaterial cellular samples were used to develop a multilinear material model, approximating the response of the metamaterial structure. Finite Element Analysis (FEA) using a previously developed generic limb-liner-socket model was employed to simulate and compare the biomechanical behavior of these novel liners against conventional silicone liners, focusing on key parameters such as peak contact pressure and liner deformation during donning, heel strike, and the push-off phase of the gait cycle. The results showed that while silicone liners provide good overall contact pressure reduction, cellular liners offer superior customization and performance optimization. The soft cellular liner significantly reduced peak contact pressure during donning compared to silicone liners but exhibited higher deformation, making it more suitable for sedentary individuals. In contrast, medium and hard cellular liners outperformed silicone liners for active individuals by reducing both contact pressure and deformation during dynamic gait phases, thereby enhancing stability. Specifically, a medium-density liner (10% infill) balanced contact pressure reduction with low deformation, offering a balance of comfort and stability. The hard cellular liner, ideal for high-impact activities, provided superior shape retention and support with lower liner deformation and comparable contact pressures to silicone liners. The results show that customizable stiffness in cellular metamaterial liners enables personalized design to address individual needs, whether focusing on comfort, stability, or both. These findings suggest that 3D-printed metamaterial liners could be a promising alternative to traditional prosthetic materials, warranting further research and clinical validation.
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Affiliation(s)
- Vasja Plesec
- Laboratory for Integrated Product Development and CAD, Faculty of Mechanical Engineering, University of Maribor, 2000 Maribor, Slovenia
| | - Gregor Harih
- Laboratory for Integrated Product Development and CAD, Faculty of Mechanical Engineering, University of Maribor, 2000 Maribor, Slovenia
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AlQahtani NJ, Al-Naib I, Althobaiti M. Recent progress on smart lower prosthetic limbs: a comprehensive review on using EEG and fNIRS devices in rehabilitation. Front Bioeng Biotechnol 2024; 12:1454262. [PMID: 39253705 PMCID: PMC11381415 DOI: 10.3389/fbioe.2024.1454262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/19/2024] [Indexed: 09/11/2024] Open
Abstract
The global rise in lower limb amputation cases necessitates advancements in prosthetic limb technology to enhance the quality of life for affected patients. This review paper explores recent advancements in the integration of EEG and fNIRS modalities for smart lower prosthetic limbs for rehabilitation applications. The paper synthesizes current research progress, focusing on the synergy between brain-computer interfaces and neuroimaging technologies to enhance the functionality and user experience of lower limb prosthetics. The review discusses the potential of EEG and fNIRS in decoding neural signals, enabling more intuitive and responsive control of prosthetic devices. Additionally, the paper highlights the challenges, innovations, and prospects associated with the incorporation of these neurotechnologies in the field of rehabilitation. The insights provided in this review contribute to a deeper understanding of the evolving landscape of smart lower prosthetic limbs and pave the way for more effective and user-friendly solutions in the realm of neurorehabilitation.
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Affiliation(s)
- Nouf Jubran AlQahtani
- Biomedical Engineering Department, College of Engineering, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ibraheem Al-Naib
- Bioengineering Department, King Fahd University of Petroleum & Minerals, Dhahran, Saudi Arabia
- Interdisciplinary Research Center for Communication Systems and Sensing, King Fahd University of Petroleum & Minerals, Dhahran, Saudi Arabia
| | - Murad Althobaiti
- Biomedical Engineering Department, College of Engineering, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Dickinson AS, Steer JW, Rossides C, Diment LE, Mbithi FM, Bramley JL, Hannett D, Blinova J, Tankard Z, Worsley PR. Insights into the spectrum of transtibial prosthetic socket design from expert clinicians and their digital records. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1354069. [PMID: 39071770 PMCID: PMC11272479 DOI: 10.3389/fresc.2024.1354069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/25/2024] [Indexed: 07/30/2024]
Abstract
Background Transtibial prosthetic sockets are often grouped into patella tendon bearing (PTB) or total surface bearing (TSB) designs, but many variations in rectifications are used to apply these principles to an individual's personalised socket. Prosthetists currently have little objective evidence to assist them as they make design choices. Aims To compare rectifications made by experienced prosthetists across a range of patient demographics and limb shapes to improve understanding of socket design strategies. Methodology 163 residual limb surface scans and corresponding CAD/CAM sockets were analysed for 134 randomly selected individuals in a UK prosthetics service. This included 142 PTB and 21 TSB designs. The limb and socket scans were compared to determine the location and size of rectifications. Rectifications were compiled for PTB and TSB designs, and associations between different rectification sizes were assessed using a variety of methods including linear regression, kernel density estimation (KDE) and a Naïve Bayes (NB) classification. Results Differences in design features were apparent between PTB and TSB sockets, notably for paratibial carves, gross volume reduction and distal end elongation. However, socket designs varied across a spectrum, with most showing a hybrid of the PTB and TSB principles. Pairwise correlations were observed between the size of some rectifications (e.g., paratibial carves; fibular head build and gross volume reduction). Conversely, the patellar tendon carve depth was not associated significantly with any other rectification, indicating its relative design insensitivity. The Naïve Bayes classifier produced design patterns consistent with expert clinician practice. For example, subtle local rectifications were associated with a large volume reduction (i.e., a TSB-like design), whereas more substantial local rectifications (i.e., a PTB-like design) were associated with a low volume reduction. Clinical implications This study demonstrates how we might learn from design records to support education and enhance evidence-based socket design. The method could be used to predict design features for newly presenting patients, based on categorisations of their limb shape and other demographics, implemented alongside expert clinical judgement as smart CAD/CAM design templates.
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Affiliation(s)
- A. S. Dickinson
- Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - J. W. Steer
- Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
- Radii Devices Ltd., Bristol, United Kingdom
| | - C. Rossides
- Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
- Radii Devices Ltd., Bristol, United Kingdom
| | - L. E. Diment
- Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - F. M. Mbithi
- Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - J. L. Bramley
- Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
- Radii Devices Ltd., Bristol, United Kingdom
| | - D. Hannett
- Opcare Ltd., Oxfordshire, United Kingdom
| | - J. Blinova
- Opcare Ltd., Oxfordshire, United Kingdom
| | - Z. Tankard
- Opcare Ltd., Oxfordshire, United Kingdom
| | - P. R. Worsley
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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Paternò L, Truppa L, Ibrahimi M, Rosini E, Gruppioni E, Ricotti L, Menciassi A. Quantitative analysis of interface pressures in transfemoral prosthetic sockets. Prosthet Orthot Int 2024; 48:176-183. [PMID: 37379468 PMCID: PMC11005673 DOI: 10.1097/pxr.0000000000000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/16/2023] [Accepted: 05/12/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Among the different factors affecting socket comfort, the pressure applied on residual limb tissues is a crucial parameter for the success or failure of any prosthetic device. However, only a few incomplete data are available on people with transfemoral amputation, in this regard. This work aims at filling this gap in the literature. METHODS Ten people with transfemoral amputation wearing 3 different socket designs were recruited in this study: 2 ischial containment sockets featured by proximal trim lines that contain the ischial tuberosity and ramus and greater trochanter, 2 subischial sockets with proximal trim lines under the ischium level, and 6 quadrilateral sockets with proximal trim lines that contain the greater trochanter and create a horizontal seat for the ischial tuberosity. The pressure values at the anterior, lateral, posterior, and medial areas of the socket interface were recorded during 5 locomotion tasks (ie, horizontal, ascent, and descent walking, upstairs and downstairs) by using an F-Socket System (Tekscan Inc., Boston, MA). Gait segmentation was performed by exploiting plantar pressure, which was acquired by an additional sensor under the foot. Mean and standard deviation of minimum and maximum values were calculated for each interface area, locomotion task, and socket design. The mean pressure patterns during different locomotion tasks were reported, as well. RESULTS Considering all subjects irrespective of socket design, the mean pressure range resulted 45.3 (posterior)-106.7 (posterior) kPa in horizontal walking; 48.3 (posterior)-113.8 (posterior) kPa in ascent walking; 50.8 (posterior)-105.7 (posterior) kPa in descent walking; 47.9 (posterior)-102.9 (lateral) kPa during upstairs; and 41.8 (posterior)-84.5 (anterior) kPa during downstairs. Qualitative differences in socket designs have been found. CONCLUSIONS These data allow for a comprehensive analysis of pressures acting at the tissue-socket interface in people with transfemoral amputation, thus offering essential information for the design of novel solutions or to improve existing ones, in this field.
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Affiliation(s)
- Linda Paternò
- The BioRobotics Institute—Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Luigi Truppa
- The BioRobotics Institute—Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Michele Ibrahimi
- The BioRobotics Institute—Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Elisa Rosini
- The BioRobotics Institute—Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | | | - Leonardo Ricotti
- The BioRobotics Institute—Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Arianna Menciassi
- The BioRobotics Institute—Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
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Reuvekamp H, Hekman E, van der Heide E, Matthews D. Strategies in surface engineering for the regulation of microclimates in skin-medical product interactions. Heliyon 2024; 10:e25395. [PMID: 38370189 PMCID: PMC10869805 DOI: 10.1016/j.heliyon.2024.e25395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/17/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
There is a growing number of personal healthcare devices that are in prolonged contact with the skin. The functionality of these products is linked to the interface formed by the contact between the medical apparatus and the skin. The interface can be characterised by its topology, compliance, and moisture and thermal regulating capabilities. Many devices are, however, described to have suboptimal and occlusive contacts, resulting in physiological unfavourable microclimates at the interface. The resulting poor management of moisture and temperature can impact the functionality and utility of the device and, in severe cases, lead to physical harm to the user. Being able to control the microclimate is therefore expected to limit medical-device related injuries and prevent associated skin complications. Surface engineering can modify and potentially enhance the regulation of the microclimate factors surrounding the interface between a product's surface and the skin. This review provides an overview of potential engineering solutions considering the needs for, and influences on, regulation of temperature and moisture by considering the skin-medical device interface as a system. These findings serve as a platform for the anticipated progress in the role of surface engineering for skin-device microclimate regulation.
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Affiliation(s)
- H. Reuvekamp
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - E.E.G. Hekman
- Biomedical Device Design and Production Lab, Department of Biomechanical Engineering (BE), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - E. van der Heide
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - D.T.A. Matthews
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
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Arnstein T, Buis A. Methodology to Investigate Effect of Prosthetic Interface Design on Residual Limb Soft Tissue Deformation. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2024; 6:42196. [PMID: 38873008 PMCID: PMC11168601 DOI: 10.33137/cpoj.v6i1.42196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/10/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Residual limb discomfort and injury is a common experience for people living with lower limb amputation. Frequently, inadequate load distribution between the prosthetic device and the residual limb is the root cause of this issue. To advance our understanding of prosthetic interface fit, tools are needed to evaluate the mechanical interaction at the prosthetic interface, allowing interface designs to be evaluated and optimised. OBJECTIVE Present a methodology report designed to facilitate comprehension of the mechanical interaction between the prosthetic interface and the residual limb. As a pilot study, this methodology is used to compare a hands-on and hands-off interface for a single transtibial prosthesis user using secondary Magnetic Resonance Imaging (MRI) data. METHODOLOGY MRI data of the residual limb while wearing a prosthetic interface is segmented into a hard tissue and a skin surface model. These models are exported as stereolithography (STL) files. Two methods are used to analyse the interface designs. Firstly, CloudCompare software is used to compute the nearest vertex on the skin surface for every vertex on the compiled internal bony surface for both interface types. Secondly, CloudCompare software is used to compare registered skin surfaces of the residual limb while wearing the hands-on and hands-off interfaces. FINDINGS The maximum and minimum nearest distances between the internal bony surface and skin surface were similar between interface types. However, the distribution of nearest distances was different. When comparing the skin surface while wearing both interfaces, where the fit is more compressive can be visualized. For the dataset used in this study, the classic features of a hands-on Patella Tendon Bearing interface and hands-off pressure cast interface could be identified. CONCLUSION The methodology presented in this report may give researchers a further tool to better understand how interface designs affect the soft tissues of the residual limb.
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Affiliation(s)
- T Arnstein
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, Scotland
| | - A Buis
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, Scotland
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Eshraghi A, Phillips C, Heim W. Business practices efficiency: Impact of integrating digital technology on clinical P&O practices. Prosthet Orthot Int 2023; 47:621-624. [PMID: 37395754 DOI: 10.1097/pxr.0000000000000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 04/23/2023] [Indexed: 07/04/2023]
Abstract
Additive manufacturing (AM) is on the path to transforming the approach to Prosthetics and Orthotics (P&O) manufacturing. Although digitalization of limbs and other body parts is not new to the field, it has not been widely accepted by the industry for various reasons. However, the reliability and precision that AM can attain, and the availability of various materials is improving rapidly. This professional opinion article discusses the ways that AM has changed P&O services, with a specific focus on prosthetic socket manufacturing. Digitalizing P&O services will eventually change the business model used in clinics, which is further explored here.
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Affiliation(s)
- Arezoo Eshraghi
- Prosthetic and Orthotic Services, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Clara Phillips
- Biomedical Engineering Department, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Winfried Heim
- Prosthetic and Orthotic Services, West Park Healthcare Centre, Toronto, Ontario, Canada
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Shi QQ, Yick KL, Wu J, Huang X, Tse CY, Chan MK. A Scientometric Analysis and Visualization of Prosthetic Foot Research Work: 2000 to 2022. Bioengineering (Basel) 2023; 10:1138. [PMID: 37892868 PMCID: PMC10604169 DOI: 10.3390/bioengineering10101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
This study aims to highlight recent research work on topics around prosthetic feet through a scientometric analysis and historical review. The most cited publications from the Clarivate Analytics Web of Science Core Collection database were identified and analyzed from 1 January 2000 to 31 October 2022. Original articles, reviews with full manuscripts, conference proceedings, early access documents, and meeting abstracts were included. A scientometric visualization analysis of the bibliometric information related to the publications, including the countries, institutions, journals, references, and keywords, was conducted. A total of 1827 publications met the search criteria in this study. The related publications grouped by year show an overall trend of increase during the two decades from 2000 to 2022. The United States is ranked first in terms of overall influence in this field (n = 774). The Northwestern University has published the most papers on prosthetic feet (n = 84). Prosthetics and Orthotics International has published the largest number of studies on prosthetic feet (n = 151). During recent years, a number of studies with citation bursts and burst keywords (e.g., diabetes, gait, pain, and sensor) have provided clues on the hotspots of prosthetic feet and prosthetic foot trends. The findings of this study are based on a comprehensive analysis of the literature and highlight the research topics on prosthetic feet that have been primarily explored. The data provide guidance to clinicians and researchers to further studies in this field.
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Affiliation(s)
- Qiu-Qiong Shi
- Laboratory for Artificial Intelligence in Design, Hong Kong, China;
| | - Kit-Lun Yick
- Laboratory for Artificial Intelligence in Design, Hong Kong, China;
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China;
| | - Jinlong Wu
- College of Physical Education, Southwest University, Chongqing 400715, China;
| | - Xujia Huang
- School of Recreational Sports and Tourism, Beijing Sport University, Beijing 100084, China;
| | - Chi-Yung Tse
- Centre for Orthopaedic Surgery, Hong Kong, China;
| | - Mei-Ki Chan
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China;
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Deisenhofer J, Greitemann B, Putz C, Horsch A, Wolf M, Mick P, Renkawitz T, Alimusaj M. [Possibilities of orthopedic technical care for extremity lengthening and reconstruction]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:756-766. [PMID: 37491653 DOI: 10.1007/s00132-023-04424-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Orthopedic technical care plays a crucial role in improving function and mobility for patients undergoing limb lengthening and reconstruction. The treatment strategy is based on a precise classification of the defect, taking into account factors such as joint instability, muscle pathology and limb length discrepancy. CHOICE OF AIDS The selection of orthopedic aids depends on the specific deformity, its classification and the individual needs of the patient. Through interdisciplinary decision-making and customized adaptations of prostheses and orthoses, optimal function and aesthetically pleasing outcomes can be achieved. The utilization of custom-made technical components, such as traction devices combined with elastic liners, is essential for long-term treatment success and can support surgical interventions. The treating physician's expertise is crucial in selecting the appropriate orthopedic technical device following limb lengthening and reconstruction.
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Affiliation(s)
- Julian Deisenhofer
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | | | - Cornelia Putz
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Axel Horsch
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Matthias Wolf
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Paul Mick
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Tobias Renkawitz
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Merkur Alimusaj
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
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Armitage L, Cho K, Sariyildiz E, Buller A, O’Brien S, Kark L. Validation of a Custom Interface Pressure Measurement System to Improve Fitting of Transtibial Prosthetic Check Sockets. SENSORS (BASEL, SWITZERLAND) 2023; 23:3778. [PMID: 37050838 PMCID: PMC10099032 DOI: 10.3390/s23073778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 06/19/2023]
Abstract
Achievement of fit between the residual limb and prosthetic socket during socket manufacture is a priority for clinicians and is essential for safety. Clinicians have recognised the potential benefits of having a sensor system that can provide objective socket-limb interface pressure measurements during socket fitting, but the cost of existing systems makes current technology prohibitive. This study will report on the characterisation, validation and preliminary clinical implementation of a low cost, portable, wireless sensor system designed for use during socket manufacture. Characterisation and benchtop testing demonstrated acceptable accuracy, behaviour at variable temperature, and dynamic response for use in prosthetic socket applications. Our sensor system was validated with simultaneous measurement by a commercial sensor system in the sockets of three transtibial prosthesis users during a fitting session in the clinic. There were no statistically significant differences between the sensor system and the commercial sensor for a variety of functional activities. The sensor system was found to be valid in this clinical context. Future work should explore how pressure data relates to ratings of fit and comfort, and how objective pressure data might be used to assist in clinical decision making.
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Affiliation(s)
- Lucy Armitage
- School of Mechanical, Materials, Mechatronic and Biomedical Engineering, University of Wollongong, Wollongong, NSW 2522, Australia
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2052, Australia
| | - Kenny Cho
- School of Mechanical, Materials, Mechatronic and Biomedical Engineering, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Emre Sariyildiz
- School of Mechanical, Materials, Mechatronic and Biomedical Engineering, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Angela Buller
- Orthopaedic Appliances, Pty, Ltd. (OAPL), Alexandria, NSW 2015, Australia
| | - Stephen O’Brien
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2052, Australia
| | - Lauren Kark
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2052, Australia
- Tyree Foundation Institute of Health Engineering, University of New South, Sydney, NSW 2052, Australia
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12
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Armitage L, McDonald KA, Kark L, Buller A, Ford B. Transtibial prosthetic socket fitting: Australian prosthetist perspectives on primary challenges, management strategies, and opportunities for workflow and technological innovation. Prosthet Orthot Int 2023; 47:194-203. [PMID: 36112475 DOI: 10.1097/pxr.0000000000000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Following transtibial amputation, a custom-built socket is the most common interface between the prosthesis and residual limb. Desire from both prosthetists and prosthesis users for improved socket fitting processes have been well documented. However, there is currently limited information available about prosthetists' experiences of how prosthetic manufacturing workflow can contribute to socket fit problems. OBJECTIVES This study aims to determine how socket fit problems are currently detected and managed by prosthetists and to identify challenges, management strategies, and opportunities for workflow and technological innovation during prosthesis manufacture and socket fitting. STUDY DESIGN Mixed-method (quantitative and qualitative) survey. METHODS An online survey was developed and piloted in consultation with members of the Australian Orthotic Prosthetic Association. The final 25-question survey was distributed through their membership database. Mixed methods were used to analyze survey items. Qualitative items were grouped and coded under themes relating to challenges, management strategies, and opportunities. Quantitative data were analyzed using nonparametric descriptive methods. RESULTS Twenty-three respondents with a range of experience completed the survey. Seven of eight major Australian states/territories were represented. Primary workflow stages presenting challenges with limited strategies/solutions available to the prosthetists were roll-on liner selection, mold or cast modifications, communication with the client, and check socket fitting. Suggested solutions included improved socket-limb interface monitoring technology. CONCLUSIONS This study provides the first insights into prosthetist-identified challenges and limitations at different stages of the socket workflow and presents a starting point for more targeted research into innovation that may assist in these processes.
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Affiliation(s)
- Lucy Armitage
- School of Mechanical, Materials and Mechatronic Engineering, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kirsty A McDonald
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Lauren Kark
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Angela Buller
- Orthopaedic Appliances Pty. Ltd, Sydney, New South Wales, Australia
| | - Belinda Ford
- Health Systems Science, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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13
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Frossard L, Langton C, Perevoshchikova N, Feih S, Powrie R, Barrett R, Lloyd D. Next-generation devices to diagnose residuum health of individuals suffering from limb loss: A narrative review of trends, opportunities, and challenges. J Sci Med Sport 2023:S1440-2440(23)00032-4. [PMID: 36878761 DOI: 10.1016/j.jsams.2023.02.004] [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: 06/14/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES There is a need for diagnostic devices that can assist prosthetic care providers to better assess and maintain residuum health of individuals suffering from neuromusculoskeletal dysfunctions associated with limb loss. This paper outlines the trends, opportunities, and challenges that will facilitate the development of next-generation diagnostic devices. DESIGN Narrative literature review. METHODS Information about technologies suitable for integration into next-generation diagnostic devices was extracted from 41 references. We considered the invasiveness, comprehensiveness, and practicality of each technology subjectively. RESULTS This review highlighted a trend toward future diagnostic devices of neuromusculoskeletal dysfunctions of the residuum capable to support evidence-based patient-specific prosthetic care, patient empowerment, and the development of bionic solutions. This device should positively disrupt the organization healthcare by enabling cost-utility analyses (e.g., fee-for-device business models) and addressing healthcare gaps due to labor shortages. There are opportunities to develop wireless, wearable and noninvasive diagnostic devices integrating wireless biosensors to measure change in mechanical constraints and topography of residuum tissues during real-life conditions as well as computational modeling using medical imaging and finite element analysis (e.g., digital twin). Developing the next-generation diagnostic devices will require to overcome critical barriers associated with the design (e.g., gaps between technology readiness levels of essential parts), clinical roll-out (e.g., identification of primary users), and commercialization (e.g., limited interest from investors). CONCLUSIONS We anticipate that next-generation diagnostic devices will contribute to prosthetic care innovations that will safely increase mobility, thereby improving the quality of life of the growing global population of individuals suffering from limb loss.
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Affiliation(s)
- Laurent Frossard
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University /Menzies Health Institute Queensland, Australia.
| | - Christian Langton
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University /Menzies Health Institute Queensland, Australia.
| | - Nataliya Perevoshchikova
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University /Menzies Health Institute Queensland, Australia.
| | - Stefanie Feih
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University /Menzies Health Institute Queensland, Australia.
| | | | - Rod Barrett
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University /Menzies Health Institute Queensland, Australia.
| | - David Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering, Griffith University /Menzies Health Institute Queensland, Australia.
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14
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Yang X, Zhao R, Solav D, Yang X, Lee DR, Sparrman B, Fan Y, Herr H. Material, design, and fabrication of custom prosthetic liners for lower-extremity amputees: A review. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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15
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Kumar S, Bhowmik S. Potential use of natural fiber-reinforced polymer biocomposites in knee prostheses: a review on fair inclusion in amputees. IRANIAN POLYMER JOURNAL 2022. [DOI: 10.1007/s13726-022-01077-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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Rykaczewski K. Thermophysiological aspects of wearable robotics: Challenges and opportunities. Temperature (Austin) 2022; 10:313-325. [PMID: 37554385 PMCID: PMC10405755 DOI: 10.1080/23328940.2022.2113725] [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: 06/16/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022] Open
Abstract
Technological advancements in the last two decades have enabled development of a variety of mechanically supporting wearable robots (i.e. exoskeletons) that are transitioning to practice in medical and industrial settings. The feedback from industry and recent controlled studies is highlighting thermal discomfort as a major reason for the disuse of the devices and a substantial barrier to their long-term adoption. Furthermore, a brief overview of the devices and their intended applications reveals that many of the potential users are likely to face thermal comfort issues because of either high exertion or medically related high heat sensitivity. The aim of this review is to discuss these emerging thermal challenges and opportunities surrounding wearable robots. This review discusses mechanisms, potential solutions, and a platform for systematically measuring heat transfer inhibition caused by wearing of an exoskeleton. Lastly, the potential for substantial metabolic rate reduction provided by exoskeletons to reduce worker thermal strain in warm-to-hot conditions is also considered.
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Affiliation(s)
- Konrad Rykaczewski
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, AZ, US
- Julie Ann Wrigley Global Futures Laboratory, Arizona State University, Tempe, AZ, USA
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17
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Frossard L, Conforto S, Aszmann OC. Editorial: Bionics limb prostheses: Advances in clinical and prosthetic care. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:950481. [PMID: 36189016 PMCID: PMC9397676 DOI: 10.3389/fresc.2022.950481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Laurent Frossard
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | | | - Oskar C. Aszmann
- Bionic Laboratory of Extremity Reconstruction and Department of Plastic & Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
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18
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Ngan CC, Sivasambu H, Kelland K, Ramdial S, Andrysek J. Understanding the adoption of digital workflows in orthotic & prosthetic practice from practitioner perspectives: a qualitative descriptive study. Prosthet Orthot Int 2022; 46:282-289. [PMID: 35315819 DOI: 10.1097/pxr.0000000000000107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 01/04/2022] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Calvin C Ngan
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Harry Sivasambu
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Kerri Kelland
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Sandra Ramdial
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Jan Andrysek
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- University of Toronto, Toronto, Canada
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19
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Powers OA, Palmer JR, Wilken JM. Reliability and validity of 3D limb scanning for ankle-foot orthosis fitting. Prosthet Orthot Int 2022; 46:84-90. [PMID: 35179523 PMCID: PMC9346570 DOI: 10.1097/pxr.0000000000000066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Recent decreases in the cost of 3D scanners and improved functionality have resulted in increased adoption for ankle-foot orthosis (AFO) fittings, despite limited supporting data. For 3D limb scanning to be a feasible alternative to traditional casting methods, a consistent and accurate representation of limb geometry must be produced at a reasonable cost. OBJECTIVES To evaluate the repeatability and validity of multiple lower limb measurements obtained using low-cost 3D limb scanning technology. STUDY DESIGN Prospective, randomized, crossover-controlled, cross-sectional, reliability, and validity study. METHODS Physical measurements and 3D limb scans were completed for 30 participants. 11 measurements were selected for comparison based on their relevance to AFO fittings. Validity was assessed by comparison of physical and scan-based measures using Pearson's correlation coefficients and root mean square differences. Reliability was assessed using intraclass correlation coefficients and minimal detectable change (MDC) values. Bland-Altman plots were generated for data visualization. RESULTS All correlation values were above or equal to 0.80. Most intraclass correlation coefficient values were above 0.95. MDC values for physical and scan-based measurements differed by less than 2.0 mm. Scan MDC values were around or below 4 mm for foot and ankle measures and under 6 mm for circumference and length measures. CONCLUSIONS The results of this study demonstrate that low-cost 3D limb scanning can be used to obtain valid and reliable measurements of 3D limb geometry for the purpose of AFO fitting, when collected using the clinically relevant standardized conditions presented here.
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Affiliation(s)
- Olivia A Powers
- Department of Physical Therapy and Rehabilitation Science, the University of Iowa, IA, USA
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20
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Bramley JL, Worsley PR, Bader DL, Everitt C, Darekar A, King L, Dickinson AS. Changes in Tissue Composition and Load Response After Transtibial Amputation Indicate Biomechanical Adaptation. Ann Biomed Eng 2021; 49:3176-3188. [PMID: 34580782 PMCID: PMC8671271 DOI: 10.1007/s10439-021-02858-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/20/2021] [Indexed: 12/03/2022]
Abstract
Despite the potential for biomechanical conditioning with prosthetic use, the soft tissues of residual limbs following lower-limb amputation are vulnerable to damage. Imaging studies revealing morphological changes in these soft tissues have not distinguished between superficial and intramuscular adipose distribution, despite the recognition that intramuscular fat levels indicate reduced tolerance to mechanical loading. Furthermore, it is unclear how these changes may alter tissue tone and stiffness, which are key features in prosthetic socket design. This study was designed to compare the morphology and biomechanical response of limb tissues to mechanical loading in individuals with and without transtibial amputation, using magnetic resonance imaging in combination with tissue structural stiffness. The results revealed higher adipose infiltrating muscle in residual limbs than in intact limbs (residual: median 2.5% (range 0.2-8.9%); contralateral: 1.7% (0.1-5.1%); control: 0.9% (0.4-1.3%)), indicating muscle atrophy and adaptation post-amputation. The intramuscular adipose content correlated negatively with daily socket use, although there was no association with time post-amputation. Residual limbs were significantly stiffer than intact limbs at the patellar tendon site, which plays a key role in load transfer across the limb-prosthesis interface. The tissue changes following amputation have relevance in the clinical understanding of prosthetic socket design variables and soft tissue damage risk in this vulnerable group.
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Affiliation(s)
- J L Bramley
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Mailpoint M7, University Road, Southampton, SO17 1BJ, UK
| | - P R Worsley
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - D L Bader
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - C Everitt
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Darekar
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - L King
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A S Dickinson
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Mailpoint M7, University Road, Southampton, SO17 1BJ, UK.
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21
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Huang H(H, Si J, Brandt A, Li M. Taking Both Sides: Seeking Symbiosis Between Intelligent Prostheses and Human Motor Control during Locomotion. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2021; 20:100314. [PMID: 34458654 PMCID: PMC8388605 DOI: 10.1016/j.cobme.2021.100314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Robotic lower-limb prostheses aim to replicate the power-generating capability of biological joints during locomotion to empower individuals with lower-limb loss. However, recent clinical trials have not demonstrated clear advantages of these devices over traditional passive devices. We believe this is partly because the current designs of robotic prothesis controllers and clinical methods for fitting and training individuals to use them do not ensure good coordination between the prosthesis and user. Accordingly, we advocate for new holistic approaches in which human motor control and intelligent prosthesis control function as one system (defined as human-prosthesis symbiosis). We hope engineers and clinicians will work closely to achieve this symbiosis, thereby improving the functionality and acceptance of robotic prostheses and users' quality of life.
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Affiliation(s)
- He (Helen) Huang
- NC State/UNC Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina, USA, 27695
- NC State/UNC Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, 27514
| | - Jennie Si
- Department of Electrical, Computer, and Energy Engineering, Arizona State University, Tempe, Arizona, USA, 85281
| | - Andrea Brandt
- NC State/UNC Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina, USA, 27695
- NC State/UNC Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, 27514
| | - Minhan Li
- NC State/UNC Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina, USA, 27695
- NC State/UNC Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, 27514
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22
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Armitage L, Turner S, Sreenivasa M. Human-device interface pressure measurement in prosthetic, orthotic and exoskeleton applications: A systematic review. Med Eng Phys 2021; 97:56-69. [PMID: 34756339 DOI: 10.1016/j.medengphy.2021.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/16/2021] [Accepted: 09/20/2021] [Indexed: 02/02/2023]
Abstract
This study aimed to investigate normal and shear load sensor technology that has been characterised and used at the human-device interface in prosthetic, orthotic and exoskeleton applications. In addition to taking a cross-disciplinary view, this study expands on previous reviews by considering recently published papers, clinical translation of sensors, and development of the sensor technology itself. A search of MEDLINE, INSPEC, SCOPUS and Web of Science was performed up to 26 January 2021. A total of 33 studies were assessed for quality and their data extracted. The review found variable quality of published papers, with normal load being most commonly measured, and resistive sensor technology most commonly used. The translation to clinical environments was indicated in most studies, though the study population was not always made up of the target users. Studies could benefit from more direct comparison with clinically relevant load thresholds and by ensuring clinical testing is performed in the most realistic and representative way possible. Additionally, more focus on developing sensors that measure shear loads would enable further insights into conditions at the human-device interface. Finally, all researchers would benefit from better and more widespread anonymous data sharing practices to facilitate further experimentation.
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Affiliation(s)
- Lucy Armitage
- School of Mechanical, Materials, Mechatronic and Biomedical Engineering, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
| | - Shruti Turner
- Sackler MSk Laboratory, Department of Surgery and Cancer, Sir Michael Uren Hub, Imperial College London, 86 Wood Ln, London W12 0BZ, United Kingdom.
| | - Manish Sreenivasa
- School of Mechanical, Materials, Mechatronic and Biomedical Engineering, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
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23
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Characterising Residual Limb Morphology and Prosthetic Socket Design Based on Expert Clinician Practice. PROSTHESIS 2021. [DOI: 10.3390/prosthesis3040027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Functional, comfortable prosthetic limbs depend on personalised sockets, currently designed using an iterative, expert-led process, which can be expensive and inconvenient. Computer-aided design and manufacturing (CAD/CAM) offers enhanced repeatability, but far more use could be made from clinicians’ extensive digital design records. Knowledge-based socket design using smart templates could collate successful design features and tailor them to a new patient. Based on 67 residual limb scans and corresponding sockets, this paper develops a method of objectively analysing personalised design approaches by expert prosthetists, using machine learning: principal component analysis (PCA) to extract key categories in anatomic and surgical variation, and k-means clustering to identify local ‘rectification’ design features. Rectification patterns representing Total Surface Bearing and Patella Tendon Bearing design philosophies are identified automatically by PCA, which reveals trends in socket design choice for different limb shapes that match clinical guidelines. Expert design practice is quantified by measuring the size of local rectifications identified by k-means clustering. Implementing smart templates based on these trends requires clinical assessment by prosthetists and does not substitute training. This study provides methods for population-based socket design analysis, and example data, which will support developments in CAD/CAM clinical practice and accuracy of biomechanics research.
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24
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Ko ST, Asplund F, Zeybek B. A Scoping Review of Pressure Measurements in Prosthetic Sockets of Transfemoral Amputees during Ambulation: Key Considerations for Sensor Design. SENSORS (BASEL, SWITZERLAND) 2021; 21:5016. [PMID: 34372253 PMCID: PMC8347332 DOI: 10.3390/s21155016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 02/05/2023]
Abstract
Sensor systems to measure pressure at the stump-socket interface of transfemoral amputees are receiving increasing attention as they allow monitoring to evaluate patient comfort and socket fit. However, transfemoral amputees have many unique characteristics, and it is unclear whether existing research on sensor systems take these sufficiently into account or if it is conducted in ways likely to lead to substantial breakthroughs. This investigation addresses these concerns through a scoping review to profile research regarding sensors in transfemoral sockets with the aim of advancing and improving prosthetic socket design, comfort and fit for transfemoral amputees. Publications found from searching four scientific databases were screened, and 17 papers were found relating to the aim of this review. After quality assessment, 12 articles were finally selected for analysis. Three main contributions are provided: a de facto methodology for experimental studies on the implications of intra-socket pressure sensor use for transfemoral amputees; the suggestion that associated sensor design breakthroughs would be more likely if pressure sensors were developed in close combination with other types of sensors and in closer cooperation with those in possession of an in-depth domain knowledge in prosthetics; and that this research would be facilitated by increased interdisciplinary cooperation and open research data generation.
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Affiliation(s)
- Siu-Teing Ko
- Research and Innovation, Össur, 110 Reykjavík, Iceland
| | - Fredrik Asplund
- Department of Machine Design, KTH Royal Institute of Technology, 10044 Stockholm, Sweden;
| | - Begum Zeybek
- Healthcare Innovation Centre, School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK;
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25
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Investigation of Orthopedic Prosthesis Socket Management after Transfemoral Amputation by Expert Survey. PROSTHESIS 2021. [DOI: 10.3390/prosthesis3020015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prosthesis treatment requires the close interaction of different actors. In fitting prostheses to patients, special attention is given to the manufacturing of the socket. The continuous development of the technologies involved in the fitting and optimization of prostheses is shown in the literature. The assessment of orthopedic technicians and their influence in the process is thus far largely unexplored. Ten orthopedic technicians were interviewed about the socket fitting process after transfemoral amputation. The research goal was to clarify the socket treatment process with regards to the German context. The results showed that the orthopedic technicians focussing on the patient during the fitting process. This study underlines the importance of interaction and empathy. Volume fluctuations are decisive within the treatment process and are interactively influenced by various factors. Furthermore, the research emphasizes the need for appropriate assistive technologies and the potential for the further development of existing systems.
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