Prosthetics and Orthotics International最新文献

Introduction: Upper limb prosthetics aim to restore function and aesthetics of a lost arm and/or hand, which affects a growing population. A "Golden Period," the first month after the amputation, has been identified as the optimal time when a prosthesis should be fitted to amputees to maximize their chances for a fast and successful return to their daily life. This time window is often surpassed because of delays in approvals by health insurance companies and time requirements for producing personally customized and costly sockets. This study aims to develop an adaptable and versatile temporary transradial socket design capable of multidimensional adjustments and easy user fitting to better capitalize on the "Golden Period" and allow for early prosthetic training. In addition, the socket should be useable within research in need for flexible prosthesis as well as a hybrid prosthesis within the context of bionic reconstruction.

Methods and material: The socket was designed, 3D printed, and assembled as a wearable prototype, hosting all relevant myoelectric hand components. The estimated satisfaction with the socket was evaluated in a monocentric, explorative study with both, prosthetic users and experts in the field.

Results and discussion: The proposed design is able to change its diameter and length. Moreover, according to the conducted survey, it is perceived as satisfactory with respect to both user needs and expectations of the experts. "Weight," "ease in donning and doffing," and "breathability" were rated particularly well, whereas an improved, more versatile, and smaller design is needed for broad clinical use.

Background: Cranial remolding orthoses are an effective treatment of deformational plagiocephaly. Typical treatment durations are well documented. However, treatment duration can be affected by multiple factors and may not be a true representation of the time necessary to achieve a successful clinical outcome.

Objective: This study compared the time to achieve a successful clinical outcome against the total treatment duration for cranial remolding orthosis therapy in infants with deformational plagiocephaly.

Study design: This is a retrospective study of infants treated for deformational plagiocephaly with a cranial remolding orthosis.

Methods:  A total of 300 infants with deformational plagiocephaly who were treated with a cranial remolding orthosis were grouped by corrected age at initiation of treatment and by severity of deformity. A successful outcome was defined as achieving a final cranial vault asymmetry of 5 mm or less. For the 226 infants who achieved a successful outcome, time to successful outcome and treatment duration were compared between the groups.

Results: The time to successful outcome depended on severity but not on age at initiation. The median time to successful outcome ranged from 6 weeks to 17.5 weeks, depending on the severity of the deformity. Time to successful outcome was significantly shorter than treatment duration for infants with an initial cranial vault asymmetry of less than 17 mm.

Conclusion: Current treatment durations for infants with moderate plagiocephaly may be longer than necessary. Estimated treatment time lines should be based on the initial severity of the infant's deformity.

There is an increased clinical use of elbow orthoses. It is important to consider patient experiences in their use. Patient-reported outcome measures (PROMs) serve as essential tools for gathering patient perspectives. This review provides a comprehensive list of PROMs used in clinical trials of elbow orthoses, and documents their properties, uses, and quality. A systematic literature search across PubMed, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature, and Web of Science identified 31 clinical trials of elbow orthoses that used PROMs as outcome measures. Subsequently, manual searches were conducted to report on each PROM's characteristics. A total of 15 different PROMs were used as outcome measurements in clinical trials that used an elbow orthosis as an intervention for 11 different conditions. Researchers can use this review to aid in making informed decisions about which PROMs to use for future clinical trials.

Stiffness of ankle-foot orthoses (AFOs) has been assessed using many methods; however, results are unstandardized due to varied testing conditions such as range of motion and speed. Therefore, the aim of this scoping review was to provide a state-of-the-space review of the studies that investigate AFO ankle stiffness in the sagittal plane and then provide insight into the details of the developed devices and protocols. Six electronic databases (MEDLINE, SCOPUS, Web of Science, CINAHL, EMBASE, and IEEE Xplore) were searched for studies from when indexing began to April 2024. Articles of any design that developed or used testing devices and/or protocols to assess AFO ankle stiffness in the sagittal plane were eligible. Seventy-two articles were included in this review, of which 51 developed mechanical testing devices/protocols to quantify AFO stiffness while 21 articles referenced existing methods. The most common apparatuses used in the primary studies were the universal testing machine and customized manual machines. Other methods included specialty automated devices, manual devices in a gait analysis laboratory, hanging weights, universal testing machine combined with motion capture, muscle training machine, and 6-axis robot arm. Ankle angle of the AFO was the most common controlled variable, followed by loading force. This scoping review comprehensively outlines the variety of devices and protocols used to assess AFO ankle stiffness in the sagittal plane. Many researchers chose methods that leveraged their available resources, demonstrating a variety of approaches. For future studies, we recommend that parameters chosen are justified, reliability studies are undertaken, and AFO design is adequately reported.

Background: Tilt-in-space and reclining functions are commonly used to improve comfort in ergonomic seating. However, fluctuations in shear (parallel) forces on the buttocks during postural changes may cause discomfort, yet this relationship is not well understood.

Objectives: To examine how combined use of tilt-in-space and reclining functions affects fluctuations in parallel forces on the buttocks, and how these fluctuations relate to subjective discomfort.

Study design: Cross-sectional experimental study.

Methods: Nineteen healthy adult males (mean age: 27.7 ± 10.3 years) participated. An experimental ergonomic chair was used under 2 conditions: 1 with a seat-cover assembly that conforms to the back shape, and a control condition with a flat back-support. Participants experienced a 10 degrees tilt-in-space and reclining angles from 100 degrees to 130 degrees. Fluctuations in parallel forces on the buttocks were measured using a force plate, and subjective discomfort was assessed with a visual analog scale. Stepwise multiple regression was used to analyze associations between force fluctuation and discomfort.

Results: The seat-cover assembly condition resulted in significantly lower visual analog scale scores (median: 4, interquartile range: 0-13) compared to the control (median: 46, interquartile range: 24-72; p < 0.01). Regression analysis revealed that only the fluctuation in parallel forces significantly predicted discomfort (β = 0.722, R² = 0.507, p < 0.01).

Conclusions: Fluctuations in parallel forces during tilt and recline use are significantly associated with discomfort. Ergonomic designs that reduce shear force variability may enhance seating comfort during postural adjustments.

Objectives: To explore the facilitators and barriers to community accessibility from the perspective of persons with lower limb amputation (LLA).

Methods: A qualitative study using an adapted version of the Photovoice methods described by Wang and Burris was undertaken. Analysis of the interviews and photos was conducted following thematic content analysis.

Results: Seven adults with LLA who were ambulating with a prosthesis at the time of the interview participated in the Photovoice interviews. From the interviews with the participants, 3 main themes were developed: (1) current state of accessibility, (2) impact of community inaccessibility, and (3) hope for the future. Participants described what accessibility currently involved in their community (eg, the positive and negative structures) as well as the impact of inaccessibility on their physical and emotional health. Participants also spoke about what improvements they would like to see in the future regarding community accessibility.

Conclusions: By using the Photovoice methods, participants were able to provide tangible examples of what influences their community accessibility. This study highlights the broad range of changes that could provide accessibility opportunities for individuals with LLA from simple changes (eg, adding handrails to arenas) to more complex changes (eg, improvements in parking lot accessibility).

Background: Assessing the fit and suitability of lower limb prosthetics is heavily reliant upon clinician observation and subjective feedback, often resulting in negative impacts on the comfort and quality of life of amputees. This is particularly important in the early stages of new socket fitment.

Objective: This paper aims to use optoelectronic motion capture to measure the 5 degree of freedom coupling effectiveness of a newly fitted prosthetic limb during the adjustment period (6 weeks) of an active transtibial amputee.

Methods: A 2-part calibration and trial data collection system was employed using Qualisys 3D motion capture, to track the relative position of limb and socket during walking trials. A single active transtibial amputee (27 male) was fitted with a new prosthetic socket and attended weekly data capture sessions using their prosthesis normally.

Results: Here, we present evidence for alteration in prosthesis-residuum coupling performance, notably, the average proximal/distal displacement (pistoning) increased from 3.36 to 10.60 mm at week 6 from the first fit, which further increased to 12.90 mm with the use of a single prosthetic sock. Participant reported Socket Comfort Score reduced from 9 to 7 during this time.

Conclusions: This pilot study provides new insight into the dynamic behavior of prosthetic sockets and could form the basis for larger studies determining a framework for safe and comfortable coupling limits.

Background: Little empirical evidence supports the widely held belief that early upper limb prosthesis fitting is associated with improved longer-term outcomes.

Objectives: To quantify the relationship between timing of initial prosthesis receipt and (1) continued prosthesis use, (2) hours of use, and (3) satisfaction.

Study design: Cross-sectional survey study of 698 Veterans with major upper limb amputation.

Methods: Participant characteristics were described by time to receipt of initial prosthesis. Logistic regressions examined relationships between receipt timing, prosthesis use, and odds of using a prosthesis ≥8 h/d. Linear regression examined the relationship between receipt timing and scores of the Trinity Amputation and Prosthetic Experience Satisfaction Scale satisfaction scale. Models controlled for potential confounders including age, gender, amputation level, race, ethnicity, amputation etiology, time from injury to amputation, years since amputation, and prosthesis type.

Results: Odds of current prosthesis use were lower with prosthesis receipt within 6-12 months (odds ratio: 0.56; 95% confidence interval [CI], 0.34, 0.92) and ≥12 months (odds ratio: 0.55; 95%CI, 0.32, 0.96) compared with within 3-6 months. Trinity Amputation and Prosthetic Experience Satisfaction Scale scores were -0.22 points lower (95%CI, -0.38, -0.06) for receipt within 6-12 months. Receipt timing was not associated with 8+ h/d of prosthesis use.

Conclusions: This nationally representative study of Veterans found initial prosthesis receipt within 3-6 months (compared with 6-12 months) was associated with increased odds of continued prosthesis use. Prosthesis receipt within 6 months was associated with greater prosthesis satisfaction.

Background: Ideally, an individual will undergo rehabilitation to optimize functional abilities with a prosthetic leg after lower-limb amputation (LLA). Using standardized outcome measures capable of capturing changes in prosthetic mobility provides the clinical utility necessary to evaluate treatment efficacy.

Objective: To assess the potential of the component timed-up-and-go (cTUG) in evaluating changes in basic prosthetic mobility tasks after a structured prosthetic training program.

Study design: Retrospective cohort.

Methods: Pre- and post-intervention data was analyzed from individuals referred to a prosthetic training program. Specific subtasks of cTUG were assessed (the 180° turn and sit-to-stand transitions), as well as the total time to perform the test.

Results: Complete data from 85 adults with unilateral LLA were analyzed. The study sample consisted of 75.3% of individuals with acquired LLA because of dysvascular causes, and 41.2% had transfemoral amputation. Individuals with transtibial amputation exhibited significantly faster performance of cTUG subtasks and total times than those with transfemoral amputation (P < 0.02). Stratified by amputation level, both groups exhibited significantly better cTUG scores upon final performance compared with initial performance in all subtasks and total time (P < 0.01). Furthermore, comparing cTUG times based on insurer (public or private insurance), individuals with private insurance generally outperformed those with public insurance, although significance varied based on amputation level.

Conclusions: cTUG exhibits the ability to capture changes in basic prosthetic mobility in individuals with varied causes and levels of LLA, enhancing confidence in the clinical utility of the test for measuring efficacy of interventions.

Background: Impaired muscle strength has been linked to increased fall risk in clinical populations (Hunter SW, et al. Risk factors for falls in people with a lower limb amputation: a systematic review. Amer Acad of Phys Med and Rehabil. 2017; 9(2):170-180). Limited studies have investigated muscle power output for individuals with lower-limb loss and high fall risk. This study aims to examine the effects of contraction speed on lower-extremity muscle power among 3 groups: control, nonfaller, and fallers with lower-limb loss.

Methods: Thirteen adults without lower-limb loss and 15 adults with lower-limb loss were recruited. Bilateral average power for hip, knee, and ankle was evaluated at 60°/s and 120°/s using a Biodex™ dynamometer. A mixed-model ANOVA was used to identify group and speed effects on muscle power.

Results: Sound limb hip extensor and flexor muscle power were significantly weaker in fallers compared with nonfallers (P = 0.048 and P = 0.43, respectively). Fallers were significantly weaker than control in sound limb hip extensor/flexor and affected knee extensor/flexor muscle groups, while nonfallers' sound hip muscle power was similar to the control. Significant speed effects were found in most muscle power values for control and nonfallers but only found in fallers' sound knee extensors.

Conclusions: Sound hip muscle weakness may contribute to a higher fall risk for individuals with lower-limb loss. Control and nonfallers with limb loss actively adjusted their muscle power output during higher velocity contractions, while fallers with limb loss could not adapt. Incorporating high-velocity power training may reduce fall risk in individuals with lower-limb loss.