Prosthetics and Orthotics International最新文献

Background: The unavailability of validated outcome measures in local languages limits the extent to which the impact of prosthetic and orthotic devices can be assessed.

Objectives: This study examined the psychometric properties of the Khmer locomotor capabilities index (LCI-5) for use with lower-limb prosthesis users. An additional aim was to explore its psychometric properties when used on lower-limb orthosis users.

Study design: A cross-sectional design was used.

Methods: The Khmer version of the LCI-5 was administered to clients attending 3 prosthetic and orthotic clinics in urban and rural Cambodia. Internal consistency and floor and ceiling effects were evaluated. Exploratory Factor Analysis and Confirmatory Factor Analysis (CFA) were performed on independent samples of prosthesis user data. A separate CFA was conducted on a data from orthosis users.

Results: Four hundred thirty-seven clients completed the LCI-5. The data had high internal consistency; however, a significant ceiling effect was observed. For prosthesis users, the optimal solution arising from exploratory Factor Analysis and CFA was a 2-factor model. A modified 2-factor model produced an acceptable fit for orthosis users.

Conclusions: The results present a 2-factor structure of the Khmer LCI-5, which can be used to assess mobility in prosthesis and orthosis users. It is important to note that the factor structure of the Khmer version is not consistent with the English version. Additional work is required to address ceiling effects associated with the Khmer LCI-5.

Background: During the alignment process, the 3D Laser Assisted Static Alignment Reference (L.A.S.A.R.) is clinically used to objectively aid rehabilitation teams to optimize static prosthetic alignment. Although this device is used routinely within the clinic, its reliability and validity are unknown.

Objectives: To assess the test-retest reproducibility and concurrent validity of the 3D L.A.S.A.R.

Study design: Clinimetric study.

Methods: In this cross-sectional study, participants using a unilateral transtibial bone-anchored prosthesis were recruited by convenience sampling. Reproducibility was assessed by calculating reliability (intraclass correlation coefficients [ICC]) and agreement parameters (standard error of measurement, smallest detectable change, and limits of agreement). Concurrent validity was assessed through ICC and limits of agreement.

Results: The reliability parameters (ICCagreement) ranged from 0.86 to 0.97, with a standard error of measurement (%) of 6.5%‒29.5% in 2D mode and 5.3%‒23.9% in 3D mode and smallest detectable change (%) of 17.9%‒81.6% in 2D mode and 14.6%‒66.1% in 3D mode with no systematic bias. Concurrent validity (ICCconsistency) ranged from 0.11 to 0.87, with systematic bias found between both systems in several perspectives.

Conclusions: The 3D L.A.S.A.R. shows very good to excellent test-retest reliability. However, the measurement errors exceeded clinically considerable deviations. Concurrent validity ranged between poor to very good. Further development of the 3D L.A.S.A.R. and research focusing on clinimetric properties such as responsiveness or interrater reliability is needed.

This study created an orthosis with several functions in addition to the triangular bandage. The triangular bandage positioned the forearm forward, suspended the arm from the neck, and secured the arm from the neck to the wrist. The design was modified from this limb position. Phase 1: Shoulder rotation was changed from extreme internal rotation to 30 degree internal rotation, Kapandji's physiological reference position (flexion/extension, 0 degree; abduction/adduction, 0 degree; rotation, 30 degree internal rotation position), allowing for the partial use of the hand. Phase 2: The sling knot position was changed from the neck to above the ipsilateral shoulder to avoid neck pain. Phase 3: A sling with elbow pads and straps replaced the Velcro to prevent the knot from loosening. Phase 4: To prevent the shoulder straps of the sling from being pulled off by the forearm during external shoulder rotation, the twisted straps pass through the shoulder and forearm loops. Phase 5: Additional straps around the shoulder and axilla were placed outward to prevent the straps from falling off due to scapular movement. Because the humeral head is rotated 30 degree posteriorly, immobilization in the 30 degree internal rotation position of the shoulder joint improves scapulohumeral joint conformity and achieves rotator cuff equilibrium. Suspension from the ipsilateral shoulder also counteracts gravity and reduces the load on intrinsic muscles such as the rotator cuff. Allowing anterior-posterior pendulum motion not only stabilizes the trunk but can also be used for early range-of-motion training. The sling has evolved as an immobilization and a suspension device.

Stroke often leads to hemiplegia, significantly impairing walking ability. Traditional rehabilitation methods commonly use mechanical knee-ankle-foot orthoses (KAFOs) to stabilize gait, but these can restrict knee flexion and reduce walking efficiency. This study aimed to evaluate the feasibility and effectiveness of an Electric KAFO (E-KAFO) for stroke survivors with hemiplegia, using the Berg Balance Scale to determine its impact on walking function. Fourteen individuals with hemiplegia (mean age: 55.1 ± 13.7 years; gender: 12 males, 2 females; height: 168.2 ± 7.7 cm; weight: 67.1 ± 11.5 kg; duration after injury: 46.4 ± 44.1 months) were categorized into high-balance groups and low-balance groups based on their Berg Balance Scale scores. Participants underwent a multisession intervention program using the E-KAFO. Walking ability was assessed using the 5-m walk test, 3-minute walk test, and 6-minute walk test before and after the intervention with the E-KAFO. The results showed that the low-balance groups demonstrated significant improvements in all walking tests postintervention, whereas the high-balance groups did not show significant changes. These findings indicate that E-KAFO training may be more beneficial for patients with lower initial balance abilities. The study highlights the importance of assessing balance ability when considering the use of E-KAFOs in stroke rehabilitation, suggesting that individuals with poorer balance may derive the most benefit from such interventions.

Objectives: To investigate the physical abilities, satisfaction levels, and personal experiences of lower limb amputees in Malaysia and identify key determinants associated with these factors with a specific focus on their utilization of prosthetics.

Study design: A cross-sectional study.

Methods: This study recruited 70 people (34 transfemoral, 36 transtibial). Participants completed a comprehensive survey encompassing demographic information, amputation characteristics, details of prosthetic usage, physical capabilities, satisfaction levels, and reported challenges. All data were collected and analyzed using the SPSS software, with descriptive analysis and inferential statistics tests performed.

Results: On average, participants wore prostheses for over 10 h every day. However, limitations were noted in performing certain physical activities, such as sports and stair climbing. Satisfaction levels varied across different aspects, with the highest satisfaction reported for walking on flat and uneven surfaces, while walking on stairs yielded lower satisfaction. Commonly reported issues included perspiration-related problems, skin irritation, and piston-related difficulties. The study found that self-reported comorbidities were significant influencers and correlated with the physical capabilities, satisfaction, and experiences of prosthetic users, whereas the level of amputation exhibited a lesser impact.

Conclusions: This study reveals Malaysian lower limb amputees' prosthetic satisfaction and experiences. Key factors during design, fitting, and rehabilitation must be considered for improvement. Targeted interventions and further research are needed to address specific concerns in the Malaysian population.

Objective: To investigate whether wearing a neck brace during a sling exercise program positively affects craniovertebral angle, mechanical properties of neck muscles, and headache in adults with a forward head posture.

Methods: Thirty adults with forward head postures were randomly assigned to an experimental group (sling exercise wearing a neck brace, n = 15) or a control group (sling exercise without a neck brace, n = 15). All participants undertook the sling exercise program (3×/week for 4 weeks). The outcomes were the craniovertebral angle, the mechanical properties of muscles (tone, stiffness, elasticity), and headache. All the outcomes were measured before and after the 4-week training.

Results: The experimental group showed a significantly greater magnitude of decreases in mechanical properties of muscle and headache than the control group (frequency of splenius capitis: -3.0 Hz, F (1, 28) = 20.733, p < 0.001, ƞ 2 = 0.425; stiffness of splenius capitis: -67.4 N/m, F (1, 28) = 9.999, p = 0.004, ƞ 2 = 0.263; decrement of splenius capitis: -0.1 d, F (1, 28) = 6.188, p = 0.019, ƞ 2 = 0.181; frequency of upper trapezius: -2.8 Hz, F (1, 28) = 8.718, p = 0.006, ƞ 2 = 0.237; decrement of upper trapezius: -0.2 d, F (1, 28) = 5.194, p = 0.030, ƞ 2 = 0.156; frequency of sternocleidomastoid: -2.7 Hz, F (1, 28) = 8.561, p = 0.007, ƞ 2 = 0.234; stiffness of sternocleidomastoid: -112.8 N/m, F (1, 28) = 13.586, p = 0.001, ƞ 2 = 0.327; headache: -4.7 points, F (1, 28) = 7.221, p = 0.012, ƞ 2 = 0.205, respectively).

Conclusions: Wearing a neck brace while performing sling exercises might provide an effective means of relaxing neck muscles and reducing headaches in adults with forward head posture.

Lower-limb amputation (LLA) has a profound impact on functional mobility, which is essential for maintaining independence and quality of life. With a rising number of LLAs performed annually, particularly due to diabetes-related complications, understanding the factors that influence mobility outcomes is critical for optimizing rehabilitation strategies. This systematic review aimed to identify and evaluate prognostic factors associated with functional mobility in adults with LLA. A comprehensive literature search was conducted in PubMed, EMBASE, CINAHL, and Cochrane databases, supplemented by gray literature sources, following PRISMA-P guidelines. Eligible studies examined various prognostic factors affecting mobility outcomes, which were assessed for quality using the Quality In Prognosis Studies tool. Fourteen studies were included, encompassing prospective, retrospective, and cross-sectional designs. Identified prognostic factors were categorized into 4 key domains: sociodemographic, medical, physical function, and psychological. Age, sex, comorbidities, and level of amputation emerged as primary determinants of mobility, with psychological factors such as cognitive function and mental health also playing a significant role. Although higher amputation levels, older age, and multiple comorbidities were associated with reduced mobility, mental well-being and male sex were linked to better outcomes. Limited evidence was found regarding other potential predictors, including race/ethnicity, prosthetic use, balance, employment status, and activity level, highlighting the need for further high-quality research. These findings emphasize the importance of a multidimensional rehabilitation approach that considers both physical and psychological factors to enhance mobility and overall well-being in individuals with LLA.

Background: Individuals with amputation have a high prevalence of painful (PLP) and nonpainful limb sensations over a lifetime, and it has been suggested that phantom limb phenomena interfere with motor imagery ability because of loss of afferent information and brain reorganization.

Objective: To investigate the relationship between motor imagery and phantom limb painful and nonpainful sensations.

Method: Detailed data from 15 transradial amputees evaluated in the MeganePro project were acquired. The data collected were the motor imagery ability scores assessed using the Vividness of Movement Imagery Questionnaire-2 and PLP and painful limb sensations measures.

Results: A significant positive correlation was found between total external visual imagery score and phantom pain magnitude (r = 0.60, p = 0.01). In particular, a larger and stronger significant positive correlation was observed between the external visual imagery of the complex tasks, running (r = 0.57, p = 0.02), jumping sideways (r = 0.55, p = 0.03), and running downhill (r = 0.65, p = 0.001). In addition, a significant positive correlation was found between external and internal visual imagery scores corresponding to the activity "swinging on a rope" and phantom limb sensation average.

Conclusions: Our findings suggest a potential protective effect against PLP in subjects with the ability for more complex types of motor imagery, thus suggesting this modality of imagery may be a surrogate for better motor engagement and plasticity that would be protective against PLP, indicating that subjects with stronger motor cortex plasticity reserve would be protected against PLP.

Background: The dynamic stability during forward propulsion in the stance phase of prosthetic gait can be quantified using the center of pressure (COP). Although previous studies focused primarily on the single-limb support phase, COP movement during the double-limb support phase remains unclear.

Objective: This study quantitatively analyzed the weight-transfer mechanism during gait by examining the forward velocity of the combined COP and the duration of the loading response (LR) on the prosthetic and intact sides.

Method: This study conducted experiments involving 6 individuals with unilateral transtibial amputation and 11 able-bodied individuals. The participants were instructed to walk at 3 different speeds, and data were collected under each condition, using a 3D motion capture system. The peak value and timing of the forward velocity of combined COP in the LR were compared between the prosthetic and intact sides.

Result: Regarding the forward velocity of the combined COP in the prosthetic-side LR, the peak value was smaller at slow walking speeds and the peak timing tended to be delayed under all walking-speed conditions compared with the intact-side LR. These parameters during the prosthetic-side LR were similar to those of able-bodied individuals. Analysis of the LR duration revealed no consistent trend in the relative durations of the prosthetic-side LR and intact-side LR.

Conclusions: The results of this study suggest that individuals with unilateral transtibial amputation may employ a characteristic movement strategy during intact-side LR while the prosthetic side is in the pre-swing phase.

Restoring independent daily activity is crucial for patients with a lower extremity amputation. Amputations at or distal to the midtarsal level pose unique challenges, necessitating specialized prosthetic and orthotic interventions to improve functionality, wellness, and quality of life. The objective of this scoping review was to examine the impact of prosthetic and orthotic use on clinical and health care outcomes in adults with a minor lower extremity amputation. Following Arksey and O'Malley's framework and the updated Joanna Briggs Institute's methodology, a systematic search of MEDLINE, CINAHL, SPORTDiscus, APA PsycInfo, Scopus, and the Cochrane Database of Systematic Reviews, was conducted. Fifty-nine relevant studies, primarily originating from the United States of America and Australia, were included. Trauma (47.5%) and diabetes (35.6%) were the leading causes of amputation. The most reported biomechanical outcomes were gait alterations (49.2%), revealing deficits and improvements in spatiotemporal parameters (33.9%), and plantar pressure distribution (22.0%). Custom-made devices insertable into the shoe, such as toe fillers and foot orthoses, enhanced walking speed and plantar pressure distribution, whereas above-ankle devices were more effective than foot orthoses in more proximal amputations. Well-fitted devices increased satisfaction and quality of life, but economic impacts were less frequently addressed. Despite most of the included studies being case reports (23.7%), which have a higher risk of bias, the review underscores the essential role of prosthetic and orthotic prescriptions based on tailored patient-centered care. The findings highlight the need for higher-quality research considering cost, and a broader range of patient-related outcomes and experiences measures, including psycho-social aspects.