Prosthetics and Orthotics International最新文献

Background: Vertical displacement of the residual limb within transtibial prosthetic socket, often known as "pistoning" or downward movement, may lead to skin breakdowns and ulcers. Downward movement is particularly difficult to self-manage for diabetic individuals living with amputation because of diminished sensation in the residual limb from peripheral neuropathy. Therefore, a customizable sensor at the distal end that can alert the users when high-risk downward movement and pistoning occurs is urgently needed.

Objectives: Presented herein for the first time is a lightweight, inexpensive sensing system inspired by soft robotics that can detect the occurrence and severity of downward movement at the distal end.

Methods: The sensing system consists of a multilayered torus-shaped balloon, allowing easy integration with pin-lock socket systems. The design allows sensing of vertical displacement without imparting high reaction forces back onto the distal end. A benchtop compression tester was used to characterize system performance. Systematic and parametric benchtop tests were conducted to examine the sensor's physical characteristics. Long-term (24-h) stability of the sensor was also recorded.

Results: Compared with water, air was determined to be a better medium with a higher linear full-scale span (FSS) because of its compressible nature. Repeatable 0.5-mm vertical displacements yielded a linear (>0.99 R 2 ) FSS of 4.5 mm and a sensitivity of 0.8 kPa/mm. The sensing system is highly precise, with as low as 1% FSS total error band and average hysteresis of 2.84% of FSS. Over 24 h, a 4% FSS drift was observed.

Conclusion: Sensing system characteristics, coupled with low-cost, customizable fabrication, indicates promising performance for daily use to notify and alert transtibial prosthetic users of downward movement and/or pistoning.

Background: Self-aligning ankle feet have an increased range of motion and are marketed to improve compliance over uneven terrain and increase function and balance; however, much of the existing literature focuses on the biomechanical aspect of these prostheses as opposed to patient-reported measures.

Objective: To compare activities-specific balance confidence (ABC), health-related quality of life (HR-QoL), perceived mobility, gait speed, and step length before and after provision of a self-aligning ankle foot in the active unilateral transtibial prosthesis user.

Study design: Retrospective analysis of prospectively collected data.

Methods: Patient-reported and functional measures were captured for 85 users who were provided with a self-aligning ankle foot. Measures were recorded immediately before self-aligning ankle foot provision and again at 6 months afterward. The primary outcome was the ABC Score, along with the following secondary measures; HR-QoL using EQ-5D-5L Health Index Prosthetic Limb User Survey of Mobility and 10-meter timed walk test.

Results: The median age of the cohort was 55.2 years old and 71% were males, with the majority having their transtibial amputation due to trauma. There was a statistically significant improvement in ABC from 76 to 86% ( p < 0.001) with a medium effect size. There was no statistically significant improvement in HR-QoL ( p = 0.051), Prosthetic Limb User Survey of Mobility ( p = 0.043), time taken to walk 10 m ( p = 0.15) and step length ( p = 0.003).

Conclusions: Self aligning ankle feet increased ABC and step length with no detrimental effect on HR-QoL, perceived mobility or walking speed in those with a unilateral trans-tibial amputation.

The SARS-CoV-2 disease had a severe impact on global socioeconomic growth, and its harmful effects continue with virus mutation. Over the past 3 years, the pandemic has caused isolation, mental trauma, stress, financial losses, and various health complications in individuals. Recent reports have stressed the sufferings of the physically abled population. However, we should not neglect the challenges faced by the disabled population, which were more severe in many ways due to their dependency on others at various levels. The strategies implemented to contain the virus have further aggravated their sufferings and made it even worse because health care priorities were skewed toward public-centered care. As a result, it is difficult to determine the extent of care the disabled population received during the pandemic. Moreover, a single-centered study reports that amputations in India increased by 54.1% compared with those during the prepandemic era. This indicates the need for special attention to the physically disabled community, especially persons with movement disabilities. These individuals are partially dependent and have the potential to make significant contributions to the gross domestic product if included in the human resources pool. The Indian government had launched various initiatives to improve their living status. But delays in policy implementation, reduction in budget allocation, and the ongoing pandemic have derailed the efforts. For these reasons, this article emphasizes several challenges in movement disability care. In addition, it makes recommendations for improving the quality of life of persons with movement disabilities. These include collaboration, creating start-up businesses, applying state-of-the-art logistics, establishing a technological ecosystem, raising public awareness, accessing high-quality care, and using contemporary medical devices.

Background: Dart-throwing motion from radial dorsiflexion to palmar flexion has recently attracted attention as a functional movement direction of the wrist joint. We developed a novel artificial muscle-type dynamic traction orthosis (DTSaM) that includes these movements. This prospective crossover controlled study aimed to compare the traction effects in the presence and absence of DTSaM using computed tomography.

Methods: Healthy participants with no history of finger disease (6 men: 6 fingers, 4 women: 4 fingers; average age [range]: 29.4 [34-24] years) were examined. The distance and area of the joint space between the radiolunate (RL) and capitolunate (CL) joints were evaluated using 2 types of computed tomography: automatic movement and DTSaM.

Results: Participants with DTSaM showed more dilated joint space distance on the dorsal and central sides ( p < 0.05) and larger joint space areas on the dorsal side ( p < 0.05) of the RL and CL joints than those without orthosis. Significant differences in the magnitude of change in each joint were observed between the RL and CL joints regarding the joint space distance on the dorsal ( p = 0.021) and central ( p = 0.038) sides and the joint space area on the dorsal side ( p = 0.044).

Conclusions: The movement of the CL joint is important in the dorsiflexion direction. Our results suggest that the dilated CL joint allows dorsiflexion and that combined traction and dart-throwing motion exercises may be possible for wrist joint contracture.

This systematic review aims to assess and summarize the current landscape in exoskeletons and orthotic solutions developed for upper limb medical assistance, which are partly or fully produced using 3-dimensional printing technologies and contain at least the elbow or the shoulder joints. The initial search was conducted on Web of Science, PubMed, and IEEEXplore, resulting in 92 papers, which were reduced to 72 after removal of duplicates. From the application of the inclusion and exclusion criteria and selection questionnaire, 33 papers were included in the review, being divided according to the analyzed joints. The analysis of the selected papers allowed for the identification of different solutions that vary in terms of their target application, actuation type, 3-dimensional printing techniques, and material selection, among others. The results show that there has been far more research on the elbow joint than on the shoulder joint, which can be explained by the relative complexity of the latter. Moreover, the findings of this study also indicate that there is still a gap between the research conducted on these devices and their practical use in real-world conditions. Based on current trends, it is anticipated that the future of 3-dimensional printed exoskeletons will revolve around the use of flexible and high-performance materials, coupled with actuated devices. These advances have the potential to replace the conventional fabrication methods of exoskeletons with technologies based on additive manufacturing.

Background: After lower limb amputation, several prosthesis design options exist. However, prosthesis design decisions do not always reflect a prosthesis user's needs, values, and preferences.

Objective: To develop a patient decision aid (PDA) prototype for prosthetists and new prosthesis users facing prosthesis design decisions after lower limb amputation, and to assess its usability, accuracy, and comprehensibility.

Study design: Exploratory mixed methods.

Methods: PDA development was informed by a qualitative needs assessment and guided by the International Patient Decision Aid Standards. The PDA was evaluated by steering groups of experienced prosthesis users and prosthetic professionals (prosthetists and researchers) to test usability, accuracy, and comprehensibility through focus groups, individual interviews, and rating on a Likert scale ranging from 1 to 10.

Results: The resulting PDA included 6 sections: (1) Amputation and Early Recovery, (2) Communication, (3) Values, (4) Prosthesis Design, (5) Preferences, and (6) Prosthetic Journey. Usability, accuracy, and comprehensibility were rated as 9.2, 9.6, and 9.6, respectively, by prosthetic professionals, and 9.4, 9.6, and 9.6, respectively, by prosthesis users.

Discussion: The PDA incorporated guidance by relevant stakeholders and was rated favorably, emphasizing a need for shared decision-making support in prosthesis design. One challenge was determining the amount of information in the PDA, highlighting the diversity in end users' informational needs. Future iterations of the PDA should undergo beta testing in clinical settings.

Conclusions: A standardized, iterative method was used to develop a PDA for new lower limb prosthesis users and prosthetists when considering prosthesis design decisions. The PDA was considered useable, accurate, and comprehensible.

Background: Mobility is a major goal of prosthetic and orthotic rehabilitation, and use of outcome measures to evaluate mobility is necessary for good clinical practice. To support the use of outcome measures worldwide, work is needed to translate relevant instruments and adapt them for use in multiple cultures.

Objectives: The objective of this research was to use a standardized method to translate the Locomotor Capabilities Index-5 (LCI-5) into Khmer, the national language in Cambodia, and to evaluate its cultural integrity by assessing it with a group of prosthesis and orthosis users.

Study design: Instrument translation and cultural validation.

Methods: Two forward translations of the LCI-5 were produced and then reconciled into a single document. The Khmer version was back translated into English, and a group of experts reviewed the back translation. Two rounds of cognitive interviews were conducted with lower-limb prosthetic and orthotic users who provided feedback.

Results: During the reconciliation process, minor changes were made to 6 of the 14 items. Changes were most often made to better reflect the conceptual meaning of the original English version. Cognitive interviews resulted in the addition of a new response alternative.

Conclusions: Use of a standardized method to translate the LCI-5 resulted in a linguistically and culturally valid Khmer version of the instrument. Following appropriate psychometric testing, this instrument will facilitate measurement of mobility in prosthetic and orthotic clinical practice in Cambodia as well as support national and multinational research.

Background: After lower limb amputations, a decrease in gait capacity, even with prostheses, is common and persistent. Functional ability involves multiple constructs; therefore, several outcome measures, such as performance tests or self-report questionnaires, should be used to evaluate people with amputation who use prostheses.

Objective: To analyze the convergent construct validity of the Brazilian version of the Houghton scale in a sample of lower limb prosthesis users.

Methods: Volunteers selected were older than 18 years with any level of lower limb amputation and prosthesis use for at least 6 months. In this study, evidence of construct validity of the Houghton scale was established by the Spearman rho correlation with the Brazilian translation of the Prosthetic Limb Users Survey of Mobility and with the Physical Function (PF) and Emotional Well-being subdomains of the Medical Outcomes Study 36-Short Form Health Survey.

Results: Seventy-one volunteers were recruited for the study. The sample consisted mainly of men (70.4%) with a mean age of 50 ± 12 years. The primary cause of amputation was traumatic (53.5%), and most participants (54.9%) had a transtibial amputation. The Houghton questionnaire correlated strongly with the Brazilian translation of the Prosthetic Limb Users Survey of Mobility questionnaire (rho: 0.74, p < 0.01) and weakly with the PF and Emotional Well-being of the 36-Short Form Health Survey (rho: 0.06 and rho: 0.22, respectively, p > 0.05).

Conclusion: This study showed evidence of convergent construct validity of the Houghton questionnaire to measure and classify functional use of lower limb prostheses, with great value to clinical practice. Additional work is needed to assess other measurement properties in different samples.

Background: Prosthetic treatment options for people with ankle disarticulation (i.e., Syme amputation) are limited. Prosthetic feet designed for people with Syme amputation are often low profile to accommodate build-height restrictions, resulting in decreased energy return during gait. High-profile crossover feet that attach to the posterior proximal aspect of the prosthetic socket can bypass these restrictions and may promote a more physiologic gait pattern.

Objectives: To compare level-ground gait biomechanics and patient-reported outcomes between crossover and traditional energy-storing feet in people with Syme amputation.

Study design: Within-participant pilot study.

Methods: Both participants were fit with energy-storing and crossover feet and were randomized to the order they used the feet. Participants used each foot for 2 weeks before assessment. Step length symmetry, prosthetic ankle range of motion, prosthetic-side energy return, and peak sound-side loading were determined from motion capture data obtained in a laboratory. Mobility and balance confidence were measured using standardized patient-reported outcome measures. Foot preference was assessed with an ad hoc survey.

Results: Two participants with Syme amputations completed the study. Prosthetic ankle peak dorsiflexion and push-off power increased with the crossover foot compared with the energy-storing foot for both participants. Both participants reported an overall preference of the crossover foot. Changes in patient-reported outcomes did not exceed published minimum detectable change values.

Conclusion: Crossover feet increased prosthetic ankle range of motion and energy return compared with traditional energy-storing feet in this pilot investigation of 2 participants. Crossover feet seem to promote physiologic gait and may be a promising alternative to traditional low-profile feet for people with Syme amputation.