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}
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}
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