Prosthetics and Orthotics International最新文献

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.

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).

Rowing requires both the upper and lower body to be active for balance, steering, and propulsion, constituting a real challenge for athletes with disabilities. To our knowledge, adapted setups allowing pararowing for people with bilateral transfemoral amputation have not yet been described. This case report describes the adapted setup for Mr S, 24 years old, who underwent bilateral transfemoral amputation in 2019 after a motorcycle accident. He walks with 2 prostheses and practices high-level para-rowing in the Para-Rowing 2 single sculls category. We designed 2 prostheses consisting of a liner (Iceross Seal-In® X5 TF), an adapted socket, a knee (aqua-knee 3WR95), and a prosthetic foot (RushHiPro). We also designed a seat made of Plastazote and thermoplastic polymer foot rests. This equipment allows Mr S to wear his prostheses, which helps him to stabilize in the boat and to use maximum trunk amplitude during the rowing movement. However, the weight of the current equipment limits Mr S's performance. This case study demonstrates that it is possible to adapt equipment to allow an individual with double transfemoral amputation to perform pararowing at competition level.

Background: Numerous factors can affect mobility of individuals with lower limb amputation, including prosthesis-dependent, physical and psychological determinants.Objective:This study aimed to investigate the prosthesis and health-related factors of mobility in people with nontraumatic unilateral transtibial amputation.Study Design:Cross-sectional observational study.

Methods: Individuals with nontraumatic unilateral transtibial amputation who are using a prosthetic leg were included. All participants were asked to fill out the Prosthesis Evaluation Questionnaire, 12-Item Short-Form Health Survey (SF-12), Comprehensive Lower Limb Amputee Socket Survey, and 12-item Prosthetic Limb Users Survey of Mobility. The relationships between the variables of interest and mobility were investigated using correlation coefficient analyses. Multiple regression analysis was run to investigate the impact of a set of predictor variables on mobility.

Results: A total of 168 people with lower limb amputation were included. Mobility had a significant association with age, comorbidity, occupation, Prosthesis Evaluation Questionnaire score, physical and mental component scores of SF-12, subscales of the Comprehensive Lower Limb Amputee Socket Survey, educational status, amputation cause, time since amputation, time since using the prosthesis, and socket insert type. In the final model of multiple regression analysis, the Physical Component Summary score of SF-12 showed the strongest predictor of mobility (beta = 0.40, p < 0.001).

Conclusions: Nonprosthetic factors play a significant role in mobility of people with nontraumatic unilateral transtibial amputation. Although some predictors, such as age and time since amputation, are immutable, clinicians may still enhance the mobility of this population through the utilization of health-related factors, such as improving their physical activity.

Background: Individuals with lower limb amputation have increased risk of developing knee osteoarthritis (KOA) in the intact limb, however there is little information regarding strength profiles in individuals with KOA with and without amputation.

Objective: To compare lower extremity strength in individuals with KOA with and without unilateral transfemoral (TF) amputation.

Study design: Descriptive laboratory study.

Methods: Seven participants with unilateral TF amputation (3F/4M, 58.0 ± 11.0 years, 172.7 ± 12.8 cm, 90.8 ± 19.1 kg, 38.8 ± 14.4 years after amputation) and symptomatic KOA in the intact limb and 9 participants with unilateral KOA (control (CON)) without leg amputation (4F/5M, 66.0 ± 9.9 years, 170.5 ± 10.7 cm, 86.8 ± 18.1 kg) participated in this study. Both groups completed strength testing on the involved limb with KOA and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire to meaure subjective function. Strength variables were mass-normalized.

Results: There were no significant differences between groups in age, mass, or height. The CON group reported significantly reduced subjective function on the KOOS total score (P = 0.049; d = 1.03) and KOOS symptoms scores (P = 0.047, d = 0.95) compared with the TF amputation group. A lower subjective function score indicates worse function. There were no other significant differences between groups on KOOS subcategories. The TF amputation group had significantly greater average isokinetic quadriceps torque (P = 0.05; d = 1.10), peak isokinetic quadriceps torque (P = 0.02; d = 1.36), and average isokinetic quadriceps power (P = 0.02; d = 1.38) compared with the CON group. There were no differences between groups in isometric knee extensor strength or any differences in knee flexor isokinetic or isometric strength.

Conclusions: The TF amputation group demonstrated greater isokinetic knee extensor strength in their intact limb with KOA compared with the CON group osteoarthritic limb; however, there were no differences in isometric strength. Furthermore, the differences in isokinetic strength may suggest that those with a history of leg amputation may require more strength and power in the intact limb to maintain daily activity and, therefore, may require greater thresholds of strength to protect the knee joint from cartilage degradation.