Prosthetics and Orthotics International最新文献

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.

Background: Transfemoral and transhumeral amputees rely on socket prosthetics, which are susceptible to difficulties with fit, skin integrity, pain, and biomechanical disadvantage, ultimately decreasing prosthetic limb utilization. Osseointegrated percutaneous prosthetic systems may help eliminate these challenges. However, no study has identified the estimated number of patients who may be candidates for osseointegrated prosthetics.

Objectives: To indentify the estimated number of patients who may be candidates for osseointegrated prosthetics using the National Inpatient Sample (NIS) Database.

Study design: Observational.

Methods: We queried the National Inpatient Sample (NIS) database for all above knee amputations (AKA) and above elbow amputations (AEA) occurring between 2001 and 2014, in patients aged 22‒65, using International Classification of Diseases-9 procedure codes 84.17 and 84.07, respectively. International Classification of Diseases-9 diagnosis codes for the amputation were categorized as dysvascular, malignancy, prosthetic joint infection, trauma, and other. Weighted National Estimates (WNE) were calculated using NIS sampling weights. Amputations secondary to dysvascular conditions, prosthetic joint infections, or nonconnective tissue neoplasms were excluded as contraindications for osseointegration surgery.

Results: The NIS query revealed a WNE of 362,867 AKAs and 5544 AEAs performed between 2001 and 2014. Applying exclusion criteria, there were 1776 AKAs (WNE: 8444) and 415 AEAs (WNE: 1984). Seven patients had both AKA and AEA. A mean estimate of 603 transfemoral and 142 transhumeral amputees may be candidates for osseointegration each year.

Conclusions: Our analysis of the NIS reveals that 745 US civilians per year, including 603 AKA and 142 AEA patients, may be candidates for an osseointegrated percutaneous prosthetic system. This amounts to an estimated incidence of 2/million/year in the US population.

Background: Individuals with unilateral lower-limb amputation (LLA) are exposed to conditions such as low-back pain, which limit everyday activities and trunk musculature for stability.

Objective: To determine the trunk kinematics and muscle activation of lumbar-erector-spinae (LES) and rectus-abdominis during the instrumented timed-up-and-go (iTUG) test and its correlation with co-activation, muscle activation pattern, gait asymmetry, and center-of-pressure (CoP) sway measures between individuals with and without LLA.

Methods: The kinematic (trunk forward and lateral flexion, and rotation) and the ratio of muscle activation of LES over rectus-abdominis (LRR) were compared between LLA (n = 26) and the control (n = 16) performing the iTUG test, gait (symmetry-index [SI], co-activation index, and muscle activation pattern), and static test (measures of CoP sway).

Results: The LLA group showed greater alterations in balance indicators than the control (iTUG duration, gait SI, weight-bearing SI, CoP-excursion, and CoP-velocity). The trunk's kinematic variables were higher during turn-to-sit than in sit-to-walk, but the LRR was higher during sit-to-walk. The turn-to-sit peak-angular-velocity significantly correlated with the LRR, co-activation index, gait SI, weight-bearing SI, and the measurements of CoP sway.

Conclusions: The peak-angular-velocity of the turn-to-sit component indicates balance impairment and trunk muscle disorders better than the iTUG duration or turning times. Slow turning movements may be linked to increased CoP sway, gait and weight-bearing asymmetries, and muscle activation issues in the LES during daily activities, which could raise the risk of low-back pain over time.

Background: The growth dynamics of the amputated limb are currently unknown for children, affecting prosthetic provision and child's overall wellbeing.

Objective: The objective of this study was to investigate the growth patterns of the residual limbs of children with a transtibial traumatic amputation.

Study design: A retrospective observational cohort study of anthropometric data from Cambodia was conducted using casefile of 19 children with a transtibial unilateral traumatic amputation (>100 visits).

Methods: Anthropometrics of the lower limbs were correlated with age and limb length, and linear regression models were created to predict growth. Residual limb volume changes were estimated using a validated method.

Results: The growth rate of the proximal epiphysis of the residual limb was found to be stunted and grew 33.3% slower than would have been expected for typically developing proximal epiphysis growth. This stunted growth can be accurately predicted using the known growth of the contralateral limb (adjusted R2 = 0.743, p < 0.0001, r = 0.864). Residual limb size (girth, bone condylar width) was correlated with age and limb length and can be predicted using linear regression models (girth: adjusted R2 = 0.665, p < 0.0001, r = 0.663 with age and r = -0.338 with limb length; tibial condyle width: adjusted R2 = 0.61, p < 0.0001, r = 0.784). Residual limb percentage volume changes between prosthetic replacements were above the 10% threshold used for prosthetic replacement in adult cohorts over 60% of the cases.

Conclusions: This paper found that longitudinal residual limb growth is stunted because of growth plate injury and altered mechanics, paving the way for future research on novel rehabilitation interventions. The regression models developed can help prosthetists and prosthetic manufacturers design prostheses that accommodate growth. These data provide compelling evidence and hard data to prosthetists and manufacturers to better provide for children in this specific setting.

Background: Many individuals with Charcot-Marie-Tooth disease (CMT) use ankle foot orthoses (AFOs) to address balance and functional deficits.

Objectives: This study was conducted to further understand how individuals with CMT perceive the effects of AFO use on function.

Study design: Cross-sectional online survey.

Methods: Individuals with CMT provided free text responses to 3 questions: (Q1) What would you change about your orthosis if you could? (Q2) What activities does your ankle foot orthosis improve? (Q3) What activities does your ankle foot orthosis limit? Two independent reviewers evaluated responses and used an inductive approach to identify primary themes. Percent agreement between reviewers was calculated for each primary theme.

Results: A total of 310 individuals participated, and 5 primary themes were identified for each question. Q1 primary themes included ease of use or functionality, compatibility with shoes, durability, appearance, and comfort or fit. Q2 primary themes included walking, standing, balance and stability, physical health, and activities of daily life. Q3 primary themes were related to shoes or clothing, balance or inclines, mobility, long-term use, and general activities. Average percent agreement between reviewers was 63% (17%).

Conclusions: Study results align with previously reported data collected using patient-reported outcome surveys. In addition, participants highlighted concerns that are not usually addressed in orthosis-related questionnaires. These data emphasize areas of improvement for orthotic treatment relevant to individuals with CMT and which may help guide future research aiming to improve functional outcomes and compliance with orthotic interventions.

Ankle foot orthoses (AFOs) and foot orthoses (FOs) are 2 commonly prescribed lower limb orthoses. Traditionally produced using artisanal methods, the design and manufacture of these devices have increasingly used computer-aided design (CAD) and computer-aided manufacturing technologies in recent decades. The CAD workflows can vary considerably, making generalization of research findings difficult. In this scoping review, research studies of any design that reported using CAD to produce designs for AFOs or FOs were eligible for inclusion. The review was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Six electronic databases were searched till December 2024. Seventy-three articles were included in this review. A wide range of CAD programs was used to produce orthotic devices; however, the procedures and reproducibility of the design processes were poorly or not at all described in 46.6% of the included articles. A mix of general-purpose and orthotic-specific CAD software was recorded, with SolidWorks and Rhinoceros being the most popular options. OrthoModel and Rodin4D were the most reported currently available orthotic-specific CAD software for FOs and AFOs, respectively. The CAD operation time for general-purpose software was generally longer than that for orthotic-specific ones. In addition, we have developed a checklist to assist in standardizing and ensuring reproducibility of FOs and AFOs studies. Researchers, clinicians, and those in industry need to exchange their knowledge to help address real-world need, enhance CAD functionalities, and support CAD programs in clinical studies.

Background: Ankle-foot orthoses (AFO) design, including geometry and material selection, is tailored to meet specific clinical objectives. Understanding AFO mechanical behavior may provide insight into the effect of design considerations on the functional benefits to AFO users. Mechanical characteristics of AFOs are primarily assessed using strain gauges or computational modeling, both of which have limitations.

Objectives: Determine the test-retest reliability of weight-bearing carbon fiber dynamic AFO (CDO) surface strain measurements obtained using digital image correlation (DIC).

Study design: Prospective, randomized, cross-sectional reliability study.

Methods: CDO displacement and surface strain were measured at three strut locations using DIC while 30 participants deflected the CDO into dorsiflexion at three time points. Test-retest reliability of strain measurements was assessed by intraclass correlation coefficient (ICC), minimum detectable change (MDC), and percentage MDC values.

Results: Minimum detectable change and ICC values were between 0.005%‒0.010% and 0.14‒0.76, respectively. Intraclass correlation coefficient were generally higher at more distal strut locations and larger ankle dorsiflexion angles, with a mean ICC across locations of 0.55. Proximal strain was 31%‒59% lower than strain in middle and distal regions, respectively. Lower absolute strain values in the proximal location resulted in higher average relative measurement error (12.2%) compared to the distal and middle locations (4.4% and 6.5%, respectively).

Conclusions: Three-dimensional digital image correlation can provide reliable estimates of CDO surface strain, supporting its use for evaluating orthosis mechanical behavior. Better understanding of in vivo strain behavior across the CDO surface may assist with future device design and prescription to improve functional outcomes.