Clinical implication of interface pressure for a new prosthetic suspension system

A simulation-based analysis of the effects of variable prosthesis stiffness on interface dynamics between the prosthetic socket and residual limb

Introduction: Loading of a residual limb within a prosthetic socket can cause tissue damage such as ulceration. Computational simulations may be useful tools for estimating tissue loading within the socket, and thus provide insights into how prosthesis designs affect residual limb-socket interface dynamics. The purpose of this study was to model and simulate residual limb-socket interface dynamics and evaluate the effects of varied prosthesis stiffness on interface dynamics during gait.

Methods: A spatial contact model of a residual limb-socket interface was developed and integrated into a gait model with a below-knee amputation. Gait trials were simulated for four subjects walking with low, medium, and high prosthesis stiffness settings. The effects of prosthesis stiffness on interface kinematics, normal pressure, and shear stresses were evaluated.

Results: Model-predicted values were similar to those reported previously in sensor-based experiments; increased stiffness resulted in greater average normal pressure and shear stress (p < 0.05).

Conclusions: These methods may be useful to aid experimental studies by providing insights into the effects of varied prosthesis design parameters or gait conditions on residual limb-socket interface dynamics. The current results suggest that these effects may be subject-specific.

Proof of Concept for the Detection of Local Pressure Marks in Prosthesis Sockets Using Structural Dynamics Measurement

The wear comfort of a prosthesis is of great importance for amputee patients. The wear comfort can be affected by changes in the interface between the residual limb and prosthesis socket, which can be caused by time-dependent volume fluctuations of the tissue, leading to unwanted local pressure marks. The basis to ensure time-independent wear comfort of a prosthesis is to identify these changes. Common techniques for identifying these variations have a negative impact on the sensitive interface between the residual limb and prosthesis. The following paper contains a proof of concept for the detection of local pressure marks without affecting the described interface using structural dynamics measurements, exemplarily shown at a prosthetic socket for transfemoral amputees in a test bench scenario. The dynamical behaviour of the investigated system is analysed in the form of frequency response functions acquired for different pressure locations and preloads using an impact hammer for excitation and a triaxial acceleration sensor. The frequency response functions show major changes for the various boundary conditions with respect to their frequency-dependent compositions. The results demonstrate how the utilised method enables the identification of changes in local pressure marks regarding the variation of position and magnitude.

Evaluating shear and normal force with the use of an instrumented transtibial socket: A case study

Patients with transtibial amputation experience ulcers on their residual limb. The loading between the device and underlying material plays a role in loads transmitted to the skin. The objective was to evaluate normal and shear forces at the socket/liner interface during walking. A 53 year old male (85.45 kg and 177.8 cm) with a transtibial amputation participated in this case study. A transtibial prosthesis was instrumented with a load cell to measure normal and shear forces at the socket interface. Three conditions were evaluated during walking: gel liner, additional three ply sock and a hole in the gel liner. Shear and normal forces were highest with the addition of a three ply. Longitudinal shear stresses ranged from 0.4-7.66 kPa, transverse shear stresses ranged from 0.01-7.79 kPa and normal stresses ranged from 2.7-61.9 kPa. Increased shear and normal forces can cause a significant decrease in blood perfusion, linked to an increased risk of ulcer formation. Experimental force results are also important for future work involving finite element modeling of the skin/liner/device interface.

Stakeholder perspectives for possible residual limb monitoring system for persons with lower-limb amputation

Purpose: To gather ideas from lower-limb prosthesis users and certified prosthetists regarding possible residual limb monitoring system features and data presentation. We also gathered information on the type of residual limb problems typically encountered, how they currently manage those problems, and their ideas for methods to better manage them.Materials and methods: Two focus groups were held; one with certified prosthetists and another with lower-limb prosthesis users. Open-ended questions were used in a moderated discussion that was audio recorded, transcribed, and assessed using applied thematic analysis.Results and conclusions: Seven individuals participated in each focus group. Prosthetists came from a mix of practice settings, while prosthesis users were diverse in level of amputation, aetiology, and years of experience using lower-limb prostheses. Residual limb problems reported by participants were consistent with those in the literature. Participants suggested better managing residual limb problems through improved education, better detection of residual limb problems, and using sensor-based information to improve prosthetic technology. Participants favoured short-term use of a possible residual limb monitoring systems to troubleshoot residual limb problems, with temperature and pressure the most frequently mentioned measurements. Participants described that an ideal residual limb monitoring system would be lightweight, not interfere with prosthesis function, and result in benefits with regard to prosthetic care and socket function that outweighed inconveniences or concerns regarding system use. A potential positive of system use included having objective data for reimbursement justification, although it was pointed out that the residual limb monitoring system itself also needed to be reimbursable.Implications for RehabilitationStakeholders suggested better managing residual limb problems through improved education, better detection of residual limb problems, and using sensor-based information to improve prosthetic technology.Stakeholders favored short-term use of a possible system to troubleshoot residual limb problems, with temperature and pressure the most frequently mentioned measurements.Stakeholders described that an ideal residual limb monitoring system would be lightweight, not interfere with prosthesis function, and result in benefits with regard to prosthetic care and socket function that outweighs any inconveniences or concerns regarding system use.Stakeholders indicated that a potential positive of system use included having objective data for reimbursement justification, although it was pointed out that the residual limb monitoring system itself also needed to be reimbursable.

Clinical evaluation of a prosthetic suspension system: Looped silicone liner

OBJECTIVES

This study aimed to evaluate and compare a newly designed suspension system with a common suspension in the market.

STUDY DESIGN

Prospective study.

METHODS

Looped liners with hook fastener and Iceross Dermo Liner with pin/lock system were mechanically tested using a tensile testing machine in terms of system safety. A total of 10 transtibial amputees participated in this study and were asked to use these two different suspension systems. The pistoning was measured between the liner and socket through a photographic method. Three static axial loading conditions were implemented, namely, 30, 60, and 90 N. Furthermore, subjective feedback was obtained.

RESULTS

Tensile test results showed that both systems could safely tolerate the load applied to the prosthesis during ambulation. Clinical evaluation confirmed extremely low pistoning in both systems (i.e. less than 0.4 cm after adding 90 N traction load to the prosthesis). Subjective feedback also showed satisfaction with both systems. However, less traction at the end of the residual limb was reported while looped liner was used.

CONCLUSION

The looped liner with hook fastener is safe and a good alternative for individuals with transtibial amputation as this system could solve some problems with the current systems. Clinical relevance The looped liner and hook fastener were shown to be good alternative suspension for people with lower limb amputation especially those who have difficulty to use and align the pin/lock systems. This system could safely tolerate centrifugal forces applied to the prosthesis during normal and fast walking.