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Miyata Y, Sasaki K, Guerra G, Dacharux W, Chaisumritchoke S. The AERO prosthetic liner: socket pressure distribution, comfort and material composition. Ann Med 2024; 56:2380798. [PMID: 39061117 DOI: 10.1080/07853890.2024.2380798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/29/2023] [Accepted: 02/22/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE This study aimed to evaluate the pressure distribution and comfort of transtibial prosthesis wearers using an affordable ethyl-vinyl acetate (EVA) roll-on (AERO) liner. METHOD Fifteen unilateral transtibial prosthesis users wore patella tendon bearing (PTB) sockets with a polyethylene foam (PE-lite) liner were enrolled this study. AERO liners were provided to all participants. Six force sensors were applied to the residual limb to evaluate pressure distribution during treadmill walking, and the socket comfort score (SCS) was used to evaluate comfortability. Fourier transform infrared (FT-IR) spectroscopy was performed on the EVA and PE-lite liners. RESULTS Eleven participants used prefabricated AERO liners and four participants used custom-made AERO liners. The pressure distribution was analysed by the coefficient of variation (CV): PE-lite was 75.7 ± 6.0 and AERO liner 83.3 ± 4.1. Residual limb pressure was significantly decreased when using the AERO liner (p = .0007), with a large effect size (r = 0.87). Mean SCS was 7.5 ± 1.3 and 8.9 ± 1.1 for PE-lite and AERO liner respectively. CONCLUSION Better pressure distribution and comfort were observed when the participants used the AERO liner. AERO had a greater proportion of calcium carbonate (CaCO3). These findings suggest that the AERO liner is a better off-the-shelf option for persons using traditional prosthetic sockets and liners.
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Affiliation(s)
- Yusuke Miyata
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kazuhiko Sasaki
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Gary Guerra
- Department of Exercise and Sport Science, St. Mary's University, San Antonio, TX, USA
| | - Woratee Dacharux
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirarat Chaisumritchoke
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Abstract
This article describes fundamental lower limb prosthesis concepts and componentry, including skeletal structure (endoskeletal vs exoskeletal), transtibial and transfemoral sockets, prosthetic suspension and interfaces, prosthetic knees, and prosthetic foot and ankle systems.
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Affiliation(s)
- Rebecca A Speckman
- Regional Amputation Center, Rehabilitation Care Services, VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, USA.
| | - Wayne T Biggs
- Regional Amputation Center, Rehabilitation Care Services, VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, USA
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3
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Pousett BM, Cumming D, Azhari F, Phillips C, MacKay C. The physical experiences of women with lower limb absence during pregnancy and postpartum: symptoms, prosthesis management & mobility. Disabil Rehabil 2024:1-8. [PMID: 39023179 DOI: 10.1080/09638288.2024.2378234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Little information is available to women with lower limb absence (LLA) and their health care providers regarding the impacts they may experience during the perinatal period. This study explores the physical impacts of pregnancy on women with LLA, including mobility, prosthesis fit and prosthesis use. METHODS We conducted semi-structured interviews with 19 women with LLA who had experienced pregnancy in the last 10 years. Interviews were analyzed using thematic analysis. RESULTS Substantial variation exists in the experience of women's physical symptoms, prosthesis management and mobility. Physical symptoms were similar to any pregnant individual, but the impacts were more substantial. As volume change in the residual limb can impact prosthesis fit, self-management techniques and prosthetist adjustments were used to manage it. Pregnancy impacted the way in which women were mobile and the activities they chose to participate in. A wide variety of creative mobility solutions were utilized to complete activities including prosthesis use, assistive equipment and adaptive movement. CONCLUSIONS Women with LLA and their health care providers must be aware of the wide range of experiences women face during pregnancy and treat each pregnancy uniquely. Planning ahead and working with a health care team can mitigate many of these challenges.
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Affiliation(s)
- Brittany Mae Pousett
- Barber Prosthetics Clinic, Vancouver, British Columbia, Canada
- Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Donna Cumming
- Barber Prosthetics Clinic, Vancouver, British Columbia, Canada
| | - Fae Azhari
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Clara Phillips
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
- West Park Healthcare Centre, Toronto, ON, Canada
| | - Crystal MacKay
- West Park Healthcare Centre, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Dickinson AS, Steer JW, Rossides C, Diment LE, Mbithi FM, Bramley JL, Hannett D, Blinova J, Tankard Z, Worsley PR. Insights into the spectrum of transtibial prosthetic socket design from expert clinicians and their digital records. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1354069. [PMID: 39071770 PMCID: PMC11272479 DOI: 10.3389/fresc.2024.1354069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/25/2024] [Indexed: 07/30/2024]
Abstract
Background Transtibial prosthetic sockets are often grouped into patella tendon bearing (PTB) or total surface bearing (TSB) designs, but many variations in rectifications are used to apply these principles to an individual's personalised socket. Prosthetists currently have little objective evidence to assist them as they make design choices. Aims To compare rectifications made by experienced prosthetists across a range of patient demographics and limb shapes to improve understanding of socket design strategies. Methodology 163 residual limb surface scans and corresponding CAD/CAM sockets were analysed for 134 randomly selected individuals in a UK prosthetics service. This included 142 PTB and 21 TSB designs. The limb and socket scans were compared to determine the location and size of rectifications. Rectifications were compiled for PTB and TSB designs, and associations between different rectification sizes were assessed using a variety of methods including linear regression, kernel density estimation (KDE) and a Naïve Bayes (NB) classification. Results Differences in design features were apparent between PTB and TSB sockets, notably for paratibial carves, gross volume reduction and distal end elongation. However, socket designs varied across a spectrum, with most showing a hybrid of the PTB and TSB principles. Pairwise correlations were observed between the size of some rectifications (e.g., paratibial carves; fibular head build and gross volume reduction). Conversely, the patellar tendon carve depth was not associated significantly with any other rectification, indicating its relative design insensitivity. The Naïve Bayes classifier produced design patterns consistent with expert clinician practice. For example, subtle local rectifications were associated with a large volume reduction (i.e., a TSB-like design), whereas more substantial local rectifications (i.e., a PTB-like design) were associated with a low volume reduction. Clinical implications This study demonstrates how we might learn from design records to support education and enhance evidence-based socket design. The method could be used to predict design features for newly presenting patients, based on categorisations of their limb shape and other demographics, implemented alongside expert clinical judgement as smart CAD/CAM design templates.
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Affiliation(s)
- A. S. Dickinson
- Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - J. W. Steer
- Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
- Radii Devices Ltd., Bristol, United Kingdom
| | - C. Rossides
- Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
- Radii Devices Ltd., Bristol, United Kingdom
| | - L. E. Diment
- Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - F. M. Mbithi
- Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - J. L. Bramley
- Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
- Radii Devices Ltd., Bristol, United Kingdom
| | - D. Hannett
- Opcare Ltd., Oxfordshire, United Kingdom
| | - J. Blinova
- Opcare Ltd., Oxfordshire, United Kingdom
| | - Z. Tankard
- Opcare Ltd., Oxfordshire, United Kingdom
| | - P. R. Worsley
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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Arnstein T, Buis A. Methodology to Investigate Effect of Prosthetic Interface Design on Residual Limb Soft Tissue Deformation. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2024; 6:42196. [PMID: 38873008 PMCID: PMC11168601 DOI: 10.33137/cpoj.v6i1.42196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/10/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Residual limb discomfort and injury is a common experience for people living with lower limb amputation. Frequently, inadequate load distribution between the prosthetic device and the residual limb is the root cause of this issue. To advance our understanding of prosthetic interface fit, tools are needed to evaluate the mechanical interaction at the prosthetic interface, allowing interface designs to be evaluated and optimised. OBJECTIVE Present a methodology report designed to facilitate comprehension of the mechanical interaction between the prosthetic interface and the residual limb. As a pilot study, this methodology is used to compare a hands-on and hands-off interface for a single transtibial prosthesis user using secondary Magnetic Resonance Imaging (MRI) data. METHODOLOGY MRI data of the residual limb while wearing a prosthetic interface is segmented into a hard tissue and a skin surface model. These models are exported as stereolithography (STL) files. Two methods are used to analyse the interface designs. Firstly, CloudCompare software is used to compute the nearest vertex on the skin surface for every vertex on the compiled internal bony surface for both interface types. Secondly, CloudCompare software is used to compare registered skin surfaces of the residual limb while wearing the hands-on and hands-off interfaces. FINDINGS The maximum and minimum nearest distances between the internal bony surface and skin surface were similar between interface types. However, the distribution of nearest distances was different. When comparing the skin surface while wearing both interfaces, where the fit is more compressive can be visualized. For the dataset used in this study, the classic features of a hands-on Patella Tendon Bearing interface and hands-off pressure cast interface could be identified. CONCLUSION The methodology presented in this report may give researchers a further tool to better understand how interface designs affect the soft tissues of the residual limb.
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Affiliation(s)
- T Arnstein
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, Scotland
| | - A Buis
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, Scotland
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Miyata Y, Sasaki K, Guerra G, Dacharux W, Chaiwan P. Evaluating Feasibility and Durability of the Aero Prosthetic Liner in Transtibial Prosthetic Users. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2023; 6:41865. [PMID: 38873010 PMCID: PMC11168602 DOI: 10.33137/cpoj.v6i1.41865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/19/2023] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND The choice of prosthetic socket interface material significantly affects user comfort and satisfaction. The Affordable Ethylene-Vinyl Acetate Roll-On (AERO) liner was created with the aim of improving functionality and streamlining the wearing process for users. OBJECTIVE The purpose of this study was to comprehensively assess user satisfaction, comfort, and durability of the AERO liner and compare it with the common soft Pe-Lite liner. METHODOLOGY Fourteen individuals with transtibial amputation participated in this three-month randomized crossover trial study. The Prosthesis Evaluation Questionnaire (PEQ), Expanded Socket Comfort Score (ESCS), and liner thickness measurements were used to comprehensively compare the AERO and Pe-Lite liner. FINDINGS The AERO liner demonstrated notable improvements in prosthetic comfort and functionality over Pe-Lite liner. After three months use, there was a significant reduction in reported frustration with the AERO liner (p=0.023, r=0.604) in the PEQ subscale. Specific aspects, such as walking with the prosthesis (p=0.030, r=0.601) and odor perception (p=0.024, d=0.579), favored the use of the AERO liner. The expanded socket comfort score (ESCS) revealed significant superiority for the AERO liner "at best" (p=0.04) and "on average" (p=0.02) after one and three months, respectively. Liner thickness analysis showed significant reductions at the mid-patellar tendon location for the AERO liner at one (0.57±0.48) and three months (0.90±0.69, p=0.01) and in the posterior region after three months (0.63±0.64, p=0.05). CONCLUSION Our study highlights the potential advantages of the AERO liner in enhancing comfort and satisfaction. Yet, durability and thinning of the liner when compared to Pe-Lite may be a concern which may eventually affect socket fit. These findings contribute to ongoing efforts to optimize prosthetic interventions and improve the quality of life of individuals with lower limb prosthesis in resource-limited environments.
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Affiliation(s)
- Y Miyata
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - K Sasaki
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - G Guerra
- Department of Exercise and Sport Science, St. Mary's University, San Antonio, TX, USA
| | - W Dacharux
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - P Chaiwan
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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7
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Rich TL, Voss G, Fairhurst S, Matsumoto M, Brielmaier S, Koester K, Netoff TI, Hansen AH, Ferguson JE. Feasibility testing of a novel prosthetic socket sensor system. Disabil Rehabil 2022:1-8. [PMID: 35797711 DOI: 10.1080/09638288.2022.2093997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Poorly fitting prosthetic sockets contribute to decreased quality of life, health, and well-being for persons with amputations. Therefore, improved socket fit is a high clinical priority. METHODS In this study, we describe the design and testing of a novel sensor system that can be incorporated into a prosthetic socket to measure distal end weight bearing in the socket and can alert a prosthesis user if poor socket fit is suspected. We present the results of testing this device with three Veterans who were new prosthesis users and three Veterans who were experienced prosthesis users. RESULTS AND CONCLUSIONS We collected sensor data during walking trials while participants wore varying numbers of sock plies and qualitative feedback on the design of the socket fit sensor system. For analysis, peak sensor measurements during walking cycles were identified and combined with socket fit data (i.e., a clinician-determined level of "good," "too tight," or "too loose" and the number of sock ply worn each trial). We found consistent relationships between peak sensor measurements and socket fit in our sample. Also, all users expressed an interest in the device, highlighting its potential benefits during early prosthesis training.Implications for RehabilitationEnsuring socket fit is challenging for many prosthesis users.A novel wearable sensor system can be used to identify socket fit issues for some prosthesis users.This type of system could be most helpful for new prosthesis users and those with sensory and cognitive challenges.
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Affiliation(s)
- Tonya L Rich
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America.,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Greg Voss
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Stuart Fairhurst
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Mary Matsumoto
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America.,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Steven Brielmaier
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Karl Koester
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Theoden I Netoff
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Andrew H Hansen
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America.,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America.,Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - John E Ferguson
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America.,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
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Klenow TD, Schulz J. Adjustable-Volume Prosthetic Sockets: Market Overview and Value Propositions. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2021; 4:35208. [PMID: 37615005 PMCID: PMC10443512 DOI: 10.33137/cpoj.v4i2.35208] [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] [Indexed: 11/23/2022] Open
Abstract
The prosthetic socket is commonly considered to be the most important part of the prosthesis and lack of fit can lead to skin breakdown, reduction in wear, reduction in activity, and consequential deleterious health effects. Furthermore, approximately 90% of amputations are due to a vascular etiology, which affect fluid retention regularity, and even small limb volume fluctuations can lead to lack of fit. Adjustability in the socket volume has been suggested as a potential solution to common fit issues but has lacked market penetration mostly due to lack of reimbursement. Despite this there are several adjustable-volume sockets emerging on the market today including prefabricated, modular, custom with adjustable-volume component, custom with adjustable-volume feature, and adjustable-hybrid sockets. Prefabricated sockets are mass produced in common sizes and fit directly to the patient by a prosthetist using pad kits, BOA dials, or straps. Modular sockets are assembled to a patient or model with panels or struts attached to an adjustable base. Custom sockets with adjustable-volume elements are traditionally-fabricated sockets made to a model of a patient's limb with a volume-adjustable component added or volume-adjustable feature built in. Custom-hybrid sockets are made custom to a model of the patient's limb and incorporate several aspects of the previous socket types and include some radically-unique design aspects which cannot be limited to one category. These adjustable-volume sockets offer several advantages to traditional rigid-volume sockets for the patient, prosthetist, and providing clinic. The micro-adjustability for the patient allows them to alter fit without removing the socket, maintaining a more intimate fit throughout the day than traditional sockets. The macro-adjustability for the prosthetist allows for increased options for fit customization including the ability to reverse or undo changes without necessarily re-making the socket. This allows for the most optimal fit for the patient. Adjustable volume also present efficiencies in the fitting process by simplifying or eliminating steps including residual limb shape capture, form modification, diagnostic fabrication, iterative alteration, and definitive fabrication with the different socket types affecting different steps. Due to these factors, adjustable-volume sockets have disrupted the market to the point where reimbursement reform is needed including additional L-codes in the United States and fee-for-service or fee-for-outcome associated with prosthetic follow-up care. Prosthetic care should also be separated from durable medical equipment to allow for alternative reimbursement models. As reimbursement adapts prosthetists must adapt correspondingly to differentiate their skillset from other allied health providers including incorporating more objective methods to show superior care outcomes. This adaptation should include a continued push for state and municipal licensure of prosthetists.
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Affiliation(s)
- TD Klenow
- Martin Bionics Clinical Care, Fort Myers, Florida, USA
| | - J. Schulz
- Martin Bionics Innovations, Oklahoma City, Oklahoma, USA
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Ko ST, Asplund F, Zeybek B. A Scoping Review of Pressure Measurements in Prosthetic Sockets of Transfemoral Amputees during Ambulation: Key Considerations for Sensor Design. SENSORS (BASEL, SWITZERLAND) 2021; 21:5016. [PMID: 34372253 PMCID: PMC8347332 DOI: 10.3390/s21155016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 02/05/2023]
Abstract
Sensor systems to measure pressure at the stump-socket interface of transfemoral amputees are receiving increasing attention as they allow monitoring to evaluate patient comfort and socket fit. However, transfemoral amputees have many unique characteristics, and it is unclear whether existing research on sensor systems take these sufficiently into account or if it is conducted in ways likely to lead to substantial breakthroughs. This investigation addresses these concerns through a scoping review to profile research regarding sensors in transfemoral sockets with the aim of advancing and improving prosthetic socket design, comfort and fit for transfemoral amputees. Publications found from searching four scientific databases were screened, and 17 papers were found relating to the aim of this review. After quality assessment, 12 articles were finally selected for analysis. Three main contributions are provided: a de facto methodology for experimental studies on the implications of intra-socket pressure sensor use for transfemoral amputees; the suggestion that associated sensor design breakthroughs would be more likely if pressure sensors were developed in close combination with other types of sensors and in closer cooperation with those in possession of an in-depth domain knowledge in prosthetics; and that this research would be facilitated by increased interdisciplinary cooperation and open research data generation.
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Affiliation(s)
- Siu-Teing Ko
- Research and Innovation, Össur, 110 Reykjavík, Iceland
| | - Fredrik Asplund
- Department of Machine Design, KTH Royal Institute of Technology, 10044 Stockholm, Sweden;
| | - Begum Zeybek
- Healthcare Innovation Centre, School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK;
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10
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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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11
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Abstract
BACKGROUND Strength deficits may play a central role in the severity of balance, mobility, and endurance impairments in lower limb prosthesis users. A body of literature detailing the scope and specifics of muscle weakness in lower limb prosthesis users is emerging, but has yet to be summarized. A synopsis of strength deficits, and their impact on functional abilities in lower limb prosthesis users, may inform rehabilitation and research needs. OBJECTIVES Synthesize reported strength deficits in lower limb prosthesis users, and discuss possible causes, consequences, and solutions. STUDY DESIGN Scoping review. METHODS A search of biomedical databases was performed, and inclusion/exclusion criteria were applied to identify publications relevant to the purpose of the review. RESULTS In all, 377 publications were identified, of which 12 met the inclusion/exclusion criteria. When compared with the controls and the intact limb, the primary strength outcome, peak torque, was lower in transtibial residual limb knee flexors and extensors, as well as transfemoral residual limb hip muscles. CONCLUSIONS The reviewed studies provide evidence of strength deficits in lower limb prosthesis users. These deficits appear to be consequential, as they may contribute to balance, mobility, and endurance impairments. Additional research exploring alternative strength metrics, clinical tests, and causal links to functional impairments is required. CLINICAL RELEVANCE Evidence of muscle weakness among lower limb prosthesis users, and its influence on balance, mobility, and endurance, suggests that greater clinical attention and scientific inquiry into physical conditioning of lower limb prosthesis users is merited and required.
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Affiliation(s)
- Alex Hewson
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Shaquitta Dent
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Andrew Sawers
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
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12
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M J N, G A, F F, M R. Design and Fabrication of a New Expandable Transtibial Liner with Manual Volume Control: A Prototype. J Biomed Phys Eng 2020; 10:543-548. [PMID: 32802802 PMCID: PMC7416089 DOI: 10.31661/jbpe.v0i0.2001-1056] [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: 01/22/2020] [Accepted: 03/06/2020] [Indexed: 11/16/2022]
Abstract
Diurnal volume changes is one of the main factors influencing socket fit in transtibial prosthesis and causing pressure problem issues.
Embedded bladder liners have been recently a potential approach to deal with this problem. The aim of this technical note was to introduce a new transtibial
silicone liner designed based on hybrid socket theory.
To make expandability in the liner, an integrated wax structure was constructed over the selected areas of the positive model
and then removed after lamination process. In addition, a mechanical system with manual control was designed to fit the liner with the residual limb
volume by pumping the water in or out of the liner through connective tubes. The results showed that this new design had high reliability in maintaining identical surface pressures after volume changes in laboratory trials. Therefore, it seems that selective expandability of this liner would accommodate residual limb volume fluctuations without disturbing effect on preliminary pressure pattern.
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Affiliation(s)
- Nouri M J
- PhD Candidate, Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Aminian G
- PhD, Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Farahmand F
- PhD, Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Rahgozar M
- PhD, Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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14
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Steer JW, Grudniewski PA, Browne M, Worsley PR, Sobey AJ, Dickinson AS. Predictive prosthetic socket design: part 2-generating person-specific candidate designs using multi-objective genetic algorithms. Biomech Model Mechanobiol 2019; 19:1347-1360. [PMID: 31741116 PMCID: PMC7423857 DOI: 10.1007/s10237-019-01258-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/08/2019] [Indexed: 11/06/2022]
Abstract
In post-amputation rehabilitation, a common goal is to return to ambulation using a prosthetic limb, suspended by a customised socket. Prosthetic socket design aims to optimise load transfer between the residual limb and mechanical limb, by customisation to the user. This is a time-consuming process, and with the increase in people requiring these prosthetics, it is vital that these personalised devices can be produced rapidly while maintaining excellent fit, to maximise function and comfort. Prosthetic sockets are designed by capturing the residual limb’s shape and applying a series of geometrical modifications, called rectifications. Expert knowledge is required to achieve a comfortable fit in this iterative process. A variety of rectifications can be made, grouped into established strategies [e.g. in transtibial sockets: patellar tendon bearing (PTB) and total surface bearing (TSB)], creating a complex design space. To date, adoption of advanced engineering solutions to support fitting has been limited. One method is numerical optimisation, which allows the designer a number of likely candidate solutions to start the design process. Numerical optimisation is commonly used in many industries but not prevalent in the design of prosthetic sockets. This paper therefore presents candidate shape optimisation methods which might benefit the prosthetist and the limb user, by blending the state of the art from prosthetic mechanical design, surrogate modelling and evolutionary computation. The result of the analysis is a series of prosthetic socket designs that preferentially load and unload the pressure tolerant and intolerant regions of the residual limb. This spectrum is bounded by the general forms of the PTB and TSB designs, with a series of variations in between that represent a compromise between these accepted approaches. This results in a difference in pressure of up to 31 kPa over the fibula head and 14 kPa over the residuum tip. The presented methods would allow a trained prosthetist to rapidly assess these likely candidates and then to make final detailed modifications and fine-tuning. Importantly, insights gained about the design should be seen as a compliment, not a replacement, for the prosthetist’s skill and experience. We propose instead that this method might reduce the time spent on the early stages of socket design and allow prosthetists to focus on the most skilled and creative tasks of fine-tuning the design, in face-to-face consultation with their client.
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Affiliation(s)
- J W Steer
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - P A Grudniewski
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - M Browne
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - P R Worsley
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - A J Sobey
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - A S Dickinson
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK.
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Schoepp KR, Schofield JS, Home D, Dawson MR, Lou E, Keri M, Marasco PD, Hebert JS. Real time monitoring of transtibial elevated vacuum prostheses: A case series on socket air pressure. PLoS One 2018; 13:e0202716. [PMID: 30346953 PMCID: PMC6197629 DOI: 10.1371/journal.pone.0202716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/09/2018] [Indexed: 12/03/2022] Open
Abstract
Prosthetic elevated vacuum is a suspension method used to reduce daily volume changes of the residual limb. Evaluation of the effectiveness of these systems is limited due to a lack of correlation to actual socket air pressure, particularly during unconstrained movements. This may explain some of the variability in functional outcomes reported in the literature. Our objective was to develop a light-weight portable socket measurement system to quantify internal socket air pressure, temperature, and acceleration; and to present preliminary results from implementation with three transtibial prosthesis users with mechanical elevated vacuum pumps. Participants completed five functional tasks with and without the vacuum pumps actively connected, including the 2-Minute Walk test, 5-Times Sit-to-Stand test, 4-Square Step test, L-Test, and Figure-8 test. Results demonstrated different gait profiles and pressure ranges for each user. Two of the participants demonstrated substantially lower air pressure (higher vacuum) over time while the pump was active compared to inactive. The minimum air pressure measured for all participants was -34.6 ± 7.7 kPa. One participant did not show substantial changes in pressure over time for either pump condition. Functional task performance was not significantly different between pump conditions. Correlation with accelerometer readings indicated peak positive pressures occurred just following initial contact of the foot in early stance, and the most negative pressures (highest vacuum) were observed throughout swing. This study has demonstrated the use of a portable data logging tool that may serve the clinical and research communities to quantify the operation of elevated vacuum systems, and better understand the variability of mechanical pump operation and overall system performance.
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Affiliation(s)
- Katherine R. Schoepp
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathon S. Schofield
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland, Ohio, United States of America
| | - David Home
- Prosthetics and Orthotics Department, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Michael R. Dawson
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Edmond Lou
- Department of Electrical & Computer Engineering, Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - McNiel Keri
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Paul D. Marasco
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland, Ohio, United States of America
- Advanced Platform Technology Center of Excellence, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Jacqueline S. Hebert
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Aydın A, Okur SÇ. Effects of Test Socket on Pain, Prosthesis Satisfaction, and Functionality in Patients with Transfemoral and Transtibial Amputations. Med Sci Monit 2018; 24:4031-4037. [PMID: 29897893 PMCID: PMC6031121 DOI: 10.12659/msm.910858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 06/01/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this retrospective study was to investigate the frequency of admissions, reason for admissions, and test socket satisfaction in patients who received a lower-limb prosthesis with or without a test socket in our unit. MATERIAL AND METHODS A total of 88 patients (54 men, 34 women) were included in the study. Patients were divided into 2 groups: the group with test socket (Group I, 44 patients) and the group without test socket (Group II, 44 patients). Variables related to the functional status, frequency of complaints, and test socket satisfaction were investigated in the 2 groups. The Trinity Amputation and Prosthesis Experience Scales (TAPES) and Beck Depression Inventory (BDI) were used to assess the level of patient satisfaction with their prosthesis. The VAS (Visual Analogue Scale) was used to assess pain at rest and during walking. RESULTS We found that the TAPES values were more significant in Group 1 in both transtibial and transfemoral amputations (P<0.05). However, prosthesis delivery time was more significant in Group 2 in both transtibial and transfemoral amputations (P<0.001) whereas the frequency of admissions within 3 months was more significant in Group 1 in both transtibial and transfemoral amputations (P<0.001). There was no statistically significant difference between the 2 groups in terms of other parameters (P>0.05). CONCLUSIONS Although the use of a test socket increases the cost of prosthesis units, we showed that patients with transtibial and transfemoral amputations have fewer complaints related to prosthesis increases patient functionality, and that it reduces pain and increases patient satisfaction with the prosthesis.
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Affiliation(s)
- Abdulkadir Aydın
- Department of Prosthetics and Orthotics, Dicle University Medical School, Diyarbakir, Turkey
| | - Sibel Çağlar Okur
- Department of Physical Therapy and Rehabilitation, Sadi Konuk Research Hospital, Istanbul, Turkey
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17
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Paterno L, Ibrahimi M, Gruppioni E, Menciassi A, Ricotti L. Sockets for Limb Prostheses: A Review of Existing Technologies and Open Challenges. IEEE Trans Biomed Eng 2018; 65:1996-2010. [PMID: 29993506 DOI: 10.1109/tbme.2017.2775100] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the prosthetics field, one of the most important bottlenecks is still the human-machine interface, namely the socket. Indeed, a large number of amputees still rejects prostheses or points out a low satisfaction level, due to a sub-optimal interaction between the socket and the residual limb tissues. The aim of this paper is to describe the main parameters (displacements, stress, volume fluctuations and temperature) affecting the stump-socket interface and reducing the comfort/stability of limb prostheses. In this review, a classification of the different socket types proposed in the literature is reported, together with an analysis of advantages and disadvantages of the different solutions, from multiple viewpoints. The paper then describes the technological solutions available to face an altered distribution of stresses on the residual limb tissues, volume fluctuations affecting the stump overtime and temperature variations affecting the residual tissues within the socket. The open challenges in this research field are highlighted and the possible future routes are discussed, towards the ambitious objective of achieving an advanced socket able to self-adapt in real-time to the complex interplay of factors affecting the stump, during both static and dynamic tasks.
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Major MJ, Fey NP. Considering passive mechanical properties and patient user motor performance in lower limb prosthesis design optimization to enhance rehabilitation outcomes. PHYSICAL THERAPY REVIEWS 2017; 22:1-15. [PMID: 29170616 DOI: 10.1080/10833196.2017.1346033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Selection of prosthesis mechanical characteristics to restore function of persons with lower-limb loss can be framed as an optimization problem to satisfy a given performance objective. However, the choice of a particular objective is critical, and considering only device and generalizable outcomes across users without accounting for inherent motor performance likely restricts a given patient from fully realizing the benefits of a prosthetic intervention. Objectives This review presents methods for optimizing passive below-knee prosthesis designs to maximize rehabilitation outcomes and how considerations on patient motor performance may enhance these outcomes. Major Findings Available literature supports that considering patient-specific variables pertaining to motor performance permits a multidimensional landscape relating device characteristics and user function, which may yield more accurate predictions of rehabilitation outcomes for individual patients. Moreover, the addition of targeted physical therapeutic interventions that encourage user self-organization may further improve these outcomes. We note the potential of existing paradigms to address these additional dimensions, and we encourage investigators to consider the many different performance objectives available for prosthesis optimization. Conclusions By considering user motor performance in combination with prosthesis mechanical characteristics, a staged optimization approach can be formulated which acknowledges that device modifications may only improve outcomes to a certain extent and user self-organization is a critical component to complete rehabilitation. An iterative process that can be integrated within existing rehabilitative practices accounts for changes in patient status through combined targeted prosthetic solutions and physical therapeutic techniques, and embodies the concept of personalized intervention for patients with lower limb-loss.
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Affiliation(s)
- Matthew J Major
- Jesse Brown VA Medical Center, Chicago IL, USA.,Northwestern University Prosthetics Orthotics Center, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago IL, USA
| | - Nicholas P Fey
- University of Texas at Dallas, Departments of Bioengineering and Mechanical Engineering, Richardson TX, USA.,UT Southwestern Medical Center, Department of Physical Medicine and Rehabilitation, Dallas TX, USA
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