Pub Date : 2022-02-02DOI: 10.1097/JPO.0000000000000417
W. N. Qa'dan, Mohammad A. Damhoureyeh, Sarah Day
ABSTRACT Introduction Amputations lead to great challenges for individuals with amputation that can affect their quality of life (QoL). Clinical and nonclinical factors are expected to affect QoL of individuals with amputation. Materials and Methods Seventy-nine individuals with lower-limb amputation participated in the study. The Arabic version of the PEQ and a short added questionnaire evaluating the studied factors were used to evaluate QoL of individuals with amputation. Exploratory factor analysis was used to investigate which factors may have greater effect on QoL. Results Age at amputation, etiology, and age of the person with amputation were found to be the factors explaining most of the variance. Discussion Age at amputation dictates how much time is available for the individual to adapt to using the prosthesis. Etiology controls how well the individual is. Age is a decisive factor in the general well-being of the person with amputation. Conclusions This study shows that age at amputation, etiology, and age of the individual with amputation are the most important factors affecting the QoL of individuals with amputation. Clinical Relevance As QoL determines the success of prosthetic rehabilitation, and as several factors affect QoL in individuals with amputation, determining these factors enables providing a better prosthetic experience, resulting in improved prosthetic satisfaction.
{"title":"Clinical and Nonclinical Factors Affecting Quality of Life in Individuals with Lower-Limb Amputation","authors":"W. N. Qa'dan, Mohammad A. Damhoureyeh, Sarah Day","doi":"10.1097/JPO.0000000000000417","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000417","url":null,"abstract":"ABSTRACT Introduction Amputations lead to great challenges for individuals with amputation that can affect their quality of life (QoL). Clinical and nonclinical factors are expected to affect QoL of individuals with amputation. Materials and Methods Seventy-nine individuals with lower-limb amputation participated in the study. The Arabic version of the PEQ and a short added questionnaire evaluating the studied factors were used to evaluate QoL of individuals with amputation. Exploratory factor analysis was used to investigate which factors may have greater effect on QoL. Results Age at amputation, etiology, and age of the person with amputation were found to be the factors explaining most of the variance. Discussion Age at amputation dictates how much time is available for the individual to adapt to using the prosthesis. Etiology controls how well the individual is. Age is a decisive factor in the general well-being of the person with amputation. Conclusions This study shows that age at amputation, etiology, and age of the individual with amputation are the most important factors affecting the QoL of individuals with amputation. Clinical Relevance As QoL determines the success of prosthetic rehabilitation, and as several factors affect QoL in individuals with amputation, determining these factors enables providing a better prosthetic experience, resulting in improved prosthetic satisfaction.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"246 - 251"},"PeriodicalIF":0.6,"publicationDate":"2022-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49583729","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 : 2022-02-01DOI: 10.1097/JPO.0000000000000403
Fredrik A Nilsen, Marius Molund, Eva Marie Lium, K. Hvaal
ABSTRACT Introduction Diabetic foot ulceration is one of the most significant causes of infection and amputation in neuropathic patients. Most often, the plantar surface of the foot is affected. Offloading the foot by custom-molded insoles is considered a crucial step in prevention of diabetic foot ulcers, although the most beneficial choice of materials is not well documented. This review focuses on identifying the most suitable materials and material compositions for offloading the diabetic foot. Materials and Methods A systematic review was performed with the aid of a clinical librarian on September 9, 2020. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies were included based on the following eligibility criteria: interventions in terms of material selection/properties with outcomes reported as either pressure reduction and/or ulcer prevention. Bench studies were also included. At each level of selection, records were reviewed by two independent reviewers. Clinical studies were appraised using the ROBINS-1 tool. Results Through database search, 1131 records were identified and an additional eight records were identified through references and other sources. After removal of duplicates, 927 records were screened, which resulted in 74 full-text records assessed for eligibility. Thirty-seven studies were included in the qualitative synthesis. Twelve studies examined material properties by bench testing. Five studies were based on finite element analysis. Nineteen clinical studies on material parameters were identified. Six studies supported the use of moderately deformable materials for insole production. Six studies showed better performance of combination material insoles in offloading and under sustained loading. Five studies concluded that increasing the thickness of insoles increased the offloading capabilities. Conclusions The diversity of studies and study designs to date precludes the ability to recommend one type of material over the other. Still some general considerations can be made. For solo-material insoles, moderately deformable materials are preferable, balancing the need for offloading with the need for durability. Increasing the thickness may increase the longevity of the insoles. Combining materials of different properties seems to enhance both the offloading capability and durability of insoles. Clinical Relevance When using a single-material design, moderately deformable materials are preferable. Combining materials of different properties enhances both the offloading capability and durability of insoles.
{"title":"Material Selection for Diabetic Custom Insoles: A Systematic Review of Insole Materials and Their Properties","authors":"Fredrik A Nilsen, Marius Molund, Eva Marie Lium, K. Hvaal","doi":"10.1097/JPO.0000000000000403","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000403","url":null,"abstract":"ABSTRACT Introduction Diabetic foot ulceration is one of the most significant causes of infection and amputation in neuropathic patients. Most often, the plantar surface of the foot is affected. Offloading the foot by custom-molded insoles is considered a crucial step in prevention of diabetic foot ulcers, although the most beneficial choice of materials is not well documented. This review focuses on identifying the most suitable materials and material compositions for offloading the diabetic foot. Materials and Methods A systematic review was performed with the aid of a clinical librarian on September 9, 2020. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies were included based on the following eligibility criteria: interventions in terms of material selection/properties with outcomes reported as either pressure reduction and/or ulcer prevention. Bench studies were also included. At each level of selection, records were reviewed by two independent reviewers. Clinical studies were appraised using the ROBINS-1 tool. Results Through database search, 1131 records were identified and an additional eight records were identified through references and other sources. After removal of duplicates, 927 records were screened, which resulted in 74 full-text records assessed for eligibility. Thirty-seven studies were included in the qualitative synthesis. Twelve studies examined material properties by bench testing. Five studies were based on finite element analysis. Nineteen clinical studies on material parameters were identified. Six studies supported the use of moderately deformable materials for insole production. Six studies showed better performance of combination material insoles in offloading and under sustained loading. Five studies concluded that increasing the thickness of insoles increased the offloading capabilities. Conclusions The diversity of studies and study designs to date precludes the ability to recommend one type of material over the other. Still some general considerations can be made. For solo-material insoles, moderately deformable materials are preferable, balancing the need for offloading with the need for durability. Increasing the thickness may increase the longevity of the insoles. Combining materials of different properties seems to enhance both the offloading capability and durability of insoles. Clinical Relevance When using a single-material design, moderately deformable materials are preferable. Combining materials of different properties enhances both the offloading capability and durability of insoles.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"e131 - e143"},"PeriodicalIF":0.6,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46502118","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 : 2022-01-27DOI: 10.1097/JPO.0000000000000414
T. Schmalz, Thomas Maximilian Köhler, Katharina Burkhardt, Annika Dlugoszek, Etienne Overdevest, A. Kannenberg, M. Bellmann
ABSTRACT Introduction A newly introduced generation of orthotic ankle joints with adjustable dorsiflexion and plantarflexion resistances and increased range of motion (ROM) has been well established in orthotic fittings of neurological patients with ankle foot orthoses. The aim of the present study was to investigate whether users of stance control orthoses (SCOs) may also benefit from this orthotic ankle joint principle using a biomechanical test design. Methods Six patients unilaterally fitted with an SCO (E-MAG Active) with the orthotic ankle joint NexGearTango (NGT; Ottobock, Duderstadt, Germany), an ankle joint representing the new principle, were enrolled in the study. The modular principle of the ankle joint allowed testing both the new functionality and the characteristics of a conventional orthotic ankle joint (CAJ; limited uncontrolled ROM). Level walking at slow, medium, and fast speed and with given short steps, ascending and descending a ramp with 10° inclination and standing (level ground as well as 10° incline and decline standing), were assessed while using NGT or CAJ, respectively. Kinematic and kinetic data were captured with an optoelectronic camera system and two force plates. Results The reliability of switching from stance to swing of the orthotic knee joint was clearly enhanced with NGT for short-step level walking and ascending ramps. For ascending ramps, a significantly increased dorsiflexion of 5° during stance and an earlier transition from decelerating to accelerating forces were found with NGT. When standing on slopes, the symmetry of weight distribution between the orthotic and unaffected limb was significantly increased with NGT. Conclusions The increased and resistance-controlled dorsiflexion of the new orthotic ankle joint principle resulted in relevant benefits in gait situations with unlevel conditions and higher demands. Therefore, this orthotic ankle joint principle may represent an additional option to optimize patient fittings with SCOs. Clinical Relevance Statement The use of the new orthotic ankle principle tested in the present study results in relevant benefits, especially in gait situations in unlevel conditions. Therefore, this principle represents an additional option to optimize patient fittings with SCOs.
{"title":"Evaluation of Biomechanical Effects and Patient Benefits of a New Orthotic Ankle Joint in Stance Control Orthosis Fittings","authors":"T. Schmalz, Thomas Maximilian Köhler, Katharina Burkhardt, Annika Dlugoszek, Etienne Overdevest, A. Kannenberg, M. Bellmann","doi":"10.1097/JPO.0000000000000414","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000414","url":null,"abstract":"ABSTRACT Introduction A newly introduced generation of orthotic ankle joints with adjustable dorsiflexion and plantarflexion resistances and increased range of motion (ROM) has been well established in orthotic fittings of neurological patients with ankle foot orthoses. The aim of the present study was to investigate whether users of stance control orthoses (SCOs) may also benefit from this orthotic ankle joint principle using a biomechanical test design. Methods Six patients unilaterally fitted with an SCO (E-MAG Active) with the orthotic ankle joint NexGearTango (NGT; Ottobock, Duderstadt, Germany), an ankle joint representing the new principle, were enrolled in the study. The modular principle of the ankle joint allowed testing both the new functionality and the characteristics of a conventional orthotic ankle joint (CAJ; limited uncontrolled ROM). Level walking at slow, medium, and fast speed and with given short steps, ascending and descending a ramp with 10° inclination and standing (level ground as well as 10° incline and decline standing), were assessed while using NGT or CAJ, respectively. Kinematic and kinetic data were captured with an optoelectronic camera system and two force plates. Results The reliability of switching from stance to swing of the orthotic knee joint was clearly enhanced with NGT for short-step level walking and ascending ramps. For ascending ramps, a significantly increased dorsiflexion of 5° during stance and an earlier transition from decelerating to accelerating forces were found with NGT. When standing on slopes, the symmetry of weight distribution between the orthotic and unaffected limb was significantly increased with NGT. Conclusions The increased and resistance-controlled dorsiflexion of the new orthotic ankle joint principle resulted in relevant benefits in gait situations with unlevel conditions and higher demands. Therefore, this orthotic ankle joint principle may represent an additional option to optimize patient fittings with SCOs. Clinical Relevance Statement The use of the new orthotic ankle principle tested in the present study results in relevant benefits, especially in gait situations in unlevel conditions. Therefore, this principle represents an additional option to optimize patient fittings with SCOs.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"164 - 171"},"PeriodicalIF":0.6,"publicationDate":"2022-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47490347","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 Orthotic devices can be successfully used to treat lower-limb injuries. However, their high cost is a major obstacle. Some orthotic companies have offered the semicustom alternatives at reasonable prices. The purpose of this study was to examine whether semicustom UCBL orthoses can provide similar rearfoot control as custom UCBL orthoses in individuals with flexible flatfoot. Material and Methods Eighteen subjects walked through the motion analysis laboratory under three conditions: no orthosis, custom UCBL orthosis, and semicustom UCBL orthosis. The rearfoot kinematics were assessed for each device. Results Both devices effectively reduced eversion excursion. Compared with the no orthotic condition, the custom and semicustom UCBL orthoses significantly decreased eversion excursion (P < .05), whereas peak eversion angle and velocity were not affected by any type of orthoses (P > .05). Conclusion Regarding the ability of semicustom UCBL orthoses to control rearfoot motion, they can be considered as a feasible alternative to custom UCBL orthoses for individuals with flexible flatfoot. Clinical Relevance This study provides evidence that semicustom UCBL orthoses are as effective as custom UCBL orthoses in controlling the rearfoot motion in flexible flatfoot. Therefore, owing to less fabrication time and lower price, semicustom UCBL orthoses are reasonable alternatives to custom UCBL orthoses.
{"title":"Comparison of Semicustom and Custom UCBL on Lower-Limb Kinematics in Flexible Flatfoot","authors":"Lesani Atefe, Tabatabai Ghomshe, Bahramizadeh Mahmood","doi":"10.1097/JPO.0000000000000410","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000410","url":null,"abstract":"ABSTRACT Introduction Orthotic devices can be successfully used to treat lower-limb injuries. However, their high cost is a major obstacle. Some orthotic companies have offered the semicustom alternatives at reasonable prices. The purpose of this study was to examine whether semicustom UCBL orthoses can provide similar rearfoot control as custom UCBL orthoses in individuals with flexible flatfoot. Material and Methods Eighteen subjects walked through the motion analysis laboratory under three conditions: no orthosis, custom UCBL orthosis, and semicustom UCBL orthosis. The rearfoot kinematics were assessed for each device. Results Both devices effectively reduced eversion excursion. Compared with the no orthotic condition, the custom and semicustom UCBL orthoses significantly decreased eversion excursion (P < .05), whereas peak eversion angle and velocity were not affected by any type of orthoses (P > .05). Conclusion Regarding the ability of semicustom UCBL orthoses to control rearfoot motion, they can be considered as a feasible alternative to custom UCBL orthoses for individuals with flexible flatfoot. Clinical Relevance This study provides evidence that semicustom UCBL orthoses are as effective as custom UCBL orthoses in controlling the rearfoot motion in flexible flatfoot. Therefore, owing to less fabrication time and lower price, semicustom UCBL orthoses are reasonable alternatives to custom UCBL orthoses.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"7 1","pages":"174 - 179"},"PeriodicalIF":0.6,"publicationDate":"2022-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61792214","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 : 2022-01-16DOI: 10.1097/JPO.0000000000000411
A. Kannenberg, Russell L Lundstrom, K. Hibler, Shawn Swanson Johnson
ABSTRACT Introduction Research with multiarticulating prosthetic hands on patient-reported ease of activities of daily living (ADLs) and usefulness is still limited. This study aimed at comparing ease of ADL performance and usefulness of two common multiarticulating prosthetic hands. Methods Twenty subjects with transradial amputation wearing the bebionic (n = 10) or i-Limb (n = 10) hands were assessed with a hybrid Orthotics and Prosthetics User Survey–Upper Extremity Functional Status (OPUS-UEFS)/Prosthetic Upper Extremity Functional Index (PUFI) outcome measure previously used in a study with another multigrip prosthetic hand. Results There were no significant differences between the bebionic and i-Limb hands. However, the analysis of individual activities revealed that each multiarticulating hand had specific strengths and weaknesses compared with a historic control group with conventional myoelectric hands. Discussion Both multiarticulating hands may improve ease of performing ADLs compared with conventional myoelectric hands. However, more grip types available do not necessarily result in greater ease or usefulness compared with advanced hands with fewer grip types. Conclusions Clinicians must match the patients' functional needs with the differential functional profiles of the available multiarticulating hands. Clinical Relevance The present study is the first to provide comparative patient-reported outcomes on 3 multigrip prosthetic hands as well as standard myoelectric hands in 23 common ADLs. The distinct patient-reported ease and usefulness profiles of the different hands may inform and support clinicians' decision-making on hand selection for individual patients with transradial amputation.
{"title":"Differences in Two Multiarticulating Myoelectric Hands for Facilitating Activities of Daily Living in Individuals with Transradial Amputation: A Cross-Sectional Study","authors":"A. Kannenberg, Russell L Lundstrom, K. Hibler, Shawn Swanson Johnson","doi":"10.1097/JPO.0000000000000411","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000411","url":null,"abstract":"ABSTRACT Introduction Research with multiarticulating prosthetic hands on patient-reported ease of activities of daily living (ADLs) and usefulness is still limited. This study aimed at comparing ease of ADL performance and usefulness of two common multiarticulating prosthetic hands. Methods Twenty subjects with transradial amputation wearing the bebionic (n = 10) or i-Limb (n = 10) hands were assessed with a hybrid Orthotics and Prosthetics User Survey–Upper Extremity Functional Status (OPUS-UEFS)/Prosthetic Upper Extremity Functional Index (PUFI) outcome measure previously used in a study with another multigrip prosthetic hand. Results There were no significant differences between the bebionic and i-Limb hands. However, the analysis of individual activities revealed that each multiarticulating hand had specific strengths and weaknesses compared with a historic control group with conventional myoelectric hands. Discussion Both multiarticulating hands may improve ease of performing ADLs compared with conventional myoelectric hands. However, more grip types available do not necessarily result in greater ease or usefulness compared with advanced hands with fewer grip types. Conclusions Clinicians must match the patients' functional needs with the differential functional profiles of the available multiarticulating hands. Clinical Relevance The present study is the first to provide comparative patient-reported outcomes on 3 multigrip prosthetic hands as well as standard myoelectric hands in 23 common ADLs. The distinct patient-reported ease and usefulness profiles of the different hands may inform and support clinicians' decision-making on hand selection for individual patients with transradial amputation.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"38 - 43"},"PeriodicalIF":0.6,"publicationDate":"2022-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42383203","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 : 2022-01-12DOI: 10.1097/JPO.0000000000000412
Ehsan Norouzi, Mahtab Bagheri, Behnaz Alafchi, N. Tafti
ABSTRACT Introduction The hallux valgus, a painful forefoot deformity, is defined as lateral deviation of the hallux, which is highly correlated with forefoot pronation. This study aimed to compare the effect of two types of foot orthoses, one with and one without a varus forefoot wedge, on self-reported outcomes of pain, function, and QOL (by FAOS questionnaire) in patients with moderate hallux valgus. Materials and Methods Sixteen patients with hallux valgus were assigned to two equal groups randomly in a before-after trial. Results The within-group comparison showed significant improvements in all subscales of the FAOS questionnaire for both groups (P < 0.05). The between-group analysis showed no statistically significant difference. Conclusions It seems the addition of varus forefoot wedge to foot orthoses may have no adverse effect on self-reported outcomes. Clinical Relevance It seems in conservative treatment of hallux valgus by medical insoles to correct forefoot pronation may be useful for relieving pain.
{"title":"Analyzing the Effect of Varus Forefoot Wedge in Addition to Arch Support on Self-Reported Pain, Function, and Quality of Life in Patients with Moderate Hallux Valgus: A Pilot Study","authors":"Ehsan Norouzi, Mahtab Bagheri, Behnaz Alafchi, N. Tafti","doi":"10.1097/JPO.0000000000000412","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000412","url":null,"abstract":"ABSTRACT Introduction The hallux valgus, a painful forefoot deformity, is defined as lateral deviation of the hallux, which is highly correlated with forefoot pronation. This study aimed to compare the effect of two types of foot orthoses, one with and one without a varus forefoot wedge, on self-reported outcomes of pain, function, and QOL (by FAOS questionnaire) in patients with moderate hallux valgus. Materials and Methods Sixteen patients with hallux valgus were assigned to two equal groups randomly in a before-after trial. Results The within-group comparison showed significant improvements in all subscales of the FAOS questionnaire for both groups (P < 0.05). The between-group analysis showed no statistically significant difference. Conclusions It seems the addition of varus forefoot wedge to foot orthoses may have no adverse effect on self-reported outcomes. Clinical Relevance It seems in conservative treatment of hallux valgus by medical insoles to correct forefoot pronation may be useful for relieving pain.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"198 - 202"},"PeriodicalIF":0.6,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47081632","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 : 2022-01-12DOI: 10.1097/JPO.0000000000000415
Fraser Dunlop, Alejandra Aranceta-Garza, Ramesh Munjal, Anthony McGarry, Laura Murray
ABSTRACT Introduction Microprocessor knees have been shown to improve gait biomechanics and to reduce the frequency of falls, but evidence of their influence on psychosocial health is limited. Study Design Retrospective analysis. Objective The aim of this study was to evaluate the change in psychosocial outcome measures when prosthetic users change from a non–microprocessor-controlled prosthetic knee (NMPK) to a microprocessor-controlled prosthetic knee (MPK). Methods Using validated outcome measures, physical and psychological attributes of 26 MPK users were analyzed using data collected at routine appointments. Baseline data were collected using NMPK limbs first, then compared with data collected 4 weeks and 6 months after initial MPK fitting. Results A significant improvement of 13.7% in Reintegration to Normal Living Index (RNLI) scores was observed after 6 months (P = 0.001). The Patient Health Questionnaire-9 (PHQ-9) demonstrated a 64.6% significant reduction in the presence of depression-like symptoms after 6 months of MPK use (P < 0.001), including four participants who previously scored highly enough to be diagnosed with major depressive disorder. Frequency of falls reduced significantly as well (P < 0.001). Increases in self-selected walking speed were seen in both the 2-minute walk and 6-minute walk tests. Conclusions Significant improvements were seen in all psychosocial outcome measures, indicating participants' psychosocial health improved with the prescription of an MPK despite a lack of clinically important improvements in parallel performance-based outcome measures. Clinical Relevance MPKs are well documented to reduce trips and falls, which is corroborated by this research. However, the psychosocial benefits of MPKs are not documented extensively; this study provides evidence of an improvement in psychological wellbeing in this cohort.
{"title":"A Retrospective Review of Psychosocial Outcomes After Microprocessor Knee Prescription","authors":"Fraser Dunlop, Alejandra Aranceta-Garza, Ramesh Munjal, Anthony McGarry, Laura Murray","doi":"10.1097/JPO.0000000000000415","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000415","url":null,"abstract":"ABSTRACT Introduction Microprocessor knees have been shown to improve gait biomechanics and to reduce the frequency of falls, but evidence of their influence on psychosocial health is limited. Study Design Retrospective analysis. Objective The aim of this study was to evaluate the change in psychosocial outcome measures when prosthetic users change from a non–microprocessor-controlled prosthetic knee (NMPK) to a microprocessor-controlled prosthetic knee (MPK). Methods Using validated outcome measures, physical and psychological attributes of 26 MPK users were analyzed using data collected at routine appointments. Baseline data were collected using NMPK limbs first, then compared with data collected 4 weeks and 6 months after initial MPK fitting. Results A significant improvement of 13.7% in Reintegration to Normal Living Index (RNLI) scores was observed after 6 months (P = 0.001). The Patient Health Questionnaire-9 (PHQ-9) demonstrated a 64.6% significant reduction in the presence of depression-like symptoms after 6 months of MPK use (P < 0.001), including four participants who previously scored highly enough to be diagnosed with major depressive disorder. Frequency of falls reduced significantly as well (P < 0.001). Increases in self-selected walking speed were seen in both the 2-minute walk and 6-minute walk tests. Conclusions Significant improvements were seen in all psychosocial outcome measures, indicating participants' psychosocial health improved with the prescription of an MPK despite a lack of clinically important improvements in parallel performance-based outcome measures. Clinical Relevance MPKs are well documented to reduce trips and falls, which is corroborated by this research. However, the psychosocial benefits of MPKs are not documented extensively; this study provides evidence of an improvement in psychological wellbeing in this cohort.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"67 - 74"},"PeriodicalIF":0.6,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47024369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-29DOI: 10.1097/JPO.0000000000000408
P. Kumar
ABSTRACT Introduction Glenohumeral subluxation (GHS) is reported in up to 81% of patients with stroke. Our previous studies found that a Lycra sleeve can reduce acromion-greater tuberosity (AGT) distance (used for assessment of GHS) in people with chronic stroke (n = 5). In a recent study on able-bodied people (n = 31), we report reduction in AGT, change in scapula measurements, and change in muscle activity after the application of Lycra sleeve. The aim of this study was to investigate the effect of Lycra sleeves on the AGT distance, muscle activity around the shoulder region, and scapular position in people with stroke. Method People with stroke who gave informed consent were recruited. Measurements were taken before and immediately after application of the sleeve. Portable diagnostic ultrasound, electromyography, and a tape measure were used to measure AGT distance, muscle activity (biceps, triceps, deltoid, and supraspinatus), and position of the scapula, respectively. Results Six participants with a mean age of 53 ± 8 years were recruited. There was a mean reduction of 0.13 cm (95% confidence interval, −0.01 to 0.28 cm) in AGT distance measurements but this was not statistically significant (t = 3.503, df = 5, P = .062). The inferior scapula measurements showed a mean reduction of 1 cm (95% confidence interval, 0.07-1.92 cm) and this was statistically significant (t = 2.781; df = 5, P = .039) when compared without and with sleeve application. Conclusions The application of Lycra arm sleeves did not significantly reduce the AGT distance but altered scapula mechanics by putting it in a mechanically advantaged position in a small sample of people with chronic stroke. A properly designed definitive trial would be required to confirm the effectiveness of the Lycra sleeve in reducing GHS in people with both acute and chronic stroke. Clinical Relevance Lycra sleeve may have potential to alter biomechanics and influence neuromuscular activity in the arm.
{"title":"Does the Application of a Lycra Arm Sleeve Change Shoulder Biomechanics in People With Stroke?—A Preliminary Study","authors":"P. Kumar","doi":"10.1097/JPO.0000000000000408","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000408","url":null,"abstract":"ABSTRACT Introduction Glenohumeral subluxation (GHS) is reported in up to 81% of patients with stroke. Our previous studies found that a Lycra sleeve can reduce acromion-greater tuberosity (AGT) distance (used for assessment of GHS) in people with chronic stroke (n = 5). In a recent study on able-bodied people (n = 31), we report reduction in AGT, change in scapula measurements, and change in muscle activity after the application of Lycra sleeve. The aim of this study was to investigate the effect of Lycra sleeves on the AGT distance, muscle activity around the shoulder region, and scapular position in people with stroke. Method People with stroke who gave informed consent were recruited. Measurements were taken before and immediately after application of the sleeve. Portable diagnostic ultrasound, electromyography, and a tape measure were used to measure AGT distance, muscle activity (biceps, triceps, deltoid, and supraspinatus), and position of the scapula, respectively. Results Six participants with a mean age of 53 ± 8 years were recruited. There was a mean reduction of 0.13 cm (95% confidence interval, −0.01 to 0.28 cm) in AGT distance measurements but this was not statistically significant (t = 3.503, df = 5, P = .062). The inferior scapula measurements showed a mean reduction of 1 cm (95% confidence interval, 0.07-1.92 cm) and this was statistically significant (t = 2.781; df = 5, P = .039) when compared without and with sleeve application. Conclusions The application of Lycra arm sleeves did not significantly reduce the AGT distance but altered scapula mechanics by putting it in a mechanically advantaged position in a small sample of people with chronic stroke. A properly designed definitive trial would be required to confirm the effectiveness of the Lycra sleeve in reducing GHS in people with both acute and chronic stroke. Clinical Relevance Lycra sleeve may have potential to alter biomechanics and influence neuromuscular activity in the arm.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"116 - 121"},"PeriodicalIF":0.6,"publicationDate":"2021-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46417650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-21DOI: 10.1097/JPO.0000000000000406
Praveen Kumar, Jason Leake, S. Brodie, Jennifer Molton, Rosie O'Reilly, A. Pearce, Jade Steele, P. Caleb-Solly
ABSTRACT Introduction To establish a possible effect of Lycra sleeves, accurate recording of wear time is critical. The aim of this study was to test whether an accelerometer-embedded Lycra sleeve can measure wear compliance and record upper-limb (UL) movements/activity in people with stroke. Methods Seven adults with stroke resulting in unilateral UL weakness were approached for participation in this study as a convenience sample, and five participants were recruited. Participants wore accelerometer-embedded Lycra sleeve on their affected arm for 8 to 10 hrs/d for 14 days and were prescribed four simple UL exercises. They completed a diary to record daily sleeve wear time and exercise times. Upper-limb function, shoulder muscle strength, range of movement, and pain were assessed at days 1 and 14. Results Seven participants were approached, and five participants (72 ± 10 years) were recruited. The mean time since stroke was 20 months. Using an acceleration movement threshold of 0.01 g (g = acceleration of gravity) and the constructed algorithm, the sleeve donning and doffing time was identified. The mean accelerometer and diary-recorded wear time were 11.64 hrs/d (SD, 2.64) and 11.27 hrs/d (SD, 2.03), respectively. Individual spikes above threshold indicated UL activity but could not distinguish participant-recorded exercises from daily UL use. Arm function showed improvement in three of five participants. Conclusions Accelerometers provide a practical method to record wear time of a Lycra sleeve, overcoming the necessity for patients to keep diaries, which can often be unreliable. A more sensitive accelerometer that can detect the direction of the acceleration and movement should be considered in future studies. Clinical Relevance Accelerometers provide accurate data on Lycra sleeve wear time and may help with monitoring adherence.
为了确定莱卡袖的可能效果，准确记录穿着时间至关重要。本研究的目的是测试一个内置加速计的莱卡套筒是否可以测量中风患者的佩戴依从性并记录上肢运动/活动。方法选取7例成人卒中单侧UL无力患者作为方便样本，共招募5例。参与者在他们受影响的手臂上穿着嵌入了加速计的莱卡套筒，每天8到10小时，持续14天，并规定了四种简单的UL练习。他们完成了一份日记，记录每天穿袖子的时间和锻炼的时间。在第1天和第14天评估上肢功能、肩部肌肉力量、活动范围和疼痛。结果共接触7例受试者，共招募5例(72±10岁)。中风后的平均时间是20个月。采用加速度运动阈值为0.01 g (g =重力加速度)和构造的算法，确定了套筒的穿落时间。加速度计和日记记录的平均磨损时间分别为11.64小时/天(SD值为2.64)和11.27小时/天(SD值为2.03)。个别峰值高于阈值表明UL活动，但不能区分参与者记录的锻炼和日常UL使用。五名参与者中有三人的手臂功能有所改善。结论加速度计提供了一种实用的方法来记录莱卡套袖的穿着时间，克服了患者需要记录日记的缺点。在未来的研究中应该考虑一种更灵敏的加速度计，可以检测加速度和运动的方向。临床相关性加速度计提供莱卡套筒佩戴时间的准确数据，并可能有助于监测依从性。
{"title":"Accelerometers-Embedded Lycra Sleeves to Test Wear Compliance and Upper-Limb Activity in People with Stroke: A Feasibility Study","authors":"Praveen Kumar, Jason Leake, S. Brodie, Jennifer Molton, Rosie O'Reilly, A. Pearce, Jade Steele, P. Caleb-Solly","doi":"10.1097/JPO.0000000000000406","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000406","url":null,"abstract":"ABSTRACT Introduction To establish a possible effect of Lycra sleeves, accurate recording of wear time is critical. The aim of this study was to test whether an accelerometer-embedded Lycra sleeve can measure wear compliance and record upper-limb (UL) movements/activity in people with stroke. Methods Seven adults with stroke resulting in unilateral UL weakness were approached for participation in this study as a convenience sample, and five participants were recruited. Participants wore accelerometer-embedded Lycra sleeve on their affected arm for 8 to 10 hrs/d for 14 days and were prescribed four simple UL exercises. They completed a diary to record daily sleeve wear time and exercise times. Upper-limb function, shoulder muscle strength, range of movement, and pain were assessed at days 1 and 14. Results Seven participants were approached, and five participants (72 ± 10 years) were recruited. The mean time since stroke was 20 months. Using an acceleration movement threshold of 0.01 g (g = acceleration of gravity) and the constructed algorithm, the sleeve donning and doffing time was identified. The mean accelerometer and diary-recorded wear time were 11.64 hrs/d (SD, 2.64) and 11.27 hrs/d (SD, 2.03), respectively. Individual spikes above threshold indicated UL activity but could not distinguish participant-recorded exercises from daily UL use. Arm function showed improvement in three of five participants. Conclusions Accelerometers provide a practical method to record wear time of a Lycra sleeve, overcoming the necessity for patients to keep diaries, which can often be unreliable. A more sensitive accelerometer that can detect the direction of the acceleration and movement should be considered in future studies. Clinical Relevance Accelerometers provide accurate data on Lycra sleeve wear time and may help with monitoring adherence.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"122 - 128"},"PeriodicalIF":0.6,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44583057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-25DOI: 10.1097/JPO.0000000000000405
Eric Nickel, Alana Y. Cataldo, Nicole Walker, Christine Santa Ana, Kyle Barrons, A. Gravely, Barry D. Hand, A. Hansen
ABSTRACT Introduction Additive manufacturing (also known as 3D printing) as a fabrication method is ideally suited to merging the organic shapes of human anatomy with engineered components. Many early adopters are exploring the application of these technologies for the fabrication of 3D-printed sockets, but questions remain regarding the ability to fabricate strong, well-fitting definitive sockets. The goal of the present study was to examine the real-world effect of using 3D-printed sockets with regards to mobility, comfort, balance confidence, and user acceptance. Materials and Methods Nine veterans with transtibial amputations participated in the study, three each using pin, sealing sleeve, or seal-in liner for suspension. Participants had their conventional definitive socket duplicated using 3D printing. When the 3D-printed socket was ready, using their conventional socket, participants performed a 2-minute walk test, followed by socket comfort score and rating of perceived exertion (10-point scale), Prosthetic Limb Users Survey of Mobility, Activities-Specific Balance Confidence, select subscales of the Prosthesis Evaluation Questionnaire, and the Amputee Body Image Scale–Revised. After completing the baseline data, participants were fitted with the 3D-printed socket and, after using it for 2 weeks, we repeated the data collection. Results Three participants were not able to complete the study. No large differences were observed for any of the measures. Participants were generally satisfied with the fit of the 3D-printed sockets, but there were challenges with getting the 3D-printed sockets to support elevated vacuum with the sealing sleeve and seal-in liner suspension methods. Conclusions No differences in performance or user acceptance were identified for pin suspension, but the 3D-printed sockets were not able to reliably support suction or elevated vacuum; further development will be needed before they are ready for clinical application. Clinical Relevance The present study has demonstrated the ability to achieve satisfactory fit and outcomes using 3D printing to fabricate definitive prosthetic sockets, but the printing method was unable to deliver consistent air-tight sealing for suction or elevated vacuum suspension. Other 3D printing methods and some secondary processing steps may be able to correct this deficiency.
{"title":"Pilot Test of a Definitive Prosthetic Socket Made with 3D Printing Technology","authors":"Eric Nickel, Alana Y. Cataldo, Nicole Walker, Christine Santa Ana, Kyle Barrons, A. Gravely, Barry D. Hand, A. Hansen","doi":"10.1097/JPO.0000000000000405","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000405","url":null,"abstract":"ABSTRACT Introduction Additive manufacturing (also known as 3D printing) as a fabrication method is ideally suited to merging the organic shapes of human anatomy with engineered components. Many early adopters are exploring the application of these technologies for the fabrication of 3D-printed sockets, but questions remain regarding the ability to fabricate strong, well-fitting definitive sockets. The goal of the present study was to examine the real-world effect of using 3D-printed sockets with regards to mobility, comfort, balance confidence, and user acceptance. Materials and Methods Nine veterans with transtibial amputations participated in the study, three each using pin, sealing sleeve, or seal-in liner for suspension. Participants had their conventional definitive socket duplicated using 3D printing. When the 3D-printed socket was ready, using their conventional socket, participants performed a 2-minute walk test, followed by socket comfort score and rating of perceived exertion (10-point scale), Prosthetic Limb Users Survey of Mobility, Activities-Specific Balance Confidence, select subscales of the Prosthesis Evaluation Questionnaire, and the Amputee Body Image Scale–Revised. After completing the baseline data, participants were fitted with the 3D-printed socket and, after using it for 2 weeks, we repeated the data collection. Results Three participants were not able to complete the study. No large differences were observed for any of the measures. Participants were generally satisfied with the fit of the 3D-printed sockets, but there were challenges with getting the 3D-printed sockets to support elevated vacuum with the sealing sleeve and seal-in liner suspension methods. Conclusions No differences in performance or user acceptance were identified for pin suspension, but the 3D-printed sockets were not able to reliably support suction or elevated vacuum; further development will be needed before they are ready for clinical application. Clinical Relevance The present study has demonstrated the ability to achieve satisfactory fit and outcomes using 3D printing to fabricate definitive prosthetic sockets, but the printing method was unable to deliver consistent air-tight sealing for suction or elevated vacuum suspension. Other 3D printing methods and some secondary processing steps may be able to correct this deficiency.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"55 - 60"},"PeriodicalIF":0.6,"publicationDate":"2021-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49426734","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：