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Tully TN, Thomson CJ, Clark GA, George JA. Validity and Impact of Methods for Collecting Training Data for Myoelectric Prosthetic Control Algorithms. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1974-1983. [PMID: 38739519 DOI: 10.1109/tnsre.2024.3400729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Intuitive regression control of prostheses relies on training algorithms to correlate biological recordings to motor intent. The quality of the training dataset is critical to run-time regression performance, but accurately labeling intended hand kinematics after hand amputation is challenging. In this study, we quantified the accuracy and precision of labeling hand kinematics using two common training paradigms: 1) mimic training, where participants mimic predetermined motions of a prosthesis, and 2) mirror training, where participants mirror their contralateral intact hand during synchronized bilateral movements. We first explored this question in healthy non-amputee individuals where the ground-truth kinematics could be readily determined using motion capture. Kinematic data showed that mimic training fails to account for biomechanical coupling and temporal changes in hand posture. Additionally, mirror training exhibited significantly higher accuracy and precision in labeling hand kinematics. These findings suggest that the mirror training approach generates a more faithful, albeit more complex, dataset. Accordingly, mirror training resulted in significantly better offline regression performance when using a large amount of training data and a non-linear neural network. Next, we explored these different training paradigms online, with a cohort of unilateral transradial amputees actively controlling a prosthesis in real-time to complete a functional task. Overall, we found that mirror training resulted in significantly faster task completion speeds and similar subjective workload. These results demonstrate that mirror training can potentially provide more dexterous control through the utilization of task-specific, user-selected training data. Consequently, these findings serve as a valuable guide for the next generation of myoelectric and neuroprostheses leveraging machine learning to provide more dexterous and intuitive control.
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Sturma A, Boesendorfer A, Gstoettner C, Baumgartner B, Salminger S, Farina D, Brånemark R, Vujaklija I, Hobusch G, Aszmann O. Long-term functional and clinical outcome of combined targeted muscle reinnervation and osseointegration for functional bionic reconstruction in transhumeral amputees: a case series. J Rehabil Med 2024; 56:jrm34141. [PMID: 38770700 DOI: 10.2340/jrm.v56.34141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE To describe and evaluate the combination of osseointegration and nerve transfers in 3 transhumeral amputees. DESIGN Case series. PATIENTS Three male patients with a unilateral traumatic transhumeral amputation. METHODS Patients received a combination of osseointegration and targeted muscle reinnervation surgery. Rehabilitation included graded weight training, range of motion exercises, biofeedback, table-top prosthesis training, and controlling the actual device. The impairment in daily life, health-related quality of life, and pain before and after the intervention was evaluated in these patients. Their shoulder range of motion, prosthesis embodiment, and function were documented at a 2- to 5-year follow-up. RESULTS All 3 patients attended rehabilitation and used their myoelectric prosthesis on a daily basis. Two patients had full shoulder range of motion with the prosthesis, while the other patient had 55° of abduction and 45° of anteversion. They became more independent in their daily life activities after the intervention and incorporated their prosthesis into their body scheme to a high extent. CONCLUSION These results indicate that patients can benefit from the combined procedure. However, the patients' perspective, risks of the surgical procedures, and the relatively long rehabilitation procedure need to be incorporated in the decision-making.
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Affiliation(s)
- Agnes Sturma
- Degree Program Physiotherapy, Department of Health Sciences, University of Applied Sciences FH Campus Vienna, Vienna, Austria; Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Anna Boesendorfer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria; Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Benedikt Baumgartner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Stefan Salminger
- AUVA Trauma Hospital Lorenz Böhler-European Hand Trauma Center, Vienna, Austria.
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, UK.
| | - Rickard Brånemark
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; K. Lisa Yang Center for Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, USA.
| | - Ivan Vujaklija
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland.
| | - Gerhard Hobusch
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
| | - Oskar Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria; Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
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Zbinden J, Earley EJ, Ortiz-Catalan M. Intuitive control of additional prosthetic joints via electro-neuromuscular constructs improves functional and disability outcomes during home use-a case study. J Neural Eng 2024; 21:036021. [PMID: 38489845 DOI: 10.1088/1741-2552/ad349c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/15/2024] [Indexed: 03/17/2024]
Abstract
Objective.The advent of surgical reconstruction techniques has enabled the recreation of myoelectric controls sites that were previously lost due to amputation. This advancement is particularly beneficial for individuals with higher-level arm amputations, who were previously constrained to using a single degree of freedom (DoF) myoelectric prostheses due to the limited number of available muscles from which control signals could be extracted. In this study, we explore the use of surgically created electro-neuromuscular constructs to intuitively control multiple bionic joints during daily life with a participant who was implanted with a neuromusculoskeletal prosthetic interface.Approach.We sequentially increased the number of controlled joints, starting at a single DoF allowing to open and close the hand, subsequently adding control of the wrist (2 DoF) and elbow (3 DoF).Main results.We found that the surgically created electro-neuromuscular constructs allow for intuitive simultaneous and proportional control of up to three degrees of freedom using direct control. Extended home-use and the additional bionic joints resulted in improved prosthesis functionality and disability outcomes.Significance.Our findings indicate that electro-neuromuscular constructs can aid in restoring lost functionality and thereby support a person who lost their arm in daily-life tasks.
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Affiliation(s)
- Jan Zbinden
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Eric J Earley
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Bone-Anchored Limb Research Group, University of Colorado, Aurora, CO, United States of America
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Bionics Institute, Melbourne, Australia
- Medical Bionics Department, University of Melbourne, Melbourne, Australia
- Prometei Pain Rehabilitation Center, Vinnytsia, Ukraine
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zhang Y, Wang X, Xiu H, Chen W, Ma Y, Wei G, Ren L, Ren L. An Improved Extreme Learning Machine (ELM) Algorithm for Intent Recognition of Transfemoral Amputees With Powered Knee Prosthesis. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1757-1766. [PMID: 38683719 DOI: 10.1109/tnsre.2024.3394618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
To overcome the challenges posed by the complex structure and large parameter requirements of existing classification models, the authors propose an improved extreme learning machine (ELM) classifier for human locomotion intent recognition in this study, resulting in enhanced classification accuracy. The structure of the ELM algorithm is enhanced using the logistic regression (LR) algorithm, significantly reducing the number of hidden layer nodes. Hence, this algorithm can be adopted for real-time human locomotion intent recognition on portable devices with only 234 parameters to store. Additionally, a hybrid grey wolf optimization and slime mould algorithm (GWO-SMA) is proposed to optimize the hidden layer bias of the improved ELM classifier. Numerical results demonstrate that the proposed model successfully recognizes nine daily motion modes including low-, mid-, and fast-speed level ground walking, ramp ascent/descent, sit/stand, and stair ascent/descent. Specifically, it achieves 96.75% accuracy with 5-fold cross-validation while maintaining a real-time prediction time of only 2 ms. These promising findings highlight the potential of onboard real-time recognition of continuous locomotion modes based on our model for the high-level control of powered knee prostheses.
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Lee SP, Maluotoga M, Thind R, Lindsay L, Bhatta T, Miller CA. Utilization and Perception of Peer-Support After Lower Limb Loss in the United States: Potential Benefits on Mobility Outcomes. Arch Phys Med Rehabil 2024; 105:939-946.e3. [PMID: 38242299 PMCID: PMC11069449 DOI: 10.1016/j.apmr.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/30/2023] [Accepted: 12/14/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To examine participants' experiences with peer-support after lower limb loss (LLL) and the associations between the peer-support experience (perceived benefits and barriers) and mobility outcomes. DESIGN Quantitative and qualitative descriptive study with a cross-sectional design. SETTING National survey (distributed to 169 peer-support groups in 44 states in the US). PARTICIPANTS The survey was completed by 82 individuals with a major lower limb amputation (53% female, 54% over 55 years of age; N=82). MAIN OUTCOME MEASURES A 32-item survey to examine respondents' experiences in peer-support activities. Prosthetic mobility was measured using the Prosthetic Limb Users Survey of Mobility (PLUS-M). RESULTS Two out of 3 respondents received some forms of peer-support after amputation. Among them 75% reported peer-support having a positive effect on their outlook on life, and 78% reported that information gained from peer-support was helpful. Companionship, altruistic acts, and gaining information on how to cope with amputation were the top themes of why respondents enjoyed the peer-support experience. Nearly all (94%) respondents would recommend peer-support to other people with LLL. Individuals who received peer-support exhibited a trend of greater mobility (55th vs 36th percentile on PLUS-M; P=.055). CONCLUSION Individuals with LLL reported generally positive experiences regarding their engagement in peer-support activities. Peer-support groups are viewed as a helpful source for both information and emotional support, potentially benefiting functional and psychological recovery after amputation. Individuals who have received peer-support also exhibited greater mobility.
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Affiliation(s)
- Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, NV.
| | - Moriah Maluotoga
- Department of Physical Therapy, University of Nevada, Las Vegas, NV
| | - Roopkiran Thind
- Department of Physical Therapy, University of Nevada, Las Vegas, NV
| | | | - Tirth Bhatta
- Department of Sociology, University of Nevada, Las Vegas, NV
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Abstract
Passive prosthetic legs require undesirable compensations from amputee users to avoid stubbing obstacles and stairsteps. Powered prostheses can reduce those compensations by restoring normative joint biomechanics, but the absence of user proprioception and volitional control combined with the absence of environmental awareness by the prosthesis increases the risk of collisions. This article presents a novel stub avoidance controller that automatically adjusts prosthetic knee/ankle kinematics based on suprasensory measurements of environmental distance from a small, lightweight, low-power, low-cost ultrasonic sensor mounted above the prosthetic ankle. In a case study with two transfemoral amputee participants, this control method reduced the stub rate during stair ascent by 89.95% and demonstrated an 87.50% avoidance rate for crossing different obstacles on level ground. No thigh kinematic compensation was required to achieve these results. These findings demonstrate a practical perception solution for powered prostheses to avoid collisions with stairs and obstacles while restoring normative biomechanics during daily activities.
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Fylstra BL, England DL, Stevens PM, Campbell JH, Wurdeman SR. Creating Adjusted Scores Targeting mobiLity Empowerment (CASTLE 1): determination of normative mobility scores after lower limb amputation for each year of adulthood. Disabil Rehabil 2024; 46:1904-1910. [PMID: 37203194 DOI: 10.1080/09638288.2023.2208376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/22/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE As United States healthcare transitions from traditional fee-for-service models to value-based care, there is increased need to demonstrate quality care through clinical outcomes. Therefore, the purpose of this study was to create equations to calculate an expected mobility score for lower limb prosthesis users specific to their age, etiology, and amputation level to provide benchmarks to qualify good outcomes. MATERIALS AND METHODS A retrospective cross-sectional analysis of outcomes collected during clinical care was performed. Individuals were grouped based on amputation level (unilateral above-knee (AKA) or below-knee (BKA)) and etiology (trauma or diabetes/dysvascular (DV)). The mean mobility score (PLUS-M® T-score) for each year of age was calculated. AKAs were further stratified into having a microprocessor knee (MPK) or non-microprocessor (nMPK) for secondary analysis. RESULTS As expected, average prosthetic mobility declined with age. Overall, BKAs had higher PLUS-M T-scores compared to AKAs and trauma etiologies had higher scores compared to DV. For AKAs, those with a MPK had higher T-scores compared to those with a nMPK. CONCLUSIONS Results from this study provide average mobility for adult patients across every year of life. This can be leveraged to create a mobility adjustment factor to qualify good outcomes in lower limb prosthetic care.
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Affiliation(s)
- Bretta L Fylstra
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
| | - Dwiesha L England
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
| | - Phillip M Stevens
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
- Division of Physical Medicine and Rehabilitation, University of Utah Health Care, Salt Lake City, UT, USA
| | - James H Campbell
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
| | - Shane R Wurdeman
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
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Sayeed MSI, Oakman J, Stuckey R. Factors influencing access to and participation in rehabilitation for people with lower limb amputation in East, South, and Southeast Asian developing countries: the perspective of rehabilitation professionals - a qualitative study. Disabil Rehabil 2024; 46:2097-2116. [PMID: 37272783 DOI: 10.1080/09638288.2023.2217383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 05/17/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE To identify barriers and enablers for access to and participation in rehabilitation for people with LLA in East, South, and Southeast Asian developing countries from the perspective of rehabilitation professionals. MATERIAL AND METHODS A mixed-method study involving an anonymous cross-sectional screening survey followed by in-depth interviews of rehabilitation professionals in these regions following the COREQ guidelines. Participants were surveyed online using convenience and snowball sampling techniques to inform a purposive heterogenic sample for semi-structured online interviews, between September 2021 to February 2022. Interview transcripts were analysed and thematically coded using the modified Health Care Delivery System Approach (HCDSA) framework. RESULTS A total of 201 quantitative survey responses shaped the interview questions and participation of 28 participants from 13 countries for the qualitative investigation. Important factors at the patient level were sex, economics, health issues, language differences, and lack of awareness; at the care team level, peer and/or family support, referrals, and the gender of the professional; at the organizational level, service availability, resources, and quality; and at the environmental level, policies, supports, and physical and/or social accessibility. CONCLUSIONS Identified interlinked factors at multiple levels of the HCDSA underpin the need for a systems approach to develop and address regional rehabilitation service provision but requires contextually adapted policy.
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Affiliation(s)
- Md Shapin Ibne Sayeed
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, Australia
| | - Jodi Oakman
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, Australia
| | - Rwth Stuckey
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, Australia
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Rosenblatt NJ, Major MJ, Manesh B, Schneider K, Miller SA. Validating a fear-of-falling-related activity avoidance scale in lower limb prosthesis users. PM R 2024; 16:462-473. [PMID: 37632836 PMCID: PMC10895070 DOI: 10.1002/pmrj.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/05/2023] [Accepted: 08/04/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Limited available data suggest that fear of falling (FoF) may be common among lower limb prosthesis users (LLPUs) and associated with negative rehabilitation outcomes. The impact of FoF on outcomes may be exacerbated when fear leads to self-imposed declines in activity. There is a need to identify the validity of fear-of-falling-related activity avoidance scales in LLPUs. OBJECTIVE To evaluate the convergent, discriminant, and known-group construct validity of the modified Survey of Activities and FoF in the Elderly (mSAFE) for LLPUs. Secondarily, we sought to determine if the mSAFE scale could be reduced without losing information regarding construct validity. DESIGN Online survey. SETTING Not applicable. PARTICIPANTS Fifty-nine persons with unilateral or bilateral amputation at the transtibial or transfemoral level, with ≥6 months experience using a definitive prosthesis for activities other than transfers. INTERVENTION Participants completed an online survey that consisted of the mSAFE and questions to assess FoF (yes/no), fear-of-falling-related activity avoidance (yes/no), as well as previously validated scales capturing related and unrelated constructs. T-tests were used to compare mSAFE score between yes/no respondents for known-group construct validity. Correlations between mSAFE and previously validated surveys assessed convergent and discriminant validity. Analyses were repeated on a reduced number of mSAFE items following a redundancy analysis. MAIN OUTCOME MEASURES Not applicable. RESULTS Significant correlation coefficients of |0.440-0.825| were found for convergent validity with evidence of known-group construct validity (p < .021 for all comparisons). There was evidence for discriminant validity, with non-significant associations for two-of-three correlations. Results from validity analyses for a shortened 6-item mSAFE were similar to that for the full scale. CONCLUSION This study provided initial evidence regarding validity of the mSAFE as a measure to assess fear-of-falling-related activity avoidance in LLPUs. A 6-item scale may be appropriate if the full scale would be taxing or time-consuming.
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Affiliation(s)
- Noah J Rosenblatt
- Center for Lower Extremity Ambulatory Research (CLEAR) at the Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Matthew J Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Bobak Manesh
- Center for Lower Extremity Ambulatory Research (CLEAR) at the Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Kristin Schneider
- Psychology Department, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Steven A Miller
- Psychology Department, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
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Bishay J, Yeap I, Wang T. The effectiveness of targeted muscle reinnervation in reducing pain and improving quality of life for patients following lower limb amputation. J Plast Reconstr Aesthet Surg 2024; 92:288-298. [PMID: 38599000 DOI: 10.1016/j.bjps.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Globally, over 1 million lower limb amputations are performed annually, with approximately 75% of patients experiencing significant pain, profoundly impacting their quality of life and functional capabilities. Targeted muscle reinnervation (TMR) has emerged as a surgical solution involving the rerouting of amputated nerves to specific muscle targets. Originally introduced to enhance signal amplification for myoelectric prosthesis control, TMR has expanded its applications to include neuroma management and pain relief. However, the literature assessing patient outcomes is lacking, specifically for lower limb amputees. This systematic review aims to assess the effectiveness of TMR in reducing pain and enhancing functional outcomes for patients who have undergone lower limb amputation. METHODS A systematic review was performed by examining relevant studies between 2010 and 2023, focusing on pain reduction, functional outcomes and patient-reported quality of life measures. RESULTS In total, 20 studies were eligible encompassing a total of 778 extremities, of which 75.06% (n = 584) were lower limb amputees. Average age was 46.66 years and patients were predominantly male (n = 70.67%). Seven studies (35%) reported functional outcomes. Patients who underwent primary TMR exhibited lower average patient-reported outcome measurement information system (PROMIS) scores for phantom limb pain (PLP) and residual limb pain (RLP). Secondary TMR led to improvements in PLP, RLP and general limb pain as indicated by average numeric rating scale and PROMIS scores. CONCLUSION The systematic review underscores TMR's potential benefits in alleviating pain, fostering post-amputation rehabilitation and enhancing overall well-being for lower limb amputees.
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Affiliation(s)
- Jeremy Bishay
- Department of Plastic Surgery, Royal North Shore Hospital, Reserve road, St Leonards, New South Wales 2065, Australia.
| | - Isobel Yeap
- Department of Plastic Surgery, Royal North Shore Hospital, Reserve road, St Leonards, New South Wales 2065, Australia
| | - Tim Wang
- Department of Plastic Surgery, Royal North Shore Hospital, Reserve road, St Leonards, New South Wales 2065, Australia
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Saruco E, Saimpont A, Di Rienzo F, De Witte B, Laroyenne I, Matéo F, Lapenderie M, Solard SG, Perretant I, Frenot C, Jackson PL, Guillot A. Towards efficient motor imagery interventions after lower-limb amputation. J Neuroeng Rehabil 2024; 21:55. [PMID: 38622634 PMCID: PMC11017566 DOI: 10.1186/s12984-024-01348-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The therapeutic benefits of motor imagery (MI) are now well-established in different populations of persons suffering from central nervous system impairments. However, research on similar efficacy of MI interventions after amputation remains scarce, and experimental studies were primarily designed to explore the effects of MI after upper-limb amputations. OBJECTIVES The present comparative study therefore aimed to assess the effects of MI on locomotion recovery following unilateral lower-limb amputation. METHODS Nineteen participants were assigned either to a MI group (n = 9) or a control group (n = 10). In addition to the course of physical therapy, they respectively performed 10 min per day of locomotor MI training or neutral cognitive exercises, five days per week. Participants' locomotion functions were assessed through two functional tasks: 10 m walking and the Timed Up and Go Test. Force of the amputated limb and functional level score reflecting the required assistance for walking were also measured. Evaluations were scheduled at the arrival at the rehabilitation center (right after amputation), after prosthesis fitting (three weeks later), and at the end of the rehabilitation program. A retention test was also programed after 6 weeks. RESULTS While there was no additional effect of MI on pain management, data revealed an early positive impact of MI for the 10 m walking task during the pre-prosthetic phase, and greater performance during the Timed Up and Go Test during the prosthetic phase. Also, a lower proportion of participants still needed a walking aid after MI training. Finally, the force of the amputated limb was greater at the end of rehabilitation for the MI group. CONCLUSION Taken together, these data support the integration of MI within the course of physical therapy in persons suffering from lower-limb amputations.
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Affiliation(s)
- Elodie Saruco
- Universite Lyon 1, LIBM, Laboratoire Interuniversitaire de Biologie de la Motricité, UR 7424, Villeurbanne, F-69622, France
| | - Arnaud Saimpont
- Universite Lyon 1, LIBM, Laboratoire Interuniversitaire de Biologie de la Motricité, UR 7424, Villeurbanne, F-69622, France
| | - Franck Di Rienzo
- Universite Lyon 1, LIBM, Laboratoire Interuniversitaire de Biologie de la Motricité, UR 7424, Villeurbanne, F-69622, France
| | - Benjamin De Witte
- Universite Lyon 1, LIBM, Laboratoire Interuniversitaire de Biologie de la Motricité, UR 7424, Villeurbanne, F-69622, France
| | - Isabelle Laroyenne
- Centre Médico-Chirurgical de Réadaptation des Massues - Croix-Rouge française, 92 rue Dr. Edmond Locard, Lyon Cedex 05, 69322, France
| | - Fanny Matéo
- Centre Médico-Chirurgical de Réadaptation des Massues - Croix-Rouge française, 92 rue Dr. Edmond Locard, Lyon Cedex 05, 69322, France
| | - Marion Lapenderie
- Centre Médico-Chirurgical de Réadaptation des Massues - Croix-Rouge française, 92 rue Dr. Edmond Locard, Lyon Cedex 05, 69322, France
| | - Sarah Goutte Solard
- Centre Médico-Chirurgical de Réadaptation des Massues - Croix-Rouge française, 92 rue Dr. Edmond Locard, Lyon Cedex 05, 69322, France
| | - Isabelle Perretant
- Centre Médico-Chirurgical de Réadaptation des Massues - Croix-Rouge française, 92 rue Dr. Edmond Locard, Lyon Cedex 05, 69322, France
| | - Charlotte Frenot
- Centre Médico-Chirurgical de Réadaptation des Massues - Croix-Rouge française, 92 rue Dr. Edmond Locard, Lyon Cedex 05, 69322, France
| | - Philip L Jackson
- École de Psychologie, Université Laval, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Quebec, Canada
| | - Aymeric Guillot
- Universite Lyon 1, LIBM, Laboratoire Interuniversitaire de Biologie de la Motricité, UR 7424, Villeurbanne, F-69622, France.
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Grover P, Karuppan CM. The lower limb-loss rehabilitation continuum (LLRC) - a framework for program design and implementation. Disabil Rehabil 2024; 46:1652-1661. [PMID: 37147928 DOI: 10.1080/09638288.2023.2207221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Abstract
Purpose: The multistep journey to prosthetic device-enabled functioning following amputation requires a structured approach for optimal care delivery, but such program structures and outcomes are inadequately characterized. The study is responsive by describing an implementation framework for lower limb loss rehabilitation and evaluating its utility.Materials and methods: The lower limb loss rehabilitation continuum framework (LLRC) was developed using literature-based continuum of care and amputation phase concepts as well as input from limb loss rehabilitation stakeholders. LLRC structure includes five sequential steps (Postsurgical Stabilization (PS), Preprosthetic Rehabilitation (PPR), Limb Healing and Maturation (LHM), Prosthetic Fitting (PF), Prosthetic Rehabilitation (PR)) between six touchpoints of patient-healthcare interaction (Surgery, Preprosthetic Rehabilitation Admission and Discharge, Functioning Evaluation and Prescription, Prosthetic Rehabilitation Admission and Discharge). The utility of this framework was evaluated through LLRC program implementation in a semiurban US setting and program functioning and process outcomes assessment from an IRB-approved, retrospective observational study about patients with unilateral lower-limb amputations completing this program.Results: Program functional (FIM gain; efficiency) scores were greater for PPR(32.6(8);3.1) compared with PR(24.3(8.5);3.8). Program completion duration was 149.7(63.4) days. LHM(75.8(58.5) days) and PF(51.4(24.3) days) were the longest steps. PR duration was significantly longer(p = 0.033) for the transfemoral level.Conclusion: The LLRC framework is useful for the design and implementation of structured limb loss rehabilitation programs.IMPLICATIONS FOR REHABILITATIONThe lower limb-loss rehabilitation continuum (LLRC) is a novel implementation framework with a five-step structure from limb loss to completion of prosthetic rehabilitation between six touchpoints of patient-healthcare interaction, with standardized terminology and baseline and outcome metrics. The utility of the program was demonstrated by successful program development in a suburban health setting and actionable process outcomes and superior functioning outcomes compared with literature.The LLRC can be adapted by health systems, institutions, and care providers for program development. Programs can expect high FIM gains and efficiency for Preprosthetic rehabilitation and Prosthetic rehabilitation steps. With an LLRC completion time of 5 months, long Limb healing and maturation and Prosthetic fitting steps present areas of opportunity for improvement.
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Affiliation(s)
- Prateek Grover
- Mercy Clinics and Mercy Rehabilitation Hospital, Springfield, MO, USA
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14
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Ahmed K, Blunn GW. A scoring system to evaluate stability of percutaneous osseointegrated implants for transfemoral amputation with validation in the ITAP clinical trial. Proc Inst Mech Eng H 2024; 238:412-422. [PMID: 38415608 DOI: 10.1177/09544119241231890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Percutaneous osseointegrated implants for individuals with lower limb amputation can increase mobility, reduce socket related pain, and improve quality of life. It would be useful to have an evaluation method to assess the interface between bone and implant. We assessed outpatient radiographs from the Intraosseous Transcutaneous Amputation Prosthesis clinical trial using an interface scoring system which summed and weighted equally measures of implant collar cortical ongrowth and radiolucency along the implant stem/bone interface. Radiographs from 12 participants with unilateral transfemoral amputations (10 males, 2 females, mean age = 43.2, SD = 7.4 years) in the clinical trial from cohort I (implanted in 2008/09) or cohort II (implanted in 2013/14) were collated (mean image span = 7.2, SD = 2.4 years), scale normalised, zoned, and measured in a repeatable way. Interface scores were calculated and then compared to clinical outcomes. Explanted participants received the lowest interface scores. A higher ratio of stem to residuum and shorter residuum's produced better interface scores and there was an association (weak correlation) between participants with thin cortices and the lowest interface scores. A tapered, cemented, non curved stem may provide advantageous fixation while stem alignment did not appear critical. In summary, the interface score successfully demonstrated a non-invasive evaluation of percutaneous osseointegrated implants interfaces when applied to the Intraosseous Transcutaneous Amputation Prosthesis clinical trial. The clinical significance of this work is to identify events leading to aseptic or septic implant removal and contribute to clinical guidelines for monitoring rehabilitation, design and surgical fixation choices.
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Affiliation(s)
- Kirstin Ahmed
- Center for Bionics and Pain Research, Mölndal, Sweden
- Division of Surgery and Interventional Science, University College London, Stanmore, UK
| | - Gordon William Blunn
- Division of Surgery and Interventional Science, University College London, Stanmore, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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15
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He Y, Hu M, Jor A, Hobara H, Gao F, Kobayashi T. Dynamics of Center of Pressure Trajectory in Gait: Unilateral Transfemoral Amputees Versus Non-Disabled Individuals. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1416-1425. [PMID: 38517721 DOI: 10.1109/tnsre.2024.3381046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
The primary goal of rehabilitation for individuals with lower limb amputation, particularly those with unilateral transfemoral amputation (uTFA), is to restore their ability to walk independently. Effective control of the center of pressure (COP) during gait is vital for maintaining balance and stability, yet it poses a significant challenge for individuals with uTFA. This study aims to study the COP during gait in individuals with uTFA and elucidate their unique compensatory strategies. This study involved 12 uTFA participants and age-matched non-disabled controls, with gait and COP trajectory data collected using an instrumented treadmill. Gait and COP parameters between the control limb (CL), prosthetic limb (PL), and intact limb (IL) were compared. Notably, the mediolateral displacement of COP in PL exhibited significant lateral displacement compared to the CL from 30% to 60% of the stance. In 20% to 45% of the stance, the COP forward speed of PL was significantly higher than that of the IL. Furthermore, during the initial 20% of the stance, the vertical ground reaction force of PL was significantly lower than that of IL. Additionally, individuals with uTFA exhibited a distinct gait pattern with altered duration of loading response, single limb support, pre-swing and swing phases, and step time. These findings indicate the adaptability of individuals with uTFA in weight transfer, balance control, and pressure distribution on gait stability. In conclusion, this study provides valuable insights into the unique gait dynamics and balance strategies of uTFA patients, highlighting the importance of optimizing prosthetic design, alignment procedures, and rehabilitation programs to enhance gait patterns and reduce the risk of injuries due to compensatory movements.
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Brauckmann V, Block OM, Pardo LA, Lehmann W, Braatz F, Felmerer G, Mönnighoff S, Ernst J. Can Early Post-Operative Scoring of Non-Traumatic Amputees Decrease Rates of Revision Surgery? Medicina (Kaunas) 2024; 60:565. [PMID: 38674211 PMCID: PMC11052005 DOI: 10.3390/medicina60040565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/03/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Medical registries evolved from a basic epidemiological data set to further applications allowing deriving decision making. Revision rates after non-traumatic amputation are high and dramatically impact the following rehabilitation of the amputee. Risk scores for revision surgery after non-traumatic lower limb amputation are still missing. The main objective was to create an amputation registry allowing us to determine risk factors for revision surgery after non-traumatic lower-limb amputation and to develop a score for an early detection and decision-making tool for the therapeutic course of patients at risk for non-traumatic lower limb amputation and/or revision surgery. Materials and Methods: Retrospective data analysis was of patients with major amputations lower limbs in a four-year interval at a University Hospital of maximum care. Medical records of 164 patients analysed demographics, comorbidities, and amputation-related factors. Descriptive statistics analysed demographics, prevalence of amputation level and comorbidities of non-traumatic lower limb amputees with and without revision surgery. Correlation analysis identified parameters determining revision surgery. Results: In 4 years, 199 major amputations were performed; 88% were amputated for non-traumatic reasons. A total of 27% of the non-traumatic cohort needed revision surgery. Peripheral vascular disease (PVD) (72%), atherosclerosis (69%), diabetes (42%), arterial hypertension (38%), overweight (BMI > 25), initial gangrene (47%), sepsis (19%), age > 68.2 years and nicotine abuse (17%) were set as relevant within this study and given a non-traumatic amputation score. Correlation analysis revealed delayed wound healing (confidence interval: 64.1% (47.18%; 78.8%)), a hospital length of stay before amputation of longer than 32 days (confidence interval: 32.3 (23.2; 41.3)), and a BKA amputation level (confidence interval: 74.4% (58%; 87%)) as risk factors for revision surgery after non-traumatic amputation. A combined score including all parameters was drafted to identify non-traumatic amputees at risk for revision surgery. Conclusions: Our results describe novel scoring systems for risk assessment for non-traumatic amputations and for revision surgery at non-traumatic amputations. It may be used after further prospective evaluation as an early-warning system for amputated limbs at risk of revision.
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Affiliation(s)
- Vesta Brauckmann
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany;
| | - Ole Moritz Block
- Department of Trauma Surgery, Orthopedic Surgery and Plastic Surgery, University Medical Center, 37075 Göttingen, Germany (L.A.P.J.); (W.L.); (F.B.); (G.F.)
| | - Luis A. Pardo
- Department of Trauma Surgery, Orthopedic Surgery and Plastic Surgery, University Medical Center, 37075 Göttingen, Germany (L.A.P.J.); (W.L.); (F.B.); (G.F.)
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopedic Surgery and Plastic Surgery, University Medical Center, 37075 Göttingen, Germany (L.A.P.J.); (W.L.); (F.B.); (G.F.)
| | - Frank Braatz
- Department of Trauma Surgery, Orthopedic Surgery and Plastic Surgery, University Medical Center, 37075 Göttingen, Germany (L.A.P.J.); (W.L.); (F.B.); (G.F.)
- Orthobionics Study Programme, Private University of Applied Sciences, 37073 Göttingen, Germany;
| | - Gunther Felmerer
- Department of Trauma Surgery, Orthopedic Surgery and Plastic Surgery, University Medical Center, 37075 Göttingen, Germany (L.A.P.J.); (W.L.); (F.B.); (G.F.)
| | - Sebastian Mönnighoff
- Orthobionics Study Programme, Private University of Applied Sciences, 37073 Göttingen, Germany;
| | - Jennifer Ernst
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany;
- Department of Trauma Surgery, Orthopedic Surgery and Plastic Surgery, University Medical Center, 37075 Göttingen, Germany (L.A.P.J.); (W.L.); (F.B.); (G.F.)
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Lathouwers E, Tassignon B, Maricot A, Radwan A, Naeyaert M, Raeymaekers H, Van Schuerbeek P, Sunaert S, De Mey J, De Pauw K. Human-Prosthetic Interaction (HumanIT): A study protocol for a clinical trial evaluating brain neuroplasticity and functional performance after lower limb loss. PLoS One 2024; 19:e0299869. [PMID: 38512879 PMCID: PMC10956762 DOI: 10.1371/journal.pone.0299869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Lower limb amputation contributes to structural and functional brain alterations, adversely affecting gait, balance, and overall quality of life. Therefore, selecting an appropriate prosthetic ankle is critical in enhancing the well-being of these individuals. Despite the availability of various prostheses, their impact on brain neuroplasticity remains poorly understood. OBJECTIVES The primary objective is to examine differences in the degree of brain neuroplasticity using magnetic resonance imaging (MRI) between individuals wearing a new passive ankle prosthesis with an articulated ankle joint and a standard passive prosthesis, and to examine changes in brain neuroplasticity within these two prosthetic groups. The second objective is to investigate the influence of prosthetic type on walking performance and quality of life. The final objective is to determine whether the type of prosthesis induces differences in the walking movement pattern. METHODS Participants with a unilateral transtibial amputation will follow a 24-week protocol. Prior to rehabilitation, baseline MRI scans will be performed, followed by allocation to the intervention arms and commencement of rehabilitation. After 12 weeks, baseline functional performance tests and a quality of life questionnaire will be administered. At the end of the 24-week period, participants will undergo the same MRI scans, functional performance tests and questionnaire to evaluate any changes. A control group of able-bodied individuals will be included for comparative analysis. CONCLUSION This study aims to unravel the differences in brain neuroplasticity and prosthesis type in patients with a unilateral transtibial amputation and provide insights into the therapeutic benefits of prosthetic devices. The findings could validate the therapeutic benefits of more advanced lower limb prostheses, potentially leading to a societal impact ultimately improving the quality of life for individuals with lower limb amputation. TRIAL REGISTRATION NCT05818410 (Clinicaltrials.gov).
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Affiliation(s)
- Elke Lathouwers
- Human Physiology and Sports Physiotherapy research group, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bruno Tassignon
- Human Physiology and Sports Physiotherapy research group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexandre Maricot
- Human Physiology and Sports Physiotherapy research group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ahmed Radwan
- KU Leuven, Department of Imaging and pathology, Translational MRI, Leuven, Belgium
| | - Maarten Naeyaert
- Department of Radiology and Magnetic Resonance, UZ Brussel, Jette, Belgium
| | - Hubert Raeymaekers
- Department of Radiology and Magnetic Resonance, UZ Brussel, Jette, Belgium
| | | | - Stefan Sunaert
- KU Leuven, Department of Imaging and pathology, Translational MRI, Leuven, Belgium
- UZ Leuven, Department of Radiology, Leuven, Belgium
| | - Johan De Mey
- Department of Radiology and Magnetic Resonance, UZ Brussel, Jette, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy research group, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Vrije Universiteit Brussel, Brussels, Belgium
- Strategic Research Program ‘Exercise and the Brain in Health & Disease: The Added Value of Human-Centered Robotics’, Vrije Universiteit Brussel, Brussels, Belgium
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18
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Murray CD, Havlin H, Molyneaux V. Considering the psychological experience of amputation and rehabilitation for military veterans: a systematic review and metasynthesis of qualitative research. Disabil Rehabil 2024; 46:1053-1072. [PMID: 36856319 DOI: 10.1080/09638288.2023.2182915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Research highlights the differences and unique experiences of military veterans experiencing amputation compared to civilians. This review aimed to synthesise qualitative research exploring the experience of amputation and rehabilitation among existing or previous members of the military. METHODS A systematic search of six databases (PsycINFO, AMED, MEDLINE, CINAHL, Web of Science and Scopus) was undertaken in March 2022. The results of 17 papers reporting 12 studies published between 2009 and 2022 were synthesised using a meta-ethnographic approach to generate new interpretations reflecting the experiences of members of the military who have experienced limb loss. RESULTS Three themes were developed from the data: (1) Making the physical and psychological transition to life after amputation; (2) The role of the military culture in rehabilitation; and (3) The impact of relationships and the gaze of others during rehabilitation and beyond. CONCLUSIONS Military veterans with limb loss experience difficulties in navigating civilian healthcare systems and gaining appropriate support away from the military. Rehabilitation professionals, with psychological training or mentoring, involved in the care of military veterans following amputation could offer psychological support during the transition to civilian life and targeted therapies to veterans experiencing high levels of pain, and facilitate peer support programmes.
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Affiliation(s)
- Craig D Murray
- Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
| | - Heather Havlin
- Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
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19
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Devin KM, Tang J, Hamilton AR, Moser D, Jiang L. Assessment of 3D printed mechanical metamaterials for prosthetic liners. Proc Inst Mech Eng H 2024; 238:348-357. [PMID: 38279687 PMCID: PMC10941651 DOI: 10.1177/09544119231225529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/21/2023] [Indexed: 01/28/2024]
Abstract
This study focuses on novel design and evaluation of Elastic 50A (EL50) mechanical metamaterials with open-cell patterns for its potential application to lower limb residuum/socket interfaces, specifically that of a transtibial (TT) amputee. Mechanical characteristics, that is, effective Young's modulus (E), was tuned by altering metamaterial porosity, which was experimentally verified. Specifically, pore radius of the unit cell was varied to achieve a range of E-values (0.05-1.71 MPa) for these 3D printed metamaterials. Finite Element Analysis (FEA) was conducted to evaluate pressure distribution across key load-bearing anatomical sites of a TT residuum. Using designed metamaterials for homogeneous liners, pressure profiles were studied and compared with a silicone liner case. Additionally, a custom metamaterial liner was designed by assigning appropriate metamaterials to four load-sensitive and tolerant anatomical sites of the TT residuum. The results suggest that lowest pressure variation (PV), as a measure of pressure distribution levels and potential comfort for amputees, was achieved by the custom metamaterial liner compared to any of the homogeneous liners included in this study. It is envisaged that this work may aid future design and development of custom liners using now commonly available 3D printing technologies and available elastomer materials to maximise comfort, tissue safety and overall rehabilitation outcomes for lower limb amputees.
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Affiliation(s)
- Kirstie M Devin
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Jinghua Tang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Andrew R Hamilton
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - David Moser
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Liudi Jiang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
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Persine S, Leteneur S, Gillet C, Bassement J, Charlaté F, Simoneau-Buessinger E. Kinetic adaptations of the intact limb in transfemoral amputees using a microprocessor prosthetic knee. Gait Posture 2024; 108:170-176. [PMID: 38100955 DOI: 10.1016/j.gaitpost.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND In recent decades, high-tech prostheses, including microprocessor-controlled knee (MPK), have been developed to improve the functional abilities of lower limb amputees and to reduce gait asymmetry for the prevention of early joint degradation of the intact limb. The aim of this study was to determine the differences in joint moment and power of the intact limb of transfemoral amputees (TFAs) with an MPK compared to healthy individuals in 2 walking speed conditions. METHODS Twenty-one TFAs with MPK and matched 21 healthy individuals performed a walking task at spontaneous and rapid self-selected speeds. Spatiotemporal gait parameters and intact limb kinetic data were recorded. RESULTS The hip and knee moments in the frontal plane during rapid walking were not significantly higher than spontaneous walking in TFA group (respectively p = 0.08 and p = 0.48) and were lower than the control group. In the sagittal plane, the hip extensor moment in TFA was higher than the control group in the landing phase (p < 0.001 in both speed conditions). SIGNIFICANCE The kinetics of the intact limb of active TFAs with an MPK showed a significant reduction at the knee internal abductor moment compared to the control, potentially limiting risk factors for knee osteoarthritis. However, in the sagittal plane, higher hip extensor moments could favor low-back pain appearance. Gait analysis of lower limb amputees should thus be performed to highlight these kinetic adaptations and then help to propose the most relevant rehabilitation and prevention exercises to limit the appearance of early musculoskeletal degeneration.
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Affiliation(s)
- S Persine
- Centre Jacques Calvé, Fondation HOPALE, Berck-sur-Mer, France; Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France.
| | - S Leteneur
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| | - C Gillet
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| | - J Bassement
- Soin de Suite et Réadaptation, Institut Stablinski, Centre Hospitalier de Valenciennes, France
| | - F Charlaté
- Centre Jacques Calvé, Fondation HOPALE, Berck-sur-Mer, France
| | - E Simoneau-Buessinger
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
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Weerasinghe S, Aranceta-Garza A, Murray L. Efficacy of rehabilitation after provision of ICRC lower limb prostheses in low-income and middle-income countries: A quantitative assessment from Myanmar. Prosthet Orthot Int 2024; 48:5-12. [PMID: 37870366 PMCID: PMC10852039 DOI: 10.1097/pxr.0000000000000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/11/2023] [Accepted: 08/17/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Low-income and middle-income countries (LMICs) have poorly resourced health services. Lack of access to assistive devices, such as prosthetics, may limit the functional outcomes of persons with amputation and affect quality of life (QoL). OBJECTIVE The objective of this study was to assess the functional level and QoL of prosthetic users in LMICs when prescribed a prosthesis made from International Committee for Red Cross (ICRC) components. STUDY DESIGN The study design included a quantitative descriptive methodology assessing functional outcomes and QoL after prosthetic provision. METHODS Participants were identified from the prosthetic service in Mandalay, Myanmar. Included participants were those with unilateral, traumatic, lower limb amputations, with ICRC devices delivered at least 6 months earlier. Participants attended the prosthetic service and were assessed using the Amputee Mobility Predictor with Prosthesis tool and the World Health Organization Quality of Life Brief and Disability modules. RESULTS Thirty-five participants completed the study; of them, 63% were persons with transtibial level amputation and 37% were with transfemoral level amputation. Approximately 83% achieved a score of more than 37 using the Amputee Mobility Predictor with Prosthesis. There is a strong positive correlation between QoL and physical health (r = 0.55; p < 0.001), social relationships (r = 0.66; p < 0.001), and inclusion (r = 0.53; p < 0.001). Participants had a better QoL and overall health when they had better psychological health. CONCLUSION The patient-based results presented within this study could be considered as a contribution to the evidence base and importance of provision of prosthetic services in LMICs. It was observed that participants with an amputation were able to achieve a high level of physical function with the ICRC prostheses while also reporting a high QoL.
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Affiliation(s)
- Stephney Weerasinghe
- Mandalay Orthopaedic Hospital, Prosthetics and Orthotics Department, Exceed Worldwide, Mandalay, Myanmar
| | | | - Laura Murray
- Biomedical Engineering Department, University of Strathclyde, Glasgow, United Kingdom
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Saleh NEH, Hamiye F, Summaka M, Zein H, El Mazbouh R, Naim I. Depression and Anxiety Symptoms Among Lebanese Lower Limb Traumatic Amputees: Association with Education, Employment, Adjustment to Amputation and Prosthesis Satisfaction. Psychiatry 2023; 87:51-64. [PMID: 38133532 DOI: 10.1080/00332747.2023.2286880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
ObjectiveTo examine and compare the association between the presence of depression and anxiety symptoms and different sociodemographic and clinical factors including the adjustment to amputation and prosthesis satisfaction among Lebanese individuals with lower limb amputation (LLA). Method: This cross-sectional study was conducted between December 2022 and May 2023 among 72 participants with LLA. Participants completed a questionnaire that included sociodemographic and clinical variables, the revised Trinity Amputation and Prosthesis Experience Scale (TAPES-R), and the Hopkins Symptom Checklist (HSCL-25). Result: Using the HSCL depression and anxiety cut-off, 25% of participants were categorized as having depression symptoms, with unemployment being significantly associated (p-value < .05) with depression. Similarly, 25% were classified as having anxiety symptoms, with both lower education and unemployment (p-value < .05) significantly linked to anxiety. TAPES-R subscales scores exhibited significant differences between non-depressed and depressed, as well as non-anxious and anxious participants (p-value < .05). Correlation analysis demonstrated significant relationship between HSCL scales and TAPES-R subscales; lower scores in adjustment to amputation and prosthesis satisfaction were moderately associated with increased rates of depression (r ranging between -0.331 and -0.500, p-values < .005) and increased rates of anxiety symptoms (r ranging between -0.362 and -0.441, p-values < .002). In addition, higher scores in activity limitation were moderately correlated to increased rates of depression and anxiety (r = 0.438 for anxiety and 0.490 for depression; p < .001). Conclusion: Mental health symptoms are associated with educational level, employment status, and adjustment to amputation and prosthesis satisfaction in Lebanese individuals with LLA. These findings should be considered to achieve optimal prosthetic rehabilitation.
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Blumentritt S, Schmalz T, Layher F, Timmermann A, Aschoff HH. Force transmission capacity of the lower limb during walking of amputees with bone-anchored prostheses compared with socket prostheses and persons with hip replacements. Clin Biomech (Bristol, Avon) 2023; 110:106099. [PMID: 37832468 DOI: 10.1016/j.clinbiomech.2023.106099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Restoring the ability to walk with a prosthesis is considered a fundamental rehabilitation goal after transfemoral amputation. An essential prerequisite for achieving this goal is adequate force transmission between the prosthesis and the body. Does bone anchorage of an artificial limb permit a more normal force transmission? METHODS Data of 15 healthy subjects, nine amputees fitted with bone-anchored prostheses, nine amputees using socket prostheses, and 18 patients with a total hip replacement were included in this multicenter, observational study. Ground reaction force was measured using Kistler force plates. Kinematics was recorded with 12 Vicon Bonita cameras. Subjects were instructed to walk at three different speeds: first at their self-selected, then at slow, and finally at fast speed. FINDINGS Self-selected walking speeds of subject groups were significantly different, osseointegrated amputees walked the slowest. The lowest ground reaction force was measured for osseointegrated amputees on the prosthetic side, who also showed the highest force on their contralateral side. Patients with hip replacements showed values similar as healthy subjects. The vertical center of gravity movement was specific for each subject group. INTERPRETATION The force transmission capacity of the bone-anchored prosthetic leg is limited during walking and is lower than both in socket prostheses users without symptoms and patients with total hip replacement. Therefore, active amputees well fitted with a socket prosthesis who consider a transition to bone-anchorage should be advised that their walking speed may decrease with high probability, and that their self-selected walking speed may even be slower than 3 km/h.
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Affiliation(s)
| | - Thomas Schmalz
- Ottobock SE & Co. KGaA, Clinical Research and Services, Research Biomechanics, Göttingen, Germany.
| | - Frank Layher
- Orthopaedic Professorship University Jena, Orthopaedic Clinic Eisenberg, Dept. Biomechanics, Germany.
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Mattick K, Oldfrey B, Donovan-Hall M, Magomere G, Gakunga J, Holloway C. Experiences of lower limb prosthesis users in Kenya: a qualitative study to understand motivation to use and satisfaction with prosthetic outcomes. Disabil Rehabil 2023; 45:4478-4488. [PMID: 36495104 DOI: 10.1080/09638288.2022.2152875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To explore the personal and system factors that motivate and enhance outcomes for patients accessing a prosthetic service and using a lower-limb prosthesis within a low resource setting. MATERIALS AND METHODS This study employed a qualitative approach to explore the motivations and satisfaction of individuals with lower limb loss engaging with a prosthetic service in Mombasa, Kenya. In-depth interviews were conducted over Microsoft Teams with 10 lower limb prosthesis users and thematic analysis was applied. RESULTS Five key themes emerged: acceptance, self-determination, hope, clinician relationship and perception. These findings demonstrate the importance of hopeful thinking and a supportive community in overcoming physical and stigmatising challenges. The findings further highlight the value of the service provider relationship beyond just prescribing an assistive device. CONCLUSION These results have relevance in developing patient-centred services, assistive devices and personnel training that are responsive, motivating, and cognisant of the service user. This is of particular interest as assistive technology services are newly developed in low resource settings.IMPLICATIONS FOR REHABILITATIONThis research provides an understanding of lower-limb prosthesis users' satisfaction of a device and motivation for engaging with a prosthetic service within a low resource setting.The relationship the rehabilitation professional has with the service user plays a significant role in facilitating motivation during rehabilitation.Rehabilitation professionals should consider how they can foster a network of support amongst service users when planning services in remote, rural locations.Rehabilitation professionals should be aware of how hopeful thinking can be facilitated during rehabilitation to support motivation.When reviewing the success of services, or designing new service models, the service users should be consulted on what they would deem as a successful outcome.
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Affiliation(s)
- Kate Mattick
- Global Disability Innovation Hub, University College London, London, UK
| | - Ben Oldfrey
- Global Disability Innovation Hub, University College London, London, UK
- Institute of Making UCL, London, UK
| | - Maggie Donovan-Hall
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK
| | | | - Joseph Gakunga
- Association of the Physically Disabled of Kenya, Mombasa, Kenya
| | - Catherine Holloway
- Global Disability Innovation Hub, University College London, London, UK
- UCLIC and Computer Science, UCL, London, UK
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Boos CJ, Haling U, Schofield S, Cullinan P, Bull AMJ, Fear NT, Bennett AN. Relationship between combat-related traumatic injury and its severity to predicted cardiovascular disease risk: ADVANCE cohort study. BMC Cardiovasc Disord 2023; 23:581. [PMID: 38012542 PMCID: PMC10680223 DOI: 10.1186/s12872-023-03605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND This study investigated the relationship between combat-related traumatic injury (CRTI) and its severity and predicted cardiovascular disease (CVD) risk. MATERIAL AND METHODS This was an analysis of comparative 10-year predicted CVD risk (myocardial infarction, stroke or CVD-death) using the QRISK®3 scoring-system among adults recruited into the Armed Services Trauma Rehabilitation Outcome (ADVANCE) cohort study. Participants with CRTI were compared to uninjured servicemen frequency-matched by age, sex, rank, deployment (Afghanistan 2003-2014) and role. Injury severity was quantified using the New Injury Severity Score (NISS). RESULTS One thousand one hundred forty four adult combat veterans were recruited, consisting of 579 injured (161 amputees) and 565 uninjured men of similar age ethnicity and time from deployment/injury. Significant mental illness (8.5% vs 4.4%; p = 0.006) and erectile dysfunction (11.6% vs 5.8%; p < 0.001) was more common, body mass index (28.1 ± 3.9 vs 27.4 ± 3.4 kg/m2; p = 0.001) higher and systolic blood pressure variability (median [IQR]) (1.7 [1.2-3.0] vs 2.1 [1.2-3.5] mmHg; p = 0.008) lower among the injured versus uninjured respectively. The relative risk (RR) of predicted CVD (versus the population expected risk) was higher (RR:1.67 [IQR 1.16-2.48]) among the injured amputees versus the injured non-amputees (RR:1.60 [1.13-2.43]) and uninjured groups (RR:1.52 [1.12-2.34]; overall p = 0.015). After adjustment for confounders CRTI, worsening injury severity (higher NISS, blast and traumatic amputation) were independently associated with QRISK®3 scores. CONCLUSION CRTI and its worsening severity were independently associated with increased predicted 10-year CVD risk.
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Affiliation(s)
- Christopher J Boos
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Near Loughborough, LE12 5QW, Nottinghamshire, UK.
- The Academic Department of Military Mental Health, King's College London, London, SE5 9RJ, UK.
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, BH1 3LT, UK.
- Department of Cardiology, University Hospitals Dorset, Poole Hospital, Longfleet Rd, Poole, BH15 2JB, Dorset, UK.
| | - Usamah Haling
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
| | - Susie Schofield
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
| | - Paul Cullinan
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
| | - Nicola T Fear
- The Academic Department of Military Mental Health, King's College London, London, SE5 9RJ, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Near Loughborough, LE12 5QW, Nottinghamshire, UK
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
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Sureshkumar A, Payne MW, Viana R, Hunter SW. The Effect of Advanced Age on Prosthetic Rehabilitation Functional Outcomes in People With Lower Limb Amputations: A Retrospective Chart Audit of Inpatient Admissions. Arch Phys Med Rehabil 2023; 104:1827-1832. [PMID: 37119956 DOI: 10.1016/j.apmr.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To evaluate the effect of age on functional outcomes at discharge from prosthetic rehabilitation. DESIGN Retrospective chart audit. SETTING Rehabilitation hospital. PARTICIPANTS Individuals ≥50 years with a transtibial level lower limb amputation (LLA) and above admitted to the inpatient prosthetic rehabilitation program from 2012 to 2019 (n=504). A secondary analysis included a subset of matched participants (n=156). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The L-Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence scale. RESULTS A total of 504 participants (66.7±10.1 years) met the inclusion criteria, 63 participants (84.9±3.7 years) were part of the oldest old group. The sample was stratified into 4 age groups (50-59, 60-69, 70-79, and 80+) for data analysis. The analysis of variances were statistically significant for all outcome measures (P<.001). Post-hoc testing for the L-Test, 2MWT, and 6MWT demonstrated that the oldest old had significantly reduced performance compared with people 50-59 years old (P<.05), but there were no significant differences between the oldest old and the 60-69 [(L-Test, P=.802), (2MWT, P=.570), (6MWT, P=.772)] and 70-79 [(L-Test, P=.148), (2MWT, P=.338), (6MWT, P=.300)] age groups. The oldest old reported significantly lower balance confidence compared with all 3 age groups (P<.05). CONCLUSION The oldest old achieved similar functional mobility outcomes as people 60-79 years, the most common age group of people with an LLA. Advanced age alone should not disqualify individuals from prosthetic rehabilitation.
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Affiliation(s)
| | - Michael W Payne
- Department of Physical Medicine & Rehabilitation, Parkwood Institute London, Canada; Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Ricardo Viana
- Department of Physical Medicine & Rehabilitation, Parkwood Institute London, Canada; Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Susan W Hunter
- Faculty of Health Sciences, University of Western Ontario, London, Canada; Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada; School of Physical Therapy, University of Western Ontario, London, Canada
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Dasanayaka DARK, Patwary FK, van Ravensberg CD. Functional outcomes and associated factors of individuals with unilateral traumatic lower limb amputation in Sri Lanka: An observational study. Prosthet Orthot Int 2023; 47:525-531. [PMID: 37052576 DOI: 10.1097/pxr.0000000000000224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 01/18/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Rehabilitation is important after an amputation surgery. This study was conducted to find the level of functional outcomes of individuals with unilateral traumatic lower limb amputation and the impact of sociodemographic, amputation, and rehabilitation characteristics on functional outcomes. METHODS An observational cross-sectional study was conducted with 48 participants (aged 20-60 years) who visited the Center for Handicapped from across the country. Functional outcomes were measured using the Locomotor Capabilities Index, Amputee Mobility Predictor with Prosthesis, 6-minute walk distance, and spirometry test and sociodemographic, amputation, and rehabilitation characteristics using a self-constructed questionnaire. RESULTS Amputee Mobility Predictor with Prosthesis K levels showed 65% had the ability to ambulate in the community and could master environmental barriers. Locomotor Capabilities Index scores showed 96% could independently perform basic daily activities with or without using assistive devices and 83% could perform advanced daily activities. None of the individuals had achieved their predicted 6-minute walk distance, but 52% had "good and above" level of maximum oxygen consumption; restrictive respiratory pattern was indicated among 31%. Amputee Mobility Predictor with Prosthesis and Locomotor Capabilities Index scores were significantly ( p < 0.005) affected by mobility hours/day, amputation level, prosthesis usage, and satisfaction. Six-minute walk distance was significantly ( p < 0.005) related to income, time since amputation, duration of rehabilitation, mobility hours/day, sex, job engagement, previous job, amputation level, K levels, and satisfaction with prosthesis. CONCLUSION Rehabilitation in Sri Lanka mainly focuses on basic walking training, not on long-term survival, distance walking, and cardiorespiratory endurance, which can lead to future comorbidities. Raising awareness in the society about rehabilitation services and more effective rehabilitation programs are recommended.
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Affiliation(s)
| | - Fazlul Karim Patwary
- Institute of Information Technology, Jahangirnagar University, Dhaka, Bangladesh
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Fatima SZ. Life of an amputee: predictors of quality of life after lower limb amputation. Wien Med Wochenschr 2023; 173:329-333. [PMID: 36441361 DOI: 10.1007/s10354-022-00980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022]
Abstract
Lower limb amputations (LLA) have a significant impact on global morbidity. Approximately 2 million people are living with lower limb amputation in the United States and this figure is expected to rise. LLA lead to physical disabilities and can cause restriction in functionalities in the everyday life of amputees. Patients lose their independence, which can be very debilitating and eventually causes physical, behavioral, and psychical changes. These changes after amputations should be properly addressed and must be incorporated into rehabilitation to improve and regain better adjustment to life among amputees. This article focuses on determining various factors and their effect on quality of life after lower limb amputations.
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Affiliation(s)
- Syeda Zainab Fatima
- Dow University of Health Sciences, Baba-E-Urdu Road, 74200, Karachi, Pakistan.
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29
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Persine S, Simoneau-Buessinger E, Charlaté F, Bassement J, Gillet C, Découfour N, Leteneur S. Transfemoral amputees adapt their gait during cross-slope walking with specific upper-lower limb coordination. Gait Posture 2023; 105:171-176. [PMID: 37579592 DOI: 10.1016/j.gaitpost.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Unilateral lower limb amputees have asymmetrical gaits, particularly on irregular surfaces and slopes. It is unclear how coordination between arms and legs can adapt during cross-slope walking. RESEARCH QUESTION How do transfemoral amputees (TFAs) adapt their upper-lower limb coordination on cross-slope surfaces? METHODS Twenty TFA and 20 healthy adults (Ctrl) performed a three-dimensional gait analysis in 2 walking conditions: level ground and cross-slope with prosthesis uphill. Sagittal joint angles and velocities of hips and shoulders were calculated. Continuous relative phases (CRP) were computed between the shoulder and the hip of the opposite side. The closer to 0 the CRP is, the more coordinated the joints are. Curve analysis were conducted using SPM. RESULTS The mean CRP between the downhill shoulder and the uphill hip was higher in TFA compared to Ctrl (p = 0.02), with a walking conditions effect (p = 0.005). TFA showed significant differences about the end of the stance phase (p = 0.01) between level ground and cross-slope, while Ctrl showed a significant difference (p = 0.008) between these walking conditions at the end of the swing phase. In CRP between the uphill shoulder and the downhill hip, SnPM analysis showed intergroup differences during the stance phase (p < 0.05), but not in the comparison between walking conditions in TFA and Ctrl groups. SIGNIFICANCE TFA showed an asymmetrical coordination in level ground walking compared to Ctrl. Walking on cross-slope led to upper-lower limb coordination adaptations: this condition impacted the CRP between downhill shoulder and uphill hip in both groups. The management of the prosthetic limb, positioned uphill, induced a reorganization of the coordination with the upper limb of the amputated side. Identifying upper-lower limb coordination adaptations on cross-slope surfaces will help to achieve rehabilitation goals for effective walking in urban environments.
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Affiliation(s)
- S Persine
- Centre Jacques Calvé, Fondation HOPALE, Berck-sur-mer, France; Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France.
| | - E Simoneau-Buessinger
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| | - F Charlaté
- Centre Jacques Calvé, Fondation HOPALE, Berck-sur-mer, France
| | - J Bassement
- Institut Stablinski, Centre Hospitalier de Valenciennes, France
| | - C Gillet
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| | - N Découfour
- Faculté de Médecine et de Maïeutique, Institut Catholique de Lille, France
| | - S Leteneur
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
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Poehler D, Czerniecki J, Norvell D, Henderson A, Dolan J, Devine B. Comparing Patient and Provider Priorities Around Amputation Level Outcomes Using Multiple Criteria Decision Analysis. Ann Vasc Surg 2023; 95:169-177. [PMID: 37263414 PMCID: PMC10782550 DOI: 10.1016/j.avsg.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Patients with chronic limb threatening ischemia may require a transmetatarsal amputation (TMA) or a transtibial amputation. When making an amputation-level decision, these patients face a tradeoff-a TMA preserves more limb and may provide better mobility but has a lower probability of primary wound healing and may therefore result in additional same or higher level amputation surgeries with an associated negative impact on function. Understanding differences in how patients and providers prioritize these tradeoffs and other outcomes may enhance shared decision-making. OBJECTIVES Compare patient priorities with provider perceptions of patient priorities using Multiple Criteria Decision Analysis (MCDA). METHODS The MCDA Analytic Hierarchy Process was chosen due to its low cognitive burden and ease of implementation. We included 5 criteria (outcomes): ability to walk, healing after amputation surgery, rehabilitation program intensity, limb length, and ease of use of prosthetic/orthotic device. A national sample of dysvascular lower-limb amputees and providers were recruited from the Veterans Health Administration with the MCDA administered online to providers and telephonically to patients. RESULTS Twenty-six dysvascular amputees and 38 providers participated. Fifty percent of patients had undergone a TMA; 50%, a transtibial amputation. When compared to providers, patients placed higher value on TMA (72% vs. 63%). Patient versus provider priorities were ability to walk (47% vs. 42%), healing (18% vs. 28%), ease of prosthesis use (17% vs. 13%), limb length (11% vs. 13%), and then rehabilitation intensity (7% vs. 6%). LIMITATIONS Our sample may not generalize to other populations. CONCLUSIONS Provider perceptions aligned with patient values on amputation level but varied around the importance of each outcome. IMPLICATIONS These findings illuminate some differences between patients' values and provider perceptions of patient values, suggesting a role for shared decision-making. Embedding this MCDA framework into a future decision aid may facilitate these discussions.
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Affiliation(s)
- Diana Poehler
- Advanced Methods Development, RTI International, Research Triangle Park, NC; Department of Health Services, University of Washington, Seattle, WA.
| | - Joseph Czerniecki
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Daniel Norvell
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Veterans Affairs (VA) Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, WA
| | - Alison Henderson
- Veterans Affairs (VA) Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, WA
| | - James Dolan
- Department of Public Health Sciences, University of Rochester, Rochester, NY
| | - Beth Devine
- Department of Health Services, The Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, WA
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Teater RH, Wolf DN, McDonald KA, Zelik KE. Unilateral transtibial prosthesis users load their intact limb more than their prosthetic limb during sit-to-stand, squatting, and lifting. Clin Biomech (Bristol, Avon) 2023; 108:106041. [PMID: 37478554 PMCID: PMC10550186 DOI: 10.1016/j.clinbiomech.2023.106041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Lower limb prosthesis users exhibit high rates of joint pain and disease, such as osteoarthritis, in their intact limb. Overloading of their intact limb during daily activities may be a contributing factor. Limb loading biomechanics have been extensively studied during walking, but fewer investigations into limb loading during other functional movements exist. The purpose of this study was to characterize the lower limb loading of transtibial prosthesis users during three common daily tasks: sit-to-stand, squatting, and lifting. METHODS Eight unilateral transtibial prosthesis users performed sit-to-stand (from three chair heights), squatting, and lifting a 10 kg box. Peak vertical ground reaction forces and peak knee flexion moments were computed for each limb (intact and prosthetic) to characterize limb loading and asymmetry. Ranges of motion of the intact and prosthetic ankles were also quantified. FINDINGS Users had greater peak ground reaction forces and knee flexion moments in their intact limb for all tasks (p < 0.02). On average, the intact limb had 36-48% greater peak ground reaction forces and 168-343% greater peak knee flexion moments compared to the prosthetic limb. The prosthetic ankle provided <10° of ankle range of motion for all tasks, less than half the range of motion provided by the intact ankle. INTERPRETATION Prosthesis users overloaded their intact limb during all tasks. This asymmetric loading may lead to an accumulation of damage to the intact limb joints, such as the knee, and may contribute to the development of osteoarthritis. Prosthetic design and rehabilitation interventions that promote more symmetric loading should be investigated for these tasks.
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Affiliation(s)
- Rachel H Teater
- Vanderbilt University, Department of Mechanical Engineering, Nashville, TN 37212, USA.
| | - Derek N Wolf
- Vanderbilt University, Department of Mechanical Engineering, Nashville, TN 37212, USA
| | - Kirsty A McDonald
- University of New South Wales, School of Health Sciences, Sydney, NSW 2052, Australia
| | - Karl E Zelik
- Vanderbilt University, Department of Mechanical Engineering, Nashville, TN 37212, USA; Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37212, USA; Vanderbilt University, Department of Physical Medicine and Rehabilitation, Nashville, TN 37212, USA
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Haidary A, Hoellwarth JS, Tetsworth K, Oomatia A, Al Muderis M. Transcutaneous osseointegration for amputees with burn trauma. Burns 2023; 49:1052-1061. [PMID: 36907716 DOI: 10.1016/j.burns.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/14/2023] [Accepted: 02/19/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Transcutaneous osseointegration for amputees (TOFA) surgically implants a prosthetic anchor into the residual limb's bone, enabling direct skeletal connection to a prosthetic limb and eliminating the socket. TOFA has demonstrated significant mobility and quality of life benefits for most amputees, but concerns regarding its safety for patients with burned skin have limited its use. This is the first report of the use of TOFA for burned amputees. METHODS Retrospective chart review was performed of five patients (eight limbs) with a history of burn trauma and subsequent osseointegration. The primary outcome was adverse events such as infection and additional surgery. Secondary outcomes included mobility and quality of life changes. RESULTS The five patients (eight limbs) had an average follow-up time of 3.8 ± 1.7 (range 2.1-6.6) years. We found no issues of skin compatibility or pain associated with the TOFA implant. Three patients underwent subsequent surgical debridement, one of whom had both implants removed and eventually reimplanted. K-level mobility improved (K2 +, 0/5 vs 4/5). Other mobility and quality of life outcomes comparisons are limited by available data. CONCLUSION TOFA is safe and compatible for amputees with a history of burn trauma. Rehabilitation capacity is influenced more by the patient's overall medical and physical capacity than their specific burn injury. Judicious use of TOFA for appropriately selected burn amputees seems safe and merited.
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Affiliation(s)
- Amanullah Haidary
- Western Sydney University School of Medicine, Building 30 Campbelltown Campus, Campbelltown, NSW, Australia.
| | - Jason S Hoellwarth
- Limb Lengthening and Complex Reconstruction Service, Osseointegration Limb Replacement Center, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Queensland, Australia.
| | - Atiya Oomatia
- Limb Reconstruction Centre, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia.
| | - Munjed Al Muderis
- Limb Reconstruction Centre, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia.
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Current Issues in Limb Loss Rehabilitation. PM R 2023; 15:E1-8. [PMID: 37063084 DOI: 10.1002/pmrj.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
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Hafner BJ, Amtmann D, Morgan SJ, Abrahamson DC, Askew RL, Bamer AM, Salem R, Gaunaurd IA, Gailey RS, Czerniecki JM, Fatone S, Fergason JR, Fothergill I, Kelly VE, Weber EL, Whiteneck GG. Development of an item bank for measuring prosthetic mobility in people with lower limb amputation: The Prosthetic Limb Users Survey of Mobility (PLUS-M). PM R 2023; 15:456-473. [PMID: 36787171 PMCID: PMC10121932 DOI: 10.1002/pmrj.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Achieving mobility with a prosthesis is a common post-amputation rehabilitation goal and primary outcome in prosthetic research studies. Patient-reported outcome measures (PROMs) available to measure prosthetic mobility have practical and psychometric limitations that inhibit their use in clinical care and research. OBJECTIVE To develop a brief, clinically meaningful, and psychometrically robust PROM to measure prosthetic mobility. DESIGN A cross-sectional study was conducted to administer previously developed candidate items to a national sample of lower limb prosthesis users. Items were calibrated to an item response theory model and two fixed-length short forms were created. Instruments were assessed for readability, effective range of measurement, agreement with the full item bank, ceiling and floor effects, convergent validity, and known groups validity. SETTING Participants were recruited using flyers posted in hospitals and prosthetics clinics across the United States, magazine advertisements, notices posted to consumer websites, and direct mailings. PARTICIPANTS Adult prosthesis users (N = 1091) with unilateral lower limb amputation due to traumatic or dysvascular causes. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Candidate items (N = 105) were administered along with the Patient Reported Outcome Measurement Information System Brief Profile, Prosthesis Evaluation Questionnaire - Mobility Subscale, and Activities-Specific Balance Confidence Scale, and questions created to characterize respondents. RESULTS A bank of 44 calibrated self-report items, termed the Prosthetic Limb Users Survey of Mobility (PLUS-M), was produced. Clinical and statistical criteria were used to select items for 7- and 12-item short forms. PLUS-M instruments had an 8th grade reading level, measured with precision across a wide range of respondents, exhibited little-to-no ceiling or floor effects, correlated expectedly with scores from existing PROMs, and differentiated between groups of respondents expected to have different levels of mobility. CONCLUSION The PLUS-M appears to be well suited to measuring prosthetic mobility in people with lower limb amputation. PLUS-M instruments are recommended for use in clinical and research settings.
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Affiliation(s)
- Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sara J Morgan
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- Research Department, Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Daniel C Abrahamson
- Mobile Prosthetic and Orthotic Care, Veterans Integrated Service Network 20 VA NW Health Network, Seattle, WA, USA
| | - Robert L Askew
- Department of Psychology, Stetson University, Deland, FL, USA
| | - Alyssa M Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Rana Salem
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Ignacio A Gaunaurd
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA
| | - Robert S Gailey
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA
| | - Joseph M Czerniecki
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- Center for Limb Loss and MoBility, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Stefania Fatone
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - John R Fergason
- Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX, USA
| | - Ian Fothergill
- Medical Center Orthotics & Prosthetics, Silver Spring, MD, USA
| | - Valerie E Kelly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Eric L Weber
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
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Cherni Y, Laurendeau S, Robert M, Turcot K. The Influence of Transtibial Prosthesis Type on Lower-Body Gait Adaptation: A Case Study. Int J Environ Res Public Health 2022; 20:439. [PMID: 36612761 PMCID: PMC9819038 DOI: 10.3390/ijerph20010439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Gait parameters are altered and asymmetrical in individuals with transtibial amputation. The purpose of this study was to evaluate and compare the effect of four different prosthetic feet on lower-limb biomechanics during gait. A 34-year-old man with transtibial amputation performed four gait analysis sessions with four foot-ankle prostheses (Variflex, Meridium, Echelon, and Kinterra). Kinematic and kinetic parameters and gait symmetry were analyzed in different prosthetic conditions. The type of prosthesis had little effect on the participant's spatiotemporal parameters. Throughout the stance phase, increased hip angle, reduced knee flexion and ankle dorsiflexion were observed in the amputated leg. For kinetic parameters, reduced propulsive force (SI = 0.42-0.65), reduced knee extension moment (mainly during Echelon and Kinterra conditions, SI = 0.17 and 0.32, respectively), and increased knee abduction moment (mainly during the Variflex and Meridium, SI = 5.74 and 8.93, respectively) were measured in the amputated leg. Lower support moments were observed in the amputated leg as compared to the unaffected leg, regardless of the type of prosthesis (SI = 0.61-0.80). The prostheses tested induced different lower-limb mechanical adaptations. In order to achieve the clinical goal of better gait symmetry between lower limbs, an objective gait analysis could help clinicians to prescribe prosthetic feet based on quantitative measurement indicators to optimize gait rehabilitation.
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Affiliation(s)
- Yosra Cherni
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
| | - Simon Laurendeau
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
- Department of Kinesiology, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Maxime Robert
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
| | - Katia Turcot
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
- Department of Kinesiology, Laval University, Quebec City, QC G1V 0A6, Canada
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Ichimura D, Amma R, Hisano G, Murata H, Hobara H. Spatiotemporal gait patterns in individuals with unilateral transfemoral amputation: A hierarchical cluster analysis. PLoS One 2022; 17:e0279593. [PMID: 36548294 PMCID: PMC9778493 DOI: 10.1371/journal.pone.0279593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
Gait pattern classification in individuals with lower-limb amputation could help in developing personalized prosthetic prescriptions and tailored gait rehabilitation. However, systematic classifications of gait patterns in this population have been scarcely explored. This study aimed to determine whether the gait patterns in individuals with unilateral transfemoral amputation (UTFA) can be clustered into homogeneous subgroups using spatiotemporal parameters across a range of walking speeds. We examined spatiotemporal gait parameters, including step length and cadence, in 25 individuals with UTFA (functional level K3 or K4, all non-vascular amputations) while they walked on a split-belt instrumented treadmill at eight speeds. Hierarchical cluster analysis (HCA) was used to identify clusters with homogeneous gait patterns based on the relationships between step length and cadence. Furthermore, after cluster formation, post-hoc analyses were performed to compare the spatiotemporal parameters and demographic data among the clusters. HCA identified three homogeneous gait pattern clusters, suggesting that individuals with UTFA have several gait patterns. Further, we found significant differences in the participants' body height, sex ratio, and their prosthetic knee component among the clusters. Therefore, gait rehabilitation should be individualized based on body size and prosthetic prescription.
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Affiliation(s)
- Daisuke Ichimura
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan
- * E-mail:
| | - Ryo Amma
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Genki Hisano
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan
- Department of Systems and Control Engineering, Tokyo Institute of Technology, Tokyo, Japan
- Research Fellow of the Japan Society for the Promotion of Science (JSPS), Japan
| | - Hiroto Murata
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Hiroaki Hobara
- Faculty of Advanced Engineering, Tokyo University of Science, Tokyo, Japan
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Sadowski PK, Battista S, Leuzzi G, Sansone LG, Testa M. Low Back Pain in People With Lower Limb Amputation: A Cross-Sectional Study. Spine (Phila Pa 1976) 2022; 47:1599-1606. [PMID: 35920468 PMCID: PMC9612722 DOI: 10.1097/brs.0000000000004422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study based on an online questionnaire. OBJECTIVE The aim was to investigate the prevalence and intensity of low back pain (LBP) in people with lower limb amputation (LLA) and to analyze the association factors that can influence the genesis of LBP. SUMMARY OF BACKGROUND DATA It is still unclear whether LBP is more prevalent in the amputated population than in its nonamputated counterpart. Given the multifactorial nature of LBP, it is necessary to explore possible factors that can influence its presence and intensity, to build a solid background to define a better rehabilitation pathway for the management of these people. METHODS The online questionnaire included six sections: informed consent of the study, demographic information, comorbid conditions, history of LLA, history of LBP, and acceptance of the amputation. RESULTS Between March and June 2021, 239 participants [mean age (SD): 49.2 (11.5); female 11%] completed the survey (response rate: 32%). From the results of this study, LBP in LLA showed a prevalence of 82% postamputation and 70% in the last year. A logistic regression with a backward method showed that participants who had problems in the not affected leg presented 1.58 (95% confidence interval: 0.70; 2.45) times higher odds to have LBP after the amputation. CONCLUSION This study shows that the prevalence of LBP in lower limb amputees appears to be higher than in the general population, with similar levels of pain intensity and frequency. The highest percentage of people with a sedentary lifestyle not practicing any kind of sports emphasizes the importance of educating this population on the importance of physical activity. New strategies to invest in the education of this population in terms of physical activity are needed. LEVEL OF EVIDENCE Level 4.
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Vernice NA, Askinas CA, Black GG, Truong AY, Reif TJ, Rozbruch SR, Otterburn DM. Osseointegration for Lower-Extremity Amputees: Operative Considerations from the Plastic Surgeon's Perspective. JBJS Rev 2022; 10:01874474-202211000-00003. [PMID: 36574447 PMCID: PMC10979937 DOI: 10.2106/jbjs.rvw.22.00125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
➢ Osseointegration for lower-extremity amputees, while increasing in frequency, remains in its relative infancy compared with traditional socket-based prostheses. ➢ Ideal candidates for osseointegration have documented failure of a traditional prosthesis and should be skeletally mature, have adequate bone stock, demonstrate an ability to adhere to a longitudinal rehabilitation protocol, and be in an otherwise good state of health. ➢ Lowering the reoperation rate for soft-tissue complications depends heavily on surgical technique and on the implant device itself; the current gold standard involves a smooth implant surface for dermal contact as well as maximal skin resection to prevent skin breakdown against the prosthesis. This may include the need for thighplasty to optimize skin reduction. ➢ Interdisciplinary peripheral nerve management, such as targeted muscle reinnervation, performed in tandem with a plastic surgery team can treat existing and prevent future symptomatic neuromas, ultimately improving pain outcomes.
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Affiliation(s)
- Nicholas A Vernice
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY
| | - Carly A Askinas
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY
| | - Grant G Black
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY
| | - Albert Y Truong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY
| | - Taylor J Reif
- Department of Limb Lengthening and Complex Reconstruction, Hospital for Special Surgery, New York, NY
| | - S Robert Rozbruch
- Department of Limb Lengthening and Complex Reconstruction, Hospital for Special Surgery, New York, NY
| | - David M Otterburn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY
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Lu S, Vien BS, Russ M, Fitzgerald M, Chiu WK. Monitoring Osseointegration Process Using Vibration Analysis. Sensors (Basel) 2022; 22:6727. [PMID: 36146079 PMCID: PMC9504783 DOI: 10.3390/s22186727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
Osseointegration implant has attracted significant attention as an alternative treatment for transfemoral amputees. It has been shown to improve patients' sitting and walking comfort and control of the artificial limb, compared to the conventional socket device. However, the patients treated with osseointegration implants require a long rehabilitation period to establish sufficient femur-implant connection, allowing the full body weight on the prosthesis stem. Hence, a robust assessment method on the osseointegration process is essential to shorten the rehabilitation period and identify the degree of osseointegration prior to the connection of an artificial limb. This paper investigates the capability of a vibration-related index (E-index) on detecting the degree of simulated osseointegration process with three lengths of the residual femur (152, 190 and 228 mm). The adhesive epoxy with a setting time of 5 min was applied at the femur-implant interface to represent the stiffness change during the osseointegration process. The cross-spectrum and colormap of the normalised magnitude demonstrated significant changes during the cure time, showing that application of these plots could improve the accuracy of the currently available diagnostic techniques. Furthermore, the E-index exhibited a clear trend with a noticeable average increase of 53% against the cure time for all three residual length conditions. These findings highlight that the E-index can be employed as a quantitative justification to assess the degree of osseointegration process without selecting and tracing the resonant frequency based on the geometry of the residual femur.
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Affiliation(s)
- Shouxun Lu
- Department of Mechanical & Aerospace Engineering, Monash University, Wellington Rd., Clayton, VIC 3800, Australia
| | - Benjamin Steven Vien
- Department of Mechanical & Aerospace Engineering, Monash University, Wellington Rd., Clayton, VIC 3800, Australia
| | - Matthias Russ
- The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
- National Trauma Research Institute, 89 Commercial Road, Melbourne, VIC 3004, Australia
| | - Mark Fitzgerald
- The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
- National Trauma Research Institute, 89 Commercial Road, Melbourne, VIC 3004, Australia
| | - Wing Kong Chiu
- Department of Mechanical & Aerospace Engineering, Monash University, Wellington Rd., Clayton, VIC 3800, Australia
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England DL, Miller TA, Stevens PM, Campbell JH, Wurdeman SR. Mobility Analysis of AmpuTees (MAAT 7): Normative Mobility Values for Lower Limb Prosthesis Users of Varying Age, Etiology, and Amputation Level. Am J Phys Med Rehabil 2022; 101:850-858. [PMID: 34864771 PMCID: PMC9377488 DOI: 10.1097/phm.0000000000001925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to establish normative values of lower limb amputation mobility across primary etiologies based on age and amputation level. DESIGN This study is a cross-sectional observational analysis of outcomes. A total of 11,995 lower limb prosthesis users were included in the analysis. Participants were grouped by etiology into four categories: cancer, congenital, trauma, and diabetes/dysvascular. Mobility was assessed by using the Prosthetic Limb Users Survey of Mobility. RESULTS Mobility across seven age groups for the four etiologies was established for both above-the-knee amputation and below-the-knee amputation. Differences were found between age groups for individuals: above-the-knee amputation: cancer (χ 2 (6) = 40.97, P < 0.001), congenital (χ 2 (3) = 9.41, P = 0.024), trauma (χ 2 (6) = 18.89, P = 0.004), and dysvascular (χ 2 (5) = 39.73, P < 0.001; below-the-knee amputation: cancer (χ 2 (6) = 29.77, P < 0.001), trauma (χ 2 (6) = 28.22, P < 0.001), and dysvascular (χ 2 (6) = 144.66, P < 0.001). CONCLUSIONS The awareness of differences across amputation etiologies extending across the lifespan of ages can assist the goal-setting process as part of prosthetic rehabilitation. In addition, refined normative values provide the ability to benchmark new and innovative changes in clinical practice.
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Kowal M, Winiarski S, Gieysztor E, Kołcz A, Dumas I, Paprocka-Borowicz M. Symmetry Function: The Differences between Active and Non-Active Above-the-Knee Amputees. Sensors (Basel) 2022; 22:5933. [PMID: 36015694 PMCID: PMC9413346 DOI: 10.3390/s22165933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
The number of patients with unilateral above-knee amputation (AKA) due to non-vascular causes has remained stable over the years, at 0.92 per 1000 people per year. Post-AKA individuals are at risk of experiencing a higher incidence of chronic pain. Post rehabilitation, it is estimated that between 16−62% of patients with musculoskeletal disabilities fail to meet the minimum criteria for physical activity in comparison to a healthy population. The current study included 14 participants (11 men and 3 women) with a mean age of 46.1 ± 14.2 years, body height of 1.76 ± 0.09 m, and weight of 79.6 ± 18.3 kg, who were all post-unilateral above-the-knee amputees. Patients in the study were divided into two groups: active (AC) and non-active (NAC). This study was conducted in a certified Laboratory of Biomechanical Analysis using the BTS Smart-E system (BTS Bioengineering). In order to investigate the symmetry function (SF) of gait, the only measurements included were the time series assessment of gait variables defining pelvic and lower limb joint motion and ground reaction forces (GRF). Both groups had an asymmetrical gait pattern with a different magnitude and relative position in the gait cycle, which was revealed by SF. The differences in terms of median, minimum, and maximum were statistically significant (p < 0.05), with SF ranging from −25 to 24% for the AC group and from 43 to 77% (59% on average) for the NAC group. The AC’s pattern was more symmetrical compared to the NAC’s pattern, especially in the case of pelvic and hip joint motion.
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Affiliation(s)
- Mateusz Kowal
- Department of Physiotherapy, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Sławomir Winiarski
- Department of Biomechanics, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland
| | - Ewa Gieysztor
- Department of Physiotherapy, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Anna Kołcz
- Department of Physiotherapy, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Ergonomics and Biomedical Monitoring Laboratory, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Ilias Dumas
- Department of Physiotherapy, Wroclaw Medical University, 50-367 Wroclaw, Poland
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Hashim NA, Abd Razak NA, Shanmuganathan T, Jaladin RA, Gholizadeh H, Abu Osman NA. On the use of virtual reality for individuals with upper limb loss: a systematic scoping review. Eur J Phys Rehabil Med 2022; 58:612-620. [PMID: 35044131 PMCID: PMC9987328 DOI: 10.23736/s1973-9087.22.06794-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 09/02/2021] [Accepted: 01/03/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Virtual reality has recently become a popular application for rehabilitation and motor control research. This technology has emerged as a valid addition to conventional therapy and promises a successful rehabilitation. This study describes recent research related to the use of virtual reality applications in the rehabilitation of individuals with upper limb loss and to see whether this technology has enough proof of its applicability. EVIDENCE ACQUISITION Searches were conducted with the Web of Science, Google Scholar, IEEE Xplore, and PubMed databases from inception up to September 2020. Articles that employed virtual reality in the rehabilitation of individual with upper limb loss were included in the research if it is written in English, the keyword exists in the title and abstract; it uses visual feedback in nonimmersive, semi-immersive, or fully immersive virtual environments. Data extraction was carried out by two independent researchers. The study was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA). EVIDENCE SYNTHESIS A total of 38 articles met the inclusion criteria. Most studies were published between 2010 and 2020. Thirty-nine percent of the studies (N.=15), originates from North America; 55% of the studies (N.=21), were publicly funded; 61% of the studies (N.=24), was without disclosure of conflict of interest; 82% of the studies (N.=31), were cited in other studies. All the studies were published in journals and conference proceedings. Sixty-six percent of the studies (N.=25) has come out with positive outcome. The design studies were mostly case reports, case series, and poorly designed cohort studies that made up 55% (N.=21) of all the studies cited here. CONCLUSIONS The research conducted on the use of virtual reality in individual with upper limb loss rehabilitation is of very low quality. The improvements to the research protocol are much needed. It is not necessary to develop new devices, but rather to assess existing devices with well-conducted randomized controlled trials.
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Affiliation(s)
- Nur A Hashim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Nasrul A Abd Razak
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia -
| | | | - Rafidah A Jaladin
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Noor A Abu Osman
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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Erbes CR, Ferguson J, Yang K, Koehler-McNicholas S, Polusny MA, Hafner BJ, Heinemann AW, Hill J, Rich T, Walker N, Weber M, Hansen A. Amputation-specific and generic correlates of participation among Veterans with lower limb amputation. PLoS One 2022; 17:e0270753. [PMID: 35797375 PMCID: PMC9262244 DOI: 10.1371/journal.pone.0270753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 06/16/2022] [Indexed: 11/19/2022] Open
Abstract
Participation in valued interpersonal and community activities is a key component of rehabilitation for Veterans with amputation. The purpose of this study was to identify specific factors that promote or inhibit participation to inform development of interventions that may facilitate participation in desired life activities. A convenience sample of 408 Veterans with at least one lower limb amputation and who had received outpatient care from the Regional Amputation Center (RAC) completed a mailed survey. Participation was measured using the Community Participation Indicators (CPI) Importance, Control, and Frequency scales and the Patient Reported Outcome Measurement Information System (PROMIS) Ability to Participate in Social Roles and Satisfaction with Social Participation scales. Multiple imputation procedures were used to address missing data. Correlates of participation were examined through multiple linear regression. A total of 235 participants completed the survey, a response rate of 58%. Levels of participation, measured with the PROMIS instruments, were 43.2 (SD = 8.1) for Ability and 46.4 (SD = 8.6) for Satisfaction. Regression analyses found robust amputation-specific correlates for participation, including body image and balance confidence. Generic (non-amputation specific) correlates for participation included depression and pain interference. Development of treatment approaches and devices that can address body image, balance confidence, pain, and mental health concerns such as depression have the potential to enhance the participation and rehabilitation of Veterans with lower limb amputation.
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Affiliation(s)
- Christopher R. Erbes
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
| | - John Ferguson
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Kalia Yang
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
| | - Sara Koehler-McNicholas
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Melissa A. Polusny
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Brian J. Hafner
- Departments of Rehabilitation Medicine and Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Allen W. Heinemann
- Departments of Physical Medicine and Rehabilitation, Emergency Medicine, and Medical Social Sciences, Feinberg School of Medicine, Northwestern University and Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Jessica Hill
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Tonya Rich
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Nicole Walker
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Marilyn Weber
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
| | - Andrew Hansen
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
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Mayo AL, Viana R, Dilkas S, Payne M, Devlin M, MacKay C, Cimino SR, Guilcher SJT, Hitzig SL. Self-reported health condition severity and ambulation status postmajor dysvascular limb loss. Prosthet Orthot Int 2022; 46:239-245. [PMID: 35315834 DOI: 10.1097/pxr.0000000000000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Individuals with dysvascular lower limb amputations (LLA) secondary to complications of peripheral arterial disease (PAD) and/or diabetes have high rates of co-morbidities. OBJECTIVES To describe self-reported health condition severity and their association with sociodemographic factors and ambulations status among individuals with major dysvascular LLA. STUDY DESIGN Cross sectional telephone and in person survey with adults with major dysvascular LLA living in the community setting in Ontario, Canada. METHODS Survey by phone/in person, and completion of the Dysvascular Conditions Scale and Special Interest in Amputee Medicine Mobility (SIGAM) Grade by each participant. RESULTS Two hundred thirty-one individuals with major dysvascular LLAs participated in the study. Most of them were male individuals (80.5%) and had undergone a transtibial amputation (74%). On average, participants were 3.4 years postlimb loss and had five identified Dysvascular Conditions Scale health conditions. The top five reported health conditions were diabetes, hypertension, phantom limb pain, musculoskeletal pain, and back pain. With the exclusion of hypertension, these conditions were also perceived by respondents to be quite severe for their impact. Vision impairment was also rated as being severe in nature. Lower mobility Special Interest Group in Amputee Medicine grades were associated with higher health condition severity scores. CONCLUSIONS Individuals with dysvascular limb loss experience high multimorbidity with perceived negative impact on their overall wellness and function. Rehabilitation and self-management strategies to help patients with dysvascular LLAs to manage chronic health conditions may improve outcomes.
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Affiliation(s)
- Amanda L Mayo
- St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Physical Medicine & Rehabilitation, Temerty Faculty of Medicine, University of Toronto Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ricardo Viana
- Parkwood Institute, St. Joseph's Health Care London, London, Ontario, Canada
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Steven Dilkas
- Division of Physical Medicine & Rehabilitation, Temerty Faculty of Medicine, University of Toronto Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Michael Payne
- Parkwood Institute, St. Joseph's Health Care London, London, Ontario, Canada
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | - Crystal MacKay
- West Park Healthcare Centre, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie R Cimino
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- West Park Healthcare Centre, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Gaballa A, Cavalcante RS, Lamounier E, Soares A, Cabibihan JJ. Extended Reality "X-Reality" for Prosthesis Training of Upper-Limb Amputees: A Review on Current and Future Clinical Potential. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1652-1663. [PMID: 35635835 DOI: 10.1109/tnsre.2022.3179327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The rejection rates of upper-limb prosthetic devices in adults are high, currently averaging 26% and 23% for body-powered and electric devices, respectively. While many factors influence acceptance, prosthesis training methods relying on novel virtual reality systems have been cited as a critical factor capable of increasing the likelihood of long-term, full-time use. Despite that, these implementations have not yet garnered widespread traction in the clinical setting, and their use remains immaterial. This review aims to explore the reasons behind this situation by identifying trends in existing research that seek to advance Extended Reality "X-Reality" systems for the sake of upper-limb prosthesis rehabilitation and, secondly, analyzing barriers and presenting potential pathways to deployment for successful adoption in the future. The search yielded 42 research papers that were divided into two categories. The first category included articles that focused on the technical aspect of virtual prosthesis training. Articles in the second category utilize user evaluation procedures to ensure applicability in a clinical environment. The review showed that 75% of articles that conducted whole system testing experimented with non-immersive virtual systems. Furthermore, there is a shortage of experiments performed with amputee subjects. From the large-scale studies analyzed, 71% of those recruited solely able-bodied participants. This paper shows that X-Reality technologies for prosthesis rehabilitation of upper-limb amputees carry significant benefits. Nevertheless, much still must be done so that the technology reaches widespread clinical use.
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Falbriard M, Huot G, Janier M, Chandran R, Rechsteiner M, Michaud V, Cugnoni J, Botsis J, Schönenberger K, Aminian K. A functional approach towards the design, development, and test of an affordable dynamic prosthetic foot. PLoS One 2022; 17:e0266656. [PMID: 35522670 PMCID: PMC9075626 DOI: 10.1371/journal.pone.0266656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/24/2022] [Indexed: 11/25/2022] Open
Abstract
Humanitarian actors involved in physical rehabilitation, such as the International Committee of the Red Cross (ICRC), usually provide their beneficiaries with lower-limb prostheses comprising Solid Ankle Cushion Heel (SACH) feet as these are considered appropriate (price, durability, low profile to fit a majority of patients, appearance) and reliable for all ambulation levels. However, individuals in low-resource settings having higher ambulation abilities would greatly benefit from dynamic prosthetic feet with improved biomechanics and energy storage and release. Some attempts tried to address this increasing need (e.g. Niagara Foot) but most products proposed by large manufacturers often remain unaffordable and unsuitable to the context of low-resource settings. The design requirements and a price target were defined in partnership with the ICRC according to their initial assessment and used as a starting point for the development process and related technological choices. Numerical simulation and modeling were used to work on the design and to determine the required materials properties (mechanical, chemical, wear), and a cost modeling tool was used to select suitable materials and relevant processing routes (price vs. performance). A prosthetic foot comprising an internal keel made of composite materials, a filling foam, and a cosmetic shell with a foot shape was developed. Manufacturing processes meeting the cost criteria were identified and prototype feet were produced accordingly. These were successfully tested using a compression testing system before gait analyses were performed in the laboratory with non-amputees wearing testing boots. After validation in laboratory conditions, the prototype foot was tested in the field (Vietnam) with 11 trans-tibial unilateral amputees, who showed an increased mobility compared with the SACH foot. The collaboration of different research fields led to the development of a prosthetic foot which met the technical requirements determined by the ICRC’s specific needs in its field of operation. The materials and selected production processes led to a manufacturing cost of less than 100 USD per part.
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Affiliation(s)
- Mathieu Falbriard
- Laboratory of Movement Analysis and Measurement (LMAM), EPFL, Lausanne, Switzerland
- * E-mail:
| | - Grégory Huot
- EssentialTech Center, EPFL, Lausanne, Switzerland
- Physical Rehabilitation Programme, ICRC, Geneva, Switzerland
| | - Mathieu Janier
- Laboratory of Applied Mechanics and Reliability Analysis (LMAF), EPFL, Lausanne, Switzerland
| | - Rajasundar Chandran
- iPrint Institute, HEIA-FR, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
- Laboratory for Processing of Advanced Composites (LPAC), EPFL, Lausanne, Switzerland
| | | | - Véronique Michaud
- Laboratory for Processing of Advanced Composites (LPAC), EPFL, Lausanne, Switzerland
| | - Joël Cugnoni
- Laboratory of Applied Mechanics and Reliability Analysis (LMAF), EPFL, Lausanne, Switzerland
- Institute of materials and mechanical design (COMATEC), School of Engineering and Management, University of Applied Sciences and Arts- West Switzerland (HES-SO), Yverdon-les-Bains, Switzerland
| | - John Botsis
- Laboratory of Applied Mechanics and Reliability Analysis (LMAF), EPFL, Lausanne, Switzerland
| | | | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement (LMAM), EPFL, Lausanne, Switzerland
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王 凤, 王 朴, 王 煜, 康 有, 朱 诗, 汪 华, 李 定, 杨 永. [Randomized Controlled Trial of the Effects of Repetitive Transcranial Magnetic Stimulation and Mirror Therapy on Phantom Limb Pain in Amputees]. Sichuan Da Xue Xue Bao Yi Xue Ban 2022; 53:474-480. [PMID: 35642157 PMCID: PMC10409414 DOI: 10.12182/20220560209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Indexed: 06/15/2023]
Abstract
Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on phantom limb pain (PLP) in amputees, and to compare the therapeutic effect with that of mirror therapy (MT). Methods The study was designed as a randomized controlled trial. The evaluators were blinded, while the subjects and the therapists were unblinded. Subjects were randomly assigned to either the rTMS group or the MT group with a computer-generated random number table. From June 2018 to December 2020, from out of 45 amputee patients screened for the study, 30 who met the inclusion criteria were recruited for the study. All patients were recruited from the Rehabilitation Medicine Center, West China Hospital, Sichuan University. In the end, 4 patients withdrew from the study and 26 patients (12 in the rTMS group and 14 in the MT group) completed the prescribed treatment and evaluation. The rTMS group was given rTMS (1 Hz, 15 min, 5 d/week) for 2 weeks in addition to conventional rehabilitation therapy, while the MT group received MT (corresponding movements of limbs, 15 min, 5 d/week) for 2 weeks in addition to conventional rehabilitation therapy. PLP was evaluated by the Visual Analogue Scale (VAS) and Douleur Neuropathique 4 Questions (DN-4). Subjects were assessed before treatment ( t 0), immediately after the completion of the treatment ( t 1) and 3 months after the completion of the treatment ( t 2). Results The mean age of the 26 patients was 39.73±12.64. There were 15 males and 11 females. According to the reported description of the characteristics of the PLP by the patients, the characteristics with the highest incidence were tingling, stabbing, numbing, electric shocks and burning in descending order. There was no significant difference in the incidence of PLP characteristics between the two groups ( P>0.05). The two groups had comparable baseline data, showing no significant difference in VAS and DN-4 between the two groups at t 0 ( P>0.05). At t 1 and t 2, the VAS and DN-4 scores were decreased from those of t 0, showing statistically significant difference in both groups ( P<0.01 for both scores). In the rTMS group, there was no significant difference between VAS and DN-4 scores at t 1 and those at t 2 ( P>0.05). In the MT group, the VAS and DN-4 scores at t 2 were significantly lower than those of t 1 ( P<0.05). There was no statistically significant difference between the rTMS group and MT group in the changes in pain measurements, i.e., VAS and DN-4 scores, before and after the intervention ( P>0.05). The 26 patients who completed the experiment showed no dizziness, headache, or other abnormalities during the study. Conclusion The results of this study indicate that repetitive transcranial magnetic stimulation could improve PLP in amputees, and the improvement effect was comparable to that of mirror therapy.
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Affiliation(s)
- 凤怡 王
- 四川大学华西医院 康复医学中心 (成都 610041)Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- 康复医学四川省重点实验室 (成都 610041)Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Chengdu 610041, China
| | - 朴 王
- 四川大学华西医院 康复医学中心 (成都 610041)Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 煜 王
- 四川大学华西医院 康复医学中心 (成都 610041)Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 有存 康
- 四川大学华西医院 康复医学中心 (成都 610041)Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 诗洁 朱
- 四川大学华西医院 康复医学中心 (成都 610041)Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 华琼 汪
- 四川大学华西医院 康复医学中心 (成都 610041)Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 定艮 李
- 四川大学华西医院 康复医学中心 (成都 610041)Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- 康复医学四川省重点实验室 (成都 610041)Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Chengdu 610041, China
| | - 永红 杨
- 四川大学华西医院 康复医学中心 (成都 610041)Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- 康复医学四川省重点实验室 (成都 610041)Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Chengdu 610041, China
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Kanata Y, Ito T, Yoshida T, Koyama T, Mikami Y, Domen K. Prosthetic walking after bilateral transfemoral amputation in a patient with dilated cardiomyopathy: a case report. Prosthet Orthot Int 2022; 46:195-198. [PMID: 35412526 DOI: 10.1097/pxr.0000000000000081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
In this study, we present a case of a 14-year-old adolescent boy who developed rhabdomyolysis and underwent bilateral transfemoral amputation after cardiopulmonary resuscitation for cardiac arrest because of dilated cardiomyopathy (DCM). Patients with bilateral transfemoral amputation have slower walking velocity and greater oxygen consumption during walking. Rehabilitation of such patients may be demanding especially if they have DCM, one of the major causes of advanced heart failure. The patient was admitted to our hospital on postoperative day (POD) 206. At first, we started with residuum compression. Simultaneously, resistance training and range-of-motion exercise were performed. He started the walking training with short stubbies prostheses on POD 262. Then, we used two types of knee joint prostheses, microprocessor-controlled prosthetic knee (MPK) and non-MPK. We chose MPK for his bilateral knee joints because it was easier for him to walk with MPK than with non-MPK. MPK also has the advantage of high stability and less burden on the heart. He achieved to walk with the prosthesis using T-canes with both hands on POD 374. Furthermore, he was able to return to school after discharge. In patients with transfemoral amputations and DCM with exercise restrictions, MPK is preferred because it reduces cardiac load during physical activity.
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Affiliation(s)
- Yoshihiro Kanata
- Department of Rehabilitation Medicine, Hyogo College of Medicine Sasayama Medical Center, Tanbasasayama, Hyogo, Japan
| | - Tomoyuki Ito
- Department of Rehabilitation Medicine, Kyoto Tanabe Memorial Hospital, Kyotanabe, Kyoto, Japan
| | - Takuya Yoshida
- Department of Rehabilitation Medicine, Kyoto Tanabe Memorial Hospital, Kyotanabe, Kyoto, Japan
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Kazuhiza Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Lu S, Vien BS, Russ M, Fitzgerald M, Chiu WK. Experimental Investigation of Vibration Analysis on Implant Stability for a Novel Implant Design. Sensors (Basel) 2022; 22:s22041685. [PMID: 35214590 PMCID: PMC8874639 DOI: 10.3390/s22041685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 01/04/2023]
Abstract
Osseointegrated prostheses are widely used following transfemoral amputation. However, this technique requires sufficient implant stability before and during the rehabilitation period to mitigate the risk of implant breakage and loosening. Hence, reliable assessment methods for the osseointegration process are essential to ensure initial and long–term implant stability. This paper researches the feasibility of a vibration analysis technique for the osseointegration (OI) process by investigating the change in the dynamic response of the residual femur with a novel implant design during a simulated OI process. The paper also proposes a concept of an energy index (the E–index), which is formulated based on the normalized magnitude. To illustrate the potential of the E–index, this paper reports on changes in the vibrational behaviors of a 133 mm long amputated artificial femur model and implant system, with epoxy adhesives applied at the interface to simulate the OI process. The results show a significant variation in the magnitude of the colormap against curing time. The study also shows that the E–index was sensitive to the interface stiffness change, especially during the early curing process. These findings highlight the feasibility of using the vibration analysis technique and the E–index to quantitatively monitor the osseointegration process for future improvement on the efficiency of human health monitoring and patient rehabilitation.
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Affiliation(s)
- Shouxun Lu
- Department of Mechanical & Aerospace Engineering, Monash University, Melbourne, VIC 3800, Australia; (B.S.V.); (W.K.C.)
- Correspondence:
| | - Benjamin Steven Vien
- Department of Mechanical & Aerospace Engineering, Monash University, Melbourne, VIC 3800, Australia; (B.S.V.); (W.K.C.)
| | - Matthias Russ
- The Alfred Hospital, Melbourne, VIC 3004, Australia; (M.R.); (M.F.)
- National Trauma Research Institute, Melbourne, VIC 3004, Australia
| | - Mark Fitzgerald
- The Alfred Hospital, Melbourne, VIC 3004, Australia; (M.R.); (M.F.)
- National Trauma Research Institute, Melbourne, VIC 3004, Australia
| | - Wing Kong Chiu
- Department of Mechanical & Aerospace Engineering, Monash University, Melbourne, VIC 3800, Australia; (B.S.V.); (W.K.C.)
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Fanciullacci C, McKinney Z, Monaco V, Milandri G, Davalli A, Sacchetti R, Laffranchi M, De Michieli L, Baldoni A, Mazzoni A, Paternò L, Rosini E, Reale L, Trecate F, Crea S, Vitiello N, Gruppioni E. Survey of transfemoral amputee experience and priorities for the user-centered design of powered robotic transfemoral prostheses. J Neuroeng Rehabil 2021; 18:168. [PMID: 34863213 PMCID: PMC8643009 DOI: 10.1186/s12984-021-00944-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/05/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transfemoral amputees experience a complex host of physical, psychological, and social challenges, compounded by the functional limitations of current transfemoral prostheses. However, the specific relationships between human factors and prosthesis design and performance characteristics have not yet been adequately investigated. The present study aims to address this knowledge gap. METHODS A comprehensive single-cohort survey of 114 unilateral transfemoral amputees addressed a broad range of demographic and clinical characteristics, functional autonomy, satisfaction and attitudes towards their current prostheses, and design priorities for an ideal transfemoral prosthesis, including the possibility of active assistance from a robotic knee unit. The survey was custom-developed based on several standard questionnaires used to assess motor abilities and autonomy in activities of daily living, prosthesis satisfaction, and quality of life in lower-limb amputees. Survey data were analyzed to compare the experience (including autonomy and satisfaction) and design priorities of users of transfemoral prostheses with versus without microprocessor-controlled knee units (MPKs and NMPKs, respectively), with a subsequent analyses of cross-category correlation, principal component analysis (PCA), cost-sensitivity segmentation, and unsupervised K-means clustering applied within the most cost-sensitive participants, to identify functional groupings of users with respect to their design priorities. RESULTS The cohort featured predominantly younger (< 50 years) traumatic male amputees with respect to the general transfemoral amputee population, with pronounced differences in age distribution and amputation etiology (traumatic vs. non-traumatic) between MPK and NMPK groups. These differences were further reflected in user experience, with MPK users reporting significantly greater overall functional autonomy, satisfaction, and sense of prosthesis ownership than those with NMPKs, in conjunction with a decreased incidence of instability and falls. Across all participants, the leading functional priorities for an ideal transfemoral prosthesis were overall stability, adaptability to variable walking velocity, and lifestyle-related functionality, while the highest-prioritized general characteristics were reliability, comfort, and weight, with highly variable prioritization of cost according to reimbursement status. PCA and user clustering analyses revealed the possibility for functionally relevant groupings of prosthesis features and users, based on their differential prioritization of these features-with implications towards prosthesis design tradeoffs. CONCLUSIONS This study's findings support the understanding that when appropriately prescribed according to patient characteristics and needs in the context of a proactive rehabilitation program, advanced transfemoral prostheses promote patient mobility, autonomy, and overall health. Survey data indicate overall stability, modularity, and versatility as key design priorities for the continued development of transfemoral prosthesis technology. Finally, observed associations between prosthesis type, user experience, and attitudes concerning prosthesis ownership suggest both that prosthesis characteristics influence device acceptance and functional outcomes, and that psychosocial factors should be specifically and proactively addressed during the rehabilitation process.
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Affiliation(s)
- Chiara Fanciullacci
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Zach McKinney
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy.
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy.
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
- Institute of Recovery and Care of Scientific Character (IRCCS), Fondazione Don Carlo Gnocchi Florence, Florence, Firenze, Italy
| | - Giovanni Milandri
- Rehab Technologies, Istituto Italiano di Tecnologia (IIT), via Morego, 30, 16163, Genoa, Genoa, Italy
| | - Angelo Davalli
- Centro Protesi INAIL - REPAIR Lab, Via Rabuina, 14, 40054, Vigorso di Budrio, Bologna, Italy
| | - Rinaldo Sacchetti
- Centro Protesi INAIL - REPAIR Lab, Via Rabuina, 14, 40054, Vigorso di Budrio, Bologna, Italy
| | - Matteo Laffranchi
- Rehab Technologies, Istituto Italiano di Tecnologia (IIT), via Morego, 30, 16163, Genoa, Genoa, Italy
| | - Lorenzo De Michieli
- Rehab Technologies, Istituto Italiano di Tecnologia (IIT), via Morego, 30, 16163, Genoa, Genoa, Italy
| | - Andrea Baldoni
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Alberto Mazzoni
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Linda Paternò
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Elisa Rosini
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Luigi Reale
- Healthcare Area, Fondazione ISTUD, Via Paolo Lomazzo, 19, 20154, Milano, Milan, Italy
| | - Fabio Trecate
- Dept. of Physical Medicine and Functional Re-Education, Istituto Palazzolo, Fondazione Don Carlo Gnocchi, Via Don Luigi Palazzolo, 21, 20149, Milano, Milan, Italy
| | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
- Institute of Recovery and Care of Scientific Character (IRCCS), Fondazione Don Carlo Gnocchi Florence, Florence, Firenze, Italy
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
- Institute of Recovery and Care of Scientific Character (IRCCS), Fondazione Don Carlo Gnocchi Florence, Florence, Firenze, Italy
| | - Emanuele Gruppioni
- Centro Protesi INAIL - REPAIR Lab, Via Rabuina, 14, 40054, Vigorso di Budrio, Bologna, Italy
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