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Badaire P, Robert MT, Turcot K. The Overlay, a New Solution for Volume Variations in the Residual Limb for Individuals with a Transtibial Amputation. SENSORS (BASEL, SWITZERLAND) 2024; 24:4744. [PMID: 39066140 PMCID: PMC11281076 DOI: 10.3390/s24144744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/05/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND The company Ethnocare has developed the Overlay, a new pneumatic solution for managing volumetric variations (VVs) of the residual limb (RL) in transtibial amputees (TTAs), which improves socket fitting. However, the impact of the Overlay during functional tasks and on the comfort and pain felt in the RL is unknown. METHODS 8 TTAs participated in two evaluations, separated by two weeks. We measured compensatory strategies (CS) using spatio-temporal parameters and three-dimensional lower limb kinematics and kinetics during gait and sit-to-stand (STS) tasks. During each visit, the participant carried out our protocol while wearing the Overlay and prosthetic folds (PFs), the most common solution to VV. Between each task, comfort and pain felt were assessed using visual analog scales. RESULTS While walking, the cadence with the Overlay was 105 steps/min, while it was 101 steps/min with PFs (p = 0.021). During 35% and 55% of the STS cycle, less hip flexion was observed while wearing the Overlay compared to PFs (p = 0.004). We found asymmetry coefficients of 13.9% with the Overlay and 17% with PFs during the STS (p = 0.016) task. Pain (p = 0.031), comfort (p = 0.017), and satisfaction (p = 0.041) were better with the Overlay during the second visit. CONCLUSION The Overlay's impact is similar to PFs' but provides less pain and better comfort.
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Affiliation(s)
- Pierre Badaire
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris)—525, Boul. Wilfrid-Hamel, Aile H Local 1300, Québec, QC G1M 2S8, Canada; (P.B.); (M.T.R.)
- Département de Kinésiologie, Pavillon de l’Éducation Physique et des Sports, Université Laval, (PEPS) 2300, rue de la Terrasse, Local 2144, Québec, QC G1V 0A6, Canada
| | - Maxime T. Robert
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris)—525, Boul. Wilfrid-Hamel, Aile H Local 1300, Québec, QC G1M 2S8, Canada; (P.B.); (M.T.R.)
- École des Sciences de la Réadaptation, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Local 4770, Québec, QC G1V 0A6, Canada
| | - Katia Turcot
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris)—525, Boul. Wilfrid-Hamel, Aile H Local 1300, Québec, QC G1M 2S8, Canada; (P.B.); (M.T.R.)
- Département de Kinésiologie, Pavillon de l’Éducation Physique et des Sports, Université Laval, (PEPS) 2300, rue de la Terrasse, Local 2144, Québec, QC G1V 0A6, Canada
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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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Lee KH, Heo HS, Kim J, Cho JH, Kim KT, Hur JY, Kim JH, Lee Y. A Pneumatically Controlled Prosthetic Socket for Transfemoral Amputees. SENSORS (BASEL, SWITZERLAND) 2023; 24:133. [PMID: 38202994 PMCID: PMC10780925 DOI: 10.3390/s24010133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/15/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024]
Abstract
Amputees typically experience changes in residual limb volume in their daily lives. It causes an uncomfortable fit of the socket by applying high pressure on the sensitive area of the residual limb or by loosening the socket. In this study, we developed a transfemoral prosthetic socket for above-the-knee amputees that ensures a good socket fit by maintaining uniform and constant contact pressure despite volume changes in the residual limb. The socket has two air bladders in the posterior femoral region, and the pneumatic controller is located on the tibia of the prosthesis. The pneumatic system aims to minimize unstable fitting of the socket and improve walking performance by inflating or deflating the air bladder. The developed socket autonomously maintains the air pressure inside the prosthetic socket at a steady-state error of 3 mmHg or less by adjusting the amount of air in the air bladder via closed-loop control. In the clinical trial, amputee participants walked on flat and inclined surfaces. The displacement between the residual limb and socket during the gait cycle was reduced by up to 33.4% after air injection into the socket. The inflatable bladder increased the knee flexion angle on the affected side, resulting in increased stride length and gait velocity. The pneumatic socket provides a stable and comfortable walking experience not only when walking on flat ground but also on slopes.
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Affiliation(s)
- Kang-Ho Lee
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Republic of Korea; (J.K.); (Y.L.)
| | - Hyun-Seok Heo
- Shinsegae Prosthetic Center, Daegu 41710, Republic of Korea; (H.-S.H.); (J.-Y.H.)
| | - Jeongmin Kim
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Republic of Korea; (J.K.); (Y.L.)
| | - Jang Hyuk Cho
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (J.H.C.); (K.T.K.)
| | - Kyoung Tae Kim
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (J.H.C.); (K.T.K.)
| | - Jeong-Yong Hur
- Shinsegae Prosthetic Center, Daegu 41710, Republic of Korea; (H.-S.H.); (J.-Y.H.)
| | - Jang Hwan Kim
- Department of Rehabilitation Technology, Graduate School of Hanseo University, Seosan 31962, Republic of Korea;
| | - Yongkoo Lee
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Republic of Korea; (J.K.); (Y.L.)
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Ghoseiri K, Rastkhadiv MY, Allami M, Page P, Andersen LL, Button DC. The association of the localized pain sensitivity in the residual limb and prosthesis use in male veterans with transtibial amputation. Assist Technol 2023; 35:358-366. [PMID: 35594305 DOI: 10.1080/10400435.2022.2079763] [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] [Accepted: 05/13/2022] [Indexed: 10/18/2022] Open
Abstract
The association of localized pain sensitivity in the residual limb and prosthesis use has clinical implications, however, rarely been assessed. This study aimed to investigate pain sensitivity and explore its range, variability, and association with prosthesis use alongside other demographic and clinical characteristics of veterans with transtibial amputation. Pain sensitivity was determined as pressure pain threshold (PPT) and pressure tolerance (PT) in 19 male veterans with a mean age of 49.5 years using pressure algometry at 12 anatomical locations on the residual limb. A comparison of pain sensitivity at each location, and among anatomical locations and participants was explored using independent t-test, analysis of variance, and Kruskal-Wallis tests, respectively. Pain sensitivity range (PSR), the difference between PT and PPT, was significantly different (p < 0.05) at mid-patellar tendon, medial tibial flare, and the distal end of the tibia. The lowest PPT and PT (20.5 and 33 Ncm-2, p = 0.13) were recorded at the distal end of the residual limb, and the highest PPT and PT (73.4 and 94.3 Ncm-2, p = 0.03) were recorded at the mid-patellar tendon. Pain sensitivity was significantly different among anatomical locations and participants. The correlation tests (Pearson and partial eta squared) showed non-significant associations of pain sensitivity with participants' demographic and clinical characteristics except for daily prosthesis use. The mid-patellar tendon, medial tibial flare, and distal end of the tibia revealed the lowest pain hypersensitivity due to higher PSR. Longer daily prosthesis use was associated with increased pain sensitivity.
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Affiliation(s)
- Kamiar Ghoseiri
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
- Biomedical Instruments Department, Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
| | - Mohammad Yusuf Rastkhadiv
- Biomedical Instruments Department, Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
| | - Mostafa Allami
- Biomedical Instruments Department, Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
| | - Phillip Page
- Doctor of Physical Therapy Program, School of Health Professions, Franciscan University, Baton Rouge, Louisiana, USA
| | - Lars L Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Duane C Button
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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Conway BJ, Taquet L, Boerger TF, Young SC, Krucoff KB, Schmit BD, Krucoff MO. Quantifying Hand Strength and Isometric Pinch Individuation Using a Flexible Pressure Sensor Grid. SENSORS (BASEL, SWITZERLAND) 2023; 23:5924. [PMID: 37447773 DOI: 10.3390/s23135924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
Modulating force between the thumb and another digit, or isometric pinch individuation, is critical for daily tasks and can be impaired due to central or peripheral nervous system injury. Because surgical and rehabilitative efforts often focus on regaining this dexterous ability, we need to be able to consistently quantify pinch individuation across time and facilities. Currently, a standardized metric for such an assessment does not exist. Therefore, we tested whether we could use a commercially available flexible pressure sensor grid (Tekscan F-Socket [Tekscan Inc., Norwood, MA, USA]) to repeatedly measure isometric pinch individuation and maximum voluntary contraction (MVC) in twenty right-handed healthy volunteers at two visits. We developed a novel equation informed by the prior literature to calculate isometric individuation scores that quantified percentage of force on the grid generated by the indicated digit. MVC intra-class correlation coefficients (ICCs) for the left and right hands were 0.86 (p < 0.0001) and 0.88 (p < 0.0001), respectively, suggesting MVC measurements were consistent over time. However, individuation score ICCs, were poorer (left index ICC 0.41, p = 0.28; right index ICC -0.02, p = 0.51), indicating that this protocol did not provide a sufficiently repeatable individuation assessment. These data support the need to develop novel platforms specifically for repeatable and objective isometric hand dexterity assessments.
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Affiliation(s)
| | - Léon Taquet
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Timothy F Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Sarah C Young
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Kate B Krucoff
- Department of Plastic & Reconstructive Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Max O Krucoff
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Design of adjustable frame-type prosthetic socket for lower limb. Ing Rech Biomed 2022. [DOI: 10.1016/j.irbm.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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7
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Lee PS, Gao RZ, Colpitts A, Murdock RW, Dittmer D, Schirm A, Tung JY, Ren CL. Air microfluidics-enabled soft robotic transtibial prosthesis socket liner toward dynamic management of residual limb contact pressure and volume fluctuation. BIOMICROFLUIDICS 2022; 16:034107. [PMID: 35783680 PMCID: PMC9242678 DOI: 10.1063/5.0087900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
Residual limb volume fluctuation and the resulting contact pressures are some of the key factors leading to skin ulcerations, suboptimal prosthetic functioning, pain, and diminishing quality of life of transtibial amputees. Self-management of socket fit is complicated by peripheral neuropathy, reducing the perception of pressure and pain in the residual limb. We introduce a novel proof-of-concept for a transtibial prosthetic socket liner with the potential to dynamically adjust the fit between the limb and socket. The core of the technology is a small air microfluidic chip (10 cm3 and 10 g) with 10 on-chip valves that enable sequential pressurizing of 10 actuators in custom sizes to match the pressures required by the residual limb's unique anatomy. The microfluidic chip largely reduced the number of electromechanical solenoid valves needed for sequential control of 10 actuators (2 instead of 10 valves), resulting in the reduction of the required power, size, mass, and cost of the control box toward an affordable and wearable prosthetic socket. Proof-of-concept testing demonstrated that the applied pressures can be varied in the desired sequence and to redistribute pressure. Future work will focus on integrating the system with biofidelic prosthetic sockets and residual limb models to investigate the ability to redistribute pressure away from pressure-sensitive regions (e.g., fibular head) to pressure tolerant areas. Overall, the dynamic prosthesis socket liner is very encouraging for creating a dynamic socket fit system that can be seamlessly integrated with existing socket fabrication methods for managing residual limb volume fluctuations and contact pressure.
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Affiliation(s)
- Peter S. Lee
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
| | - Run Ze Gao
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
| | - Alyson Colpitts
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
| | | | - Doug Dittmer
- Freeport Campus, Grand River Hospital, 3570 King St. E, Kitchener, Ontario N2A 2W6, Canada
| | - Andreas Schirm
- Prosthetic Ability, 1-407 Gage Ave., Kitchener, Ontario N2M 5E1, Canada
| | - James Y. Tung
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
| | - Carolyn L. Ren
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
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8
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Weathersby EJ, Vamos AC, Larsen BG, McLean JB, Carter RV, Allyn KJ, Ballesteros D, Wang H, deGrasse NS, Friedly JL, Hafner BJ, Garbini JL, Ciol MA, Sanders JE. Performance of an auto-adjusting prosthetic socket during walking with intermittent socket release. J Rehabil Assist Technol Eng 2022; 9:20556683221093271. [PMID: 35558157 PMCID: PMC9087223 DOI: 10.1177/20556683221093271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 03/24/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction A challenge in the engineering of auto-adjusting prosthetic sockets is to
maintain stable operation of the control system while users change their
bodily position and activity. The purpose of this study was to test the
stability of a socket that automatically adjusted socket size to maintain
fit. Socket release during sitting was conducted between bouts of
walking. Methods Adjustable sockets with sensors that monitored distance between the liner and
socket were fabricated. Motor-driven panels and a microprocessor-based
control system adjusted socket size during walking to maintain a target
sensed distance. Limb fluid volume was recorded continuously. During eight
sit/walk cycles, the socket panels were released upon sitting and then
returned to position for walking, either the size at the end of the prior
bout or a size 1.0% larger in volume. Results In six transtibial prosthesis users, the control system maintained stable
operation and did not saturate (move to and remain at the end of the
actuator’s range) during 98% of the walking bouts. Limb fluid volume changes
generally matched the panel position changes executed by the control
system. Conclusions Stable operation of the control system suggests that the auto-adjusting
socket is ready for testing in users’ at-home settings.
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Affiliation(s)
- Ethan J Weathersby
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Andrew C Vamos
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - 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 V Carter
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Daniel Ballesteros
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Horace Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | | | - Janna L Friedly
- Department of Rehabilitation Medicine, 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
| | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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Abstract
INTRODUCTION The prosthetic socket is the connecting part between the stump and the prosthesis, which is the important basis for the function of the prosthesis. The current prosthetic socket is difficult in meeting the needs of amputees current, which is the main reason for amputees abandoning their prostheses. This paper reviews the design and use of prosthetic sockets for lower limb. AREAS COVERED The contribution of this publication is to review the skin problem, interface stress and volume fluctuations for prosthetic sockets, which are proposed as the key factors affecting the use of prosthetic sockets. Moreover, the lower limb prosthetic sockets are classified into the full-contact and the frame-type sockets according to the different contact type between stump and prosthetic socket, and their advantages and disadvantages are analyzed from different perspectives. EXPERT OPINION Aim to design the prosthetic socket with function transfer, suspension stability and comfort of socket, a design concept for prosthetic socket with self-adapt in real-time is proposed. It can be achieved by the smart materials with special mechanical properties.
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Affiliation(s)
- Minghui Wang
- Institute of Rehabilitation Engineering and Technology, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Qingjun Nong
- Institute of Rehabilitation Engineering and Technology, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Yunlong Liu
- Institute of Rehabilitation Engineering and Technology, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
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Mbithi FM, Chipperfield AJ, Steer JW, Dickinson AS. Developing a control framework for self-adjusting prosthetic sockets incorporating tissue injury risk estimation and generalized predictive control. Biomed Eng Lett 2021; 12:59-73. [DOI: 10.1007/s13534-021-00211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/21/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022] Open
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Seo JH, Lee HJ, Seo DW, Lee DK, Kwon OW, Kwak MK, Lee KH. A Prosthetic Socket with Active Volume Compensation for Amputated Lower Limb. SENSORS 2021; 21:s21020407. [PMID: 33435553 PMCID: PMC7827594 DOI: 10.3390/s21020407] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 12/03/2022]
Abstract
Typically, the actual volume of the residual limb changes over time. This causes the prosthesis to not fit, and then pain and skin disease. In this study, a prosthetic socket was developed to compensate for the volume change of the residual limb. Using an inflatable air bladder, the proposed socket monitors the pressure in the socket and keeps the pressure distribution uniform and constant while walking. The socket has three air bladders on anterior and posterior tibia areas, a latching type 3-way pneumatic valve and a portable control device. In the paper, the mechanical properties of the air bladder were investigated, and the electromagnetic analysis was performed to design the pneumatic valve. The controller is based on a hysteresis control algorithm with a closed loop, which keeps the pressure in the socket close to the initial set point over a long period of time. In experiments, the proposed prosthesis was tested through the gait simulator that can imitate a human’s gait cycle. The active volume compensation of the socket was successfully verified during repetitive gait cycle using the weight loads of 50, 70, and 90 kg and the residual limb model with a variety of volumes. It was confirmed that the pressure of the residual limb recovered to the initial state through the active control. The pressure inside the socket had a steady state error of less than 0.75% even if the volume of the residual limb was changed from −7% to +7%.
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Affiliation(s)
- Ji-Hyeon Seo
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Korea; (J.-H.S.); (H.-J.L.); (D.-K.L.); (O.-W.K.)
- School of Mechanical Engineering, College of Engineering, Kyungpook National University, Daegu 41566, Korea;
| | - Hyuk-Jin Lee
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Korea; (J.-H.S.); (H.-J.L.); (D.-K.L.); (O.-W.K.)
| | - Dong-Wook Seo
- Department of Radio Communication Engineering/Interdisciplinary Major of Maritime AI Convergence, Korea Maritime and Ocean University, Busan 49112, Korea;
| | - Dong-Kyu Lee
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Korea; (J.-H.S.); (H.-J.L.); (D.-K.L.); (O.-W.K.)
| | - Oh-Won Kwon
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Korea; (J.-H.S.); (H.-J.L.); (D.-K.L.); (O.-W.K.)
| | - Moon-Kyu Kwak
- School of Mechanical Engineering, College of Engineering, Kyungpook National University, Daegu 41566, Korea;
| | - Kang-Ho Lee
- Daegu Research Center for Medical Devices, Korea Institute of Machinery and Materials, Daegu 42994, Korea; (J.-H.S.); (H.-J.L.); (D.-K.L.); (O.-W.K.)
- Correspondence:
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12
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Weathersby EJ, Garbini JL, Larsen BG, McLean JB, Vamos AC, Sanders JE. Automatic Control of Prosthetic Socket Size for People WithTranstibial Amputation: Implementation and Evaluation. IEEE Trans Biomed Eng 2020; 68:36-46. [PMID: 32386137 DOI: 10.1109/tbme.2020.2992739] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose was to design, implement, and test a control system for a motor-actuated, cable-panel prosthetic socket that automatically maintains socket fit by continuous adjustment of the socket size. METHODS Sockets with motor-driven adjustable panels were fabricated for participants with transtibial amputation. A proportional-integral control system was implemented to adjust socket size based on Socket Fit Metric (SFM) data collected by an inductive sensor embedded within the socket wall. The sensed distance was representative of limb-to-socket distance. Testing was conducted with participants walking on a treadmill to characterize the system's capability to maintain a set point and to respond to a change in the set point. RESULTS Test results from 10 participants with transtibial amputation showed that the Integral of Absolute Error (IAE) to maintain a set point ranged from 0.001 to 0.046 mm with a median of 0.003 mm. When the set point was changed, IAE errors ranged from 0.001 to 0.005 mm, with a median of 0.003 mm. An IAE of 0.003 mm corresponded to approximately a 0.08% socket volume error, which was considered clinically acceptable. CONCLUSION The capability of the control system to maintain and respond to a change in set point indicates that it is ready for evaluation outside of the laboratory. SIGNIFICANCE Integration of the developed control system into everyday prostheses may improve quality of life of prosthesis users by relieving them of the burden of continually adjusting socket size to maintain fit.
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13
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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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Carter RV, Larsen BG, McLean JB, Garbini JL, Sanders JE. Incorporating a Ferrous Polymer Target into Elastomeric Liners for Socket Fit Sensing in Prosthesis Users. SENSORS 2020; 20:s20195620. [PMID: 33019604 PMCID: PMC7582797 DOI: 10.3390/s20195620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022]
Abstract
Liner-to-socket distance measurement using inductive sensing may be an effective means to continuously monitor socket fit in people using trans-tibial prostheses. A practical limitation, however, is a means to incorporate a thin uniform-thickness layer of conductive or magnetically permeable target material into the wide range of prosthetic liner products that people with limb amputation commonly use. In this paper, a method is presented whereby a 0.50-mm thickness ferrous polymer made from a SEEPS polymer and iron powder that is formed adjacent to a 0.25-mm thick non-ferrous layer of SEEPS polymer is assembled between two sheets of elastic fabric material. Bench testing showed that the fabrication procedure achieved a root-mean-square error in the thickness of this construct of 58 μm, helping to create a consistent calibration result over the entire surface. The original fabric backing of an off-the-shelf prosthetic liner was removed and replaced with the developed construct. When worn in the shoe of an able-bodied participant for 7.5 h per day for 28 days, the sensor well maintained the shape of its calibration curve at the start of wear, but a distance offset (shifting of the y-intercept) was introduced that increased during the initial approximately 12 days of wear. When the distance offset was corrected, for the primary distance range of clinical interest for this application (0.00–5.00 mm), the sensor maintained its calibration within 4.4%. Before being used in clinical application for liner-to-socket distance monitoring, new ferrous liners may need to be pre-worn so as to achieve a consistent distance reference.
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15
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Gupta S, Loh KJ, Pedtke A. Sensing and actuation technologies for smart socket prostheses. Biomed Eng Lett 2019; 10:103-118. [PMID: 32175132 DOI: 10.1007/s13534-019-00137-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/17/2019] [Accepted: 10/26/2019] [Indexed: 01/20/2023] Open
Abstract
The socket is the most critical part of every lower-limb prosthetic system, since it serves as the interfacial component that connects the residual limb with the artificial system. However, many amputees abandon their socket prostheses due to the high-level of discomfort caused by the poor interaction between the socket and residual limb. In general, socket prosthesis performance is determined by three main factors, namely, residual limb-socket interfacial stress, volume fluctuation of the residual limb, and temperature. This review paper summarizes the various sensing and actuation solutions that have been proposed for improving socket performance and for realizing next-generation socket prostheses. The working principles of different sensors and how they have been tested or used for monitoring the socket interface are discussed. Furthermore, various actuation methods that have been proposed for actively modifying and improving the socket interface are also reviewed. Through the continued development and integration of these sensing and actuation technologies, the long-term vision is to realize smart socket prostheses. Such smart socket systems will not only function as a socket prosthesis but will also be able to sense parameters that cause amputee discomfort and self-adjust to optimize its fit, function, and performance.
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Affiliation(s)
- Sumit Gupta
- 1Department of Structural Engineering, University of California-San Diego, La Jolla, CA 92093-0085 USA
| | - Kenneth J Loh
- 1Department of Structural Engineering, University of California-San Diego, La Jolla, CA 92093-0085 USA
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Larsen BG, McLean JB, Allyn KJ, Brzostowski JT, Garbini JL, Sanders JE. How do transtibial residual limbs adjust to intermittent incremental socket volume changes? Prosthet Orthot Int 2019; 43:528-539. [PMID: 31339448 DOI: 10.1177/0309364619864771] [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 Strategies to maintain prosthesis users' daily limb volume are needed. OBJECTIVES Test how intermittent incremental socket volume adjustments affect limb fluid volume and limb-socket distance. STUDY DESIGN Repeated measures. METHODS People with transtibial limb loss walked on an outdoor trail wearing a motor-driven adjustable socket that they adjusted a small amount, approximately 0.3% socket volume, every 2 min using a mobile phone app. Limb fluid volume and sensed distance between the socket and a target in their elastomeric liner were monitored. A gradual socket enlargement phase was followed by a gradual socket reduction phase. RESULTS An incremental socket enlargement significantly increased limb fluid volume (p < 0.001) but not sensed distance (p = 0.063). An incremental socket reduction significantly decreased both limb fluid volume (p < 0.001) and sensed distance (p < 0.001). CONCLUSION Participants' residual limb fluid volume increases during ambulation compensated for incremental socket volume increases. For incremental socket volume decreases, residual limb fluid volume decreases did not compensate and the socket fit became tighter. CLINICAL RELEVANCE Results support the hypothesis that for people without co-morbidities, intermittent incremental socket volume enlargements are an effective accommodation strategy to increase limb fluid volume while maintaining socket fit. Intermittent incremental socket volume reductions decreased limb fluid volume but also made the socket fit tighter.
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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
| | - Katheryn J Allyn
- Department of Bioengineering, 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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17
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Weathersby EJ, Gurrey CJ, McLean JB, Sanders BN, Larsen BG, Carter R, Garbini JL, Sanders JE. Thin Magnetically Permeable Targets for Inductive Sensing: Application to Limb Prosthetics. SENSORS (BASEL, SWITZERLAND) 2019; 19:E4041. [PMID: 31546816 PMCID: PMC6767675 DOI: 10.3390/s19184041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 11/16/2022]
Abstract
The purpose of this research was to create a thin ferrous polymer composite to be used as a target for inductive sensing in limb prosthetics. Inductive sensors are used to monitor limb-to-socket distance in prosthetic sockets, which reflects socket fit. A styrene-ethylene-ethylene/propylene-styrene (SEEPS) polymer was mixed with iron powder at three concentrations (75, 77, 85 wt%), and thin disk-shaped samples were fabricated (0.50, 0,75, 1.00 mm thickness). For 85 wt% samples of 0.50 mm thickness, which proved the best combination of high signal strength and low target volume, inductive sensor sensitivity ranged from 3.2E5 counts/mm at 0.00-1.00 mm distances to 7.2E4 counts/mm at 4.00-5.00 mm distances. The application of compressive stress (up to 425 kPa) introduced an absolute measurement error of less than 3.3 μm. Tensile elasticity was 282 kPa, which is comparable to that of commercial elastomeric liners. Durability testing in the shoe of an able-bodied participant demonstrated a change in calibration coefficient of less than 3.8% over two weeks of wear. The ferrous polymer composite may facilitate the development of automatically adjusting sockets that use limb-to-socket distance measurement for feedback control.
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Affiliation(s)
- Ethan J Weathersby
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
| | - Clement J Gurrey
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
| | - Jake B McLean
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
| | - Benjamin N Sanders
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
| | - Ryan Carter
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
| | - Joseph L Garbini
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA 98195-5061, USA.
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18
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Sanders JE, Garbini JL, McLean JB, Hinrichs P, Predmore TJ, Brzostowski JT, Redd CB, Cagle JC. A motor-driven adjustable prosthetic socket operated using a mobile phone app: A technical note. Med Eng Phys 2019; 68:94-100. [DOI: 10.1016/j.medengphy.2019.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 03/08/2019] [Accepted: 04/03/2019] [Indexed: 11/26/2022]
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19
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Swanson E, Weathersby E, Cagle J, Sanders JE. Evaluation of Force Sensing Resistors for the Measurement of Interface Pressures in Lower Limb Prosthetics. J Biomech Eng 2019; 141:2732257. [PMID: 31017621 DOI: 10.1115/1.4043561] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 12/14/2022]
Abstract
Understanding pressure distributions at the limb-socket interface is essential to the design and evaluation of prosthetic components for lower limb prosthesis users. Force sensing resistors (FSRs) are employed in prosthetics research to measure pressure at this interface due to their low cost, thin profile, and ease of use. While FSRs are known to be sensitive to many sources of error, few studies have systematically quantified these errors using test conditions relevant to lower limb prosthetics. The purpose of this study was to evaluate FSR accuracy for the measurement of lower limb prosthetics interface pressures. Two FSR models (Flexiforce A201 and Interlink 402) were subjected to a series of prosthetic-relevant tests. These tests included: (1) static compression, (2) cyclic compression, and (3) a combined static and cyclic compression protocol mimicking a variable activity (Walk-Sit-Stand) procedure. Flexiforce sensors outperformed Interlink sensors and were then subjected to two additional tests: (4) static curvature and (5) static shear stress. Results demonstrated that FSRs experienced significant errors all five tests. We concluded that: (1) if used carefully, FSRs can provide an estimate of prosthetic interface pressure, but these measurements should be interpreted within the expected range of possible measurement error given the setup; (2) FSRs should be calibrated in a setup that closely matches how they will be used for taking measurements; and (3) both Flexiforce and Interlink sensors can be used to estimate interface pressures, however in most cases Flexiforce sensors are likely to provide more accurate measurements.
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Affiliation(s)
- Eric Swanson
- Department of Bioengineering, University of Washington, Seattle, WA 98195
| | - Ethan Weathersby
- Department of Bioengineering, University of Washington, Seattle, WA 98195
| | - John Cagle
- Department of Bioengineering, University of Washington, Seattle, WA 98195
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA 98195
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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: 96] [Impact Index Per Article: 16.0] [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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22
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Al-Fakih EA, Abu Osman NA, Mahmad Adikan FR. Techniques for Interface Stress Measurements within Prosthetic Sockets of Transtibial Amputees: A Review of the Past 50 Years of Research. SENSORS 2016; 16:s16071119. [PMID: 27447646 PMCID: PMC4970162 DOI: 10.3390/s16071119] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/12/2016] [Accepted: 06/02/2016] [Indexed: 11/18/2022]
Abstract
The distribution of interface stresses between the residual limb and prosthetic socket of a transtibial amputee has been considered as a direct indicator of the socket quality fit and comfort. Therefore, researchers have been very interested in quantifying these interface stresses in order to evaluate the extent of any potential damage caused by the socket to the residual limb tissues. During the past 50 years a variety of measurement techniques have been employed in an effort to identify sites of excessive stresses which may lead to skin breakdown, compare stress distributions in various socket designs, and evaluate interface cushioning and suspension systems, among others. The outcomes of such measurement techniques have contributed to improving the design and fitting of transtibial sockets. This article aims to review the operating principles, advantages, and disadvantages of conventional and emerging techniques used for interface stress measurements inside transtibial sockets. It also reviews and discusses the evolution of different socket concepts and interface stress investigations conducted in the past five decades, providing valuable insights into the latest trends in socket designs and the crucial considerations for effective stress measurement tools that lead to a functional prosthetic socket.
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Affiliation(s)
- Ebrahim A Al-Fakih
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Noor Azuan Abu Osman
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Faisal Rafiq Mahmad Adikan
- Department of Electrical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia.
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