Prosthetics and Orthotics International最新文献

Background: Recent fused deposition modeling (FDM) technology could offer accessible socket fabrication and resolve conventional fabrication issues. However, the printing orientation in FDM affects the structural integrity and reliability.Objective:To examine the effect of printing orientation on the structural strength of 3D-printed sockets using FDM.Study Design:Experimental study of 3D-printed socket at different printing orientations in static and cyclic loadings.

Methods: This study scanned residual limbs of 2 transtibial amputees weighing 53 kg (P4) and 125 kg (P6) to create 3D-printed prosthetic sockets using FDM. Ten sockets of a P4 amputee were printed at various orientations from 0° to 90° for a structural static test. In addition, 6 sockets of the P6 amputee were printed at 90° for static and cyclic tests according to ISO 10328.

Results: Based on the results, sockets printed at 0° and 90° for the P4 amputee exceeded static ultimate force under condition I according to ISO 10328 standards with 4880 N and 4430 N, respectively. Sockets at 30°, 45°, and 60° failed before the minimum force requirement was reached. Further validation of the 90° printed socket passed the static test in conditions I and II, and the cyclic test in condition II, enduring 3 million cycles without failure.

Conclusion: The 0° and 90° printing orientations are recommended for their superior mechanical properties, whereas other orientations may pose safety risks because of insufficient structural strength. These findings could contribute to developing more reliable and durable prosthetic sockets that meet ISO 10328 standards to enhance the quality of life for amputees.

Background: Telerehabilitation provides a viable alternative for individuals facing barriers to in-person rehabilitation because of transportation issues and physical limitations. It enables remote monitoring and guidance, allowing patients to continue rehabilitation at home.

Objective: This study aimed to assess the effectiveness of a telerehabilitation program in improving physical and psychological outcomes for lower limb amputees and to evaluate adherence to a home-based exercise program delivered via video.

Study design: A randomized controlled trial.

Methods: Sixty participants with lower limb amputations were randomized to an experimental group (telerehabilitation) or a control group (standard care). The intervention involved a 4-week supervised phase followed by a 4-week unsupervised phase. Primary outcomes were physical capacity, measured by the Six-Minute Walk Test (6MWT), and psychological status, assessed using the Hospital Anxiety and Depression Scale. Secondary outcomes included adherence rates and patient satisfaction.

Results: The experimental group showed significant improvements in 6MWT distance and Hospital Anxiety and Depression Scale scores compared to the control group. The mean 6MWT distance increased by 20% from baseline to the end of the supervised phase (P < 0.01) and was maintained during the unsupervised phase. Anxiety and depression scores significantly decreased (P < 0.05). Adherence was higher during the supervised phase (85%) but dropped during the unsupervised phase (60%).

Conclusions: Telerehabilitation significantly improved physical and psychological outcomes for lower limb amputees. High adherence during the supervised phase emphasizes the importance of clinician support, whereas strategies are needed to sustain long-term engagement during the unsupervised phase.

The history of a profession is valuable literature as it recognizes the noteworthy contributions of its forerunners and the scientific evolution from its earliest state. The purpose of this paper is to recount the historical developments in the profession of Prosthetics and Orthotics (P & O) in South Africa. An electronic literature search identified 54 Sabinet and 17,400 Google Scholar records. Key search words were "medical orthotics and prosthetics," "South Africa," and "history." The selection criteria of literature were accomplished in the subsequent 3 phases: (1) the title review, (2) the abstract review, and (3) the full-text review. The records were screened by all 3 authors. Records were excluded if they were unrelated to the history and/or development of P & O in South Africa, the history and development of other medical professions in South Africa, the historical development of P & O in other countries, the historical development of other medical professions of other countries, and records that were non-English. No peer-reviewed record was found describing the history of P & O in South Africa. Faced with the paucity of peer-reviewed evidence, the authors browsed Tshwane University of Technology, Durban University of Technology, and Walter Sisulu University websites to secure historical context. The analyses of these P & O training institutions websites provide a glimpse of the history of P & O in South Africa. The authors had identified the following areas noteworthy to be reported on (1) the historical account of the profession in South Africa, (2) the recognized tertiary training institutions, (3) the minimum admission criteria to South Africa P & O training institutions, and (4) regulatory and statutory bodies of the profession of P & O in South Africa.

Knee bracing is commonly used for rehabilitation after ligament surgery. However, the effectiveness of knee bracing in preventing ligament injuries is not widely studied. This study aimed to develop a computational methodology to investigate the effectiveness of a novel type of cable-stabilized knee brace on anterior cruciate ligament (ACL) strain during single-leg jump landing. The brace features a compliant design with nonextensible pretensioned cables integrated within a compression tight garment. A combined in vivo/in silico method was developed for this purpose. A computational model of the cable-stabilized knee brace was developed with linked truss elements used to simulate the cable. The cables were integrated into an existing computational model of the knee. Subsequently, single-leg jump landing simulations were conducted on the model, using muscle forces and joint kinematic/kinetic profiles from 10 participants. Anterior cruciate ligament strain behaviors were then compared between the braced and unbraced configurations. The computational methodology was successful in simulating the differences in ACL strain because of the brace. The average peak ACL strain in the braced configuration was 4.99% ± 2.36% and in the unbraced configuration was 3.23% ± 2.31% ( p = 0.091). The methodology developed lays the groundwork for future advancements in optimizing the cable-stabilized knee brace design and refining its potential in preventing ligament injuries.

Introduction: Prosthetic silicone liners improve comfort and skin protection and allow the use of total surface bearing (TSB) sockets, which provide enhanced proprioception and comfort. Unfortunately, silicone liners are cost-prohibitive in resource-limited environments (RLEs) where patellar tendon bearing (PTB) sockets with PE-lite liners remain standard, leading to patient discomfort and skin issues.

Objective: This study evaluates the benefits and durability of an affordable silicone liner locally manufactured in an RLE to promote TSB socket adoption, aiming to enhance prosthetic care and patient outcomes.

Methods: Ethical approval was granted by the Nepal Health Research Council. Twelve people with a unilateral transtibial amputation who were using a PTB socket with PE-lite participated in the study and received a new prosthesis (TSB socket with an affordable silicone liner). Participants performed mobility tests (2-Minute Walking Test, Timed Up and Go Test) and completed self-reported questionnaires for both prostheses. Liner durability was assessed.

Results: Participant mobility improved while wearing the TSB socket and silicone liner. The new prosthesis was found to be comfortable, and there were no major problems identified although excessive sweating, typical with silicone liners, was reported. Liners were replaced after 6.1 (±3.1) months.

Conclusion: A locally manufactured liner provided increased mobility and high levels of satisfaction. This affordable liner may be suitable for use in RLEs, enabling adoption of TSB sockets and improving rehabilitation outcomes of people with a transtibial amputation. However, durability concerns and excessive sweating would suggest that improvements can still be made.

Rehabilitation is often complex for persons with transfemoral amputation, and poor socket fit is one of the main factors affecting gait re-education, rehabilitation, and quality of life. The present study systematically reviewed the literature to test whether the subischial socket provides better outcomes in comfort, quality of life, and mobility than other transfemoral sockets. Systematic review and meta-analysis. We searched MEDLINE, Physical Therapy Evidence Database Scale, Epistemonikos, Cochrane, BIREME, Web of Science, and Scopus from inception to January 2024 to identify randomized and controlled trials. Two authors independently screened records and assessed the risk of bias. We performed a narrative synthesis of the evidence and used the standardized mean difference and mean difference for meta-analyses and the Grading of Recommendations, Assessment, Development, and Evaluation approach for recommendations. We identified 7 randomized and controlled clinical trials. Five studies compared the subischial socket with the ischial containment socket (IC), 1 study compared the IC with the Marlo anatomical socket, and 1 study compared the IC with the quadrilateral. Very low certainty showed a difference in comfort (1 study: mean difference = 1.4 [95% CI 0.61, 2.19]), but no in quality of life (2 studies: standardized mean difference = 1.28 (95% CI -1.04, 3.59), and mobility (2 studies: mean difference = 0.11 (95% CI -1.08, 1.29). We observed differences between the subischial socket and the IC in comfort but not in quality of life, mobility, and stability. Furthermore, we found a very low certainty that the subischial socket provides better outcomes than the IC in comfort, quality of life, and mobility.

Background: Ankle foot orthoses (AFOs) improve ankle-foot stability and alignment. They might reduce the burden of care because they facilitate independent function. However, AFO use can add additional stressors such as adherence to wearing schedules and aiding with donning that might increase caregiver burden.

Objectives: The study aimed to quantify the burden experienced by family caregivers of children wearing AFOs in South Africa and to determine if there is a difference in the burden experienced by caregivers of children who have AFOs and those waiting for AFOs.

Study design: A cross-sectional survey was done in 4 South African provinces.

Methods: One hundred and twenty-three caregivers were identified through consecutive sampling. They completed the Burden Scale for Family Caregivers between March and June 2023. Descriptive and comparative analysis (χ 2 test and Pearson correlation coefficient) were done.

Results: Eighty-three (67.48%) children had an AFO, whereas 40 (32.52%) needed one. The mean caregiver burden score for caregivers of children with AFOs was 21.82/60 (standard deviation 6.49), and for caregivers of children needing AFOs was 24.60 (standard deviation 5.63). Most family caregivers (69; 83.13%) of children with AFOs and children needing AFOs (32; 80.00%) experienced no to mild levels of burden. The difference in burden experienced by the 2 groups was not statistically significant ( P = 0.671082).

Conclusions: Caregivers of children who can walk and use AFOs experience low to moderate levels of burden. AFOs did not reduce the caregiver burden statistically. However, clinically the burden experienced by caregivers was reduced.

The abandonment rates of upper-limb (UL) prostheses are concerning and are related to limitations in the functional and kinematic aspects of the UL prosthesis. Evaluating the usability of prostheses is essential to make improvements in relation to these aspects and develop effective equipment and inform clinical results relevant to rehabilitation. The purpose of this scoping review is to explore the current state of the literature, the characteristics of studies on the topic, and the main parameters and instruments used to evaluate UL prosthesis, regarding kinematic and functional aspects. The search was performed in 7 databases using descriptors related to "Prosthesis," "Outcome Measures," and "Upper Limb." Specific data were extracted from full-text articles included in the final sample. A literature search identified 1122 articles. After analyzing the articles using predetermined inclusion and exclusion criteria, 121 relevant articles were included in the final review. Most of the studies found originated from the United States and United Kingdom, predominating quasi-experimental studies and case studies. The predominant level of disability was transradial, and the most cited type of prosthesis was electric/myoelectric. The studies predominated in the clinical context and focused on the use of functional assessments. About 101 assessment instruments in total were found, 82 (81.2%) of which were related to functionality and 19 (18.8%) related to kinematic aspects. Kinematic focus is still scarce on the evaluation of users of UL prostheses. Combining kinematic and functional assessments expands the approach and data collection with the target population. There is a need to develop instruments specifically aimed at this audience.