Journal of Prosthetics and Orthotics最新文献

Introduction: During aquatic therapy, without a prosthesis, individuals with lower-limb difference are limited in navigating stairs or ladders, performing gait training, balance, and strengthening exercises. A noncustom prosthesis for individuals with transtibial limb difference in aquatic therapy, consisting of interchangeable sockets and pylons, does not exist. Dilatancy has not been applied within a socket to provide an accommodative shape for multiple users.

Objectives: This study explores the development and usability of an adjustable prosthesis, utilizing dilatancy, for aquatic therapy.

Study design: The design of this study is developmental.

Methods: Participants underwent an informed written consent process (IRB STU00219525). Three individuals (1 male, 55 years; and 2 female, 47 and 22 years) with unilateral transtibial amputations were recruited. A set of interchangeable adjustable sockets and pylons were developed. Utilizing dilatant properties, small particles under vacuum were assessed for their ability to provide a rigid, lightweight, and remoldable pouch within the socket. Participants trialed the prosthesis during two fittings and three aquatic therapy sessions. Upon completion, participants and treating therapists completed the System Usability Scale. Survey results were converted to a 100-point scale. Time to don the prosthesis was recorded, and socket comfort scores at the final session were averaged.

Results: The System Usability Scale indicated that the prosthesis was usable for aquatic therapy. Participant scores were 97.5, 95, and 87.5, and therapist's scores were 92.5 and 85 of a total possible 100. Average socket comfort scores were 10, 9, and 7.6/10. Times to don the prosthesis were 5:45, 5:32, and 4:10 (minutes:seconds).

Conclusions: This system functioned successfully as a noncustom prosthesis for multiple users in aquatic therapy from the participant and therapists' perspective.

Clinical relevance: The novelty of this system is utilizing a prosthesis for multiple users, improving the rehabilitation capabilities during aquatic therapy.

Introduction: Postural control and balance are necessary for activities of daily living. Passive prostheses that reduce ankle dorsiflexion/plantarflexion control can require different balance strategies compared with able-bodied individuals. Powered prostheses may restore ankle joint control and improve balance compared with passive prostheses. Muscle activity as the prosthetic control input leverages the human neural control system to directly modulate prosthetic dynamics. This study evaluates continuous myoelectric control during quiet standing tasks with an untethered electromechanically actuated bionic ankle prosthesis.

Methods: Six individuals with transtibial amputation conducted four 30-second trials of quiet standing for four standing conditions (Eyes Open, Eyes Closed, Eyes Open Foam, and Eyes Closed Foam) using their passive, prescribed prosthesis and a bionic prosthesis under two types of myoelectric control. One strategy solely used residual gastrocnemius muscle as input (GAS), whereas the second used the gastrocnemius and tibialis anterior (GAS+TA). Postural stability was evaluated via Total Excursion, Body Sway Area, and Prediction Ellipse Area center of pressure measures from force plates. We hypothesized that the bionic prosthesis would improve balance control compared with the passive prosthesis. We also quantified weight bearing of prosthetic and sound limbs. Participants completed a preference/sense of stability survey between the prostheses.

Results: We found no significant differences in individual prostheses and controllers across our four standing conditions, or between prostheses and controllers for a single standing condition for all center of pressure measures. Participants tended to increase weight on their sound limb from Eyes Open to Eyes Closed Foam conditions. Participants trended toward preferring myoelectric control, but there were no significant differences among prostheses.

Conclusions: Compared with a passive transtibial prosthesis, a myoelectrically controlled bionic prosthesis did not alter standing balance performance.

Clinical relevance: Our study did not demonstrate differences between the myoelectrically controlled bionic transtibial prosthesis and the prescribed passive prosthesis in balance control. It is possible that other metrics would be necessary to increase sensitivity in comparisons.

Background: Custom accommodative insoles have become the gold standard for managing plantar pressures and reducing ulceration risk in persons with diabetes. With advances in 3D printing technologies, methods of fabricating 3D printed accommodative insoles have emerged. Clinician feedback is imperative to developing a 3D printed accommodative insole that meets clinical needs and is more effective than the current standard of care.

Objective: To inform the development of 3D printed accommodative insoles by gaining clinician perspective on insole requirements and application of the digital workflow for seamless translation into the clinical setting.

Study design: Qualitative study.

Methods: Four focus groups with a total of 16 Orthotists were held, prompting discussions on the current standard of care accommodative insole and other 3D printed insoles we have developed. Sessions were recorded, transcribed, and main themes were derived from transcriptions.

Results: Review and analysis of the transcripts resulted in four main themes: 1) Reimbursement, 2) Durability, 3) Effectiveness, and 4) Workflow application in clinic.

Conclusions: The responses showed areas to focus improvements on the 3D printed insole design and ways to ease the transition into a clinical setting. Clinician support is crucial in the adoption of a new device to clinical practice. Their feedback is essential to ensuring the item meets the clinical needs and the workflow is not disruptive to the clinical setting.

Clinical relevance: Understanding clinician perspective on current SoC disadvantages and shortcomings, areas for improvement in the 3D printed insole fabrication, and what is feasible in clinic appointments will help inform insole design and aid in translating new 3D-printing technology to clinical care for improved patient outcomes.