Canadian Prosthetics Orthotics Journal最新文献

Background: Assistive technology is often incorporated into rehabilitation and support for those impacted by upper limb impairments. When powered, these devices provide additional force to the joints of users with muscle weakness. Actuated devices allow dynamic movement compared to splints, therefore improving the ability to complete activities of daily living. However, these devices are not often prescribed and are underrepresented in research and clinical settings.

Objective: This review examined the existing literature on devices developed to support hand and wrist functionality in daily activities. Focusing on active, powered, and actuated devices, to gain a clearer understanding of the current limitations in their design and prescription.

Methodology: The scoping review was conducted using the PRISMA-ScR guidelines. A systematic search was done on MEDLINE, EMBASE, Scopus, Web of Science, and NHS the Knowledge Network from inception to May 2023. Articles were included if the device was portable; supported the hands and wrist actively using an actuator; and could be used for assistive living during or post-rehabilitation period.

Findings: A total of 135 studies were included in the analysis of which 34 were clinical trials. The design and control methods of 121 devices were analyzed. Electrical stimulation and direct mechanical transmission were popular actuation methods. Electromyography (EMG) and joint movement detection were highly used control methods to translate user intentions to device actuation. A total of 226 validation methods were reported, of which 44% were clinically validated. Studies were often not conducted in operational environments with 69% at technology readiness levels ≤ 6, indicating that further development and testing is required.

Conclusion: The existing literature on hand and wrist exoskeletons presents large variations in validation methods and technical requirements for user-specific characteristics. This suggests a need for well-defined testing protocols and refined reporting of device designs. This would improve the significance of clinical outcomes and new assistive technology.

Background: An individual experiencing tetraplegia faces functional limitations due to impaired hand function. The use of an affordable tenodesis wrist-hand orthosis (WHO) can enable finger flexion with active wrist extension, thereby enhancing the three-jaw chuck grasp and overall hand functionality.

Objectives: To assess hand function and satisfaction in patients with tetraplegia using a modified tenodesis wrist-hand orthosis (WHO), utilizing the Duruöz Hand Index (DHI) and the Orthotics and Prosthetics User Survey (OPUS) satisfaction with device and services subscales.

Methodology: The study was conducted at a tertiary care center in central India, enrolling patients with tetraplegia admitted to the Department of Physical Medicine and Rehabilitation. A modified tenodesis wrist-hand orthosis (WHO) was designed using low-temperature thermoplastic components. Twenty-two individuals with a minimum wrist extensor power of grade 3/5 were included in the study. These patients were provided with the modified tenodesis WHO and underwent daily training sessions for a period of 2 weeks. Duruöz Hand Index (DHI) scores were assessed at baseline, 6 weeks, and 12 weeks postenrolment. Patient satisfaction was evaluated using the Orthotics and Prosthetics User's Survey (OPUS) satisfaction with device and services subscales.

Findings: The analysis of the DHI scores indicated a significant enhancement in functional abilities at both 6-week and 12-week follow-ups compared to the baseline assessment. Notably, the most substantial progress at 6 weeks follow-up was observed in tasks such as buttoning a shirt, while significant improvement at the 12-week mark was noted in activities like turning a key in a lock. The median OPUS device satisfaction score was 50, corresponding to a Rasch score of 68.8. Additionally, the median OPUS satisfaction score for services stood at 46, with a Rasch score of 72.7. Patients expressed the highest satisfaction levels with the courteous demeanor of the staff, prompt scheduling of appointments, and accurate fitting of the orthosis.

Conclusion: The study findings indicate that the modified tenodesis WHO is an effective and satisfactory therapeutic device for improving hand function in patients with tetraplegia. The findings encourage further investigation and application of the modified tenodesis WHO in clinical practice.

Background: Functional mobility, comfort and the absence of pain are key goals of prosthetic treatment. Outcome measures (OMs) evaluate the impact of treatment and normative and minimal detectable change (MDC) values are key to interpreting these scores and measuring treatment outcomes.

Objectives: This study seeks to 1) present practice-based normative values of four commonly used OMs at four prosthetic milestones and 2) explore the MDC of the measures over the treatment period.

Methodology: A chart review was conducted of OMs collected with individuals with lower limb loss between January 1, 2015, and December 31, 2023. This included data for individuals with unilateral transtibial (TT), transfemoral (TF) and rotationplasty (RP) amputations and bilateral transtibial amputation (BTT). OMs included the Socket Comfort Score (SCS), Pain Scale (PS), 2 Minute Walk Test (2MWT), and Prosthetic Limb Users Survey of Mobility (PLUS-M). Data were collected at four milestone time points: (1) Baseline and (2) Discharge from Rehabilitation for those in initial prosthetic rehabilitation, and (3) Initial Evaluation and (4) Definitive Delivery for those receiving a replacement socket. Normative values and MDC values were calculated.

Findings: Data from 30 individuals undergoing in-patient rehabilitation and 74 individuals receiving a replacement socket were included. Practice-based normative data were different for each level of amputation and milestone and had the following ranges: SCS: 5.7 - 9.1, PS: 0.8 - 3.7, 2MWT: 68.4 - 146.3 m and PLUS-M: 38.9 - 57.3. MDC values also varied based on time in treatment (Rehabilitation: SCS = 2.5, PS = 1.6, 2MWT = 32.6, PLUS-M = 8.8; Replacement Socket: SCS = 3.1, PS = 2.6, 2MWT = 38.9, PLUS-M = 4.0). All measures had a statistically significant change over the intervention, however, no average scores changed by greater than the MDC.

Conclusions: The normative data and MDC scores demonstrate the PS & PLUS-M are useful measures of pain and mobility at all points within treatment. The 2MWT is indicated for individuals in rehabilitation, while the SCS is indicated for those receiving a replacement socket, as both effectively measure treatment goals that are particularly important for each phase of rehabilitation. This provides clinicians with practice-based evidence that enables them to interpret OM scores, a critical part of the decision-making process along the treatment journey.

Background: Limb loss is a life-changing event, which may be associated with limited mobility, pain, and low mood. Yoga interventions have been found to be beneficial for improving emotional wellness and pain in other patient populations. The benefits of including yoga in limb loss rehabilitation have not been well studied.

Objective: The purpose of this study was to determine if an adaptive yoga program would be suitable for individuals with newly acquired limb loss in a rehabilitation program.

Methodology: A yoga video was co-designed by rehabilitation clinicians and a limb loss patient partner certified in yoga instruction. Surveys were used to collect patients' socio-demographics and previous yoga experience. Participants completed a therapist guided group yoga video session, and then given online access to practice independently. Post-yoga participation surveys and qualitative interviews were conducted with patients to determine acceptance and feasibility of the yoga intervention.

Findings: Twenty-four participants with lower limb amputation(s) were approached to participate. The majority of participants (63%) had dysvascular-related amputations. Nineteen out of 24 recruited patients (79%) completed the yoga video session and the pre-yoga survey. Sixteen out of 19 participants completed the post-yoga survey, and eight also completed a qualitative interview. Five had previously undertaken yoga but rated themselves as novices. All participants felt that yoga was beneficial, easy to complete, and should be included in rehabilitation. Participants found yoga to be relaxing and some noted reduction in pain. Most preferred to do yoga in a group. Five out of eight patients (63%) interviewed continued to do the yoga video independently in hospital and post-discharge. Challenges with the yoga intervention included lack of a quiet yoga space, and dedicated time given other appointments/priorities.

Conclusion: Yoga was widely accepted by the inpatient limb loss population. Yoga may complement traditional limb loss rehabilitation by providing patients a relaxing experience; however, further research is needed.

Women in India, particularly those with amputation, face significant challenges, including but not limited to, unequal prosthetic access and satisfaction, societal discrimination, and the physical and emotional consequences of amputation. These challenges are further exacerbated by gender biases towards access to education and socioeconomic factors, which increases their vulnerability to unemployment and mental health issues. This article emphasizes the urgent need for affordable and customizable prosthetic options tailored to the unique needs of women with amputation, particularly those from low-income backgrounds who often face neglect. Thus, addressing these disparities would significantly enhance their overall well-being and independence.

Background: Actuated devices can be beneficial for individuals with upper limb muscle weakness, offering extra force and grip. Utilising this type of assistive device can facilitate daily activities, thereby enhancing independence and overall quality of life. The development of actuated assistive devices has been growing, and current literature shows promise in their clinical use. However, they are not yet medically recommended by global guidelines and councils. Studies have suggested why assistive devices have barriers to access, but actuated devices have not been a focus in these discussions.

Objectives: To address this issue, a survey was conducted among professionals who prescribe and assess upper limb assistive devices. The survey aimed to gather their opinions and quantify the factors that might contribute to the limited use of actuated devices in the field.

Methodology: A web-based cross-sectional study was designed using Qualtrics, contained 25 items and was conducted between October 2023 and January 2024. The survey was piloted, validated, and ethically approved. Results were statistically analysed, and open questions underwent thematic analysis.

Findings: 87 Allied Health Professionals (AHPs) contributed to the survey, with a completion rate of 69% (60/87). Survey respondents predominately worked from the USA (72%). The survey revealed that 66% of respondents felt they did not have sufficient access to assistive devices and 58% indicated that outcome measures could be improved. They also noted that actuated devices needed to better meet user-centric needs. Barriers to prescribing these devices included a lack of awareness, experience and standardised prescription methods. In addition, the limited time with patients made decision-making and validation of an actuated device difficult.

Conclusion: AHP's have experience prescribing assistive devices but do not have access, knowledge, or clinical methods to assess the use of actuated devices. Future designs for actuated devices should focus on wearability, comfort, user satisfaction, safety and ease of use.

Background: Charcot foot deformity, a severe complication of diabetes, involves neuropathy and abnormal peak plantar pressure in the midfoot and forefoot. However, orthotic interventions and shoe modifications are used to address the sequelae of Charcot neuroarthropathy, offering different approaches to managing abnormal peak plantar pressure.

Objective: To compare the effects of three types of therapeutic offloading diabetic shoes; prefabricated, relasting, and double rocker-modified shoes on peak plantar pressure in the midfoot and forefoot of nonulcerated chronic Charcot foot during walking.

Methodology: A repeated measure design involved 15 participants (40% males and 60% females) with a mean age of 60.73 years (SD=10.50), with Charcot neuropathy. Participants were provided with three types of shoes; prefabricated, relasting, and double rocker-modified shoes, each equipped with the same custom-made insole (CMI). Plantar pressure was recorded while walking on level ground, focusing on the forefoot, midfoot, and hindfoot. The study also investigated additional variables affecting plantar pressure distribution, including the pressure-time integral and contact area.

Findings: The type of shoe had distinct effects on the distribution of plantar pressure. The double rocker-modified shoe particularly impacted forefoot pressure during the terminal stance phase of the gait cycle. Peak plantar pressure at the forefoot increased by 5.37% with double rocker-modified shoes compared to relasting shoes. Both double rocker-modified and prefabricated shoes reduced midfoot peak plantar pressure by 8.73% and 11.97%, respectively. Similar trends were observed at the hindfoot, with reductions in peak plantar pressure. However, there were no significant differences in regional peak plantar pressure between the types of shoes except for the central forefoot (F (1.61, 22.5) = 5.69, p = 0.014).

Conclusion: There were no significant differences in the effectiveness of prefabricated, relasting, and double rocker-modified shoes in reducing and redistributing peak plantar pressure in high-risk areas of chronic Charcot foot.

Background: While waiting to receive a prosthesis, individuals with amputations could benefit from using a temporary training prosthesis to expedite the rehabilitation process and prepare them for subsequent walking with their prosthesis.

Objectives: To design and build a temporary training prosthesis for people with a transtibial amputation.

Methodology: Various temporary training prostheses were designed and simulated using SolidWorks software, followed by fabricating and testing multiple prototypes. Initial tests were conducted on five able bodied subjects without amputation to evaluate comfort, ensure the prototype functioned as intended, and to refine the design. The final prototype design had no weight-bearing on the residual limb end and required the person to wear a shrinker or silicone liner.

Findings: SolidWorks simulations showed that the device could tolerate up to 200 kg load. Subjective feedback indicated that body weight is primarily supported by the thigh section, while partially utilizing the patellar tendon and tibial flares. The thigh section can be shifted 5 cm up or down and 2.5 cm to the front or back from the knee joint center (to enhance knee stability or function). Additionally, the thigh angle can be adjusted to 0, 5, 10, or 15 degrees to accommodate hip flexion contracture. The shank section width is adjustable and can be shifted up or down based on the residual limb shape. All five able-bodied participants successfully walked with the non-amputee version of the temporary prosthesis prototype and the device withstood walking, sitting, and standing loads.

Conclusion: An adjustable temporary training prosthesis was successfully designed, and pilot tested by five able-bodied individuals. Future testing will involve five experienced prosthetic users before conducting trials with individuals with a new transtibial amputation.