Prosthetics and Orthotics International最新文献

Background: Falls are a major concern for persons wearing a prosthesis. Little is known about the ability to rise from the floor among persons with a transtibial amputation (TTA).

Objectives: The objectives of this pilot study were to (1) identify movement strategies and performance time demonstrated when rising from the floor among persons with a transtibial prosthesis and (2) examine concurrent validity of the timed supine to stand test (TSST).

Study design: The study used a cross-sectional design.

Methods: Eleven participants (9 male; mean age 58.7 [SD 12.7] years) with a unilateral TTA participated. Participants completed a TSST and were observed for common motor strategies, including chair use and half-kneel transitions. Additional outcomes included the Activities-specific Balance Confidence Scale (ABC), Timed Up and Go Test, and Short Physical Performance Battery.

Results: The mean time to rise from the floor was 10.6 (5.6) s. There was a significant association between TSST performance and age (r = 0.67; P = .03), the ABC (r = -0.72; P = .01), and performance on the Timed Up and Go (r = 0.64; P = .04) and Short Physical Performance Battery (rho = -0.67; P = .007). Six participants (54.5%) required the use of external support (chair) to stand, and 6 (54.5%) initially led with the prosthetic limb to achieve half-kneeling with the prosthetic foot on the surface.

Discussion: Findings support that the TSST is related to physical performance, age, and ABC among persons with a TTA. A predominant strategy used to rise included the half-kneel position with the prosthetic limb leading. Descriptive findings offer practitioners strategies to teach clients to rise from the floor.

Background: Lateral wedge insole (LWI) is known to reduce abnormal mechanical stress in knee osteoarthritis; however, clinical improvement across cases varies. The increase in medial meniscal extrusion (⊿MME) during walking could describe the dysfunction of shock absolution and the reaction of mechanical stress in individual knee joints.

Objective: This study aimed to investigate whether the ⊿MME affects LWI responders.

Study design: Quasi-experimental design.

Methods: The ⊿MME during walking was assessed using a dynamic ultrasound technique. Knee adduction moment was evaluated using motion analysis. The activity of the patients during the study period was evaluated as the number of steps counted by the acceleration sensor, and the cumulative knee adduction moment (CKAM) was calculated. These parameters were obtained at the initial visit (baseline) and after intervention with LWI after 3 months (post-LWI), and are expressed as the rates of change. The global rating of change was assessed and compared after the intervention; the patients were classified as responders or nonresponders accordingly.

Results: Responders had a significantly higher reduction rate of ⊿MME than nonresponders (responder: 33.6% ± 14.4%, nonresponder: 14.8% ± 26.9%; P = 0.035), whereas there was no significant difference in rates of change in the number of steps, knee adduction moment, and CKAM between groups. The ⊿MME was significantly correlated with CKAM among the parameters of rates of change (r = 0.416, P = 0.034).

Conclusions: Reduction in mechanical stress in a laboratory setting does not directly affect the clinical response to LWI. The functional features of the meniscal hoop during walking can mediate the response to mechanical stress and help elucidate pain-relief mechanisms.

Background: Patients with stroke with hemiplegia often experience gait impairments and use ankle foot orthoses (AFOs) to support their walking. Despite the wide use of AFOs, the specific impact of dorsiflexion control in AFOs on gait parameters has yet to be clarified.

Objectives: This study aimed to evaluate the effects of 2 types of AFOs with different dorsiflexion control mechanisms on gait parameters in patients with stroke with hemiplegia.

Study design: A cross-sectional comparative study.

Methods: Eleven patients with stroke with hemiplegia were analyzed using 2 types of AFOs: a dorsiflexion-assisted AFO (Gait Solution Design®: GSD) and a bidirectional control AFO (WalkOn Trimable®: WOT). Gait analysis was performed using 3-dimensional motion analysis to measure gait speed, ankle plantarflexion moment, hip extension angle, shank inclination angle, and the percentage of terminal stance. Statistical analyses were conducted to compare the effects of GSD and WOT on these gait parameters.

Results: The GSD significantly increased ankle plantarflexion moment and shank inclination angle, supporting the heel rocker (HR) and ankle rocker (AR) functions. In contrast, the WOT significantly increased hip extension angle and the percentage of terminal stance, facilitating the Forefoot Rocker function.

Conclusions: For patients with stroke with impaired HR and AR function, dorsiflexion-assisted AFOs like GSD are preferable. For patients with established HR and AR function but impaired Forefoot Rocker, bidirectional control AFOs such as WOT are recommended.

Quadruple amputation is a rare situation that significantly limits daily activities. Driving is crucial for daily independence. However, there is little literature on the use of adaptive devices to enable individuals with multiple limb amputations to drive. This case study examined the return to driving of Mrs X, a 35-year-old woman who underwent amputation of all 4 limbs (bilateral transtibial, left forearm, and right carpal radius) because of peripheral necrosis following septic shock. After completing a multidisciplinary care and rehabilitation program, Mrs X was able to use customized prostheses and a vehicle specifically adapted to her needs. These modifications enabled her to operate a steering wheel, automatic gearbox, and direction controls. As a result, her driving license was revalidated by the authorities. Mrs X regained the ability to drive independently after her quadruple amputation using adapted prostheses and car controls. Mrs X is now able collect her daughter from school and to attend riding lessons, abilities which have contributed to improving her quality of life.

Background: Continuous training with expert monitoring is challenging and often restricted to hospitals or rehabilitation facilities.

Objective: To design a feedback system using orthotic devices and inertial sensors to align the pelvis and trunk in transfemoral amputee gait and to investigate its kinematic effects.

Study design: Within-subjects design.

Methods: Ten transfemoral amputees participated in this study. We developed a device that integrated an orthotic device and inertial sensor fixed to the trunk and pelvis, providing feedback. The participants performed walking trials without attachments, with only sensors with audible warning of inclination, with only the orthotic device, and with both the sensors and orthotic device.

Results: No significant differences in the similarity index parameters were observed under the 4 conditions; however, significant effects emerged in the trunk rotation and lateral bending ranges of motion (ROM; P < 0.05). Similar effects were observed in the anterior-posterior pelvic tilt, pelvic rotation, and lateral bending ROMs. The rotation and lateral flexion ROMs during the prosthetic leg stance phase decreased with combined orthotic device and sensor feedback or with only the orthotic device. Similarly, the lateral flexion ROM during the healthy leg stance phase decreased with sensor feedback. The pelvic lateral flexion ROM decreased during the prosthetic leg stance phase with only the orthotic device or combined sensor use, and rotation decreased with sensor-only feedback.

Conclusions: Unlike in the ROM, no noticeable change in the similarity index of the trunk or pelvis was observed. This combined feedback system may partially reduce compensatory movements in the trunk and pelvis during transfemoral amputee gait.

Background: Currently, clinicians use a ball of plasticine to measure contact between the end of amputated residual limbs and prosthetic sockets to assess distal-end fit.

Objectives: This study characterizes the forces required to deform plasticine and relates these to clinical decisions made about socket fit.

Study design: Cross-sectional study.

Methods: Loading thresholds for plasticine deformation were identified. Three different sized check sockets were loaded with a phantom limb, distal-end sensors, and in-situ plasticine. Three transtibial prosthesis users were recruited and completed a socket fitting assessment with distal end sensors and in-situ plasticine. Forces and deformations were recorded and compared with the thresholds and with prosthetist and prosthesis users' ratings of fit.

Results: Plasticine deformation associated with a "good fit" was associated with loads of 4.8-48.5 N for 7- to 8-mm balls and 15.5-148 N for 10- to 11-mm balls. Plasticine deformation magnitudes alone could not detect differences between sockets of various sizes for a standardized limb model. Distal-end force sensors could differentiate between sockets to some extent. In the 3 transtibial prosthesis users, plasticine and force measurements aligned with the "good fit" reported by the prosthetist and the end user.

C onclusions: This study has characterized the forces required to achieve clinically relevant types of plasticine deformation at the distal end of a socket. It has also related these plasticine deformations and distal-end force measurements to clinical judgements about socket fit in the clinic and end user ratings of comfort and fit. Future work should test these thresholds on end user and clinician ratings of poor fit.

Background: Current processes for identifying the best microprocessor-controlled prosthetic knee (MPK) for individuals with transfemoral amputations are subjective, nonscientific, and sometimes fail to consider unique patient needs. Inaccurate prescriptions may hinder a patient's ability to make a speedy rehab.

Objectives: We developed a clinical decision equation that outputs MPK recommendation scores for 3 commercially available MPKs (Power Knee, C-Leg 4.0, Rheo Knee) based on easily acquirable user evaluation data.

Study design: Participants wore each of the study MPKs at home for a 1-week acclimation period. On the experiment day, participants completed a set of functional tasks including a 10-m walk test, stair and ramp ambulation tasks, a 2-minute walk test, and a narrow beam walking test. Performance outcome measures were collected.

Methods: Microprocessor-controlled prosthetic knees were scored relatively to the best performing knee based on their performance in 5 areas of interest: agility, community ambulation, energy, stability, and gait quality. The relative importance of each of these areas was computed based on a quantitative prediction of a user's functional needs from features including age, body mass index (BMI), AMPnoPRO score, and likelihood of stairs/ramps. We describe the algorithm-suggested optimal patient profiles for each device.

Results: We developed an application that allows clinicians to obtain instant recommendations. Clinicians can further adjust the relative importance of each area of interest based on patient needs.

Conclusions: This algorithm represents a transparent, experimentally backed clinical decision-making aid with the potential to streamline the prosthesis fitting process. Future studies are required to evaluate the effectiveness of the algorithm.

Background: Successful prosthetic socket fitting contributes to prosthesis user satisfaction and facilitates rehabilitation, but is often challenging to achieve and maintain. There is a lack of information available that explores firsthand experiences of prosthetic users throughout socket fitting sessions and, in particular, their preferences regarding information exchange between them and their prosthetist.

Objectives: Assess satisfaction with prosthetic service, confidence in clinical judgement, and confidence providing feedback to prosthetists, examine experiences of prosthesis users in providing feedback to prosthetists and identify the types of information that prosthesis users want to communicate to their prosthetist, as well receive before, during, and after the socket fitting process.

Study design: Mixed-method (quantitative and qualitative) survey.

Methods: A questionnaire was designed and administered in consultation with Amputees NSW (an amputee community support group) and distributed through their membership database. Quantitative items with discrete or scale-based responses were analyzed using descriptive, nonparametric methods and described satisfaction and confidence during prosthetic fitting. A thematic analysis was performed on qualitative responses to explore prosthesis user experiences of information exchange before, during, and after socket fitting.

Results: There were 24 survey responses. Ninety-six percentage of respondents were satisfied with their prosthetic service and were confident in their prosthetists' clinical judgement as well as ensuring socket comfort for their client. Most prosthesis users felt comfortable to provide feedback to their prosthetist (median =100 [interquartile range = 20], where 0 = not at all confident and 100 = completely confident). Experiences in providing input on comfort and fitting fell under 4 interrelated themes: collaboration, frustrations with process, impacts of poor fit, and prosthetic fit. Experiences with exchanging information with their prosthetist before, during, and after socket fitting fell under a further 4 themes: process-based information and provision options, taking history and treatment planning, collaboration and communication, and functional concerns.

Conclusions: Prosthesis users' confidence to provide feedback and satisfaction with prosthetic services could be helped by ensuring a responsive working relationship, facilitating information exchange between the prosthetist and prosthesis user, as well as improved prosthesis user education on the socket fit process.

Objectives: The aim of the current study is to translate the original prosthetic limb users survey of mobility (PLUS-M) instrument to Norwegian, investigate its psychometric properties, and conduct a survey on mobility in Norwegian lower limb prosthetic users (LLPU).

Methods: The Functional Assessment of Chronic Illness Therapy methodology was followed for translation and cross-cultural validation. After translation, invitations to participate in a survey was sent from prosthetic and orthotic clinics in Norway to registered LLPU. Of 1279 invitations, 454 people with unilateral lower limb amputation (age, 62.6 ± 14.4 years) were included in the study. Known-groups construct validity was investigated by comparing the T-scores of men vs. women, transtibial vs. transfemoral amputation, vascular vs. nonvascular etiology, and younger vs. older persons.

Results: The overall PLUS-M T-score (mean ± SD) was 53.2 ± 11.1. Men (n = 318) had better mobility than women (n = 137), with T-scores of 54.7 ± 10.4 and 49.6 ± 12.4, respectively (P < 0.0005). All hypotheses about assumed differences in T-scores between known-groups were confirmed (all comparisons; P < 0.0005). Internal consistency (Cronbach α, 0.962) and test-retest reliability (intraclass correlation coefficient 0.936, 95% confidence interval, 0.871-0.968) were excellent. Standard error of measurement was 2.02, and minimal detectable change (95% CI) was 5.59. Furthermore, floor and ceiling effect was 1.8% and 10.9%, respectively.

Conclusion: The Norwegian version of the PLUS-M 12-item short form is valid and has excellent reproducibility and psychometric properties. The overall T-score for the Norwegian LLPU is marginally higher compared to the mean ± SD T-score (50 ± 10) of the original development sample (N = 1091).

Background: The reliability of Dutch questionnaires assessing performance of activities of daily living (ADL) has not been established in chronic hand orthotic users.

Objective: To examine the reliability of the custom short form of the Dutch-Flemish Patient-Reported Outcomes Measurement Information System-Upper Extremity (DF-PROMIS-UE) and the Michigan Hand Questionnaire Dutch language version (MHQ-DLV) in chronic hand orthotic users and evaluate the correlation between the DF-PROMIS-UE and MHQ-DLV ADL domain.

Methods: Seventy-four chronic hand orthotic users (mean [SD] age 60.5 [10.71] years, 60 female) completed the DF-PROMIS-UE and MHQ-DLV twice. Reliability was assessed as internal consistency (Cronbach's α), test-retest reliability (intraclass correlation coefficient), and agreement (95% limits of agreement, standard error of measurement, smallest detectable change). Furthermore, the Pearson correlation coefficient were determined.

Results: Cronbach's α for both ADL questionnaires was ≥0.90. The intraclass correlation coefficient was 0.88 (95% confidence interval [CI], 0.82-0.93) for the DF-PROMIS-UE and 0.81 (95% CI, 0.72-0.88) for the MHQ-DLV ADL domain. The limits of agreement were narrower for the DF-PROMIS-UE (-4.43 to 5.85) than for the MHQ-DLV ADL domain (-27.4 to 26.4). The standard error of measurement and smallest detectable change for the DF-PROMIS-UE were 1.91 and 5.29 points and for MHQ-DLV ADL domain 9.65 and 26.8 points, respectively. The correlation between the ADL questionnaires was 0.83 (95% CI, 0.75 to 0.89).

Conclusions: Although the DF-PROMIS-UE and MHQ-DLV ADL domain were highly correlated and showed good internal consistency, the DF-PROMIS-UE showed better test-retest reliability and lower measurement error than the MHQ-DLV ADL domain in chronic hand orthotic users.