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Malaheem MS, Abd Razak NA, Abu Osman NA. A systematic review of methods used to assist transtibial prosthetic alignment decision-making. Prosthet Orthot Int 2024; 48:242-257. [PMID: 38018968 DOI: 10.1097/pxr.0000000000000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 09/28/2023] [Indexed: 11/30/2023]
Abstract
Prosthetic alignment is a highly subjective process that is still based on clinical judgments. Thus, researchers have aimed their effort to quantify prosthetic alignment by providing an objective method that can assist and guide prosthetists in achieving transtibial (TT) prosthetic alignment. This systematic review aimed to examine the current literature on TT prosthetic alignment to scope the qualitative and quantitative methods designed to guide prosthetists throughout the TT prosthetic alignment process as well as evaluate the reported instruments and devices that are used to align TT prostheses and their clinical feasibility. A literature search, completed in June 2022, was performed using the following databases: Web of Science (Clarivate), SCOPUS (Elsevier), and Pub Med (Medline) with searching terms focusing on TT, prosthesis, prosthetist, prosthetic alignment, and questionnaires, resulting in 2790 studies being screened. Twenty-four studies have used quantitative methodologies, where sensor technologies were found to be the most frequently proposed technology combined with gait analysis tools and/or subjective assessments. A qualitative method that assists prosthetists throughout the alignment process was not found. In this systematic review, we presented diverse methods for guiding and assisting clinical decision-making regarding TT prosthetic alignment. However, most of these methods considered varied parameters, and there is a need for elaboration toward standardized methods, which would improve the prosthetic alignment clinical outcome.
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Affiliation(s)
- Mohammad S Malaheem
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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Jonkergouw N, Prins MR, Donse D, van der Wurff P, van Dieën JH, Buis A, Houdijk H. Application of ultrasound to monitor in vivo residual bone movement within transtibial prosthetic sockets. Sci Rep 2024; 14:9725. [PMID: 38678076 PMCID: PMC11055853 DOI: 10.1038/s41598-024-60353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
Transtibial prosthetic users do often struggle to achieve an optimal prosthetic fit, leading to residual limb pain and stump-socket instability. Prosthetists face challenges in objectively assessing the impact of prosthetic adjustments on residual limb loading. Understanding the mechanical behaviour of the pseudo-joint formed by the residual bone and prosthesis may facilitate prosthetic adjustments and achieving optimal fit. This study aimed to assess the feasibility of using B-mode ultrasound to monitor in vivo residual bone movement within a transtibial prosthetic socket during different stepping tasks. Five transtibial prosthesis users participated, and ultrasound images were captured using a Samsung HM70A system during five dynamic conditions. Bone movement relative to the socket was quantified by tracking the bone contour using Adobe After-Effect. During the study a methodological adjustment was made to improve data quality, and the first two participants were excluded from analysis. The remaining three participants exhibited consistent range of motion, with a signal to noise ratio ranging from 1.12 to 2.59. Medial-lateral and anterior-posterior absolute range of motion varied between 0.03 to 0.88 cm and 0.14 to 0.87 cm, respectively. This study demonstrated that it is feasible to use B-mode ultrasound to monitor in vivo residual bone movement inside an intact prosthetic socket during stepping tasks.
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Affiliation(s)
- Niels Jonkergouw
- Department of Orthopaedic Technology, Military Rehabilitation Centre Aardenburg, Korte Molenweg 3, 3941 PW, Doorn, The Netherlands.
- Department of Human Movement Sciences, University Medical Centre Groningen, Groningen, The Netherlands.
| | - Maarten R Prins
- Department of Orthopaedic Technology, Military Rehabilitation Centre Aardenburg, Korte Molenweg 3, 3941 PW, Doorn, The Netherlands
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daniël Donse
- Department of Mechanical Engineering, TU Delft, Delft, The Netherlands
| | - Peter van der Wurff
- Department of Orthopaedic Technology, Military Rehabilitation Centre Aardenburg, Korte Molenweg 3, 3941 PW, Doorn, The Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arjan Buis
- Department of Biomedical Engineering, Strathclyde University, Scotland, UK
| | - Han Houdijk
- Department of Human Movement Sciences, University Medical Centre Groningen, Groningen, The Netherlands
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Yang X, Zhao R, Solav D, Yang X, Lee DR, Sparrman B, Fan Y, Herr H. Material, design, and fabrication of custom prosthetic liners for lower-extremity amputees: A review. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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A review of user needs to drive the development of lower limb prostheses. J Neuroeng Rehabil 2022; 19:119. [PMCID: PMC9636812 DOI: 10.1186/s12984-022-01097-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 10/25/2022] [Indexed: 11/08/2022] Open
Abstract
Abstract
Background
The development of bionic legs has seen substantial improvements in the past years but people with lower-limb amputation still suffer from impairments in mobility (e.g., altered balance and gait control) due to significant limitations of the contemporary prostheses. Approaching the problem from a human-centered perspective by focusing on user-specific needs can allow identifying critical improvements that can increase the quality of life. While there are several reviews of user needs regarding upper limb prostheses, a comprehensive summary of such needs for those affected by lower limb loss does not exist.
Methods
We have conducted a systematic review of the literature to extract important needs of the users of lower-limb prostheses. The review included 56 articles in which a need (desire, wish) was reported explicitly by the recruited people with lower limb amputation (N = 8149).
Results
An exhaustive list of user needs was collected and subdivided into functional, psychological, cognitive, ergonomics, and other domain. Where appropriate, we have also briefly discussed the developments in prosthetic devices that are related to or could have an impact on those needs. In summary, the users would like to lead an independent life and reintegrate into society by coming back to work and participating in social and leisure activities. Efficient, versatile, and stable gait, but also support to other activities (e.g., sit to stand), contribute to safety and confidence, while appearance and comfort are important for the body image. However, the relation between specific needs, objective measures of performance, and overall satisfaction and quality of life is still an open question.
Conclusions
Identifying user needs is a critical step for the development of new generation lower limb prostheses that aim to improve the quality of life of their users. However, this is not a simple task, as the needs interact with each other and depend on multiple factors (e.g., mobility level, age, gender), while evolving in time with the use of the device. Hence, novel assessment methods are required that can evaluate the impact of the system from a holistic perspective, capturing objective outcomes but also overall user experience and satisfaction in the relevant environment (daily life).
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Hashimoto H, Kobayashi T, Kataoka M, Okuda K. Angulation vs translation of transtibial prosthetic socket: their difference analyzed by socket reaction moments. Gait Posture 2022; 97:137-146. [PMID: 35952524 DOI: 10.1016/j.gaitpost.2022.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/22/2022] [Accepted: 06/30/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous studies investigated the effects of alignment changes in transtibial prostheses on socket reaction moments. However, the effects of angular and translational alignment changes with equal displacement between the foot and the socket were not directly compared. RESEARCH QUESTIONS What are the different effects of angular and translational alignment changes in transtibial prostheses? METHODS Ten individuals with transtibial prostheses participated in the measurement of temporo-spatial parameters, socket reaction moments, and their timings under nine alignment conditions (3° flexion/extension, anterior/posterior translation, 6° adduction/abduction, medial/lateral translation, and baseline). The displacement of the prosthetic feet was set to be equal between the angular and translational changes. RESULTS No significant changes in walking speed were found. Similar effects were observed in the magnitudes, but not in timing, of the moments under angular and translational changes in the sagittal plane (p < 0.01 for the differences in peak extension moment among anterior translation, baseline, and extension conditions, and in peak flexion moment among anterior translation, baseline, and extension conditions). In the coronal plane, similar effects were found in the magnitudes of the moments in the early stance (p < 0.01 at 5 %, 20 %, and 75 % stance). A significant difference in magnitude was observed in the late stance (p < 0.01 between adduction and medial translation conditions). SIGNIFICANCE The timing of the socket reaction moment may be different in the sagittal plane, while the magnitudes of the socket reaction moment in the late stance may be different in the coronal plane between the angular and translational alignment changes.
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Affiliation(s)
- Hiroshi Hashimoto
- Osaka Prefecture University, Habikino City, Osaka, Japan; Pacific Supply co. Ltd., Daito City, Osaka, Japan.
| | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Kuniharu Okuda
- Osaka Prefecture University, Habikino City, Osaka, Japan
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Hashimoto H, Kobayashi T, Kataoka M, Okuda K. Influence of coronal and sagittal prosthetic foot alignment on socket reaction moments in transtibial prostheses during walking. Gait Posture 2021; 90:252-260. [PMID: 34534864 DOI: 10.1016/j.gaitpost.2021.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The socket reaction moment (SRM) has been reported to change because of alignment changes in transtibial prosthetic sockets. However, the influence of prosthetic foot alignment on SRM remains unclear. RESEARCH QUESTION Are SRMs predictable from alignment changes of prosthetic feet? METHODS Ten users of transtibial prostheses participated in this study. Under five alignment conditions (3 ° plantarflexion and dorsiflexion, 6 ° inversion and eversion, and baseline alignment), temporal-spatial parameters and sagittal and coronal SRMs were measured during walking. Cadence, walking speed, step time, single support time, and step length were compared. The maximum/minimum SRM, % stance (timing) of the maximum/minimum SRM, Zero-cross, and SRMs at 5 %, 20 %, and 75 % stance were extracted and compared. Repeated measures analysis of variance or Friedman tests, and linear regression analyses were conducted for statistical analyses (i.e., alignment conditions as independent variables and SRM parameters as dependent variables). RESULTS The SRMs at 5%, 20 %, and 75 % stance showed significant differences under coronal angular changes. The minimum SRM, % stance of the minimum/maximum SRM, and Zero-cross showed significant differences under sagittal alignment changes. In linear regression analysis, the minimum SRM, % stance of the minimum/maximum SRM, SRM at 20 % stance, and Zero-cross were significant dependent variables in the sagittal plane. The maximum/minimum SRM, SRM at 20 % and 75 % stance, and % stance of the minimum SRM were significant dependent variables in the coronal plane. SIGNIFICANCE The results indicated that the changes in prosthetic feet angles may predict the magnitude of SRM (maximum/minimum SRM, SRM at 20 % and 75 % stance) in the coronal plane, and the timing of SRM (Zero-cross, % stance of the maximum/minimum SRM) in the sagittal plane. These findings suggest that the SRM may be useful for evaluating foot alignment in transtibial prostheses.
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Affiliation(s)
- Hiroshi Hashimoto
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino City, Osaka, Japan; Pacific Supply Co. Ltd., Daito City, Osaka, Japan.
| | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Masataka Kataoka
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino City, Osaka, Japan
| | - Kuniharu Okuda
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino City, Osaka, Japan
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Ko ST, Asplund F, Zeybek B. A Scoping Review of Pressure Measurements in Prosthetic Sockets of Transfemoral Amputees during Ambulation: Key Considerations for Sensor Design. SENSORS 2021; 21:s21155016. [PMID: 34372253 PMCID: PMC8347332 DOI: 10.3390/s21155016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 02/05/2023]
Abstract
Sensor systems to measure pressure at the stump–socket interface of transfemoral amputees are receiving increasing attention as they allow monitoring to evaluate patient comfort and socket fit. However, transfemoral amputees have many unique characteristics, and it is unclear whether existing research on sensor systems take these sufficiently into account or if it is conducted in ways likely to lead to substantial breakthroughs. This investigation addresses these concerns through a scoping review to profile research regarding sensors in transfemoral sockets with the aim of advancing and improving prosthetic socket design, comfort and fit for transfemoral amputees. Publications found from searching four scientific databases were screened, and 17 papers were found relating to the aim of this review. After quality assessment, 12 articles were finally selected for analysis. Three main contributions are provided: a de facto methodology for experimental studies on the implications of intra-socket pressure sensor use for transfemoral amputees; the suggestion that associated sensor design breakthroughs would be more likely if pressure sensors were developed in close combination with other types of sensors and in closer cooperation with those in possession of an in-depth domain knowledge in prosthetics; and that this research would be facilitated by increased interdisciplinary cooperation and open research data generation.
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Affiliation(s)
- Siu-Teing Ko
- Research and Innovation, Össur, 110 Reykjavík, Iceland
- Correspondence:
| | - Fredrik Asplund
- Department of Machine Design, KTH Royal Institute of Technology, 10044 Stockholm, Sweden;
| | - Begum Zeybek
- Healthcare Innovation Centre, School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK;
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Rajula VR, Springgate L, Haque A, Kamrunnahar M, Piazza SJ, Kaluf B. A Biomimetic Adapter for Passive Self-alignment of Prosthetic Feet. Mil Med 2021; 186:665-673. [PMID: 33499476 DOI: 10.1093/milmed/usaa230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/15/2020] [Accepted: 08/18/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Dynamic alignment of lower limb prostheses is subjective and time-consuming. Compensatory gait strategies caused by prosthesis misalignment can negatively affect lower limb amputees who cannot access a certified prosthetist for alignment adjustments. The objective of this study is to evaluate a novel six-degrees-of-freedom passive transtibial prosthetic adapter that self-aligns during various phases of gait. This self-aligning adapter may benefit service members and veterans stationed or living far from a clinical facility. METHODS Four transtibial amputee subjects, aged 47 to 62 (mean: 55.75) years with mean weight of 163.6 lbs and mean K-level of 3.25, walked at self-selected speeds on a 10-m level walkway. Subjects walked with the self-aligning and a size- or weight-matched control adapter, assembled to a commercially available energy-storing-and-returning foot and their own socket, with 22-mm alignment perturbations in the anterior, posterior, medial, or lateral directions. Subjects were blinded to both adapter type and misalignment. Socket moments, spatiotemporal gait parameters, and subjective socket comfort were recorded. RESULTS Preliminary results showed improvements in mean peak socket moments and step length differential with the self-aligning adapter across all alignments. Walking speed and prosthesis-side base of support showed little change in all configurations. Prosthesis-side stance duration and Functional Ambulation Profile Score increased with the self-aligning adapter in some alignments. Patient-reported socket comfort increased slightly with the self-aligning adapter across all misalignments. CONCLUSION Subjects maintained similar walking speeds and experienced greater gait symmetry and reduced sagittal plane peak moments with the self-aligning adapter when exposed to misalignments. These trends suggest a benefit to transtibial amputees from a reduction in secondary gait effects from prosthesis misalignments. Additionally, a wider range of acceptable prosthesis alignments may be possible with the self-aligning adapter. Subsequent trials are underway to evaluate the self-aligning adapter in real-world environments like walking on uneven terrains, stairs, ramps, and abrupt turns.
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Affiliation(s)
| | | | - Aman Haque
- Impulse Technology LLC., State College, PA 16803, USA
| | | | - Stephen J Piazza
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA
| | - Brian Kaluf
- Ability Prosthetics & Orthotics, Mechanicsburg, PA 17050, USA
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Shepherd MK, Simon AM, Zisk J, Hargrove LJ. Patient-Preferred Prosthetic Ankle-Foot Alignment for Ramps and Level-Ground Walking. IEEE Trans Neural Syst Rehabil Eng 2021; 29:52-59. [PMID: 33104504 PMCID: PMC8060022 DOI: 10.1109/tnsre.2020.3033711] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient preference of lower limb prosthesis behavior informally guides clinical decision making, and may become increasingly important for tuning new robotic prostheses. However, the processes for quantifying preference are still being developed, and the strengths and weaknesses of preference are not adequately understood. The present study sought to characterize the reliability (consistency) of patient preference of alignment during level-ground walking, and determine the patient-preferred ankle angle for ascent and descent of a 10° ramp, with implications for the design and control of robotic prostheses. Seven subjects with transtibial amputation walked over level ground, and ascended and descended a 10° ramp on a semi-active prosthetic ankle capable of unweighted repositioning in dorsiflexion and plantarflexion. Preferred ankle angle was measured with an adaptive forced-choice psychophysics paradigm, in which subjects walked on a randomized static ankle angle and reported whether they would prefer the ankle to be dorsiflexed or plantarflexed. Subjects had reliable preferences for alignment during level-ground walking, with deviations of 1.5° from preference resulting in an 84% response rate preferring changes toward the preference. Relative to level walking, subjects preferred 7.8° (SD: 4.8°) of dorsiflexion during ramp ascent, and 5.3° (SD: 3.8°) plantarflexion during ramp descent. As the ankle angle better matched the ramp angle, socket pressures and tibial progression (shank pitch) both more closely mirrored those during level walking. These findings provide baseline behaviors for prosthetic ankles capable of adapting to slopes based on patient preference, and provide strong evidence that people with transtibial amputation can finely perceive ankle alignment.
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Material properties and application of biomechanical principles provide significant motion control performance in experimental ankle foot orthosis-footwear combination. Clin Biomech (Bristol, Avon) 2021; 82:105285. [PMID: 33548768 DOI: 10.1016/j.clinbiomech.2021.105285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study, the first of its kind, originated with the need for a brace (an ankle foot orthosis), to constrain ankle plantarflexion and dorsiflexion within a motion threshold of <5°. A conventional thermoplastic, solid brace failed during a quasi-static loading study, informing the investigation and development of an experimental carbon composite brace, maximizing stiffness and proximity of shank and foot cylindrical shells to provide the required degree of control. METHODS Two experiments were conducted: a quasi-static loading study, using cadaveric limbs (n = 2), and a gait study with healthy subjects (n = 14). Conditions tested were STOP, FREE, and CONTROL. Data for all studies were collected using six motion-capture cameras (Vicon, Oxford, UK; 120 Hz) tracking bone-anchored markers (cadaveric limbs) and skin-anchored markers (subjects). In the quasi-static loading study, loading conditions were congruent with the gait study. Study 1 involved a quasi-static loading analysis using cadaveric limbs, compared motion data from a conventional thermoplastic solid brace and the experimental brace. Study 2 involved quantifying ankle plantarflexion and dorsiflexion in subjects during treadmill walking, in brace STOP, FREE, and CONTROL conditions. FINDINGS The experimental brace in STOP condition consistently constrained ankle plantarflexion and dorsiflexion below the motion threshold of <5°, across all studies. INTERPRETATION Collectively, these findings demonstrate (1) that a conventional thermoplastic, solid brace was ineffective for clinical applications that required significant motion control, and (2) that ankle motion control is most effective when considered as a relationship between the brace, the ankle-foot complex, and the external forces that affect them both.
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Suyi Yang E, Aslani N, McGarry A. Influences and trends of various shape-capture methods on outcomes in trans-tibial prosthetics: A systematic review. Prosthet Orthot Int 2019; 43:540-555. [PMID: 31364475 DOI: 10.1177/0309364619865424] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In trans-tibial prosthetics, shape-capture methods are employed to create a representation of the residuum. Shape-capture methods can be grouped into the categories of 'hands-on', 'hands-off' and computer-aided design. OBJECTIVE This review examines the influences and trends of shape-capture methods on the outcomes of quality, comfort of user and clinical efficiency, in the population of trans-tibial prosthesis users. STUDY DESIGN Systematic Review. METHOD Databases and relevant journals were searched. Participants included trans-tibial prosthetics users/limb models. Interventions included shape-capture methods. Outcomes included quality, comfort of user and clinical efficiency. RESULTS Overall, 22 papers were evaluated; 8 papers evaluated hands-on and hands-off methods, 2 evaluated computer-aided design and 12 evaluated measurement systems used with shape capture. No papers relating to clinical efficiency were found. CONCLUSION Overall evidence was weak in suggesting that effects on outcomes were due to the sole influences of shape capture. However, studies suggest that hands-on methods are dependent on a prosthetist's skill. Hands-off methods, although repeatable, might still require experience to attain a good fit. Computer-aided design studies were mostly done on theoretical models. Shape-capture measurements require more consistent 'gold standards'. The relation between socket fit and comfort is still unclear. Overall, more research is required in each area. CLINICAL RELEVANCE A good fitting prosthetic socket is crucial for efficient and comfortable use of a prosthesis. To attain the best chances of a good fit, it is important that the characteristics of the residuum are captured as accurately as possible during the initial "shape capture" stage. This paper attempts to categorize and evaluate the existing shape capture methods on their influence and trends on various outcomes - Quality of shape capture, comfort of user and clinical efficiency.
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Affiliation(s)
- Eddie Suyi Yang
- National Centre for Prosthetics and Orthotics, Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Navid Aslani
- National Centre for Prosthetics and Orthotics, Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Anthony McGarry
- National Centre for Prosthetics and Orthotics, Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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Hashimoto H, Kobayashi T, Gao F, Kataoka M, Okuda K. The effect of coronal prosthetic alignment changes on socket reaction moments, spatiotemporal parameters, and perception of alignment during gait in individuals with transtibial amputation. J Rehabil Assist Technol Eng 2019; 5:2055668318795402. [PMID: 31191953 PMCID: PMC6531796 DOI: 10.1177/2055668318795402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 07/24/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction The alignment of a prosthesis is clinically determined based on observations
by clinicians and the subjective perception of amputees during gait.
However, this process has been reported to be unreliable. Socket reaction
moment has been reported to be significantly impacted by alignment changes,
but the impact of these alignment changes on other gait parameters is
unclear. The aim of this study was to investigate the effects of coronal
alignment changes of a transtibial prosthesis on socket reaction moment,
spatiotemporal parameters, and perceptions of alignment during gait in
amputees. Methods Nine individuals with transtibial amputation participated in this study.
Socket reaction moment and spatiotemporal parameters (step time, step
length, step width, single limb support time, cadence, and gait speed) were
measured under nine coronal alignment conditions (angulation: ±3°, ±6°,
translation: ±5 mm, ±10 mm, and baseline) using a three-dimensional motion
capture system (Vicon) and an embedded load-cell system (Europa™). In
addition, subjective perceptions of alignment were examined. Results Coronal alignment changes of the transtibial prostheses demonstrated
significant changes in socket reaction moment; however, no significant
changes were found with spatiotemporal parameters or the amputee’s
perception. Conclusion Measurement of socket reaction moment, along with the embedded load-cell
system, may be a better metric for tuning the coronal alignment of
transtibial prostheses compared to spatiotemporal parameters and amputee’s
perceptions.
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Affiliation(s)
- Hiroshi Hashimoto
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino City, Osaka, Japan.,Pacific Supply Co. Ltd, Daito City, Osaka, Japan
| | - Toshiki Kobayashi
- Department of Prosthetics and Orthotics, Faculty of Health Science, Hokkaido University of Science, Sapporo, Hokkaido, Japan
| | - Fan Gao
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | - Masataka Kataoka
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino City, Osaka, Japan
| | - Kuniharu Okuda
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino City, Osaka, Japan
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Tafti N, Hemmati F, Safari R, Karimi MT, Farmani F, Khalaf A, Mardani MA. A systematic review of variables used to assess clinically acceptable alignment of unilateral transtibial amputees in the literature. Proc Inst Mech Eng H 2018; 232:826-840. [PMID: 30088444 DOI: 10.1177/0954411918789450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prosthetic alignment is a subjective concept which lacks reliability. The outcome responsiveness to prosthetic alignment quality could help to improve subjective and instrument assisted prosthetic alignment. This study was aimed to review variables used to assess clinically acceptable alignment in the literature. The search was done in some databases including: Google Scholar, PubMed, EBSCO, EMBASE, ISI Web of Knowledge and Scopus. The first selection criterion was based on abstracts and titles to address the research questions of interest. The American Academy of Orthotics and Prosthetics checklists were used for paper risk of bias assessment. A total of 25 studies were included in this study. Twenty-four studies revealed the critics of standing position or walking to locate clinically acceptable alignment, only one study measured outcomes in both situations. A total of 253 adults with transtibial amputations and mean age of 48.71 years participated in included studies. The confidence level of included studies was low to moderate, and before-after trial was the most common study design (n = 19). The joint angle, load line location with respect to joints and center of pressure-related parameters were reported as sensitive outcomes to prosthetic alignment quality in standing posture. The amount of forces at various parts of gait cycle and time of events were sensitive to prosthetic alignment quality during walking. Standing balance and posture and temporal parameters of walking could help to locate clinically acceptable alignment.
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Affiliation(s)
- Nahid Tafti
- 1 Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Hemmati
- 1 Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Reza Safari
- 2 Health and Social Care Research Centre, University of Derby, Derby, England
| | - Mohammad Taghi Karimi
- 3 Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzad Farmani
- 4 Department of Orthotics and Prosthetics, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Ali Khalaf
- 5 Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Ali Mardani
- 5 Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Paterno L, Ibrahimi M, Gruppioni E, Menciassi A, Ricotti L. Sockets for Limb Prostheses: A Review of Existing Technologies and Open Challenges. IEEE Trans Biomed Eng 2018; 65:1996-2010. [PMID: 29993506 DOI: 10.1109/tbme.2017.2775100] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the prosthetics field, one of the most important bottlenecks is still the human-machine interface, namely the socket. Indeed, a large number of amputees still rejects prostheses or points out a low satisfaction level, due to a sub-optimal interaction between the socket and the residual limb tissues. The aim of this paper is to describe the main parameters (displacements, stress, volume fluctuations and temperature) affecting the stump-socket interface and reducing the comfort/stability of limb prostheses. In this review, a classification of the different socket types proposed in the literature is reported, together with an analysis of advantages and disadvantages of the different solutions, from multiple viewpoints. The paper then describes the technological solutions available to face an altered distribution of stresses on the residual limb tissues, volume fluctuations affecting the stump overtime and temperature variations affecting the residual tissues within the socket. The open challenges in this research field are highlighted and the possible future routes are discussed, towards the ambitious objective of achieving an advanced socket able to self-adapt in real-time to the complex interplay of factors affecting the stump, during both static and dynamic tasks.
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