Prosthetics and Orthotics International最新文献

The limb amputations caused due to emergent incidents of trauma injuries and vascular diseases currently represent crucial global problems. The patients/amputees with limb amputation who lost the residual limb (knee-ankle foot system) must depend on the prosthetic limb. Prosthetic clinicians and technicians have attempted to develop optimal limb prosthetics that will enhance the ability and functional elements of the patients/users. However, the amputees still do not gain the same level of comfort and functional stability as compared to normal limbs (without amputation). Thus, to provide that comfort and stability, proper construction with accurate positioning and alignment of constructed prosthetic limb is crucial to reconstitute these amputees/patients to do their activities for daily life. The objective of technical report is to provide the brief summary about basic principle and biomechanics regarding gait analysis, construction, and alignment of prosthetic limb during gait cycle. The study also summarized the kinematics and kinetic biomechanical response of prosthetic limbs to assess the biomechanics of limb prosthetics, socket assembly principle, gait parameters, and static and dynamic alignment during walking. The basic principle of positioning and alignment with different flexion and torque moment at hip, knee, and ankle joint has been analyzed.

Background: Many factors affect the rehabilitation of lower limb amputation. One of these factors is the length of the stump.

Objective: The aim of this study was to assess the relationship of stump length with muscle strength, proprioception, and balance in patients with traumatic unilateral transfemoral amputation.

Study design: Sixteen patients with traumatic unilateral transfemoral amputation were included in this cross-sectional study.

Methods: Stump length was determined by measuring the distance from the trochanter major to the tip of the stump. Hip extensor and flexor muscle strength on the amputated side was determined using the computer-assisted isokinetic system. The proprioceptive sensation of the lower extremities was measured at hip flexion with computer-assisted isokinetic system. Balance of the patients was determined using the Berg Balance Scale.

Results: There was a statistically significant negative correlation between the stump length and proprioception measurements (r = -0.508, p = 0.044). There was also a statistically significant correlation between Berg Balance Scale and the flexion total work value at 60° angular velocity (r = 0.541, p = 0.03). There was no significant correlation between stump length and other muscle strength, proprioception, and balance parameters.

Conclusions: A relationship was found between stump length and proprioception, and balance and hip flexor muscle strength in patients with traumatic unilateral transfemoral amputation. In elective lower limb amputations, the level of amputation should be determined at the most functional level with the longest possible stump.

Background: Conventional myoelectric prostheses (myo-prostheses) training involves repetitive grasping and manipulation training, which requires considerable training time. It is necessary to develop a short and efficient myo-prostheses training. This study aimed to verify the immediate and sustained effects of action observation and motor imagery (AOMI) using virtual reality (VR) on myo-prostheses control and clarify the effect of visual feedback of electromyogram (EMG) signals during AOMI using VR.

Study design and methods: We evaluated 24 healthy right-handed individuals wearing a myo-prostheses simulator in their dominant hands. We divided participants into 3 groups: VR video observation with EMG presentation during manipulation (VR+), VR video observation without EMG presentation (VR), and control group. We evaluated prosthetic control skills using the Grasp Force Adjustment Test (GFAT) and Bowknot task immediately before and after AOMI and 1 week later. In addition, we evaluated the level of immersion during AOMI.

Results: The rate of change in the GFAT 1 week after the intervention was significantly greater in the VR+ (P < 0.05, d = 1.32) and VR (P < 0.01, d = 2.34) groups than in the control group. Immersion was significantly higher in the VR+ and VR groups than in the control group. The condition and time required for GFAT had significant effects, although the post-hoc test showed no significant difference between VR+ and VR groups.

Conclusions: AOMI using VR had sustained effects on motor learning of myo-prosthetic control despite EMG presentation. Therefore, AOMI, using VR, manipulates prostheses once learned, and it might be used for future training of myo-prosthetic control.

Background: Numerous factors can affect mobility of individuals with lower limb amputation, including prosthesis-dependent, physical and psychological determinants.Objective:This study aimed to investigate the prosthesis and health-related factors of mobility in people with nontraumatic unilateral transtibial amputation.Study Design:Cross-sectional observational study.

Methods: Individuals with nontraumatic unilateral transtibial amputation who are using a prosthetic leg were included. All participants were asked to fill out the Prosthesis Evaluation Questionnaire, 12-Item Short-Form Health Survey (SF-12), Comprehensive Lower Limb Amputee Socket Survey, and 12-item Prosthetic Limb Users Survey of Mobility. The relationships between the variables of interest and mobility were investigated using correlation coefficient analyses. Multiple regression analysis was run to investigate the impact of a set of predictor variables on mobility.

Results: A total of 168 people with lower limb amputation were included. Mobility had a significant association with age, comorbidity, occupation, Prosthesis Evaluation Questionnaire score, physical and mental component scores of SF-12, subscales of the Comprehensive Lower Limb Amputee Socket Survey, educational status, amputation cause, time since amputation, time since using the prosthesis, and socket insert type. In the final model of multiple regression analysis, the Physical Component Summary score of SF-12 showed the strongest predictor of mobility (beta = 0.40, p < 0.001).

Conclusions: Nonprosthetic factors play a significant role in mobility of people with nontraumatic unilateral transtibial amputation. Although some predictors, such as age and time since amputation, are immutable, clinicians may still enhance the mobility of this population through the utilization of health-related factors, such as improving their physical activity.

The International Classification of Functioning, Disability, and Health (ICF) provides a universal framework for assessing the functioning of any person. To facilitate the application of the ICF in practice, ICF core sets are being developed. This study is part of a project intended to develop an ICF core set for upper-limb amputation (ULA) and aims to identify relevant concepts included in the outcome measurements used in studies of ULA. Articles involving ULA aged 18 years or older from January 2011 to December 2021 were searched on Cumulative Index to Nursing and Allied Health Literature, SPORTdiscus, and Medical Literature Analysis and Retrieval System Online. We included studies with particular designs (randomized controlled trials, before/after studies, cross-sectional studies, and longitudinal observational studies) and published in English. Relevant concepts were extracted from measurements and linked to the ICF using linking rules, and a frequency analysis was conducted. Sixty-one of the 1272 identified publications were included, from which 86 measurements were extracted. Concepts extracted from measurements were linked to 129 ICF categories. Three hundred twenty-six (29.23%) of the 1115 concepts were related to body functions, 643 (57.66%) to activity and participation, 96 (8.60%) to environmental factors, 19 (1.70%) to body structures, and 6 (0.53%) to personal factors. Twenty-five (2.24%) were characterized as "nd-not definable." "Fifty-four" categories identified in at least 5% of the publications will be considered for inclusion in the final ICF core set for ULA during the consensus conference. This review provides information about the content of measures, and the identified ICF categories reveal the research perspective for developing an ICF core set for ULA.

Background: A significant number of Colombian farmers who are transtibial amputees are civilian victims of landmines. Current prostheses are inadequately adapted for agricultural work, resulting in functional challenges in this context.

Objectives: This study aims to analyze and categorize the functional problems of transtibial prostheses in the Colombian agricultural context, incorporating perspectives from prosthesis users, manufacturers, and designers.

Study design: Descriptive qualitative research involving 49 transtibial amputees using prostheses and 18 professionals engaged in prosthesis design, manufacture, or prescription.

Methods: Participants were interviewed. Each interview was transcribed, and a conventional content analysis was conducted to identify functional problems with transtibial prostheses in agricultural settings.

Results: Interviewees reported that sockets become loose from residual limbs, and soft sockets and socks are prone to damage and maladjustment. The prosthetic foot undergoes stress due to stiffness, causing cracks and accelerated deterioration. Fastening screws loosen, break, and rust, while cosmetic foam retains moisture, perforates, and deteriorates in sunlight. Prosthesis deterioration is exacerbated by weather, moisture, mud, tall grass, and uneven or sloping terrain.

Conclusions: Prosthesis designs should facilitate sweat drainage or quick drying to address issues with soft sockets and socks. Sockets should be padded to minimize residual limb injuries. Durable, low-cost, and easily replaceable soft sockets are essential for farming environments. Additionally, farmers need a prosthetic foot that flexes when caught in brush or walking on uneven/inclined surfaces, allowing movement in two physiological planes without compromising strength and durability.

Stroke is the main cause of acquired adult disability globally, with motor impairment affecting 80% of people after stroke. To regain mobility, diminish falls, and improve quality of life (QoL), after a stroke, orthoses are recommended. Most studies, to date, have focused on the positive impact of ankle-foot orthoses on spatial-temporal, kinematic, and kinetic outcomes. The objective of this review is to assess the evidence of the effects of lower-extremity orthoses on perceptions of QoL, psychological well-being, and social participation after stroke. The following databases were used to search the literature: CINAHL, EMBASE, Scopus, and PubMed, between 1990 and 2022. Previous reviews and reference lists were also screened. Information on the trial design, sample characteristics, information of orthoses used, outcome measures, and results were extracted. Critical appraisal was conducted using SIGN guidelines. Ten articles were identified as meeting the inclusion criteria. The effect of orthoses on QoL was inconsistent: 4 articles reported a positive relationship, one found a negative relationship, and 3 did not find any relationship. Six of 7 articles reported a positive relationship between the use of orthoses and psychological well-being and participation, although the level of evidence was low. This literature review has identified a small number of articles addressing the research question. Furthermore, varied study designs, low levels of evidence seen, the variation in follow-up times, and the limited information about the fitting and appropriateness of the orthoses in the studies highlight that more research is needed.

Background: Microprocessor knees (MPKs) improve the functional mobility, quality of life, and safety of individuals with a knee disarticulation or above knee amputation and are cost-effective when adjusting for quality-of-life years gained. However, few studies have been conducted on the K2 population, and to this point, the Centers for Medicare and Medicaid Services has not covered MPKs for the K2 population.

Objectives: The aim of this study was to determine the extent to which MPK provision to the K2 population is cost effective at the person and population levels. A secondary objective was to determine the effectiveness of MPKs at reducing injurious falls within the K2 population.

Study design: A retrospective cohort study using Medicare fee-for-service claims data from the Centers for Medicare and Medicaid Services.

Methods: Propensity score weighting using inverse probability treatment weights was used to balance beneficiary characteristics and a generalized linear regression with log-link function and Gamma distribution was run to determine per-member-per-month cost and prosthetic device cost. A 10-year Congressional Budget Office-style score was conducted. A logistic regression was run for the fallers analysis.

Results: Microprocessor knee provision to K2 beneficiaries reduced injured fallers by 18.5% and resulted in medical savings of $1,351 per-member-per-month, amortizing the $25,075 difference between the MPK and nonmicroprocessor knee in 19 months. Providing MPKs to K2 users resulted in cumulative Medicare savings of $410.3 million over 10 years.

Conclusion: The MPK prosthetic device could provide meaningful safety benefits to the K2 population and result in fiscal savings to Medicare at both the person and population levels.

Background: Participation in physical activity (PA) for health by people with transtibial amputation (PTTA) may moderate comorbidities experienced by this population. It is more likely that interventions which aim to increase participation by PTTA in PA for health will increase participation if the type of PA used is tailored to the preferences of the PTTA.

Objective: This study aimed to identify the types of PA performed by PTTA, the types of PA PTTA who performed no physical activities would like to adopt, and if these outcomes were influenced by the cause of amputation.

Methods: The cross-sectional survey was accessible through an online survey tool and in paper format. It was distributed primarily at sports events and relevant locations, which support people with limb differences. A total of 115 PTTA adults (both active and those who did not perform any physical activities) completed the survey, consisting of 65 people with amputation due to traumatic causes and 50 people with amputation due to nontraumatic causes.

Results: From all PTTA respondents, the most popular current activities were walking (N = 42), going to the gym (N = 39), swimming (N = 35), and cycling (N = 32). For PTTA who did not perform any physical activity, the most popular PA they would like to participate in were walking (N = 10), going to the gym (N = 8), swimming (N = 7), and cycling (N = 6). While there are differences in the hierarchy of popularity of different types of PA depending on the cause of amputation, these results indicate some consistencies.

Conclusions: Walking, going to the gym, swimming, and cycling appear throughout the results, indicating a potential to encourage PTTA participation in PA for health through these activities.

Background: Energy Storage and Return (ESAR) prosthetic feet provide improved walking when compared with previous designs. However, it may not mimic the unimpaired smooth and progressive movement of the foot on the floor (foot rollover).

Objective: To characterize the temporal foot rollover of participants with unilateral transtibial amputation using an ESAR prosthetic foot.

Study design: Cross-sectional.

Methods: Plantar pressure data were collected from 11 participants with unilateral transtibial amputation using ESAR prostheses (2 females, mean age 37 ± 10 years, activity levels K2-K4) and 9 unimpaired participants (3 females, mean age 33 ± 10 years). The Initial Contact, Final Contact, and Total Contact times of 7 areas of the feet (unimpaired, intact, and prosthetic feet) were studied together with the duration of the Heel Rocker, Ankle Rocker, and Forefoot Rocker. Results were compared using a mixed analysis of the variance test.

Results: Statistical analysis revealed an interaction (P < 0.05) between foot and areas. The contact times were different (P < 0.05) between unimpaired and prosthetic feet for most foot areas. Furthermore, the prosthetic foot showed the longest duration of Heel Rocker (21.1 ± 8.5% of stance phase vs. 17.7 ± 10.2% for the intact foot and 15.7 ± 8.8% for the unimpaired feet, P < 0.05) and the shortest duration of Ankle Rocker (43.8 ± 18.1% vs. 47.2 ± 16.9% for the intact foot and 50.0 ± 13.4% for the unimpaired feet, P < 0.05).

Conclusions: Results suggest that the ESAR foot does not mimic the unimpaired foot rollover, especially in the contact pattern and the heel and ankle rockers. This might have an impact on efficiency and stability of gait.