Pub Date : 2021-11-01DOI: 10.1097/JPO.0000000000000397
Miho Asano, Yu Li Ng, Khalid Anuar, Yi Tian Felicity Yeo, G. Koh, K. Tan
ABSTRACT Introduction Singapore's aging population and prevalence of chronic diseases and conditions continue to grow along with the need for prosthetic and orthotic services. We need to understand the supply of prosthetic and orthotic services and prosthetists and orthotists (P&Os) to optimize care. Therefore, the objective of this study was to estimate the recent and the future supply and demand for P&Os in Singapore. Methods This was a retrospective medical record review. We identified the seven conditions requiring prosthetic and orthotic services and applied condition-specific admission rates on the projected population of Singapore through 2060 to obtain the number of inpatient admissions requiring the services. We then converted these numbers to prosthetist/orthotist hours by multiplying by prosthetist/orthotist workload for each condition. Finally, we applied two supply scenarios to examine potential P&O shortfall. Results The shortfall was estimated to be 9.4 and 5.4 in 2016 under the respective scenarios. These gaps increase to 18.4 and 5.8, respectively, in 2030, and 28.1 and 6.2, respectively, in 2060. Conclusions The existing shortfall of P&Os in Singapore will continue to grow from 2016 to 2060. Appropriate strategies should be considered and implemented in a timely manner to manage the potential shortfall. Clinical Relevance Projecting the demand for future prosthetist/orthotist manpower through a specific condition-driven and time-based utility approach provides an alternative model to only a linear population growth. This may provide a more accurate predictability and selection of precise strategies to manage future manpower demands.
{"title":"Projecting the Supply and Demand of Prosthetists and Orthotists in Singapore","authors":"Miho Asano, Yu Li Ng, Khalid Anuar, Yi Tian Felicity Yeo, G. Koh, K. Tan","doi":"10.1097/JPO.0000000000000397","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000397","url":null,"abstract":"ABSTRACT Introduction Singapore's aging population and prevalence of chronic diseases and conditions continue to grow along with the need for prosthetic and orthotic services. We need to understand the supply of prosthetic and orthotic services and prosthetists and orthotists (P&Os) to optimize care. Therefore, the objective of this study was to estimate the recent and the future supply and demand for P&Os in Singapore. Methods This was a retrospective medical record review. We identified the seven conditions requiring prosthetic and orthotic services and applied condition-specific admission rates on the projected population of Singapore through 2060 to obtain the number of inpatient admissions requiring the services. We then converted these numbers to prosthetist/orthotist hours by multiplying by prosthetist/orthotist workload for each condition. Finally, we applied two supply scenarios to examine potential P&O shortfall. Results The shortfall was estimated to be 9.4 and 5.4 in 2016 under the respective scenarios. These gaps increase to 18.4 and 5.8, respectively, in 2030, and 28.1 and 6.2, respectively, in 2060. Conclusions The existing shortfall of P&Os in Singapore will continue to grow from 2016 to 2060. Appropriate strategies should be considered and implemented in a timely manner to manage the potential shortfall. Clinical Relevance Projecting the demand for future prosthetist/orthotist manpower through a specific condition-driven and time-based utility approach provides an alternative model to only a linear population growth. This may provide a more accurate predictability and selection of precise strategies to manage future manpower demands.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"60 - 65"},"PeriodicalIF":0.6,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42678916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-27DOI: 10.1097/JPO.0000000000000398
Maureen E. Johnson, Heather David, Mohan Ganesan
ABSTRACT Introduction This study investigated surfing performance in surfers with transfemoral amputations (TFAs) and transtibial amputations (TTAs) who participated in international para surfing competitions. The purpose of this research was to compare surfers with lower-limb amputations with judged wave scores and surfing experience for para surfing classification efficacy. Materials and Methods Collected archived data (n = 20) from classification records included demographics, residual limb lengths, surfing experiences, and judged wave scores. Continuous variables age (years), residual leg length (cm), remaining leg length (%), prior surfing experience (years), and duration of competing experience (years) were analyzed using independent sample t-test. Ordinal variables surfing performance scores of 2019 and 2020 between the groups were compared using Mann-Whitney U test. Spearman ρ correlation coefficient was used to determine the association between the duration of prior surfing experience and duration of competition experience with the surfing score in both groups. Results Surfers with TFA with longer residual limb lengths (n = 3) and surfers with TTA (n = 14) surfed with a prosthetic leg standing. Surfers with TFA with shorter residual limb lengths (n = 3) surfed without a prosthesis kneeling. We found that para surfers who stood or kneeled with TFA performed significantly better than para surfers with TTA, reflected through judged wave scores in 2019 (P = 0.028) and 2020 (P = 0.019). No statistically significant relationship existed between para surfers with TFA who kneeled or stood. No statistically significant relationship existed between years of para surfing and judged wave scores. Conclusions Surfers with TFA who stood or kneeled received higher judged wave scores than surfers with TTA; however, no other significant significance was found for TFA intragroup comparisons or prior surf experience. The data size was too small for confirmatory analysis. Results appeal to a new need for inquiry on para surfers with TFA and TTA, specifically biomechanical performance surfing differences. Clinical Relevance Individuals with transfemoral and/or transtibial amputations can participate competitively in para surfing contests. Surfers with TFAs can successfully compete either standing with a prosthesis or kneeling without a prosthesis.
{"title":"Surfing Performance in Para Surfers with Lower-Limb Amputations: A Cross-Sectional Study","authors":"Maureen E. Johnson, Heather David, Mohan Ganesan","doi":"10.1097/JPO.0000000000000398","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000398","url":null,"abstract":"ABSTRACT Introduction This study investigated surfing performance in surfers with transfemoral amputations (TFAs) and transtibial amputations (TTAs) who participated in international para surfing competitions. The purpose of this research was to compare surfers with lower-limb amputations with judged wave scores and surfing experience for para surfing classification efficacy. Materials and Methods Collected archived data (n = 20) from classification records included demographics, residual limb lengths, surfing experiences, and judged wave scores. Continuous variables age (years), residual leg length (cm), remaining leg length (%), prior surfing experience (years), and duration of competing experience (years) were analyzed using independent sample t-test. Ordinal variables surfing performance scores of 2019 and 2020 between the groups were compared using Mann-Whitney U test. Spearman ρ correlation coefficient was used to determine the association between the duration of prior surfing experience and duration of competition experience with the surfing score in both groups. Results Surfers with TFA with longer residual limb lengths (n = 3) and surfers with TTA (n = 14) surfed with a prosthetic leg standing. Surfers with TFA with shorter residual limb lengths (n = 3) surfed without a prosthesis kneeling. We found that para surfers who stood or kneeled with TFA performed significantly better than para surfers with TTA, reflected through judged wave scores in 2019 (P = 0.028) and 2020 (P = 0.019). No statistically significant relationship existed between para surfers with TFA who kneeled or stood. No statistically significant relationship existed between years of para surfing and judged wave scores. Conclusions Surfers with TFA who stood or kneeled received higher judged wave scores than surfers with TTA; however, no other significant significance was found for TFA intragroup comparisons or prior surf experience. The data size was too small for confirmatory analysis. Results appeal to a new need for inquiry on para surfers with TFA and TTA, specifically biomechanical performance surfing differences. Clinical Relevance Individuals with transfemoral and/or transtibial amputations can participate competitively in para surfing contests. Surfers with TFAs can successfully compete either standing with a prosthesis or kneeling without a prosthesis.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"252 - 258"},"PeriodicalIF":0.6,"publicationDate":"2021-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43547843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-13DOI: 10.1097/JPO.0000000000000392
H. H. Sears, K. Doolan, Denise D. Keenan
ABSTRACT Introduction Bilateral upper-limb loss (Bil UL Loss) is perhaps the greatest challenge for upper-limb prosthetic care, now even more than ever as we witness the increase of sepsis as a cause of limb loss. Methods This small-n survey has recruited 28 individuals with Bil UL Loss, 27 of whom are prosthesis wearers. Twelve of the 28 lost four limbs to sepsis; 17 of the 27 prosthesis wearers use body-powered hooks, six use electric hooks, and four use electric hands as their dominant terminal device (within this report, dominant side is the wearer's postloss dominant side, i.e., the side the subject used more frequently). The survey used person-to-person interviews to compile the broad data about how tasks are performed, how many tasks are performed, whether two prostheses are used, and other details. Results Users of each type of prosthesis demonstrate a high level of function. Electric hook users scored slightly higher in number of tasks and other measures. However, no outcomes were significant statistically, except the use of the dominant side prosthesis, which was three times higher than the nondominant side usage. Users identified a dozen categories for desired improvements, with greater dependability and greater grip security as the most commonly requested. Discussion The information will be useful for not only for clinical guidance, but hopefully also to help guide the development of future prosthetic devices, considering that the disabled community has called for prioritizing the actual needs and desires of the consumers to guide future developments. Conclusions The planning and execution of this small-scale study could be a model for other groups to collect useful outcomes data without requiring a research grant, without large institutional oversight, and by only a small group of interested professionals with access to a reasonable number of individuals with a severe disability. Clinical Relevance All caregivers of individuals with bilateral limb loss could benefit from both the data presented and the challenges revealed by this survey group. Future prosthetic designs as well as training and other therapies will also hopefully benefit from the needs expressed directly by these consumers.
摘要简介双侧上肢丢失（Bil UL loss）可能是上肢假肢护理面临的最大挑战，现在甚至比以往任何时候都更大，因为我们目睹了败血症作为肢体丢失原因的增加。方法本次小n调查共招募了28名Bil UL丢失患者，其中27人为假体佩戴者。28人中有12人因败血症失去四肢；27名假肢佩戴者中有17人使用身体供电的挂钩，6人使用电动挂钩，4人使用电动手作为主要终端设备（在本报告中，主要侧是佩戴者丢失后的主要侧，即受试者更频繁使用的侧）。这项调查使用了人与人之间的访谈来汇编关于如何执行任务、执行了多少任务、是否使用了两个假肢以及其他细节的广泛数据。结果每种假体的使用者都表现出较高的功能水平。电钩用户在任务数量和其他指标上得分略高。然而，除了使用优势侧假体外，没有任何结果具有统计学意义，优势侧假体的使用量是非优势侧假体使用量的三倍。用户确定了十几个需要改进的类别，其中最常见的要求是更高的可靠性和更高的抓握安全性。讨论考虑到残疾人社区呼吁优先考虑消费者的实际需求和愿望，以指导未来的发展，这些信息不仅有助于临床指导，而且有望帮助指导未来假肢设备的开发。结论这项小规模研究的规划和执行可以成为其他群体收集有用结果数据的一个模式，而无需研究拨款，无需大型机构监督，也只有一小群感兴趣的专业人员可以接触到合理数量的严重残疾者。临床相关性所有双侧肢体丧失患者的护理人员都可以从该调查组提供的数据和揭示的挑战中受益。未来的假肢设计、训练和其他疗法也有望从这些消费者直接表达的需求中受益。
{"title":"A Small-Scale Survey of Bilateral Upper-Limb Loss Individuals","authors":"H. H. Sears, K. Doolan, Denise D. Keenan","doi":"10.1097/JPO.0000000000000392","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000392","url":null,"abstract":"ABSTRACT Introduction Bilateral upper-limb loss (Bil UL Loss) is perhaps the greatest challenge for upper-limb prosthetic care, now even more than ever as we witness the increase of sepsis as a cause of limb loss. Methods This small-n survey has recruited 28 individuals with Bil UL Loss, 27 of whom are prosthesis wearers. Twelve of the 28 lost four limbs to sepsis; 17 of the 27 prosthesis wearers use body-powered hooks, six use electric hooks, and four use electric hands as their dominant terminal device (within this report, dominant side is the wearer's postloss dominant side, i.e., the side the subject used more frequently). The survey used person-to-person interviews to compile the broad data about how tasks are performed, how many tasks are performed, whether two prostheses are used, and other details. Results Users of each type of prosthesis demonstrate a high level of function. Electric hook users scored slightly higher in number of tasks and other measures. However, no outcomes were significant statistically, except the use of the dominant side prosthesis, which was three times higher than the nondominant side usage. Users identified a dozen categories for desired improvements, with greater dependability and greater grip security as the most commonly requested. Discussion The information will be useful for not only for clinical guidance, but hopefully also to help guide the development of future prosthetic devices, considering that the disabled community has called for prioritizing the actual needs and desires of the consumers to guide future developments. Conclusions The planning and execution of this small-scale study could be a model for other groups to collect useful outcomes data without requiring a research grant, without large institutional oversight, and by only a small group of interested professionals with access to a reasonable number of individuals with a severe disability. Clinical Relevance All caregivers of individuals with bilateral limb loss could benefit from both the data presented and the challenges revealed by this survey group. Future prosthetic designs as well as training and other therapies will also hopefully benefit from the needs expressed directly by these consumers.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"95 - 107"},"PeriodicalIF":0.6,"publicationDate":"2021-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46331690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-12DOI: 10.1097/JPO.0000000000000391
Temrah Okonski, M. Cabell
ABSTRACT Introduction This article describes the benefit of combining a thoracic lumbar sacral orthosis (TLSO) and a hip spica orthosis (HSO) to create a sitting frame for children with emerging neck and trunk control who cannot sit by themselves. Materials and Methods A child with motor disabilities who cannot sit independently benefits from a custom floor sitting frame. The sitting frame's thoracic lumbar sacral orthosis and hip spica orthosis are separate entities but are used together to allow a child to sit on the floor independently. Although the presented child does not need added head support, the TLSO-HSO sitting frame can be fabricated with cervical support. This sitting frame has a versatile joint allowing for movement between upright sitting and sitting with upper-limb weight bearing. The frame's hip joint can also be locked in different degrees of tilt. The described child uses the frame in a locked 90° upright position. Evaluation, fitting, fabrication, and reimbursement submission is explained. Conclusions Floor sitting is an important developmental milestone. Available equipment, such as floor sitters and compression garments intended to support a child in sitting, fail to sufficiently support all children with significant motor disabilities who have floor sitting goals. The TLSO-HSO sitting frame is a custom-made floor sitter that may give children with significant motor disabilities who have emerging neck and trunk control the support they need to independently sit on the floor. This orthosis has the potential to improve the lives of many children and their families as it can be used in both home and classroom settings and can give children with significant motor disabilities the opportunity to use their hands freely to play and to interact with peers during floor play time. Clinical Relevance Some children with severe motor disabilities cannot floor sit independently. The present study describes a new floor sitting frame that closes the gap between available products designed as these products do not meet the needs of all children with severe motor disabilities who have emerging neck and trunk control.
{"title":"New Orthosis: The Thoracic Lumbar Sacral–Hip Spica Orthotic Sitting Frame","authors":"Temrah Okonski, M. Cabell","doi":"10.1097/JPO.0000000000000391","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000391","url":null,"abstract":"ABSTRACT Introduction This article describes the benefit of combining a thoracic lumbar sacral orthosis (TLSO) and a hip spica orthosis (HSO) to create a sitting frame for children with emerging neck and trunk control who cannot sit by themselves. Materials and Methods A child with motor disabilities who cannot sit independently benefits from a custom floor sitting frame. The sitting frame's thoracic lumbar sacral orthosis and hip spica orthosis are separate entities but are used together to allow a child to sit on the floor independently. Although the presented child does not need added head support, the TLSO-HSO sitting frame can be fabricated with cervical support. This sitting frame has a versatile joint allowing for movement between upright sitting and sitting with upper-limb weight bearing. The frame's hip joint can also be locked in different degrees of tilt. The described child uses the frame in a locked 90° upright position. Evaluation, fitting, fabrication, and reimbursement submission is explained. Conclusions Floor sitting is an important developmental milestone. Available equipment, such as floor sitters and compression garments intended to support a child in sitting, fail to sufficiently support all children with significant motor disabilities who have floor sitting goals. The TLSO-HSO sitting frame is a custom-made floor sitter that may give children with significant motor disabilities who have emerging neck and trunk control the support they need to independently sit on the floor. This orthosis has the potential to improve the lives of many children and their families as it can be used in both home and classroom settings and can give children with significant motor disabilities the opportunity to use their hands freely to play and to interact with peers during floor play time. Clinical Relevance Some children with severe motor disabilities cannot floor sit independently. The present study describes a new floor sitting frame that closes the gap between available products designed as these products do not meet the needs of all children with severe motor disabilities who have emerging neck and trunk control.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"e18 - e23"},"PeriodicalIF":0.6,"publicationDate":"2021-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49219229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：