Pub Date : 2023-01-01DOI: 10.1097/JPO.0000000000000458
G. Farì, Dario Macchiarola, F. Quarta, F. Bianchi, L. Caforio, A. Cutti, M. Megna, M. Ranieri
ABSTRACT Introduction Wheelchair basketball (WB) is one of the most practiced sports among people with disabilities worldwide. There is a lack of data in scientific literature about injuries in sports for disabled people compared with able-bodied sports. The aim of this study is to investigate the epidemiology of injuries in professional WB athletes in an Italian cohort, distinguishing between trauma and overuse lesions and discussing the role of rehabilitation to prevent them. Materials and Methods The design is that of a cross-sectional study. An online survey was distributed to a group of Italian WB athletes competing in the first and second division of FIPIC (Wheelchair Basketball Italian Federation). The survey included demographic data, medical diagnoses, and athletes’ injuries history. The sample size consisted of 104 players. Results Forty-six injuries were reported. Of these, 32/46 (69.6%) were traumatic injuries and 14/46 (30.4%) were overuse injuries. The incidence of tendinopathies and fractures was significantly higher than for other injuries (P < 0.0001). Right shoulder (P < 0.0001), right hand (P = 0.002), and left hand (P = 0.041) injuries incidence was higher than any other injury in a statistically significant manner. The traumatic injuries group had a statistically significant difference in terms of days of suspension from sport activities compared with overuse injuries group (traumatic: median, 30; interquartile range [IQR], 14.5–40.0; range, 1–730 vs. overuse: median, 20.5; IQR, 10–21; range, 1–30; P = 0.006). Conclusions Trauma injuries are more common than overuse injuries. Injury prevention strategies should be based on rethinking protection devices technologies and integrating sport activities into a tailored rehabilitation global project that considers each athlete’s functional impairment and needs. Clinical Relevance Implementing the knowledge on WB injuries can really help to reinterpret rehabilitation in a new way, aimed at both the treatment and the prevention of these injuries. This will make this sport safer and more effective in improving the physical skills of people with disabilities.
{"title":"Epidemiology of Injuries in Wheelchair Basketball: Trauma Versus Overuse Mechanism and Prevention Rehabilitative Strategies","authors":"G. Farì, Dario Macchiarola, F. Quarta, F. Bianchi, L. Caforio, A. Cutti, M. Megna, M. Ranieri","doi":"10.1097/JPO.0000000000000458","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000458","url":null,"abstract":"ABSTRACT Introduction Wheelchair basketball (WB) is one of the most practiced sports among people with disabilities worldwide. There is a lack of data in scientific literature about injuries in sports for disabled people compared with able-bodied sports. The aim of this study is to investigate the epidemiology of injuries in professional WB athletes in an Italian cohort, distinguishing between trauma and overuse lesions and discussing the role of rehabilitation to prevent them. Materials and Methods The design is that of a cross-sectional study. An online survey was distributed to a group of Italian WB athletes competing in the first and second division of FIPIC (Wheelchair Basketball Italian Federation). The survey included demographic data, medical diagnoses, and athletes’ injuries history. The sample size consisted of 104 players. Results Forty-six injuries were reported. Of these, 32/46 (69.6%) were traumatic injuries and 14/46 (30.4%) were overuse injuries. The incidence of tendinopathies and fractures was significantly higher than for other injuries (P < 0.0001). Right shoulder (P < 0.0001), right hand (P = 0.002), and left hand (P = 0.041) injuries incidence was higher than any other injury in a statistically significant manner. The traumatic injuries group had a statistically significant difference in terms of days of suspension from sport activities compared with overuse injuries group (traumatic: median, 30; interquartile range [IQR], 14.5–40.0; range, 1–730 vs. overuse: median, 20.5; IQR, 10–21; range, 1–30; P = 0.006). Conclusions Trauma injuries are more common than overuse injuries. Injury prevention strategies should be based on rethinking protection devices technologies and integrating sport activities into a tailored rehabilitation global project that considers each athlete’s functional impairment and needs. Clinical Relevance Implementing the knowledge on WB injuries can really help to reinterpret rehabilitation in a new way, aimed at both the treatment and the prevention of these injuries. This will make this sport safer and more effective in improving the physical skills of people with disabilities.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"32 - 37"},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42543593","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 : 2022-11-26DOI: 10.1097/JPO.0000000000000453
P. Saravanan, Jessica Menold
ABSTRACT Introduction Proper prosthetic prescription directly impacts rehabilitation and the quality of life of an individual with amputation, yet complications during the prescription process remain a challenge for prosthetists as a variety of patient-specific and prosthetic-specific factors need to be considered simultaneously during prescription. This research aims to identify the factors that affect decision making during prosthetic prescription and rehabilitation processes of individuals with lower-limb amputation via evidence-based approaches. Materials and Methods Abstracts of 140 articles were analyzed using topic modeling—a natural language processing algorithm. Results Mining abstracts of relevant literature revealed seven factors that influence prosthetic prescription and six factors that affect rehabilitation of individuals with amputation. Conclusion The findings of this study focus on improving the rehabilitation process of individuals with lower-limb amputation, enhancing the patient-provider relationship, and improving the overall quality of life via evidence-based methods. Clinical Relevance Understanding the factors that affect prosthetic prescription and patient rehabilitation from the past literature is critical to the establishment of formal and standard prescription strategies that can eventually improve the quality of life of persons with lower-limb amputation.
{"title":"Mining Literature to Identify Factors Influencing Prosthetic Prescription and Rehabilitation of Persons With Lower-Limb Amputations","authors":"P. Saravanan, Jessica Menold","doi":"10.1097/JPO.0000000000000453","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000453","url":null,"abstract":"ABSTRACT Introduction Proper prosthetic prescription directly impacts rehabilitation and the quality of life of an individual with amputation, yet complications during the prescription process remain a challenge for prosthetists as a variety of patient-specific and prosthetic-specific factors need to be considered simultaneously during prescription. This research aims to identify the factors that affect decision making during prosthetic prescription and rehabilitation processes of individuals with lower-limb amputation via evidence-based approaches. Materials and Methods Abstracts of 140 articles were analyzed using topic modeling—a natural language processing algorithm. Results Mining abstracts of relevant literature revealed seven factors that influence prosthetic prescription and six factors that affect rehabilitation of individuals with amputation. Conclusion The findings of this study focus on improving the rehabilitation process of individuals with lower-limb amputation, enhancing the patient-provider relationship, and improving the overall quality of life via evidence-based methods. Clinical Relevance Understanding the factors that affect prosthetic prescription and patient rehabilitation from the past literature is critical to the establishment of formal and standard prescription strategies that can eventually improve the quality of life of persons with lower-limb amputation.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"131 - 138"},"PeriodicalIF":0.6,"publicationDate":"2022-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45325188","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 : 2022-11-21DOI: 10.1097/JPO.0000000000000454
Haley L. Dutton, Nathan Kearns, R. Spragg
ABSTRACT Introduction The objective of this study was to reproduce a skater-style shoe lift. Methods Tracings and measurements taken from the previous skater shoe lift were used to make a reproduction of a new skater shoe lift. Results A successful reproduction of the skater sole lift was completed. Clinical Relevance This is clinically relevant due to allowing patients an additional option for large leg-length discrepancies to avoid surgery while still providing a strong, stable base and reducing overall weight.
{"title":"Methods for Replicating a Skater-Style Shoe Lift for People with Limb-Length Discrepancy: A Technical Note","authors":"Haley L. Dutton, Nathan Kearns, R. Spragg","doi":"10.1097/JPO.0000000000000454","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000454","url":null,"abstract":"ABSTRACT Introduction The objective of this study was to reproduce a skater-style shoe lift. Methods Tracings and measurements taken from the previous skater shoe lift were used to make a reproduction of a new skater shoe lift. Results A successful reproduction of the skater sole lift was completed. Clinical Relevance This is clinically relevant due to allowing patients an additional option for large leg-length discrepancies to avoid surgery while still providing a strong, stable base and reducing overall weight.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"e66 - e72"},"PeriodicalIF":0.6,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46841618","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 : 2022-10-19DOI: 10.1097/JPO.0000000000000448
Faisal S Alqusaiyer, Abdullah H Alsergani, Fayez G Aldarsouni, Abdulrahman Aldawood, Yazeed Alkhayyal, Homoud Alzaid, Ali M. Al-hazmi
ABSTRACT Introduction Quality of life (QoL) has been advocated for as an outcome measure for assessing the effect of treatment and quality of care given to prosthetic users. As such, it is necessary to assess the factors that play a role in influencing QoL to achieve better outcomes. Unfortunately, QoL has not been adequately studied in Saudi Arabia, which warranted further research. The objectives of this study were to estimate the QoL of prosthetic users in Riyadh and determine its association with Ambulation (AM), Social Burden (SB), and Appearance (AP). Methods A cross-sectional study design was used to achieve our objectives. Our participants were asked to fill out our self-administered questionnaire, which was composed of the Arabic versions of the Well-being (WB), AP, AM, and SB scales of the Prosthesis Evaluation Questionnaire (PEQ). Results A sample of 62 prosthetic users due to unilateral amputations were randomly selected from our sampling frame, 10 of which acted as outliers from the 95% confidence interval of QoL (CI) (56.13–67.94) and were omitted. The WB scale was shown to have a median of 57.5, whereas QoL had a mean of 62.58. In addition, a positive relationship was found between QoL and SB (P < 0.001; Rs = 0.657), AP (P < 0.001; R = 0.547), and AM (P < 0.001; R = 0.634). Conclusion Prosthetic users in Riyadh suffer from low QoL and satisfaction. Moreover, QoL was shown to be a multifactorial concept with many different elements and constituents. This suggests that a more comprehensive and inclusive method of prosthetic rehabilitation is required. Clinical Relevance There is a scarcity of QoL and well-being studies in Saudi Arabia regarding individuals with amputation and prosthetic users, given the number of prosthetic users, estimated to be around 2092 individuals. By estimating their QoL, we could identify what improvements are to be made to improve their lives.
{"title":"Quality of Life and Well-being in Patients with Lower-limb Amputation Using a Prosthetic Limb: A Cross-sectional Study in a Major Center in Riyadh, Saudi Arabia","authors":"Faisal S Alqusaiyer, Abdullah H Alsergani, Fayez G Aldarsouni, Abdulrahman Aldawood, Yazeed Alkhayyal, Homoud Alzaid, Ali M. Al-hazmi","doi":"10.1097/JPO.0000000000000448","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000448","url":null,"abstract":"ABSTRACT Introduction Quality of life (QoL) has been advocated for as an outcome measure for assessing the effect of treatment and quality of care given to prosthetic users. As such, it is necessary to assess the factors that play a role in influencing QoL to achieve better outcomes. Unfortunately, QoL has not been adequately studied in Saudi Arabia, which warranted further research. The objectives of this study were to estimate the QoL of prosthetic users in Riyadh and determine its association with Ambulation (AM), Social Burden (SB), and Appearance (AP). Methods A cross-sectional study design was used to achieve our objectives. Our participants were asked to fill out our self-administered questionnaire, which was composed of the Arabic versions of the Well-being (WB), AP, AM, and SB scales of the Prosthesis Evaluation Questionnaire (PEQ). Results A sample of 62 prosthetic users due to unilateral amputations were randomly selected from our sampling frame, 10 of which acted as outliers from the 95% confidence interval of QoL (CI) (56.13–67.94) and were omitted. The WB scale was shown to have a median of 57.5, whereas QoL had a mean of 62.58. In addition, a positive relationship was found between QoL and SB (P < 0.001; Rs = 0.657), AP (P < 0.001; R = 0.547), and AM (P < 0.001; R = 0.634). Conclusion Prosthetic users in Riyadh suffer from low QoL and satisfaction. Moreover, QoL was shown to be a multifactorial concept with many different elements and constituents. This suggests that a more comprehensive and inclusive method of prosthetic rehabilitation is required. Clinical Relevance There is a scarcity of QoL and well-being studies in Saudi Arabia regarding individuals with amputation and prosthetic users, given the number of prosthetic users, estimated to be around 2092 individuals. By estimating their QoL, we could identify what improvements are to be made to improve their lives.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"203 - 207"},"PeriodicalIF":0.6,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44641524","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 : 2022-10-16DOI: 10.1097/JPO.0000000000000452
Ashley H Mullen, Sally Kenworthy, K. Ewing, M. Forbus, Regan Hoelscher Thompson
ABSTRACT Introduction Flexible flatfeet are commonly treated with functional foot orthoses (FFOs) and University of California Berkeley Laboratory (UCBL) designs. This study sought to evaluate the immediate effects of low-profile FFOs and high-profile UCBL orthoses on Foot Posture Index (FPI), spatiotemportal measures of gait, and perceived comfort and compliance in adults with flexible flatfeet. Materials and Methods Fourteen individuals with self-reported asymptomatic flexible flatfeet participated in this randomized cross-sectional study. Custom FFOs and UCBL orthoses were fabricated for each participant, who then walked at a self-selected speed in each condition on a Zeno Mat. Foot Posture Index, perceived comfort and compliance, and spatiotemporal parameters were collected across conditions. Results There were no significant differences in velocity, cadence, step length, stride width, toe-in/toe-out, or stance center of pressure distance percentage. Stance phase duration significantly increased from baseline to UCBL condition. There was a statistically significant decrease bilaterally in FPI from baseline to FFO and from baseline to UCBL orthosis, but not between FFO and UCBL orthosis. There were no significant differences in comfort and compliance ratings between FFOs and UCBL orthoses. Conclusions With regard to immediate effects, both the UCBL and FFO designs improve foot posture without significant impact on spatiotemporal gait patterns or perceived comfort and compliance. Additional research is needed to determine the longevity of these effects. Clinical Relevance The results of this study support the use of both FFOs and UCBL orthoses when trying to provide foot posture correction for adults with asymptomatic flexible flatfeet.
{"title":"Immediate Impacts of Two Foot Orthotic Designs on Foot Posture Index, Gait, and Comfort in Adults With Asymptomatic, Flexible Pes Planus","authors":"Ashley H Mullen, Sally Kenworthy, K. Ewing, M. Forbus, Regan Hoelscher Thompson","doi":"10.1097/JPO.0000000000000452","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000452","url":null,"abstract":"ABSTRACT Introduction Flexible flatfeet are commonly treated with functional foot orthoses (FFOs) and University of California Berkeley Laboratory (UCBL) designs. This study sought to evaluate the immediate effects of low-profile FFOs and high-profile UCBL orthoses on Foot Posture Index (FPI), spatiotemportal measures of gait, and perceived comfort and compliance in adults with flexible flatfeet. Materials and Methods Fourteen individuals with self-reported asymptomatic flexible flatfeet participated in this randomized cross-sectional study. Custom FFOs and UCBL orthoses were fabricated for each participant, who then walked at a self-selected speed in each condition on a Zeno Mat. Foot Posture Index, perceived comfort and compliance, and spatiotemporal parameters were collected across conditions. Results There were no significant differences in velocity, cadence, step length, stride width, toe-in/toe-out, or stance center of pressure distance percentage. Stance phase duration significantly increased from baseline to UCBL condition. There was a statistically significant decrease bilaterally in FPI from baseline to FFO and from baseline to UCBL orthosis, but not between FFO and UCBL orthosis. There were no significant differences in comfort and compliance ratings between FFOs and UCBL orthoses. Conclusions With regard to immediate effects, both the UCBL and FFO designs improve foot posture without significant impact on spatiotemporal gait patterns or perceived comfort and compliance. Additional research is needed to determine the longevity of these effects. Clinical Relevance The results of this study support the use of both FFOs and UCBL orthoses when trying to provide foot posture correction for adults with asymptomatic flexible flatfeet.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"260 - 265"},"PeriodicalIF":0.6,"publicationDate":"2022-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48264915","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 : 2022-10-12DOI: 10.1097/JPO.0000000000000450
R. Anitha Kumari, Sakshi Saharawat
ABSTRACT Introduction Rheumatoid arthritis (RA) causes structural damage that causes joint deformity including metacarpophalangeal (MCP) joint ulnar drift (UD), thus hindering the pinch strength and the functional ability of the hand. Orthosis or splints are designed to maintain the hand’s function, improve joint alignment, restore biomechanical balance, and reduce tissue stress. Limited studies have been done on the effects of dynamic splint on pinch strength and functional ability. Therefore, the purpose of this study was to evaluate and quantify the effects of dynamic MCP splint in treatment of ulnar deviation of RA on pinch strength and functional ability in women. Methods Twenty women with RA were recruited and completed a 4-week intervention period with dynamic MCP splint. Pinch strength and functional ability score were measured at baseline and after 4 weeks. Results The results showed a significant improvement in pinch strength (mean ± SD, 11.68 ± 2.14 to 13.53 ± 2.14; P = 0.000) and functional ability score (mean ± SD, 22.70 ± 9.12 to 19.70 ± 8.14; P = 0.000). Conclusion The results of this study show that the dynamic MCP splint had a positive impact on rheumatoid hands that align the joints in their functional position. The dynamic MCP splint improved the mechanical stability of the hand, thus reducing pain and stress on joints, which in turn improves the pinch strength and functional ability of rheumatoid hand. Clinical Relevance To increase patient acceptance and use of the splint, the splint designed and used in this study was compact and only covered the affected areas and joints of the hand. Because there was no involvement of the wrist joint and the fingertips were free, the splint was lightweight and allowed the patient to perform activity while wearing it.
{"title":"Effectiveness of Dynamic Metacarpophalangeal Splint in Treatment of Ulnar Deviation of Rheumatoid Arthritis on Pinch Strength and Functional Ability in Women","authors":"R. Anitha Kumari, Sakshi Saharawat","doi":"10.1097/JPO.0000000000000450","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000450","url":null,"abstract":"ABSTRACT Introduction Rheumatoid arthritis (RA) causes structural damage that causes joint deformity including metacarpophalangeal (MCP) joint ulnar drift (UD), thus hindering the pinch strength and the functional ability of the hand. Orthosis or splints are designed to maintain the hand’s function, improve joint alignment, restore biomechanical balance, and reduce tissue stress. Limited studies have been done on the effects of dynamic splint on pinch strength and functional ability. Therefore, the purpose of this study was to evaluate and quantify the effects of dynamic MCP splint in treatment of ulnar deviation of RA on pinch strength and functional ability in women. Methods Twenty women with RA were recruited and completed a 4-week intervention period with dynamic MCP splint. Pinch strength and functional ability score were measured at baseline and after 4 weeks. Results The results showed a significant improvement in pinch strength (mean ± SD, 11.68 ± 2.14 to 13.53 ± 2.14; P = 0.000) and functional ability score (mean ± SD, 22.70 ± 9.12 to 19.70 ± 8.14; P = 0.000). Conclusion The results of this study show that the dynamic MCP splint had a positive impact on rheumatoid hands that align the joints in their functional position. The dynamic MCP splint improved the mechanical stability of the hand, thus reducing pain and stress on joints, which in turn improves the pinch strength and functional ability of rheumatoid hand. Clinical Relevance To increase patient acceptance and use of the splint, the splint designed and used in this study was compact and only covered the affected areas and joints of the hand. Because there was no involvement of the wrist joint and the fingertips were free, the splint was lightweight and allowed the patient to perform activity while wearing it.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"266 - 271"},"PeriodicalIF":0.6,"publicationDate":"2022-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49124082","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 : 2022-10-01Epub Date: 2021-12-30DOI: 10.1097/JPO.0000000000000409
Joshua M Caputo, Evan Dvorak, Kate Shipley, Mary Ann Miknevich, Peter G Adamczyk, Steven H Collins
Introduction: The design and selection of lower-limb prosthetic devices is currently hampered by a shortage of evidence to drive the choice of prosthetic foot parameters. We propose a new approach wherein prostheses could be designed, specified, and provided based on individualized measurements of the benefits provided by candidate feet. In this manuscript, we present a pilot test of this evidence-based and personalized process.
Methods: We previously developed a "prosthetic foot emulator," a wearable robotic system that provides users with the physical sensation of trying on different prosthetic feet before definitive fitting. Here we detail preliminary demonstrations of two possible approaches to personalizing foot design: 1) an emulation and test-drive strategy of representative commercial foot models, and 2) a prosthetist-driven tuning procedure to optimize foot parameters.
Results: The first experiment demonstrated large and sometimes surprising differences in optimal prosthetic foot parameters across a variety of subjects, walking conditions, and outcome measures. The second experiment demonstrated a quick and effective simple manual tuning procedure for identifying preferred prosthetic foot parameters.
Conclusions: Emulator-based approaches could improve individualization of prosthetic foot prescription. The present results motivate future clinical studies of the validity, efficacy, and economics of the approach across larger and more diverse subject populations.
Clinical relevance: Today, emulator technology is being used to accelerate research and development of novel prosthetic and orthotic devices. In the future, after further refinement and validation, this technology could benefit clinical practice by providing a means for rapid test-driving and optimal selection of clinically available prosthetic feet.
{"title":"Robotic Emulation of Candidate Prosthetic Foot Designs May Enable Efficient, Evidence-Based, and Individualized Prescriptions.","authors":"Joshua M Caputo, Evan Dvorak, Kate Shipley, Mary Ann Miknevich, Peter G Adamczyk, Steven H Collins","doi":"10.1097/JPO.0000000000000409","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000409","url":null,"abstract":"<p><strong>Introduction: </strong>The design and selection of lower-limb prosthetic devices is currently hampered by a shortage of evidence to drive the choice of prosthetic foot parameters. We propose a new approach wherein prostheses could be designed, specified, and provided based on individualized measurements of the benefits provided by candidate feet. In this manuscript, we present a pilot test of this evidence-based and personalized process.</p><p><strong>Methods: </strong>We previously developed a \"prosthetic foot emulator,\" a wearable robotic system that provides users with the physical sensation of trying on different prosthetic feet before definitive fitting. Here we detail preliminary demonstrations of two possible approaches to personalizing foot design: 1) an emulation and test-drive strategy of representative commercial foot models, and 2) a prosthetist-driven tuning procedure to optimize foot parameters.</p><p><strong>Results: </strong>The first experiment demonstrated large and sometimes surprising differences in optimal prosthetic foot parameters across a variety of subjects, walking conditions, and outcome measures. The second experiment demonstrated a quick and effective simple manual tuning procedure for identifying preferred prosthetic foot parameters.</p><p><strong>Conclusions: </strong>Emulator-based approaches could improve individualization of prosthetic foot prescription. The present results motivate future clinical studies of the validity, efficacy, and economics of the approach across larger and more diverse subject populations.</p><p><strong>Clinical relevance: </strong>Today, emulator technology is being used to accelerate research and development of novel prosthetic and orthotic devices. In the future, after further refinement and validation, this technology could benefit clinical practice by providing a means for rapid test-driving and optimal selection of clinically available prosthetic feet.</p>","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":" ","pages":"202-212"},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/81/92/j-p-o-34-202.PMC9481294.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33482344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-05DOI: 10.1097/JPO.0000000000000441
Ketut B. Putra, Heather Wood, J. Wensman, J. Leonard, A. Shih
ABSTRACT Introduction Patients with partial foot amputations are prone to skin breakdown due to concentrated contact stress and shearing. A custom silicone foot orthosis (FO) can be used to redistribute the concentrated stress and reduce the shearing and discomfort of the skin of a patient with partial calcanectomy. This study presents a custom silicone FO, which is molded using a 3D-printed mold. Methods The subject's left (amputated) partial foot and right (intact) foot were scanned using a 3D scanner. A custom silicone FO was designed by modifying the models of both feet. A mold for the FO was designed using computer-aided design software and fabricated by 3D printing. Room temperature vulcanization silicone was molded to fabricate the FO. The fit of the FO was clinically evaluated by the subject walking with the FO. Results A custom silicone FO was fabricated using a 3D-printed mold. Conclusions The custom silicone FO follows the contour of the residual foot to distribute pressure away from bony prominences during standing and ambulation. 3D printing of the mold can reduce labor time and material cost while facilitating the digital record when compared with a conventional plaster casting approach. Clinical Relevance The 3D printing approach used to fabricate the custom silicone FO may be applied to develop custom silicone orthotic/prosthetic devices for other types of partial foot amputations.
{"title":"A Custom Silicone Foot Orthosis for Partial Calcanectomy Fabricated Using a 3D-Printed Mold","authors":"Ketut B. Putra, Heather Wood, J. Wensman, J. Leonard, A. Shih","doi":"10.1097/JPO.0000000000000441","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000441","url":null,"abstract":"ABSTRACT Introduction Patients with partial foot amputations are prone to skin breakdown due to concentrated contact stress and shearing. A custom silicone foot orthosis (FO) can be used to redistribute the concentrated stress and reduce the shearing and discomfort of the skin of a patient with partial calcanectomy. This study presents a custom silicone FO, which is molded using a 3D-printed mold. Methods The subject's left (amputated) partial foot and right (intact) foot were scanned using a 3D scanner. A custom silicone FO was designed by modifying the models of both feet. A mold for the FO was designed using computer-aided design software and fabricated by 3D printing. Room temperature vulcanization silicone was molded to fabricate the FO. The fit of the FO was clinically evaluated by the subject walking with the FO. Results A custom silicone FO was fabricated using a 3D-printed mold. Conclusions The custom silicone FO follows the contour of the residual foot to distribute pressure away from bony prominences during standing and ambulation. 3D printing of the mold can reduce labor time and material cost while facilitating the digital record when compared with a conventional plaster casting approach. Clinical Relevance The 3D printing approach used to fabricate the custom silicone FO may be applied to develop custom silicone orthotic/prosthetic devices for other types of partial foot amputations.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"224 - 228"},"PeriodicalIF":0.6,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46451353","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 : 2022-05-12DOI: 10.1097/JPO.0000000000000438
Ashley H Mullen, C. Horn
ABSTRACT Introduction Orthotic and prosthetic clinicians need to self-assess their performance and make decisions about practice limitations and continuing education throughout their careers. The objectives of this study were to evaluate the internal consistency of a self-assessment survey, examine the latent common factors and responsiveness of the survey, and use the results of the analysis to develop a shortened self-assessment survey. Methods Residents completed a self-assessment 29-item survey based on the six domains of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) Practice Analysis of Certified Practitioners in the Disciplines of Orthotics and Prosthetics at multiple times during the clinical residency. Internal consistency was examined through Cronbach α. Confirmatory and exploratory factor analysis were used to examine latent common factors and inform item reduction. Responsiveness was examined through repeated-measures analysis of variance (ANOVA). Results Analysis revealed a Cronbach α of 0.927. Confirmatory factor analysis indicated a poor fit of the six-factor model. The final and best-fitting model suggested four latent common factors: patient centeredness, regulatory awareness, device evaluation, and professional responsibility. Review and revision of the items resulted in a 14-item instrument. The instrument was responsive to changes over time. Conclusions The results indicate a need to reexamine current clinical practice framework in orthotics and prosthetics, particularly as it relates to clinical competence. Future research should evaluate the performance of the shortened self-assessment survey and consider implications for educational standards. Clinical Relevance The use of validated educational tools can strengthen the efficacy of assessments in clinical education and residency. Improved clinical education assessments may result in standardization of competency and improved graduate preparedness.
{"title":"Analysis of a Resident Competence Self-Assessment Survey","authors":"Ashley H Mullen, C. Horn","doi":"10.1097/JPO.0000000000000438","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000438","url":null,"abstract":"ABSTRACT Introduction Orthotic and prosthetic clinicians need to self-assess their performance and make decisions about practice limitations and continuing education throughout their careers. The objectives of this study were to evaluate the internal consistency of a self-assessment survey, examine the latent common factors and responsiveness of the survey, and use the results of the analysis to develop a shortened self-assessment survey. Methods Residents completed a self-assessment 29-item survey based on the six domains of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) Practice Analysis of Certified Practitioners in the Disciplines of Orthotics and Prosthetics at multiple times during the clinical residency. Internal consistency was examined through Cronbach α. Confirmatory and exploratory factor analysis were used to examine latent common factors and inform item reduction. Responsiveness was examined through repeated-measures analysis of variance (ANOVA). Results Analysis revealed a Cronbach α of 0.927. Confirmatory factor analysis indicated a poor fit of the six-factor model. The final and best-fitting model suggested four latent common factors: patient centeredness, regulatory awareness, device evaluation, and professional responsibility. Review and revision of the items resulted in a 14-item instrument. The instrument was responsive to changes over time. Conclusions The results indicate a need to reexamine current clinical practice framework in orthotics and prosthetics, particularly as it relates to clinical competence. Future research should evaluate the performance of the shortened self-assessment survey and consider implications for educational standards. Clinical Relevance The use of validated educational tools can strengthen the efficacy of assessments in clinical education and residency. Improved clinical education assessments may result in standardization of competency and improved graduate preparedness.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"242 - 249"},"PeriodicalIF":0.6,"publicationDate":"2022-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47014972","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 : 2022-04-28DOI: 10.1097/JPO.0000000000000431
Shamsher Singh, H. Mali
ABSTRACT Introduction Clubfoot, mainly CTEV, is a complex three-dimensional deformity challenging physicians from ancient times. Among a thousand babies born, one to six suffer from clubfoot deformity; that is, in India alone, around 35,000 need treatment for clubfoot annually. This review summarizes the various practices of clubfoot assessment, noninvasive treatment, and engineering aspects of clubfoot treatment. The shortcomings of assessment methods and challenges with implementation of treatment methods are also presented. Methods A narrative review of all related research papers available to authors was carried out. Results Various clubfoot assessment methods have been developed to help physicians understand the severity of the problem and predict treatment parameters. The Pirani score and Dimeglio score are used predominantly for the assessment of deformity. However, these methods suffer from implementation-related limitations. Noninvasive methods, namely, Kite's method, functional physiotherapy method, and Ponseti method, are used in practice for treatment. The Ponseti method is the most popular with parents and physicians and is considered the gold standard for the treatment of clubfoot. However, it also suffers from various implementation issues, like treatment cost and lack of experts, particularly in low- and middle-income countries (LMICs). Engineers are using various technologies like computer-aided design (CAD)/computer-aided engineering (CAE) and additive manufacturing for modeling and analysis of clubfoot. Engineers have also attempted to develop corrective and maintenance orthosis for CTEV treatment. Conclusions Because newer and newer technologies are becoming accessible for interdisciplinary use, there is a need to apply contemporary technologies, especially to develop a corrective orthosis so that the current challenges of clubfoot assessment and treatment are addressed. The corrective orthosis should be based on Dr Ponseti's insights into clubfoot biomechanics. Clinical Relevance There is a need to explore contemporary technologies like data acquisition and CAD/CAE to address CTEV assessment–related issues. A corrective orthosis based on the understanding of the foot biomechanics for treatment can solve the various implementation-related challenges of the Ponseti method, particularly in low-resource settings.
{"title":"Clubfoot: Review on Assessment, Treatment, Challenges, and Engineering Aspects","authors":"Shamsher Singh, H. Mali","doi":"10.1097/JPO.0000000000000431","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000431","url":null,"abstract":"ABSTRACT Introduction Clubfoot, mainly CTEV, is a complex three-dimensional deformity challenging physicians from ancient times. Among a thousand babies born, one to six suffer from clubfoot deformity; that is, in India alone, around 35,000 need treatment for clubfoot annually. This review summarizes the various practices of clubfoot assessment, noninvasive treatment, and engineering aspects of clubfoot treatment. The shortcomings of assessment methods and challenges with implementation of treatment methods are also presented. Methods A narrative review of all related research papers available to authors was carried out. Results Various clubfoot assessment methods have been developed to help physicians understand the severity of the problem and predict treatment parameters. The Pirani score and Dimeglio score are used predominantly for the assessment of deformity. However, these methods suffer from implementation-related limitations. Noninvasive methods, namely, Kite's method, functional physiotherapy method, and Ponseti method, are used in practice for treatment. The Ponseti method is the most popular with parents and physicians and is considered the gold standard for the treatment of clubfoot. However, it also suffers from various implementation issues, like treatment cost and lack of experts, particularly in low- and middle-income countries (LMICs). Engineers are using various technologies like computer-aided design (CAD)/computer-aided engineering (CAE) and additive manufacturing for modeling and analysis of clubfoot. Engineers have also attempted to develop corrective and maintenance orthosis for CTEV treatment. Conclusions Because newer and newer technologies are becoming accessible for interdisciplinary use, there is a need to apply contemporary technologies, especially to develop a corrective orthosis so that the current challenges of clubfoot assessment and treatment are addressed. The corrective orthosis should be based on Dr Ponseti's insights into clubfoot biomechanics. Clinical Relevance There is a need to explore contemporary technologies like data acquisition and CAD/CAE to address CTEV assessment–related issues. A corrective orthosis based on the understanding of the foot biomechanics for treatment can solve the various implementation-related challenges of the Ponseti method, particularly in low-resource settings.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"e114 - e130"},"PeriodicalIF":0.6,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42195238","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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