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Squibb CO, Madigan ML, Philen MK. A high precision laser scanning system for measuring shape and volume of transtibial amputee residual limbs: Design and validation. PLoS One 2024; 19:e0301619. [PMID: 38991031 PMCID: PMC11239001 DOI: 10.1371/journal.pone.0301619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/19/2024] [Indexed: 07/13/2024] Open
Abstract
Changes in limb volume and shape among transtibial amputees affects socket fit and comfort. The ability to accurately measure residual limb volume and shape and relate it to comfort could contribute to advances in socket design and overall care. This work designed and validated a novel 3D laser scanner that measures the volume and shape of residual limbs. The system was designed to provide accurate and repeatable scans, minimize scan duration, and account for limb motion during scans. The scanner was first validated using a cylindrical body with a known shape. Mean volumetric errors of 0.17% were found under static conditions, corresponding to a radial spatial resolution of 0.1 mm. Limb scans were also performed on a transtibial amputee and yielded a standard deviation of 8.1 ml (0.7%) across five scans, and a 46 ml (4%) change in limb volume when the socket was doffed after 15 minutes of standing.
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Affiliation(s)
- Carson O Squibb
- Kevin T. Crofton Department of Aerospace and Ocean Engineering, Virginia Tech (Mail Code 0203), Blacksburg, VA, United States of America
| | - Michael L Madigan
- Grado Department of Industrial and Systems Engineering, Virginia Tech (Mail Code 0118), Blacksburg, VA, United States of America
| | - Michael K Philen
- Kevin T. Crofton Department of Aerospace and Ocean Engineering, Virginia Tech (Mail Code 0203), Blacksburg, VA, United States of America
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Reliability of three different methods for assessing amputee residuum shape and volume: 3D scanners vs. circumferential measurements. Prosthet Orthot Int 2022; 46:327-334. [PMID: 35320149 DOI: 10.1097/pxr.0000000000000105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Objective and reliable methods are necessary to monitor and manage amputee residuum shape and volume and design prosthetic residuum-prosthesis interfaces. Portable 3D scanners are potential solutions for digitally recording the amputee residuum characteristics. OBJECTIVE To investigate test-operator reliability when measuring lower limb residuum shape and volume using two different types of 3D laser-free scanners compared with tape measurements generally adopted in clinic. STUDY DESIGN Ten lower limb amputees took part in this study. Residuum volume, cross sectional areas, and perimeter lengths were measured by three different operators on three different occasions using two types of 3D scanners (Artec Eva scanner and OMEGA Scanner 3D) and circumferential measurements. METHODS Variance components, intraclass correlation coefficients and intra-rater and inter-rater reliability coefficients were calculated for all measurement conditions. RESULTS Residuum volume outputs ranged from 569 to 3115 mL. The factor contributing mostly to the residuum volume error variance was the shape of the residuum (75.85%). Volume intraclass correlation coefficients for both intra-rater and inter-rater reliability exceeded 0.9 for all three conditions. Volume reliability coefficients ranged from 70.68 mL (Artec Eva intra-rater reliability) to 256.85 mL (circumferential measurements inter-rater reliability). Shape relative error reached the highest values for the circumferential measurements (>10% for the cross-sectional areas and >5% for the perimeters). CONCLUSIONS The Artec Eva scanner resulted in the lowest test-operator reliability coefficients. However, both investigated scanners are a potential alternative for measuring small and macroscopic changes in residuum characteristics.
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Paternò L, Ibrahimi M, Rosini E, Menfi G, Monaco V, Gruppioni E, Ricotti L, Menciassi A. Residual limb volume fluctuations in transfemoral amputees. Sci Rep 2021; 11:12273. [PMID: 34112873 PMCID: PMC8192500 DOI: 10.1038/s41598-021-91647-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/31/2021] [Indexed: 11/08/2022] Open
Abstract
This study constitutes the first attempt to systematically quantify residual limb volume fluctuations in transfemoral amputees. The study was carried out on 24 amputees to investigate variations due to prosthesis doffing, physical activity, and testing time. A proper experimental set-up was designed, including a 3D optical scanner to improve precision and acceptability by amputees. The first test session aimed at measuring residual limb volume at 7 time-points, with 10 min intervals, after prosthesis doffing. This allowed for evaluating the time required for volume stabilization after prosthesis removal, for each amputee. In subsequent sessions, 16 residual limb scans in a day for each amputee were captured to evaluate volume fluctuations due to prosthesis removal and physical activity, in two times per day (morning and afternoon). These measurements were repeated in three different days, a week apart from each other, for a total of 48 scans for each amputee. Volume fluctuations over time after prosthesis doffing showed a two-term decay exponential trend (R2 = 0.97), with the highest variation in the initial 10 min and an average stabilization time of 30 min. A statistically significant increase in residual limb volume following both prosthesis removal and physical activity was verified. No differences were observed between measures collected in the morning and in the afternoon.Clinical Trials.gov ID: NCT04709367.
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Affiliation(s)
- Linda Paternò
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Michele Ibrahimi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Elisa Rosini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giuseppe Menfi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- IRCCS Fondazione Don Carlo Gnocchi, 20148, Milan, Italy
| | | | - Leonardo Ricotti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
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Armitage L, Buller A, Rajan G, Prusty G, Simmons A, Kark L. Clinical utility of pressure feedback to socket design and fabrication. Prosthet Orthot Int 2020; 44:18-26. [PMID: 31769736 DOI: 10.1177/0309364619868364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The clinical utility of measuring pressure at the prosthetic socket-residual limb interface is currently unknown. OBJECTIVES This study aimed to identify whether measuring interface pressure during prosthetic design and fabrication results in closer agreement in pressure measurements between sockets made by different clinicians, and a reduction in pressure over areas of concern. It also investigated whether clinicians value knowing the interface pressure during the fabrication process. STUDY DESIGN Mixed methods. METHODS Three prosthetists designed a complete prosthetic system for a transtibial residual limb surrogate. Standardised mechanical testing was performed on each prosthetic system to gain pressure measurements at four key anatomical locations. These measurements were provided to the clinicians, who subsequently modified their sockets as each saw fit. The pressure at each location was re-measured. Each prosthetist completed a survey that evaluated the usefulness of knowing interface pressures during the fabrication process. RESULTS Feedback and subsequent socket modifications saw a reduction in the pressure measurements at three of the four anatomical locations. Furthermore, the pressure measurements between prosthetists converged. All three prosthetists found value in the pressure measurement system and felt they would use it clinically. CONCLUSIONS Results suggest that sensors measuring pressure at the socket-limb interface has clinical utility in the context of informing prosthetic socket design and fabrication. If the technology is used at the check socket stage, iterative designs with repeated measurements can result in increased consistency between clinicians for the same residual limb, and reductions in the magnitudes of pressures over specific anatomical landmarks. CLINICAL RELEVANCE This study provides new information on the value of pressure feedback to the prosthetic socket design process. It shows that with feedback, socket modifications can result in reduced limb pressures, and more consistent pressure distributions between prosthetists. It also justifies the use of pressure feedback in informing clinical decisions.
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Affiliation(s)
- Lucy Armitage
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
| | | | - Ginu Rajan
- School of Electrical, Computer and Telecommunications Engineering, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Gangadhara Prusty
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, Sydney, NSW, Australia
| | - Anne Simmons
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
| | - Lauren Kark
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
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Armitage L, Kark L, Czerniec S, Kwah LK. Reliability and Validity of Measurement Tools for Residual Limb Volume in People With Limb Amputations: A Systematic Review. Phys Ther 2019; 99:612-626. [PMID: 30722026 DOI: 10.1093/ptj/pzz010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Measurements of residual limb volume often guide decisions on the type and timing of prosthetic prescription. To help inform these decisions, it is important that clinicians use measurement tools that are reliable and valid. PURPOSE The aim of this systematic review was to investigate the reliability and validity of measurement tools for residual limb volume in people with limb amputations. DATA SOURCES A comprehensive search on MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science was performed on July 11, 2016. STUDY SELECTION Studies were included if they examined the reliability or validity of measurement tools for residual limb volume, were conducted on humans, and were published in English. DATA EXTRACTION Data were extracted from 11 reliability and 4 validity studies and included study characteristics, volumetric estimates, and reliability and validity estimates. The quality of the studies was also rated. DATA SYNTHESIS Data from 2 studies (38 participants) indicated good to excellent intrarater (intraclass correlation coefficient [ICC] ≥0.88) and interrater (ICC ≥0.88) reliability and high between-session reliability (coefficient of variation [CV] = 10%) for water displacement volumetry. One study (28 participants) reported excellent intrarater and interrater reliability (ICC ≥0.93) for the circumferential method, and data from 2 studies (19 participants) indicated high between-session reliability for the optical surface scanner (CV ≤9.8%). Three studies (26 participants) indicated good to excellent between-session reliability results for computed tomography (CV = 9.2%-10.9%). One study (7 participants) showed moderate within-session reliability (CV = 50%). Using water displacement volumetry as the gold standard, 2 studies (79 participants) indicated excellent validity for the circumferential method ( r ≥0.92; ICC ≥0.92). All studies reporting measures of reliability or validity were performed with people who had transtibial amputations. LIMITATIONS Only studies published in English and in which water displacement volumetry was used as the gold standard were included in this review. The reliability and validity of the quality rating scale used in this review have not been tested. CONCLUSIONS On the basis of a limited number of moderate- to high-quality studies with small sample sizes, circumferential and water displacement methods were found to be reliable, and the circumferential method was found to be valid in people with transtibial amputations. There are inadequate data for drawing conclusions about volume measurement methods in people with other types of limb amputations.
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Affiliation(s)
- Lucy Armitage
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, New South Wales, Australia 2052
| | - Lauren Kark
- Graduate School of Biomedical Engineering, UNSW Sydney
| | - Sharon Czerniec
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Li Khim Kwah
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Armitage L, Kwah LK, Kark L. Reliability and validity of the iSense optical scanner for measuring volume of transtibial residual limb models. Prosthet Orthot Int 2019; 43:213-220. [PMID: 30343619 DOI: 10.1177/0309364618806038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: Residual limb volume is often measured as part of routine care for people with amputations. These measurements assist in the timing of prosthetic fitting or replacement. In order to make well informed decisions, clinicians need access to measurement tools that are valid and reliable. OBJECTIVES: To assess the reliability and criterion validity of the iSense optical scanner in measuring volume of transtibial residual limb models. STUDY DESIGN: Three assessors performed two measurements each on 13 residual limb models with an iSense optical scanner (3D systems, USA). Intra-rater and inter-rater reliability were calculated using intraclass correlation coefficients. Bland Altman plots were inspected for agreement. Criterion validity was assessed using a steel rod of known dimensions. Ten repeated measurements were performed by one assessor. A t-test was used to determine differences between measured and true rod volume. RESULTS: Intra-rater reliability was excellent (range of intraclass correlation coefficients: 0.991-0.997, all with narrow 95% confidence intervals). While the intraclass correlation coefficients suggest excellent inter-rater reliability between all three assessors (range of intraclass correlation coefficients: 0.952-0.986), the 95% confidence intervals were wide between assessor 3 and the other two assessors. Poor agreement with assessor 3 was also seen in the Bland-Altman plots. Criterion validity was very poor with a significant difference between the mean iSense measurement and the true rod volume (difference: 221.18 mL; p < 0.001). CONCLUSIONS: Although intra-rater reliability was excellent for the iSense scanner, we did not find similar results for inter-rater reliability and validity. These results suggest that further testing of the iSense scanner is required prior to use in clinical practice. CLINICAL RELEVANCE The iSense offers a low cost scanning option for residual limb volume measurement. Intra-rater reliability was excellent, but inter-rater reliability and validity were such that clinical adoption is not indicated at present.
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Affiliation(s)
| | - Li Khim Kwah
- 2 University of Technology Sydney, Sydney, NSW, Australia
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Kofman R, Beekman AM, Emmelot CH, Geertzen JHB, Dijkstra PU. Measurement properties and usability of non-contact scanners for measuring transtibial residual limb volume. Prosthet Orthot Int 2018; 42:280-287. [PMID: 29113533 DOI: 10.1177/0309364617736088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Non-contact scanners may have potential for measurement of residual limb volume. Different non-contact scanners have been introduced during the last decades. Reliability and usability (practicality and user friendliness) should be assessed before introducing these systems in clinical practice. OBJECTIVES The aim of this study was to analyze the measurement properties and usability of four non-contact scanners (TT Design, Omega Scanner, BioSculptor Bioscanner, and Rodin4D Scanner). STUDY DESIGN Quasi experimental. METHODS Nine (geometric and residual limb) models were measured on two occasions, each consisting of two sessions, thus in total 4 sessions. In each session, four observers used the four systems for volume measurement. Mean for each model, repeatability coefficients for each system, variance components, and their two-way interactions of measurement conditions were calculated. User satisfaction was evaluated with the Post-Study System Usability Questionnaire. RESULTS Systematic differences between the systems were found in volume measurements. Most of the variances were explained by the model (97%), while error variance was 3%. Measurement system and the interaction between system and model explained 44% of the error variance. Repeatability coefficient of the systems ranged from 0.101 (Omega Scanner) to 0.131 L (Rodin4D). Differences in Post-Study System Usability Questionnaire scores between the systems were small and not significant. CONCLUSION The systems were reliable in determining residual limb volume. Measurement systems and the interaction between system and residual limb model explained most of the error variances. The differences in repeatability coefficient and usability between the four CAD/CAM systems were small. Clinical relevance If accurate measurements of residual limb volume are required (in case of research), modern non-contact scanners should be taken in consideration nowadays.
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Affiliation(s)
- Rianne Kofman
- 1 Vogellanden-Centre for Rehabilitation, Zwolle, The Netherlands
| | - Anna M Beekman
- 2 Region Kronoberg-Center for Rehabilitation, Växjö, Sweden
| | | | - Jan H B Geertzen
- 4 University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, the Netherlands
| | - Pieter U Dijkstra
- 4 University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, the Netherlands
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Postema SG, van der Sluis CK, Waldenlöv K, Norling Hermansson LM. Body structures and physical complaints in upper limb reduction deficiency: a 24-year follow-up study. PLoS One 2012; 7:e49727. [PMID: 23226218 PMCID: PMC3511484 DOI: 10.1371/journal.pone.0049727] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 10/17/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To describe upper body structures associated with upper limb reduction deficiency and the development of these structures over time, to examine the presence of physical complaints in this population, and to compare body structures and complaints between groups based on prosthesis use. DESIGN Prospective cohort study with a follow-up period of 24 years, with matched able-bodied controls. SUBJECTS Twenty-eight patients with unilateral below-elbow reduction deficiency fitted with myoelectric prostheses, aged 8-18 years at inclusion. METHOD Measurements of upper arm, trunk and spine were performed and study-specific questionnaires were answered at baseline and follow-up; the Brief Pain Inventory and the Quick Disability of Arm, Shoulder, and Hand questionnaires were answered at follow-up. RESULTS Both at baseline and follow-up, within-subjects differences in structures of the arm and trunk were shown in patients but not in controls. Spinal deviations, although small, were greater in patients compared to controls. Self-reported disability was higher in patients compared to controls. Differences in back pain and effect of prostheses use could not be shown. CONCLUSIONS Patients with unilateral below-elbow reduction deficiency have consistent differences in upper body structures. Deviations of the spine, probably of functional origin, do not progress to clinically relevant scoliosis.
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Affiliation(s)
- Sietke G. Postema
- Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Corry K. van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kristina Waldenlöv
- Limb Deficiency and Arm Prosthesis Centre, Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
| | - Liselotte M. Norling Hermansson
- Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden
- Department of Prosthetics and Orthotics, Örebro County Council, Örebro, Sweden
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
- * E-mail:
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Variation in Results of Volume Measurements of Stumps of Lower-Limb Amputees: A Comparison of 4 Methods. Arch Phys Med Rehabil 2011; 92:941-6. [DOI: 10.1016/j.apmr.2011.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 12/22/2010] [Accepted: 01/03/2011] [Indexed: 11/21/2022]
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