Prosthetics and Orthotics International最新文献

Background: Lateral epicondylitis (LE) is one of the most common causes of lateral elbow pain, and orthoses are often used in its conservative treatment. However, the number of studies examining the effectiveness of the orthoses used and their differences compared to each other is limited.

Objective: To determine the effects of 2 orthoses types, wrist orthosis (WO) and counterforce brace (CB), commonly used in the treatment of lateral epicondylitis on muscle activation, grip strength, hand function, and satisfaction level in healthy individuals.

Study design: Quasi-experimental study.

Methods: Thirty-seven healthy individuals were recruited. Muscle activation was evaluated by surface electromyography, and maximum grip strength was evaluated with a handheld dynamometer. Hand function and satisfaction level were evaluated with Jebsen Taylor Hand Function Test and Orthotics and Prosthetics Users Survey, respectively. All evaluations were conducted for each individual in 3 conditions (no orthosis, WO, and CB).

Results: Extensor carpi radialis (ECR) muscle activation was greater when using CB compared with that when without orthosis ( p = 0.036). There was no significant difference in extensor digitorum communis (EDC) muscle activation and maximum grip strength among the conditions ( p > 0.05). Hand function was worse when using the WO compared with the other conditions ( p < 0.001). In terms of orthosis satisfaction, individuals were found to be significantly more satisfied with the use of CB ( p = 0.001).

Conclusions: In our study highlight the use of CB in terms of EDC muscle activity, grip strength, hand function, and satisfaction, while the use of WO is prominent in terms of keeping extensor carpi radialis muscle activity low, which has been shown to be important for LE. To obtain definitive results on the effectiveness of different orthoses in the treatment of LE, more research is needed to compare the muscular activation in the extensor carpi radialis brevis (ECRB) and EDC muscles with objective methods.

Background: Implicit magnitudes and distribution of excessive contact pressures under hand orthoses hinder clinicians from precisely adjusting them to relieve the pressures. To address this, contact pressure under a hand orthosis were analysed using finite element method.

Methods: This paper proposed a method to numerically predict the relatively high magnitudes and critical distribution of contact pressures under hand orthosis through finite element analysis, to identify excessive contact pressure locations. The finite element model was established consisting of the hand, orthosis and bones. The hand and bones were assumed to be homogeneous and elastic bodies, and the orthosis was considered as an isotropic and elastic shell. Two predictions were conducted by assigning either low (fat) or high (skin) material stiffness to the hand model to attain the range of pressure magnitudes. An experiment was conducted to measure contact pressures at the predicted pressure locations.

Results: Identical pressure distributions were obtained from both predictions with relatively high pressure values disseminated at 12 anatomical locations. The highest magnitude was found at the thumb metacarpophalangeal joint with the maximum pressure range from 13 to 78 KPa. The measured values were within the predicted range of pressure magnitudes. Moreover, 6 excessive contact pressure locations were identified.

Conclusions: The proposed method was verified by the measurement results. It renders understanding of interface conditions underneath the orthosis to inform clinicians regarding orthosis design and adjustment. It could also guide the development of 3D printed or sensorised orthosis by indicating optimal locations for perforations or pressure sensors.

Jumping is involved in a wide range of sports and activities, and foot orthoses (FO) are suggested to enhance performance and prevent injury. The aim of this systematic review was to investigate whether using FO with different modifications affects jump landing biomechanics and improves performance in healthy individuals. The search strategy included 7 databases that identified 19 studies. The study quality was evaluated using a modified Downs and Black index. The primary outcome measures were joint kinematics, kinetics, muscle activity, vertical jump height, and horizontal jump distance. Our findings indicated that incorporating arch support with a rearfoot post and softer forefoot region into FO may improve several biomechanical variables during jump landing activities. Improvements in vertical ground reaction force loading rates, knee and ankle kinematics, and muscle cocontraction during jumping with FO could enhance jumping performance. In addition, improvements in hip, knee, ankle, and tibial kinematics and vertical ground reaction force loading rates during landing could reduce impact forces and related injuries. Although a limited number of studies have addressed the effects of FO on vertical jump height and horizontal jump distance, inserting such FO inside shoes with optimum bending stiffness could facilitate jumping performance. A rigorous exploration of the effect and mechanism of FO designs on jumping performance could benefit jumping-related activities and prevent ankle and knee injuries.

Chronic pain following amputation is debilitating. Due to its mechanisms in modulating muscle contraction and pain, botulinum toxin has been investigated as a treatment option for phantom limb pain (PLP) and residual limb pain (RLP). The objective of this study was to determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation using a systematic review of the literature. The databases Medline, CINAHL, EMBASE, Scopus, Web of Science, and Cochrane were searched from inception through October 30, 2023. The search identified 50 articles; 37 underwent full-text review, and 11 were included in the final review. Eighty-nine individuals with pain were investigated by the included studies; 53 had RLP and 63 had PLP. There was significant variation in botulinum toxin type, injection method, and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively. Therefore, there is potential for use of botulinum toxin for the treatment of PLP and RLP. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on the treatment of PLP and RLP following amputation is limited.

The rates of prosthetic abandonment are not extensively understood especially in resource-limited countries. A scoping review was conducted to examine the literature on the satisfaction with and barriers to using specifically upper limb prostheses. A systematic search of the literature identified 425 studies. After reviewing the articles using predetermined inclusion and exclusion criteria, 7 cross-sectional studies were included in the final review. Barriers to the use of upper limb prostheses include the characteristics of the prosthesis (type, comfort, weight, functionality, price, and availability) and individual patient factors (recent prosthetic user, level of amputation, congenital and accidental limb loss, pain, and duration between amputation and prosthetic fitting). Considering tailored prosthetic design and funding may result in improved prosthetic adherence.

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.

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.

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.

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.

A boy with bilateral congenital anomalies of the upper extremities with transverse absence of the left arm (agenesis) and absence of right thumb (disgenesis), fixed elbow in extension due to humeroradial synostosis thought that the humerus was intact. His wrist could move passively with 50° flexion, 0° extension, and 70° radial deviation. The other 4 fingers were intact, 4-5 metatarsal bones were in synostosis, and the fifth finger was clinodactyly. He was born by normal delivery. The physiotherapist started sensorimotor training to achieve functional movements of the right upper extremity. The exercises for the trunk muscles were emphasized to prevent the future possible thoracolumbar curve due to the absence of loading of the left arm on trunk muscles. Serial splinting was performed to position the wrist and fingers for functional purposes and abduction and internal rotation of the index finger to perform the opposition position until the pollicization surgery. At 1 and a half, his trunk was straight, and the wrist was partially corrected (15° extension; 35° radial deviation). He was able to play with toys and eat food. The mother rated his performance as 8/10 and 10/10, respectively. Both mother and father were satisfied with his performance in activities of daily living according to his age compared with his peers (9/10; 10/10, respectively). Thus, the physiotherapist's sensorimotor training and the positioning splints may be considered as feasible interventions in this case.