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Ahmed K, Thornton M, Taylor SJG. Mechanical load applied by Intraosseous Transcutaneous Amputation Prosthesis (ITAP) during walking on level and sloped treadmill: A case study. Med Eng Phys 2024; 124:104097. [PMID: 38418026 DOI: 10.1016/j.medengphy.2023.104097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 03/01/2024]
Abstract
This proof of concept study presents a method to collect and analyse kinetic data from one participant with a transfemoral amputation fitted with a percutaneous osseointegrated implant walking on a level and sloped treadmill. We describe the construction of and results from a bespoke wireless six axis load cell built into one participant's prosthetic assembly. The load cell does not clinically compromise the participant in any way and is an initial milestone in the development of a light-weight wireless load cell for use with percutaneous osseointegrated implants. In this case, it is the first time that kinetic data from a participant fitted with an Intraosseous Transcutaneous Amputation Prosthesis has been published. We propose that the data can be used to model the load transfer to the host bone, with several clinically significant applications. The raw dynamic data are made available and quasi-static load cases for each functional phase of gait are presented. Peak forces obtained in the medio-lateral (X), cranio-caudal (Y) and antero-posterior (Z) axes over level ground respectively were -243.8 N (0.24 BW), 1321.5 N (1.31 BW) and -421.8 N (0.42 BW); uphill were -141.0 N (0.14 BW), 1604.2 N (1.59 BW), -498.1 N (0.49 BW); downhill were -206.0 N (0.20 BW), 1103.9 N (1.09 BW), -547.2 N (0.54 BW). The kinetics broadly followed able bodied gait patterns with some gait strategies consistent in participants with other implant designs or prosthetic socket connections, for example offloading the artificial limb downhill.
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Affiliation(s)
- K Ahmed
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK; Center for Bionics and Pain Research, Mölndals Sjukhus, 431 30 Sweden.
| | - M Thornton
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK; Motor Learning Laboratory, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - S J G Taylor
- Department of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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Valero JM, Satústegui PJ, Salavera CE, Sanz López V, Laborda AA, Hidalgo C. A systematic review on cross-cultural validations and psychometric solidity of the orthotics and prosthetics user survey. Prosthet Orthot Int 2024; 48:83-88. [PMID: 37639569 DOI: 10.1097/pxr.0000000000000268] [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: 08/04/2022] [Accepted: 06/09/2023] [Indexed: 08/31/2023]
Abstract
Research is essential to reflect patients' satisfaction with their devices in the field of Prosthetics and Orthotics, record their performance and health-related quality of life. This requires culturally adapted questionnaires for each country. Periodic assessment of validity and test fit are essential elements for the long-term utility and effectiveness of psychometric tests. This article reviews the psychometric properties of the Orthotics and Prosthetics Users Survey (OPUS). The purpose, in addition to its adaptation to the Spanish-speaking population, involves a review/update of content, statistical analyses, and validity studies, until a larger number of studies are conducted. Study design: a Systematic review. A systematic literature search was carried out in specialized search engines: Alcorze (University of Zaragoza), MEDLINE (PubMed), and EMBASE of original articles published since 2000. Eleven items belonging to the OPUS were obtained, according to the language of the country where they were validated, and promising psychometric properties were confirmed (reflecting reliability values between 0.62 and 0.95; Cronbach's α scores between 0.73 and 0.98) with sample sizes between 10 and 321. The study concluded by stating that the OPUS was validated in different languages, reporting good psychometric robustness so far. Further deployment, refinement, and validation of this survey by country is warranted in view of its promising use.
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Affiliation(s)
- Julián M Valero
- PhD Candidate in Medicine, University of Zaragoza, Miguel Servet University Hospital, Professor YMCA, Zaragoza, Spain
| | | | - Carlos E Salavera
- Faculty of Education, Department of Developmental and Educational Psychology, University of Zaragoza, Zaragoza, Spain
| | - Vanessa Sanz López
- PhD Student in Health Sciences, University of Zaragoza. Professor Rey Ardid, Zaragoza, Spain
| | - Ana A Laborda
- PhD Student in Health Sciences, University of Zaragoza. Professor Rey Ardid, Zaragoza, Spain
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3
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Lee KH, Heo HS, Kim J, Cho JH, Kim KT, Hur JY, Kim JH, Lee Y. A Pneumatically Controlled Prosthetic Socket for Transfemoral Amputees. SENSORS (BASEL, SWITZERLAND) 2023; 24:133. [PMID: 38202994 PMCID: PMC10780925 DOI: 10.3390/s24010133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/15/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024]
Abstract
Amputees typically experience changes in residual limb volume in their daily lives. It causes an uncomfortable fit of the socket by applying high pressure on the sensitive area of the residual limb or by loosening the socket. In this study, we developed a transfemoral prosthetic socket for above-the-knee amputees that ensures a good socket fit by maintaining uniform and constant contact pressure despite volume changes in the residual limb. The socket has two air bladders in the posterior femoral region, and the pneumatic controller is located on the tibia of the prosthesis. The pneumatic system aims to minimize unstable fitting of the socket and improve walking performance by inflating or deflating the air bladder. The developed socket autonomously maintains the air pressure inside the prosthetic socket at a steady-state error of 3 mmHg or less by adjusting the amount of air in the air bladder via closed-loop control. In the clinical trial, amputee participants walked on flat and inclined surfaces. The displacement between the residual limb and socket during the gait cycle was reduced by up to 33.4% after air injection into the socket. The inflatable bladder increased the knee flexion angle on the affected side, resulting in increased stride length and gait velocity. The pneumatic socket provides a stable and comfortable walking experience not only when walking on flat ground but also on slopes.
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Affiliation(s)
- Kang-Ho Lee
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Republic of Korea; (J.K.); (Y.L.)
| | - Hyun-Seok Heo
- Shinsegae Prosthetic Center, Daegu 41710, Republic of Korea; (H.-S.H.); (J.-Y.H.)
| | - Jeongmin Kim
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Republic of Korea; (J.K.); (Y.L.)
| | - Jang Hyuk Cho
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (J.H.C.); (K.T.K.)
| | - Kyoung Tae Kim
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (J.H.C.); (K.T.K.)
| | - Jeong-Yong Hur
- Shinsegae Prosthetic Center, Daegu 41710, Republic of Korea; (H.-S.H.); (J.-Y.H.)
| | - Jang Hwan Kim
- Department of Rehabilitation Technology, Graduate School of Hanseo University, Seosan 31962, Republic of Korea;
| | - Yongkoo Lee
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Republic of Korea; (J.K.); (Y.L.)
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Manz S, Seifert D, Altenburg B, Schmalz T, Dosen S, Gonzalez-Vargas J. Using embedded prosthesis sensors for clinical gait analyses in people with lower limb amputation: A feasibility study. Clin Biomech (Bristol, Avon) 2023; 106:105988. [PMID: 37230008 DOI: 10.1016/j.clinbiomech.2023.105988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Biomechanical gait analyses are typically performed in laboratory settings, and are associated with limitations due to space, marker placement, and tasks that are not representative of the real-world usage of lower limb prostheses. Therefore, the purpose of this study was to investigate the possibility of accurately measuring gait parameters using embedded sensors in a microprocessor-controlled knee joint. METHODS Ten participants were recruited for this study and equipped with a Genium X3 prosthetic knee joint. They performed level walking, stair/ramp descent, and ascent. During these tasks, kinematics and kinetics (sagittal knee and thigh segment angle, and knee moment) were recorded using an optical motion capture system and force plates (gold standard), as well as the prosthesis-embedded sensors. Root mean square errors, relative errors, correlation coefficients, and discrete outcome variables of clinical relevance were calculated and compared between the gold standard and the embedded sensors. FINDINGS The average root mean square errors were found to be 0.6°, 5.3°, and 0.08 Nm/kg, for the knee angle, thigh angle, and knee moment, respectively. The average relative errors were 0.75% for the knee angle, 11.67% for the thigh angle, and 9.66%, for the knee moment. The discrete outcome variables showed small but significant differences between the two measurement systems for a number of tasks (higher differences only at the thigh). INTERPRETATION The findings highlight the potential of prosthesis-embedded sensors to accurately measure gait parameters across a wide range of tasks. This paves the way for assessing prosthesis performance in realistic environments outside the lab.
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Affiliation(s)
- Sabina Manz
- Ottobock SE & Co. KGaA, Duderstadt, Germany; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | | | | | | | - Strahinja Dosen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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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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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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Lathouwers E, Díaz MA, Maricot A, Tassignon B, Cherelle C, Cherelle P, Meeusen R, De Pauw K. Therapeutic benefits of lower limb prostheses: a systematic review. J Neuroeng Rehabil 2023; 20:4. [PMID: 36639655 PMCID: PMC9840272 DOI: 10.1186/s12984-023-01128-5] [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: 02/28/2022] [Accepted: 01/07/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Enhancing the quality of life of people with a lower limb amputation is critical in prosthetic development and rehabilitation. Yet, no overview is available concerning the impact of passive, quasi-passive and active ankle-foot prostheses on quality of life. OBJECTIVE To systematically review the therapeutic benefits of performing daily activities with passive, quasi-passive and active ankle-foot prostheses in people with a lower limb amputation. METHODS We searched the Pubmed, Web of Science, Scopus and Pedro databases, and backward citations until November 3, 2021. Only English-written randomised controlled trials, cross-sectional, cross-over and cohort studies were included when the population comprised individuals with a unilateral transfemoral or transtibial amputation, wearing passive, quasi-passive or active ankle-foot prostheses. The intervention and outcome measures had to include any aspect of quality of life assessed while performing daily activities. We synthesised the participants' characteristics, type of prosthesis, intervention, outcome and main results, and conducted risk of bias assessment using the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021290189. RESULTS We identified 4281 records and included 34 studies in total. Results indicate that quasi-passive and active prostheses are favoured over passive prostheses based on biomechanical, physiological, performance and subjective measures in the short-term. All studies had a moderate or high risk of bias. CONCLUSION Compared to passive ankle-foot prostheses, quasi-passive and active prostheses significantly enhance the quality of life. Future research should investigate the long-term therapeutic benefits of prosthetics devices.
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Affiliation(s)
- Elke Lathouwers
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - María Alejandra Díaz
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Alexandre Maricot
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Bruno Tassignon
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | | | | | - Romain Meeusen
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium. .,Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium.
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DeGrasse NS, Mertens JC, Brzostowski JT, Allyn KJ, Vamos AC, Krout AJ, Hafner BJ, Garbini JL, Sanders JE. Beyond step counts: Including wear time in prosthesis use assessment for lower-limb amputation. J Rehabil Assist Technol Eng 2023; 10:20556683231163337. [PMID: 36935866 PMCID: PMC10021104 DOI: 10.1177/20556683231163337] [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] [Indexed: 03/17/2023] Open
Abstract
Introduction The purpose of this study was to test a novel activity monitor that tracks the time a prosthesis is worn, and the nature of the ambulatory activity conducted with the prosthesis. These capabilities allow prosthesis users' wear and accommodation practices (e.g., temporary doffing) to be monitored, and the intensity of their activities to be assessed. Methods A portable limb-socket motion sensing system was used to monitor doffs, walk bouts (≥5 steps), low locomotion (2-4 steps), stationary positions, and weight shifts in a group of transtibial prosthesis users. The relationship between doff time and active motion time was investigated, and durations of low and high intensity active motions were compared. Results For the 14 participants tested, the median prosthesis day duration ranged from 12.8-18.8 h. Eleven participants typically doffed five or fewer times per day, and three participants typically doffed 10 or more times per day. Nine participants demonstrated a positive correlation between daily doff duration and active motion duration. Six participants spent more time in weight shifts than walk bouts, while eight participants spent more time in walk bouts than weight shifts. Conclusion Capturing don time and temporary doffs and distinguishing weight shifts from walks may provide insight relevant to patient care. Longer-term monitoring studies should be conducted, and the clinical utility of the data evaluated.
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Affiliation(s)
| | - Joseph C Mertens
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
| | | | - Katheryn J Allyn
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
| | - Andrew C Vamos
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
| | - Adam J Krout
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
| | - Brian J Hafner
- Department of Rehabilitation
Medicine, University
of Washington, Seattle, WA, USA
| | - Joseph L Garbini
- Department of Mechanical
Engineering, University
of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
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Saraceno M, Apelle M. Normes et standards de la marche symétrique. ANTHROPOLOGIE ET SANTÉ 2022. [DOI: 10.4000/anthropologiesante.12169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Yagos WO, Olok GT, Moro EB, Huck J, Nirmalan M. Use of mobile phones for rehabilitative services among prosthetics users in rural Acholi sub-region of northern Uganda: findings from a qualitative study. BMC Med Inform Decis Mak 2022; 22:263. [PMID: 36207722 PMCID: PMC9547425 DOI: 10.1186/s12911-022-02008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/15/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Digital technologies such as mobile phones have shown potential as vital tools for use in healthcare and related services. However, little has been done to explore its use for prosthetics rehabilitative services, especially in the Acholi sub-region of northern Uganda. We address this gap by exploring ownership of the mobile phone, knowledge of the use of mobile phone applications, use of mobile phones for prosthetics rehabilitative services and challenges faced in using the mobile phones. Methods A case study design was used. We conducted semi-structured one-on-one interviews with 16 prosthetics users spread in the four districts of Nwoya, Amuru, Omoro, and Gulu of the Acholi sub-region of northern Uganda. We transcribed the data verbatim and explored the contents thematically to derive themes. Results More prosthetics users (63%) owned mobile phones compared to those without (37%). Many who owned and use mobile phones are knowledgeable about applications for calls and messaging (47%). Some prosthetics users are knowledgeable in mobile money applications (21%), call applications only (16%) and, others were able to use the internet (16%). Many of the prosthetics users in this study use mobile phones to seek information, mainly relating to the management of prosthetics and treatment of diseases. Many participants were positive about the benefits of the use of mobile phones for prosthetics rehabilitation and related services. Common challenges affecting the use of mobile phones include the expensive price of airtime, few places for charging mobile phones, lack of electricity and inadequate skills to operate a mobile phone. Conclusion The use of mobile phones can break down barriers created by distance and allow effective communication linkages between prosthetics users and rehabilitation services. Our results suggest that some prosthetics users owned mobile phones and used them to seek information relating to prosthetics rehabilitation services. We believe that promoting the use of the mobile phone for prosthetic rehabilitative services among prosthetics users is necessary and should be considered for practical and policy discussion relating to its use for prosthetics rehabilitation in rural areas.
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Affiliation(s)
- Walter Onen Yagos
- Department of Medical Library, Faculty of Medicine, Gulu University, Gulu City, Uganda.
| | - Geoffrey Tabo Olok
- Department of Computer Science, Faculty of Science, Gulu University, Gulu City, Uganda
| | - Emmanuel Ben Moro
- Department of Surgery, Faculty of Medicine, Gulu University, Gulu City, Uganda
| | - Jonathan Huck
- Department of Geography, School of Environment, Education and Development, University of Manchester, Manchester, UK
| | - Mahesh Nirmalan
- Department of Social Responsibility and Public Engagement, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Rakbangboon T, Guerra G, Kla-arsa S, Padungjaroen U, Tangpornprasert P, Virulsri C, Sasaki K. High-Level Mobility of Trans-Tibial Prosthesis Users Wearing Commercial and sPace Energy-Storing Prosthetic Feet. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12606. [PMID: 36231917 PMCID: PMC9566704 DOI: 10.3390/ijerph191912606] [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: 08/26/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED Outcomes of users provided with a commercial ESR Vari-Flex foot (Össur, Reykjavik, Iceland) and a locally designed sPace foot were investigated. Step activity with users' own prosthetic foot compared to the sPace foot was explored. METHODS Eleven individuals with unilateral trans-tibial amputation participated and were provided with an sPace and Vari-Flex foot. Ten- and twenty-meter walk tests (10/20MWT) at comfortable and fast walking speeds (CWS/FWS), the two-minute walk test (2-MWT) and Comprehensive High-Level Activity Mobility Predictor (CHAMP) were administered. A subgroup was provided a pedometer to record their steps over a 7-day period in their own foot and later the sPace. RESULTS The sPace foot performed well in a battery of high-level mobility outcome measures. On CHAMP, participants scored 16.94 ± 5.41 and 16.72 ± 6.09 with the sPace and Vari-Flex feet, respectively. Subgroup testing of step activity showed 4490 ± 3444 steps in users' own feet and 3115 ± 1967 in the sPace foot, p = 0.176. CONCLUSIONS Participants using the sPace foot were capable of performing walking, high-level mobility and activity outcome measures.
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Affiliation(s)
- Thanyaporn Rakbangboon
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Gary Guerra
- Department of Exercise and Sport Science, St. Mary’s University, San Antonio, TX 78228, USA
| | - Saloottra Kla-arsa
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Uthumporn Padungjaroen
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Pairat Tangpornprasert
- Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok 10330, Thailand
| | - Chanyaphan Virulsri
- Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok 10330, Thailand
| | - Kazuhiko Sasaki
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Mertens JC, Brzostowski JT, Vamos A, Allyn KJ, Hafner BJ, Friedly JL, DeGrasse NS, Ballesteros D, Krout A, Larsen BG, Garbini JL, Sanders JE. A novel portable sensor to monitor bodily positions and activities in transtibial prosthesis users. Clin Biomech (Bristol, Avon) 2022; 99:105741. [PMID: 36041309 PMCID: PMC10545288 DOI: 10.1016/j.clinbiomech.2022.105741] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/22/2022] [Accepted: 08/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Step activity monitors provide insight into the amount of physical activity prosthesis users conduct but not how they use their prosthesis. The purpose of this research was to help fill this void by developing and testing a technology to monitor bodily position and type of activity. METHODS Thin inductive distance sensors were adhered to the insides of sockets of a small group of transtibial prosthesis users, two at proximal locations and two at distal locations. An in-lab structured protocol and a semi-structured out-of-lab protocol were video recorded, and then participants wore the sensing system for up to 7 days. A data processing algorithm was developed to identify sit, seated shift, stand, standing weight-shift, walk, partial doff, and non-use. Sensed distance data from the structured and semi-structured protocols were compared against the video data to characterize accuracy. Bodily positions and activities during take-home testing were tabulated to characterize participants' use of the prosthesis. FINDINGS Sit and walk detection accuracies were above 95% for all four participants tested. Stand detection accuracy was above 90% for three participants and 62.5% for one participant. The reduced accuracy may have been due to limited stand data from that participant. Step count was not proportional to active use time (sum of stand, walk, and standing weight-shift times). INTERPRETATION Step count may provide an incomplete picture of prosthesis use. Larger studies should be pursued to investigate how bodily position and type of activity may facilitate clinical decision-making and improve the lives of people with lower limb amputation.
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Affiliation(s)
- Joseph C Mertens
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Jacob T Brzostowski
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Andrew Vamos
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Janna L Friedly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Nicholas S DeGrasse
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Daniel Ballesteros
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Adam Krout
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Joseph L Garbini
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Joan E Sanders
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA.
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13
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Salminger S, Gstoettner C, Sturma A, Mayer JA, Papst H, Aszmann OC. Actual prosthetic usage in relation to functional outcomes and wearing time in individuals with below-elbow amputation. Prosthet Orthot Int 2022; 46:408-413. [PMID: 35511449 DOI: 10.1097/pxr.0000000000000137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Wearing time of a prosthesis is regarded as an indicator for success of prosthetic rehabilitation. However, prostheses are frequently worn for esthetic purposes only. Although different supervised measurements to assess prosthetic dexterity are used, it is not clear how performance in such tests translates into actual use in everyday life. OBJECTIVES To evaluate the actual daily use of the prosthetic device in patients with below-elbow amputations by recording the number of grasping motions. STUDY DESIGN Observational study. METHODS Upper extremity function was evaluated using different objective and timed assessments in five unilateral patients with below-elbow amputations. In addition, patients reported daily wearing time, and the number of performed prosthetic movements over a period of at least three months was recorded. RESULTS The patients achieved a mean Southampton Hand Assessment Procedure score of 66.60 ± 18.64 points. The average blocks moved in the Box and Block Test were 20.80 ± 7.46, and the mean score in the Action Research Arm Test was 37.20 ± 5.45. The mean time for the Clothespin-Relocation Test was 26.90 ± 11.61 seconds. The patients reported a wearing time of an average of 12.80 ± 3.11 hours per day. The mean number of prosthetic motions performed each day was 257.23 ± 192.95 with a range from 23.07 to 489.13. CONCLUSIONS Neither high functionality nor long wearing times necessitated frequent use of a prosthesis in daily life. However, frequent daily motions did translate into good functional scores, indicating that regular device use in different real-life settings relates to functionality.
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Affiliation(s)
- Stefan Salminger
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
| | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
| | - Agnes Sturma
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
- Department of Bioengineering, Imperial College London, London, UK
| | - Johannes A Mayer
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
| | - Helmut Papst
- Otto Bock Healthcare Products GmbH, Vienna, Austria
| | - Oskar C Aszmann
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
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14
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Volume Fluctuations in Active and Nonactive Transtibial Prosthetics Users. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2669484. [PMID: 36132074 PMCID: PMC9484881 DOI: 10.1155/2022/2669484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 05/07/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022]
Abstract
This study aims to evaluate the validity and reliability of the Biosculptor’s Bioscanner system in capturing transtibial residual limb volume fluctuations in active and nonactive amputees during walking activity. Residual limb volume was obtained by measuring the limb circumference after amputees walked for 5 to 25 minutes for five consecutive days. The comparison of mean circumference between Bioscanner and manual measurements (i.e., tape measure) showed that the Bioscanner gave a higher estimation of circumference for the different amputees. Short-term changes in girth and volume due to an activity such as walking do not fluctuate uniformly. The results reflected as such as nonconsistence circumference change identified at different locations of the circumference profiles. Both amputees experienced a significant increase in circumference at the distal end of the limbs after 5 minutes of walking (7.35% change in nonactive and 8.83% in active amputees), and the measurement decreased as amputees walked longer. At 4-8 cm below the mid-patella tendon (pressure tolerant areas), both amputees experienced minor changes in the size of their circumference. The residual limb volume calculation resulted in the percentage difference between the two methods ranging from 2.4% to 9.3%. Pearson coefficient correlation obtained showed a high correlation between the two techniques, ranging from 0.97 to 1. The analysis of the limit of agreements showed that the majority of measurements were closed to the mean, suggesting that Bioscanner and manual techniques may be interchangeable and agree with one another. This study has implied that Bioscanner is comparable to the standard measurement method and may serve as an alternative tool in managing daily residual limb volume change.
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15
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Wu H, Dyson M, Nazarpour K. Internet of Things for beyond-the-laboratory prosthetics research. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2022; 380:20210005. [PMID: 35762812 PMCID: PMC9335889 DOI: 10.1098/rsta.2021.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/03/2021] [Indexed: 06/15/2023]
Abstract
Research on upper-limb prostheses is typically laboratory-based. Evidence indicates that research has not yet led to prostheses that meet user needs. Inefficient communication loops between users, clinicians and manufacturers limit the amount of quantitative and qualitative data that researchers can use in refining their innovations. This paper offers a first demonstration of an alternative paradigm by which remote, beyond-the-laboratory prosthesis research according to user needs is feasible. Specifically, the proposed Internet of Things setting allows remote data collection, real-time visualization and prosthesis reprogramming through Wi-Fi and a commercial cloud portal. Via a dashboard, the user can adjust the configuration of the device and append contextual information to the prosthetic data. We evaluated this demonstrator in real-time experiments with three able-bodied participants. Results promise the potential of contextual data collection and system update through the internet, which may provide real-life data for algorithm training and reduce the complexity of send-home trials. This article is part of the theme issue 'Advanced neurotechnologies: translating innovation for health and well-being'.
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Affiliation(s)
- Hancong Wu
- Edinburgh Neuroprosthetics Laboratory, School of Informatics, The University of Edinburgh, Edinburgh EH8 9AB, UK
| | - Matthew Dyson
- Intelligent Sensing Laboratory, School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Kianoush Nazarpour
- Edinburgh Neuroprosthetics Laboratory, School of Informatics, The University of Edinburgh, Edinburgh EH8 9AB, UK
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16
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Jamshidi MA, Esmaili S, Azhari F. A case study on the value of in-socket force measurements in gait monitoring of lower-limb prosthesis users. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4237-4240. [PMID: 36085719 DOI: 10.1109/embc48229.2022.9871480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Wearable sensors have the potential to drastically improve gait rehabilitation and assessments. This is especially the case for lower limb prosthesis users as small wearables can provide useful information about in-socket conditions. Through a simple case study, we investigated the value of measuring in-socket forces in addition to gait parameters in gauging the effectiveness of a training intervention. The results showed that the additional objective information obtained through in-socket measurements can enhance our understanding of how a particular intervention affects both gait and socket comfort.
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17
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Earley EJ, Zbinden J, Munoz-Novoa M, Mastinu E, Smiles A, Ortiz-Catalan M. Competitive motivation increased home use and improved prosthesis self-perception after Cybathlon 2020 for neuromusculoskeletal prosthesis user. J Neuroeng Rehabil 2022; 19:47. [PMID: 35578249 PMCID: PMC9112467 DOI: 10.1186/s12984-022-01024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Assistive technologies, such as arm prostheses, are intended to improve the quality of life of individuals with physical disabilities. However, certain training and learning is usually required from the user to make these technologies more effective. Moreover, some people can be encouraged to train more through competitive motivation. Methods In this study, we investigated if the training for and participation in a competitive event (Cybathlon 2020) could promote behavioral changes in an individual with upper limb amputation (the pilot). We defined behavioral changes as the active time while his prosthesis was actuated, ratio of opposing and simultaneous movements, and the pilot’s ability to finely modulate his movement speeds. The investigation was based on extensive home-use data from the period before, during and after the Cybathlon 2020 competition. Results Relevant behavioral changes were found from both quantitative and qualitative analyses. The pilot’s home use of his prosthesis nearly doubled in the period before the Cybathlon, and remained 66% higher than baseline after the competition. Moreover, he improved his speed modulation when controlling his prosthesis, and he learned and routinely operated new movements in the prosthesis (wrist rotation) at home. Additionally, as confirmed by semi-structured interviews, his self-perception of the prosthetic arm and its functionality also improved. Conclusions An event like the Cybathlon may indeed promote behavioral changes in how competitive individuals with amputation use their prostheses. Provided that the prosthesis is suitable in terms of form and function for both competition and at-home daily use, daily activities can become opportunities for training, which in turn can improve prosthesis function and create further opportunities for daily use. Moreover, these changes appeared to remain even well after the event, albeit relevant only for individuals who continue using the technology employed in the competition. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01024-4.
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Affiliation(s)
- Eric J Earley
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Jan Zbinden
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Maria Munoz-Novoa
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Enzo Mastinu
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Andrew Smiles
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.,Waterloo Engineering Bionics Lab, University of Waterloo, Waterloo, Canada
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden. .,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden. .,Operational Area 3, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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18
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Osborn LE, Moran C, Dodd LD, Sutton E, Norena Acosta N, Wormley J, Pyles CO, Gordge KD, Nordstrom M, Butkus J, Forsberg JA, Pasquina P, Fifer MS, Armiger RS. Monitoring at-home prosthesis control improvements through real-time data logging. J Neural Eng 2022; 19. [PMID: 35523131 DOI: 10.1088/1741-2552/ac6d7b] [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: 11/15/2021] [Accepted: 05/06/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Validating the ability for advanced prostheses to improve function beyond the laboratory remains a critical step in enabling long-term benefits for prosthetic limb users. APPROACH A nine week take-home case study was completed with a single participant with upper limb amputation and osseointegration (OI) to better understand how an advanced prosthesis is used during daily activities. The participant was already an expert prosthesis user and used the Modular Prosthetic Limb (MPL) at home during the study. The MPL was controlled using wireless electromyography (EMG) pattern recognition-based movement decoding. Clinical assessments were performed before and after the take-home portion of the study. Data was recorded using an onboard data log in order to measure daily prosthesis usage, sensor data, and EMG data. MAIN RESULT The participant's continuous prosthesis usage steadily increased (p = 0.04, max = 5.5 hr) over time and over 30% of the total time was spent actively controlling the prosthesis. The duration of prosthesis usage after each pattern recognition training session also increased over time (p = 0.04), resulting in up to 5.4 hr of usage before retraining the movement decoding algorithm. Pattern recognition control accuracy improved (1.2% per week, p < 0.001) with a maximum number of 10 classes trained at once and the transitions between different degrees of freedom increased as the study progressed, indicating smooth and efficient control of the advanced prosthesis. Variability of decoding accuracy also decreased with prosthesis usage (p < 0.001) and 30% of the time was spent performing a prosthesis movement. During clinical evaluations, Box and Blocks and the Assessment of the Capacity for Myoelectric Control (ACMC) scores increased by 43% and 6.2%, respectively, demonstrating prosthesis functionality and the NASA Task Load Index (NASA-TLX) scores decreased, on average, by 25% across assessments, indicating reduced cognitive workload while using the MPL, over the nine week study. SIGNIFICANCE In this case study, we demonstrate that an onboard system to monitor prosthesis usage enables better understanding of how prostheses are incorporated into daily life. That knowledge can support the long-term goal of completely restoring independence and quality of life to individuals living with upper limb amputation.
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Affiliation(s)
- Luke E Osborn
- Research & Exploratory Development, Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Rd, Laurel, Maryland, 20723, UNITED STATES
| | - Courtney Moran
- Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Rd, Laurel, Maryland, 20723, UNITED STATES
| | - Lauren D Dodd
- Henry M Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Dr, Bethesda, Maryland, 20817, UNITED STATES
| | - Erin Sutton
- Research & Exploratory Development, Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Rd, Laurel, Maryland, 20723, UNITED STATES
| | - Nicolas Norena Acosta
- Research & Exploratory Development, Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Rd, Laurel, Maryland, 20723, UNITED STATES
| | - Jared Wormley
- Research & Exploratory Development, Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Rd, Laurel, Maryland, 20723, UNITED STATES
| | - Connor O Pyles
- Research & Exploratory Development, Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Rd, Laurel, Maryland, 20723, UNITED STATES
| | - Kelles D Gordge
- Research & Exploratory Development, Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Rd, Laurel, Maryland, 20723, UNITED STATES
| | - Michelle Nordstrom
- Department of Rehabilitation, Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, 20889, UNITED STATES
| | - Josef Butkus
- Department of Rehabilitation, Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, 20889, UNITED STATES
| | - Jonathan A Forsberg
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, 1800 Orleans St, Baltimore, Maryland, 21287, UNITED STATES
| | - Paul Pasquina
- Department of Rehabilitation, Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, Maryland, 20814, UNITED STATES
| | - Matthew S Fifer
- Research & Exploratory Development, Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Rd, Laurel, Maryland, 20723, UNITED STATES
| | - Robert S Armiger
- Research & Exploratory Development, Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Rd, Laurel, Maryland, 20723, UNITED STATES
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19
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Diment L, Nguon R, Seng S, Sit V, Lors P, Thor P, Srors S, Kheng S, Granat M, Donovan-Hall M, Worsley P, Dickinson A. Activity, socket fit, comfort and community participation in lower limb prosthesis users: a Cambodian cohort study. J Neuroeng Rehabil 2022; 19:42. [PMID: 35501879 PMCID: PMC9059463 DOI: 10.1186/s12984-022-01021-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After amputation, many people become less active, feel lonely and lose independence. Understanding the factors associated with low physical activity levels and participation could contribute to defining key interventions which can support prosthesis users so they can live a more active and socially included lifestyle. This longitudinal observational study aims to assess relationships between physical activity, community participation, prosthetic fit, comfort and user satisfaction using actimetry, 3D scans and questionnaires in a Cambodian cohort of established lower limb prosthesis users. METHODS Twenty participants (5F:15M, nine transfemoral, eleven transtibial, 24-60 years old and 3-43 years since amputation) were recruited. They completed a questionnaire which included their demographics, community participation, prosthesis satisfaction and comfort at the start of the study, and between three and six months later. Their prosthetic sockets and residual limbs were 3D scanned at the start and end of the study. Accelerometers were embedded under the cosmesis on the shank of the prosthesis, to collect ten weeks of activity data. RESULTS Participants averaged 4470 steps/day (743-7315 steps/day), and wore their prosthesis for most waking hours, averaging 13.4 h/day (4.5-17.6 h/day). Self-reported measures of activity and hours of wear correlated with these accelerometer data (Spearman's rho rs = 0.59, and rs = 0.71, respectively). Participants who were more active wore their prosthesis for more hours/day (Pearson r = 0.73) and were more satisfied with socket fit (rs = 0.49). A longer residual limb correlated with better community participation (rs = 0.56) and comfort (rs = 0.56). Self-reported community participation did not correlate with a person's activity level (rs = 0.13), or their prosthesis comfort (rs = 0.19), and there was only weak correlation between how important the activity was to an individual, and how often they participated in it (rs = 0.37). A simple 0-10 scale of overall comfort did not provide enough detail to understand the types and severity of discomfort experienced. CONCLUSION Associations between perceived and measured activity levels correlated with socket satisfaction in this cohort of people with established lower limb amputations. The small sample size means these correlations should be interpreted with caution, but they indicate variables worthy of further study to understand barriers to community engagement and physical activity for prosthesis users in Cambodia, and potentially in other settings.
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Affiliation(s)
| | | | | | - Vannsnavy Sit
- Department of Prosthetics and Orthotics, Phnom Penh, Cambodia
| | - Ply Lors
- Department of Prosthetics and Orthotics, Phnom Penh, Cambodia
| | - Phearsa Thor
- Department of Prosthetics and Orthotics, Phnom Penh, Cambodia
| | - Samedy Srors
- Department of Prosthetics and Orthotics, Phnom Penh, Cambodia
| | - Sisary Kheng
- Department of Prosthetics and Orthotics, Phnom Penh, Cambodia
- Exceed Research Network, Lisburn, UK
| | | | - Maggie Donovan-Hall
- University of Southampton, Southampton, UK
- Exceed Research Network, Lisburn, UK
| | | | - Alex Dickinson
- University of Southampton, Southampton, UK.
- Exceed Research Network, Lisburn, UK.
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20
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Jones H, Webb L, Dyson M, Nazarpour K. Towards User-Centred Prosthetics Research Beyond the Laboratory. Front Neurosci 2022; 16:863833. [PMID: 35495033 PMCID: PMC9048479 DOI: 10.3389/fnins.2022.863833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to explore a range of perspectives on how academic research and clinical assessment of upper-limb prosthetics could happen in environments outside of laboratories and clinics, such as within peoples' homes. Two co-creation workshops were held, which included people who use upper limb prosthetic devices (hereafter called users), clinicians, academics, a policy stakeholder, and a representative from the upper-limb prosthetics industry (hereafter called professionals). The discussions during the workshops indicate that research and clinical assessment conducted remotely from a laboratory or clinic could inform future solutions that address user needs. Users were open to the idea of sharing sensor and contextual data from within their homes to external laboratories during research studies. However, this was dependent upon several considerations, such as choice and control over data collection. Regarding clinical assessment, users had reservations of how data may be used to inform future prosthetic prescriptions whilst, clinicians were concerned with resource implications and capacity to process user data. The paper presents findings of the discussions shared by participants during both workshops. The paper concludes with a conjecture that collecting sensor and contextual data from users within their home environment will contribute towards literature within the field, and potentially inform future care policies for upper limb prosthetics. The involvement of users during such studies will be critical and can be enabled via a co-creation approach. In the short term, this may be achieved through academic research studies, which may in the long term inform a framework for clinical in-home trials and clinical remote assessment.
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Affiliation(s)
- Hannah Jones
- Edinburgh Neuroprosthetics Laboratory, The University of Edinburgh, Edinburgh, United Kingdom
- Intelligent Sensing Laboratory, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lynda Webb
- Edinburgh Neuroprosthetics Laboratory, The University of Edinburgh, Edinburgh, United Kingdom
| | - Matthew Dyson
- Intelligent Sensing Laboratory, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kianoush Nazarpour
- Edinburgh Neuroprosthetics Laboratory, The University of Edinburgh, Edinburgh, United Kingdom
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21
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Mellema M, Gjøvaag T. Reported Outcome Measures in Studies of Real-World Ambulation in People with a Lower Limb Amputation: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:2243. [PMID: 35336412 PMCID: PMC8955603 DOI: 10.3390/s22062243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The rapidly increasing use of wearable technology to monitor free-living ambulatory behavior demands to address to what extent the chosen outcome measures are representative for real-world situations. This scoping review aims to provide an overview of the purpose of use of wearable activity monitors in people with a Lower Limb Amputation (LLA) in the real world, to identify the reported outcome measures, and to evaluate to what extent the reported outcome measures capture essential information from real-world ambulation of people with LLA. METHODS The literature search included a search in three databases (MEDLINE, CINAHL, and EMBASE) for articles published between January 1999 and January 2022, and a hand-search. RESULTS AND CONCLUSIONS 98 articles met the inclusion criteria. According to the included studies' main objective, the articles were classified into observational (n = 46), interventional (n = 34), algorithm/method development (n = 12), and validity/feasibility studies (n = 6). Reported outcome measures were grouped into eight categories: step count (reported in 73% of the articles), intensity of activity/fitness (31%), type of activity/body posture (27%), commercial scores (15%), prosthetic use and fit (11%), gait quality (7%), GPS (5%), and accuracy (4%). We argue that researchers should be more careful with choosing reliable outcome measures, in particular, regarding the frequently used category step count. However, the contemporary technology is limited in providing a comprehensive picture of real-world ambulation. The novel knowledge from this review should encourage researchers and developers to engage in debating and defining the framework of ecological validity in rehabilitation sciences, and how this framework can be utilized in the development of wearable technologies and future studies of real-world ambulation in people with LLA.
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Affiliation(s)
- Mirjam Mellema
- Department of Mechanical, Electronic and Chemical Engineering, Faculty of Technology, Art and Design, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway;
| | - Terje Gjøvaag
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway;
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22
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Evaluating Real-World Ambulation and Activity in Prosthetic Users with Wearable Sensors. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-021-00338-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Frey S, Motawar B, Buchanan K, Kaufman C, Stevens P, Cirstea C, Morrow S. Greater and More Natural Use of the Upper Limbs During Everyday Life by Former Amputees Versus Prosthesis Users. Neurorehabil Neural Repair 2022; 36:227-238. [PMID: 34996313 DOI: 10.1177/15459683211062889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hand loss profoundly impacts daily functioning. Reversal of amputation through hand replantation or transplantation offers an alternative to prosthetics for some. Whether recipients exhibit more extensive and natural limb use during everyday life than prosthesis users is, however, unknown.We asked unilateral, below-elbow amputees (N = 22), hand graft recipients (transplants N = 4; replants N = 2), and healthy matched controls (N = 20) to wear wireless accelerometers distally on their forearms/prostheses and proximally on their upper arms. These units captured limb activity over 3 days within participants' natural environments.Graft recipients exhibited heavier reliance on their affected hands compared to amputees' reliance on their prostheses, P < .001. Likewise, reliance on the injured side upper arm was also greater for hand graft recipients than amputees, regardless of whether they were wearing their prostheses, P < .05 in both cases. Hand graft recipients, like healthy controls, also relied more on forearm vs upper arm movements when controlling their limbs, P < .001.Compared with conventional prosthesis users, graft recipients exhibited more extensive and natural functioning of the upper limbs during everyday activities. This information is an important addition to other considerations when evaluating risk-benefit of these treatment alternatives.
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Affiliation(s)
- Scott Frey
- Dept. of Psychological Sciences, 14716University of Missouri, Columbia, MO, USA.,Dept. of Physical Medicine and Rehabilitation, 14716University of Missouri, Columbia, MO, USA.,Dept. of Cardiovascular and Thoracic Surgery, 12254University of Louisville School of Medicine, Louisville, KY, USA
| | - Binal Motawar
- Dept. of Physical Medicine and Rehabilitation, 14716University of Missouri, Columbia, MO, USA
| | - Kelli Buchanan
- Dept. of Physical Medicine and Rehabilitation, 14716University of Missouri, Columbia, MO, USA
| | - Christina Kaufman
- Dept. of Cardiovascular and Thoracic Surgery, 12254University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Carmen Cirstea
- Dept. of Physical Medicine and Rehabilitation, 14716University of Missouri, Columbia, MO, USA
| | - Sean Morrow
- Dept. of Psychological Sciences, 14716University of Missouri, Columbia, MO, USA
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Jamieson A, Murray L, Stankovic L, Stankovic V, Buis A. Human Activity Recognition of Individuals with Lower Limb Amputation in Free-Living Conditions: A Pilot Study. SENSORS 2021; 21:s21248377. [PMID: 34960463 PMCID: PMC8704297 DOI: 10.3390/s21248377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 12/21/2022]
Abstract
This pilot study aimed to investigate the implementation of supervised classifiers and a neural network for the recognition of activities carried out by Individuals with Lower Limb Amputation (ILLAs), as well as individuals without gait impairment, in free living conditions. Eight individuals with no gait impairments and four ILLAs wore a thigh-based accelerometer and walked on an improvised route in the vicinity of their homes across a variety of terrains. Various machine learning classifiers were trained and tested for recognition of walking activities. Additional investigations were made regarding the detail of the activity label versus classifier accuracy and whether the classifiers were capable of being trained exclusively on non-impaired individuals’ data and could recognize physical activities carried out by ILLAs. At a basic level of label detail, Support Vector Machines (SVM) and Long-Short Term Memory (LSTM) networks were able to acquire 77–78% mean classification accuracy, which fell with increased label detail. Classifiers trained on individuals without gait impairment could not recognize activities carried out by ILLAs. This investigation presents the groundwork for a HAR system capable of recognizing a variety of walking activities, both for individuals with no gait impairments and ILLAs.
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Affiliation(s)
- Alexander Jamieson
- Wolfson Centre, Department of Biomedical Engineering, University of Strathclyde, Glasgow G4 0NW, UK; (A.J.); (L.M.)
| | - Laura Murray
- Wolfson Centre, Department of Biomedical Engineering, University of Strathclyde, Glasgow G4 0NW, UK; (A.J.); (L.M.)
| | - Lina Stankovic
- Department of Electronic and Electrical Engineering, University of Strathclyde, Glasgow G1 1XW, UK; (L.S.); (V.S.)
| | - Vladimir Stankovic
- Department of Electronic and Electrical Engineering, University of Strathclyde, Glasgow G1 1XW, UK; (L.S.); (V.S.)
| | - Arjan Buis
- Wolfson Centre, Department of Biomedical Engineering, University of Strathclyde, Glasgow G4 0NW, UK; (A.J.); (L.M.)
- Correspondence:
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25
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Griffiths B, Diment L, Granat MH. A Machine Learning Classification Model for Monitoring the Daily Physical Behaviour of Lower-Limb Amputees. SENSORS (BASEL, SWITZERLAND) 2021; 21:7458. [PMID: 34833534 PMCID: PMC8625063 DOI: 10.3390/s21227458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 11/22/2022]
Abstract
There are currently limited data on how prosthetic devices are used to support lower-limb prosthesis users in their free-living environment. Possessing the ability to monitor a patient's physical behaviour while using these devices would enhance our understanding of the impact of different prosthetic products. The current approaches for monitoring human physical behaviour use a single thigh or wrist-worn accelerometer, but in a lower-limb amputee population, we have the unique opportunity to embed a device within the prosthesis, eliminating compliance issues. This study aimed to develop a model capable of accurately classifying postures (sitting, standing, stepping, and lying) by using data from a single shank-worn accelerometer. Free-living posture data were collected from 14 anatomically intact participants and one amputee over three days. A thigh worn activity monitor collected labelled posture data, while a shank worn accelerometer collected 3-axis acceleration data. Postures and the corresponding shank accelerations were extracted in window lengths of 5-180 s and used to train several machine learning classifiers which were assessed by using stratified cross-validation. A random forest classifier with a 15 s window length provided the highest classification accuracy of 93% weighted average F-score and between 88 and 98% classification accuracy across all four posture classes, which is the best performance achieved to date with a shank-worn device. The results of this study show that data from a single shank-worn accelerometer with a machine learning classification model can be used to accurately identify postures that make up an individual's daily physical behaviour. This opens up the possibility of embedding an accelerometer-based activity monitor into the shank component of a prosthesis to capture physical behaviour information in both above and below-knee amputees. The models and software used in this study have been made open source in order to overcome the current restrictions of applying activity monitoring methods to lower-limb prosthesis users.
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Affiliation(s)
- Benjamin Griffiths
- School of Health and Society, University of Salford, Salford M5 4WT, UK;
| | - Laura Diment
- People Powered Prosthetic Group, University of Southampton, Southampton SO17 1BJ, UK;
| | - Malcolm H. Granat
- School of Health and Society, University of Salford, Salford M5 4WT, UK;
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26
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Wei B, Ding Z, Yi C, Guo H, Wang Z, Zhu J, Jiang F. A Novel sEMG-Based Gait Phase-Kinematics-Coupled Predictor and Its Interaction With Exoskeletons. Front Neurorobot 2021; 15:704226. [PMID: 34447302 PMCID: PMC8384035 DOI: 10.3389/fnbot.2021.704226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
The interaction between human and exoskeletons increasingly relies on the precise decoding of human motion. One main issue of the current motion decoding algorithms is that seldom algorithms provide both discrete motion patterns (e.g., gait phases) and continuous motion parameters (e.g., kinematics). In this paper, we propose a novel algorithm that uses the surface electromyography (sEMG) signals that are generated prior to their corresponding motions to perform both gait phase recognition and lower-limb kinematics prediction. Particularly, we first propose an end-to-end architecture that uses the gait phase and EMG signals as the priori of the kinematics predictor. In so doing, the prediction of kinematics can be enhanced by the ahead-of-motion property of sEMG and quasi-periodicity of gait phases. Second, we propose to select the optimal muscle set and reduce the number of sensors according to the muscle effects in a gait cycle. Finally, we experimentally investigate how the assistance of exoskeletons can affect the motion intent predictor, and we propose a novel paradigm to make the predictor adapt to the change of data distribution caused by the exoskeleton assistance. The experiments on 10 subjects demonstrate the effectiveness of our algorithm and reveal the interaction between assistance and the kinematics predictor. This study would aid the design of exoskeleton-oriented motion-decoding and human–machine interaction methods.
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Affiliation(s)
- Baichun Wei
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China.,Pengcheng Laboratory, Shenzhen, China
| | - Zhen Ding
- School of Mechatronics Engineering, Harbin Institute of Technology, Harbin, China
| | - Chunzhi Yi
- School of Mechatronics Engineering, Harbin Institute of Technology, Harbin, China
| | - Hao Guo
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China.,Pengcheng Laboratory, Shenzhen, China
| | - Zhipeng Wang
- School of Mechatronics Engineering, Harbin Institute of Technology, Harbin, China
| | - Jianfei Zhu
- School of Mechatronics Engineering, Harbin Institute of Technology, Harbin, China
| | - Feng Jiang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China.,Pengcheng Laboratory, Shenzhen, China
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27
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Lonini L, Shawen N, Hoppe-Ludwig S, Deems-Dluhy S, Mummidisetty CK, Eisenberg Y, Jayaraman A. Combining Accelerometer and GPS Features to Evaluate Community Mobility in Knee Ankle Foot Orthoses (KAFO) Users. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1386-1393. [PMID: 34252030 PMCID: PMC8363134 DOI: 10.1109/tnsre.2021.3096434] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Orthotic and assistive devices such as knee ankle foot orthoses (KAFO), come in a variety of forms and fits, with several levels of available features that could help users perform daily activities more naturally. However, objective data on the actual use of these devices outside of the research lab is usually not obtained. Such data could enhance traditional lab-based outcome measures and inform clinical decision-making when prescribing new orthotic and assistive technology. Here, we link data from a GPS unit and an accelerometer mounted on the orthotic device to quantify its usage in the community and examine the correlations with clinical metrics. We collected data from 14 individuals over a period of 2 months as they used their personal KAFO first, and then a novel research KAFO; for each device we quantified number of steps, cadence, time spent at community locations and time wearing the KAFO at those locations. Sensor-derived metrics showed that mobility patterns differed widely between participants (mean steps: 591.3, SD =704.2). The novel KAFO generally enabled participants to walk faster during clinical tests ( ∆6 Minute-Walk-Test=71.5m, p=0.006). However, some participants wore the novel device less often despite improved performance on these clinical measures, leading to poor correlation between changes in clinical outcome measures and changes in community mobility ( ∆6 Minute-Walk-Test - ∆ Community Steps: r=0.09, p=0.76). Our results suggest that some traditional clinical outcome measures may not be associated with the actual wear time of an assistive device in the community, and obtaining personalized data from real-world use through wearable technology is valuable.
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28
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Jones H, Dupan S, Dyson M, Krasoulis A, Kenney LPJ, Donovan-Hall M, Memarzadeh K, Day S, Coutinho M, Nazarpour K. Co-creation and User Perspectives for Upper Limb Prosthetics. Front Neurorobot 2021; 15:689717. [PMID: 34305564 PMCID: PMC8299561 DOI: 10.3389/fnbot.2021.689717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
People who either use an upper limb prosthesis and/or have used services provided by a prosthetic rehabilitation centre, experience limitations of currently available prosthetic devices. Collaboration between academia and a broad range of stakeholders, can lead to the development of solutions that address peoples' needs. By doing so, the rate of prosthetic device abandonment can decrease. Co-creation is an approach that can enable collaboration of this nature to occur throughout the research process. We present findings of a co-creation project that gained user perspectives from a user survey, and a subsequent workshop involving: people who use an upper limb prosthesis and/or have experienced care services (users), academics, industry experts, charity executives, and clinicians. The survey invited users to prioritise six themes, which academia, clinicians, and industry should focus on over the next decade. The prioritisation of the themes concluded in the following order, with the first as the most important: function, psychology, aesthetics, clinical service, collaboration, and media. Within five multi-stakeholder groups, the workshop participants discussed challenges and collaborative opportunities for each theme. Workshop groups prioritised the themes based on their discussions, to highlight opportunities for further development. Two groups chose function, one group chose clinical service, one group chose collaboration, and another group chose media. The identified opportunities are presented within the context of the prioritised themes, including the importance of transparent information flow between all stakeholders; user involvement throughout research studies; and routes to informing healthcare policy through collaboration. As the field of upper limb prosthetics moves toward in-home research, we present co-creation as an approach that can facilitate user involvement throughout the duration of such studies.
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Affiliation(s)
- Hannah Jones
- Edinburgh Neuroprosthetics Laboratory, School of Informatics, University of Edinburgh, Edinburgh, United Kingdom.,Intelligent Sensing Laboratory, School of Engineering, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sigrid Dupan
- Edinburgh Neuroprosthetics Laboratory, School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthew Dyson
- Intelligent Sensing Laboratory, School of Engineering, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Agamemnon Krasoulis
- Intelligent Sensing Laboratory, School of Engineering, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Laurence P J Kenney
- School of Health and Society, University of Salford, Manchester, United Kingdom
| | | | | | - Sarah Day
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Maxford Coutinho
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Kianoush Nazarpour
- Edinburgh Neuroprosthetics Laboratory, School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
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29
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Biofunctionalization of Porous Ti Substrates Coated with Ag Nanoparticles for Potential Antibacterial Behavior. METALS 2021. [DOI: 10.3390/met11050692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Ti prosthesis have shown better biological compatibility, mechanical performance, and resistance to corrosion in cases of bone replacements. Nevertheless, fully dense Ti in connection with bone-host tissues show stress-shielding phenomenon that, together with the development of frequent undesirable microbial infections, may lead to implant failures. To overcome these issues, the present study aimed at the development of a novel combination of a chemically functionalized porous Ti substrate with a potentially therapeutic AgNPs coating. Fully dense and porous Ti substrates (30 and 60 vol.%, 100–200 and 355–500 μm, as spacer particles) were studied. Ti surface was treated with acid or basic medium followed by silanization and deposition of AgNPs by “submerged” and “in situ” methods. In general, for similar porosity, mechanical resistance decreased as pore size increased. Acidic reagent and submerged methodology were the best combination for fully dense Ti substrates. Hence, they were also employed for porous Ti substrates. Depending on the porosity of the substrates, variations can be observed both in the size and degree of agglomeration of the deposited AgNPs, entailing differences in the antibacterial behavior of the samples.
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30
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Abstract
People who either use an upper limb prosthesis and/or have used services provided by a prosthetic rehabilitation centre, hereafter called users, are yet to benefit from the fast-paced growth in academic knowledge within the field of upper limb prosthetics. Crucially over the past decade, research has acknowledged the limitations of conducting laboratory-based studies for clinical translation. This has led to an increase, albeit rather small, in trials that gather real-world user data. Multi-stakeholder collaboration is critical within such trials, especially between researchers, users, and clinicians, as well as policy makers, charity representatives, and industry specialists. This paper presents a co-creation model that enables researchers to collaborate with multiple stakeholders, including users, throughout the duration of a study. This approach can lead to a transition in defining the roles of stakeholders, such as users, from participants to co-researchers. This presents a scenario whereby the boundaries between research and participation become blurred and ethical considerations may become complex. However, the time and resources that are required to conduct co-creation within academia can lead to greater impact and benefit the people that the research aims to serve.
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31
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Kim J, Wensman J, Colabianchi N, Gates DH. The influence of powered prostheses on user perspectives, metabolics, and activity: a randomized crossover trial. J Neuroeng Rehabil 2021; 18:49. [PMID: 33726802 PMCID: PMC7962267 DOI: 10.1186/s12984-021-00842-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Powered prosthetic ankles provide battery-powered mechanical push-off, with the aim of reducing the metabolic demands of walking for people with transtibial amputations. The efficacy of powered ankles has been shown in active, high functioning individuals with transtibial amputation, but is less clear in other populations. Additionally, it is unclear how use of a powered prosthesis influences everyday physical activity and mobility. METHODS Individuals with unilateral transtibial amputations participated in a randomized clinical trial comparing their prescribed, unpowered prosthesis and the BiOM powered prosthesis. Participants' metabolic costs and self-selected walking speeds were measured in the laboratory and daily step count, daily steps away from home, and walking speed were measured over two weeks of at-home prosthesis use. Participants also rated their perception of mobility and quality of life and provided free-form feedback. Dependent measures were compared between prostheses and the relationships between metabolic cost, perception of mobility, and characteristics of walking in daily life were explored using Pearson's correlations. RESULTS Twelve people were randomly allocated to the powered prosthesis first (n = 7) or unpowered prosthesis first (n = 5) and ten completed the full study. There were no differences in metabolic costs (p = 0.585), daily step count (p = 0.995), walking speed in-lab (p = 0.145) and in daily life (p = 0.226), or perception of mobility between prostheses (p ≥ 0.058). Changes varied across participants, however. There were several medium-sized effects for device comparisons. With the powered prosthesis, participants had increased self-reported ambulation (g = 0.682) and decreased frustration (g = 0.506). CONCLUSIONS There were no universal benefits of the powered prosthesis on function in the lab or home environment. However, the effects were subject-specific, with some reporting preference for power and improved mobility, and some increasing their activity and decreasing their metabolic effort. Additionally, self-reported preferences did not often correlate with objective measures of function. This highlights the need for future clinical research to include both perception and objective measures to better inform prosthetic prescription. TRIAL REGISTRATION https://clinicaltrials.gov , #NCT02828982. Registered 12 July 2016, https://clinicaltrials.gov/ct2/show/NCT02828982.
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Affiliation(s)
- Jay Kim
- School of Kinesiology, University of Michigan, 401 Washtenaw Avenue, Ann Arbor, MI, 48109-2214, USA.,Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey Wensman
- University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI, USA
| | - Natalie Colabianchi
- School of Kinesiology, University of Michigan, 401 Washtenaw Avenue, Ann Arbor, MI, 48109-2214, USA
| | - Deanna H Gates
- School of Kinesiology, University of Michigan, 401 Washtenaw Avenue, Ann Arbor, MI, 48109-2214, USA. .,Department of Biomedical Engineering, University of Michigan, 401 Washtenaw Avenue, Ann Arbor, MI, 48109-2214, USA.
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32
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Quantifying Step Count and Oxygen Consumption with Portable Technology during the 2-Min Walk Test in People with Lower Limb Amputation. SENSORS 2021; 21:s21062080. [PMID: 33809581 PMCID: PMC7999204 DOI: 10.3390/s21062080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/03/2021] [Accepted: 03/15/2021] [Indexed: 12/17/2022]
Abstract
Step counts and oxygen consumption have yet to be reported during the 2-min walk test (2MWT) test in persons with lower-limb amputations (LLA). The purpose of this study was to determine step counts and oxygen consumption during the 2MWT in LLA. Thirty-five men and women walked for two minutes as quickly as possible while wearing activity monitors (ActiGraph Link on the wrist (LW) and ankle (LA), Garmin vivofit®3 on the wrist (VW) and ankle (VA), and a modus StepWatch on the ankle (SA), and a portable oxygen analyzer. The StepWatch on the ankle (SA) and the vivofit3 on the wrist (VW) had the least error and best accuracy of the activity monitors studied. While there were no significant differences in distance walked, oxygen consumption (VO2) or heart rate (HR) between sexes or level of amputation (p > 0.05), females took significantly more steps than males (p = 0.034), and those with unilateral transfemoral amputations took significantly fewer steps than those with unilateral transtibial amputations (p = 0.023). The VW and SA provided the most accurate step counts among the activity monitors and were not significantly different than hand counts. Oxygen consumption for all participants during the 2MWT was 8.9 ± 2.9 mL/kg/min, which is lower than moderate-intensity activity. While some may argue that steady-state activity has not yet been reached in the 2MWT, it may also be possible participants are not walking as fast as they can, thereby misclassifying their performance to a lower standard.
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33
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Nazarpour K. A more human prosthetic hand. Sci Robot 2021; 5:5/46/eabd9341. [PMID: 32967992 DOI: 10.1126/scirobotics.abd9341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 11/02/2022]
Abstract
Co-creation leads the way for bioinspired prosthetics with improved design and performance.
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Affiliation(s)
- Kianoush Nazarpour
- School of Informatics, University of Edinburgh, 10 Crichton Street, Edinburgh EH8 9AB, UK.
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34
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Wu H, Dyson M, Nazarpour K. Arduino-Based Myoelectric Control: Towards Longitudinal Study of Prosthesis Use. SENSORS 2021; 21:s21030763. [PMID: 33498801 PMCID: PMC7866037 DOI: 10.3390/s21030763] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
Understanding how upper-limb prostheses are used in daily life helps to improve the design and robustness of prosthesis control algorithms and prosthetic components. However, only a very small fraction of published research includes prosthesis use in community settings. The cost, limited battery life, and poor generalisation may be the main reasons limiting the implementation of home-based applications. In this work, we introduce the design of a cost-effective Arduino-based myoelectric control system with wearable electromyogram (EMG) sensors. The design considerations focused on home studies, so the robustness, user-friendly control adjustments, and user supports were the main concerns. Three control algorithms, namely, direct control, abstract control, and linear discriminant analysis (LDA) classification, were implemented in the system. In this paper, we will share our design principles and report the robustness of the system in continuous operation in the laboratory. In addition, we will show a first real-time implementation of the abstract decoder for prosthesis control with an able-bodied participant.
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Affiliation(s)
- Hancong Wu
- School of Informatics, The University of Edinburgh, Edinburgh EH8 9YL, UK
- Correspondence: (H.W.); (K.N.)
| | - Matthew Dyson
- School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Kianoush Nazarpour
- School of Informatics, The University of Edinburgh, Edinburgh EH8 9YL, UK
- Correspondence: (H.W.); (K.N.)
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35
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Seo JH, Lee HJ, Seo DW, Lee DK, Kwon OW, Kwak MK, Lee KH. A Prosthetic Socket with Active Volume Compensation for Amputated Lower Limb. SENSORS 2021; 21:s21020407. [PMID: 33435553 PMCID: PMC7827594 DOI: 10.3390/s21020407] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 12/03/2022]
Abstract
Typically, the actual volume of the residual limb changes over time. This causes the prosthesis to not fit, and then pain and skin disease. In this study, a prosthetic socket was developed to compensate for the volume change of the residual limb. Using an inflatable air bladder, the proposed socket monitors the pressure in the socket and keeps the pressure distribution uniform and constant while walking. The socket has three air bladders on anterior and posterior tibia areas, a latching type 3-way pneumatic valve and a portable control device. In the paper, the mechanical properties of the air bladder were investigated, and the electromagnetic analysis was performed to design the pneumatic valve. The controller is based on a hysteresis control algorithm with a closed loop, which keeps the pressure in the socket close to the initial set point over a long period of time. In experiments, the proposed prosthesis was tested through the gait simulator that can imitate a human’s gait cycle. The active volume compensation of the socket was successfully verified during repetitive gait cycle using the weight loads of 50, 70, and 90 kg and the residual limb model with a variety of volumes. It was confirmed that the pressure of the residual limb recovered to the initial state through the active control. The pressure inside the socket had a steady state error of less than 0.75% even if the volume of the residual limb was changed from −7% to +7%.
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Affiliation(s)
- Ji-Hyeon Seo
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Korea; (J.-H.S.); (H.-J.L.); (D.-K.L.); (O.-W.K.)
- School of Mechanical Engineering, College of Engineering, Kyungpook National University, Daegu 41566, Korea;
| | - Hyuk-Jin Lee
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Korea; (J.-H.S.); (H.-J.L.); (D.-K.L.); (O.-W.K.)
| | - Dong-Wook Seo
- Department of Radio Communication Engineering/Interdisciplinary Major of Maritime AI Convergence, Korea Maritime and Ocean University, Busan 49112, Korea;
| | - Dong-Kyu Lee
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Korea; (J.-H.S.); (H.-J.L.); (D.-K.L.); (O.-W.K.)
| | - Oh-Won Kwon
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Korea; (J.-H.S.); (H.-J.L.); (D.-K.L.); (O.-W.K.)
| | - Moon-Kyu Kwak
- School of Mechanical Engineering, College of Engineering, Kyungpook National University, Daegu 41566, Korea;
| | - Kang-Ho Lee
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Korea; (J.-H.S.); (H.-J.L.); (D.-K.L.); (O.-W.K.)
- Correspondence:
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36
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Safari R. Lower limb prosthetic interfaces: Clinical and technological advancement and potential future direction. Prosthet Orthot Int 2020; 44:384-401. [PMID: 33164655 DOI: 10.1177/0309364620969226] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The human-prosthesis interface is one of the most complicated challenges facing the field of prosthetics, despite substantive investments in research and development by researchers and clinicians around the world. The journal of the International Society for Prosthetics and Orthotics, Prosthetics and Orthotics International, has contributed substantively to the growing body of knowledge on this topic. In celebrating the 50th anniversary of the International Society for Prosthetics and Orthotics, this narrative review aims to explore how human-prosthesis interfaces have changed over the last five decades; how research has contributed to an understanding of interface mechanics; how clinical practice has been informed as a result; and what might be potential future directions. Studies reporting on comparison, design, manufacturing and evaluation of lower limb prosthetic sockets, and osseointegration were considered. This review demonstrates that, over the last 50 years, clinical research has improved our understanding of socket designs and their effects; however, high-quality research is still needed. In particular, there have been advances in the development of volume and thermal control mechanisms with a few designs having the potential for clinical application. Similarly, advances in sensing technology, soft tissue quantification techniques, computing technology, and additive manufacturing are moving towards enabling automated, data-driven manufacturing of sockets. In people who are unable to use a prosthetic socket, osseointegration provides a functional solution not available 50 years ago. Furthermore, osseointegration has the potential to facilitate neuromuscular integration. Despite these advances, further improvement in mechanical features of implants, and infection control and prevention are needed.
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Affiliation(s)
- Reza Safari
- Health and Social Care Research Centre, University of Derby, Derby, UK
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Maimon-Mor RO, Obasi E, Lu J, Odeh N, Kirker S, MacSweeney M, Goldin-Meadow S, Makin TR. Talking with Your (Artificial) Hands: Communicative Hand Gestures as an Implicit Measure of Embodiment. iScience 2020; 23:101650. [PMID: 33103087 PMCID: PMC7578755 DOI: 10.1016/j.isci.2020.101650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/14/2020] [Accepted: 10/02/2020] [Indexed: 11/16/2022] Open
Abstract
When people talk, they move their hands to enhance meaning. Using accelerometry, we measured whether people spontaneously use their artificial limbs (prostheses) to gesture, and whether this behavior relates to everyday prosthesis use and perceived embodiment. Perhaps surprisingly, one- and two-handed participants did not differ in the number of gestures they produced in gesture-facilitating tasks. However, they did differ in their gesture profile. One-handers performed more, and bigger, gesture movements with their intact hand relative to their prosthesis. Importantly, one-handers who gestured more similarly to their two-handed counterparts also used their prosthesis more in everyday life. Although collectively one-handers only marginally agreed that their prosthesis feels like a body part, one-handers who reported they embody their prosthesis also showed greater prosthesis use for communication and daily function. Our findings provide the first empirical link between everyday prosthesis use habits and perceived embodiment and a novel means for implicitly indexing embodiment.
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Affiliation(s)
- Roni O. Maimon-Mor
- Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London WC1N 3AZ, UK
- WIN Centre, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford OX3 9DU, UK
| | - Emeka Obasi
- Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London WC1N 3AZ, UK
| | - Jenny Lu
- Department of Psychology, University of Chicago, Chicago, IL 60637, USA
| | - Nour Odeh
- Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London WC1N 3AZ, UK
| | - Stephen Kirker
- Addenbrooke's Rehabilitation Clinic, Cambridge University Hospitals NHS Trust, Cambridge CB2 0DA, UK
| | - Mairéad MacSweeney
- Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London WC1N 3AZ, UK
- Deafness, Cognition and Language Research Centre, University College London, London WC1H 0PD, UK
| | | | - Tamar R. Makin
- Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London WC1N 3AZ, UK
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