Pub Date : 2021-11-25DOI: 10.1097/JPO.0000000000000404
Mahimaa Gupta, S. Singh, D. Arya, Brijesh Mishra, Rishabh Keshri, Pooran Chand
ABSTRACT Introduction An amputated thumb causes aesthetic deficit and functional loss. Reconstruction can be surgical or prosthetic. A small residuum leaves little scope for rehabilitation with suction-retained prosthesis. Prosthetic management requires implant placement or distraction osteogenesis to be successful. This report presents the use of bone-anchored dental implants to support a prosthesis for rehabilitation of an amputated thumb. Case Description Satisfactory osseointegration of a dental implant placed in the amputated right pollex of a 24-year-old woman was achieved, after a two-stage surgical procedure. A healing abutment, which is normally placed transitionally after second-stage surgery, was modified to create a permanent friction fit coping. This was used to retain the silicone thumb. Discussion and Conclusions The study to some extent established off-the-label use of dental implants in rehabilitating amputated digits. Also, the friction fit retention system proved to be a cost- and armamentarium-effective method of retaining thumb prosthesis for cases with small residuum. Clinical Relevance This report describes a procedure for two-stage surgical placement of an osseointegrated dental implant in an amputated thumb with fabrication of prosthesis, which was effectively retained by a modified healing abutment.
{"title":"Dental Implant Supported Thumb Prosthesis with Friction Fit Retention System","authors":"Mahimaa Gupta, S. Singh, D. Arya, Brijesh Mishra, Rishabh Keshri, Pooran Chand","doi":"10.1097/JPO.0000000000000404","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000404","url":null,"abstract":"ABSTRACT Introduction An amputated thumb causes aesthetic deficit and functional loss. Reconstruction can be surgical or prosthetic. A small residuum leaves little scope for rehabilitation with suction-retained prosthesis. Prosthetic management requires implant placement or distraction osteogenesis to be successful. This report presents the use of bone-anchored dental implants to support a prosthesis for rehabilitation of an amputated thumb. Case Description Satisfactory osseointegration of a dental implant placed in the amputated right pollex of a 24-year-old woman was achieved, after a two-stage surgical procedure. A healing abutment, which is normally placed transitionally after second-stage surgery, was modified to create a permanent friction fit coping. This was used to retain the silicone thumb. Discussion and Conclusions The study to some extent established off-the-label use of dental implants in rehabilitating amputated digits. Also, the friction fit retention system proved to be a cost- and armamentarium-effective method of retaining thumb prosthesis for cases with small residuum. Clinical Relevance This report describes a procedure for two-stage surgical placement of an osseointegrated dental implant in an amputated thumb with fabrication of prosthesis, which was effectively retained by a modified healing abutment.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"e103 - e108"},"PeriodicalIF":0.6,"publicationDate":"2021-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47990791","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 : 2021-11-16DOI: 10.1097/JPO.0000000000000402
Maira Jaqueline da Cunha, C. Pinto, Bruna Zanfir, V. Cimolin, A. Pagnussat
ABSTRACT Introduction Foot drop stimulator (FDS) devices induce positive clinical effects on foot drop secondary to stroke. Literature does not establish a recommended period or a standard intensity of stimulation to achieve training and therapeutic effects in individuals after stroke. The objective of this study was to evaluate the training and therapeutic effects of 2 weeks of FDS use combined with intensive treadmill gait training in chronic poststroke individuals. Materials and Methods The study design was a quasiexperimental clinical trial. Participants underwent gait training on a treadmill associated with FDS stimulation for 20 minutes, five times a week for 2 weeks. Gait analysis was measured at pre-training and 2 weeks after the training with FDS off/on mode. Results Sixteen chronic poststroke individuals were included. One participant was excluded from the analysis due to data processing fault. After the period of training, and with the orthosis on mode on, individuals ameliorated the active dorsiflexion and increased the distance covered, that is, positive training effect of FDS use. Training and therapeutic effects were not observed in other outcomes. Conclusions Our results demonstrated a positive training effect on ankle active movement during gait. FDS combined with gait training is able to increase the total distance walked after 2 weeks of treatment. Clinical Relevance FDS ameliorated the active dorsiflexion and increased the distance covered in people with chronic poststroke. Our results suggest a positive training effect of FDS that can guide physiotherapists in their clinical practice.
{"title":"Combining Foot Drop Stimulation Devices with Gait Training Improves Gait, Active Ankle Movement of Chronic Poststroke Individuals","authors":"Maira Jaqueline da Cunha, C. Pinto, Bruna Zanfir, V. Cimolin, A. Pagnussat","doi":"10.1097/JPO.0000000000000402","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000402","url":null,"abstract":"ABSTRACT Introduction Foot drop stimulator (FDS) devices induce positive clinical effects on foot drop secondary to stroke. Literature does not establish a recommended period or a standard intensity of stimulation to achieve training and therapeutic effects in individuals after stroke. The objective of this study was to evaluate the training and therapeutic effects of 2 weeks of FDS use combined with intensive treadmill gait training in chronic poststroke individuals. Materials and Methods The study design was a quasiexperimental clinical trial. Participants underwent gait training on a treadmill associated with FDS stimulation for 20 minutes, five times a week for 2 weeks. Gait analysis was measured at pre-training and 2 weeks after the training with FDS off/on mode. Results Sixteen chronic poststroke individuals were included. One participant was excluded from the analysis due to data processing fault. After the period of training, and with the orthosis on mode on, individuals ameliorated the active dorsiflexion and increased the distance covered, that is, positive training effect of FDS use. Training and therapeutic effects were not observed in other outcomes. Conclusions Our results demonstrated a positive training effect on ankle active movement during gait. FDS combined with gait training is able to increase the total distance walked after 2 weeks of treatment. Clinical Relevance FDS ameliorated the active dorsiflexion and increased the distance covered in people with chronic poststroke. Our results suggest a positive training effect of FDS that can guide physiotherapists in their clinical practice.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"213 - 222"},"PeriodicalIF":0.6,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48382349","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 : 2021-11-16DOI: 10.1097/JPO.0000000000000401
A. P. Arantes, N. Bressan
ABSTRACT Introduction Over the years, several studies have been published reporting the use of distinct sources of information used for pattern recognition that can be translated into commands to control human-machine interface system, for example, electromyography (EMG), pressure sensors, and accelerometers. Studies using muscle motion patterns and its combination with EMG in the context of pattern recognition for evaluation of the muscles and human-machine interface system in able-bodied individuals and limb-absent subjects are scarce. Material and Methods In this context, this research presents the assessment of the classification of patterns formed by features extracted from both muscle motion and electromyographic signals. Data sets were collected from both arms of five unilateral transradial limb-absent subjects and seven able-bodied subjects in the control group. The features from the EMG and the muscle motion such as amplitude, frequency, predictability, and variability of the signals were estimated. Results The results were presented in terms of the sensitivity, specificity, precision, and accuracy of the classifier. The combination of both measurements, EMG and muscle motion, defined the six basic movements for limb-absent subjects within an accuracy of 98% ± 1% for the sound forearm against 96% ± 4% for the amputated forearm. Conclusions For future work, it is expected that the strategy of classification and the combination of inertial and electromyographic activity will be used in actual scenarios for the controlling of artificial limbs and other applications related to human-machine interaction. Clinical Relevance The use of inertial sensors may increase the usability and accuracy of systems used for diagnosing, training, therapy, or controlling devices such as orthoses and prostheses.
{"title":"Classification of Muscle Inertial Motion and Electromyographic Activity Integration to Improve Accuracy in Pattern Recognition","authors":"A. P. Arantes, N. Bressan","doi":"10.1097/JPO.0000000000000401","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000401","url":null,"abstract":"ABSTRACT Introduction Over the years, several studies have been published reporting the use of distinct sources of information used for pattern recognition that can be translated into commands to control human-machine interface system, for example, electromyography (EMG), pressure sensors, and accelerometers. Studies using muscle motion patterns and its combination with EMG in the context of pattern recognition for evaluation of the muscles and human-machine interface system in able-bodied individuals and limb-absent subjects are scarce. Material and Methods In this context, this research presents the assessment of the classification of patterns formed by features extracted from both muscle motion and electromyographic signals. Data sets were collected from both arms of five unilateral transradial limb-absent subjects and seven able-bodied subjects in the control group. The features from the EMG and the muscle motion such as amplitude, frequency, predictability, and variability of the signals were estimated. Results The results were presented in terms of the sensitivity, specificity, precision, and accuracy of the classifier. The combination of both measurements, EMG and muscle motion, defined the six basic movements for limb-absent subjects within an accuracy of 98% ± 1% for the sound forearm against 96% ± 4% for the amputated forearm. Conclusions For future work, it is expected that the strategy of classification and the combination of inertial and electromyographic activity will be used in actual scenarios for the controlling of artificial limbs and other applications related to human-machine interaction. Clinical Relevance The use of inertial sensors may increase the usability and accuracy of systems used for diagnosing, training, therapy, or controlling devices such as orthoses and prostheses.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"83 - 91"},"PeriodicalIF":0.6,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45533645","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 : 2021-11-16DOI: 10.1097/JPO.0000000000000400
Vikranth H. Nagaraja, Runbei Cheng, D. H. Slater, M. Thompson, Jeroen H. M. Bergmann
ABSTRACT Introduction Understanding repair patterns of upper-limb (UL) prosthetic devices have received little attention compared with their lower-limb counterparts. This study focuses on a retrospective analysis of anonymized UL prosthetic maintenance data to establish if there were any patterns of repairs at a regional prosthetic limb-fitting center in the United Kingdom. A secondary aim of this study is to describe the patient demographics of this center. Methods Data containing prosthetic repair log and demographic description (n = 212) were acquired through our clinical partners and subjected to statistical analyses. Results On average, each client visited the center 0.2 times/year for a new device and 0.9 times/year for maintenance-related activities. It is found that the repair rates are generally higher for body-powered devices (1.28 visits/device per year) compared with passive (0.94 visits/device per year) and externally powered devices (0.90 visits/device per year). In keeping with the typical UK UL-deficient population, there is a high male-to-female ratio, and higher instances of traumatic amputations were noticed for males at the center. There is a very high preponderance of congenital cases and an overall emphasis on prescribing passive devices to a majority of patients at the center. Conclusions The data from our study are similar to previously published data from other centers and show a consistent pattern in terms of relative rates of maintenance attendances for different types of UL prostheses. Clinical Relevance This study provides a longitudinal perspective and insights on ever-changing requirements (prostheses and related care) of the users at the level of a regional limb-fitting center. This study underscores current gaps in prosthetic device durability/reliability and opens up avenues for improvement of prosthetic services and devices.
{"title":"Upper-Limb Prosthetic Maintenance Data: A Retrospective Analysis Study","authors":"Vikranth H. Nagaraja, Runbei Cheng, D. H. Slater, M. Thompson, Jeroen H. M. Bergmann","doi":"10.1097/JPO.0000000000000400","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000400","url":null,"abstract":"ABSTRACT Introduction Understanding repair patterns of upper-limb (UL) prosthetic devices have received little attention compared with their lower-limb counterparts. This study focuses on a retrospective analysis of anonymized UL prosthetic maintenance data to establish if there were any patterns of repairs at a regional prosthetic limb-fitting center in the United Kingdom. A secondary aim of this study is to describe the patient demographics of this center. Methods Data containing prosthetic repair log and demographic description (n = 212) were acquired through our clinical partners and subjected to statistical analyses. Results On average, each client visited the center 0.2 times/year for a new device and 0.9 times/year for maintenance-related activities. It is found that the repair rates are generally higher for body-powered devices (1.28 visits/device per year) compared with passive (0.94 visits/device per year) and externally powered devices (0.90 visits/device per year). In keeping with the typical UK UL-deficient population, there is a high male-to-female ratio, and higher instances of traumatic amputations were noticed for males at the center. There is a very high preponderance of congenital cases and an overall emphasis on prescribing passive devices to a majority of patients at the center. Conclusions The data from our study are similar to previously published data from other centers and show a consistent pattern in terms of relative rates of maintenance attendances for different types of UL prostheses. Clinical Relevance This study provides a longitudinal perspective and insights on ever-changing requirements (prostheses and related care) of the users at the level of a regional limb-fitting center. This study underscores current gaps in prosthetic device durability/reliability and opens up avenues for improvement of prosthetic services and devices.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"223 - 232"},"PeriodicalIF":0.6,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46091191","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 : 2021-11-16DOI: 10.1097/JPO.0000000000000399
M. van der Stelt, A. Verhulst, C. Slump, Marco Papenburg, M. Grobusch, L. Brouwers, T. Maal
ABSTRACT Introduction Only 5% to 15% of individuals with amputation living in low- and middle-income countries (LMICs) have access to proper prostheses. Mainly, prosthetic costs are too high, and facilities are not within reach. Measurement and production of traditional prosthetic sockets are time-consuming, labor-intensive, and highly dependent on the experience and skills of the personnel involved. Materials and Methods This report describes the workflow to produce low-cost patella tendon bearing transtibial prosthetic sockets. Using computer-aided design (CAD) and computer-aided manufacturing (CAM), transtibial prostheses can be easily produced in rural areas. The size of the residual limb was scanned with a handheld 3D-scanner (Einscanner Pro Plus), and the sockets were printed using fused filament fabrication (FFF) with an Ultimaker S5. The foot was made locally, and the other prosthetic parts were imported. The 3D-printed socket costs US $20 (excluding value-added tax [VAT]). The total material cost of the prosthesis, including the other prosthetic materials, amounts to approximately US $100 (excluding VAT). Assuming the asset cost of the devices, the costs of one local employee, overhead expenses, a profit margin, and the VAT included, a 3D-printed prosthesis could be sold for US $170. Conclusions This report provides a blueprint to produce low-cost 3D-printed transtibial prosthetic sockets. Further research will be conducted to replace the imported prosthetic parts for local products and to automatize the digital design process. Clinical Relevance With this workflow, prosthetic sockets can be produced consistently, which makes it a suitable method in LMICs.
在低收入和中等收入国家(LMICs)，只有5%至15%的截肢患者能够获得合适的假肢。主要原因是假肢成本太高，而且设备也不够。传统义肢窝的测量和生产是耗时、劳动密集型的，高度依赖于相关人员的经验和技能。材料和方法本报告描述了低成本的髌骨肌腱承载经胫骨假体窝的生产流程。利用计算机辅助设计(CAD)和计算机辅助制造(CAM)技术，可以方便地在农村地区生产跨胫假体。使用手持式3d扫描仪(Einscanner Pro Plus)扫描残肢的尺寸，并使用Ultimaker S5使用熔丝制造(FFF)打印插座。这只脚是当地制造的，其他假肢部件都是进口的。这个3d打印插座售价20美元(不包括增值税)。假体的总材料成本，包括其他假体材料，大约为100美元(不包括增值税)。假设设备的资产成本、一名当地员工的成本、管理费用、利润率和增值税在内，一个3d打印假肢的售价可以达到170美元。结论本报告为低成本3d打印胫骨假体提供了一个蓝图。将进一步研究用本地产品取代进口假肢部件，并实现数字化设计过程的自动化。通过这种工作流程，可以一致地制作假体窝，这使其成为中低收入国家的合适方法。
{"title":"Design and Production of Low-Cost 3D-Printed Transtibial Prosthetic Sockets","authors":"M. van der Stelt, A. Verhulst, C. Slump, Marco Papenburg, M. Grobusch, L. Brouwers, T. Maal","doi":"10.1097/JPO.0000000000000399","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000399","url":null,"abstract":"ABSTRACT Introduction Only 5% to 15% of individuals with amputation living in low- and middle-income countries (LMICs) have access to proper prostheses. Mainly, prosthetic costs are too high, and facilities are not within reach. Measurement and production of traditional prosthetic sockets are time-consuming, labor-intensive, and highly dependent on the experience and skills of the personnel involved. Materials and Methods This report describes the workflow to produce low-cost patella tendon bearing transtibial prosthetic sockets. Using computer-aided design (CAD) and computer-aided manufacturing (CAM), transtibial prostheses can be easily produced in rural areas. The size of the residual limb was scanned with a handheld 3D-scanner (Einscanner Pro Plus), and the sockets were printed using fused filament fabrication (FFF) with an Ultimaker S5. The foot was made locally, and the other prosthetic parts were imported. The 3D-printed socket costs US $20 (excluding value-added tax [VAT]). The total material cost of the prosthesis, including the other prosthetic materials, amounts to approximately US $100 (excluding VAT). Assuming the asset cost of the devices, the costs of one local employee, overhead expenses, a profit margin, and the VAT included, a 3D-printed prosthesis could be sold for US $170. Conclusions This report provides a blueprint to produce low-cost 3D-printed transtibial prosthetic sockets. Further research will be conducted to replace the imported prosthetic parts for local products and to automatize the digital design process. Clinical Relevance With this workflow, prosthetic sockets can be produced consistently, which makes it a suitable method in LMICs.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"e30 - e36"},"PeriodicalIF":0.6,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44592276","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 : 2021-11-16DOI: 10.1097/JPO.0000000000000395
M. Brodie, Laura Murray, Anthony McGarry
ABSTRACT Introduction The prosthetic socket is the interface that connects the human body to the artificial limb and allows transmission of body weight and forces during gait. The review purpose is to assess the quality of scientific evidence and compare this for a variety of available transfemoral socket designs. Comparisons will be made of socket biomechanics, metabolic efficiency and comfort, and the advantages/disadvantages associated with each design. Methods Socket designs included were quadrilateral (quad), ischial containment (IC), Marlo Anatomical Socket, subischial, high-fidelity (HiFi), and the Socket-less Socket. A literature review was conducted in five online databases: Compendex, Embase, PubMed, ProQuest Materials Science, and ProQuest Biological Science, using Boolean search terms and truncation of relevant keywords. Included articles were published between 1989 and 2018. A predetermined methodological criterion was used in conjunction with a modified version of the Oxford Levels of Evidence to assess and grade the quality of selected articles. Results Thirteen clinical studies were included in this review. Based on the chosen search strategy and quality criterion, this review found a limited, low-quality evidence base for all included socket designs. All articles, except one, compared the various socket designs (quad, quad and MAS, MAS, subischial, and HiFi) against an IC socket as this was deemed the “standard of care” design. Conclusions Although IC attained the highest volume of evidence, this socket design was not proven to be superior. The variety of biomechanical features pertaining to each socket design provides several advantages/disadvantages. Recommendations are made for future research. Clinical Relevance Findings from this literature review promote knowledge and understanding of transfemoral socket design by highlighting the underlying theory, strengths, and weaknesses of each design acknowledged to facilitate improved evidence-based practice.
{"title":"Transfemoral Prosthetic Socket Designs: A Review of the Literature","authors":"M. Brodie, Laura Murray, Anthony McGarry","doi":"10.1097/JPO.0000000000000395","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000395","url":null,"abstract":"ABSTRACT Introduction The prosthetic socket is the interface that connects the human body to the artificial limb and allows transmission of body weight and forces during gait. The review purpose is to assess the quality of scientific evidence and compare this for a variety of available transfemoral socket designs. Comparisons will be made of socket biomechanics, metabolic efficiency and comfort, and the advantages/disadvantages associated with each design. Methods Socket designs included were quadrilateral (quad), ischial containment (IC), Marlo Anatomical Socket, subischial, high-fidelity (HiFi), and the Socket-less Socket. A literature review was conducted in five online databases: Compendex, Embase, PubMed, ProQuest Materials Science, and ProQuest Biological Science, using Boolean search terms and truncation of relevant keywords. Included articles were published between 1989 and 2018. A predetermined methodological criterion was used in conjunction with a modified version of the Oxford Levels of Evidence to assess and grade the quality of selected articles. Results Thirteen clinical studies were included in this review. Based on the chosen search strategy and quality criterion, this review found a limited, low-quality evidence base for all included socket designs. All articles, except one, compared the various socket designs (quad, quad and MAS, MAS, subischial, and HiFi) against an IC socket as this was deemed the “standard of care” design. Conclusions Although IC attained the highest volume of evidence, this socket design was not proven to be superior. The variety of biomechanical features pertaining to each socket design provides several advantages/disadvantages. Recommendations are made for future research. Clinical Relevance Findings from this literature review promote knowledge and understanding of transfemoral socket design by highlighting the underlying theory, strengths, and weaknesses of each design acknowledged to facilitate improved evidence-based practice.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"e73 - e92"},"PeriodicalIF":0.6,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41872627","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 : 2021-11-01DOI: 10.1097/JPO.0000000000000397
Miho Asano, Yu Li Ng, Khalid Anuar, Yi Tian Felicity Yeo, G. Koh, K. Tan
ABSTRACT Introduction Singapore's aging population and prevalence of chronic diseases and conditions continue to grow along with the need for prosthetic and orthotic services. We need to understand the supply of prosthetic and orthotic services and prosthetists and orthotists (P&Os) to optimize care. Therefore, the objective of this study was to estimate the recent and the future supply and demand for P&Os in Singapore. Methods This was a retrospective medical record review. We identified the seven conditions requiring prosthetic and orthotic services and applied condition-specific admission rates on the projected population of Singapore through 2060 to obtain the number of inpatient admissions requiring the services. We then converted these numbers to prosthetist/orthotist hours by multiplying by prosthetist/orthotist workload for each condition. Finally, we applied two supply scenarios to examine potential P&O shortfall. Results The shortfall was estimated to be 9.4 and 5.4 in 2016 under the respective scenarios. These gaps increase to 18.4 and 5.8, respectively, in 2030, and 28.1 and 6.2, respectively, in 2060. Conclusions The existing shortfall of P&Os in Singapore will continue to grow from 2016 to 2060. Appropriate strategies should be considered and implemented in a timely manner to manage the potential shortfall. Clinical Relevance Projecting the demand for future prosthetist/orthotist manpower through a specific condition-driven and time-based utility approach provides an alternative model to only a linear population growth. This may provide a more accurate predictability and selection of precise strategies to manage future manpower demands.
{"title":"Projecting the Supply and Demand of Prosthetists and Orthotists in Singapore","authors":"Miho Asano, Yu Li Ng, Khalid Anuar, Yi Tian Felicity Yeo, G. Koh, K. Tan","doi":"10.1097/JPO.0000000000000397","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000397","url":null,"abstract":"ABSTRACT Introduction Singapore's aging population and prevalence of chronic diseases and conditions continue to grow along with the need for prosthetic and orthotic services. We need to understand the supply of prosthetic and orthotic services and prosthetists and orthotists (P&Os) to optimize care. Therefore, the objective of this study was to estimate the recent and the future supply and demand for P&Os in Singapore. Methods This was a retrospective medical record review. We identified the seven conditions requiring prosthetic and orthotic services and applied condition-specific admission rates on the projected population of Singapore through 2060 to obtain the number of inpatient admissions requiring the services. We then converted these numbers to prosthetist/orthotist hours by multiplying by prosthetist/orthotist workload for each condition. Finally, we applied two supply scenarios to examine potential P&O shortfall. Results The shortfall was estimated to be 9.4 and 5.4 in 2016 under the respective scenarios. These gaps increase to 18.4 and 5.8, respectively, in 2030, and 28.1 and 6.2, respectively, in 2060. Conclusions The existing shortfall of P&Os in Singapore will continue to grow from 2016 to 2060. Appropriate strategies should be considered and implemented in a timely manner to manage the potential shortfall. Clinical Relevance Projecting the demand for future prosthetist/orthotist manpower through a specific condition-driven and time-based utility approach provides an alternative model to only a linear population growth. This may provide a more accurate predictability and selection of precise strategies to manage future manpower demands.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"60 - 65"},"PeriodicalIF":0.6,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42678916","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 : 2021-10-27DOI: 10.1097/JPO.0000000000000398
Maureen E. Johnson, Heather David, Mohan Ganesan
ABSTRACT Introduction This study investigated surfing performance in surfers with transfemoral amputations (TFAs) and transtibial amputations (TTAs) who participated in international para surfing competitions. The purpose of this research was to compare surfers with lower-limb amputations with judged wave scores and surfing experience for para surfing classification efficacy. Materials and Methods Collected archived data (n = 20) from classification records included demographics, residual limb lengths, surfing experiences, and judged wave scores. Continuous variables age (years), residual leg length (cm), remaining leg length (%), prior surfing experience (years), and duration of competing experience (years) were analyzed using independent sample t-test. Ordinal variables surfing performance scores of 2019 and 2020 between the groups were compared using Mann-Whitney U test. Spearman ρ correlation coefficient was used to determine the association between the duration of prior surfing experience and duration of competition experience with the surfing score in both groups. Results Surfers with TFA with longer residual limb lengths (n = 3) and surfers with TTA (n = 14) surfed with a prosthetic leg standing. Surfers with TFA with shorter residual limb lengths (n = 3) surfed without a prosthesis kneeling. We found that para surfers who stood or kneeled with TFA performed significantly better than para surfers with TTA, reflected through judged wave scores in 2019 (P = 0.028) and 2020 (P = 0.019). No statistically significant relationship existed between para surfers with TFA who kneeled or stood. No statistically significant relationship existed between years of para surfing and judged wave scores. Conclusions Surfers with TFA who stood or kneeled received higher judged wave scores than surfers with TTA; however, no other significant significance was found for TFA intragroup comparisons or prior surf experience. The data size was too small for confirmatory analysis. Results appeal to a new need for inquiry on para surfers with TFA and TTA, specifically biomechanical performance surfing differences. Clinical Relevance Individuals with transfemoral and/or transtibial amputations can participate competitively in para surfing contests. Surfers with TFAs can successfully compete either standing with a prosthesis or kneeling without a prosthesis.
{"title":"Surfing Performance in Para Surfers with Lower-Limb Amputations: A Cross-Sectional Study","authors":"Maureen E. Johnson, Heather David, Mohan Ganesan","doi":"10.1097/JPO.0000000000000398","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000398","url":null,"abstract":"ABSTRACT Introduction This study investigated surfing performance in surfers with transfemoral amputations (TFAs) and transtibial amputations (TTAs) who participated in international para surfing competitions. The purpose of this research was to compare surfers with lower-limb amputations with judged wave scores and surfing experience for para surfing classification efficacy. Materials and Methods Collected archived data (n = 20) from classification records included demographics, residual limb lengths, surfing experiences, and judged wave scores. Continuous variables age (years), residual leg length (cm), remaining leg length (%), prior surfing experience (years), and duration of competing experience (years) were analyzed using independent sample t-test. Ordinal variables surfing performance scores of 2019 and 2020 between the groups were compared using Mann-Whitney U test. Spearman ρ correlation coefficient was used to determine the association between the duration of prior surfing experience and duration of competition experience with the surfing score in both groups. Results Surfers with TFA with longer residual limb lengths (n = 3) and surfers with TTA (n = 14) surfed with a prosthetic leg standing. Surfers with TFA with shorter residual limb lengths (n = 3) surfed without a prosthesis kneeling. We found that para surfers who stood or kneeled with TFA performed significantly better than para surfers with TTA, reflected through judged wave scores in 2019 (P = 0.028) and 2020 (P = 0.019). No statistically significant relationship existed between para surfers with TFA who kneeled or stood. No statistically significant relationship existed between years of para surfing and judged wave scores. Conclusions Surfers with TFA who stood or kneeled received higher judged wave scores than surfers with TTA; however, no other significant significance was found for TFA intragroup comparisons or prior surf experience. The data size was too small for confirmatory analysis. Results appeal to a new need for inquiry on para surfers with TFA and TTA, specifically biomechanical performance surfing differences. Clinical Relevance Individuals with transfemoral and/or transtibial amputations can participate competitively in para surfing contests. Surfers with TFAs can successfully compete either standing with a prosthesis or kneeling without a prosthesis.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"252 - 258"},"PeriodicalIF":0.6,"publicationDate":"2021-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43547843","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 : 2021-10-13DOI: 10.1097/JPO.0000000000000392
H. H. Sears, K. Doolan, Denise D. Keenan
ABSTRACT Introduction Bilateral upper-limb loss (Bil UL Loss) is perhaps the greatest challenge for upper-limb prosthetic care, now even more than ever as we witness the increase of sepsis as a cause of limb loss. Methods This small-n survey has recruited 28 individuals with Bil UL Loss, 27 of whom are prosthesis wearers. Twelve of the 28 lost four limbs to sepsis; 17 of the 27 prosthesis wearers use body-powered hooks, six use electric hooks, and four use electric hands as their dominant terminal device (within this report, dominant side is the wearer's postloss dominant side, i.e., the side the subject used more frequently). The survey used person-to-person interviews to compile the broad data about how tasks are performed, how many tasks are performed, whether two prostheses are used, and other details. Results Users of each type of prosthesis demonstrate a high level of function. Electric hook users scored slightly higher in number of tasks and other measures. However, no outcomes were significant statistically, except the use of the dominant side prosthesis, which was three times higher than the nondominant side usage. Users identified a dozen categories for desired improvements, with greater dependability and greater grip security as the most commonly requested. Discussion The information will be useful for not only for clinical guidance, but hopefully also to help guide the development of future prosthetic devices, considering that the disabled community has called for prioritizing the actual needs and desires of the consumers to guide future developments. Conclusions The planning and execution of this small-scale study could be a model for other groups to collect useful outcomes data without requiring a research grant, without large institutional oversight, and by only a small group of interested professionals with access to a reasonable number of individuals with a severe disability. Clinical Relevance All caregivers of individuals with bilateral limb loss could benefit from both the data presented and the challenges revealed by this survey group. Future prosthetic designs as well as training and other therapies will also hopefully benefit from the needs expressed directly by these consumers.
摘要简介双侧上肢丢失（Bil UL loss）可能是上肢假肢护理面临的最大挑战，现在甚至比以往任何时候都更大，因为我们目睹了败血症作为肢体丢失原因的增加。方法本次小n调查共招募了28名Bil UL丢失患者，其中27人为假体佩戴者。28人中有12人因败血症失去四肢；27名假肢佩戴者中有17人使用身体供电的挂钩，6人使用电动挂钩，4人使用电动手作为主要终端设备（在本报告中，主要侧是佩戴者丢失后的主要侧，即受试者更频繁使用的侧）。这项调查使用了人与人之间的访谈来汇编关于如何执行任务、执行了多少任务、是否使用了两个假肢以及其他细节的广泛数据。结果每种假体的使用者都表现出较高的功能水平。电钩用户在任务数量和其他指标上得分略高。然而，除了使用优势侧假体外，没有任何结果具有统计学意义，优势侧假体的使用量是非优势侧假体使用量的三倍。用户确定了十几个需要改进的类别，其中最常见的要求是更高的可靠性和更高的抓握安全性。讨论考虑到残疾人社区呼吁优先考虑消费者的实际需求和愿望，以指导未来的发展，这些信息不仅有助于临床指导，而且有望帮助指导未来假肢设备的开发。结论这项小规模研究的规划和执行可以成为其他群体收集有用结果数据的一个模式，而无需研究拨款，无需大型机构监督，也只有一小群感兴趣的专业人员可以接触到合理数量的严重残疾者。临床相关性所有双侧肢体丧失患者的护理人员都可以从该调查组提供的数据和揭示的挑战中受益。未来的假肢设计、训练和其他疗法也有望从这些消费者直接表达的需求中受益。
{"title":"A Small-Scale Survey of Bilateral Upper-Limb Loss Individuals","authors":"H. H. Sears, K. Doolan, Denise D. Keenan","doi":"10.1097/JPO.0000000000000392","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000392","url":null,"abstract":"ABSTRACT Introduction Bilateral upper-limb loss (Bil UL Loss) is perhaps the greatest challenge for upper-limb prosthetic care, now even more than ever as we witness the increase of sepsis as a cause of limb loss. Methods This small-n survey has recruited 28 individuals with Bil UL Loss, 27 of whom are prosthesis wearers. Twelve of the 28 lost four limbs to sepsis; 17 of the 27 prosthesis wearers use body-powered hooks, six use electric hooks, and four use electric hands as their dominant terminal device (within this report, dominant side is the wearer's postloss dominant side, i.e., the side the subject used more frequently). The survey used person-to-person interviews to compile the broad data about how tasks are performed, how many tasks are performed, whether two prostheses are used, and other details. Results Users of each type of prosthesis demonstrate a high level of function. Electric hook users scored slightly higher in number of tasks and other measures. However, no outcomes were significant statistically, except the use of the dominant side prosthesis, which was three times higher than the nondominant side usage. Users identified a dozen categories for desired improvements, with greater dependability and greater grip security as the most commonly requested. Discussion The information will be useful for not only for clinical guidance, but hopefully also to help guide the development of future prosthetic devices, considering that the disabled community has called for prioritizing the actual needs and desires of the consumers to guide future developments. Conclusions The planning and execution of this small-scale study could be a model for other groups to collect useful outcomes data without requiring a research grant, without large institutional oversight, and by only a small group of interested professionals with access to a reasonable number of individuals with a severe disability. Clinical Relevance All caregivers of individuals with bilateral limb loss could benefit from both the data presented and the challenges revealed by this survey group. Future prosthetic designs as well as training and other therapies will also hopefully benefit from the needs expressed directly by these consumers.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"95 - 107"},"PeriodicalIF":0.6,"publicationDate":"2021-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46331690","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 : 2021-10-12DOI: 10.1097/JPO.0000000000000391
Temrah Okonski, M. Cabell
ABSTRACT Introduction This article describes the benefit of combining a thoracic lumbar sacral orthosis (TLSO) and a hip spica orthosis (HSO) to create a sitting frame for children with emerging neck and trunk control who cannot sit by themselves. Materials and Methods A child with motor disabilities who cannot sit independently benefits from a custom floor sitting frame. The sitting frame's thoracic lumbar sacral orthosis and hip spica orthosis are separate entities but are used together to allow a child to sit on the floor independently. Although the presented child does not need added head support, the TLSO-HSO sitting frame can be fabricated with cervical support. This sitting frame has a versatile joint allowing for movement between upright sitting and sitting with upper-limb weight bearing. The frame's hip joint can also be locked in different degrees of tilt. The described child uses the frame in a locked 90° upright position. Evaluation, fitting, fabrication, and reimbursement submission is explained. Conclusions Floor sitting is an important developmental milestone. Available equipment, such as floor sitters and compression garments intended to support a child in sitting, fail to sufficiently support all children with significant motor disabilities who have floor sitting goals. The TLSO-HSO sitting frame is a custom-made floor sitter that may give children with significant motor disabilities who have emerging neck and trunk control the support they need to independently sit on the floor. This orthosis has the potential to improve the lives of many children and their families as it can be used in both home and classroom settings and can give children with significant motor disabilities the opportunity to use their hands freely to play and to interact with peers during floor play time. Clinical Relevance Some children with severe motor disabilities cannot floor sit independently. The present study describes a new floor sitting frame that closes the gap between available products designed as these products do not meet the needs of all children with severe motor disabilities who have emerging neck and trunk control.
{"title":"New Orthosis: The Thoracic Lumbar Sacral–Hip Spica Orthotic Sitting Frame","authors":"Temrah Okonski, M. Cabell","doi":"10.1097/JPO.0000000000000391","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000391","url":null,"abstract":"ABSTRACT Introduction This article describes the benefit of combining a thoracic lumbar sacral orthosis (TLSO) and a hip spica orthosis (HSO) to create a sitting frame for children with emerging neck and trunk control who cannot sit by themselves. Materials and Methods A child with motor disabilities who cannot sit independently benefits from a custom floor sitting frame. The sitting frame's thoracic lumbar sacral orthosis and hip spica orthosis are separate entities but are used together to allow a child to sit on the floor independently. Although the presented child does not need added head support, the TLSO-HSO sitting frame can be fabricated with cervical support. This sitting frame has a versatile joint allowing for movement between upright sitting and sitting with upper-limb weight bearing. The frame's hip joint can also be locked in different degrees of tilt. The described child uses the frame in a locked 90° upright position. Evaluation, fitting, fabrication, and reimbursement submission is explained. Conclusions Floor sitting is an important developmental milestone. Available equipment, such as floor sitters and compression garments intended to support a child in sitting, fail to sufficiently support all children with significant motor disabilities who have floor sitting goals. The TLSO-HSO sitting frame is a custom-made floor sitter that may give children with significant motor disabilities who have emerging neck and trunk control the support they need to independently sit on the floor. This orthosis has the potential to improve the lives of many children and their families as it can be used in both home and classroom settings and can give children with significant motor disabilities the opportunity to use their hands freely to play and to interact with peers during floor play time. Clinical Relevance Some children with severe motor disabilities cannot floor sit independently. The present study describes a new floor sitting frame that closes the gap between available products designed as these products do not meet the needs of all children with severe motor disabilities who have emerging neck and trunk control.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"e18 - e23"},"PeriodicalIF":0.6,"publicationDate":"2021-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49219229","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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