Pub Date : 2021-09-29DOI: 10.1097/JPO.0000000000000390
D. Rimaud, Naomi Rieffel, I. Fayolle-Minon, P. Vedreine, E. Ebermeyer, J.-F. Salmochi, O. Jacquin, Emmanuel Dye, Clément Mazel, P. Calmels
ABSTRACT Introduction In chronic low back pain, the use of lumbar orthosis treatment is not part of general recommendations due to a lack of supporting evidence. However, interest in segmental immobilization at the mechanical and postural level is still current in practice, with, however, the belief of negative effects on muscular capacity. The objective of our study was to assess the evolution of muscle capacity after wearing custom-made rigid corset in patients with chronic low back pain. Materials and Methods This is a multicenter study in patients with chronic low back pain, for which the wearing of a rigid postural immobilization corset for 3 months was prescribed. Twenty-two patients completed all follow-up assessments at baseline, 45 days, and 3 months. Evaluations included Biering-Sørensen test, Shirado test, chair test, hand/ground test, lateral inclination test, Quebec scale, and visual analog scale. Results The results revealed a significant improvement of Biering-Sørensen test after 3 months (37.0 ± 53.6 seconds at D0, 41.3 ± 51.7 seconds at D45, and 53.2 ± 60.5 seconds at D90; P < 0.05), in hand/ground distance (21.8 ± 28.5 cm at D0, 15.5 ± 17.8 cm at D45, and 12.2 ± 15.5 cm at D90; P < 0.05), in disability based on the Quebec questionnaire (0.52 ± 0.21 at D0, 0.45 ± 0.19 at D45, and 0.39 ± 0.19 at D90; P < 0.05), and significant reductions in visual analog scale measures of pain (6.0 ± 1.7 at D0, 3.7 ± 1.7 at D45, and 2.7 ± 1.9 at D90; P < 0.05). Conclusions This study shows that the wearing of a rigid orthosis does not alter the muscular endurance capacities of the trunk muscles. In view of the results, wearing a rigid orthosis may be an alternative to treating chronic low back pain. It does not induce muscle loss and may even contribute to motor disinhibition, resulting in improved spinal mobility and functional abilities. Clinical Relevance The common belief that wearing a spinal orthosis leads to muscle loss should no longer be an obstacle to its prescription since it helps to maintain muscle capacity and reduces pain.
{"title":"The Effect of Rigid Spinal Orthosis on the Muscular Capacity of Patients With Low Back Pain - A 3-Month Follow-up Study","authors":"D. Rimaud, Naomi Rieffel, I. Fayolle-Minon, P. Vedreine, E. Ebermeyer, J.-F. Salmochi, O. Jacquin, Emmanuel Dye, Clément Mazel, P. Calmels","doi":"10.1097/JPO.0000000000000390","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000390","url":null,"abstract":"ABSTRACT Introduction In chronic low back pain, the use of lumbar orthosis treatment is not part of general recommendations due to a lack of supporting evidence. However, interest in segmental immobilization at the mechanical and postural level is still current in practice, with, however, the belief of negative effects on muscular capacity. The objective of our study was to assess the evolution of muscle capacity after wearing custom-made rigid corset in patients with chronic low back pain. Materials and Methods This is a multicenter study in patients with chronic low back pain, for which the wearing of a rigid postural immobilization corset for 3 months was prescribed. Twenty-two patients completed all follow-up assessments at baseline, 45 days, and 3 months. Evaluations included Biering-Sørensen test, Shirado test, chair test, hand/ground test, lateral inclination test, Quebec scale, and visual analog scale. Results The results revealed a significant improvement of Biering-Sørensen test after 3 months (37.0 ± 53.6 seconds at D0, 41.3 ± 51.7 seconds at D45, and 53.2 ± 60.5 seconds at D90; P < 0.05), in hand/ground distance (21.8 ± 28.5 cm at D0, 15.5 ± 17.8 cm at D45, and 12.2 ± 15.5 cm at D90; P < 0.05), in disability based on the Quebec questionnaire (0.52 ± 0.21 at D0, 0.45 ± 0.19 at D45, and 0.39 ± 0.19 at D90; P < 0.05), and significant reductions in visual analog scale measures of pain (6.0 ± 1.7 at D0, 3.7 ± 1.7 at D45, and 2.7 ± 1.9 at D90; P < 0.05). Conclusions This study shows that the wearing of a rigid orthosis does not alter the muscular endurance capacities of the trunk muscles. In view of the results, wearing a rigid orthosis may be an alternative to treating chronic low back pain. It does not induce muscle loss and may even contribute to motor disinhibition, resulting in improved spinal mobility and functional abilities. Clinical Relevance The common belief that wearing a spinal orthosis leads to muscle loss should no longer be an obstacle to its prescription since it helps to maintain muscle capacity and reduces pain.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"19 - 24"},"PeriodicalIF":0.6,"publicationDate":"2021-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42210174","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 : 2021-09-27DOI: 10.1097/JPO.0000000000000393
V. Monaco, F. Aprigliano, L. Palmerini, Pierpaolo Palumbo, L. Chiari, S. Micera
ABSTRACT Introduction Transfemoral amputations are known to compromise balance control capabilities, thus increasing the probability of falling. Current research in robotic prostheses is exploring novel strategies to assess the risk of fall and, if required, enable assistive strategies to promote balance recovery. Objectives The aim of this study was to identify a set of biomechanical variables associated with fall risk and fall detection in people with transfemoral amputation (pwTFA), which can be potentially assessed through the next generation of sensorized powered prostheses. Study Design The study design was scoping review. Methods Screening of the literature (CINAHL, PubMed, Scopus, and Web of Science) carried out in February 2020 (quality assessment of retained articles through Downs and Black checklist; retrieved information: measurement tests and biomechanical variables). Results From the initial 595 documents, only 25 citations met eligibility criteria. The pwTFA's fall risk assessment and fall detection are usually carried out by using different measurement tests. Conclusions Two classes of biomechanical markers for fall risk assessment have the potential to be incorporated in self-contained transfemoral powered prostheses equipped with sensory network and suitable computational capabilities. The first consists of kinematic/kinetic variables of some prosthesis components (e.g., foot acceleration, force loading the pylon, knee angle) to detect either an abrupt lack of balance or a fall-related occurrence as a consequence of knee buckling, slipping, or tripping. The second involves implementing automatic procedures to allow pwTFA to routinely carry out clinical tests, such as the timed up and go test and/or the Four Square Step Test to monitor the decline of sensory motor capabilities, likely documenting an increased fall risk. Clinical Relevance The next generation of powered prostheses could both monitor decline on neuromuscular capabilities and gather early signs of an acute lack of balance based on a suitable network of sensors on board. This approach is expected to prevent the fall risk in pwTFA.
摘要引言众所周知，经股截肢会损害平衡控制能力，从而增加跌倒的概率。目前对机器人假肢的研究正在探索新的策略来评估跌倒的风险，并在需要时启用辅助策略来促进平衡恢复。目的本研究的目的是确定一组与经股截肢（pwTFA）患者跌倒风险和跌倒检测相关的生物力学变量，这些变量可以通过下一代传感动力假肢进行评估。研究设计研究设计为范围审查。方法对2020年2月进行的文献筛选（CINAHL、PubMed、Scopus和Web of Science）（通过Downs和Black检查表对保留文章进行质量评估；检索信息：测量测试和生物力学变量）。结果在最初的595篇文献中，只有25篇引文符合资格标准。pwTFA的跌倒风险评估和跌倒检测通常通过使用不同的测量测试来进行。结论两类用于跌倒风险评估的生物力学标志物有可能被纳入配备有感觉网络和适当计算能力的自给式经股动力假体中。第一个由一些假体组件的运动学/动力学变量组成（例如，脚加速度、支架上的力负载、膝盖角度），以检测由于膝盖屈曲、滑动或绊倒而导致的突然缺乏平衡或跌倒相关事件。第二个涉及实施自动程序，使pwTFA能够定期进行临床测试，如定时即用测试和/或四步测试，以监测感觉运动能力的下降，可能会记录跌倒风险的增加。临床相关性下一代电动假肢既可以监测神经肌肉能力的下降，也可以根据船上合适的传感器网络收集急性缺乏平衡的早期迹象。这种方法有望防止pwTFA中的跌倒风险。
{"title":"Biomechanical Measures for Fall Risk Assessment and Fall Detection in People with Transfemoral Amputations for the Next-Generation Prostheses: A Scoping Review","authors":"V. Monaco, F. Aprigliano, L. Palmerini, Pierpaolo Palumbo, L. Chiari, S. Micera","doi":"10.1097/JPO.0000000000000393","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000393","url":null,"abstract":"ABSTRACT Introduction Transfemoral amputations are known to compromise balance control capabilities, thus increasing the probability of falling. Current research in robotic prostheses is exploring novel strategies to assess the risk of fall and, if required, enable assistive strategies to promote balance recovery. Objectives The aim of this study was to identify a set of biomechanical variables associated with fall risk and fall detection in people with transfemoral amputation (pwTFA), which can be potentially assessed through the next generation of sensorized powered prostheses. Study Design The study design was scoping review. Methods Screening of the literature (CINAHL, PubMed, Scopus, and Web of Science) carried out in February 2020 (quality assessment of retained articles through Downs and Black checklist; retrieved information: measurement tests and biomechanical variables). Results From the initial 595 documents, only 25 citations met eligibility criteria. The pwTFA's fall risk assessment and fall detection are usually carried out by using different measurement tests. Conclusions Two classes of biomechanical markers for fall risk assessment have the potential to be incorporated in self-contained transfemoral powered prostheses equipped with sensory network and suitable computational capabilities. The first consists of kinematic/kinetic variables of some prosthesis components (e.g., foot acceleration, force loading the pylon, knee angle) to detect either an abrupt lack of balance or a fall-related occurrence as a consequence of knee buckling, slipping, or tripping. The second involves implementing automatic procedures to allow pwTFA to routinely carry out clinical tests, such as the timed up and go test and/or the Four Square Step Test to monitor the decline of sensory motor capabilities, likely documenting an increased fall risk. Clinical Relevance The next generation of powered prostheses could both monitor decline on neuromuscular capabilities and gather early signs of an acute lack of balance based on a suitable network of sensors on board. This approach is expected to prevent the fall risk in pwTFA.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"e144 - e162"},"PeriodicalIF":0.6,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44205225","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 : 2021-09-20DOI: 10.1097/JPO.0000000000000388
Beke Wahl, C. Gutenbrunner, B. Greitemann, Marcus Oergel, Diego Somoza López, Jörg Schiller, A. Ranker
ABSTRACT Introduction The aim of this study was to translate and cross-culturally adapt the Satisfaction with Prosthesis Questionnaire (SAT-PRO) into German and to evaluate its validity and reliability. Materials and Methods The 2-fold forward and backward translations were carried out according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. Subsequently, the German version of the SAT-PRO was administered to 68 patients with major lower-limb amputation (LLA) fitted with a prosthesis. The internal consistency, floor and ceiling effects, item-to-total correlation, and test-retest reliability were determined. In addition, the standard error of the mean (SEM) and minimal detectable change (MDC) were calculated. Convergent construct validity was assessed by correlation to a Numerical Rating Scale for Satisfaction Level (NRS-SAT), the 36-Item Short-Form Health Survey (SF-36), the Rivermead Mobility Index (RMI), and the Medicare Functional Classification Level (K-Levels). Descriptive subgroup analysis included levels of amputation (transtibial vs. transfemoral persons with amputations) and user type (long-term vs. subacute users). Results The mean SAT-PRO total score was 32.27 ± 6.89 (77.6%). Internal consistency was high (Cronbach α = 0.88), and reproducibility demonstrated excellent findings with an intraclass correlation coefficient (ICC2,1) of 0.90 (95% confidence interval [CI], 0.84–0.94). Floor or ceiling effects were not detected. Convergent construct validity indicated a strong correlation to the NRS-SAT (r = 0.89), K-Levels (r = 0.66), and RMI (r = 0.52, all with P < 0.001). Moderate to high correlations were shown to all eight domains of the SF-36 (in a range of r = 0.55 [physical function] to r = 0.39 [mental health], all with P < 0.001). MDC was 2.32 (MDC% = 3.4%). Conclusions The translation according to ISPOR guidelines and cross-cultural adaptation of the SAT-PRO into German were successfully conducted in the pilot study. The psychometric testing showed high reliability and validity of the German version of the SAT-PRO. Hence, it can be used as an outcome measure to assess a patient's satisfaction with prosthesis in a German-speaking population. Clinical Relevance Statement The SAT-PRO can make an important contribution to the treatment of patients with major LLA. The use of objective measurement parameters and guideline-based translation should be applied to increase the validity and comparability of the data.
{"title":"The German Version of the Satisfaction with Prosthesis Questionnaire: Translation, Adaptation, Reliability, and Validity in Adults with Major Lower-Limb Amputation","authors":"Beke Wahl, C. Gutenbrunner, B. Greitemann, Marcus Oergel, Diego Somoza López, Jörg Schiller, A. Ranker","doi":"10.1097/JPO.0000000000000388","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000388","url":null,"abstract":"ABSTRACT Introduction The aim of this study was to translate and cross-culturally adapt the Satisfaction with Prosthesis Questionnaire (SAT-PRO) into German and to evaluate its validity and reliability. Materials and Methods The 2-fold forward and backward translations were carried out according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. Subsequently, the German version of the SAT-PRO was administered to 68 patients with major lower-limb amputation (LLA) fitted with a prosthesis. The internal consistency, floor and ceiling effects, item-to-total correlation, and test-retest reliability were determined. In addition, the standard error of the mean (SEM) and minimal detectable change (MDC) were calculated. Convergent construct validity was assessed by correlation to a Numerical Rating Scale for Satisfaction Level (NRS-SAT), the 36-Item Short-Form Health Survey (SF-36), the Rivermead Mobility Index (RMI), and the Medicare Functional Classification Level (K-Levels). Descriptive subgroup analysis included levels of amputation (transtibial vs. transfemoral persons with amputations) and user type (long-term vs. subacute users). Results The mean SAT-PRO total score was 32.27 ± 6.89 (77.6%). Internal consistency was high (Cronbach α = 0.88), and reproducibility demonstrated excellent findings with an intraclass correlation coefficient (ICC2,1) of 0.90 (95% confidence interval [CI], 0.84–0.94). Floor or ceiling effects were not detected. Convergent construct validity indicated a strong correlation to the NRS-SAT (r = 0.89), K-Levels (r = 0.66), and RMI (r = 0.52, all with P < 0.001). Moderate to high correlations were shown to all eight domains of the SF-36 (in a range of r = 0.55 [physical function] to r = 0.39 [mental health], all with P < 0.001). MDC was 2.32 (MDC% = 3.4%). Conclusions The translation according to ISPOR guidelines and cross-cultural adaptation of the SAT-PRO into German were successfully conducted in the pilot study. The psychometric testing showed high reliability and validity of the German version of the SAT-PRO. Hence, it can be used as an outcome measure to assess a patient's satisfaction with prosthesis in a German-speaking population. Clinical Relevance Statement The SAT-PRO can make an important contribution to the treatment of patients with major LLA. The use of objective measurement parameters and guideline-based translation should be applied to increase the validity and comparability of the data.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"44 - 54"},"PeriodicalIF":0.6,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46299474","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 : 2021-09-16DOI: 10.1097/JPO.0000000000000389
Sally Kenworthy, Ariel Reno, Andrew Reid
ABSTRACT Introduction The provision of orthoses is a specialized practice within healthcare that requires collaboration among professionals for successful treatment outcomes. Although orthotists are an integral part of the process, the role of the orthotists may not be commonly understood or appreciated. Among the rehabilitative health care team, physical therapists (PTs) and orthotists are especially aligned, with overlapping roles in each profession's scope of practice. Materials and Methods A cross-sectional survey was distributed to members of the health care team, including certified prosthetist orthotists and PTs. Chi-squared tests were calculated to compare PT and orthotist responses to a question regarding role responsibilities of each team member. We hypothesized that there would be disagreement among the professions as to which tasks orthotists are responsible for performing. Results The results of this study suggest that PTs and orthotists agree that orthotists are responsible for recommending a patient-specific orthosis. Interestingly, PTs did not identify orthotists as a team member responsible for performing patient assessment and evaluation tasks, despite these tasks being a key driver of patient-specific orthosis recommendations. Conclusions Interprofessional education to increase knowledge of orthotic management principles among PTs may improve collaboration and communication within the health care team. Clinical Relevance The present study identified a potential gap in PT awareness of the scope of practice and training of certified orthotists. Provision of optimal patient management requires clear understanding of respective roles and responsibilities of the health care team.
{"title":"Perceived Role Responsibilities Among Physical Therapists and Orthotists","authors":"Sally Kenworthy, Ariel Reno, Andrew Reid","doi":"10.1097/JPO.0000000000000389","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000389","url":null,"abstract":"ABSTRACT Introduction The provision of orthoses is a specialized practice within healthcare that requires collaboration among professionals for successful treatment outcomes. Although orthotists are an integral part of the process, the role of the orthotists may not be commonly understood or appreciated. Among the rehabilitative health care team, physical therapists (PTs) and orthotists are especially aligned, with overlapping roles in each profession's scope of practice. Materials and Methods A cross-sectional survey was distributed to members of the health care team, including certified prosthetist orthotists and PTs. Chi-squared tests were calculated to compare PT and orthotist responses to a question regarding role responsibilities of each team member. We hypothesized that there would be disagreement among the professions as to which tasks orthotists are responsible for performing. Results The results of this study suggest that PTs and orthotists agree that orthotists are responsible for recommending a patient-specific orthosis. Interestingly, PTs did not identify orthotists as a team member responsible for performing patient assessment and evaluation tasks, despite these tasks being a key driver of patient-specific orthosis recommendations. Conclusions Interprofessional education to increase knowledge of orthotic management principles among PTs may improve collaboration and communication within the health care team. Clinical Relevance The present study identified a potential gap in PT awareness of the scope of practice and training of certified orthotists. Provision of optimal patient management requires clear understanding of respective roles and responsibilities of the health care team.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"12 - 18"},"PeriodicalIF":0.6,"publicationDate":"2021-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44336690","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 : 2021-09-07DOI: 10.1097/JPO.0000000000000394
F. Routhier, J. Lettre, J. Bouffard, P. Archambault, M. Lemay, I. Gélinas
ABSTRACT Introduction Research is still limited on the impacts of robotic arms in improving independent living and social participation of individuals with upper-limb disabilities, and several knowledge gaps remain. This study aims to investigate the impacts of the JACO robotic arm on individuals with upper-limb impairments due to a neuromuscular disease. Methods For this prospective study, participants used the robotic arm in their daily life for a 2-month period. The effectiveness of the robotic arm was objectively observed during activities performed in a controlled environment. The perception of the users and of their main family caregivers was also documented. Finally, the nature and importance of activities carried out with the robotic arm in a community-living environment were explored. Results Participants' abilities with the JACO robotic arm improved continuously during the trial duration. Participants actively took part in more life habits, perceived fewer difficulties, and were more satisfied with their social participation. Despite these findings, very few life habits could be performed completely independently, limiting the impacts on global caregivers' burden. Conclusions Even if participants encountered some difficulties, this study demonstrates short-term benefits of the robotic arm for individuals with upper-limb impairments due to a neuromuscular disorder. Future studies should mainly focus on the psychosocial, economic, and occupational long-term impacts of the robotic arm. The development of services to assist the integration of such devices in people's lives could optimize their impacts. Clinical Relevance The results of this study contribute to the body of knowledge of clinicians for the prescription of a robotic arm.
{"title":"Impacts of a Robotic Arm on People with Upper-Limb Disabilities Due to Neuromuscular Disorder","authors":"F. Routhier, J. Lettre, J. Bouffard, P. Archambault, M. Lemay, I. Gélinas","doi":"10.1097/JPO.0000000000000394","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000394","url":null,"abstract":"ABSTRACT Introduction Research is still limited on the impacts of robotic arms in improving independent living and social participation of individuals with upper-limb disabilities, and several knowledge gaps remain. This study aims to investigate the impacts of the JACO robotic arm on individuals with upper-limb impairments due to a neuromuscular disease. Methods For this prospective study, participants used the robotic arm in their daily life for a 2-month period. The effectiveness of the robotic arm was objectively observed during activities performed in a controlled environment. The perception of the users and of their main family caregivers was also documented. Finally, the nature and importance of activities carried out with the robotic arm in a community-living environment were explored. Results Participants' abilities with the JACO robotic arm improved continuously during the trial duration. Participants actively took part in more life habits, perceived fewer difficulties, and were more satisfied with their social participation. Despite these findings, very few life habits could be performed completely independently, limiting the impacts on global caregivers' burden. Conclusions Even if participants encountered some difficulties, this study demonstrates short-term benefits of the robotic arm for individuals with upper-limb impairments due to a neuromuscular disorder. Future studies should mainly focus on the psychosocial, economic, and occupational long-term impacts of the robotic arm. The development of services to assist the integration of such devices in people's lives could optimize their impacts. Clinical Relevance The results of this study contribute to the body of knowledge of clinicians for the prescription of a robotic arm.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"180 - 191"},"PeriodicalIF":0.6,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49609191","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 : 2021-08-20DOI: 10.1097/JPO.0000000000000384
S. Sudeesh, S. Sujatha, M. Shunmugam
ABSTRACT Introduction Typically, polycentric prosthetic knees have been designed with a focus on improved performance during stance. This study analyzes the influence of geometric aspects such as linkage dimensions of the polycentric knees and anterior-posterior (A/P) alignment on the swing phase of walking. Such a study would enable the development of polycentric knees with improved performance during both stance and swing phases. Methods A simulation-based approach was used to analyze the influence of geometric aspects on swing dynamics. A newly developed four-bar knee called IITM polycentric knee (IPK) was used as a baseline prosthesis. First, the swing was simulated with the baseline prosthesis. The IPK in the lower limb was then replaced with the linkage dimensions of four other commercial polycentric knees (Ottobock's 3R36, 3R55, and 3R70 and Ohio Willow Wood's Pendulum knee) for the simulation of swing phase. Effect of A/P alignment was analyzed by translating the socket adapter of the IPK along the A/P axis in the baseline prosthesis, which has the effect of moving the knee and foot in the opposite direction. A maximum of 20 mm translation of the socket adapter was applied on either side of its base location in the lower-limb model. The gait parameters from the simulations and the centrode of different polycentric knees were then analyzed to understand how linkage dimensions and A/P translations of the knee and foot affect the swing dynamics. Results All four-bar knees without extension assists extended to less than 6° before heel contact, which is significantly lower than the 24° obtained for a single-axis knee in a previous study. The swing performances of the different four-bar knees studied here were found to depend on their centrode. The instant centers (ICs) of the 3R55 and IPK, which were comparatively located more superior to the anatomical knee center during swing, enabled better knee extension and foot clearance than other knees. A/P translation of the knee and foot significantly affected the foot clearance. A 20 mm anterior translation increased toe and heel clearance by 1.6 cm and 1.4 cm, respectively, when compared with a 20 mm posterior translation. Conclusions This study shows that polycentric knees, which generally perform better than single-axis knees with improved stance stability and ease of push-off, can also perform well during swing in terms of knee extension before heel contact and foot clearance throughout swing. The extended moment arm for the weight of the shank and foot due to the superior location of the IC in polycentric knees is the reason for the improved swing performance of polycentric knees. Appropriate placement of the socket adapter, which affects A/P alignment, is crucial so that foot clearance during swing is not compromised. The insights obtained from the study would be useful in developing simpler polycentric knees, which can extend completely without any extension assist if proper alignment is used
{"title":"The Effects of Polycentric Knee Design and Alignment on Swing Phase Gait Parameters: A Simulation Approach","authors":"S. Sudeesh, S. Sujatha, M. Shunmugam","doi":"10.1097/JPO.0000000000000384","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000384","url":null,"abstract":"ABSTRACT Introduction Typically, polycentric prosthetic knees have been designed with a focus on improved performance during stance. This study analyzes the influence of geometric aspects such as linkage dimensions of the polycentric knees and anterior-posterior (A/P) alignment on the swing phase of walking. Such a study would enable the development of polycentric knees with improved performance during both stance and swing phases. Methods A simulation-based approach was used to analyze the influence of geometric aspects on swing dynamics. A newly developed four-bar knee called IITM polycentric knee (IPK) was used as a baseline prosthesis. First, the swing was simulated with the baseline prosthesis. The IPK in the lower limb was then replaced with the linkage dimensions of four other commercial polycentric knees (Ottobock's 3R36, 3R55, and 3R70 and Ohio Willow Wood's Pendulum knee) for the simulation of swing phase. Effect of A/P alignment was analyzed by translating the socket adapter of the IPK along the A/P axis in the baseline prosthesis, which has the effect of moving the knee and foot in the opposite direction. A maximum of 20 mm translation of the socket adapter was applied on either side of its base location in the lower-limb model. The gait parameters from the simulations and the centrode of different polycentric knees were then analyzed to understand how linkage dimensions and A/P translations of the knee and foot affect the swing dynamics. Results All four-bar knees without extension assists extended to less than 6° before heel contact, which is significantly lower than the 24° obtained for a single-axis knee in a previous study. The swing performances of the different four-bar knees studied here were found to depend on their centrode. The instant centers (ICs) of the 3R55 and IPK, which were comparatively located more superior to the anatomical knee center during swing, enabled better knee extension and foot clearance than other knees. A/P translation of the knee and foot significantly affected the foot clearance. A 20 mm anterior translation increased toe and heel clearance by 1.6 cm and 1.4 cm, respectively, when compared with a 20 mm posterior translation. Conclusions This study shows that polycentric knees, which generally perform better than single-axis knees with improved stance stability and ease of push-off, can also perform well during swing in terms of knee extension before heel contact and foot clearance throughout swing. The extended moment arm for the weight of the shank and foot due to the superior location of the IC in polycentric knees is the reason for the improved swing performance of polycentric knees. Appropriate placement of the socket adapter, which affects A/P alignment, is crucial so that foot clearance during swing is not compromised. The insights obtained from the study would be useful in developing simpler polycentric knees, which can extend completely without any extension assist if proper alignment is used","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"33 1","pages":"266 - 278"},"PeriodicalIF":0.6,"publicationDate":"2021-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48276668","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 : 2021-08-20DOI: 10.1097/JPO.0000000000000385
S. Alsancak, S. Güner, I. C. Tuncay
ABSTRACT Introduction Congenital longitudinal tibial deficiency is a rare condition. It is characterized by partial or complete absence of tibia with a relatively intact fibula. Its standard treatment is surgery and employing orthoprosthesis or prosthesis. However, the effects of gaits according to the types of prosthesis is barely known. Methods Orthoprosthesis is offered to a 30-year-old man experiencing left-side congenital type 1 tibial hemimelia (classified as Jones type 1B) deficiency with thoracolumbar scoliosis and exhibiting a depressed shoulder as well as a stiff knee. He decided to have an amputation to wear a transfemoral (TF) prosthesis comprising a microprocessor-controlled knee. Results Three-dimensional gait analyses and a 6-minute walk test were performed preoperatively and postoperatively with the orthoprosthesis and TF prosthesis. Furthermore, the kinematics of hip flexion/extension and pelvic anterior/posterior tilt range of the motion degree were increased using TF prosthesis. The result of the kinetics of the hip flexion/extension moment and hip power parameters were affected using the TF prosthesis. Conclusions This case study suggests that the new prosthesis provides removable and adaptable component; further, it delivers a comfortable sitting experience because of its new socket design and knee joint flexion. Clinical Relevance Patient satisfaction is better with TF prosthesis than with orthoprosthesis. TF prosthesis is more cosmetic than orthoprosthesis, provides a symmetrical gait pattern, decreases donning and doffing durations, and there is no uncomfortable protrusion when sitting (due to amputation of the foot and leg part).
{"title":"Kinetic and Kinematics Parameters of Hip in Gait for a Congenital Longitudinal Tibial Deficiency with Orthoprosthesis and Transfemoral Prosthesis: A Case Study","authors":"S. Alsancak, S. Güner, I. C. Tuncay","doi":"10.1097/JPO.0000000000000385","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000385","url":null,"abstract":"ABSTRACT Introduction Congenital longitudinal tibial deficiency is a rare condition. It is characterized by partial or complete absence of tibia with a relatively intact fibula. Its standard treatment is surgery and employing orthoprosthesis or prosthesis. However, the effects of gaits according to the types of prosthesis is barely known. Methods Orthoprosthesis is offered to a 30-year-old man experiencing left-side congenital type 1 tibial hemimelia (classified as Jones type 1B) deficiency with thoracolumbar scoliosis and exhibiting a depressed shoulder as well as a stiff knee. He decided to have an amputation to wear a transfemoral (TF) prosthesis comprising a microprocessor-controlled knee. Results Three-dimensional gait analyses and a 6-minute walk test were performed preoperatively and postoperatively with the orthoprosthesis and TF prosthesis. Furthermore, the kinematics of hip flexion/extension and pelvic anterior/posterior tilt range of the motion degree were increased using TF prosthesis. The result of the kinetics of the hip flexion/extension moment and hip power parameters were affected using the TF prosthesis. Conclusions This case study suggests that the new prosthesis provides removable and adaptable component; further, it delivers a comfortable sitting experience because of its new socket design and knee joint flexion. Clinical Relevance Patient satisfaction is better with TF prosthesis than with orthoprosthesis. TF prosthesis is more cosmetic than orthoprosthesis, provides a symmetrical gait pattern, decreases donning and doffing durations, and there is no uncomfortable protrusion when sitting (due to amputation of the foot and leg part).","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"33 1","pages":"304 - 310"},"PeriodicalIF":0.6,"publicationDate":"2021-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44300665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT Introduction Analyzing the frequency content of ground reaction forces (GRFs) might be helpful when assessing gait abnormalities in children with flexible flatfeet. The aims of this study were therefore to evaluate 1) differences in GRF frequency content between children with and without flatfeet; and 2) whether the long-term wearing of foot orthoses changes the GRF frequency contents in children with flatfeet. Materials and Methods This is a pre-post study design. GRFs were collected at baseline for boys both with and without flatfeet. Boys with flatfeet wore custom-made foot orthoses with unique shoes for 4 months; GRFs were collected for the flatfeet group after 4 months too. Data were collected while participants wore shoes without foot orthoses in the pretest and shoes with foot orthoses in the posttest. GRFs were collected during walking by two Kistler force platforms (each force plate was used for each leg). Multivariate analysis of variance (MANOVA) test and a separate 2 (side: dominant vs. nondominant) × 2 (time: pretest vs. posttest) ANOVA with repeated measures were used for statistical analysis. Results The flatfeet group indicated lower vertical GRF frequency (P = 0.003; d = 1.21; 95% confidence interval [CI], 7.12–7.59) and greater vertical amplitude of harmonic 16 for the nondominant limb (P = 0.030; d = 0.71; 95% CI, 0.0001–0.0022) than the normal feet group. No significant differences in GRF frequency content were found for the dominant limb between pretest and posttest (P > 0.05; d = 0.01–039). However, for nondominant limb, vertical GRF frequency content (P < 0.001; d = 0.85; 95% CI, 6.21–7.36) was diminished at posttest compared with pretest. In the nondominant limb, the anteroposterior GRF frequency with a power of 99.5% showed a significant increase at posttest compared with pretest (P = 0.025; d = 0.50; 95% CI, 13.30–16.20). For both limbs, amplitudes of three-dimensional GRF components were lower at posttest than at pretest (P < 0.05; d = 0.0.14–1.20; 95% CI, −0.0005 to −0.0083). Conclusions The results indicated lower GRF frequency content and amplitudes after long-term wearing of foot orthoses. Therefore, long-term wearing of foot orthoses may be applied to obtain functional improvements in children with flatfeet. Clinical Relevance Clinicians are advised to apply foot orthoses to improve functions in children with flatfeet.
{"title":"The Long-Term Wearing of Foot Orthoses Can Change the Frequency Domain of Ground Reaction Forces in Children with Flexible Flat Feet","authors":"A. Jafarnezhadgero, Seyed Hamed Musavi, Seyed Majid Alavi Mehr, Morteza Madadi-Shad","doi":"10.1097/JPO.0000000000000386","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000386","url":null,"abstract":"ABSTRACT Introduction Analyzing the frequency content of ground reaction forces (GRFs) might be helpful when assessing gait abnormalities in children with flexible flatfeet. The aims of this study were therefore to evaluate 1) differences in GRF frequency content between children with and without flatfeet; and 2) whether the long-term wearing of foot orthoses changes the GRF frequency contents in children with flatfeet. Materials and Methods This is a pre-post study design. GRFs were collected at baseline for boys both with and without flatfeet. Boys with flatfeet wore custom-made foot orthoses with unique shoes for 4 months; GRFs were collected for the flatfeet group after 4 months too. Data were collected while participants wore shoes without foot orthoses in the pretest and shoes with foot orthoses in the posttest. GRFs were collected during walking by two Kistler force platforms (each force plate was used for each leg). Multivariate analysis of variance (MANOVA) test and a separate 2 (side: dominant vs. nondominant) × 2 (time: pretest vs. posttest) ANOVA with repeated measures were used for statistical analysis. Results The flatfeet group indicated lower vertical GRF frequency (P = 0.003; d = 1.21; 95% confidence interval [CI], 7.12–7.59) and greater vertical amplitude of harmonic 16 for the nondominant limb (P = 0.030; d = 0.71; 95% CI, 0.0001–0.0022) than the normal feet group. No significant differences in GRF frequency content were found for the dominant limb between pretest and posttest (P > 0.05; d = 0.01–039). However, for nondominant limb, vertical GRF frequency content (P < 0.001; d = 0.85; 95% CI, 6.21–7.36) was diminished at posttest compared with pretest. In the nondominant limb, the anteroposterior GRF frequency with a power of 99.5% showed a significant increase at posttest compared with pretest (P = 0.025; d = 0.50; 95% CI, 13.30–16.20). For both limbs, amplitudes of three-dimensional GRF components were lower at posttest than at pretest (P < 0.05; d = 0.0.14–1.20; 95% CI, −0.0005 to −0.0083). Conclusions The results indicated lower GRF frequency content and amplitudes after long-term wearing of foot orthoses. Therefore, long-term wearing of foot orthoses may be applied to obtain functional improvements in children with flatfeet. Clinical Relevance Clinicians are advised to apply foot orthoses to improve functions in children with flatfeet.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"22 - 32"},"PeriodicalIF":0.6,"publicationDate":"2021-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43754798","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 : 2021-07-19DOI: 10.1097/JPO.0000000000000382
N. Eddison, S. Benyahia, N. Chockalingam
ABSTRACT Introduction The purpose of this article is to review the literature on the effect of immobilization of the cervical spine using orthotic devices. The review focused on the methodologies of the studies to see if this might be a contributing factor to the lack of available clinical guidelines on spinal immobilization using orthoses. Methods This review was conducted using PRISMA guidelines (PLoS Med. 2009;6:e1000097). The search was conducted in August 2019 within all major databases using relevant phrases. No date restrictions were applied, but the search was restricted to full manuscripts published in English. These searches were then supplemented by tracking all key references from the appropriate articles identified. Articles were selected according to a priori–defined criteria. Initially, data were extracted regarding publication details, orthosis name and group, spinal level studied, and whether cervical range of motion was measured. Results A total of 52 articles fulfilled the inclusion criteria. This article discusses the methodology of the included studies. Conclusions There is a clear paucity of well-designed research on immobilization of the cervical spine using orthotic devices. Comparing the results of studies using different types of orthoses is difficult due to the type and age of the participants involved (healthy, pathological, cadaver) and the different techniques of measurement used. This lack of standardization prevents meta-analyses from being performed and may be a contributing factor to the lack of available clinical guidelines. An agreed structured methodology is required to enable meta-analyses and determine clinical guidelines for the prescription of spinal orthoses for cervical spine pathology.
{"title":"The Effect of Spinal Orthoses on Immobilizing the Cervical Spine: A Systematic Review of Research Methodologies","authors":"N. Eddison, S. Benyahia, N. Chockalingam","doi":"10.1097/JPO.0000000000000382","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000382","url":null,"abstract":"ABSTRACT Introduction The purpose of this article is to review the literature on the effect of immobilization of the cervical spine using orthotic devices. The review focused on the methodologies of the studies to see if this might be a contributing factor to the lack of available clinical guidelines on spinal immobilization using orthoses. Methods This review was conducted using PRISMA guidelines (PLoS Med. 2009;6:e1000097). The search was conducted in August 2019 within all major databases using relevant phrases. No date restrictions were applied, but the search was restricted to full manuscripts published in English. These searches were then supplemented by tracking all key references from the appropriate articles identified. Articles were selected according to a priori–defined criteria. Initially, data were extracted regarding publication details, orthosis name and group, spinal level studied, and whether cervical range of motion was measured. Results A total of 52 articles fulfilled the inclusion criteria. This article discusses the methodology of the included studies. Conclusions There is a clear paucity of well-designed research on immobilization of the cervical spine using orthotic devices. Comparing the results of studies using different types of orthoses is difficult due to the type and age of the participants involved (healthy, pathological, cadaver) and the different techniques of measurement used. This lack of standardization prevents meta-analyses from being performed and may be a contributing factor to the lack of available clinical guidelines. An agreed structured methodology is required to enable meta-analyses and determine clinical guidelines for the prescription of spinal orthoses for cervical spine pathology.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"e93 - e98"},"PeriodicalIF":0.6,"publicationDate":"2021-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41877255","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 : 2021-06-29DOI: 10.1097/JPO.0000000000000381
S. Topuz, Ö. Ülger, Y. Yakut, Gülseren Yazicioğlu
ABSTRACT Introduction The purpose of this study was to identify the relation of daily prosthesis usage time (DPUT) of individuals with amputation with quality of life (QoL) questionnaires. Methods The research was carried out on 125 individuals with amputation. Prosthetic-related parameters were searched, as well as demographic data. A generic (Nottingham Health Profile [NHP]) questionnaire and a questionnaire specific to individuals with amputation (Trinity Amputation and Prosthesis Experience Scales [TAPES]) QoL measurements were used. Results Ninety-one males and 28 females with a mean age of 42.4 ± 14.7 years participated in the study. The average DPUT was 11.1 ± 4.4 hrs/d. Study results showed that there was significant correlation between both of the QoL questionnaires (NHP and TAPES) and DPUT. High correlation was determined between DPUT and NHP total score and NHP-Pain, and very high correlation was found between DPUT and NHP–Physical Activity subscale. A moderate negative correlation was found between DPUT and NHP–Energy Level, NHP–Emotional Reaction, NHP–Social Isolation, and NHP–Sleep. A moderate negative correlation was found between DPUT and TAPES–Activity Restriction. A high correlation was found between DPUT and residual limb pain, prosthetic satisfaction, time interval after amputation, and number of prosthetic fittings. A moderate correlation was found between DPUT and walking aids, whereas a poor relationship was shown between phantom pain and DPUT. Conclusions This study showed that “the average DPUT” may be used in terms of short assessment of QoL of individuals with amputation. The outcomes of this study pointed out that especially prosthetic-related parameters affected the QoL in individuals with amputation. In problems resulting from routine assessment and questionnaires having so many items, a single-item question, “the average DPUT,” may be used effectively in a shorter period and is helpful for organizing a rehabilitation program. Clinical Relevance A single-item question, “The average daily prosthesis usage time (DPUT),” be used effectively in a shorter assessment of quality of life of individuals with amputation and is helpful for organizing a rehabilitation program.
{"title":"Quality of Life Evaluation Through a Single-Item “Daily Prosthesis Usage Time” in Individuals with Lower-Limb Amputation","authors":"S. Topuz, Ö. Ülger, Y. Yakut, Gülseren Yazicioğlu","doi":"10.1097/JPO.0000000000000381","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000381","url":null,"abstract":"ABSTRACT Introduction The purpose of this study was to identify the relation of daily prosthesis usage time (DPUT) of individuals with amputation with quality of life (QoL) questionnaires. Methods The research was carried out on 125 individuals with amputation. Prosthetic-related parameters were searched, as well as demographic data. A generic (Nottingham Health Profile [NHP]) questionnaire and a questionnaire specific to individuals with amputation (Trinity Amputation and Prosthesis Experience Scales [TAPES]) QoL measurements were used. Results Ninety-one males and 28 females with a mean age of 42.4 ± 14.7 years participated in the study. The average DPUT was 11.1 ± 4.4 hrs/d. Study results showed that there was significant correlation between both of the QoL questionnaires (NHP and TAPES) and DPUT. High correlation was determined between DPUT and NHP total score and NHP-Pain, and very high correlation was found between DPUT and NHP–Physical Activity subscale. A moderate negative correlation was found between DPUT and NHP–Energy Level, NHP–Emotional Reaction, NHP–Social Isolation, and NHP–Sleep. A moderate negative correlation was found between DPUT and TAPES–Activity Restriction. A high correlation was found between DPUT and residual limb pain, prosthetic satisfaction, time interval after amputation, and number of prosthetic fittings. A moderate correlation was found between DPUT and walking aids, whereas a poor relationship was shown between phantom pain and DPUT. Conclusions This study showed that “the average DPUT” may be used in terms of short assessment of QoL of individuals with amputation. The outcomes of this study pointed out that especially prosthetic-related parameters affected the QoL in individuals with amputation. In problems resulting from routine assessment and questionnaires having so many items, a single-item question, “the average DPUT,” may be used effectively in a shorter period and is helpful for organizing a rehabilitation program. Clinical Relevance A single-item question, “The average daily prosthesis usage time (DPUT),” be used effectively in a shorter assessment of quality of life of individuals with amputation and is helpful for organizing a rehabilitation program.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"241 - 245"},"PeriodicalIF":0.6,"publicationDate":"2021-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47608065","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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