1
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Cullen S, Mackay R, Mohagheghi A, Du X. 3D Motion Analysis for the Assessment of Dynamic Coupling in Transtibial Prosthetics: A Proof of Concept. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 4:141-147. [PMID: 38274781 PMCID: PMC10810304 DOI: 10.1109/ojemb.2023.3296978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/09/2023] [Accepted: 07/10/2023] [Indexed: 01/27/2024] Open
Abstract
Assessment of coupling between transtibial sockets and users is historically based on clinicians' observations and experience, but can be inaccurate and unreliable. Therefore, we present a proof of concept, for five out of six possible degrees of freedom coupling metric system for a socket, using motion analysis calibrated on a 3D printed limb substitute. The method is compatible with any socket suspension method and does not require prior modifications to the socket. Calibration trials were used to locate the axis of rotation of the knee joint referenced against a marker cluster on the thigh; this allowed for the identification of the limb during test trials despite the entire residuum being obscured from view by the socket. The error in the technique was found to be within 0.7 mm in displacement and 0.7 degrees in rotation, based on the control data. Dynamic testing showed the Inter Quartile Range (IQR) of inter time step variance was <0.5 mm/deg for all metrics. The method can form a basis for objective socket evaluation, improve clinical practice and the quality of life for amputees.
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Affiliation(s)
- Sean Cullen
- Department of Mechanical and Aerospace Engineering, College of Engineering, Design and Physical SciencesBrunel University LondonUB8 3PHUxbridgeU.K.
| | - Ruth Mackay
- Department of Mechanical and Aerospace Engineering, College of Engineering, Design and Physical SciencesBrunel University LondonUB8 3PHUxbridgeU.K.
| | - Amir Mohagheghi
- Division of Sport, Health & Exercise Sciences, College of Health, Medicine and Life SciencesBrunel University LondonUB8 3PHUxbridgeU.K.
| | - Xinli Du
- Department of Mechanical and Aerospace Engineering, College of Engineering, Design and Physical SciencesBrunel University LondonUB8 3PHUxbridgeU.K.
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2
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Neupetsch C, Hensel E, Heinke A, Stapf T, Stecher N, Malberg H, Heyde CE, Drossel WG. Approach for Non-Intrusive Detection of the Fit of Orthopaedic Devices Based on Vibrational Data. SENSORS (BASEL, SWITZERLAND) 2023; 23:6500. [PMID: 37514793 PMCID: PMC10386735 DOI: 10.3390/s23146500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/05/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
The soft tissues of residual limb amputees are subject to large volume fluctuations over the course of a day. Volume fluctuations in residual limbs can lead to local pressure marks, causing discomfort, pain and rejection of prostheses. Existing methods for measuring interface stress encounter several limitations. A major problem is that the measurement instrumentation is applied in the sensitive interface between the prosthesis and residual limb. This paper presents the principle investigation of a non-intrusive technique to evaluate the fit of orthopaedic prosthesis sockets in transfemoral amputees based on experimentally obtained vibrational data. The proposed approach is based on changes in the dynamical behaviour detectable at the outer surface of prostheses; thus, the described interface is not affected. Based on the experimental investigations shown and the derived results, it can be concluded that structural dynamic measurements are a promising non-intrusive technique to evaluate the fit of orthopaedic prosthesis sockets in transfemoral amputee patients. The obtained resonance frequency changes of 2% are a good indicator of successful applicabilityas these changes can be detected without the need for complex measurement devices.
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Affiliation(s)
- Constanze Neupetsch
- Fraunhofer Institute for Machine Tools and Forming Technology, 09126 Chemnitz, Germany
- Professorship Adaptronics and Lightweight Design, Faculty of Mechanical Engineering, Chemnitz University of Technology, 09111 Chemnitz, Germany
- Department of Orthopaedic, Trauma and Plastic Surgery, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Eric Hensel
- Fraunhofer Institute for Machine Tools and Forming Technology, 09126 Chemnitz, Germany
| | - Andreas Heinke
- Institute of Biomedical Engineering, Dresden University of Technology, 01307 Dresden, Germany
| | - Tom Stapf
- Fraunhofer Institute for Machine Tools and Forming Technology, 09126 Chemnitz, Germany
| | - Nico Stecher
- Institute of Biomedical Engineering, Dresden University of Technology, 01307 Dresden, Germany
| | - Hagen Malberg
- Institute of Biomedical Engineering, Dresden University of Technology, 01307 Dresden, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopaedic, Trauma and Plastic Surgery, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Welf-Guntram Drossel
- Fraunhofer Institute for Machine Tools and Forming Technology, 09126 Chemnitz, Germany
- Professorship Adaptronics and Lightweight Design, Faculty of Mechanical Engineering, Chemnitz University of Technology, 09111 Chemnitz, Germany
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3
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DeGrasse NS, Mertens JC, Brzostowski JT, Allyn KJ, Vamos AC, Krout AJ, Hafner BJ, Garbini JL, Sanders JE. Beyond step counts: Including wear time in prosthesis use assessment for lower-limb amputation. J Rehabil Assist Technol Eng 2023; 10:20556683231163337. [PMID: 36935866 PMCID: PMC10021104 DOI: 10.1177/20556683231163337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Introduction The purpose of this study was to test a novel activity monitor that tracks the time a prosthesis is worn, and the nature of the ambulatory activity conducted with the prosthesis. These capabilities allow prosthesis users' wear and accommodation practices (e.g., temporary doffing) to be monitored, and the intensity of their activities to be assessed. Methods A portable limb-socket motion sensing system was used to monitor doffs, walk bouts (≥5 steps), low locomotion (2-4 steps), stationary positions, and weight shifts in a group of transtibial prosthesis users. The relationship between doff time and active motion time was investigated, and durations of low and high intensity active motions were compared. Results For the 14 participants tested, the median prosthesis day duration ranged from 12.8-18.8 h. Eleven participants typically doffed five or fewer times per day, and three participants typically doffed 10 or more times per day. Nine participants demonstrated a positive correlation between daily doff duration and active motion duration. Six participants spent more time in weight shifts than walk bouts, while eight participants spent more time in walk bouts than weight shifts. Conclusion Capturing don time and temporary doffs and distinguishing weight shifts from walks may provide insight relevant to patient care. Longer-term monitoring studies should be conducted, and the clinical utility of the data evaluated.
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Affiliation(s)
| | - Joseph C Mertens
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
| | | | - Katheryn J Allyn
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
| | - Andrew C Vamos
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
| | - Adam J Krout
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
| | - Brian J Hafner
- Department of Rehabilitation
Medicine, University
of Washington, Seattle, WA, USA
| | - Joseph L Garbini
- Department of Mechanical
Engineering, University
of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
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4
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An Instrumented Printed Insert for Continuous Monitoring of Distal Limb Motion in Suction and Elevated Vacuum Sockets. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4040056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
A suction or elevated vacuum prosthetic socket that loses vacuum pressure may cause excessive limb motion, putting the user at risk of skin irritation, gait instability and injury. The purpose of this research was to develop a method to monitor distal limb motion and then test a small group of participants wearing suction sockets to identify variables that strongly influenced motion. A thin plastic insert holding two inductive sensor antennae was designed and printed. Inserts were placed in suction sockets made for four participants who regularly used suction or elevated vacuum suspension. Participants wore a liner with a trace amount of iron powder in the elastomer that served as a distance target for the sensors. In-lab testing demonstrated that the sensed distance increased when participants added socks and decreased when they removed socks, demonstrating proper sensor performance. Results from take-home testing (3–5 days) suggest that research investigation into cyclic limb motion for sock presence v. absence should be pursued, as should the influence of bodily position between bouts of walking. These variables may have an important influence on suspension. Long-term monitoring may provide clinical insight to improve fit and to enhance suction and elevated vacuum technology.
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5
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Yang X, Zhao R, Solav D, Yang X, Lee DR, Sparrman B, Fan Y, Herr H. Material, design, and fabrication of custom prosthetic liners for lower-extremity amputees: A review. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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6
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Youngblood RT, Hafner BJ, Czerniecki JM, Larsen BG, Allyn KJ, Sanders JE. Mechanically and physiologically optimizing prosthetic elevated vacuum systems in people with transtibial amputation: a pilot study. JOURNAL OF PROSTHETICS AND ORTHOTICS : JPO 2022; 34:194-201. [PMID: 36582938 PMCID: PMC9793861 DOI: 10.1097/jpo.0000000000000396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction The most suitable elevated vacuum (EV) pressure may differ for each individual prosthesis user depending on suspension needs, socket fit, prosthetic components, and health. Mechanical and physiological effects of EV were evaluated in an effort to determine the optimal vacuum pressure for three individuals. Methods Instrumented EV sockets were created based on the participants' regular EV sockets. Inductive distance sensors were embedded into the wall of the socket at select locations to measure limb movement relative to the socket. Each participant conducted an activity protocol while limb movement, limb fluid volume, and user-reported comfort were measured at various socket vacuum pressure settings. Results Increased socket vacuum pressure resulted in reduced limb-socket displacement for each participant; however, 81-93% of limb movement was eliminated by a vacuum pressure setting of 12 (approximately -9 inHg). Relative limb-socket displacement by sensor location varied for each participant, suggesting distinct differences related to socket fit or residual limb tissue content. The rate of limb fluid volume change and the change in socket comfort did not consistently differ with socket vacuum pressure, suggesting a more complex relationship unique to each individual. Conclusions Practitioners may use individual responses to optimize socket vacuum pressure settings, balancing mechanical and physiological effects of EV for improved clinical outcomes.
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Affiliation(s)
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Czerniecki
- VA Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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7
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Jamshidi MA, Esmaili S, Azhari F. A case study on the value of in-socket force measurements in gait monitoring of lower-limb prosthesis users. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4237-4240. [PMID: 36085719 DOI: 10.1109/embc48229.2022.9871480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Wearable sensors have the potential to drastically improve gait rehabilitation and assessments. This is especially the case for lower limb prosthesis users as small wearables can provide useful information about in-socket conditions. Through a simple case study, we investigated the value of measuring in-socket forces in addition to gait parameters in gauging the effectiveness of a training intervention. The results showed that the additional objective information obtained through in-socket measurements can enhance our understanding of how a particular intervention affects both gait and socket comfort.
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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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9
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McGeehan MA, Adamczyk PG, Nichols KM, Hahn ME. A simulation-based analysis of the effects of variable prosthesis stiffness on interface dynamics between the prosthetic socket and residual limb. J Rehabil Assist Technol Eng 2022; 9:20556683221111986. [PMID: 35859652 PMCID: PMC9289901 DOI: 10.1177/20556683221111986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction: Loading of a residual limb within a prosthetic socket
can cause tissue damage such as ulceration. Computational simulations may be
useful tools for estimating tissue loading within the socket, and thus provide
insights into how prosthesis designs affect residual limb-socket interface
dynamics. The purpose of this study was to model and simulate residual
limb-socket interface dynamics and evaluate the effects of varied prosthesis
stiffness on interface dynamics during gait. Methods: A spatial contact model of a residual limb-socket interface
was developed and integrated into a gait model with a below-knee amputation.
Gait trials were simulated for four subjects walking with low, medium, and high
prosthesis stiffness settings. The effects of prosthesis stiffness on interface
kinematics, normal pressure, and shear stresses were evaluated. Results: Model-predicted values were similar to those reported
previously in sensor-based experiments; increased stiffness resulted in greater
average normal pressure and shear stress (p < 0.05). Conclusions: These methods may be useful to aid experimental studies
by providing insights into the effects of varied prosthesis design parameters or
gait conditions on residual limb-socket interface dynamics. The current results
suggest that these effects may be subject-specific.
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Affiliation(s)
| | - Peter G Adamczyk
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Kieran M Nichols
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael E Hahn
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
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10
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Hewitt MA, Smith DG, Heckman JT, Pasquina PF. COVID-19: A catalyst for change in virtual health care utilization for persons with limb loss. PM R 2021; 13:637-646. [PMID: 33866685 PMCID: PMC8250996 DOI: 10.1002/pmrj.12605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/24/2021] [Accepted: 04/05/2021] [Indexed: 12/16/2022]
Abstract
The dramatic uptake of virtual care, or telehealth, utilization because of COVID‐19 restrictions for persons with limb loss has led to a much greater understanding of this health care delivery method for this complex patient population. However, much is still unknown. Therefore, the authors provide a comprehensive literature review of existing evidence for virtual care delivery across the phases of amputation rehabilitation, as well as anecdotal evidence, to provide a platform for further discussion and development of research and innovative opportunities. Evidence reveals that virtual care serves as a complement to in‐person health care for individuals with limb loss because it allows for increased accessibility to these services. The authors conclude that continued use of telehealth beyond the COVID‐19 restrictions to optimize outcomes across the continuum of care for persons with limb loss is warranted.
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Affiliation(s)
- Melissa A Hewitt
- The Center for Rehabilitation Sciences Research, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.,Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Douglas G Smith
- The Center for Rehabilitation Sciences Research, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.,Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Jeffrey T Heckman
- James A. Haley VA Medical Center, Tampa, Florida, USA.,Physical Medicine and Rehabilitation, University of South Florida, Tampa, Florida, USA
| | - Paul F Pasquina
- The Center for Rehabilitation Sciences Research, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.,Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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11
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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: 19] [Impact Index Per Article: 4.8] [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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14
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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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Youngblood RT, Hafner BJ, Czerniecki JM, Brzostowski JT, Allyn KJ, Sanders JE. Modeling the mechanics of elevated vacuum systems in prosthetic sockets. Med Eng Phys 2020; 84:75-83. [PMID: 32977925 DOI: 10.1016/j.medengphy.2020.07.019] [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: 05/19/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
Elevated vacuum (EV) is suggested to improve suspension and limb volume management for lower limb prosthesis users. However, few guidelines have been established to facilitate configuration of EV sockets to ensure their safe and proper function. A benchtop model of an EV socket was created to study how prosthetic liner tensile elasticity, socket fit, and socket vacuum pressure affect liner displacement and subsequent pressure on the residual limb. A domed carbon fiber layup was used to represent an EV socket. Inserts were used to simulate various air gaps between the socket and liner. Various prosthetic liner samples were placed under the carbon fiber layup. Liner displacement and the corresponding pressure change underneath the liner were measured as vacuum was applied between the liner sample and socket wall. Tissue vacuum pressure increased linearly with socket vacuum pressure until the liner contacted the socket wall. Predicted tissue vacuum pressure matched well with experimental results. Findings suggest that the effect of vacuum pressure on the residual limb is primarily determined by air gap distance. The developed model may be used to assess effects of EV on residual limb tissues based on an individual's socket fit, liner characteristics, and applied vacuum. Understanding the physiological effects of EV on the residual limb could help practitioners avoid blister formation and improve EV implementation.
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Affiliation(s)
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Czerniecki
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; VA Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, WA, USA
| | | | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle WA, USA
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle WA, USA
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16
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Agcayazi T, Menguc Y, Reese S. Skin in the Game: A Tunable Interface-Quality Sensor for Human-Coupled Accessories. IEEE SENSORS LETTERS 2020; 4:1-4. [DOI: 10.1109/lsens.2020.3011864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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17
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Flexible Piezoresistive Sensor with the Microarray Structure Based on Self-Assembly of Multi-Walled Carbon Nanotubes. SENSORS 2019; 19:s19224985. [PMID: 31731758 PMCID: PMC6891501 DOI: 10.3390/s19224985] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/28/2019] [Accepted: 11/10/2019] [Indexed: 12/29/2022]
Abstract
High-performance flexible pressure sensors have great application prospects in numerous fields, including the robot skin, intelligent prosthetic hands and wearable devices. In the present study, a novel type of flexible piezoresistive sensor is presented. The proposed sensor has remarkable superiorities, including high sensitivity, high repeatability, a simple manufacturing procedure and low initial cost. In this sensor, multi-walled carbon nanotubes were assembled onto a polydimethylsiloxane film with a pyramidal microarray structure through a layer-by-layer self-assembly system. It was found that when the applied external pressure deformed the pyramid microarray structure on the surface of the polydimethylsiloxane film, the resistance of the sensor varied linearly as the pressure changed. Tests that were performed on sensor samples with different self-assembled layers showed that the pressure sensitivity of the sensor could reach - 2.65 kPa - 1 , which ensured the high dynamic response ability and the high stability of the sensor. Moreover, it was proven that the sensor could be applied as a strain sensor under the tensile force to reflect the stretching extent or the bending object. Finally, a flexible pressure sensor was installed on five fingers and the back of the middle finger of a glove. The obtained results from grabbing different weights and different shapes of objects showed that the flexible pressure sensor not only reflected the change in the finger tactility during the grasping process, but also reflected the bending degree of fingers, which had a significant practical prospect.
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18
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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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19
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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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Noll V, Whitmore S, Beckerle P, Rinderknecht S. A Sensor Array for the Measurement of Relative Motion in Lower Limb Prosthetic Sockets. SENSORS (BASEL, SWITZERLAND) 2019; 19:E2658. [PMID: 31212837 PMCID: PMC6631854 DOI: 10.3390/s19122658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/28/2019] [Accepted: 06/06/2019] [Indexed: 01/04/2023]
Abstract
The relative motion between residual limb and prosthetic socket could be a relevant factor in quantifying socket fit. The measurement of these movements, particularly in dynamic gait situations, poses a challenging task. This paper presents the realization of a measurement concept based on multiple optical 2D-motion sensors. The performance of the system was evaluated on a test rig considering accuracy and precision as well as accomplished measurement frequency and reliability of the system. Additionally, results of a pilot study measuring the relative motion between residual limb and prosthetic socket at seven specific locations of one individual with transtibial amputation during straight level walking are presented. The sensor functionality of the array was confirmed and the test rig experiments were comparable to the previously tested functional model ( e r r rel = 0.52 ± 1.87 %). With a sampling frequency of 1.3 kHz to be distributed among the number of sensor units, the developed system is suitable for investigating the relative movement between residual limb and prosthetic socket in dynamic gait situations. Results of the pilot study show the majority of relative motion occurring during the second half of the gait cycle. The measured relative motions show the residual limb sinking deeper into the socket, extending in the Sagittal plane and rotating internally in the Transverse plane during stance phase. Data captured during swing phase indicate a lower limb extension in the Sagittal plane as well as an external rotation in the Transverse plane.
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Affiliation(s)
- Veronika Noll
- Institute for Mechatronic Systems in Mechanical Engineering, Technische Universität Darmstadt, Otto-Berndt-Str. 2, 64287 Darmstadt, Germany; (P.B.); (S.R.)
| | - Sigrid Whitmore
- Institute for Mechatronic Systems in Mechanical Engineering, Technische Universität Darmstadt, Otto-Berndt-Str. 2, 64287 Darmstadt, Germany; (P.B.); (S.R.)
- Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
| | - Philipp Beckerle
- Institute for Mechatronic Systems in Mechanical Engineering, Technische Universität Darmstadt, Otto-Berndt-Str. 2, 64287 Darmstadt, Germany; (P.B.); (S.R.)
- Elastic Lightweight Robotics Group, Robotics Research Institute, TU Dortmund University, 44227 Dortmund, Germany
| | - Stephan Rinderknecht
- Institute for Mechatronic Systems in Mechanical Engineering, Technische Universität Darmstadt, Otto-Berndt-Str. 2, 64287 Darmstadt, Germany; (P.B.); (S.R.)
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21
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McLean JB, Redd CB, Larsen BG, Garbini JL, Brzostowski JT, Hafner BJ, Sanders JE. Socket size adjustments in people with transtibial amputation: Effects on residual limb fluid volume and limb-socket distance. Clin Biomech (Bristol, Avon) 2019; 63:161-171. [PMID: 30901641 DOI: 10.1016/j.clinbiomech.2019.02.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Small intermittent adjustments of socket size using adjustable sockets may be a means for people with transtibial amputation to better maintain residual limb fluid volume and limb position while using a prosthesis. METHODS Socket size, limb fluid volume, and distance from the limb to the socket, termed "sensed distance," were recorded while participants with transtibial amputation walked on a treadmill wearing a motor-driven, cabled-panel, adjustable socket. Researchers made frequent socket size adjustments using a mobile phone app to identify participants' acceptable socket size range. Limb fluid volume and sensed distance were then monitored as incremental adjustments were made to the socket. FINDINGS Prosthesis users in this study (n = 10) accepted socket sizes between -5% and +5% of their neutral socket volume. There was a rapid increase in limb fluid volume and sensed distance upon socket enlargement, and a rapid decrease upon reduction. Subsequently, there were gradual changes in fluid volume and sensed distance. While visually monitoring limb fluid volume data in real time, researchers were able to adjust socket size to maintain consistent limb fluid volume within a -0.7% to +0.9% volume change for 24 min. INTERPRETATION Participant residual limbs compensated to socket size adjustment. Using socket-mounted sensors to monitor limb-socket mechanics, an automatic adjustable socket that maintains limb fluid volume may be possible and may improve socket fit in instances where fit deteriorates during use.
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Affiliation(s)
- Jake B McLean
- Department of Bioengineering, 355061, 3720 15th Ave NE, University of Washington, Seattle, WA 98105, USA
| | - Christian B Redd
- Department of Bioengineering, 355061, 3720 15th Ave NE, University of Washington, Seattle, WA 98105, USA
| | - Brian G Larsen
- Department of Bioengineering, 355061, 3720 15th Ave NE, University of Washington, Seattle, WA 98105, USA
| | - Joseph L Garbini
- Department of Mechanical Engineering, 352600, 3900 E Stevens Way NE, University of Washington, Seattle, WA 98105, USA
| | - Jacob T Brzostowski
- Department of Bioengineering, 355061, 3720 15th Ave NE, University of Washington, Seattle, WA 98105, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, 356490, 1959 NE Pacific St, 8th floor North Wing, University of Washington, Seattle, WA 98195, USA
| | - Joan E Sanders
- Department of Bioengineering, 355061, 3720 15th Ave NE, University of Washington, Seattle, WA 98105, USA.
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