Prosthetics and Orthotics International最新文献

Background: Preferred walking speed (PWS), maximal walking speed (MWS), and walking speed reserve (WSR)-the difference between MWS and PWS-can be easily obtained from the 10-m walk test (10MWT) to assess walking ability and function. However, their test-retest reliability has not been determined in persons with unilateral lower-limb amputation (LLA).

Objectives: To determine the reliability of the PWS, MWS, and WSR obtained from the 10MWT in persons with LLA.

Study design: Test-retest with a 48- to 120-h interval between test days.

Methods: Test-retest relative and absolute reliability was assessed by the intraclass correlation coefficient (ICC) and the %change in mean (%CM) and coefficient of variation (CV), respectively.

Results: Preferred walking speed showed excellent reliability between day 1 (familiarization day) and day 2 (ICC = 0.97; %CM = -1.8; CV = 7.7) and a significant speed increase from day 2 to day 3 (ICC = 0.96; %CM = 8.5, p < 0.003; CV = 7.4). Maximal walking speed showed excellent reliability between day 1 and day 2 (ICC = 0.94; %CM = 2.9; CV = 8.3) and between day 2 and day 3 (ICC = 0.94; %CM = 1.8; CV = 8.6). Overall, WSR was poorly reliable between day 1 and day 2 (ICC = 0.65; %CM = 39.2; CV = 39.2) and between day 2 and day 3 (ICC = 0.74; %CM = 30.0; CV = 30.0).

Conclusions: Preferred walking speed obtained from a single 10MWT and MWS obtained after a 10MWT familiarization day are reliable walking speed measures for persons with LLA with similar characteristics to those of our sample. Nonetheless, it is critical that both PWS and MWS are obtained after a 10MWT familiarization to obtain a reliable WSR.

Background: Walking speed is a measure of functional mobility that is relatively easy to quantify. In people with lower limb amputation, reduced walking speed has been linked with specific atypical spatiotemporal gait parameters. However, the influence of atypical spatiotemporal gait parameters on the walking speed of people with unilateral transtibial amputation (TTA) and transfemoral amputation (TFA) remains unclear.

Objectives: To identify spatiotemporal gait parameters influencing walking speed of people with unilateral TTA or TFA.

Study design: Cross-sectional.

Methods: The 10-meter walk test (10mWT) was used to measure walking speed, and an instrumented walkway was used to record spatiotemporal gait parameters. Regression analyses were used to determine the best subset of spatiotemporal gait parameters that influence the walking speed of people with TTA and TFA.

Results: The study included 43 people with TTA and 49 with TFA. In the TTA group, spatiotemporal gait parameters accounted for 65.5% of the variance in walking speed, with prosthetic single limb support accounting for 52.2%, prosthetic terminal double limb support accounting for 8.9%, and stride width accounting for 4.4%. In the TFA group, intact swing accounted for 46.7% of the variance in walking speed. There was no significant difference in walking speed between the TTA and the TFA groups (p > 0.05).

Conclusions: The study's results highlight specific spatiotemporal gait parameters that affect the walking speed of people with unilateral TTA and TFA. In addition, results suggest that walking speed over short distances is not confounded by amputation level (i.e., TTA and TFA).

Objective: This paper presents a preclinical feasibility study to investigate the efficacy of a game-based virtual reality (VR) intervention in the functional training of upper-limb prosthesis use.

Methods: The study compared the skill of 2 able-bodied groups (intervention and control, 5 participants in each group) using a surface electromyography controlled self-experience prosthetic hand and wrist through the Box and Blocks Test (BBT). The Intervention Group followed the game-based VR intervention for 4 weeks and underwent real-life (RL) BBT assessments before and after the intervention using the self-experience prosthesis. The Control Group performed the RL BBT assessments 4 weeks apart with no VR intervention in between. As a follow-on study, the Control Group then underwent the VR intervention for further validation. The VR intervention consisted of 2 games designed to train the control and use of a surface electromyography-controlled prosthetic hand and an assessment (VR BBT). The VR intervention protocol included three 30-minute sessions per week over a period of 4 weeks.

Results: A significantly larger improvement was shown in the BBT scores from the Intervention Group (mean 6.375) compared to the Control Group (1.5). The follow-on study further confirmed the result.

Conclusion: The study demonstrated promising outcomes in the use of a game-based VR intervention for training functional prosthesis use, with participants showing significant improvements in prosthesis use skills measured with RL BBT. This motivates further development of VR interventions for prosthesis use training and their validation through clinical trials.

Background: Prosthetic socket is a key component of the prosthesis for clinical application; its performance directly affects the adaptation of the residual limb to the prosthetic socket. There are long-term and short-term volume fluctuation of the residual limb. The volume fluctuation of the residual limb will lead to the pressure mismatch at the interface of the residual limb and the prosthetic socket, which will cause a series of skin and fit problems. The volume fluctuation of the residual limb is considered a key factor for the successful application of the prosthetic socket; its solution is imminent. The purpose of this paper is to design a prosthetic socket with a constant force unit to solve the problem of volume fluctuation of the residual limb.

Methods: Constant force extrusion for the residual limb is proposed to solve the problem in this paper. A constant force unit is designed based on the superelasticity of shape memory alloy, and a semi-open prosthetic socket embedded in the constant force unit is designed. The constant force property of prosthetic socket is optimized and verified by finite element analysis.

Results: The constant force unit obtains a maximum constant force region of 9.36 mm at 13 mm applied displacement, and the minimum stress amplitude is 0.0264%.

Conclusions: The semi-open prosthetic socket may achieve constant pressure at the interface between the residual limb and prosthetic socket within a certain range of the residual limb volume change, and it has a lightweight, good heat dissipation, size adjustability, and constant interface pressure.

Rowing requires both the upper and lower body to be active for balance, steering, and propulsion, constituting a real challenge for athletes with disabilities. To our knowledge, adapted setups allowing pararowing for people with bilateral transfemoral amputation have not yet been described. This case report describes the adapted setup for Mr S, 24 years old, who underwent bilateral transfemoral amputation in 2019 after a motorcycle accident. He walks with 2 prostheses and practices high-level para-rowing in the Para-Rowing 2 single sculls category. We designed 2 prostheses consisting of a liner (Iceross Seal-In® X5 TF), an adapted socket, a knee (aqua-knee 3WR95), and a prosthetic foot (RushHiPro). We also designed a seat made of Plastazote and thermoplastic polymer foot rests. This equipment allows Mr S to wear his prostheses, which helps him to stabilize in the boat and to use maximum trunk amplitude during the rowing movement. However, the weight of the current equipment limits Mr S's performance. This case study demonstrates that it is possible to adapt equipment to allow an individual with double transfemoral amputation to perform pararowing at competition level.

Background: Iterative design and modification are used to manufacture lower limb prosthetic sockets that meet users' needs while also fulfilling safety and mobility criteria. Greater understanding of the expectations of prosthesis users regarding prosthetic fit as well as their experiences at the time of socket fitting is needed.

Objectives: Describe lower limb prosthesis user perceptions and experiences of socket comfort and discomfort during their last fitting and compare this to their expectations for a perfectly fitting socket and their satisfaction with the socket they had fitted.

Study design: Mixed methods (quantitative and qualitative).

Methods: A questionnaire was designed and administered in consultation with Amputees NSW (an amputee advocacy group) and distributed through their membership database. Qualitative responses were analyzed to explore prosthesis user experiences of socket fitting, general wear, as well as socket comfort, discomfort, and satisfaction. Quantitative responses were analyzed using descriptive, nonparametric methods.

Results: Thirty participants with a range of lived experiences completed the questionnaire. Reported comfort and discomfort varied across participants and indicated that expectations and experiences of fit varied and changed over time, with some participants anticipating adjustment over time would be necessary. Qualitative analysis found experiences of prosthesis socket comfort/discomfort on the day of fitting and general experiences of socket comfort related to 2 key factors-the prosthesis itself and the individual prosthesis user.

Conclusions: Understanding the experiences and expectations of prosthesis users for comfort and intended activities is central to ensure success of the socket fitting approach. Investigation into fit changes over time could provide insights into follow-up requirements, user education, and funding mechanisms.

Background: Hallux valgus (HV) is a condition characterized by the lateral deviation of the first phalanx and medial deviation of the first metatarsal, leading to subluxation of the first metatarsophalangeal joint. Various orthotic applications are employed in the treatment of HV deformity. This study aimed to compare the effects of a toe separator (TS) and dynamic orthosis (DO) on hallux valgus angle (HVA), plantar pressure (PP), and quality of life (QoL).

Methods: Thirty individuals aged between 18 and 65 years who had mild to moderate HV deformity were included in our study. Participants were randomized into TS and DO groups. Pretest and post-test evaluations at 4 weeks included goniometric measurement for HVA, PP measurement using the Sensor Medica device, QoL assessment using the American Orthopaedic Foot & Ankle Society-Hallux MTP-IP Scale and Manchester-Oxford Foot Questionnaire, and numerical evaluation scale for orthosis satisfaction.

Results: No statistically significant changes were observed in HVA measurements (p > 0.05). In the DO group, significant differences were observed in PP assessment for right rearfoot loading (p = 0.048) and total average pressure measurement of the right foot (p = 0.025). QoL assessments were observed significant differences in the DO group compared with the TS group (p < 0.05).

Conclusions: After a 4-week period of wearing the TS and DO orthoses, no change in HVA was observed. In the DO group, a more balanced load distribution between the right and left foot (50.2% left, 49.8% right) and a more pronounced effect in reducing deformity-related pain and improving QoL by increasing functionality were noted.

Background: Functional capacity assessments have an important role in determining the level of mobility in lower-limb prosthetic users.

Objectives: Our aim was to investigate the reliability and validity of the Glittre activities of daily living (ADL) test in lower-limb prosthetic users.

Study design: A cross-sectional study.

Methods: The study included 66 people over the age of 18 years who had used a lower-limb prosthesis for at least 6 months and could walk at least 30 m independently. For construct validity, the correlation of the Glittre ADL test with the 2-min walk test, timed up and go test, and functional reach test was examined, and Bland-Altman agreement analysis was performed. Intra-rater reliability was examined with 2 tests performed by the same physiotherapist on different days, and inter-rater reliability was examined with a test performed by a second physiotherapist on a different day.

Results: The reliability of the Glittre ADL test was found to be excellent for intra-rater (intraclass correlation coefficient = 0.940, 95% confidence interval = 0.903-0.963, standard error of measurement = 26.03, minimal detectable change = 72.31) and good for inter-rater (intraclass correlation coefficient = 0.890, 95% confidence interval = 0.806-0.936, standard error of measurement = 36.80, minimal detectable change = 102.06, p < 0.001). There was a strong negative correlation between Glittre ADL test and 2-min walk test (r = -0.785), a strong positive correlation with timed up and go (r = 0.805), and a weak negative correlation with functional reach test (r = -0.266, p < 0.05). Bland-Altman plots showed 95% agreement for both validity and reliability measurements.

Conclusions: The Glittre ADL test is a valid and reliable test that can be used in the assessment of functional capacity in lower extremity prosthesis users.

Background: Foot drop is a common condition for patients with upper motor neuron syndrome such as cerebral palsy (CP). This study aimed to investigate the effects of functional electrical stimulation (FES) on gait function, quality of life, and FES satisfaction in adults with CP and foot drop. To analyze effects over time, an observational, longitudinal study was performed.

Methods: In this observational prospective cohort study, 8 adults with CP (median age of 22 years; range: 18.5-33.25) received a FES system for 12 weeks. 3D gait analysis was performed at beginning (T1) and end of the study period (T2). To detect effects of FES, ankle kinematics, kinetics, and spatiotemporal parameters were monitored for the conditions FES-OFF and -ON at each examination.

Results: Over time, walking speed increased significantly from T1ON (1.08 m/s) to T2OFF (1.21 m/s) with further improvement at T2ON. The ON-OFF difference of maximum dorsiflexion during swing tended to increase at T2 (2.49 degrees) compared with T1 (1.73 degrees) but with a more plantarflexed ankle position at T2 (range: -7.1 to 1.31 degrees) than T1 (range: -1.53 to 4.51 degrees) resulting in a significant decrease between T1ON and T2OFF. With FES, push-off energy tended to decrease for both examinations and lead to lower values over time.

Conclusion: Positive therapeutic effects are represented in walking speed over time regardless of FES being OFF or ON even with a reduction in push-off energy. Despite no significant increase in maximum dorsiflexion in swing, over time, participants showed the tendency of an improvement in foot lift with FES-ON.

Background: The dynamic elastomeric fabric orthoses (DEFOs) are made of neoprene material, providing the right biomechanical alignment and afferent input in the trunk, pelvis, and extremities, potentially allowing individuals to actively participate in daily life.

Objective: The aim of this study was to investigate the effects of DEFOs applied to the lower trunk and pelvis, on balance, gait parameters, and pelvic symmetry in children with cerebral palsy (CP).

Study design: An evaluator-blinded randomized controlled trial.

Methods: Twenty-two children (7 girls, 15 boys) aged 4-10 years, with spastic CP, Gross Motor Function Classification System levels 1 and 2 were included. Thirteen children were randomly assigned to the control group (group 1) and 13 to the orthosis group (group 2), but 4 withdrew before treatment commenced. There were 10 children in group 1 and 12 in group 2. Both groups received a physiotherapy and rehabilitation program twice a week for 8 weeks. Children in group 2 received lower body and pelvis DEFOs in addition to physiotherapy and rehabilitation sessions. Dynamic elastomeric fabric orthoses wearing tolerance was gradually built up over the first week, until the child was wearing the DEFO 8 h per day. The pediatric balance scale and timed up and go test were used to assess balance, while gait parameters and pelvic kinematic values were evaluated using the BTS G-Walk, a wireless mini digital gait analysis system. All of the measurement tools used were validated for CP.

Results: Only stride length among the gait parameters changed in the group using DEFO compared with the group not using it (p = 0.035). There was no change in gait speed and cadence nor were there any differences in the balance scores between the groups. However, the pelvic tilt in the frontal plane of the pelvis improved significantly in the group using DEFOs compared with the group not using it (p = 0.014).

Conclusions: Dynamic elastomeric fabric orthoses used in the lower body and pelvis conferred superior stride length and the pelvic tilt in the frontal plane to conventional physiotherapy. All other outcomes were equally effective between groups.