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Aflatooni S, Beekman K, Hennessy K, Highsmith MJ, Heckman JT, Shumaker PR, Hivnor CM, Beachkofsky TM. Dermatologic Conditions Following Limb Loss. Phys Med Rehabil Clin N Am 2024; 35:739-755. [PMID: 39389634 DOI: 10.1016/j.pmr.2024.06.002] [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] [Indexed: 10/12/2024]
Abstract
The use of prostheses in individuals with limb loss increases the risk of maceration, friction, and pressure-induced skin injuries due to the vulnerability of the residual limb and the close contact with the socket. Poorly fitting prostheses exacerbate these issues, especially for those with immunosuppression or vascular conditions. Skin pathologies disrupt daily prosthetic limb use and impact the independence of those with limb loss. Preventive measures, including proper prosthesis socket fitting and meticulous skin care, are crucial. This review explores residual limb-site skin pathologies and details current mitigation and management strategies.
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Affiliation(s)
- Shaliz Aflatooni
- Morsani College of Medicine, University of South Florida, 560 Channelside Drive, Tampa, FL 33602, USA
| | - Kate Beekman
- Morsani College of Medicine, University of South Florida, 560 Channelside Drive, Tampa, FL 33602, USA
| | - Kerry Hennessy
- Department of Dermatology and Cutaneous Surgery, Morsani College of Medicine, University of South Florida, 13330 USF Laurel Drive, Tampa, FL 33612, USA
| | - Michael Jason Highsmith
- Orthotic, Prosthetic & Pedorthic Clinical Services (OPPCS) Program Office (12RPS4), Rehabilitation & Prosthetic Services, US Department of Veterans Affairs, 810 Vermont Avenue Northwest, Washington, DC 20420, USA; School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, 3515 East Fletcher Avenue, Tampa, FL 33613, USA
| | - Jeffrey T Heckman
- Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Boulevard, MDC 55, Tampa, FL 33612, USA; James A. Haley Veterans' Hospital & Clinics, 13000 Bruce B. Downs Boulevard, Mailstop-117 Tampa, FL 33612, USA
| | - Peter R Shumaker
- Dermatology Department, US Department of Veterans Affairs, Veterans Administration San Diego Healthcare System, 3350 La Jolla Village Drive, Suite 111B, San Diego, CA 92161, USA
| | - Chad M Hivnor
- Dermatology Department, US Department of Veterans Affairs, South Texas Veterans Health Care System, 7400 Merton Mentor Drive, San Antonio, TX 78229, USA
| | - Thomas M Beachkofsky
- Dermatology Department, US Department of Veterans Affairs, James A. Haley Veterans' Hospital, 12210 Bruce B Downs Boulevard, Building 111H, Tampa, FL 33612, USA.
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Sanders JE, Vamos AC, Mertens JC, Allyn KJ, Larsen BG, Ballesteros D, Wang H, DeGrasse NS, Garbini JL, Hafner BJ, Friedly JL. An adaptive prosthetic socket for people with transtibial amputation. Sci Rep 2024; 14:11168. [PMID: 38750086 PMCID: PMC11096356 DOI: 10.1038/s41598-024-61234-9] [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: 01/20/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024] Open
Abstract
It is essential that people with limb amputation maintain proper prosthetic socket fit to prevent injury. Monitoring and adjusting socket fit, for example by removing the prosthesis to add prosthetic socks, is burdensome and can adversely affect users' function and quality-of-life. This study presents results from take-home testing of a motor-driven adaptive socket that automatically adjusted socket size during walking. A socket fit metric was calculated from inductive sensor measurements of the distance between the elastomeric liner surrounding the residual limb and the socket's inner surface. A proportional-integral controller was implemented to adjust socket size. When tested on 12 participants with transtibial amputation, the controller was active a mean of 68% of the walking time. In general, participants who walked more than 20 min/day demonstrated greater activity, less doff time, and fewer manual socket size adjustments for the adaptive socket compared with a locked non-adjustable socket and a motor-driven socket that participants adjusted with a smartphone application. Nine of 12 participants reported that they would use a motor-driven adjustable socket if it were available as it would limit their socket fit issues. The size and weight of the adaptive socket were considered the most important variables to improve.
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Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA.
| | - Andrew C Vamos
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Joseph C Mertens
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Daniel Ballesteros
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Horace Wang
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Nicholas S DeGrasse
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Joseph L Garbini
- Department of Mechanical Engineering, University of Washington, 3900 E Stevens Way NE, Box 352600, Seattle, WA, 98195, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, Box 356490, Seattle, WA, 98195, USA
| | - Janna L Friedly
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Ave, Box 359612, Seattle, WA, 98104, USA
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Devin KM, Tang J, Moser D, Jiang L. Assessing Socket Fit Effects on Pressure and Shear at a Transtibial Residuum/Socket Interface. Appl Bionics Biomech 2023; 2023:3257059. [PMID: 37621485 PMCID: PMC10447010 DOI: 10.1155/2023/3257059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/29/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Fluctuations in residuum volume during daily activities are known to occur in lower-limb amputees. This can cause frequent changes to fit, which cannot be accommodated by commonly-used prosthetic sockets. The real-time effects, if any, of these minor socket fit changes on interface biomechanics have not been studied extensively. Amputees commonly use different layers of socks to accommodate frequent volume fluctuations, enabling adjustment of socket fit. We, thus, altered socket fit levels via addition/removal of sock layers to a transtibial amputee who habitually-donned two-sock layers to mimic relatively looser and tighter socket fits. Interface pressure and shear sensors were placed at known prominent load-bearing sites of the transtibial residuum/socket interface, i.e., patellar tendon (PT), popliteal fossa (PF), and anterior-distal (AD) end, to measure real-time biomechanical interactions during standing and level walking. Although socket fit level was only slightly modified, changes in interface pressure and shear across anatomical sites were still observed. Tighter fit corresponds to notable pressure reduction at AD during early stance and pressure increase at PT during terminal stance due to the residuum being pushed up. Shear-to-pressure ratios were used to assess comfort, while pressure- and shear-time integrals were used to assess tissue health. We observed more notable changes at tissue sites (e.g., AD and PF). Combined evaluation of pressure and shear, including shear-to-pressure ratio and time integrals, may offer insight for residuum care.
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Affiliation(s)
- Kirstie M. Devin
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Jinghua Tang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - David Moser
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Liudi Jiang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ, UK
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Lanahan CR, Coburn KA, Hafner BJ, Ballesteros D, Allyn KJ, Friedly JL, Ciol MA, Carter RV, Mertens JC, Krout AJ, Sanders JE. Short partial doffs of release/relock sockets may effectively stabilize limb fluid volume in prosthesis users with transtibial amputation. Clin Biomech (Bristol, Avon) 2023; 106:105986. [PMID: 37210769 DOI: 10.1016/j.clinbiomech.2023.105986] [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: 12/02/2022] [Revised: 04/18/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND A challenge often faced by people with lower extremity amputation is management of prosthetic socket fit due to changes in fluid volume within their residual limb. Prior research suggests that intermittently doffing the prosthetic socket may help stabilize daily residual limb fluid volume. METHODS To assess the effects of partial doff duration on residual limb fluid volume retention, participants with transtibial amputation were tested by walking on a treadmill in a controlled, laboratory setting under three conditions. An automated system to release the locking pin and enlarge the socket was used to produce the partial doffing. Percent limb fluid volume changes after partial doffing for 4 min (Short Rest) and for 10 min (Long Rest) were compared with no partial doffing (No Release). Limb fluid volume was monitored using bioimpedance analysis. FINDINGS Mean percent fluid volume changes in the posterior region were -1.2% for No Release, 2.7% for Short Rest, and 1.0% for Long Rest. Short and Long Rests had larger increases than No Release (P = 0.005 and 0.03, respectively); Short and Long Rests were not statistically different (P = 0.10). Eight of the thirteen participants experienced a higher percent fluid volume gain for both release protocols while four experienced a higher percent fluid volume gain for only one release protocol. INTERPRETATION A partial doff duration as short as 4 min may be an effective strategy to stabilize limb fluid volume in prosthesis users with transtibial amputation. Trials in at-home settings should be pursued.
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Affiliation(s)
- Conor R Lanahan
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Kendrick A Coburn
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Brian J Hafner
- University of Washington, Department of Rehabilitation Medicine, Seattle, WA, USA
| | - Daniel Ballesteros
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Katheryn J Allyn
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Janna L Friedly
- University of Washington, Department of Rehabilitation Medicine, Seattle, WA, USA
| | - Marcia A Ciol
- University of Washington, Department of Rehabilitation Medicine, Seattle, WA, USA
| | - Ryan V Carter
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Joseph C Mertens
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Adam J Krout
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Joan E Sanders
- University of Washington, Department of Bioengineering, Seattle, WA, USA.
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5
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Coburn KA, DeGrasse NS, Allyn KJ, Larsen BG, Garbini JL, Sanders JE. Using magnetic panels to enlarge a transtibial prosthetic socket. Med Eng Phys 2022; 110:103924. [PMID: 36564131 DOI: 10.1016/j.medengphy.2022.103924] [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: 03/25/2022] [Revised: 10/10/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
A novel method is described to connect a prosthetic liner to the panels of an adjustable socket to facilitate limb fluid volume stabilization in prosthesis users. Magnets are placed in the socket panels, and iron powder is embedded in the user's prosthetic liner. When the magnet is in close proximity to the liner, a firm connection is formed. The system's capability to execute panel pull on transtibial prosthesis users was tested. The backs of the panels were supported by a bracket mounted to the external surface of the socket that allowed the radial position of the panels to be adjusted. Bench testing demonstrated an optimized strength-to-weight ratio using 1.27-cm thick annular-shaped magnets supported by 0.32-cm thick backplates. Testing on four people with transtibial amputation showed that the maximum socket increase achieved using magnetic panel pull ranged from 5.3% to 13.8% of the initial (panels flush) socket volume. The results indicate that magnetic panel pull induces a meaningful increase in socket volume during sitting. The clinical relevance is a novel strategy that may help stabilize prosthesis users' limb fluid volume over the day.
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Affiliation(s)
- Kendrick A Coburn
- Department of Bioengineering, University of Washington, Seattle, WA, 98195, United States
| | - Nicholas S DeGrasse
- Department of Bioengineering, University of Washington, Seattle, WA, 98195, United States
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, 98195, United States
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA, 98195, United States
| | - Joseph L Garbini
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, United States
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, 98195, United States.
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6
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Raschke SU. Limb Prostheses: Industry 1.0 to 4.0: Perspectives on Technological Advances in Prosthetic Care. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:854404. [PMID: 36188935 PMCID: PMC9397934 DOI: 10.3389/fresc.2022.854404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/10/2022] [Indexed: 11/13/2022]
Abstract
Technological advances from Industry 1.0 to 4.0, have exercised an increasing influence on prosthetic technology and practices. This paper explores the historical development of the sector within the greater context of industrial revolution. Over the course of the first and up the midpoint of the second industrial revolutions, Industry 1.0 and 2.0, the production and provision of prosthetic devices was an ad hoc process performed by a range of craftspeople. Historical events and technological innovation in the mid-part of Industry 2.0 created an inflection point resulting in the emergence of prosthetists who concentrated solely on hand crafting and fitting artificial limbs as a professional specialty. The third industrial revolution, Industry 3.0, began transforming prosthetic devices themselves. Static or body powered devices began to incorporate digital technology and myoelectric control options and hand carved wood sockets transitioned to laminated designs. Industry 4.0 continued digital advancements and augmenting them with data bases which to which machine learning (M/L) could be applied. This made it possible to use modeling software to better design various elements of prosthetic componentry in conjunction with new materials, additive manufacturing processes and mass customization capabilities. Digitization also began supporting clinical practices, allowing the development of clinical evaluation tools which were becoming a necessity as those paying for devices began requiring objective evidence that the prosthetic technology being paid for was clinically and functionally appropriate and cost effective. Two additional disruptive dynamics emerged. The first was the use of social media tools, allowing amputees to connect directly with engineers and tech developers and become participants in the prosthetic design process. The second was innovation in medical treatments, from diabetes treatments having the potential to reduce the number of lower limb amputations to Osseointegration techniques, which allow for the direct attachment of a prosthesis to a bone anchored implant. Both have the potential to impact prosthetic clinical and business models. Questions remains as to how current prosthetic clinical practitioners will respond and adapt as Industry 4.0 as it continues to shape the sector.
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Affiliation(s)
- Silvia Ursula Raschke
- British Columbia Institute of Technology, Applied Research, MAKE+, Burnaby, BC, Canada
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Binedell T, Ghazali MFB, Wong C, Subburaj K, Blessing L. Measuring discomfort-An objective method for quantifying peak pressure discomfort and improved fit in adults with transtibial amputation. PM R 2022; 15:482-492. [PMID: 35233956 DOI: 10.1002/pmrj.12796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 02/07/2022] [Accepted: 02/23/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prosthetic socket coupling with the residual limb should be comfortable without causing skin breakdown or excessive pressure. However, users report socket discomfort, and there is a scarcity of objective measurements available to assess this feeling of discomfort. Quantifying the specific pressure may enable clinicians and users to determine and improve comfort levels objectively. OBJECTIVES (1) To evaluate if a peak pressure reduction assists in resolving wounds, redness, and pain inside prosthetic sockets in people with transtibial amputation. (2) To determine if peak pressures measured inside the prosthetic socket due to external forces could be used to quantify the level of improvement in socket discomfort. DESIGN In this cohort study, we used a pressure sensor to quantify and facilitate adjustments to the prosthetic socket, correlating this information to the user's socket comfort. SETTING Outpatient clinic in a tertiary hospital in Singapore. PARTICIPANTS People (N = 16) with unilateral transtibial lower limb amputation using a prosthesis. INTERVENTIONS NA. MAIN OUTCOME MEASURES Peak pressure and socket comfort score (SCS). RESULTS The peak pressure value showed a statistically significant reduction across all participants following adjustments at a 50% delta change in pressure (p = .001). This was achieved with a mean number of 2.6 ± 1.4 adjustments per participant. Following the adjustments, the paired t-test results showed a mean increase between the first SCS and final SCS was 2.6 (p = .001). CONCLUSION The wound, redness, and pain resolved in 15 of 16 participants regardless of diabetic status following socket adjustments. Although the peak pressures values did not correlate to the SCS score, the reduction in peak pressure saw significant improvement to the SCS. The use of a portable sensor is a fast and efficient means to quantify adjustments inside the prosthetic socket and could potentially be considered as part of future care delivery.
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Affiliation(s)
- Trevor Binedell
- Prosthetics and Orthotics Department, Tan Tock Seng Hospital, Singapore, Singapore.,Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore.,SUTD-MIT International Design Centre, Singapore University of Technology and Design, Singapore, Singapore
| | | | - Clara Wong
- Prosthetics and Orthotics Department, Tan Tock Seng Hospital, Singapore, Singapore
| | - Karupppasamy Subburaj
- Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore
| | - Lucienne Blessing
- Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore.,SUTD-MIT International Design Centre, Singapore University of Technology and Design, Singapore, Singapore
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Gurrey CJ, Garbini JL, Bennett SP, Wang HY, Allyn KJ, Friedly JL, Hafner BJ, McLean JB, Larsen BG, Sanders JE. Socket release/relock: An innovative mechanism to maintain residual limb volume. Med Eng Phys 2021; 90:100-106. [PMID: 33781476 DOI: 10.1016/j.medengphy.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
Management of socket fit is challenging for people using lower-limb prostheses because of residual limb volume fluctuation throughout the day. Releasing socket pressures during sitting (partial doffing) may help users increase their limb volume after they have undergone volume loss earlier in the day. The purpose of this research was to develop and evaluate a system to allow for quick and easy locking pin and socket panel release during sitting and relock upon standing. The system was to allow the partial doff tether length to be custom set for each user, accomplish release and relock in less than 2.0 s each, require only one hand, and require a finger push force comparable to a push button on a phone. A motor-driven release/relock system (<240 g build weight) housed within the socket adjusts locking pin tether length, and an instrumented ratcheting dial adjusts socket panel position. Three participants with a trans-tibial amputation operated the system properly using one hand. For a partial doff, users preferred a tether length between 5 and 6 cm. All users executed release within 1.5 s and relock within 1.5 s.
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Affiliation(s)
- Clement J Gurrey
- Research Engineer/Scientist, Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA, United States
| | - Joseph L Garbini
- Professor, Department of Mechanical Engineering, University of Washington, 3900 E Stevens Way NE, Seattle, WA 98195, United States.
| | - Samuel P Bennett
- Research Engineer/Scientist. Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA 98195, United States
| | - Horace Y Wang
- Research Engineer/Scientist. Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA 98195, United States.
| | - Katheryn J Allyn
- Research Prosthetist. Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA 98195, United States.
| | - Janna L Friedly
- Professor, Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, 356490, Seattle, WA 98105, United States.
| | - Brian J Hafner
- Professor, Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, 356490, Seattle, WA 98105, United States.
| | - Jake B McLean
- Research Engineer/Scientist. Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA 98195, United States
| | - Brian G Larsen
- Research Engineer/Scientist. Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA 98195, United States.
| | - Joan E Sanders
- Professor. Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA 98195, United States.
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9
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Towards Management of Residual Limb Volume: Monitoring the Prosthetic Interface Pressure to Detect Volume Fluctuations—A Feasibility Study. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10196841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
(1) Motivation: Variations in the volume of the residual limb negatively impact various aspects of prosthesis use including the prosthetic socket fit. Although volume adjustment systems mitigate corresponding fit problems to some extent, some users still find the management of these systems challenging. With the ultimate goal of creating a feedback system that assists users with the management of their volume adjustment systems, this study demonstrates the feasibility of detecting variations in the volume of the residual limb. (2) Methods: Measurements of the interface force at the bottom of the prosthetic socket were used as indicators of variations in the volume of the residual limb. Force sensitive resistors (FSRs) were placed at the bottom of participants’ prosthetic sockets to monitor the interface limb–socket force as participants walked on a flat surface. Two phases of experiments were carried out: The first phase considered variations simulated by three prosthetic sock plies, established the feasibility of detecting variations in the volume of the limb based on the interface force, and further determined the locations at which the interface force could be used to detect variations in the limb’s volume. Having validated the effectiveness of the proposed method in the first phase, the second phase was carried out to determine the smallest detectable variation of the limb’s volume using the proposed method. In this phase, variations simulated by one and two prosthetic sock plies were considered. Four and three volunteers with transtibial amputations participated in the first and the second phases, respectively. (3) Results: Results of the first phase showed that an increase in the volume of the limb resulted in a decrease in the force measured at the distal location of the prosthetic sockets of all participants; however, the smallest detected variation could not be statistically confirmed.
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10
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Larsen BG, McLean JB, Brzostowski JT, Carter R, Allyn KJ, Hafner BJ, Garbini JL, Sanders JE. Does actively enlarging socket volume during resting facilitate residual limb fluid volume recovery in trans-tibial prosthesis users? Clin Biomech (Bristol, Avon) 2020; 78:105001. [PMID: 32619870 DOI: 10.1016/j.clinbiomech.2020.105001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Residual limb volume loss is a source of prosthetic socket fit problems in people with lower-limb amputation. The aim of this study was to investigate a novel volume recovery strategy for people with trans-tibial amputation. METHODS Test sockets for people with trans-tibial amputation were created that allowed panels of an adjustable socket and the underlying elastomeric liner to be pulled radially outward, using small motors mounted to the socket. One Control and one Intervention session were conducted with each participant. During Intervention sessions, panel-pull was executed during the sits of a multi-cycle sit/walk protocol. No panel-pull was executed during the Control sessions. Residual limb fluid volume was monitored in anterior and posterior regions using bioimpedance analysis. FINDINGS Results from 12 participants demonstrated that short-term (12 min after the intervention was applied) median posterior residual limb fluid volume change for Intervention (0.44%) was higher than that for Control (-0.02%) (P = .015). Long-term (40 min after the intervention was applied) median posterior residual limb fluid volume change for Intervention (0.95%) was higher than that for Control (-0.26%) (P = .002). INTERPRETATION If a panel-pull mechanism that was easy to assemble and operate could be created, then panel-pull may be an effective accommodation strategy to reduce daily limb volume loss in trans-tibial prosthesis users.
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Affiliation(s)
- Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Jake B McLean
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | | | - Ryan Carter
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Katheryn J Allyn
- 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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11
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Youngblood RT, Brzostowski JT, Hafner BJ, Czerniecki JM, Allyn KJ, Foster RL, Sanders JE. Effectiveness of elevated vacuum and suction prosthetic suspension systems in managing daily residual limb fluid volume change in people with transtibial amputation. Prosthet Orthot Int 2020; 44:155-163. [PMID: 32186238 PMCID: PMC7443051 DOI: 10.1177/0309364620909044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Previous studies investigating limb volume change with elevated vacuum have shown inconsistent results and have been limited by out-of-socket volume measurements and short, single-activity protocols. OBJECTIVES To evaluate the effectiveness of elevated vacuum for managing limb fluid volume compared to suction suspension with an in-socket measurement modality during many hours of activity. STUDY DESIGN Fixed-order crossover design with a standardized out-of-laboratory activity protocol. METHODS Transtibial electronic elevated vacuum users participated in two sessions. Elevated vacuum was used during the first session, and suction suspension in the second. Participants completed a 5.5-h protocol consisting of multiple intervals of activity. In-socket residual limb fluid volume was continuously measured using a custom portable bioimpedance analyzer. RESULTS A total of 12 individuals participated. Overall rate of fluid volume change was not significantly different, though the rate of posterior fluid volume change during Cycle 3 was significantly lower with elevated vacuum. Although individual results varied, 11 participants experienced lower overall rates of fluid volume loss in at least one limb region using elevated vacuum. CONCLUSION Elevated vacuum may be more effective as a volume management strategy after accumulation of activity. Individual variation suggests the potential to optimize the limb fluid volume benefits of elevated vacuum by reducing socket vacuum pressure for some users. CLINICAL RELEVANCE A better understanding of how elevated vacuum (EV) affects residual limb fluid volume will allow prosthetists to make more informed clinical decisions regarding accommodation strategies designed to improve daily socket fit.
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Affiliation(s)
| | | | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Czerniecki
- VA Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | | | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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12
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13
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McLean JB, Larsen BG, Weathersby EJ, Carter Bs RV, Allyn KJ, Garbini JL, Sanders JE. Fluid Volume Management in Prosthesis Users: Augmenting Panel Release with Pin Release. PM R 2020; 12:1236-1243. [PMID: 32103634 DOI: 10.1002/pmrj.12349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/03/2020] [Accepted: 02/12/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Management of fluid in the limbs is a challenge faced by people with disabilities. In prosthetics, a means for transtibial prosthesis users to stabilize their residual limb fluid volume during the day may improve socket fit. OBJECTIVE To determine if releasing the panels and locking pin of a cabled-panel adjustable socket during socket release significantly improved limb fluid volume recovery and retention over releasing the panels alone. DESIGN Repeated-measures experiment to assess the effects on limb fluid volume retention. SETTING Participants were tested in a laboratory setting while walking on a treadmill. INTERVENTION Release of a locking pin tether during sitting as a limb volume accommodation strategy. MAIN OUTCOME MEASURE Percent limb fluid volume retention for panel and pin release compared with panel release alone at 2 minutes (short term) and 50 minutes (long term) after subsequent activity. Limb fluid volume was monitored using bioimpedance analysis. RESULTS Median percent limb fluid volume retention for the panel and pin release was significantly greater than panel release alone for both anterior and posterior regions for the long term (P = .0499 and .0096, respectively) but not the short term (P = .0712 and .1580, respectively). CONCLUSION Augmenting panel release with pin release may be an effective accommodation strategy for prosthesis users with transtibial amputation to better retain limb fluid volume.
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Affiliation(s)
- Jake B McLean
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Ethan J Weathersby
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Ryan V Carter Bs
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Joseph L Garbini
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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Brzostowski JT, Larsen BG, Youngblood RT, Ciol MA, Hafner BJ, Gurrey CJ, McLean JB, Allyn KJ, Sanders JE. Adjustable sockets may improve residual limb fluid volume retention in transtibial prosthesis users. Prosthet Orthot Int 2019; 43:250-256. [PMID: 30628522 PMCID: PMC7447526 DOI: 10.1177/0309364618820140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Loss of residual limb volume degrades socket fit and may require accommodation. OBJECTIVES To examine if either of two accommodation strategies executed during resting, socket release with full socket size return and socket release with partial socket size return, enhanced limb fluid volume retention during subsequent activity. STUDY DESIGN Two repeated-measures experiments were conducted to assess the effects of socket release on limb fluid volume retention. METHODS Limb fluid volume was monitored while participants wore a socket with a single adjustable panel. Participants performed eight activity cycles that each included 10 min of sitting and 2 min of walking. The socket's posterior panel and pin lock were released during the fifth cycle while participants were sitting. In one experiment (Full Return), the socket was returned to its pre-release size; in a second experiment (Partial Return), it was returned to 102% of its pre-release size. Short-term and long-term limb fluid volume retention were calculated and compared to a projected, No Intervention condition. RESULTS Partial Return and Full Return short-term retentions and Partial Return long-term retention were greater than those projected under the control condition ( p < 0.05). CONCLUSION Socket release during resting after activity, particularly when the socket is returned to a slightly larger size, may be an effective accommodation strategy to reduce fluid volume loss in transtibial prosthesis users. CLINICAL RELEVANCE This study suggests that existing prosthetic technologies' adjustable sockets and locking pin tethers can be used in novel ways to help maintain residual limb fluid volume in active prosthesis users.
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Affiliation(s)
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle
| | | | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | | | - Jake B McLean
- Department of Bioengineering, University of Washington, Seattle
| | | | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle
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Youngblood RT, Hafner BJ, Allyn KJ, Cagle JC, Hinrichs P, Redd CB, Vamos AC, Ciol MA, Bean N, Sanders JE. Effects of activity intensity, time, and intermittent doffing on daily limb fluid volume change in people with transtibial amputation. Prosthet Orthot Int 2019; 43:28-38. [PMID: 30010494 PMCID: PMC7447527 DOI: 10.1177/0309364618785729] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: The volume of a prosthesis user's residual limb changes during the day and may affect the fit of the prosthesis. These changes must be managed by the user to prevent discomfort, skin breakdown, and falls. OBJECTIVES: The objectives were to test how activity, time of day, and intermittent doffing affected residual limb fluid volume in people with transtibial amputation. STUDY DESIGN: Standardized, repeated measure (A-B-A) out-of-laboratory protocol. METHODS: Participants with transtibial amputation completed three 6-h test sessions. Two sessions served as controls (A protocol) during which participants left their prosthesis donned, and one session was an intervention (B protocol) where participants doffed their prosthesis twice for 20 min during the 6 h of testing. Within-socket fluid volume was measured using a custom portable bioimpedance analysis system. RESULTS: A total of 13 participants completed the study. The rate of limb fluid volume loss was higher early in the session compared with late in the session. Participants experienced less fluid volume loss during high activity than low activity. Socket users with pin suspension experienced less posterior fluid volume loss when they intermittently doffed their prosthesis. Intermittent doffing did not benefit limb fluid volume of mechanical vacuum and suction suspension users. CONCLUSION: High activity may reduce fluid volume loss compared with low activity. Intermittent doffing may provide volume accommodation for transtibial prosthesis users with pin suspension. CLINICAL RELEVANCE Prosthetists should query their patients about the intensity of activity they conduct when advising them on limb volume management. Patients using sockets with pin suspension may be able to offset limb fluid volume loss by periodically doffing the prosthesis.
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Affiliation(s)
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of
Washington
| | | | - John C Cagle
- Department of Bioengineering, University of Washington
| | - Paul Hinrichs
- Department of Bioengineering, University of Washington
| | | | | | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of
Washington
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16
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How Do Socket Size Adjustments during Ambulation Affect Residual Limb Fluid Volume? Case Study Results. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/jpo.0000000000000224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fatone S, Yohay J, Caldwell R. Change in residual limb size over time in the NU-FlexSIV socket: A case study. Prosthet Orthot Int 2018; 42:620-625. [PMID: 29775131 DOI: 10.1177/0309364618775445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: This case study represented a unique opportunity wherein a long-time user of sub-ischial sockets had kept nearly every socket he wore for a decade. This individual let us borrow these sockets so we could digitize them and indirectly assess change in residual limb size over time by calculating changes in socket volume and circumferences over time. CASE DESCRIPTION AND METHODS: Over a decade, the subject maintained a relatively stable body weight of 84-88 kg and received nine sub-ischial sockets. The internal surface of each socket was scanned using a mechanical digitizer and volume and circumferences calculated. FINDINGS AND OUTCOMES: Socket volume increased 31.3%, from a low of 2659.2 cm3 for the oldest socket to a high of 3490.6 cm3 for the most recent socket. Proximal circumferences increased more than distal circumferences with a 15.9% total increase proximally versus 8.9% total increase distally. DISCUSSION AND CONCLUSION: The results suggest that this individual's residual limb increased in size over time despite the compressive effect of the socket and liner. In addition, the increase in circumference was greater proximally than distally, which is where the remaining muscle bellies are located. CLINICAL RELEVANCE This case study provides insight into the long-term effect of the sub-ischial socket on residual limb volume given compression of the soft tissues by the socket system.
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Affiliation(s)
- Stefania Fatone
- 1 Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA
| | - Jessica Yohay
- 1 Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA
| | - Ryan Caldwell
- 1 Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA.,2 Sheck & Siress Prosthetics Inc., Schaumburg, IL, USA
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18
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A Novel Method for Assessing Prosthesis Use and Accommodation Practices of People with Transtibial Amputation. ACTA ACUST UNITED AC 2018; 30:214-230. [PMID: 32577075 DOI: 10.1097/jpo.0000000000000209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sanders JE, Youngblood RT, Hafner BJ, Ciol MA, Allyn KJ, Gardner D, Cagle JC, Redd CB, Dietrich CR. Residual limb fluid volume change and volume accommodation: Relationships to activity and self-report outcomes in people with trans-tibial amputation. Prosthet Orthot Int 2018; 42:415-427. [PMID: 29402170 PMCID: PMC7447528 DOI: 10.1177/0309364617752983] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fluctuations in limb volume degrade prosthesis fit and require users to accommodate changes using management strategies, such as donning and doffing prosthetic socks. OBJECTIVES To examine how activities and self-report outcomes relate to daily changes in residual limb fluid volume and volume accommodation. STUDY DESIGN Standardized, two-part laboratory protocol with an interim observational period. METHODS Participants were classified as "accommodators" or "non-accommodators," based on self-report prosthetic sock use. Participants' residual limb fluid volume change was measured using a custom bioimpedance analyzer and a standardized in-laboratory activity protocol. Self-report health outcomes were assessed with the Socket Comfort Score and Prosthesis Evaluation Questionnaire. Activity was monitored while participants left the laboratory for at least 3 h. They then returned to repeat the bioimpedance test protocol. RESULTS Twenty-nine people were enrolled. Morning-to-afternoon percent limb fluid volume change per hour was not strongly correlated to percent time weight-bearing or to self-report outcomes. As a group, non-accommodators ( n = 15) spent more time with their prosthesis doffed and reported better outcomes than accommodators. CONCLUSION Factors other than time weight-bearing may contribute to morning-to-afternoon limb fluid volume changes and reported satisfaction with the prosthesis among trans-tibial prosthesis users. Temporary doffing may be a more effective and satisfying accommodation method than sock addition. Clinical relevance Practitioners should be mindful that daily limb fluid volume change and prosthesis satisfaction are not dictated exclusively by activity. Temporarily doffing the prosthesis may slow daily limb fluid volume loss and should be investigated as an alternative strategy to sock addition.
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20
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Swanson EC, McLean JB, Allyn KJ, Redd CB, Sanders JE. Instrumented socket inserts for sensing interaction at the limb-socket interface. Med Eng Phys 2017; 51:111-118. [PMID: 29229405 DOI: 10.1016/j.medengphy.2017.11.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/18/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
The objective of this research was to investigate a strategy for designing and fabricating computer-manufactured socket inserts that were embedded with sensors for field monitoring of limb-socket interactions of prosthetic users. An instrumented insert was fabricated for a single trans-tibial prosthesis user that contained three sensor types (proximity sensor, force sensing resistor, and inductive sensor), and the system was evaluated through a sequence of laboratory clinical tests and two days of field use. During in-lab tests 3 proximity sensors accurately distinguish between don and doff states; 3 of 4 force sensing resistors measured gradual pressure increases as weight-bearing increased; and the inductive sensor indicated that as prosthetic socks were added the limb moved farther out of the socket and pistoning amplitude decreased. Multiple sensor types were necessary in analysis of field collected data to interpret how sock changes affected limb-socket interactions. Instrumented socket inserts, with sensors selected to match clinical questions of interest, have the potential to provide important insights to improve patient care.
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Affiliation(s)
- Eric C Swanson
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195 USA.
| | - Jake B McLean
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195 USA.
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195 USA.
| | - Christian B Redd
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195 USA.
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195 USA.
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21
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Gholizadeh H, Lemaire ED, Eshraghi A. The evidence-base for elevated vacuum in lower limb prosthetics: Literature review and professional feedback. Clin Biomech (Bristol, Avon) 2016; 37:108-116. [PMID: 27423025 DOI: 10.1016/j.clinbiomech.2016.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 06/17/2016] [Accepted: 06/21/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND An optimal suspension system can improve comfort and quality of life in people with limb loss. To guide practice on prosthetic vacuum suspension systems, assessment of the current evidence and professional opinion are required. METHODS PubMed, Web of Science, and Google Scholar databases were explored to find related articles. Search terms were amputees, artificial limb, prosthetic suspension, prosthetic liner, vacuum, and prosthesis. The results were refined by vacuum socket or vacuum assisted suspension or sub-atmospheric suspension. Study design, research instrument, sample size, and outcome measures were reviewed. An online questionnaire was also designed and distributed worldwide among professionals and prosthetists (www.ispoint.org, OANDP-L, LinkedIn, personal email). FINDINGS 26 articles were published from 2001 to March 2016. The number of participants averaged 7 (SD=4) for transtibial and 6 (SD=6) for transfemoral amputees. Most studies evaluated the short-term effects of vacuum systems by measuring stump volume changes, gait parameters, pistoning, interface pressures, satisfaction, balance, and wound healing. 155 professionals replied to the questionnaire and supported results from the literature. Elevated vacuum systems may have some advantages over the other suspension systems, but may not be appropriate for all people with limb loss. INTERPRETATION Elevated vacuum suspension could improve comfort and quality of life for people with limb loss. However, future investigations with larger sample sizes are needed to provide strong statistical conclusions and to evaluate long-term effects of these systems.
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Affiliation(s)
- H Gholizadeh
- Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada; Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.
| | - E D Lemaire
- Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Canada.
| | - A Eshraghi
- Bloorview Research Institute, Holland Bloorview Kid's Rehabilitation Hospital, Toronto, Canada.
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22
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Sanders JE, Hartley TL, Phillips RH, Ciol MA, Hafner BJ, Allyn KJ, Harrison DS. Does temporary socket removal affect residual limb fluid volume of trans-tibial amputees? Prosthet Orthot Int 2016; 40:320-8. [PMID: 25710944 PMCID: PMC4601934 DOI: 10.1177/0309364614568413] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/03/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lower-limb prosthesis users typically experience residual limb volume losses over the course of the day that can detrimentally affect socket fit. OBJECTIVES To determine whether temporarily doffing the prosthesis encouraged residual limb fluid volume recovery and whether the recovered fluid was maintained. STUDY DESIGN Experimental design. METHODS Residual limb fluid volume was monitored on 16 participants in three test sessions each. Participants conducted six cycles of resting/standing/walking. Between the third and fourth cycles, participants sat for 30 min with the prosthesis and liner: donned (ON), the prosthesis doffed but the liner donned (LINER), or the prosthesis and liner doffed (OFF). RESULTS Percentage fluid volume gain and retention were greatest for the OFF condition followed by the LINER condition. Participants experienced fluid volume losses for the ON condition. CONCLUSION Doffing the prosthesis or both the prosthesis and liner during rest improved residual limb fluid volume retention compared with leaving the prosthesis and liner donned. CLINICAL RELEVANCE Practitioners should advise patients who undergo high daily limb volume losses to consider temporarily doffing their prosthesis. Fluid volume retention during subsequent activity will be highest if both the prosthesis and liner are doffed.
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23
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Sanders JE, Redd CB, Cagle JC, Hafner BJ, Gardner D, Allyn KJ, Harrison DS, Ciol MA. Preliminary evaluation of a novel bladder-liner for facilitating residual limb fluid volume recovery without doffing. ACTA ACUST UNITED AC 2016; 53:1107-1120. [PMID: 28355030 DOI: 10.1682/jrrd.2014.12.0316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 01/25/2016] [Indexed: 11/05/2022]
Abstract
For people who wear a prosthetic limb, residual-limb fluid volume loss during the day may be problematic and detrimentally affect socket fit. The purpose of this research was to test the capability of a novel liner with adjustable bladders positioned within its wall to mitigate volume loss and facilitate limb fluid volume recovery and retention. Bioimpedance analysis was used to monitor fluid volume changes in the anterior and posterior residual limb of participants with transtibial amputation. Participants underwent six cycles of sitting for 90 s, standing for 90 s, and walking for 5 min with liquid within the bladder-liners. Between the third and fourth cycles, participants sat for 10 min with liquid left within the bladders (Liquid-In) or removed (Liquid-Out). Results showed that participants recovered more fluid volume during the 10 min of sitting with Liquid-Out than Liquid-In (p = 0.09 for anterior and p = 0.04 for posterior). However, those fluid volume recoveries were not well retained in the short term (after the fourth cycle) or the long term (after the sixth cycle). Physiologic differences between sessions, reflected in the rates of fluid volume change at the outset of the session, and excessive stiffness of the bladder-liners may have affected fluid volume retentions.
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Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA
| | - Christian B Redd
- Department of Bioengineering, University of Washington, Seattle, WA
| | | | - Brian J Hafner
- Department of Bioengineering, University of Washington, Seattle, WA
| | - David Gardner
- Department of Bioengineering, University of Washington, Seattle, WA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA
| | | | - Marcia A Ciol
- Department of Bioengineering, University of Washington, Seattle, WA
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D’Silva K, Hafner BJ, Allyn KJ, Sanders JE. Self-reported prosthetic sock use among persons with transtibial amputation. Prosthet Orthot Int 2014; 38:321-31. [PMID: 23986464 PMCID: PMC4438706 DOI: 10.1177/0309364613499064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 07/02/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Daily changes in the shape and size of the residual limb affect prosthetic socket fit. Prosthetic socks are often added or removed to manage changes in limb volume. Little has been published about how persons with transtibial amputations use socks to manage diurnal changes in volume and comfort. OBJECTIVES To investigate prosthetic sock use with a customized, self-report questionnaire. STUDY DESIGN Cross-sectional survey. METHODS Persons with transtibial amputation reported number, thickness, and timing of socks used over a 14-day period. RESULTS Data from 23 subjects (16 males and 7 females) were included. On average, socks were changed less than once per day (0.6/day) and ply increased over the day (4.8-5.5 ply). Subjects wore prostheses significantly longer (15.0-14.1 h, p = 0.02) and changed socks significantly more often (0.6/day-0.4/day, p = 0.03) on weekdays compared to weekends. Participants were also divided into two subgroups: those who used socks to manage limb volume and those who used socks for socket comfort. Sock use did not differ (p > 0.05) between subgroups. CONCLUSIONS Sock changes are infrequent among persons with lower limb loss. Initial, verbal reports of sock use were often inconsistent with data measured by logs. Tools (e.g. sock logs or objective instruments) to better understand sock-use habits among persons with limb loss are needed. CLINICAL RELEVANCE Knowledge of prosthetic patients' sock use may help practitioners enhance volume management strategies or troubleshoot fitting issues. Results showed that subjects generally added socks to account for volume loss, and end-of-day sock thickness frequently exceeded 5 ply. Use of sock logs in clinical practice may facilitate improved residual limb health.
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Affiliation(s)
- Krittika D’Silva
- Department of Bioengineering University of Washington 3720 15th Ave
NE Box 355061 Seattle, WA 98195, USA
| | - Brian J. Hafner
- Department of Rehabilitation Medicine University of Washington 1959
NE Pacific Street Box 356490 Seattle, WA 98195
| | - Katheryn J. Allyn
- Department of Bioengineering University of Washington 3720 15th Ave
NE Box 355061 Seattle, WA 98195, USA
| | - Joan E. Sanders
- Department of Bioengineering University of Washington 3720 15th Ave
NE Box 355061 Seattle, WA 98195, USA
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25
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Sanders JE, Cagle JC, Allyn KJ, Harrison DS, Ciol MA. How do walking, standing, and resting influence transtibial amputee residual limb fluid volume? JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2014; 51:201-12. [PMID: 24933719 DOI: 10.1682/jrrd.2013.04.0085] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 09/17/2013] [Indexed: 11/05/2022]
Abstract
The purpose of this research was to determine how fluid volume changes in the residual limbs of people with transtibial amputation were affected by activity during test sessions with equal durations of resting, standing, and walking. Residual limb extracellular fluid volume was measured using biompedance analysis in 24 participants. Results showed that all subjects lost fluid volume during standing with equal weight-bearing, averaging a loss rate of -0.4%/min and a mean loss over the 25 min test session of 2.6% (standard deviation [SD] 1.1). Sixteen subjects gained limb fluid volume during walking (mean gain of 1.0% [SD 2.5]), and fifteen gained fluid volume during rest (mean gain of 1.0% [SD 2.2]). Walking explained only 39.3% of the total session fluid volume change. There was a strong correlation between walk and rest fluid volume changes (-0.81). Subjects with peripheral arterial disease experienced relatively high fluid volume gains during sitting but minimal changes or losses during sit-to-stand and stand-to-sit transitioning. Healthy female subjects experienced high fluid volume changes during transitioning from sit-to-stand and stand-to-sit. The differences in fluid volume response among subjects suggest that volume accommodation technologies should be matched to the activity-dependent fluid transport characteristics of the individual prosthesis user.
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Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, University of Washington, Box 355061, William H. Foege Bldg, 3720 15th Ave NE, Seattle, WA 98195.
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26
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Sanders JE, Cagle JC, Harrison DS, Myers TR, Allyn KJ. How does adding and removing liquid from socket bladders affect residual-limb fluid volume? JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2013; 50:845-60. [PMID: 24203546 DOI: 10.1682/jrrd.2012.06.0121] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Adding and removing liquid from socket bladders is a means for people with limb loss to accommodate residual-limb volume change. We fit 19 people with transtibial amputation using their regular prosthetic socket with fluid bladders on the inside socket surface to undergo cycles of bladder liquid addition and removal. In each cycle, subjects sat, stood, and walked for 90 s with bladder liquid added, and then sat, stood, and walked for 90 s again with the bladder liquid removed. The amount of bladder liquid added was increased in each cycle. We used bioimpedance analysis to measure residual-limb fluid volume. Results showed that the preferred bladder liquid volume was 16.8 +/- 8.4 mL (mean +/- standard deviation), corresponding with 1.7% +/- 0.8% of the average socket volume between the bioimpedance voltage-sensing electrodes. Residual-limb fluid volume driven out of the residual limb when bladder liquid was added was typically not recovered upon subsequent bladder liquid removal. Of the 19 subjects, 15 experienced a gradual residual-limb fluid volume loss over the test session. Care should be taken when implementing adjustable socket technologies in people with limb loss. Reducing socket volume may accentuate residual-limb fluid volume loss.
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Affiliation(s)
- Joan E Sanders
- University of Washington, 3720 15th Ave NE, Seattle, WA 98195.
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27
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Hornero G, Díaz D, Casas O. Bioimpedance system for monitoring muscle and cardiovascular activity in the stump of lower-limb amputees. Physiol Meas 2013; 34:189-201. [PMID: 23348608 DOI: 10.1088/0967-3334/34/2/189] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A bioimpedance system for the continuous measurement of non-invasive physiological parameters in lower-limb amputees is presented. The aim of the system is to monitor as many physiological parameters as possible from a single bioimpedance electrode configuration. In this way, a simple, low-cost and low-size autonomous system is developed that is able to continuously monitor the amputee in different environments (home, work, etc). The system measures both electrical impedance myography and electrical impedance plethysmography in the stump with electrodes placed in the inside face of a silicone interface. Such a system allows for the monitoring of a patient's muscle activity, and heart and breath rate, thus enabling the study and continuous monitoring of prosthesis adaptation and improvement of patient's gait to reduce physiological stress. Additionally, it can prevent cardiovascular problems due to the effort involved in the use of prostheses, which can decrease the life expectancy of amputees with previous vascular diseases. Experimental results obtained from different amputees' test validate the purpose of the system.
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Affiliation(s)
- G Hornero
- Instrumentation, Sensors and Interfaces Group, EETAC, Universitat Politècnica de Catalunya, Barcelona, Spain.
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Sanders JE, Harrison DS, Cagle JC, Myers TR, Ciol MA, Allyn KJ. Post-doffing residual limb fluid volume change in people with trans-tibial amputation. Prosthet Orthot Int 2012; 36:443-9. [PMID: 22588848 PMCID: PMC4423811 DOI: 10.1177/0309364612444752] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Residual limb volume may change after doffing, affecting the limb shape measured and used as a starting point for socket design. OBJECTIVES The purpose of this study was to compare residual limb fluid volume changes after doffing for different test configurations. STUDY DESIGN The study was a repeated measures experimental design with three conditions (Sit, Liner, and Walk). METHODS Residual limb fluid volume on 30 people with trans-tibial amputation was measured using bioimpedance analysis. Three tests were conducted--Sit: sit for 10 minutes, remove the prosthesis, socks and liner, sit for 10 minutes; Liner: sit for 10 minutes, remove the prosthesis and socks but not the liner, sit for 10 minutes; Walk: conduct sit, stand and walk activities for 30 minutes, remove the prosthesis, socks and liner, sit for 10 minutes. RESULTS The percentage fluid volume increase after doffing was significantly higher for Walk (2.8%) than for Sit (1.8%) (p = 0.03). The time to achieve a maximum or stable fluid volume was shorter for Liner (4.3 min) than for Sit (6.6 min) (p = 0.03). CONCLUSIONS Activity before doffing intensified the post-doffing limb fluid volume increase. Maintaining a liner after doffing caused limb fluid volume to stabilize faster than removing the liner. Clinical relevance To minimize residual limb volume increase before casting or imaging, practitioners should have patients sit with their prosthesis donned for 10 minutes. Leaving a liner on the residuum will not reduce the post-doffing volume increase, but it will help to more quickly achieve a consistent limb fluid volume.
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Affiliation(s)
- Joan E Sanders
- University of Washington, Box 355061, 3720 15th Ave NE, Seattle, WA 98195, USA.
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Sanders JE, Allyn KJ, Harrison DS, Myers TR, Ciol MA, Tsai EC. Preliminary investigation of residual-limb fluid volume changes within one day. ACTA ACUST UNITED AC 2012; 49:1467-78. [DOI: 10.1682/jrrd.2011.12.0236] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, Foege N430J, 1705 Pacific St, University of Washington, Seattle, WA 98195, USA.
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