Prosthetics and Orthotics International最新文献

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.

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.

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: Passive prosthetic knees incorporate extension assist mechanisms to enhance the swing phase of the gait cycle for persons with above/through-knee amputations. In conventional polycentric knees using a 4-bar linkage, the extension assist mechanism connects one of the bars to the body of the prosthesis. However, this design introduces a singularity in the spring action delivery, causing the spring to push the knee into flexion beyond a certain angle. In contrast, polycentric prosthetic knees with an extension assist mechanism that links the upper and lower parts of the knee eliminate the singularity feature, ensuring that the knee is pushed toward extension throughout the full range of motion.

Objective: This study aims to investigate the effects of different spring extension assist mechanisms in polycentric knees on the walking capacity of unilateral above/through-knee amputees.

Study design: Repeated measures.

Methods: Gait data were collected at self-selected and fast speeds from 8 unilateral above/through-knee traumatic amputees using a 10-camera motion capture system. Participants trialed 2 different polycentric prosthetic knees with and without the singularity feature, both coupled with a solid-ankle-cushioned-heel prosthetic foot. They underwent gait analysis with both prosthetic knees, and a comparison analysis was conducted to examine the trial conditions.

Results: The symmetry between the prosthetic and intact knee flexion angles was higher for the design without singularity by 5.2% ( p = 0.025) at self-selected speeds and by 7.7% ( p = 0.003) at fast speeds. Also, peak prosthetic knee flexion angles were lower for the design without singularity by 9.4° ( p < 0.001) at self-selected speeds and by 9.6° ( p = 0.012) at fast speeds.

Conclusions: The extension assist mechanism without singularity improved the symmetry between the intact and prosthetic knee flexion angles by preventing excessive prosthetic knee flexion in the swing phase of the gait cycle.

Background: Females with lower limb amputations have different risk factors and lower success with their prostheses overall. Studying priorities of this population, specifically in how they differ between sexes, through survey methods may improve understanding of female-specific needs and inform sex-specific prosthetic design.

Objectives: To adapt the Prosthesis Evaluation Questionnaire and use this to assess sex differences in needs and priorities of people with lower limb amputations (pLLAs).

Study design: Cross-sectional questionnaire study.

Methods: A committee was formed to modify the Prosthesis Evaluation Questionnaire. The modified questionnaire was completed online by 26 pLLAs (13 females, 13 males). Sex differences in subscale and individual closed-question responses were analyzed using Mann-Whitney U tests. Sex differences in open-ended question responses were analyzed using affinity diagramming.

Results: Significant sex differences were found in subscale scores and separate closed questions, with resulting qualitative themes further suggesting sex-specific priorities and perspectives. Females reported lower satisfaction with prosthetic appearance, poorer overall ambulation abilities, and greater perception of social burden than males. Sex differences were also found in themes related to prosthesis satisfaction and other psychosocial factors including social adjustment.

Conclusions: Findings demonstrated all-encompassing sex differences in the priorities and needs of pLLAs. This work can be used to better understand and target female's unique priorities through sex-specific considerations in research and prosthetic design.

Background: After a stroke, activities of daily living (ADL) are often limited. Therefore, recovery of ADL and shortening of length of stay (LOS) are major challenges for patients with stroke. Thus, this study aimed to examine the relationship between the number of days from stroke onset to knee-ankle-foot orthosis (KAFO) wearing and ADL, LOS, and functional independence measure (FIM) motor subitems at discharge.

Objectives: Thus, this study aimed to examine the relationship between the number of days from stroke onset to knee-ankle-foot orthosis (KAFO) wearing and ADL, LOS, and functional independence measure (FIM) motor subitems at discharge.

Study design: This retrospective observational study included 107 poststroke participants (59 men and 48 women; median age, 71 years) who were prescribed KAFO.

Methods: This retrospective observational study included 107 poststroke participants (59 men and 48 women; median age, 71 years) who were prescribed KAFO. Patients were divided into 4 groups according to the quartiles (Q1-Q4) of days from stroke onset to KAFO wearing. The primary outcome was the FIM score at discharge.

Results: The median number of days from stroke onset to KAFO administration was 43. Functional independence measure, FIM-motor, and FIM-cognitive scores decreased significantly with increasing number of days from onset to KAFO wearing. In the multiple regression analysis, the number of days from stroke onset to KAFO wearing was associated with the FIM motor score and LOS ( P = 0.038 and P = 0.037, respectively).

Conclusions: Early KAFO wearing had a positive impact on the LOS and ADL, irrespective of stroke severity.

Objectives: To explore the rationale for prescribing ankle-foot orthoses and supramalleolar orthoses in children with cerebral palsy among pediatric orthotists in Australia.

Methods: Purposive, convenience, and snowballing sampling were used to recruit pediatric orthotists across Australia. Semistructured interviews were recorded and transcribed. The data were independently coded to derive themes and subthemes with illustrative first-person quotes.

Results: Participants (n = 16) in the sample were diverse in their age, years of clinical experience, and state of residence reflecting the breadth of pediatric orthotists in Australia. Two themes were generated: rationale for orthotic prescription and alignment of prescription rationale with child/family goals. Experienced clinicians could clearly articulate the key factors that influence their orthotic prescription aligned to the reasons why children/families sought orthotic intervention. Early to mid-career clinicians found this more challenging.

Conclusions: The rationale for the orthotic prescription should be aligned with the child/family's treatment goals. With a clear focus on treatment goals, the rationale for prescribing either ankle-foot orthoses or supramalleolar orthoses could be clearer if clinicians focused on key primary factors (eg, presence of crouch gait) and then optimized the prescription using a range of secondary factors (eg, body mass).