Prosthetics and Orthotics International最新文献

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.

Background: Falls are a major concern for persons wearing a prosthesis. Little is known about the ability to rise from the floor among persons with a transtibial amputation (TTA).

Objectives: The objectives of this pilot study were to (1) identify movement strategies and performance time demonstrated when rising from the floor among persons with a transtibial prosthesis and (2) examine concurrent validity of the timed supine to stand test (TSST).

Study design: The study used a cross-sectional design.

Methods: Eleven participants (9 male; mean age 58.7 [SD 12.7] years) with a unilateral TTA participated. Participants completed a TSST and were observed for common motor strategies, including chair use and half-kneel transitions. Additional outcomes included the Activities-specific Balance Confidence Scale (ABC), Timed Up and Go Test, and Short Physical Performance Battery.

Results: The mean time to rise from the floor was 10.6 (5.6) s. There was a significant association between TSST performance and age (r = 0.67; P = .03), the ABC (r = -0.72; P = .01), and performance on the Timed Up and Go (r = 0.64; P = .04) and Short Physical Performance Battery (rho = -0.67; P = .007). Six participants (54.5%) required the use of external support (chair) to stand, and 6 (54.5%) initially led with the prosthetic limb to achieve half-kneeling with the prosthetic foot on the surface.

Discussion: Findings support that the TSST is related to physical performance, age, and ABC among persons with a TTA. A predominant strategy used to rise included the half-kneel position with the prosthetic limb leading. Descriptive findings offer practitioners strategies to teach clients to rise from the floor.

Background: Lateral wedge insole (LWI) is known to reduce abnormal mechanical stress in knee osteoarthritis; however, clinical improvement across cases varies. The increase in medial meniscal extrusion (⊿MME) during walking could describe the dysfunction of shock absolution and the reaction of mechanical stress in individual knee joints.

Objective: This study aimed to investigate whether the ⊿MME affects LWI responders.

Study design: Quasi-experimental design.

Methods: The ⊿MME during walking was assessed using a dynamic ultrasound technique. Knee adduction moment was evaluated using motion analysis. The activity of the patients during the study period was evaluated as the number of steps counted by the acceleration sensor, and the cumulative knee adduction moment (CKAM) was calculated. These parameters were obtained at the initial visit (baseline) and after intervention with LWI after 3 months (post-LWI), and are expressed as the rates of change. The global rating of change was assessed and compared after the intervention; the patients were classified as responders or nonresponders accordingly.

Results: Responders had a significantly higher reduction rate of ⊿MME than nonresponders (responder: 33.6% ± 14.4%, nonresponder: 14.8% ± 26.9%; P = 0.035), whereas there was no significant difference in rates of change in the number of steps, knee adduction moment, and CKAM between groups. The ⊿MME was significantly correlated with CKAM among the parameters of rates of change (r = 0.416, P = 0.034).

Conclusions: Reduction in mechanical stress in a laboratory setting does not directly affect the clinical response to LWI. The functional features of the meniscal hoop during walking can mediate the response to mechanical stress and help elucidate pain-relief mechanisms.

Background: Patients with stroke with hemiplegia often experience gait impairments and use ankle foot orthoses (AFOs) to support their walking. Despite the wide use of AFOs, the specific impact of dorsiflexion control in AFOs on gait parameters has yet to be clarified.

Objectives: This study aimed to evaluate the effects of 2 types of AFOs with different dorsiflexion control mechanisms on gait parameters in patients with stroke with hemiplegia.

Study design: A cross-sectional comparative study.

Methods: Eleven patients with stroke with hemiplegia were analyzed using 2 types of AFOs: a dorsiflexion-assisted AFO (Gait Solution Design®: GSD) and a bidirectional control AFO (WalkOn Trimable®: WOT). Gait analysis was performed using 3-dimensional motion analysis to measure gait speed, ankle plantarflexion moment, hip extension angle, shank inclination angle, and the percentage of terminal stance. Statistical analyses were conducted to compare the effects of GSD and WOT on these gait parameters.

Results: The GSD significantly increased ankle plantarflexion moment and shank inclination angle, supporting the heel rocker (HR) and ankle rocker (AR) functions. In contrast, the WOT significantly increased hip extension angle and the percentage of terminal stance, facilitating the Forefoot Rocker function.

Conclusions: For patients with stroke with impaired HR and AR function, dorsiflexion-assisted AFOs like GSD are preferable. For patients with established HR and AR function but impaired Forefoot Rocker, bidirectional control AFOs such as WOT are recommended.

Quadruple amputation is a rare situation that significantly limits daily activities. Driving is crucial for daily independence. However, there is little literature on the use of adaptive devices to enable individuals with multiple limb amputations to drive. This case study examined the return to driving of Mrs X, a 35-year-old woman who underwent amputation of all 4 limbs (bilateral transtibial, left forearm, and right carpal radius) because of peripheral necrosis following septic shock. After completing a multidisciplinary care and rehabilitation program, Mrs X was able to use customized prostheses and a vehicle specifically adapted to her needs. These modifications enabled her to operate a steering wheel, automatic gearbox, and direction controls. As a result, her driving license was revalidated by the authorities. Mrs X regained the ability to drive independently after her quadruple amputation using adapted prostheses and car controls. Mrs X is now able collect her daughter from school and to attend riding lessons, abilities which have contributed to improving her quality of life.

Background: Continuous training with expert monitoring is challenging and often restricted to hospitals or rehabilitation facilities.

Objective: To design a feedback system using orthotic devices and inertial sensors to align the pelvis and trunk in transfemoral amputee gait and to investigate its kinematic effects.

Study design: Within-subjects design.

Methods: Ten transfemoral amputees participated in this study. We developed a device that integrated an orthotic device and inertial sensor fixed to the trunk and pelvis, providing feedback. The participants performed walking trials without attachments, with only sensors with audible warning of inclination, with only the orthotic device, and with both the sensors and orthotic device.

Results: No significant differences in the similarity index parameters were observed under the 4 conditions; however, significant effects emerged in the trunk rotation and lateral bending ranges of motion (ROM; P < 0.05). Similar effects were observed in the anterior-posterior pelvic tilt, pelvic rotation, and lateral bending ROMs. The rotation and lateral flexion ROMs during the prosthetic leg stance phase decreased with combined orthotic device and sensor feedback or with only the orthotic device. Similarly, the lateral flexion ROM during the healthy leg stance phase decreased with sensor feedback. The pelvic lateral flexion ROM decreased during the prosthetic leg stance phase with only the orthotic device or combined sensor use, and rotation decreased with sensor-only feedback.

Conclusions: Unlike in the ROM, no noticeable change in the similarity index of the trunk or pelvis was observed. This combined feedback system may partially reduce compensatory movements in the trunk and pelvis during transfemoral amputee gait.

Background: Currently, clinicians use a ball of plasticine to measure contact between the end of amputated residual limbs and prosthetic sockets to assess distal-end fit.

Objectives: This study characterizes the forces required to deform plasticine and relates these to clinical decisions made about socket fit.

Study design: Cross-sectional study.

Methods: Loading thresholds for plasticine deformation were identified. Three different sized check sockets were loaded with a phantom limb, distal-end sensors, and in-situ plasticine. Three transtibial prosthesis users were recruited and completed a socket fitting assessment with distal end sensors and in-situ plasticine. Forces and deformations were recorded and compared with the thresholds and with prosthetist and prosthesis users' ratings of fit.

Results: Plasticine deformation associated with a "good fit" was associated with loads of 4.8-48.5 N for 7- to 8-mm balls and 15.5-148 N for 10- to 11-mm balls. Plasticine deformation magnitudes alone could not detect differences between sockets of various sizes for a standardized limb model. Distal-end force sensors could differentiate between sockets to some extent. In the 3 transtibial prosthesis users, plasticine and force measurements aligned with the "good fit" reported by the prosthetist and the end user.

C onclusions: This study has characterized the forces required to achieve clinically relevant types of plasticine deformation at the distal end of a socket. It has also related these plasticine deformations and distal-end force measurements to clinical judgements about socket fit in the clinic and end user ratings of comfort and fit. Future work should test these thresholds on end user and clinician ratings of poor fit.