Journal of Prosthetics and Orthotics最新文献_第9页

Kinetic and Kinematics Parameters of Hip in Gait for a Congenital Longitudinal Tibial Deficiency with Orthoprosthesis and Transfemoral Prosthesis: A Case Study 矫形假体和经股假体治疗先天性纵向胫骨缺损患者步态中的髋关节动力学和运动学参数:一个案例研究

IF 0.6 Q4 ORTHOPEDICS

Journal of Prosthetics and Orthotics

Pub Date : 2021-08-20 DOI: 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).

摘要简介先天性胫骨纵缺是一种罕见的疾病。其特征是胫骨部分或完全缺失，腓骨相对完整。其标准治疗是手术和使用矫形假体或假体。然而，步态对假肢类型的影响却鲜为人知。方法对30岁男性左侧先天性1型胫骨偏瘫(归类为Jones型1B)缺乏症合并胸腰椎侧凸，肩关节凹陷，膝关节僵硬的患者进行矫形假体治疗。他决定截肢，佩戴由微处理器控制的膝关节组成的经股假体(TF)。结果术前、术后分别对矫形假体和TF假体进行三维步态分析和6分钟步行测试。此外，使用TF假体增加了髋关节屈伸和骨盆前后倾斜范围的运动度。使用TF假体影响髋关节屈伸力矩和髋关节动力参数的动力学结果。结论本病例研究表明新型假体具有可拆卸性和适应性强的特点;此外，由于它的新插座设计和膝关节弯曲，它提供了舒适的坐姿体验。临床意义使用TF假体患者满意度高于使用矫形假体患者。TF假体比矫形假体更美观，提供对称的步态模式，减少穿戴和脱下的持续时间，并且坐着时没有不舒服的突出(由于截肢了足部和腿部)。

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引用次数: 0

The Long-Term Wearing of Foot Orthoses Can Change the Frequency Domain of Ground Reaction Forces in Children with Flexible Flat Feet 长期佩戴足矫形器可改变柔性扁平足儿童地面反作用力的频域

IF 0.6 Q4 ORTHOPEDICS

Journal of Prosthetics and Orthotics

Pub Date : 2021-08-19 DOI: 10.1097/JPO.0000000000000386

A. Jafarnezhadgero, Seyed Hamed Musavi, Seyed Majid Alavi Mehr, Morteza Madadi-Shad

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.

摘要引言分析地面反作用力的频率含量可能有助于评估灵活扁平足儿童的步态异常。因此，本研究的目的是评估1）有扁平足和没有扁平足的儿童之间GRF频率含量的差异；以及2）长期佩戴足矫形器是否会改变扁平足儿童的GRF频率内容。材料和方法这是一个研究前后的设计。在基线时收集有和没有扁平足的男孩的GRF。扁平足男孩在4个月的时间里穿着特制的脚矫形器和独特的鞋子；扁平足组在4个月后也采集了GRF。当参与者在前测中穿着不带矫形器的鞋子，在后测中穿着带矫形剂的鞋子时，收集数据。在行走过程中，通过两个Kistler测力平台收集GRF（每条测力板用于每条腿）。多变量方差分析（MANOVA）检验和单独的2（侧：显性与非显性）×2（时间：前测与后测）ANOVA（重复测量）用于统计分析。结果与正常足组相比，扁平足组的垂直GRF频率较低（P=0.003；d=1.21；95%置信区间[CI]，7.12–7.59），非支配肢体的谐波16的垂直振幅较大（P=0.030；d=0.71；95%CI，0.0001–0.0022）。在前测和后测之间，优势肢体的GRF频率含量没有发现显著差异（P>0.05；d=0.01-039）。然而，对于非优势肢体，与前测相比，后测时垂直GRF频率内容（P<0.001；d=0.85；95%CI，6.21-7.36）减少。在非优势肢体中，前后GRF频率（功率为99.5%）在测试后比测试前显著增加（P=0.025；d=0.50；95%CI，13.30–16.20），三维GRF分量的振幅在测试后低于测试前（P<0.05；d=0.0.14-1.20；95%CI，-0.0005至-0.0083）。结论长期佩戴矫形器后，GRF频率含量和振幅较低。因此，长期佩戴足部矫形器可以改善扁平足儿童的功能。临床相关性建议临床医生使用足部矫形器来改善扁平足儿童的功能。

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引用次数: 2

The Effect of Spinal Orthoses on Immobilizing the Cervical Spine: A Systematic Review of Research Methodologies 脊柱矫形器对颈椎固定的影响:研究方法的系统回顾

IF 0.6 Q4 ORTHOPEDICS

Journal of Prosthetics and Orthotics

Pub Date : 2021-07-19 DOI: 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.

摘要:本文的目的是回顾关于使用矫形装置固定颈椎的效果的文献。这篇综述的重点是研究的方法，看看这是否可能是缺乏使用矫形器进行脊柱固定的可用临床指南的一个因素。方法本综述采用PRISMA指南(PLoS Med. 2009;6:e1000097)。该搜索于2019年8月在所有主要数据库中使用相关短语进行。没有日期限制，但搜索仅限于英文出版的全文。然后通过跟踪所确定的适当文章中的所有关键参考文献来补充这些搜索。根据优先级定义的标准选择文章。最初，提取的数据包括发表细节、矫形器名称和组、所研究的脊柱水平以及是否测量了颈椎活动范围。结果52篇文章符合纳入标准。本文讨论了纳入研究的方法。结论使用矫形器固定颈椎明显缺乏精心设计的研究。由于所涉及的参与者的类型和年龄(健康的、病理的、尸体的)以及所使用的不同测量技术，比较使用不同类型矫形器的研究结果很困难。这种标准化的缺乏阻碍了meta分析的进行，可能是缺乏可用临床指南的一个因素。需要一个商定的结构化方法来进行荟萃分析，并确定颈椎病理脊柱矫形器处方的临床指南。

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引用次数: 0

Mobility Analysis of AmpuTees (MAAT 6): Mobility, Satisfaction, and Quality of Life among Long-Term Dysvascular/Diabetic Prosthesis Users-Results of a Cross-Sectional Analysis. 截肢者的活动能力分析(MAAT 6):长期血管异常/糖尿病假体使用者的活动能力、满意度和生活质量——一项横断面分析的结果。

IF 0.6 Q4 ORTHOPEDICS

Journal of Prosthetics and Orthotics

Pub Date : 2021-07-01 Epub Date: 2020-02-20 DOI: 10.1097/JPO.0000000000000304

Shane R Wurdeman, Phillip M Stevens, James H Campbell

Objective: The aim of this study was to establish the mobility, satisfaction, and quality of life (QoL) among prosthesis users with dysvascular/diabetic amputation at both acute and long-term phases of prosthetic rehabilitation.

Methods: This is a multisite, cross-sectional outcomes analysis. A total of 341 individuals met the inclusion/exclusion criteria. Individuals were grouped into acute phases (0-3 months [n = 24], 4-6 months [n = 72]) and chronic phases (24-36 months [n = 91], 37-48 months [n = 53], 49-60 months [n = 47], and 60-84 months [n = 54]) after amputation. Mobility was measured with the Prosthetic Limb Users Survey of Mobility (PLUS-M), whereas QoL and satisfaction (Sat) were reported using 10-point scales adapted from the Prosthesis Evaluation Questionnaire-Well-Being (PEQ-WB). Composite PEQ-WB scores were also compared.

Results: The average mobility, QoL, and Sat among prosthesis users was, respectively, 44.8 ± 10.6, 7.6 ± 2.2, and 7.6 ± 2.2. There were no observed differences in mobility (F _5,330 = 1.52, P = 0.18), QoL (F _5,333 = 0.78, P = 0.57), or PEQ-WB (F _5,335 = 1.618, P = 0.155) between any groups. For Sat, there was a group difference (F _5,334 = 2.44, P = 0.03) as individuals appear to experience an initial increase in Sat with receipt of a prosthesis (0-3 months) compared with 25 to 36 months (P = 0.005), 49 to 60 months (P = 0.008), and 61 to 84 months (P = 0.009).

Conclusions: Those individuals with amputation secondary to dysvascular disease and diabetes who continue to participate in prosthetic rehabilitation appear to experience levels of mobility, Sat, and QoL 7 years after amputation comparable to that reported in the first 6 months postamputation. There may be a modest increase in Sat with receipt of an initial prosthesis, potentially due to an increased optimism for one's situation. Notably, the mobility levels observed in the dysvascular population through a range of long-term postamputation periods remain within a single standard deviation of the population mean for individuals with a lower-limb amputation using a prosthesis for mobility.

目的:本研究的目的是建立血管异常/糖尿病截肢患者在假肢康复的急性和长期阶段的活动能力、满意度和生活质量(QoL)。方法:这是一个多地点，横断面结果分析。共有341人符合纳入/排除标准。患者分为急性期(0 ~ 3个月[n = 24]、4 ~ 6个月[n = 72])和慢性期(24 ~ 36个月[n = 91]、37 ~ 48个月[n = 53]、49 ~ 60个月[n = 47]、60 ~ 84个月[n = 54])。使用假肢使用者活动能力调查(PLUS-M)测量活动能力，而使用假肢评估问卷-幸福感(PEQ-WB)的10分制来报告生活质量和满意度(Sat)。同时比较PEQ-WB综合评分。结果:义肢使用者的平均活动性为44.8±10.6，生活质量为7.6±2.2,Sat为7.6±2.2。两组间活动性(F 5,330 = 1.52, P = 0.18)、生活质量(F 5,333 = 0.78, P = 0.57)和PEQ-WB (F 5,335 = 1.618, P = 0.155)均无差异。对于Sat，存在组间差异(f5334 = 2.44, P = 0.03)，因为个体在接受假体(0-3个月)后，与25 - 36个月(P = 0.005)、49 - 60个月(P = 0.008)和61 - 84个月(P = 0.009)相比，Sat的初始增加出现在接受假体(0-3个月)时。结论:那些继发于血管异常疾病和糖尿病的截肢患者在截肢后7年继续参与假肢康复，其活动能力、Sat和生活质量水平与截肢后前6个月的报告相当。初次接受假体后，Sat可能会适度增加，这可能是由于对自己的情况更加乐观。值得注意的是，在截肢后一段时间内观察到的血管异常人群的活动水平与使用假肢进行下肢截肢的人群的平均水平相差一个标准差。

{"title":"Mobility Analysis of AmpuTees (MAAT 6): Mobility, Satisfaction, and Quality of Life among Long-Term Dysvascular/Diabetic Prosthesis Users-Results of a Cross-Sectional Analysis.","authors":"Shane R Wurdeman, Phillip M Stevens, James H Campbell","doi":"10.1097/JPO.0000000000000304","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000304","url":null,"abstract":"Objective: The aim of this study was to establish the mobility, satisfaction, and quality of life (QoL) among prosthesis users with dysvascular/diabetic amputation at both acute and long-term phases of prosthetic rehabilitation.Methods: This is a multisite, cross-sectional outcomes analysis. A total of 341 individuals met the inclusion/exclusion criteria. Individuals were grouped into acute phases (0-3 months [n = 24], 4-6 months [n = 72]) and chronic phases (24-36 months [n = 91], 37-48 months [n = 53], 49-60 months [n = 47], and 60-84 months [n = 54]) after amputation. Mobility was measured with the Prosthetic Limb Users Survey of Mobility (PLUS-M), whereas QoL and satisfaction (Sat) were reported using 10-point scales adapted from the Prosthesis Evaluation Questionnaire-Well-Being (PEQ-WB). Composite PEQ-WB scores were also compared.Results: The average mobility, QoL, and Sat among prosthesis users was, respectively, 44.8 ± 10.6, 7.6 ± 2.2, and 7.6 ± 2.2. There were no observed differences in mobility (F 5,330 = 1.52, P = 0.18), QoL (F 5,333 = 0.78, P = 0.57), or PEQ-WB (F 5,335 = 1.618, P = 0.155) between any groups. For Sat, there was a group difference (F 5,334 = 2.44, P = 0.03) as individuals appear to experience an initial increase in Sat with receipt of a prosthesis (0-3 months) compared with 25 to 36 months (P = 0.005), 49 to 60 months (P = 0.008), and 61 to 84 months (P = 0.009).Conclusions: Those individuals with amputation secondary to dysvascular disease and diabetes who continue to participate in prosthetic rehabilitation appear to experience levels of mobility, Sat, and QoL 7 years after amputation comparable to that reported in the first 6 months postamputation. There may be a modest increase in Sat with receipt of an initial prosthesis, potentially due to an increased optimism for one's situation. Notably, the mobility levels observed in the dysvascular population through a range of long-term postamputation periods remain within a single standard deviation of the population mean for individuals with a lower-limb amputation using a prosthesis for mobility.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"33 3","pages":"161-167"},"PeriodicalIF":0.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/f3/jp-33-161.PMC8216599.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39111471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 7

Quality of Life Evaluation Through a Single-Item “Daily Prosthesis Usage Time” in Individuals with Lower-Limb Amputation 通过单项“每日假肢使用时间”评估下肢截肢患者的生活质量

IF 0.6 Q4 ORTHOPEDICS

Journal of Prosthetics and Orthotics

Pub Date : 2021-06-29 DOI: 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.

摘要:本研究的目的是确定截肢患者每日义肢使用时间(DPUT)与生活质量(QoL)问卷的关系。方法对125例截肢患者进行研究。搜索假肢相关参数以及人口统计数据。使用了一份通用的(诺丁汉健康概况[NHP])问卷和一份针对截肢患者的问卷(Trinity截肢和义肢体验量表[TAPES])进行生活质量测量。结果男性91例，女性28例，平均年龄42.4±14.7岁。平均DPUT为11.1±4.4小时/d。研究结果表明，生活质量问卷(NHP和磁带)与DPUT均存在显著相关。DPUT与NHP总分、NHP- pain量表呈高度相关，DPUT与NHP- physical Activity量表呈高度相关。DPUT与nhp -能量水平、nhp -情绪反应、nhp -社会隔离和nhp -睡眠呈中度负相关。DPUT与tape - activity Restriction呈中度负相关。DPUT与残肢疼痛、义肢满意度、截肢后时间间隔和义肢安装数量之间存在高度相关。DPUT与助行器具之间存在中度相关性，而幻肢痛与DPUT之间的相关性较差。结论“平均DPUT”可用于截肢患者生活质量的短期评价。本研究结果指出，假肢相关参数尤其影响截肢患者的生活质量。在日常评估和问卷调查中出现的问题中，“平均DPUT”这一单项问题可以在较短的时间内有效地使用，并有助于组织康复计划。“平均每日义肢使用时间(DPUT)”这一单项问题可以有效地用于对截肢患者生活质量的短期评估，并有助于组织康复计划。

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引用次数: 0

Year-Long Use of Ankle-Foot Orthosis–Footwear Combination with Talar Flange Modification in an Adult Poststroke 踝足矫形器的一年使用——鞋与Talar Flange改良术在成人中风后的应用

IF 0.6 Q4 ORTHOPEDICS

Journal of Prosthetics and Orthotics

Pub Date : 2021-06-28 DOI: 10.1097/JPO.0000000000000375

D. McGovern, S. Fatone

ABSTRACT Introduction There are limited examples in the literature of detailed orthotic management related to triplanar control of the ankle-foot complex. The aim of this case report was to describe year-long use of an ankle-foot orthosis–footwear combination (AFO-FC) augmented with a talar flange that aimed to stabilize the subtalar joint during gait in an individual with poststroke hemiplegia who presented with both knee hyperextension and an unstable subtalar joint. Materials and Methods A 40-year-old woman 1-year poststroke with right hemiplegia presented with right equinovarus and knee hyperextension, with complaint of pain in the ankle and knee. Her right talocrural joint measured 15° plantarflexion with clinically significant inversion instability. Results A right solid AFO-FC, designed using published algorithms, was provided. In addition, a talar flange modification was incorporated to control subtalar inversion. During year-long use of the AFO-FC, the patient was able to return to community ambulation without pain. Successful orthotic intervention required that the device met not only biomechanical goals but also broader patient goals, which changed over time. Therapy with the device was also important for successful orthotic intervention. Conclusions This case illustrates use of a talar flange in an AFO-FC to provide triplanar control of the ankle-foot complex and improve gait in a person poststroke.

在文献中，关于踝关节-足部复合体的三平面控制的详细矫形管理的例子有限。本病例报告的目的是描述一年的使用踝足矫形器-鞋类组合(AFO-FC)与距骨凸缘增强，旨在稳定距下关节在步态中的个体卒中后偏瘫，表现为膝关节过伸和距下关节不稳定。材料与方法一名40岁女性，中风后1年右半瘫，表现为右马蹄内翻和膝关节过伸，主诉踝关节和膝关节疼痛。她的右距胫关节测量到15°跖屈，临床上明显的内翻不稳定。结果采用已发表的算法设计了右实体AFO-FC。此外，还采用距骨翼缘改良来控制距下内翻。在长达一年的AFO-FC使用期间，患者能够无疼痛地返回社区活动。成功的矫形干预要求设备不仅满足生物力学目标，而且满足更广泛的患者目标，这些目标随着时间的推移而改变。使用该装置的治疗对于成功的矫形干预也很重要。结论:本病例说明了在AFO-FC中使用距骨凸缘来提供踝关节-足复合体的三平面控制并改善中风后患者的步态。

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引用次数: 0

Use of a Knee Orthosis to Advance Motor Control in a 3-Year-Old with Achondroplasia: A Case Report 使用膝关节矫形器改善3岁软骨发育不全儿童运动控制:1例报告

IF 0.6 Q4 ORTHOPEDICS

Journal of Prosthetics and Orthotics

Pub Date : 2021-06-28 DOI: 10.1097/JPO.0000000000000377

J. Parent-Nichols, Deb Chamberlain

ABSTRACT Introduction Children with achondroplasia experience numerous impairments in body structure and function, including hypotonicity, weakness, joint laxity/hypermobility, skeletal malalignment, and delays in gross motor development. Atypical patterns of movement are often used to compensate for short limbs, weakness, laxity at the joints, and bony malalignment. As a result of these atypical patterns, pain and self-restricted movement frequently begin at a young age. Surgical interventions are the general recommendation to address progressive deformity and resultant pain. Lower-limb bracing to address alignment and motor control in children with other diagnoses that include hypotonia has had positive results, including improved alignment and gross motor skills, but has not been explored in children with achondroplasia. Materials and Methods A 3-year-old child with achondroplasia participated in an intervention using a neoprene knee orthosis with hyperextension resistance at the knee combined with a play-based, proprioceptive-intensive home exercise program. We hypothesized that the knee orthosis would increase proprioceptive input, improve alignment, and have a positive effect on gross motor skill acquisition and refinement. Early training may also have a positive impact on potential future pain and disability. Results Improvements in alignment and motor control were seen in this child after 12 weeks of this intervention but were not initially sustained. After an additional 6 weeks of intervention, significant progress was demonstrated in lower-limb alignment and motor control, as evidenced by independent use of proper movement patterns. Delay in gross motor skill was reduced from 27% to 22%. Discussion Motor skills training in proper alignment with aid of neoprene knee orthosis resulted in positive gains for a 3-year old with achondroplasia. Conclusion This intervention may be helpful for other children with achondroplasia who experience hypotonia, malalignment, and atypical movement patterns. Sufficient amounts of practice and intensity are recommended for permanent motor learning to occur.

软骨发育不全儿童会经历许多身体结构和功能的损伤，包括低张力、无力、关节松弛/过度活动、骨骼错位和大运动发育迟缓。非典型的运动模式通常用于补偿四肢短、虚弱、关节松弛和骨排列不齐。由于这些非典型的模式，疼痛和自我限制的运动经常在年轻时开始。手术干预是解决进行性畸形和由此产生的疼痛的一般建议。下肢支具用于治疗包括张力不足在内的其他诊断的儿童的下肢对齐和运动控制已经取得了积极的结果，包括改善对齐和大运动技能，但尚未在软骨发育不全儿童中进行探索。材料和方法一名患有软骨发育不全症的3岁儿童，采用膝关节超伸阻力的氯丁橡胶膝关节矫形器，并结合以游戏为基础的本体感觉强化家庭锻炼计划进行干预。我们假设膝关节矫形器会增加本体感觉输入，改善对齐，并对大运动技能的获得和改进有积极的影响。早期训练也可能对未来潜在的疼痛和残疾产生积极影响。结果在12周的干预后，这名儿童的对齐和运动控制得到了改善，但最初并没有持续。在额外的6周干预后，下肢对齐和运动控制方面取得了显著进展，独立使用适当的运动模式证明了这一点。大肌肉运动技能的延迟从27%减少到22%。在氯丁橡胶膝关节矫形器的辅助下进行运动技能训练，对一名患有软骨发育不全的3岁儿童产生了积极的影响。结论本方法对其他软骨发育不全的低张力、错位、不典型运动模式的患儿有一定的帮助。建议有足够的练习量和强度来实现永久性的运动学习。

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引用次数: 1

Impact of Level of Pediatric Amputation on Selection of Prosthetic Component Options 儿童截肢程度对假体组件选择的影响

IF 0.6 Q4 ORTHOPEDICS

Journal of Prosthetics and Orthotics

Pub Date : 2021-06-28 DOI: 10.1097/JPO.0000000000000374

A. Nemade, F. Miller, M. Thacker, Geovanny Oleas-Santillán, K. Rogers

ABSTRACT Introduction Amputation is one of the oldest surgeries known to the human race. The principles of amputation in children are different than in adults. Common indications for amputation include congenital, traumatic, infection, malignancy, vascular, and other pathology. Improper prosthetic fitting or inability to use the most modern available prosthesis can lead to dissatisfaction and compromised high-level function. The aim of this study was to assess residual limbs for compatibility to fit the most modern prosthetic components. Methods This study is a retrospective review of medical records of patients who underwent amputation between the pelvis and midfoot before 18 years of age. Age, sex, etiology, and level of amputation were recorded. A senior certified prosthetist graded the limbs based on limitations the residual limb imposed on options for the highest functioning modern prosthetic components. Results Sixty-one patients were identified (35 male, 26 female) with a mean age at assessment of 17.35 years (range, 1.86–35.35 years). Congenital causes and tumors were the most common etiology. Amputations around the ankle were most common (25), followed by transtibial (20). There were 59% grade 1 limbs with no restrictions to component options, 28% grade 2 with moderate restrictions, and 13% grade 3 or severely limited component options due to the residual limb. Most grade 1 residual limbs were transtibial or proximal. Amputations distal to transtibial were of all grades. Conclusions The choices for optimal high-level prosthetic components are much less limited for transtibial amputation than more distal amputations leading to potentially less high-level prosthetic function. Managing the residual limb length and prosthetic fitting ability is an important element in pediatric amputations if the goal is to fit mature young adults with the highest functioning level prosthetic components.

摘要截肢是人类已知的最古老的外科手术之一。儿童截肢的原则与成人不同。常见的截肢指征包括先天性、外伤性、感染、恶性肿瘤、血管和其他病理。假体安装不当或不能使用最先进的假体可导致不满意和高级功能受损。本研究的目的是评估残肢的兼容性，以适应最现代的假肢部件。方法回顾性分析18岁前骨盆至足中部截肢患者的医疗记录。记录患者的年龄、性别、病因及截肢程度。一位资深认证的义肢专家根据残肢对功能最高的现代义肢组件的选择所施加的限制对假肢进行了分级。结果共发现61例患者，男35例，女26例，平均年龄17.35岁(1.86 ~ 35.35岁)。先天性病因和肿瘤是最常见的病因。踝关节周围截肢最为常见(25例)，其次是胫骨(20例)。由于残肢，59%的1级肢体没有部件选择限制，28%的2级肢体有中度限制，13%的3级或严重限制部件选择。大多数1级残肢位于胫骨或近端。胫骨远端截肢是所有级别的。结论经胫骨截肢比远端截肢对高水平假体构件的选择限制更小，这可能导致高水平假体功能的降低。如果目标是为成熟的年轻人提供最高功能水平的假肢部件，那么管理残肢长度和假肢装配能力是儿科截肢的重要因素。

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引用次数: 0

Use of 3D Printing Technology for Cervical Thoracic Lumbosacral Orthosis Fabrication 3D打印技术在颈胸腰骶矫形器制作中的应用

IF 0.6 Q4 ORTHOPEDICS

Journal of Prosthetics and Orthotics

Pub Date : 2021-06-28 DOI: 10.1097/JPO.0000000000000379

Miranda L Yelvington, Gregory Armstrong, Ellen Mallard, Ankita Shukla, Eric Braden

ABSTRACT Introduction This case report describes orthotic design using computed tomography and three-dimensional printing technology combined with traditional orthotic modalities in a newborn patient with chondrodysplasia punctata and cervical spinal stenosis. At day 5 of life, the infant was referred for fitting with a prefabricated cervical collar. Because of the infant's unique stature and small size, traditional prefabricated devices could not be used. The spinal instability and critical nature of the infant prevented traditional methods of orthosis fabrication. A multidisciplinary team used imaging, 3D printing technology, and traditional orthosis fabrication methods to construct a cervical thoracic lumbosacral orthosis (CTLSO). Materials and Methods Using computed tomography scans, data-segmenting software, and a 3D printer, a life-sized model of the patient's upper body was constructed. Traditional plaster molding and high-temperature orthoplastic techniques were used to fabricate a custom cervical thoracic lumbosacral orthosis for spinal stabilization, necessary for safe patient transport and handling. Results The custom orthosis demonstrated proper fit and stability, as evidenced by postfitting scans. With orthosis in place, needed care could be provided to the patient more safely and efficiently. In addition, the infant could be held by the caregivers, increasing parental/infant bonding. Conclusions Technological advances, including the ability to use computer tomography scans in combination with three-dimensional printers, can be a safe and effective option in situations of difficult orthosis fabrication for medically fragile patients.

摘要简介本病例报告描述了一名患有点状软骨发育不良和颈椎管狭窄症的新生儿患者，采用计算机断层扫描和三维打印技术结合传统矫正方式进行矫正设计。在婴儿出生的第5天，婴儿被推荐佩戴预制的颈领。由于婴儿独特的身材和体型，传统的预制设备无法使用。婴儿的脊柱不稳定和关键性阻碍了传统的矫形器制造方法。一个多学科团队使用成像、3D打印技术和传统矫形器制造方法构建了颈胸腰骶矫形器（CTLSO）。材料和方法使用计算机断层扫描、数据分割软件和3D打印机，构建了患者上身的真人大小的模型。传统的石膏成型和高温矫形技术被用于制造定制的颈胸腰骶矫形器，用于脊柱稳定，这是安全运送和处理患者所必需的。结果定制矫形器显示出合适的贴合度和稳定性，如贴合后扫描所示。有了矫形器，可以更安全、更有效地为患者提供所需的护理。此外，婴儿可以由看护人抱着，增加父母/婴儿之间的联系。结论技术进步，包括将计算机断层扫描与三维打印机结合使用的能力，在医疗脆弱的患者难以制造矫形器的情况下是一种安全有效的选择。

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引用次数: 2

A Survey of Prosthetists' Perspectives on Adjustable-Volume Lower-Limb Prosthetic Sockets 假肢医师对可调节容量下肢假肢插座的看法综述

IF 0.6 Q4 ORTHOPEDICS

Journal of Prosthetics and Orthotics

Pub Date : 2021-06-16 DOI: 10.1097/JPO.0000000000000376

Emily A. Barr, Kelsey Ebbs, J. Wensman, A. Gutierrez, N. Rosenblatt, D. Gates

ABSTRACT Introduction Adjustable-volume prosthetic sockets have been available for many years to address residual limb volume changes, although little research has been conducted regarding their efficacy. As such, prosthetists are guided by patient preference, personal experience, and professional perception. The purpose of this study was to explore clinician perceptions and experiences fitting adjustable-volume prosthetic sockets. Materials and Methods An anonymous online survey was distributed to certified prosthetists. The survey contained questions about prosthetists' demographics, whether they had previously fit an adjustable-volume prosthetic socket, whether these fittings were successful, and what challenges they experienced. Those who had not previously fit adjustable sockets were asked what barriers had prevented them from doing so. Results A total of 221 certified prosthetists completed the survey. Of the 195 eligible respondents, 82% had experience in fitting adjustable prosthetic sockets. The most commonly fit socket styles were the RevoFit (n = 123), Socket-less (n = 67), and Infinite (n = 66) sockets. Prosthetists had varied success with the different socket styles, with the RevoFit being the most successful, and the Infinite and Socket-less sockets the least successful. Respondents most frequently noted increased bulk (93% of respondents; n = 181), complicated fabrication (72%; n = 141), and poor cosmesis (65%; n = 127) as challenges faced when fitting adjustable-volume sockets. Some respondents felt these sockets were a useful clinical tool; however, common themes regarding clinical perception of adjustable sockets included issues with cost/reimbursement and appropriateness for only a subset of the population of individuals with amputation only. Other respondents felt that adjustable sockets were either not adequate for clinical use or required improvements before their use would be beneficial. Conclusions There is no majority opinion regarding the benefits and challenges of adjustable sockets among prosthetists. In general, prosthetists feel that adjustable sockets can be used as one of the various tools to accommodate complicated lower-limb fittings. Additional work is needed to provide clinicians with a best practice guideline for providing adjustability within lower-limb sockets. Clinical Relevance The study showed that prosthetists feel that adjustable sockets can be one of the tools used for complicated lower-limb fittings. Additional work is needed to develop a best practice guideline for providing adjustability in lower-limb sockets.

摘要简介可调节体积的假肢插座已经问世多年，用于解决残肢体积的变化，尽管很少有人对其疗效进行研究。因此，假肢医生受患者偏好、个人经验和专业认知的指导。本研究的目的是探讨临床医生对安装可调节体积的假肢插座的看法和经验。材料和方法一项匿名的在线调查被分发给认证的假肢医生。该调查包含了关于假肢医生人口统计的问题，他们以前是否安装过可调节体积的假肢插座，这些安装是否成功，以及他们经历了什么挑战。那些以前没有安装可调节插座的人被问及是什么障碍阻止了他们这样做。结果共有221名认证的假肢医生完成了这项调查。在195名符合条件的受访者中，82%的人有安装可调节假肢插座的经验。最常见的插座类型是RevoFit（n=123）、无插座（n=67）和Infinite（n=66）插座。修复师在不同的插座样式上取得了不同的成功，RevoFit是最成功的，Infinite和socket less插座是最不成功的。受访者最常指出，体积增加（93%的受访者；n=181）、制造复杂（72%；n=141）和美容不良（65%；n=127）是安装可调节体积插座时面临的挑战。一些受访者认为这些插座是一种有用的临床工具；然而，关于可调节插座的临床认知的常见主题包括成本/报销问题以及仅适用于截肢患者的一小部分人群。其他受访者认为，可调节插座要么不适合临床使用，要么需要改进才能使用。结论对于可调节眼窝在假肢医师中的益处和挑战，没有多数意见。一般来说，假肢医生认为，可调节的插座可以作为各种工具之一，以适应复杂的下肢配件。还需要做更多的工作，为临床医生提供最佳实践指南，以提供下肢窝内的可调节性。临床相关性研究表明，假肢医生认为可调节插座可能是用于复杂下肢配件的工具之一。还需要做更多的工作来制定最佳实践指南，以提供下肢窝的可调节性。

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引用次数: 1