Pub Date : 2021-06-01DOI: 10.1097/JPO.0000000000000378
Rachel M. Thompson, E. W. Hubbard, C. Jo, Donald Virostek, L. Karol
ABSTRACT Introduction Despite successful bracing for adolescent idiopathic scoliosis (AIS), some curves progress after brace cessation. The purpose of this study was to identify the incidence, rate, and risk factors for progression after successful brace management of AIS. Materials and Methods Patients treated with orthoses for AIS were prospectively enrolled at brace initiation, followed through successful brace completion and, on average, for 33 months (range 12–95) after brace cessation. Inclusion criteria were curves 25° to 45° and Risser 0 to II at brace initiation with cessation at Risser IV with curves measuring <50°. Exclusion criteria were cessation before Risser IV or curve progression >50° during bracing. Demographics and radiographic measures were collected. Brace compliance was measured using Thermachron temperature sensor. Postbrace progressors were compared with nonprogressors using Mann-Whitney U test, Fisher exact test, and two-sample t-test. Results Eighty-five patients who completed bracing with final curves <50° were followed after brace discontinuation >1 year. Twenty-seven/85 (31.8%) progressed postbracing to surgical curve magnitude >50° (n = 12) or progressed >5° after brace cessation without progression to surgical magnitude (n = 15). There was no difference between progressors and nonprogressors in age or menarchal status at brace initiation or completion, nor was there a difference in curve magnitude or morphology at initiation. There was no difference in duration of or compliance with bracing. Patients with postbrace surgical progression completed bracing at 46° on average compared with 33° for those who did not progress to surgical magnitude (P < 0.0001). Patients who completed bracing at >45° had an incidence of postbrace surgical progression of 67%. No patients who completed bracing with curves <40° showed progression after brace cessation. Conclusions A total of 14.1% of patients successfully treated for AIS with bracing later progressed to surgical magnitude, and an additional 17.6% progressed >5° after brace completion. Findings suggest that patients with curves measuring >40° at brace completion should be followed into young adulthood. Counseling regarding the potential future need for surgery is warranted once a curve exceeds 45° in braced patients. Level of Evidence Level 2 prospective cohort study
{"title":"Is the Story Over? Progression After Bracing in AIS","authors":"Rachel M. Thompson, E. W. Hubbard, C. Jo, Donald Virostek, L. Karol","doi":"10.1097/JPO.0000000000000378","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000378","url":null,"abstract":"ABSTRACT Introduction Despite successful bracing for adolescent idiopathic scoliosis (AIS), some curves progress after brace cessation. The purpose of this study was to identify the incidence, rate, and risk factors for progression after successful brace management of AIS. Materials and Methods Patients treated with orthoses for AIS were prospectively enrolled at brace initiation, followed through successful brace completion and, on average, for 33 months (range 12–95) after brace cessation. Inclusion criteria were curves 25° to 45° and Risser 0 to II at brace initiation with cessation at Risser IV with curves measuring <50°. Exclusion criteria were cessation before Risser IV or curve progression >50° during bracing. Demographics and radiographic measures were collected. Brace compliance was measured using Thermachron temperature sensor. Postbrace progressors were compared with nonprogressors using Mann-Whitney U test, Fisher exact test, and two-sample t-test. Results Eighty-five patients who completed bracing with final curves <50° were followed after brace discontinuation >1 year. Twenty-seven/85 (31.8%) progressed postbracing to surgical curve magnitude >50° (n = 12) or progressed >5° after brace cessation without progression to surgical magnitude (n = 15). There was no difference between progressors and nonprogressors in age or menarchal status at brace initiation or completion, nor was there a difference in curve magnitude or morphology at initiation. There was no difference in duration of or compliance with bracing. Patients with postbrace surgical progression completed bracing at 46° on average compared with 33° for those who did not progress to surgical magnitude (P < 0.0001). Patients who completed bracing at >45° had an incidence of postbrace surgical progression of 67%. No patients who completed bracing with curves <40° showed progression after brace cessation. Conclusions A total of 14.1% of patients successfully treated for AIS with bracing later progressed to surgical magnitude, and an additional 17.6% progressed >5° after brace completion. Findings suggest that patients with curves measuring >40° at brace completion should be followed into young adulthood. Counseling regarding the potential future need for surgery is warranted once a curve exceeds 45° in braced patients. Level of Evidence Level 2 prospective cohort study","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"3 - 9"},"PeriodicalIF":0.6,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42785904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-29DOI: 10.1097/JPO.0000000000000373
C. K. Wong, C. Wong
ABSTRACT Introduction After amputation, altered sensory input leads to cortical reorganization that partly explains phantom limb pain (PLP). However, many factors impact the PLP phenomenon, and modern conceptualizations of chronic pain including PLP integrate both peripheral inputs and central interpretation. Clinicians without functional MRI could benefit from clinical measures related to PLP to assess clinical presentations. The purpose of this pilot study was to identify peripheral sensation and cognition measures related to PLP to inform outcome measure selection in future PLP research. Methods This cross-sectional analysis included people with PLP of any age, sex, and amputation cause or level. Assessments included patient-reported residual limb pain and PLP using the Prosthesis Evaluation Questionnaire, peripheral sensation measures (light touch, temperature, vibration, two-point discrimination), and cognition measures (laterality recognition, trail making, clock drawing). Unadjusted Spearman ρ coefficients were reported. Results Eleven volunteers (48.5 ± 13.2 years) with lower-limb amputations (seven transtibial) of various causes (nine medical) participated. More severe PLP symptoms were associated with impaired peripheral sensation (light touch, ρ = 0.514; temperature, ρ = 0.756) and poorer cognition (laterality recognition, ρ = 0.524; trail making, ρ = 0.565). Residual limb pain was not correlated with cognition measures (ρ < 0.4). Conclusions This pilot study identified clinical measures assessing cognition and peripheral sensation impairments associated with worse PLP symptoms. Phantom limb pain was related to temperature and light touch sensation measures, but two-point discrimination was not associated with PLP consistent with past research. Laterality recognition was associated with PLP per prior research, and the association of PLP with the Trail Making Test in this pilot study suggests that the Trail Making Test may be an additional cognition measure potentially useful in future clinical research to document the PLP experience.
{"title":"Relationships Among Phantom Limb Pain, Peripheral Sensations, and Cognition in People with Lower-Limb Loss","authors":"C. K. Wong, C. Wong","doi":"10.1097/JPO.0000000000000373","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000373","url":null,"abstract":"ABSTRACT Introduction After amputation, altered sensory input leads to cortical reorganization that partly explains phantom limb pain (PLP). However, many factors impact the PLP phenomenon, and modern conceptualizations of chronic pain including PLP integrate both peripheral inputs and central interpretation. Clinicians without functional MRI could benefit from clinical measures related to PLP to assess clinical presentations. The purpose of this pilot study was to identify peripheral sensation and cognition measures related to PLP to inform outcome measure selection in future PLP research. Methods This cross-sectional analysis included people with PLP of any age, sex, and amputation cause or level. Assessments included patient-reported residual limb pain and PLP using the Prosthesis Evaluation Questionnaire, peripheral sensation measures (light touch, temperature, vibration, two-point discrimination), and cognition measures (laterality recognition, trail making, clock drawing). Unadjusted Spearman ρ coefficients were reported. Results Eleven volunteers (48.5 ± 13.2 years) with lower-limb amputations (seven transtibial) of various causes (nine medical) participated. More severe PLP symptoms were associated with impaired peripheral sensation (light touch, ρ = 0.514; temperature, ρ = 0.756) and poorer cognition (laterality recognition, ρ = 0.524; trail making, ρ = 0.565). Residual limb pain was not correlated with cognition measures (ρ < 0.4). Conclusions This pilot study identified clinical measures assessing cognition and peripheral sensation impairments associated with worse PLP symptoms. Phantom limb pain was related to temperature and light touch sensation measures, but two-point discrimination was not associated with PLP consistent with past research. Laterality recognition was associated with PLP per prior research, and the association of PLP with the Trail Making Test in this pilot study suggests that the Trail Making Test may be an additional cognition measure potentially useful in future clinical research to document the PLP experience.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"89 - 94"},"PeriodicalIF":0.6,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45709837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-29DOI: 10.1097/JPO.0000000000000372
L. Frossard, Luciann Ferrada, Tanya Quincey, D. Berg
ABSTRACT Introduction This initial cost-effectiveness evaluation compared the provision of transtibial bone-anchored prostheses (TTA-BAPs) with socket-suspended prostheses (TTA-SSPs) over a 6-year time horizon from a governmental prosthetic care perspective. The purposes were to present ways we dealt with barriers encountered during the cost-effectiveness analysis. The objectives were to detail the extraction of baseline and incremental costs and utilities required to provide preliminary incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY). Materials and Methods This retrospective case-series study involved six participants fitted consecutively with TTA-SSP and TTA-BAP. Total costs combined actual and typical costs extracted from financial records and a schedule of allowable expenses, respectively. Baseline utilities were extracted from the literature, whereas incremental utilities were assumed. Results ICERs ranged between −$25,065 and $41,929 per QALY. Indicative ICER was approximately $11,400 per QALY. Provision of TTA-BAP was cost-effective and cost saving for 83% and 33% of cases, respectively. Discussion Educated choices were required to overcome unavailability of individual costs (e.g., creation of schedule of allowable expenses, blending of actual and typical costs) and utilities (e.g., extraction of baseline from literature, assumptions for incremental gain). Indicative ICER might lead to adoption of TTA-BAP, at least from an Australian governmental prosthetic care perspective.
{"title":"Cost-Effectiveness of Transtibial Bone-Anchored Prostheses Using Osseointegrated Fixation: From Challenges to Preliminary Data","authors":"L. Frossard, Luciann Ferrada, Tanya Quincey, D. Berg","doi":"10.1097/JPO.0000000000000372","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000372","url":null,"abstract":"ABSTRACT Introduction This initial cost-effectiveness evaluation compared the provision of transtibial bone-anchored prostheses (TTA-BAPs) with socket-suspended prostheses (TTA-SSPs) over a 6-year time horizon from a governmental prosthetic care perspective. The purposes were to present ways we dealt with barriers encountered during the cost-effectiveness analysis. The objectives were to detail the extraction of baseline and incremental costs and utilities required to provide preliminary incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY). Materials and Methods This retrospective case-series study involved six participants fitted consecutively with TTA-SSP and TTA-BAP. Total costs combined actual and typical costs extracted from financial records and a schedule of allowable expenses, respectively. Baseline utilities were extracted from the literature, whereas incremental utilities were assumed. Results ICERs ranged between −$25,065 and $41,929 per QALY. Indicative ICER was approximately $11,400 per QALY. Provision of TTA-BAP was cost-effective and cost saving for 83% and 33% of cases, respectively. Discussion Educated choices were required to overcome unavailability of individual costs (e.g., creation of schedule of allowable expenses, blending of actual and typical costs) and utilities (e.g., extraction of baseline from literature, assumptions for incremental gain). Indicative ICER might lead to adoption of TTA-BAP, at least from an Australian governmental prosthetic care perspective.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"33 1","pages":"184 - 195"},"PeriodicalIF":0.6,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46663198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-22DOI: 10.1097/JPO.0000000000000371
C. Noble, G. Fiedler
ABSTRACT Introduction The risk of accidental falls is greater in people with lower-limb loss than in their able-bodied peers. Most popular strategies to mitigate injuries from such falls include technical solutions that prevent falls or protect vulnerable body segments from destructive forces. Fall training is another effective intervention, but little evidence on its use in prosthesis users has been published. This research had the goal to investigate to what extent fall training is provided to the target population and what factors may be obstacles to its wider adoption. Methods An online questionnaire was developed and administered nationwide, targeting people with lower-limb loss. Descriptive statistics were used to describe the availability of fall training, and a logistic regression was performed to investigate variables that predict whether an individual receives fall training or not. Results A total of 180 responses was recorded, 166 of which were included in the analysis. More than two-thirds of respondents had not received fall training. Those who had physical therapy as part of their rehabilitation regimen were 3.7 times more likely to also have had fall training. Discussion Our data suggest that the potential benefits of providing fall training to people with lower-limb loss are not being fully realized. Interdisciplinary collaboration between prosthetists and therapists can help expand access to fall training interventions to better prepare patients for the likely event of an accidental fall.
{"title":"Preparing for the Worst or Hoping for the Best? The State of Fall Training in Prosthesis Users","authors":"C. Noble, G. Fiedler","doi":"10.1097/JPO.0000000000000371","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000371","url":null,"abstract":"ABSTRACT Introduction The risk of accidental falls is greater in people with lower-limb loss than in their able-bodied peers. Most popular strategies to mitigate injuries from such falls include technical solutions that prevent falls or protect vulnerable body segments from destructive forces. Fall training is another effective intervention, but little evidence on its use in prosthesis users has been published. This research had the goal to investigate to what extent fall training is provided to the target population and what factors may be obstacles to its wider adoption. Methods An online questionnaire was developed and administered nationwide, targeting people with lower-limb loss. Descriptive statistics were used to describe the availability of fall training, and a logistic regression was performed to investigate variables that predict whether an individual receives fall training or not. Results A total of 180 responses was recorded, 166 of which were included in the analysis. More than two-thirds of respondents had not received fall training. Those who had physical therapy as part of their rehabilitation regimen were 3.7 times more likely to also have had fall training. Discussion Our data suggest that the potential benefits of providing fall training to people with lower-limb loss are not being fully realized. Interdisciplinary collaboration between prosthetists and therapists can help expand access to fall training interventions to better prepare patients for the likely event of an accidental fall.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"135 - 139"},"PeriodicalIF":0.6,"publicationDate":"2021-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48714276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-21DOI: 10.1097/JPO.0000000000000366
Christina Lee, S. Engdahl, A. Riegger, Alicia J. Davis, Brian M. Kelly, D. Gates
ABSTRACT Introduction After upper-limb amputation, employment opportunities may be limited. Given the dramatic shift in the job market in the United States in the recent years, there is a need to examine the updated employment rates and the types of occupations to which individuals with amputation can return to. In this study, we assessed current employment status for people with upper-limb loss and determined whether these individuals needed to change jobs as a result of limb loss. Second, we examined whether demographic or impairment-specific factors were correlated with employment status or the need to switch jobs. Materials and methods Individuals with upper-limb amputation provided personal and employment information in an online survey. We explored the bivariate relationships between employment status and 11 personal factors (e.g., age at amputation, highest education level). Using the significant factors from this analysis, we built a logistic regression model for postamputation employment status. We also explored the relationship between these same 11 factors and the individuals' need to switch jobs after limb loss. Results A total of 199 and 160 respondents were deemed eligible for the employment status and job switch analyses, respectively. Of the working-aged respondents, 60.8% (121/199) were employed at the time of survey. Twenty-nine percent (47/160) reported needing to change jobs because of their amputation. Factors negatively associated with employment included having a bilateral amputation, lower education level, older age at amputation, higher pain frequency, and wearing a prosthesis less frequently. Higher education level was the only significant predictor of successful employment in the logistic regression model. There were no significant relationships between any factor and the need to change jobs after amputation. Conclusions The results suggest that individuals with upper-limb amputation have a lower employment rate than the national average. Future work should focus on understanding the reasons behind employment challenges in this population.
{"title":"Employment Status in Individuals with Upper-Limb Amputation: A Survey of Current Trends","authors":"Christina Lee, S. Engdahl, A. Riegger, Alicia J. Davis, Brian M. Kelly, D. Gates","doi":"10.1097/JPO.0000000000000366","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000366","url":null,"abstract":"ABSTRACT Introduction After upper-limb amputation, employment opportunities may be limited. Given the dramatic shift in the job market in the United States in the recent years, there is a need to examine the updated employment rates and the types of occupations to which individuals with amputation can return to. In this study, we assessed current employment status for people with upper-limb loss and determined whether these individuals needed to change jobs as a result of limb loss. Second, we examined whether demographic or impairment-specific factors were correlated with employment status or the need to switch jobs. Materials and methods Individuals with upper-limb amputation provided personal and employment information in an online survey. We explored the bivariate relationships between employment status and 11 personal factors (e.g., age at amputation, highest education level). Using the significant factors from this analysis, we built a logistic regression model for postamputation employment status. We also explored the relationship between these same 11 factors and the individuals' need to switch jobs after limb loss. Results A total of 199 and 160 respondents were deemed eligible for the employment status and job switch analyses, respectively. Of the working-aged respondents, 60.8% (121/199) were employed at the time of survey. Twenty-nine percent (47/160) reported needing to change jobs because of their amputation. Factors negatively associated with employment included having a bilateral amputation, lower education level, older age at amputation, higher pain frequency, and wearing a prosthesis less frequently. Higher education level was the only significant predictor of successful employment in the logistic regression model. There were no significant relationships between any factor and the need to change jobs after amputation. Conclusions The results suggest that individuals with upper-limb amputation have a lower employment rate than the national average. Future work should focus on understanding the reasons behind employment challenges in this population.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"79 - 88"},"PeriodicalIF":0.6,"publicationDate":"2021-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43737839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-21DOI: 10.1097/JPO.0000000000000367
Zachary A. Block, John T. Brinkmann, S. Gard
ABSTRACT Study Design This is a narrative review. Introduction Consensus techniques are an increasingly common research tool used to define levels of expert agreement on a topic where evidence is inconsistent or lacking. An assessment of commonly used consensus techniques can inform future education and research. Objective The aim of this study was to describe the use of various consensus techniques used in education and research in orthotics and prosthetics and closely related medical professions, to aid in choosing the most appropriate consensus technique for future research. Methods A systematic search of the literature was conducted using specific terms and keywords related to various consensus techniques, applications of consensus techniques in research and education, and medical disciplines related to orthotics and prosthetics. Studies were included if they described the use of a consensus technique for medical education or research and explained why the specific technique was used. Results Common consensus techniques were identified in the literature. To allow comparison of the techniques, the advantages, disadvantages, limitations, and previous applications of each were extracted from the literature. Conclusion Using the information from the literature, the most prevalent consensus techniques can be compared, aiding educators and researchers in choosing the technique most suitable for their topic of inquiry.
{"title":"The Utilization of Consensus Techniques in Education and Research in Medical Professions","authors":"Zachary A. Block, John T. Brinkmann, S. Gard","doi":"10.1097/JPO.0000000000000367","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000367","url":null,"abstract":"ABSTRACT Study Design This is a narrative review. Introduction Consensus techniques are an increasingly common research tool used to define levels of expert agreement on a topic where evidence is inconsistent or lacking. An assessment of commonly used consensus techniques can inform future education and research. Objective The aim of this study was to describe the use of various consensus techniques used in education and research in orthotics and prosthetics and closely related medical professions, to aid in choosing the most appropriate consensus technique for future research. Methods A systematic search of the literature was conducted using specific terms and keywords related to various consensus techniques, applications of consensus techniques in research and education, and medical disciplines related to orthotics and prosthetics. Studies were included if they described the use of a consensus technique for medical education or research and explained why the specific technique was used. Results Common consensus techniques were identified in the literature. To allow comparison of the techniques, the advantages, disadvantages, limitations, and previous applications of each were extracted from the literature. Conclusion Using the information from the literature, the most prevalent consensus techniques can be compared, aiding educators and researchers in choosing the technique most suitable for their topic of inquiry.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"33 1","pages":"175 - 183"},"PeriodicalIF":0.6,"publicationDate":"2021-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47385741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-21DOI: 10.1097/JPO.0000000000000365
Nicole A. Hoffman, Joanna R. Dallum, S. Hinshon, M. Finch
ABSTRACT Introduction Idiopathic toe walking (ITW) is a common pediatric diagnosis. Serial casting, a common treatment used for an ankle equinus contracture, may not be appropriate for all children. This pilot study investigated whether carbon fiber two-pull solid ankle-foot orthoses (CTP-AFOs) would have similar outcomes as serial casting in the treatment of children with a diagnosis of ITW and ankle equinus contracture. Materials and Methods Children with ITW (n = 35) were randomized to receive CTP-AFOs or serial casting. Assessments were at initial, posttreatment, and 4-month follow-up with therapy protocols until posttreatment. Results There was no statistical difference in active (<0.001) and passive (<0.001) dorsiflexion range of motion, the Observational Gait Scale (<0.001), the Pediatric Reach Test (<0.01) popliteal range of motion (<0.001), strength in dorsiflexion (<0.001) and plantarflexion (0.21), and the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (0.31). Both groups demonstrated significant improvement over time with therapeutic intervention performed by a physical therapist. Conclusions Carbon fiber two-pull solid ankle-foot orthoses are a noninferior alternative to serial casting in a population with ITW and ankle equinus contracture. Therapeutic interventions for treatment of ITW and ankle equinus contracture have demonstrated improvements in motor outcomes.
{"title":"Carbon Fiber Two-Pull Solid Ankle-Foot Orthoses versus Serial Casting in the Treatment of Idiopathic Toe Walking with Ankle Equinus Contracture","authors":"Nicole A. Hoffman, Joanna R. Dallum, S. Hinshon, M. Finch","doi":"10.1097/JPO.0000000000000365","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000365","url":null,"abstract":"ABSTRACT Introduction Idiopathic toe walking (ITW) is a common pediatric diagnosis. Serial casting, a common treatment used for an ankle equinus contracture, may not be appropriate for all children. This pilot study investigated whether carbon fiber two-pull solid ankle-foot orthoses (CTP-AFOs) would have similar outcomes as serial casting in the treatment of children with a diagnosis of ITW and ankle equinus contracture. Materials and Methods Children with ITW (n = 35) were randomized to receive CTP-AFOs or serial casting. Assessments were at initial, posttreatment, and 4-month follow-up with therapy protocols until posttreatment. Results There was no statistical difference in active (<0.001) and passive (<0.001) dorsiflexion range of motion, the Observational Gait Scale (<0.001), the Pediatric Reach Test (<0.01) popliteal range of motion (<0.001), strength in dorsiflexion (<0.001) and plantarflexion (0.21), and the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (0.31). Both groups demonstrated significant improvement over time with therapeutic intervention performed by a physical therapist. Conclusions Carbon fiber two-pull solid ankle-foot orthoses are a noninferior alternative to serial casting in a population with ITW and ankle equinus contracture. Therapeutic interventions for treatment of ITW and ankle equinus contracture have demonstrated improvements in motor outcomes.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"140 - 151"},"PeriodicalIF":0.6,"publicationDate":"2021-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44870021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-21DOI: 10.1097/JPO.0000000000000368
William Sloth, J. Fabricius, A. Pedersen
ABSTRACT Introduction Individuals with transfemoral amputation walking with a locked prosthetic knee joint (LPKJ) have compromised degree of freedom in leg movement compared with walking with an unlocked prosthetic knee joint (UPKJ), thus presenting a risk for compensatory gait strategies, with risk of lower back pain. The objective was to compare gait strategies in individuals with transfemoral amputation walking with an LPKJ and a UPKJ. Materials and Methods This was a crossover trial. Nine individuals with transfemoral amputation habitually walking with a UPKJ completed an intervention of 1 to 2 weeks of walking with a UPKJ followed by 1 to 2 weeks of walking with an LPKJ. Gait strategies were analyzed after each intervention using three-dimensional gait analysis. The outcome was pelvic and lumbar spinal movement from terminal stance to initial swing in the sagittal and transversal plane. Results The maximum anterior tilt of the pelvis in the sagittal plane and the pelvic rotation shifted from preswing to initial swing in the gait cycle when walking with an LPKJ compared with the UPKJ. Conclusions A compensatory gait strategy was observed among individuals with transfemoral amputation walking with an LPKJ compared with a UPKJ. Studies should investigate the incidence of low back pain in individuals with transfemoral amputation walking with LPKJ compared with those walking with UPKJ.
{"title":"Compensatory Gait Strategies in Persons with Transfemoral Amputations Walking with a Locked Prosthetic Knee Joint Compared with an Unlocked Knee Joint: A Crossover Trial","authors":"William Sloth, J. Fabricius, A. Pedersen","doi":"10.1097/JPO.0000000000000368","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000368","url":null,"abstract":"ABSTRACT Introduction Individuals with transfemoral amputation walking with a locked prosthetic knee joint (LPKJ) have compromised degree of freedom in leg movement compared with walking with an unlocked prosthetic knee joint (UPKJ), thus presenting a risk for compensatory gait strategies, with risk of lower back pain. The objective was to compare gait strategies in individuals with transfemoral amputation walking with an LPKJ and a UPKJ. Materials and Methods This was a crossover trial. Nine individuals with transfemoral amputation habitually walking with a UPKJ completed an intervention of 1 to 2 weeks of walking with a UPKJ followed by 1 to 2 weeks of walking with an LPKJ. Gait strategies were analyzed after each intervention using three-dimensional gait analysis. The outcome was pelvic and lumbar spinal movement from terminal stance to initial swing in the sagittal and transversal plane. Results The maximum anterior tilt of the pelvis in the sagittal plane and the pelvic rotation shifted from preswing to initial swing in the gait cycle when walking with an LPKJ compared with the UPKJ. Conclusions A compensatory gait strategy was observed among individuals with transfemoral amputation walking with an LPKJ compared with a UPKJ. Studies should investigate the incidence of low back pain in individuals with transfemoral amputation walking with LPKJ compared with those walking with UPKJ.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"159 - 164"},"PeriodicalIF":0.6,"publicationDate":"2021-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46157529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-20DOI: 10.1097/JPO.0000000000000369
Brian Kaluf, Courtney Cox, Eric M. Shoemaker
ABSTRACT Introduction In the United States, access to microprocessor-controlled prosthetic ankles is limited to patients with lower-limb loss classified as unlimited community ambulators or greater. However, the potential benefits of these devices have not been evaluated among patients classified as household or limited community ambulators. This study examined the benefit of hydraulic- and microprocessor-controlled prosthetic ankles for patients classified as limited community ambulators. Materials and Methods Four different treatment configurations were evaluated using a randomized crossover study design. These four configurations included the participant's current flexible keel (FK) prosthetic foot, an energy-storage-and-return foot (ESAR), a hydraulic ankle (HA), and a microprocessor ankle (MPA). After a 2-week accommodation period, both patient-reported and performance-based outcome measures were recorded for each ankle foot system. A StepWatch activity monitor and two-dimensional video motion analysis were also used to evaluate each system. Results A single participant meeting the inclusion criteria was recruited. The patient-reported mobility and socket fit instruments were greatest with the HA system. When assessed on slopes and stairs, the MPA demonstrated benefits on hill ascent and stair descent. In considering the walking speed and perceived exertion jointly, the HA system allowed similar walking speed but lower exertion compared with fixed-ankle systems. The patient-reported low back pain and balance confidence instruments did not provide useful data for interpretation. Two-dimensional video motion analysis showed that the HA and MPA contributed to improved ankle and knee postures when ascending and descending a slope. The step activity data showed the greatest activity with the HA. Discussion The results from the outcome measures showed a varying level of benefit across all four of the treatment configurations. Both the HA and MPA had favorable scores in varying performance-based outcome measures, but the HA scored the most favorable in a majority of the patient-reported outcome measures. Conclusion The results show varying benefits of the microprocessor- and hydraulic-controlled prosthetic components over fixed-ankle ESAR and FK feet, based on both performance-based and patient-reported outcome measures. Further studies are needed to fully evaluate these benefits in larger sample sizes.
{"title":"Hydraulic- and Microprocessor-Controlled Ankle-Foot Prostheses for Limited Community Ambulators with Unilateral Transtibial Amputation: Pilot Study","authors":"Brian Kaluf, Courtney Cox, Eric M. Shoemaker","doi":"10.1097/JPO.0000000000000369","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000369","url":null,"abstract":"ABSTRACT Introduction In the United States, access to microprocessor-controlled prosthetic ankles is limited to patients with lower-limb loss classified as unlimited community ambulators or greater. However, the potential benefits of these devices have not been evaluated among patients classified as household or limited community ambulators. This study examined the benefit of hydraulic- and microprocessor-controlled prosthetic ankles for patients classified as limited community ambulators. Materials and Methods Four different treatment configurations were evaluated using a randomized crossover study design. These four configurations included the participant's current flexible keel (FK) prosthetic foot, an energy-storage-and-return foot (ESAR), a hydraulic ankle (HA), and a microprocessor ankle (MPA). After a 2-week accommodation period, both patient-reported and performance-based outcome measures were recorded for each ankle foot system. A StepWatch activity monitor and two-dimensional video motion analysis were also used to evaluate each system. Results A single participant meeting the inclusion criteria was recruited. The patient-reported mobility and socket fit instruments were greatest with the HA system. When assessed on slopes and stairs, the MPA demonstrated benefits on hill ascent and stair descent. In considering the walking speed and perceived exertion jointly, the HA system allowed similar walking speed but lower exertion compared with fixed-ankle systems. The patient-reported low back pain and balance confidence instruments did not provide useful data for interpretation. Two-dimensional video motion analysis showed that the HA and MPA contributed to improved ankle and knee postures when ascending and descending a slope. The step activity data showed the greatest activity with the HA. Discussion The results from the outcome measures showed a varying level of benefit across all four of the treatment configurations. Both the HA and MPA had favorable scores in varying performance-based outcome measures, but the HA scored the most favorable in a majority of the patient-reported outcome measures. Conclusion The results show varying benefits of the microprocessor- and hydraulic-controlled prosthetic components over fixed-ankle ESAR and FK feet, based on both performance-based and patient-reported outcome measures. Further studies are needed to fully evaluate these benefits in larger sample sizes.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"33 1","pages":"294 - 303"},"PeriodicalIF":0.6,"publicationDate":"2021-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42151924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-02DOI: 10.1097/JPO.0000000000000364
Hanieh Seyyedzadeh, M. Arazpour, H. Saeedi, M. Mousavi, Navid Golchin
ABSTRACT Introduction This study evaluated the efficacy of two different medial linkage mechanisms (sliding mechanism [SM] and medial linkage mechanism associated with reciprocating gait motion (MLRGM), used within otherwise identical knee-ankle-foot orthoses (KAFOs) on patients with spinal cord injury (SCI). Methods Three volunteer subjects with SCI were fitted with a KAFO equipped with 1) an SM and 2) a medial linkage mechanism (MLRGM). Subjects walked at their self-selected speed along a flat walkway to enable a comparison of walking speed, endurance, and the resulting physiological cost index to be performed. Results The use of a KAFO fitted with the MLRGM resulted in improvements in walking speed, distance walked, and energy costs when compared with the more standard SM. However, the time required to don the KAFO increased with use of the MLRGM, but doffing time was approximately equal for both types. Conclusions This study demonstrated that the use of a KAFO with an MLRGM could provide significant benefits for patients with SCI when compared with a KAFO with a standard SM.
{"title":"Comparison of the Efficacy of Two Different Medial Linkage Mechanisms in Knee-Ankle-Foot Orthoses on Walking Ability in Subjects with Spinal Cord Injury","authors":"Hanieh Seyyedzadeh, M. Arazpour, H. Saeedi, M. Mousavi, Navid Golchin","doi":"10.1097/JPO.0000000000000364","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000364","url":null,"abstract":"ABSTRACT Introduction This study evaluated the efficacy of two different medial linkage mechanisms (sliding mechanism [SM] and medial linkage mechanism associated with reciprocating gait motion (MLRGM), used within otherwise identical knee-ankle-foot orthoses (KAFOs) on patients with spinal cord injury (SCI). Methods Three volunteer subjects with SCI were fitted with a KAFO equipped with 1) an SM and 2) a medial linkage mechanism (MLRGM). Subjects walked at their self-selected speed along a flat walkway to enable a comparison of walking speed, endurance, and the resulting physiological cost index to be performed. Results The use of a KAFO fitted with the MLRGM resulted in improvements in walking speed, distance walked, and energy costs when compared with the more standard SM. However, the time required to don the KAFO increased with use of the MLRGM, but doffing time was approximately equal for both types. Conclusions This study demonstrated that the use of a KAFO with an MLRGM could provide significant benefits for patients with SCI when compared with a KAFO with a standard SM.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"33 1","pages":"311 - 314"},"PeriodicalIF":0.6,"publicationDate":"2021-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44777932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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