Pub Date : 2022-04-11DOI: 10.1097/JPO.0000000000000436
Daniela Mitiyo Odagiri Utiyama, F. Alfieri, A. C. A. dos Santos, C. Ribeiro, Viviane Caroline Sales, L. Battistella
ABSTRACT Introduction Rehabilitation after amputation is essential, and descriptions of inpatient rehabilitation programs for individuals with amputation are scarce. Therefore, the objective of this study was to describe the effects of an inpatient physical rehabilitation program on mobility, balance, function, and gait of individuals with unilateral lower-limb amputations. Materials and Methods This was a retrospective before-after study. Data were extracted from medical records of individuals with lower-limb amputation admitted for inpatient intensive rehabilitation programs. Data on etiology, functional mobility (by timed up and go [TUG]), balance and functionality (amputee mobility predictor [AMP]), and gait (2-minute walk test [2MWT]) were collected before and after prosthetic fitting phase of an inpatient rehabilitation program. Patient information was stratified as traumatic and vascular etiologies, and after descriptive analysis, general outcomes and intragroup results were compared with t-test and followed by linear regressions analysis for a better understanding of the demographic and clinical roles on treatment evolution. Results Group comparison evidenced differences of age between traumatic and vascular groups, as traumatic amputations had greater incidence among younger individuals, regardless of the prosthesis phase. Before the prosthesis fitting and regardless of the groups, there were significant improvements on AMP, 2MWT, and TUG, and the differences between both groups were influenced by their baseline conditions. After prosthesis fitting, significant improvements were identified, regardless of the etiology. Conclusions This study provides evidence that individuals with amputation who are admitted to an intensive hospitalized physical rehabilitation program experience benefits in mobility, balance, functionality, and gait capacity irrespective of causality or if the prosthesis was provided. Gains evidenced in the preprosthetic phase were continued in the postprosthetic phase. Clinical Relevance Inpatient rehabilitation programs for individuals with amputation are beneficial for improving the functionality of these individuals. This type of multidisciplinary rehabilitation provides functional improvements to the patient from the preprosthetic to the prosthetic phases, favoring global rehabilitation in a short period, which can reduce treatment time and provide better living conditions for the patient.
{"title":"Effects of an Inpatient Physical Rehabilitation Program Designed for Persons with Amputations of Traumatic or Vascular Etiologies","authors":"Daniela Mitiyo Odagiri Utiyama, F. Alfieri, A. C. A. dos Santos, C. Ribeiro, Viviane Caroline Sales, L. Battistella","doi":"10.1097/JPO.0000000000000436","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000436","url":null,"abstract":"ABSTRACT Introduction Rehabilitation after amputation is essential, and descriptions of inpatient rehabilitation programs for individuals with amputation are scarce. Therefore, the objective of this study was to describe the effects of an inpatient physical rehabilitation program on mobility, balance, function, and gait of individuals with unilateral lower-limb amputations. Materials and Methods This was a retrospective before-after study. Data were extracted from medical records of individuals with lower-limb amputation admitted for inpatient intensive rehabilitation programs. Data on etiology, functional mobility (by timed up and go [TUG]), balance and functionality (amputee mobility predictor [AMP]), and gait (2-minute walk test [2MWT]) were collected before and after prosthetic fitting phase of an inpatient rehabilitation program. Patient information was stratified as traumatic and vascular etiologies, and after descriptive analysis, general outcomes and intragroup results were compared with t-test and followed by linear regressions analysis for a better understanding of the demographic and clinical roles on treatment evolution. Results Group comparison evidenced differences of age between traumatic and vascular groups, as traumatic amputations had greater incidence among younger individuals, regardless of the prosthesis phase. Before the prosthesis fitting and regardless of the groups, there were significant improvements on AMP, 2MWT, and TUG, and the differences between both groups were influenced by their baseline conditions. After prosthesis fitting, significant improvements were identified, regardless of the etiology. Conclusions This study provides evidence that individuals with amputation who are admitted to an intensive hospitalized physical rehabilitation program experience benefits in mobility, balance, functionality, and gait capacity irrespective of causality or if the prosthesis was provided. Gains evidenced in the preprosthetic phase were continued in the postprosthetic phase. Clinical Relevance Inpatient rehabilitation programs for individuals with amputation are beneficial for improving the functionality of these individuals. This type of multidisciplinary rehabilitation provides functional improvements to the patient from the preprosthetic to the prosthetic phases, favoring global rehabilitation in a short period, which can reduce treatment time and provide better living conditions for the patient.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"152 - 158"},"PeriodicalIF":0.6,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46721251","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 : 2022-03-10DOI: 10.1097/JPO.0000000000000428
David J. Ojeda Sersun, K. Swafford, Heather Orosco, Chelsie Rodgers, Michel Davidson, G. Bains, Ben Becerra
ABSTRACT Introduction Documented by the International Committee of the Red Cross, consolidation time for polypropylene (PP) plastic must be left on the plaster model for 24 hrs. If not followed, this will result in an incorrect shape and volume of PP plastic. To the best of our knowledge, there are no studies that address the comparison of PP plastic expansion at various time domains of plastic cooling after being thermoformed. The purpose of this research was to compare plastic expansion or shrinkage and heat ratio (dimensional stability [DS]) of PP plastic through cooling periods of 6, 12, 18, and 24 hrs, respectively. Materials and Methods Forty-one identical plaster models were made. Vacuum was applied at times of 6, 12, 18, and 24 hrs, respectively. PP was cut and removed. Measurements were taken and recorded at initial times and after 24 hrs. Results DS was not significantly different across the four time groups of 6, 12, 18, and 24 hrs, respectively (P = 0.10). There was a statistically significant linear relationship between DS with room temperature (P = 0.01) and oven temperature (P = 0.04). Conclusions There is no scientific foundation to perform a 24-hr wait before finishing a device. This translates to an effective time frame for removing the plastic from the model, saving time and resources, quicker delivery to the patient, and improvement in whole patient care. Clinical Relevance This article has important implications for the O&P clinic. Creating more dimensionally stable PP devices faster translates to better fitting braces fabricated in a shorter time, thus benefiting patients and clinics and increasing the success rate when delivering this device.
{"title":"The Effects of Cooling Time on the Dimensional Stability of Thermoforming Polypropylene","authors":"David J. Ojeda Sersun, K. Swafford, Heather Orosco, Chelsie Rodgers, Michel Davidson, G. Bains, Ben Becerra","doi":"10.1097/JPO.0000000000000428","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000428","url":null,"abstract":"ABSTRACT Introduction Documented by the International Committee of the Red Cross, consolidation time for polypropylene (PP) plastic must be left on the plaster model for 24 hrs. If not followed, this will result in an incorrect shape and volume of PP plastic. To the best of our knowledge, there are no studies that address the comparison of PP plastic expansion at various time domains of plastic cooling after being thermoformed. The purpose of this research was to compare plastic expansion or shrinkage and heat ratio (dimensional stability [DS]) of PP plastic through cooling periods of 6, 12, 18, and 24 hrs, respectively. Materials and Methods Forty-one identical plaster models were made. Vacuum was applied at times of 6, 12, 18, and 24 hrs, respectively. PP was cut and removed. Measurements were taken and recorded at initial times and after 24 hrs. Results DS was not significantly different across the four time groups of 6, 12, 18, and 24 hrs, respectively (P = 0.10). There was a statistically significant linear relationship between DS with room temperature (P = 0.01) and oven temperature (P = 0.04). Conclusions There is no scientific foundation to perform a 24-hr wait before finishing a device. This translates to an effective time frame for removing the plastic from the model, saving time and resources, quicker delivery to the patient, and improvement in whole patient care. Clinical Relevance This article has important implications for the O&P clinic. Creating more dimensionally stable PP devices faster translates to better fitting braces fabricated in a shorter time, thus benefiting patients and clinics and increasing the success rate when delivering this device.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"180 - 185"},"PeriodicalIF":0.6,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41885752","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 : 2022-03-10DOI: 10.1097/JPO.0000000000000430
E. Kırdı, A. Yalçın, H. Keklicek, S. Topuz, Ozlem Ulger, Gülseren Yazicioğlu
ABSTRACT Introduction With the loss of a lower limb, an individual with amputation may face impaired gait and balance. Different rehabilitation techniques can be used to deal with those functional disabilities. The purpose of this study was to determine whether computerized balance training could have any possible effects on balance in individuals with unilateral transtibial amputation. Materials and Methods A total of 16 subjects who used a prosthesis in their daily life and were between 18 and 65 years of age were included in the study. Individuals were randomly divided into two groups: control group (CG) (n = 7) trained with traditional prosthetic rehabilitation and the experimental group (EG) (n = 9) trained with computerized balance training for five sessions for 2 weeks. Percentage of prosthetic weight bearing (PWB) timed up and go test (TUG), single-leg stance test (SLST), postural sway score, and limits of stability (LoS) were evaluated at baseline and posttreatment. Results No significant differences were observed in between-group comparisons after treatment. Within-group comparison showed that PWB, SLST, and LoS score increased in EG, whereas only PWB increased in CG. Conclusions Similar results were revealed with both computerized and traditional prosthetic training. Although there were no significant differences in between-group comparisons, computerized balance training improved the amputated side single-leg stance and stability limits, which are highly related to fall risk in individuals with amputation. Clinical Relevance Clinical relevance: Usage of computerized balance training can be helpful to improve single-leg stance and LoS in individuals with transtibial amputation.
{"title":"The Effects of Instrumental Balance Training on Balance in Individuals with Unilateral Transtibial Amputation: A Pilot Study","authors":"E. Kırdı, A. Yalçın, H. Keklicek, S. Topuz, Ozlem Ulger, Gülseren Yazicioğlu","doi":"10.1097/JPO.0000000000000430","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000430","url":null,"abstract":"ABSTRACT Introduction With the loss of a lower limb, an individual with amputation may face impaired gait and balance. Different rehabilitation techniques can be used to deal with those functional disabilities. The purpose of this study was to determine whether computerized balance training could have any possible effects on balance in individuals with unilateral transtibial amputation. Materials and Methods A total of 16 subjects who used a prosthesis in their daily life and were between 18 and 65 years of age were included in the study. Individuals were randomly divided into two groups: control group (CG) (n = 7) trained with traditional prosthetic rehabilitation and the experimental group (EG) (n = 9) trained with computerized balance training for five sessions for 2 weeks. Percentage of prosthetic weight bearing (PWB) timed up and go test (TUG), single-leg stance test (SLST), postural sway score, and limits of stability (LoS) were evaluated at baseline and posttreatment. Results No significant differences were observed in between-group comparisons after treatment. Within-group comparison showed that PWB, SLST, and LoS score increased in EG, whereas only PWB increased in CG. Conclusions Similar results were revealed with both computerized and traditional prosthetic training. Although there were no significant differences in between-group comparisons, computerized balance training improved the amputated side single-leg stance and stability limits, which are highly related to fall risk in individuals with amputation. Clinical Relevance Clinical relevance: Usage of computerized balance training can be helpful to improve single-leg stance and LoS in individuals with transtibial amputation.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"186 - 192"},"PeriodicalIF":0.6,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49378917","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 : 2022-03-07DOI: 10.1097/JPO.0000000000000422
Nora Emilia Sirrs Díaz, Carlos Galván-Duque, José Luis Zavaleta, Jorge Letechipia Moreno
ABSTRACT Introduction Daily volume loss of residual limb is a condition that most prosthetic users face, negatively affecting their life. One of the consequences is the loss of contact between the residual limb and the socket, which modifies internal pressures. Objective The aim of this study was to study how the loss of volume of the residual limb affects socket adjustment through measuring pressures inside the socket. Study design The study design is prospective longitudinal. Materials and Methods Four subjects with unilateral transtibial amputation, with at least 1 year of prosthetic use, and walking with a comfortable prosthesis participated in this study. The pressure between the socket and the subject's residual limb was measured with an FSocket System (Tekscan). Residual limb volume was measured before and after each test with two different methods: optical scanning (Structure Sensor, Occipital) and conical frustum model. Sanders' protocol for volume loss was followed (Sanders et al. J Rehabil Res Dev. 2012;49:1467–1478). Volume changes in the residual limb and socket internal pressures were analyzed. Results/Discussion The pressure graph obtained is consistent with Sanders' volume graphs. The pressure distribution inside the socket is lost after 5 hours of use of the prosthetic device; this can be related to volume loss and alignment. The only area where the pressure increases is in the distal zone, given that once the prosthetic fit is lost, weight bearing is transferred to the socket's distal section (mean volume loss, intrasession −3%; mean pressure loss, intrasession −39%). Conclusions The study suggests that a small change in the volume can cause a change in the distribution of pressures inside the socket, indicating that the prosthetic fit may be compromised. For patient follow-up, measuring pressure inside the socket could be a useful indicator of socket misfit. Clinical Relevance Daily volume changes in the prosthesis can produce pressures that lead to pain, injuries, an inefficient gait, and prosthesis abandonment. Consequently, it is important to understand the behavior of the pressures inside the socket and the influence of the daily changes of volume on the socket adjustment to design better strategies and techniques of daily volume changes management.
{"title":"Impact of Residual Limb Volume Loss on Socket Internal Pressures: A Preliminary Study","authors":"Nora Emilia Sirrs Díaz, Carlos Galván-Duque, José Luis Zavaleta, Jorge Letechipia Moreno","doi":"10.1097/JPO.0000000000000422","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000422","url":null,"abstract":"ABSTRACT Introduction Daily volume loss of residual limb is a condition that most prosthetic users face, negatively affecting their life. One of the consequences is the loss of contact between the residual limb and the socket, which modifies internal pressures. Objective The aim of this study was to study how the loss of volume of the residual limb affects socket adjustment through measuring pressures inside the socket. Study design The study design is prospective longitudinal. Materials and Methods Four subjects with unilateral transtibial amputation, with at least 1 year of prosthetic use, and walking with a comfortable prosthesis participated in this study. The pressure between the socket and the subject's residual limb was measured with an FSocket System (Tekscan). Residual limb volume was measured before and after each test with two different methods: optical scanning (Structure Sensor, Occipital) and conical frustum model. Sanders' protocol for volume loss was followed (Sanders et al. J Rehabil Res Dev. 2012;49:1467–1478). Volume changes in the residual limb and socket internal pressures were analyzed. Results/Discussion The pressure graph obtained is consistent with Sanders' volume graphs. The pressure distribution inside the socket is lost after 5 hours of use of the prosthetic device; this can be related to volume loss and alignment. The only area where the pressure increases is in the distal zone, given that once the prosthetic fit is lost, weight bearing is transferred to the socket's distal section (mean volume loss, intrasession −3%; mean pressure loss, intrasession −39%). Conclusions The study suggests that a small change in the volume can cause a change in the distribution of pressures inside the socket, indicating that the prosthetic fit may be compromised. For patient follow-up, measuring pressure inside the socket could be a useful indicator of socket misfit. Clinical Relevance Daily volume changes in the prosthesis can produce pressures that lead to pain, injuries, an inefficient gait, and prosthesis abandonment. Consequently, it is important to understand the behavior of the pressures inside the socket and the influence of the daily changes of volume on the socket adjustment to design better strategies and techniques of daily volume changes management.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"106 - 113"},"PeriodicalIF":0.6,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46483047","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 : 2022-03-07DOI: 10.1097/JPO.0000000000000425
Therese E Parr, A. R. Hippensteal, J. DesJardins
ABSTRACT Introduction The functional goal for unilateral transfemoral prosthesis users during ambulation is to restore the proper biomechanics and minimize the compensatory actions caused by limb asymmetries. These goals can often lead to embedded design elements that assume the prosthetic limb to look and move like the intact limb. An unconventional artificial limb design can transfer the focus from mimicking the skeletal structure to producing functional symmetry between limbs. In this pilot study, we introduce a length-actuated prosthesis design with the goal of functional biomimicry and collect qualitative feedback from two prosthesis users. Materials and Methods The length-actuated apparatus is attached to the distal end of a transfemoral prosthetic socket and consists of an external motor and a cam and Bowden cable system for powering and dynamically adjusting the prosthesis' length in synchronization with the gait cycle. Two transfemoral prosthesis users ambulated on a treadmill with the length-actuated prosthesis and gave anecdotal feedback. Results The prosthesis was able to support the patient's full weight and adjust to the lengths needed during the gait cycle, including toe clearance. The overall response to the prosthesis and concept was positive; prosthesis users stated that the prosthesis and the action of the knee seemed “comfortable,” and physicians concluded a sufficient and confident ambulation by the prosthesis users. The next iteration will address specific concerns of the prosthesis users by incorporating a more compact electromechanical system with sensors. This will aid in matching and continuously adjusting the prosthesis' length change timing with the cadence of the user's ambulation. Conclusions Overall, the prototype and study proved that linear motion could replace the leg shortening functions of lower-joint rotations, with anecdotal improvements in kinematics and comfort. Future work will consist of a quantitative evaluation of center of gravity displacement, ground reaction forces, toe clearance distance, and the possibilities of knee buckling. Clinical Relevance There are no commercially available lower-limb prostheses that control leg length with dynamic linear motion rather than user flexion and extension of a knee joint. Possible benefits that may come from a length-actuated prosthesis include improved loading symmetry and balance, as well as decreased muscle activity.
{"title":"Development of a Length-Actuated Lower Limb Prosthesis: Functional Prototype and Pilot Study","authors":"Therese E Parr, A. R. Hippensteal, J. DesJardins","doi":"10.1097/JPO.0000000000000425","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000425","url":null,"abstract":"ABSTRACT Introduction The functional goal for unilateral transfemoral prosthesis users during ambulation is to restore the proper biomechanics and minimize the compensatory actions caused by limb asymmetries. These goals can often lead to embedded design elements that assume the prosthetic limb to look and move like the intact limb. An unconventional artificial limb design can transfer the focus from mimicking the skeletal structure to producing functional symmetry between limbs. In this pilot study, we introduce a length-actuated prosthesis design with the goal of functional biomimicry and collect qualitative feedback from two prosthesis users. Materials and Methods The length-actuated apparatus is attached to the distal end of a transfemoral prosthetic socket and consists of an external motor and a cam and Bowden cable system for powering and dynamically adjusting the prosthesis' length in synchronization with the gait cycle. Two transfemoral prosthesis users ambulated on a treadmill with the length-actuated prosthesis and gave anecdotal feedback. Results The prosthesis was able to support the patient's full weight and adjust to the lengths needed during the gait cycle, including toe clearance. The overall response to the prosthesis and concept was positive; prosthesis users stated that the prosthesis and the action of the knee seemed “comfortable,” and physicians concluded a sufficient and confident ambulation by the prosthesis users. The next iteration will address specific concerns of the prosthesis users by incorporating a more compact electromechanical system with sensors. This will aid in matching and continuously adjusting the prosthesis' length change timing with the cadence of the user's ambulation. Conclusions Overall, the prototype and study proved that linear motion could replace the leg shortening functions of lower-joint rotations, with anecdotal improvements in kinematics and comfort. Future work will consist of a quantitative evaluation of center of gravity displacement, ground reaction forces, toe clearance distance, and the possibilities of knee buckling. Clinical Relevance There are no commercially available lower-limb prostheses that control leg length with dynamic linear motion rather than user flexion and extension of a knee joint. Possible benefits that may come from a length-actuated prosthesis include improved loading symmetry and balance, as well as decreased muscle activity.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"114 - 121"},"PeriodicalIF":0.6,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45851532","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 : 2022-03-07DOI: 10.1097/JPO.0000000000000423
N. V. Kang, A. Woollard, Sanjay Gupta, Dominika Michno, E. Davison, Beth Langley
ABSTRACT Introduction After limb loss, many patients undergo treatment with an osseointegrated implant. Unfortunately, some develop persistent peristomal pain after surgery. This can be sufficiently severe to reduce the speed of their rehabilitation or may halt the process altogether. The pain may be due to an enthesopathy of the residual muscles. We describe the phenomenon and outcomes of treatment in a series of patients who underwent treatment with an osseointegrated prosthetic limb, bone-anchor. Materials and Methods Over 36 months, we followed 14 patients with symptoms consistent with enthesopathy. Thirteen had undergone treatment with a transfemoral bone-anchor and one underwent treatment with a transhumeral bone-anchor. One patient had a bilateral transfemoral amputation. Analysis of the patients' ages, heights, weight at the time of surgery, length of residual femur, or preoperative dual-energy x-ray absorptiometry scans showed no correlation with the development of enthesopathy pain. Thirteen patients received steroid injections. Most received at least one injection of Adcortyl™ and bupivacaine. Patients were then encouraged to follow a program of physiotherapy to stretch out their enthesis, after injection. Results All patients experienced relief from their symptoms, but only two were rendered completely pain free. The remaining 11 patients gained sufficient control of their symptoms to allow them to continue daily use of their prosthesis with less difficulty or, where rehabilitation had been delayed or halted completely, to resume this process. Conclusion Enthesopathy seems to be a common phenomenon after bone-anchor surgery in individuals with transfemoral amputation. Steroid injections can help to relieve pain, allowing physiotherapy to be carried out. Patients undergoing treatment with a bone-anchor should be advised of the possibility of enthesopathy pain but can be reassured that there is a solution that works well in most cases. Clinical Relevance This article may be of benefit to clinicians who are struggling to manage patients with persistent peristomal pain after insertion of a bone-anchor. It may also encourage further research into measures for securing the soft tissues around the stoma for patients undergoing bone-anchor surgery.
{"title":"Enthesopathy, a Cause for Persistent Peristomal Pain after Treatment with an Osseointegrated Bone-Anchor: A Retrospective Case Series","authors":"N. V. Kang, A. Woollard, Sanjay Gupta, Dominika Michno, E. Davison, Beth Langley","doi":"10.1097/JPO.0000000000000423","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000423","url":null,"abstract":"ABSTRACT Introduction After limb loss, many patients undergo treatment with an osseointegrated implant. Unfortunately, some develop persistent peristomal pain after surgery. This can be sufficiently severe to reduce the speed of their rehabilitation or may halt the process altogether. The pain may be due to an enthesopathy of the residual muscles. We describe the phenomenon and outcomes of treatment in a series of patients who underwent treatment with an osseointegrated prosthetic limb, bone-anchor. Materials and Methods Over 36 months, we followed 14 patients with symptoms consistent with enthesopathy. Thirteen had undergone treatment with a transfemoral bone-anchor and one underwent treatment with a transhumeral bone-anchor. One patient had a bilateral transfemoral amputation. Analysis of the patients' ages, heights, weight at the time of surgery, length of residual femur, or preoperative dual-energy x-ray absorptiometry scans showed no correlation with the development of enthesopathy pain. Thirteen patients received steroid injections. Most received at least one injection of Adcortyl™ and bupivacaine. Patients were then encouraged to follow a program of physiotherapy to stretch out their enthesis, after injection. Results All patients experienced relief from their symptoms, but only two were rendered completely pain free. The remaining 11 patients gained sufficient control of their symptoms to allow them to continue daily use of their prosthesis with less difficulty or, where rehabilitation had been delayed or halted completely, to resume this process. Conclusion Enthesopathy seems to be a common phenomenon after bone-anchor surgery in individuals with transfemoral amputation. Steroid injections can help to relieve pain, allowing physiotherapy to be carried out. Patients undergoing treatment with a bone-anchor should be advised of the possibility of enthesopathy pain but can be reassured that there is a solution that works well in most cases. Clinical Relevance This article may be of benefit to clinicians who are struggling to manage patients with persistent peristomal pain after insertion of a bone-anchor. It may also encourage further research into measures for securing the soft tissues around the stoma for patients undergoing bone-anchor surgery.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"156 - 163"},"PeriodicalIF":0.6,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41589801","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 : 2022-03-07DOI: 10.1097/JPO.0000000000000426
M. Christ, J. Ha, Timothy Baerg, G. Green
ABSTRACT Introduction Cricotracheal resection (CTR) and tracheal resection (TR) are open surgical options to treat airway stenoses. One of the most devastating complications is anastomosal dehiscence, owing to excessive tension on the anastomosis from cervical extension. To prevent excessive tension on the anastomosis during the postoperative period, the neck is kept in a neutral or slightly flexed position. We describe a novel design and fitting of a modified pediatric Lerman Minerva cervical-thoracic orthosis (CTO) in our pediatric patient population after CTR or TR to protect the anastomosis. Method A Minerva CTO is customized to reduce anastomotic tension. The mandibular extension is removed, occipital extension is recontoured, plastic is trimmed, and a perineal strap is added. The orthosis allows avoidance/removal of the manubrial-mandibular suture, reducing skin complications and increasing mobilization. Discussion This modified Minerva CTO provided three key benefits: it can be sized down to fit small children, provides the desired immobilization, and is adjustable during fitting to ensure that the angle of cervical flexion is appropriate to protect the anastomosis. Conclusion After CTR and TR, proper cervical positioning is crucial to avoid tension on the anastomosis. Our novel modification of the Minerva orthosis is a useful adjunct in the postoperative management of these patients. Clinical relevance This modified pediatric Lerman Minerva CTO is a useful adjunct to protect the anastomosis following CTR or TR.
{"title":"Modified Minerva Orthosis for Postoperative Management of Cricotracheal Resection in Children","authors":"M. Christ, J. Ha, Timothy Baerg, G. Green","doi":"10.1097/JPO.0000000000000426","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000426","url":null,"abstract":"ABSTRACT Introduction Cricotracheal resection (CTR) and tracheal resection (TR) are open surgical options to treat airway stenoses. One of the most devastating complications is anastomosal dehiscence, owing to excessive tension on the anastomosis from cervical extension. To prevent excessive tension on the anastomosis during the postoperative period, the neck is kept in a neutral or slightly flexed position. We describe a novel design and fitting of a modified pediatric Lerman Minerva cervical-thoracic orthosis (CTO) in our pediatric patient population after CTR or TR to protect the anastomosis. Method A Minerva CTO is customized to reduce anastomotic tension. The mandibular extension is removed, occipital extension is recontoured, plastic is trimmed, and a perineal strap is added. The orthosis allows avoidance/removal of the manubrial-mandibular suture, reducing skin complications and increasing mobilization. Discussion This modified Minerva CTO provided three key benefits: it can be sized down to fit small children, provides the desired immobilization, and is adjustable during fitting to ensure that the angle of cervical flexion is appropriate to protect the anastomosis. Conclusion After CTR and TR, proper cervical positioning is crucial to avoid tension on the anastomosis. Our novel modification of the Minerva orthosis is a useful adjunct in the postoperative management of these patients. Clinical relevance This modified pediatric Lerman Minerva CTO is a useful adjunct to protect the anastomosis following CTR or TR.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"e62 - e65"},"PeriodicalIF":0.6,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41777386","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 : 2022-03-07DOI: 10.1097/JPO.0000000000000421
J. Shaw, J. Hackney, Kristi Shook Vandeloecht, Sean C. Newton, Matthew A. Rainey, Joshua J. Reed, D. Suess, Jennifer N. Tinker
ABSTRACT Introduction Individuals after a transtibial amputation (TTA) are at risk to develop a hip flexion contracture, which may adversely affect future ambulation with a prosthesis. Although patients have traditionally been advised to lie prone to maintain or improve hip extension, compensatory pelvic tilting may occur in prone lying (PL). We sought to compare hip extension range of motion (ROM) in PL to the modified Thomas test (MTT) position, because research implies that, in the MTT, patients are better able to control for compensatory pelvic tilting. We hypothesized that individuals after a TTA would have a greater peak hip extension angle in the MTT position compared with the PL position. Methods Ten individuals after a dysvascular TTA, mean age of 60 ± 8.42 years, participated in this study. The same physical therapist marked the femur and pelvis for goniometric measurement of peak hip extension angle by 12 raters blinded to each other's measurements. The markers remained unchanged as six raters measured all participants in PL and six different raters measured all participants in the MTT position. Results and Discussion The intraclass correlation (ICC) indicated high interrater reliability between the raters for the PL and MTT positions (ICC = 0.985 for PL and 0.976 for MTT). The average peak hip extension angle in PL was −14.0° ± 13.3°, standard error of mean = 4.3°; and in the MTT position was −8.6° ± 15.3°, standard error of mean = 4.8° (the negative mean connotes that, on average, participants did not have hip extension to neutral for either condition). We found a mean of 5.4° ± 6.6° more hip extension ROM for the MTT position compared with PL (P = 0.028). Conclusions Our findings show that, on average, patients after a TTA have significantly greater peak hip extension angle in the MTT position compared with the PL position. Thus, passive PL may not be as effective of a stretching position for preventing a hip flexion contracture after a TTA, because PL does not always extend the patient's hip to its maximum available ROM, due to the reduced ability to control the pelvis from tilting anteriorly. Clinical Relevance Adequate hip flexor length is positively correlated with gait parameters, which include increased velocity and step length in people using a prosthesis after transtibial amputation. This study implies that the MTT position may be a better method for improving and maintaining hip flexor length over the traditional strategy of passive PL.
{"title":"Is Maximum Available Hip Extension Range of Motion of the Residual Limb Reached During Passive Prone Lying in the Acute Stage After Dysvascular Transtibial Amputation?","authors":"J. Shaw, J. Hackney, Kristi Shook Vandeloecht, Sean C. Newton, Matthew A. Rainey, Joshua J. Reed, D. Suess, Jennifer N. Tinker","doi":"10.1097/JPO.0000000000000421","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000421","url":null,"abstract":"ABSTRACT Introduction Individuals after a transtibial amputation (TTA) are at risk to develop a hip flexion contracture, which may adversely affect future ambulation with a prosthesis. Although patients have traditionally been advised to lie prone to maintain or improve hip extension, compensatory pelvic tilting may occur in prone lying (PL). We sought to compare hip extension range of motion (ROM) in PL to the modified Thomas test (MTT) position, because research implies that, in the MTT, patients are better able to control for compensatory pelvic tilting. We hypothesized that individuals after a TTA would have a greater peak hip extension angle in the MTT position compared with the PL position. Methods Ten individuals after a dysvascular TTA, mean age of 60 ± 8.42 years, participated in this study. The same physical therapist marked the femur and pelvis for goniometric measurement of peak hip extension angle by 12 raters blinded to each other's measurements. The markers remained unchanged as six raters measured all participants in PL and six different raters measured all participants in the MTT position. Results and Discussion The intraclass correlation (ICC) indicated high interrater reliability between the raters for the PL and MTT positions (ICC = 0.985 for PL and 0.976 for MTT). The average peak hip extension angle in PL was −14.0° ± 13.3°, standard error of mean = 4.3°; and in the MTT position was −8.6° ± 15.3°, standard error of mean = 4.8° (the negative mean connotes that, on average, participants did not have hip extension to neutral for either condition). We found a mean of 5.4° ± 6.6° more hip extension ROM for the MTT position compared with PL (P = 0.028). Conclusions Our findings show that, on average, patients after a TTA have significantly greater peak hip extension angle in the MTT position compared with the PL position. Thus, passive PL may not be as effective of a stretching position for preventing a hip flexion contracture after a TTA, because PL does not always extend the patient's hip to its maximum available ROM, due to the reduced ability to control the pelvis from tilting anteriorly. Clinical Relevance Adequate hip flexor length is positively correlated with gait parameters, which include increased velocity and step length in people using a prosthesis after transtibial amputation. This study implies that the MTT position may be a better method for improving and maintaining hip flexor length over the traditional strategy of passive PL.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"165 - 173"},"PeriodicalIF":0.6,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43165409","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}
ABSTRACT Introduction Foot orthoses have injury prevention and human performance benefits. The carbon fiber foot plate (CFFP) is a possible orthotic intervention for preventing foot injury and enhancing sports performance. However, the cost of these devices is generally acceptable for developed settings but might serve as a barrier for use in developing settings. In this study, we aimed to develop an affordable locally custom-made CFFP and evaluate its function along with subjective feedback. Materials and Methods Three types of foot plates were designed each with a unique layup and fabric orientation. Carbon fiber preimpregnated with activated resin was used for foot plate fabrication. Three participants were provided with each prototype of the foot plate. Outcome measurements include walking speed (20-m walk test [20MWT]), treadmill jogging energy expenditure, and user feedback. Results The 20MWT self-selected speed increased for two participants with the CFFP. The maximum average walking speed increased in two participants with CFFP prototype B (8%–11%). Moreover, the average increase of walking speed for prototypes A and C were 2%–2.6% and 4%–4.6%, respectively. The third participant showed a 5% reduction of speed with CFFP prototype B and 3%–5% with prototypes A and B. For all participants, no improvements of energy expenditure were observed with all prototypes compared to without foot plate. Conversely, an increase in energy expenditure was found with all prototypes at all speeds. The subjective feedback in each prototype showed that all participants were satisfied with the CFFP prototype A, but the first participant was identified with metatarsal head pain. Prototype B also evidenced a consensus among participants with increased comfort compared with prototype A, especially at the metatarsal heads. Conclusions The study describes the development and effects of using three types of CFFPs. Although prototypes increased the energy expenditure, prototype B improved walking speed. Prototypes A and B were useful and accepted by all participants. Further exploration is required in a larger heterogeneous sample of able-bodied persons and sport-specific athletes. Clinical Relevance The study demonstrates the effect of the CFFP on walking ability, which can better inform the clinician when considering the prescription for patients with foot problems and sports activities.
{"title":"Effects of Carbon Fiber Foot Plate on Able-bodied Gait: Pilot Study","authors":"Yuparat Premprasopchok, Sasithon Sukthomya, Wareerat Petmunee, P. Rayothee, Kwannate Permpool, Saw Naing Naing Eh, Feryanda Utami","doi":"10.1097/JPO.0000000000000418","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000418","url":null,"abstract":"ABSTRACT Introduction Foot orthoses have injury prevention and human performance benefits. The carbon fiber foot plate (CFFP) is a possible orthotic intervention for preventing foot injury and enhancing sports performance. However, the cost of these devices is generally acceptable for developed settings but might serve as a barrier for use in developing settings. In this study, we aimed to develop an affordable locally custom-made CFFP and evaluate its function along with subjective feedback. Materials and Methods Three types of foot plates were designed each with a unique layup and fabric orientation. Carbon fiber preimpregnated with activated resin was used for foot plate fabrication. Three participants were provided with each prototype of the foot plate. Outcome measurements include walking speed (20-m walk test [20MWT]), treadmill jogging energy expenditure, and user feedback. Results The 20MWT self-selected speed increased for two participants with the CFFP. The maximum average walking speed increased in two participants with CFFP prototype B (8%–11%). Moreover, the average increase of walking speed for prototypes A and C were 2%–2.6% and 4%–4.6%, respectively. The third participant showed a 5% reduction of speed with CFFP prototype B and 3%–5% with prototypes A and B. For all participants, no improvements of energy expenditure were observed with all prototypes compared to without foot plate. Conversely, an increase in energy expenditure was found with all prototypes at all speeds. The subjective feedback in each prototype showed that all participants were satisfied with the CFFP prototype A, but the first participant was identified with metatarsal head pain. Prototype B also evidenced a consensus among participants with increased comfort compared with prototype A, especially at the metatarsal heads. Conclusions The study describes the development and effects of using three types of CFFPs. Although prototypes increased the energy expenditure, prototype B improved walking speed. Prototypes A and B were useful and accepted by all participants. Further exploration is required in a larger heterogeneous sample of able-bodied persons and sport-specific athletes. Clinical Relevance The study demonstrates the effect of the CFFP on walking ability, which can better inform the clinician when considering the prescription for patients with foot problems and sports activities.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"61 - 66"},"PeriodicalIF":0.6,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45245337","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 : 2022-02-04DOI: 10.1097/JPO.0000000000000413
W. Hill, L. Hermansson
ABSTRACT Introduction To support clinicians who treat children with upper-limb differences, we must first understand how these children are treated around the world. Study Design A descriptive survey was carried out in this study. Objectives The aim was to describe how treatment for children with upper-limb difference is provided in different parts of the world. Methods A web-based survey was used to gather data. The survey was shared on the Handsmart website, through providers and members using snowball sampling. Results Sixty-eight respondents from 18 countries, with most being occupational therapists and prosthetists, participated. All respondents reported that they provide prosthetic treatment and most fit a passive prosthesis before 1 year of age. Respondents from 13 countries reported having governmental funding for the provision of care for people with upper-limb loss. Intervention is guided by the presentation of the limb as well as availability of funding and other resources. In 12 countries, no treatment other than fitting of prostheses is provided for the children. The children who do not receive a prosthesis continue to see an occupational or physical therapist for other treatment (other devices, follow-up). Respondents stated that they would like to see clear treatment guidelines used by multidisciplinary teams to fit children and that treatment should include regular follow-up. Conclusions Children are treated differently in various parts of the world based on different funding, family support, and therapy resources. Further studies should encompass a geographically representative sample of children’s clinics. Clinical Relevance This study provides information regarding treatment practices for children with upper-limb loss/difference in various parts of the world; prosthetic treatment is common for children, although ages for fitting vary among clinics and countries. Results will contribute by supporting clinicians to provide better treatment for children with upper-limb loss/difference.
{"title":"Treatment for Children with Upper-Limb Differences in Various Parts of the World: Preliminary Findings","authors":"W. Hill, L. Hermansson","doi":"10.1097/JPO.0000000000000413","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000413","url":null,"abstract":"ABSTRACT Introduction To support clinicians who treat children with upper-limb differences, we must first understand how these children are treated around the world. Study Design A descriptive survey was carried out in this study. Objectives The aim was to describe how treatment for children with upper-limb difference is provided in different parts of the world. Methods A web-based survey was used to gather data. The survey was shared on the Handsmart website, through providers and members using snowball sampling. Results Sixty-eight respondents from 18 countries, with most being occupational therapists and prosthetists, participated. All respondents reported that they provide prosthetic treatment and most fit a passive prosthesis before 1 year of age. Respondents from 13 countries reported having governmental funding for the provision of care for people with upper-limb loss. Intervention is guided by the presentation of the limb as well as availability of funding and other resources. In 12 countries, no treatment other than fitting of prostheses is provided for the children. The children who do not receive a prosthesis continue to see an occupational or physical therapist for other treatment (other devices, follow-up). Respondents stated that they would like to see clear treatment guidelines used by multidisciplinary teams to fit children and that treatment should include regular follow-up. Conclusions Children are treated differently in various parts of the world based on different funding, family support, and therapy resources. Further studies should encompass a geographically representative sample of children’s clinics. Clinical Relevance This study provides information regarding treatment practices for children with upper-limb loss/difference in various parts of the world; prosthetic treatment is common for children, although ages for fitting vary among clinics and countries. Results will contribute by supporting clinicians to provide better treatment for children with upper-limb loss/difference.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"149 - 155"},"PeriodicalIF":0.6,"publicationDate":"2022-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48359094","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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