Prosthetics and Orthotics International最新文献

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.

Background: Ankle proprioception deficit is a major factor causing balance dysfunction in subacute stroke survivors. However, there is still no commonly-agreed ankle proprioception evaluation method for these patients. Whether ankle proprioception tested by the active movement extent discrimination apparatus (AMEDA) when participants are standing (AMEDA-standing) or sitting (AMEDA-sitting).

Objectives: This study aimed to investigate the variations in ankle proprioception measures between the AMEDA-standing and AMEDA-sitting in subacute stroke survivors and assess the test-retest reliability of these measures.

Study design: This study analyzes sitting and standing proprioception (AMEDA scores) and their associations with static/dynamic balance in 24 subacute stroke patients using ANOVA, Pearson's correlation, and ICC analyses in SPSS 26.

Methods: The battery of tests administered included the AMEDA, the Timed Up and Go Test, the Single-leg Stance, and the Limit of Stability, as measured by the NeuroCom® Balance Manager® VSRTM. Pearson correlation was applied to discern the relationship between the acuity of ankle proprioception and balance. The intraclass correlation coefficient was used to gauge the test-retest reliability of the measures. Furthermore, an analysis of variance was conducted to scrutinize any differences between the proprioception scores obtained from the AMEDA-standing and AMEDA-sitting protocols.

Results: Area under the curve values for the AMEDA-sitting during the initial test and retest were 0.665 (0.090) and 0.665 (0.080), respectively. For the AMEDA-standing, the area under the curve values were 0.697 (0.069) for the initial test and 0.699 (0.075) for the retest. Evaluating the reliability, the intraclass correlation coefficient was calculated as 0.704 for AMEDA-sitting, while for AMEDA-standing, it was 0.752. Upon conducting a Pearson correlation analysis, a statistically significant relationship was observed between AMEDA-sitting and several balance variables: Reaction Time-affected, Endpoint Displacement-affected, Max Excursion-affected, Endpoint Displacement-unaffected, Max Excursion-unaffected, and Endpoint Displacement-back.

Conclusions: In the context of subacute stroke survivors, both AMEDA-standing and AMEDA-sitting methodologies prove to be appropriate, demonstrating commendable test-retest reliability.

Objectives: To achieve functional and comfortable prostheses, great attention must be paid to socket design, as it represents a critical interface between the residual limb and the prosthetic limb. This study aimed to evaluate the outcomes of unilateral transtibial amputees utilizing modified socket casting/molding technique in comparison to total surface bearing (TSB) socket.

Methods: Eight individuals with unilateral transtibial amputation participated in this cross-over design trial. Each participant used both the TSB and modified socket casting/molding designs. Four weeks after the utilization of each socket, the assessment was conducted on socket fit satisfaction (measured through the Comprehensive Lower Limb Amputee Socket Survey), socket rotation (evaluated using a standard meter), socket/liner interface pressure (monitored with 10 force-sensitive resistors), and the amputees' decision regarding the retention of one of the sockets after the trials (gauged via a numerical rating scale).

Results: The amputees experienced greater stability ( P = 0.02) and improved lateral rotational control ( P = 0.01) during prosthetic gait when using the modified socket, compared with the TSB socket. Local pressure on the anterodistal tibia and the head of the fibula was not statistically significant ( P > 0.05) between 2 socket types. The decision of participants to retain the modified socket was significantly higher than that for the TSB socket after the trial period ( P = 0.03).

Conclusion: The modified socket design may offer advantages by providing improved rotational control during walking and reducing local pressure on the anterodistal tibia and fibula head. In addition, it maintains the total surface contact concept.

Background: Offloading knee braces can reduce pain and improve mobility in patients with knee osteoarthritis.

Objectives: This study aimed to determine the effectiveness of the new UniReliever knee brace and to compare it to the widely used Unloader One X device.

Methods: In this open-label, three-arm parallel-group randomized trial, 60 patients with medial knee osteoarthritis (Kellgren-Lawrence grade II‒IV), 34 male and 26 female with a mean age of 69.62 ± 9.57 years and mean body mass index of 26.86 ± 3.18 kg/m2, were recruited from an orthopedic center. The patients were randomly allocated to receive a UniReliever device, an Unloader One X device, or no knee brace (control). The primary outcome was the change in the pain-free walking distance from baseline to 6 weeks. Other measures included the Lequesne index, pain on exertion, range of motion, and analgesic use.

Results: The mean pain-free walking distance more than doubled for the UniReliever group (from 2.0 ± 1.4 km to 4.6 ± 3.4 km) and the Unloader One X group (from 2.6 ± 2.3 to 5.6 ± 3.7 km), but not for the controls (from 1.3 ± 1.2 to 1.4 ± 1.3 km; comparisons with controls: p < 0.0001). The Lequesne index and pain on exertion also improved for the 2 knee brace groups (p < 0.05 for all comparisons with controls; p > 0.05 for comparisons between the knee brace groups), and the use of analgesics fell (UniReliever: 4/7 patients; Unloader One X: 8/11 patients; whereas controls: 1/9 patients). There were no serious adverse events.

Conclusions: The UniReliever offloading knee brace can improve mobility and reduce pain in patients with medial knee osteoarthritis. The benefits are similar compared with the Unloader One X.

Trial registration: Clinical Trials NCT05905809.