Prosthetics and Orthotics International最新文献

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: Multiple sclerosis (MS) affects the cognitive and motor domains. Muscle weakness often leads to abnormal gait. Several solutions are rising, including the use of passive exoskeletons.

Objective: The purpose of this study is to evaluate the effect of a first-ever use of a passive exoskeleton on walking ability in people with MS.

Methods: We recruited 50 persons with MS. All subjects were assessed using the 2-min walking test, the timed 25-foot walk test, and a two-stage rate of perceived exertion (RPE) without the exoskeleton (T0) and with the exoskeleton (T1).

Results: The data showed a significant decrease in walking endurance while the exoskeleton is worn (2-min walking test: T0: 65.19 ± 23.37 m; T1: 59.40 ± 22.99; p < 0.0001) and a not significant difference in walking speed on a shortened distance (T0: 15.71 ± 10.30 s; T1: 15.73 ± 11.86 s; p = 0.25). No significant differences were also found for the effort perception scale (RPE: T0: 13.24 ± 3.01; T1: 13.60 ± 2.9; p = 0.3). Seventy-two percent of subjects reported a positive or neutral global perceived effect.

Conclusions: The exoskeleton does not add any fatiguing or negative effects. Although the walking performance decreases, the overall perception of the subjects is positive. Further studies are needed to evaluate the effect of the exoskeleton on gait quality.

Background: Ankle-foot orthoses (AFOs) are a type of assistive device that can improve the walking ability of individuals with neurological disorders. Adjusting stiffness is a common way to customize settings according to individuals' impairment.

Objective: This study aims to design a variable-stiffness AFO by stiffness module and characterize the AFO stiffness range to provide subject-specific settings for the users.

Methods: We modeled AFO using bending beams with varying fulcrum positions to adjust the stiffness. To characterize the stiffness range and profile, we used the superposition method to generate the theoretical model to analyze the AFO numerically. The intrinsic deformation of the bending beam in the AFO is considered a combination of 2 bending deformations to replicate actual bending conditions. The corresponding experiments in different fulcrum positions were performed to compare with and optimize the theoretical model. The curve fitting method was applied to tune the theoretical model by adding a fulcrum position-related coefficient.

Results: The AFO stiffness increased as the fulcrum moved to the proximal position. The maximum stiffness obtained was 1.77 Nm/° at a 6-cm fulcrum position, and the minimum stiffness was 0.82 Nm/° at a 0.5-cm fulcrum position with a 0.43-cm thick fiberglass beam. The corresponding theoretical model had maximum and minimum stiffness of 1.71 and 0.80 Nm/°, respectively. The theoretical model had a 4.08% difference compared with experimental values.

Conclusions: The stiffness module can provide adjustable stiffness with the fulcrum position and different kinds of fiberglass bars, especially the thickness and material of the beam. The theoretical model with different fulcrum positions can be used to profile the real-time stiffness of the AFO in a dynamic motion and to determine the appropriate dimensions of the bending beam.

Background: Despite the demonstrated greater efficacy of microprocessor knees (MPK) over mechanical knees (MK), the latter is still widely used by persons with transfemoral amputation. Besides motivations related to local insurance policies, quality of life (QoL) and satisfaction with the prosthesis play a key role in user preference.

Objective: The aim of this study is to compare QoL and satisfaction in a large sample of MPK and MK users and to assess how these outcomes are explained by clinical and demographic characteristics.

Study design: Retrospective study.

Methods: The study was conducted on 75 MPK and 60 MK users. Quality of life was assessed using the EuroQoL Five Dimensions and the EuroQoL Visual Analog Scale questionnaires. Satisfaction was assessed with the Satisfaction with Prosthesis questionnaire. All 3 instruments were self-administered. Univariate and multivariate regression analyses were conducted thereafter.

Results: The difference in satisfaction between MPK and MK users was not statistically significant. Significant differences were observed instead for QoL. From the univariate regression analysis, 6 factors were significant predictors of QoL and satisfaction. On multivariate analysis, the number of significant factors was reduced to 3, namely knee type, age at the first prosthesis, and experience with prosthesis. Type of knee and age at the first prosthesis significantly predicted QoL scores, explaining 12% of EuroQoL Five Dimensions and 25% of EuroQoL Visual Analog Scale variances. Age at the first prosthesis and experience with prosthesis predicted Satisfaction with Prosthesis scores in the multivariate model, explaining 25% of the variance.

Conclusions: MPK affects QoL but not satisfaction, which is positively driven by patients' experience with prosthesis and negatively affected by the age at the time of the first prosthesis.

Background: Individuals with disabilities in low- and middle-income countries face barriers to rehabilitation services, including prosthetic care. Many countries, such as Ecuador, have adapted policies toward achieving universal health care coverage. For optimal functional outcomes, understanding the physical potential of prosthetic users is critical for appropriate prosthetic services.

Objective: To determine the association between the functional level of Ecuadorians with lower-limb amputations and the functional level of their prosthetic componentry.

Study design: Retrospective study.

Methods: A data set containing functional level (K-Level) of Ecuadorians with lower-limb amputations and the K-Level of their prosthesis was analyzed.

Results: A diverse cohort of 164 participants with unilateral lower-limb amputation was recruited. Most participants were male (76.8%) with transfemoral amputations (56.1%) due to traumatic causes (51.2%). There was a small, positive, and statistically significant correlation between participants' functional levels and prosthetic componentry. Participants's functional levels were typically superior (median = 3) to their prostheses' functional abilities (median = 1), and 37.2% of participants did not have a prosthesis at the time of assessment.

Conclusions: These data indicated that participants whose physical ability exceeded basic ambulation lacked access to prostheses to match their functional abilities. The detailed disparity between physical potential and prosthetic access derived from the study's analysis supports investment into high functioning prosthetic componentry and further investigation into where gaps in care exist.

Background: This study explored how inpatient exercise rehabilitation affected prosthetic mobility, function, and ambulation in persons with lower limb loss.

Methods: In this explorative prospective nonrandomized intervention study, experienced (EXP-INT, n = 20) and new prosthetic users (NEW-INT, n = 18) completed a 4-week rehabilitation intervention. A control group of experienced prosthetic users (n = 19) received no intervention. Tests were performed at baseline (pretest) and after 4 weeks (posttest). A step-monitoring device recorded ambulatory activity.

Results: For the primary outcome measure, Prosthetic Limb Users Survey of Mobility, the between-group analysis revealed significant differences (χ 2 = 10.91, df = 2, p < 0.01). Within-group Prosthetic Limb Users Survey of Mobility T-scores improved by 8.1% for the EXP-INT ( p < 0.01) and 15.1% for NEW-INT ( p < 0.01). Significant between-group differences were observed for the Amputee Mobility Predictor, L-test, 2-minute walk test, and 10-meter walk test. Within-group analysis demonstrated nonsignificant changes for the EXP-INT except for Prosthetic Limb Users Survey of Mobility, while the NEW-INT improved by 24.1% ( p < 0.001), 34.0% ( p < 0.01), 46.5% ( p < 0.05), and 31.0% ( p < 0.01), respectively. The number of steps during the last 7 d of rehabilitation showed significant differences between the groups (χ 2 = 13.99, df = 2, p < 0.001). The NEW-INT improved by 138% ( p < 0.05) compared with the first 7 d of rehabilitation, while the EXP-INT had nonsignificant changes.

Conclusions: A 4-week rehabilitation intervention substantially increased prosthetic mobility, function, and ambulation activity for new prosthetic users but less so for experienced users. The results of the NEW-INT at discharge signify a considerable functional improvement.

Background: Prosthetic embodiment is the perception of the prosthesis as a part of the body, and it is important for acceptance and adequate and effective use of the prosthesis.

Objective: The aim of this study was to investigate the validity and reliability of the Turkish version of the Prosthesis Embodiment Scale for Lower Limb Amputees.

Methods: This cross-sectional study included a total of 88 lower limb amputees. Internal consistency was evaluated using Cronbach α coefficient. The test-retest reliability of the scale, which was reapplied after 7-10 d, was evaluated using intraclass correlation coefficient. Principal component analysis with Varimax rotation was used to analyze the factor structure. Spearman correlation coefficient with Trinity Amputation and Prosthesis Experience Scale subscales was calculated for concurrent validity.

Results: The mean age of the participants was 45.13 ± 15.05 years, and 76.1% were male. Internal consistency (Cronbach α = 0.905) and test-retest reliability (intraclass correlation coefficient = 0.822) were high. 76.1% of the total variance could be explained by the 3 dimensions. Significant correlation was found with the Trinity Amputation and Prosthesis Experience Scale subscales (r = 0.542 for psychosocial adjustment subscale, r = -0.452 for activity restriction subscale, r = 0.490 for prosthesis satisfaction subscale, p < 0.001).

Conclusions: The results of this study showed that the Turkish version of the Prosthesis Embodiment Scale for Lower Limb Amputees is a valid and reliable tool that can be used to evaluate prosthetic rehabilitation outcomes.

Background: Outcome measures (OMs) are useful tools; however, clinicians may find implementing them into clinical practice challenging.

Objectives: To characterize Canadian prosthetists' use of OMs for people with lower-limb amputation, including motivations for use, comfort selecting OMs, resources available for administration, and barriers to implementation.

Methods: A cross-sectional study was conducted between March and July 2021. Orthotics Prosthetics Canada sent Canadian prosthetists an invitation to take the online survey.

Results: Forty-nine Certified Prosthetists completed the survey. Only 16% of participants reported that they were expected to use OMs. Participants reported being more comfortable administering performance-based OMs than self-report surveys. More than two-thirds of participants agreed that OMs "can be administered with knowledge they have" and are "within their scope of practice." However, less than 25% agreed that OMs are "administered in a standardized way in the profession," and less than 40% indicated they are "easy to make part of my routine." Participants reported they generally have time and space to do OMs, but there was no agreed-on reason to use them.

Conclusions: Use of OMs among Canadian prosthetists seems to be low relative to prosthetists in the United States. Education, financial incentives, or changes to professional expectations are likely needed to increase routine OM use. Efforts to improve the standardization of OM administration and ease the incorporation of OMs into routine practice may also increase use. Canadian prosthetists may elevate their standards of clinical practice and better understand the impact of prosthetic treatments on their patients by more routinely using OMs.

Background: Few studies have been published on the prosthetic management of bilateral upper limb amputees. Of particular interest is to study how a patient's use of his upper limb protheses had evolved over a 6-year period in the aim to decrease their rejection rate.

Case description and methods: Mr. D had undergone a bilateral upper limb amputation and had been fitted with 7 different prostheses in the past 6 years. Multiple validate instruments and analyses were then used to monitor the patient's fitting and choices.

Findings and outcomes: Initially, the left prosthesis was regarded as the dominant hand and the right one as the assistive power grip hand. However, the observational results showed that wearing only a left Greifer enabled the prosthetic user to perform the same tasks as with 2 prostheses. He has gained greater satisfaction and quality of life without losing his independence.

Conclusion: The patient seemed to make a functional choice over his worrying about his physical appearance in favor of the efficiency of his prosthesis, which was essential for his everyday life, when he decided to wear only nonanthropomorphic prosthesis.