Prosthetics and Orthotics International最新文献

Background: An important part of the orthotic treatment process includes performing adjustments to the shape or design of the orthosis to improve its fit and function. However, the ability to adjust 3D printed (3DP) materials is not well understood.

Objectives: (1) To evaluate the usability of completing adjustments on 3DP ankle foot orthoses (AFOs) vs. traditionally-fabricated AFOs, and (2) to explore orthotists' perspectives on the advantages, disadvantages, and similarities of adjusting 3DP materials and identify potential solutions for disadvantages.

Study design: Mixed-methods cross-sectional study.

Methods: Ten participating certified orthotists performed a sequence of predetermined adjustment tasks on 3DP AFOs. The Single Ease Question and the System Usability Scale (SUS) were compared between traditional vs. 3DP AFO adjustments. Semistructured interviews were conducted, and a thematic analysis identified key themes.

Results: Single Ease Question scores were significantly lower for 3DP adjustments in 50% of tasks. The mean SUS total score was significantly lower ( p < 0.001) for tasks completed on 3DP AFOs compared with traditional AFOs. The thematic analysis identified challenges related to aesthetics, heating, grinding, brittleness, and timing of adjustments. Several similarities and some minor benefits were also noted. Despite challenges, orthotists demonstrated optimism about the 3DP material and proposed several solutions for improvement including optimizing techniques and introducing postprocessing.

Conclusions: 3D printed orthoses were more difficult to adjust and had lower usability for adjustment compared with traditional ones. However, orthotists felt that they would be able to use the material in clinical practice if some of the proposed solutions were implemented.

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: Recent therapeutic and technological solutions aim to improve the daily living of people with limb amputation by considering various aspects of the phantom limb, in particular painless phantom sensations (PS) and voluntary phantom movements (VPM).

Objective: Although previous research has explored these phenomena mostly without considering the prosthesis, this study investigates the influence of prosthesis wearing on painless PS, painful PS, and VPM, in people with lower-limb amputation.

Study design: Cross-sectional study based on semi-directed interviews.

Methods: Semi-directed interviews were conducted with 111 people with major lower-limb amputations. They described their phantom limb without and with the prosthesis, in a static seated position. The influence of the prosthesis wearing on the intensity of painless PS, painful PS, and on VPM ability was classified into 5 categories: disappearance, decrease, modification, increase, and appearance.

Results: Prosthesis wearing leads mostly to an increase of painless PS intensity (44%), a decrease of painful PS intensity (44%), and an improvement of VPM ability (47%). The study also highlights the richness of prosthesis-related changes, including modifications in phantom limb position, shape, and size. The influence of prosthesis wearing on phantom phenomena was not related to the presence of referred sensations, the amputation etiology, the level of amputation, the time since amputation, or the use of medication, but might be related to the pressure applied by the socket on the residual limb.

Conclusions: This study provides valuable information on the influence of the prosthesis on PS and may allow for better consideration of this relationship in the context of research, engineering, and rehabilitation.

Background: Energy storing and return (ESAR) prosthetic feet often provide high energy return at the cost of increased foot height, compromised appearance, and reduced flexibility. An ESAR foot, Ottobock Evanto, with a novel compact design has been introduced (novel foot).

Objective: To characterize user preference and benefits of a novel foot compared with the subject's previously worn (everyday foot) and comparator foot, Össur Pro-Flex XC.Study Design:Multicenter, randomized, nonblinded, cross-over trial (ClinicalTrials.gov, NCT05628064).

Methods: Transtibial amputees using ESAR feet were eligible. Outcome measures included perceived mobility, the extent of meeting amputees' needs, pain intensity, EuroQol 5-Dimension 5-Level, Activities-specific Balance Confidence, pain interference, foot preference, and walking experience. The first 3 measures with the novel foot vs. the everyday and comparator feet were used for primary objectives.

Results: Data from 20 participants were analyzed. For all primary outcomes, improved scores while wearing the novel foot were obtained. The change in perceived mobility vs. the everyday foot score was highly significant ( P = 0.0007). The novel foot was the most preferred foot overall (55% participants) and for many activities, e.g., walking on inclines (85%) and over uneven terrain (70%). Participants confirmed that the novel foot made walking up slopes easier (95%), standing more flexible (85%), and heel strike more comfortable (85%) vs. their everyday feet.

Conclusions: The novel foot offers advantages compared with the tested feet, including making walking on uneven terrain and slopes easier and more comfortable heel strike. Activities in which the novel foot would perform worse than the other feet have not been reported.

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: 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).

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: 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.