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Abstract
The human-prosthesis interface is one of the most complicated challenges facing the field of prosthetics, despite substantive investments in research and development by researchers and clinicians around the world. The journal of the International Society for Prosthetics and Orthotics, Prosthetics and Orthotics International, has contributed substantively to the growing body of knowledge on this topic. In celebrating the 50th anniversary of the International Society for Prosthetics and Orthotics, this narrative review aims to explore how human-prosthesis interfaces have changed over the last five decades; how research has contributed to an understanding of interface mechanics; how clinical practice has been informed as a result; and what might be potential future directions. Studies reporting on comparison, design, manufacturing and evaluation of lower limb prosthetic sockets, and osseointegration were considered. This review demonstrates that, over the last 50 years, clinical research has improved our understanding of socket designs and their effects; however, high-quality research is still needed. In particular, there have been advances in the development of volume and thermal control mechanisms with a few designs having the potential for clinical application. Similarly, advances in sensing technology, soft tissue quantification techniques, computing technology, and additive manufacturing are moving towards enabling automated, data-driven manufacturing of sockets. In people who are unable to use a prosthetic socket, osseointegration provides a functional solution not available 50 years ago. Furthermore, osseointegration has the potential to facilitate neuromuscular integration. Despite these advances, further improvement in mechanical features of implants, and infection control and prevention are needed.
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Affiliation(s)
- Reza Safari
- Health and Social Care Research Centre, University of Derby, Derby, UK
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Abstract
BACKGROUND The clinical utility of measuring pressure at the prosthetic socket-residual limb interface is currently unknown. OBJECTIVES This study aimed to identify whether measuring interface pressure during prosthetic design and fabrication results in closer agreement in pressure measurements between sockets made by different clinicians, and a reduction in pressure over areas of concern. It also investigated whether clinicians value knowing the interface pressure during the fabrication process. STUDY DESIGN Mixed methods. METHODS Three prosthetists designed a complete prosthetic system for a transtibial residual limb surrogate. Standardised mechanical testing was performed on each prosthetic system to gain pressure measurements at four key anatomical locations. These measurements were provided to the clinicians, who subsequently modified their sockets as each saw fit. The pressure at each location was re-measured. Each prosthetist completed a survey that evaluated the usefulness of knowing interface pressures during the fabrication process. RESULTS Feedback and subsequent socket modifications saw a reduction in the pressure measurements at three of the four anatomical locations. Furthermore, the pressure measurements between prosthetists converged. All three prosthetists found value in the pressure measurement system and felt they would use it clinically. CONCLUSIONS Results suggest that sensors measuring pressure at the socket-limb interface has clinical utility in the context of informing prosthetic socket design and fabrication. If the technology is used at the check socket stage, iterative designs with repeated measurements can result in increased consistency between clinicians for the same residual limb, and reductions in the magnitudes of pressures over specific anatomical landmarks. CLINICAL RELEVANCE This study provides new information on the value of pressure feedback to the prosthetic socket design process. It shows that with feedback, socket modifications can result in reduced limb pressures, and more consistent pressure distributions between prosthetists. It also justifies the use of pressure feedback in informing clinical decisions.
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Affiliation(s)
- Lucy Armitage
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
| | | | - Ginu Rajan
- School of Electrical, Computer and Telecommunications Engineering, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Gangadhara Prusty
- School of Mechanical and Manufacturing Engineering, UNSW Sydney, Sydney, NSW, Australia
| | - Anne Simmons
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
| | - Lauren Kark
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
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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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Laing S, Lee PVS, Lavranos J, Lythgo N. The functional, spatio-temporal and satisfaction outcomes of transtibial amputees with a hydrocast socket following an extended usage period in an under-resourced environment. Gait Posture 2018; 66:88-93. [PMID: 30170139 DOI: 10.1016/j.gaitpost.2018.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/05/2018] [Accepted: 08/20/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Transtibial hydrocast sockets have been shown to be a potential alternative to hand-cast patella-tendon bearing sockets, the use of which would have particular benefits in under-resourced environments. However, data concerning wearer outcomes of hard hydrocast sockets (i.e. those without silicone liners), especially over long-term usage periods, is scarce in the literature. RESEARCH QUESTIONS Are there any changes in wearer functional, spatio-temporal or satisfaction outcomes over a long usage period with a hydrocast socket? And how do the post-usage period outcomes compare with those from the wearers original prostheses? METHODS In this pre-post interventional study, the clinical outcomes of twenty-one experienced transtibial prostheses users were evaluated using widely-accepted and employed methods to assess wearer functional capacity, mobility, gait and satisfaction. The participants were fit with a hard hydrocast socket and the outcomes after an extensive usage period of 5 months were compared to the pre-usage period data following initial fitting and the data collected from the participants' original prosthetic limb. RESULTS Significant differences were found in the temporal parameters of gait, all indicating decreased reliance on the intact limb and an increased loading of the prosthetic limb with the post-usage period hydrocast socket compared to both the pre-usage period socket and the participants' original limbs. No differences in the functional capacity, mobility, spatial gait parameters or satisfaction were found between the socket conditions. SIGNIFICANCE This is the largest study to date of functional, spatio-temporal and satisfaction outcomes of hydrocast sockets following an extended usage period in an under-resourced environment.
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Affiliation(s)
- Sheridan Laing
- The Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter V S Lee
- The Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia.
| | - Jim Lavranos
- Department of Prosthetics and Orthotics, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Noel Lythgo
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
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Laing S, Lythgo N, Lavranos J, Lee PVS. Transtibial Prosthetic Socket Shape in a Developing Country: A study to compare initial outcomes in Pressure Cast hydrostatic and Patella Tendon Bearing designs. Gait Posture 2017; 58:363-368. [PMID: 28869901 DOI: 10.1016/j.gaitpost.2017.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 07/06/2017] [Accepted: 08/11/2017] [Indexed: 02/02/2023]
Abstract
This study compared the physical function and comfort level of patients with unilateral transtibial amputation after being fitted with a hand-cast Patella Tendon Bearing (PTB) socket and a pressure-cast (PCAST) hydrocast socket. The latter technique aims to reduce the skill dependency currently required for socket manufacture and fit. The study was conducted at the Vietnamese Training Centre for Orthopaedic Technologies and involved seventeen Vietnamese participants with unilateral transtibial amputation, all of whom were long term users of prosthetics. All participants were fitted with two sockets manufactured using both hand-cast and PCAST techniques with International Committee of the Red Cross components. Walking tests (timed up and go test and six-minute-walk-test), spatio-temporal gait analyses and subjective comfort assessments were completed after a short acclimatisation period with each socket. The participant-preferred socket was also noted. No significant differences were found for the measures of mobility, functional capacity, spatio-temporal gait parameters, gait symmetry, perceived comfort or participant socket preference. The results show the initial patient outcomes are similar when participants are fitted with a hand-cast PTB socket and a PCAST hydrocast sockets. Future work should confirm these findings in a longer trial.
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Affiliation(s)
- Sheridan Laing
- The Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Noel Lythgo
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Jim Lavranos
- Department of Prosthetics and Orthotics, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Peter Vee Sin Lee
- The Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia.
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Abstract
The manufacturing of limb prosthesis socket that is comfortable for the amputee depends greatly on prosthetic practitioner’s knowledge of socket biomechanics and skill. It involves multistage manual corrections depending upon the clinical condition of the patient’s residual limb which may be affected by shrinkage or possible damage of plaster of paris (PoP) mold. The current work describes a novel process simplified through digitization, it integrates conventional PoP processes, reverse engineering (RE), and additive manufacturing (AM) technologies to design and develop a socket. The stereolithography (STL) file generated from the scan data was modeled on a fused deposition modeling (FDM) based AM. Its fitment was assessed with the help of INSPECTPLUS and GEOMAGIC reverse engineering tools. This approach takes the guess work out of prosthetic practitioner’s job, ensures better fitment, and shortens the total fabrication time leading to improved patient satisfaction. The proposed method is a part of the ongoing research and it will offer maximum comfort on demand to the patients through digitization.
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Affiliation(s)
- Chitresh Nayak
- Department of Mechanical Engineering, Malaviya National Institute of Technology, Jaipur, India
| | - Amit Singh
- Department of Mechanical Engineering, Malaviya National Institute of Technology, Jaipur, India
| | - Himanshu Chaudhary
- Department of Mechanical Engineering, Malaviya National Institute of Technology, Jaipur, India
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Safari MR, Meier MR. Systematic review of effects of current transtibial prosthetic socket designs—Part 1: Qualitative outcomes. ACTA ACUST UNITED AC 2015; 52:491-508. [DOI: 10.1682/jrrd.2014.08.0183] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 04/23/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Mohammad Reza Safari
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Margrit Regula Meier
- Department for Occupational Therapy, Prosthetics, and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Safari MR, Rowe P, McFadyen A, Buis A. Hands-off and hands-on casting consistency of amputee below knee sockets using magnetic resonance imaging. ScientificWorldJournal 2013; 2013:486146. [PMID: 24348164 DOI: 10.1155/2013/486146] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 09/26/2013] [Indexed: 11/17/2022] Open
Abstract
Residual limb shape capturing (Casting) consistency has a great influence on the quality of socket fit. Magnetic Resonance Imaging was used to establish a reliable reference grid for intercast and intracast shape and volume consistency of two common casting methods, Hands-off and Hands-on. Residual limbs were cast for twelve people with a unilateral below knee amputation and scanned twice for each casting concept. Subsequently, all four volume images of each amputee were semiautomatically segmented and registered to a common coordinate system using the tibia and then the shape and volume differences were calculated. The results show that both casting methods have intra cast volume consistency and there is no significant volume difference between the two methods. Inter- and intracast mean volume differences were not clinically significant based on the volume of one sock criteria. Neither the Hands-off nor the Hands-on method resulted in a consistent residual limb shape as the coefficient of variation of shape differences was high. The resultant shape of the residual limb in the Hands-off casting was variable but the differences were not clinically significant. For the Hands-on casting, shape differences were equal to the maximum acceptable limit for a poor socket fit.
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Safari MR, Rowe P, Buis A. Accuracy verification of magnetic resonance imaging (MRI) technology for lower-limb prosthetic research: utilising animal soft tissue specimen and common socket casting materials. ScientificWorldJournal 2012; 2012:156186. [PMID: 22619599 PMCID: PMC3349102 DOI: 10.1100/2012/156186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 12/12/2011] [Indexed: 11/17/2022] Open
Abstract
Lower limb prosthetic socket shape and volume consistency can be quantified using MRI technology. Additionally, MRI images of the residual limb could be used as an input data for CAD-CAM technology and finite element studies. However, the accuracy of MRI when socket casting materials are used has to be defined. A number of six, 46 mm thick, cross-sections of an animal leg were used. Three specimens were wrapped with Plaster of Paris (POP) and the other three with commercially available silicone interface liner. Data was obtained by utilising MRI technology and then the segmented images compared to corresponding calliper measurement, photographic imaging, and water suspension techniques. The MRI measurement results were strongly correlated with actual diameter, surface area, and volume measurements. The results show that the selected scanning parameters and the semiautomatic segmentation method are adequate enough, considering the limit of clinical meaningful shape and volume fluctuation, for residual limb volume and the cross-sectional surface area measurements.
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Affiliation(s)
- Mohammad Reza Safari
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Manucharian SR. An Investigation of Comfort Level Trend Differences Between the Hands-On Patellar Tendon Bearing and Hands-Off Hydrocast Transtibial Prosthetic Sockets. ACTA ACUST UNITED AC 2011; 23:124-40. [DOI: 10.1097/jpo.0b013e3182248bf2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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