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Burnie L, Chockalingam N, Holder A, Claypole T, Kilduff L, Bezodis N. Testing protocols and measurement techniques when using pressure sensors for sport and health applications: A comparative review. Foot (Edinb) 2024; 59:102094. [PMID: 38579518 DOI: 10.1016/j.foot.2024.102094] [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: 02/16/2024] [Accepted: 03/24/2024] [Indexed: 04/07/2024]
Abstract
Plantar pressure measurement systems are routinely used in sports and health applications to assess locomotion. The purpose of this review is to describe and critically discuss: (a) applications of the pressure measurement systems in sport and healthcare, (b) testing protocols and considerations for clinical gait analysis, (c) clinical recommendations for interpreting plantar pressure data, (d) calibration procedures and their accuracy, and (e) the future of pressure sensor data analysis. Rigid pressure platforms are typically used to measure plantar pressures for the assessment of foot function during standing and walking, particularly when barefoot, and are the most accurate for measuring plantar pressures. For reliable data, two step protocol prior to contacting the pressure plate is recommended. In-shoe systems are most suitable for measuring plantar pressures in the field during daily living or dynamic sporting movements as they are often wireless and can measure multiple steps. They are the most suitable equipment to assess the effects of footwear and orthotics on plantar pressures. However, they typically have lower spatial resolution and sampling frequency than platform systems. Users of pressure measurement systems need to consider the suitability of the calibration procedures for their chosen application when selecting and using a pressure measurement system. For some applications, a bespoke calibration procedure is required to improve validity and reliability of the pressure measurement system. The testing machines that are commonly used for dynamic calibration of pressure measurement systems frequently have loading rates of less than even those found in walking, so the development of testing protocols that truly measure the loading rates found in many sporting movements are required. There is clear potential for AI techniques to assist in the analysis and interpretation of plantar pressure data to enable the more complete use of pressure system data in clinical diagnoses and monitoring.
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Affiliation(s)
- Louise Burnie
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK.
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2RU, UK
| | | | - Tim Claypole
- Welsh Centre for Printing and Coating (WCPC), Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Liam Kilduff
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Neil Bezodis
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
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Burnie L, Chockalingam N, Holder A, Claypole T, Kilduff L, Bezodis N. Commercially available pressure sensors for sport and health applications: A comparative review. Foot (Edinb) 2023; 56:102046. [PMID: 37597352 DOI: 10.1016/j.foot.2023.102046] [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: 07/14/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
Pressure measurement systems have numerous applications in healthcare and sport. The purpose of this review is to: (a) describe the brief history of the development of pressure sensors for clinical and sport applications, (b) discuss the design requirements for pressure measurement systems for different applications, (c) critique the suitability, reliability, and validity of commercial pressure measurement systems, and (d) suggest future directions for the development of pressure measurements systems in this area. Commercial pressure measurement systems generally use capacitive or resistive sensors, and typically capacitive sensors have been reported to be more valid and reliable than resistive sensors for prolonged use. It is important to acknowledge, however, that the selection of sensors is contingent upon the specific application requirements. Recent improvements in sensor and wireless technology and computational power have resulted in systems that have higher sensor density and sampling frequency with improved usability - thinner, lighter platforms, some of which are wireless, and reduced the obtrusiveness of in-shoe systems due to wireless data transmission and smaller data-logger and control units. Future developments of pressure sensors should focus on the design of systems that can measure or accurately predict shear stresses in conjunction with pressure, as it is thought the combination of both contributes to the development of pressure ulcers and diabetic plantar ulcers. The focus for the development of in-shoe pressure measurement systems is to minimise any potential interference to the patient or athlete, and to reduce power consumption of the wireless systems to improve the battery life, so these systems can be used to monitor daily activity. A potential solution to reduce the obtrusiveness of in-shoe systems include thin flexible pressure sensors which can be incorporated into socks. Although some experimental systems are available further work is needed to improve their validity and reliability.
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Affiliation(s)
- Louise Burnie
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK.
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2RU, UK
| | | | - Tim Claypole
- Welsh Centre for Printing and Coating (WCPC), Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Liam Kilduff
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Neil Bezodis
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
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Binedell T, Gupta U, Sithanathan B, Subburaj K, Blessing L. Mapping lines of non-extension in persons with lower limb amputation to aid comfort-driven prosthetic socket design. Med Eng Phys 2023; 118:104018. [PMID: 37536839 DOI: 10.1016/j.medengphy.2023.104018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/16/2023] [Accepted: 06/28/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE This study aimed to develop a new technique to map the strain field for persons with lower-limb amputations to use for the design of comfortable prostheses. METHODS Using a DSLR camera with stenciled 2D markers, we demonstrated a technique to measure skin strain around the residual limb of persons with lower limb amputations. We used open-source software programs to reconstruct a series of cloud points derived from the pictures of the marked residual limb into 3D models, then calculated the minimum, maximum, and non-extension lines from directional strain fields. RESULTS A DSLR camera was successful in capturing 2D markers. The maximum mean principal strain was 68% ± 14%, observed around the patella. The minimum compressive mean principal strain of -31% ± 4% was observed posteriorly in the popliteal region of the knee. Although lines of non-extension (LoNE) appear separate in different participants, they are anatomically located in regions that could be generalized for the design of prostheses. CONCLUSIONS Marker locations extracted from the video of different poses can be compared to calculate strains from which the position of LoNE can be generated. The use of LoNE could be valuable in reducing discomfort at the socket interface and informing future socket design.
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Affiliation(s)
- Trevor Binedell
- Tan Tock Seng Hospital, Singapore; Singapore University of Technology and Design, Engineering Product Development, Singapore.
| | - Ujjaval Gupta
- Singapore University of Technology and Design, Digital Manufacturing and Design Centre, Singapore
| | | | | | - Lucienne Blessing
- Singapore University of Technology and Design, Engineering Product Development, Singapore
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Young PR, Hebert JS, Marasco PD, Carey JP, Schofield JS. Advances in the measurement of prosthetic socket interface mechanics: a review of technology, techniques, and a 20-year update. Expert Rev Med Devices 2023; 20:729-739. [PMID: 37537898 PMCID: PMC10581694 DOI: 10.1080/17434440.2023.2244418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION A key determinant of prosthesis use is the quality of fit of the prosthetic socket. The socket surrounds the residual limb and applies the appropriate force distribution to the soft tissues to maintain suspension, support, and stabilization as well as translate limb movement to prosthesis movement. The challenge in socket fabrication lays in achieving geometry that provides the appropriate force distribution at physiologically appropriate locations; a task dependent on the understanding of interface tissue-mechanics. AREAS COVERED In the last 20 years substantial advancements in sensor innovation and computational power have allowed researchers to quantify the socket-residual limb interface; this paper reviews prominent measurement and sensing techniques described in literature over this time frame. Advantages and short comings of each technique are discussed with a focus on translation to clinical environments. EXPERT OPINION Prosthetic sockets directly influence comfort, device use, user satisfaction, and tissue health. Advancements in instrumentation technology have unlocked the possibility of sophisticated measurement systems providing quantitative data that may work in tandem with a clinician's heuristic expertise during socket fabrication. If validated, many of the emerging sensing technologies could be implemented into a clinical setting to better characterize how patients interact with their device and help inform prosthesis fabrication and assessment techniques.
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Affiliation(s)
- Peyton R Young
- Department of Mechanical and Aerospace Engineering, UC Davis, One Shields Ave., Davis, CA 95616
| | - Jacqueline S. Hebert
- Faculty of Medicine & Dentistry, Division of Physical Medicine & Rehabilitation, University of Alberta, 5005 Katz building, Edmonton, Alberta, Canada, T5G 0B7
- Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue, Edmonton, Alberta, Canada, T5G 0B7
| | - Paul D. Marasco
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid, Avenue ND20, Cleveland, OH 44195
| | - Jason P. Carey
- Faculty of Engineering, Deans Office, University of Alberta, 10-203 Donadeo Innovation Centre for Engineering, Edmonton, Alberta, Canada, T6G 2G8
| | - Jonathon S. Schofield
- Department of Mechanical and Aerospace Engineering, UC Davis, One Shields Ave., Davis, CA 95616
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Tang J, Jiang L, McGrath M, Bader D, Laszczak P, Moser D, Zahedi S. Analysis of lower limb prosthetic socket interface based on stress and motion measurements. Proc Inst Mech Eng H 2022; 236:1349-1356. [PMID: 35821656 PMCID: PMC9449444 DOI: 10.1177/09544119221110712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study was designed to establish a biomechanical assessment platform for the
lower limb residuum/socket interface as a function of duration and speed of
movement. The approach exploits an interface sensor which measures
multi-directional stresses at the interface. The corresponding interface
coupling motion was assessed using a 3D motion capture system. A longitudinal
study, involving a trans-femoral amputee, was conducted with nine repeated level
walking sessions over a 12-month period. The effect of walking speed on
interface biomechanics was also assessed. Interface peak pressures and shear
stresses in the range of 55–59 kPa and 12–19 kPa were measured, respectively,
over all sessions in the 12 months study period at the posterior-proximal
location of the residuum. The peak pressure and longitudinal shear values were
found to fluctuate approximately 11% and 40% as against its maximum value,
respectively, over 12 months. In addition, up to 12° of angular coupling and up
to 28 mm of pistoning were recorded over a gait cycle, which was found to change
by 29% and 45% respectively over the study period. The variation in walking
speed, by altering self-selected cadence, resulted in changes of pressure and
shear stresses at mid-stance of the gait cycle. In particular, as compared with
self-selected cadence, for fast speed, peak pressure and peak longitudinal shear
stress decreased by 5% and 33%, respectively. For slow speed, peak pressure and
peak longitudinal shear stress increased by 7% and 17%, respectively. The
corresponding angular and pistoning revealed a variation of up to 29% and 45%,
respectively. This biomechanical assessment approach shows promise in the
quantitative assessment of interface kinematics and kinetics for lower limb
prosthetics, the usage of which could assist the clinical assessment of
prosthetic socket fit.
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Affiliation(s)
- Jinghua Tang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Liudi Jiang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Michael McGrath
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
- Blatchford Products Ltd., Basingstoke, UK
| | - Dan Bader
- Skin Health Research Group, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Piotr Laszczak
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - David Moser
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
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Binedell T, Ghazali MFB, Wong C, Subburaj K, Blessing L. Measuring discomfort-An objective method for quantifying peak pressure discomfort and improved fit in adults with transtibial amputation. PM R 2022; 15:482-492. [PMID: 35233956 DOI: 10.1002/pmrj.12796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 02/07/2022] [Accepted: 02/23/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prosthetic socket coupling with the residual limb should be comfortable without causing skin breakdown or excessive pressure. However, users report socket discomfort, and there is a scarcity of objective measurements available to assess this feeling of discomfort. Quantifying the specific pressure may enable clinicians and users to determine and improve comfort levels objectively. OBJECTIVES (1) To evaluate if a peak pressure reduction assists in resolving wounds, redness, and pain inside prosthetic sockets in people with transtibial amputation. (2) To determine if peak pressures measured inside the prosthetic socket due to external forces could be used to quantify the level of improvement in socket discomfort. DESIGN In this cohort study, we used a pressure sensor to quantify and facilitate adjustments to the prosthetic socket, correlating this information to the user's socket comfort. SETTING Outpatient clinic in a tertiary hospital in Singapore. PARTICIPANTS People (N = 16) with unilateral transtibial lower limb amputation using a prosthesis. INTERVENTIONS NA. MAIN OUTCOME MEASURES Peak pressure and socket comfort score (SCS). RESULTS The peak pressure value showed a statistically significant reduction across all participants following adjustments at a 50% delta change in pressure (p = .001). This was achieved with a mean number of 2.6 ± 1.4 adjustments per participant. Following the adjustments, the paired t-test results showed a mean increase between the first SCS and final SCS was 2.6 (p = .001). CONCLUSION The wound, redness, and pain resolved in 15 of 16 participants regardless of diabetic status following socket adjustments. Although the peak pressures values did not correlate to the SCS score, the reduction in peak pressure saw significant improvement to the SCS. The use of a portable sensor is a fast and efficient means to quantify adjustments inside the prosthetic socket and could potentially be considered as part of future care delivery.
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Affiliation(s)
- Trevor Binedell
- Prosthetics and Orthotics Department, Tan Tock Seng Hospital, Singapore, Singapore.,Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore.,SUTD-MIT International Design Centre, Singapore University of Technology and Design, Singapore, Singapore
| | | | - Clara Wong
- Prosthetics and Orthotics Department, Tan Tock Seng Hospital, Singapore, Singapore
| | - Karupppasamy Subburaj
- Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore
| | - Lucienne Blessing
- Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore.,SUTD-MIT International Design Centre, Singapore University of Technology and Design, Singapore, Singapore
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Kang NV, Woollard A, Michno DA, Al-Ajam Y, Tan J, Hansen E. A consecutive series of targeted muscle reinnervation (TMR) cases for relief of neuroma and phantom limb pain: UK perspective. J Plast Reconstr Aesthet Surg 2021; 75:960-969. [PMID: 34840118 DOI: 10.1016/j.bjps.2021.09.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/12/2021] [Accepted: 09/27/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Studies have suggested that targeted muscle reinnervation (TMR) can improve symptoms of neuroma pain (NP) and phantom limb pain (PLP) in patients. OBJECTIVES Our primary objective was to measure changes in NP and PLP levels following TMR surgery at 4-time points (baseline, 3, 6- and 12-months postoperatively). Secondary aims included identification of the character and rate of any surgical complications and patients' satisfaction with TMR. METHODS A retrospective review of outcomes of 36 patients who underwent TMR surgery to treat intractable NP and/or PLP after major amputation of an upper (UL) or lower limb (LL) at a single centre in London, UK over 7 years. The surgical techniques, complications, and satisfaction with TMR are described. RESULTS Forty TMR procedures were performed on 36 patients. Thirty patients had complete data for NP and PLP levels at all pre-defined time points. Significant improvements (p<0.01) in both types of pain were observed for both upper and LL amputees. However, there were varying patterns of recovery. For example, UL amputees experienced worsening of PLP in the first few months post-operatively whereas surgical complications were more common in LL cases. Patients were overwhelmingly satisfied with the improvements in their symptoms (90%). CONCLUSIONS TMR surgery appeared to relieve both NP and PLP although the retrospective nature of this study limits the strength of this conclusion. However, complication rates were high, and it is crucial for surgeons and patients to fully understand the course and outcomes of this novel surgery prior to undertaking treatment.
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Affiliation(s)
- Norbert Venantius Kang
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, Pond Street, London NW3 2QG, United Kingdom.
| | - Alexander Woollard
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, Pond Street, London NW3 2QG, United Kingdom
| | - Dominika Antonina Michno
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, Pond Street, London NW3 2QG, United Kingdom
| | - Yazan Al-Ajam
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, Pond Street, London NW3 2QG, United Kingdom
| | - Jaclyn Tan
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, Pond Street, London NW3 2QG, United Kingdom
| | - Esther Hansen
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, Pond Street, London NW3 2QG, United Kingdom
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Petkovšek-Gregorin R. Razjede in njihovo celjenje pri pacientih po amputaciji. OBZORNIK ZDRAVSTVENE NEGE 2021. [DOI: 10.14528/snr.2021.55.2.2987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Najpogostejši vzroki, ki vplivajo na celjenje razjed pri pacientih po amputaciji, so periferna arterijska bolezen, sladkorna bolezen in kronična venska insuficienca. Namen raziskave je bil prepoznati dejavnike, ki lahko vplivajo na celjenje razjede na amputacijskem krnu.Metode: Uporabljena je bila kvantitativna neeksperimentalna raziskovalna metodologija. Izvedena je bila retrospektivna raziskava s pregledom negovalne dokumentacije o spremljanju razjede. V raziskavo je bilo vključenih 134 pacientov po amputaciji spodnjega uda z razjedo, hospitaliziranih v letu 2017. Uporabljeni sta bili opisna statistika in logistična regresija.Rezultati: Razjedo, nastalo zaradi različnih vzrokov, je imelo 134 pacientov. Ženske imajo v primerjavi v moškimi več možnosti za prisotnost razjede ob odpustu (RO = 4,8, 95 % IZ: 1–22), prav tako pacienti, ki so imeli razjedo že ob sprejemu (RO = 7,7, 95 % IZ: 3–19,2), in tisti z več kot eno razjedo (RO = 4,7, 95 % IZ: 1–22,3). Pri pacientih, ki imajo razjedo na amputacijskem krnu, imajo večjo možnost, da se bo ta do konca rehabilitacije zacelila (RO = 0,2, 95 % IZ: 0,1–0,6 p = 0,004).Diskusija in zaključek: Ugotovitve nakazujejo, da je pri ženskah večja verjetnost, da razjeda ob odpustu ne bo zaceljena, kot pri pacientih, pri katerih je bila razjeda prisotna že ob sprejemu, in pri tistih, ki imajo več razjed. Treba bi bilo izvesti raziskavo, ki bi zajela večje število pacientov. Prav tako bi bilo treba natančneje določiti parametre spremljanja.
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9
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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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10
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Chronic prosthesis-related residual limb ulcer treated with autologous micro-fragmented adipose tissue. Regen Ther 2021; 18:21-23. [PMID: 33778135 PMCID: PMC7985278 DOI: 10.1016/j.reth.2021.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/21/2021] [Indexed: 11/23/2022] Open
Abstract
A 56-year-old male with a past medical history significant for a left below-knee amputation and a left total knee replacement presented with knee pain at a non-healing stage 2 prosthesis-related residual limb ulcer. The ulcer at the weight-bearing surface at the anterior patella had not closed despite three years of conservative management; including offloading and wound clinic follow up. To assist with the healing process, the ulcer was treated with autologous micro-fragmented adipose tissue therapy. He was injected with 8 mLs of minimally manipulated adipose tissue (Lipogems) underneath the ulcer. Upon the four-week follow-up, his pain had resolved, and the wound was significantly reduced in size with new skin appearing. The goal of this case report is to examine if autologous micro-fragmented adipose tissue can represent a feasible and safe treatment option for chronic prosthesis-related residual limb ulcers. To our knowledge, this is the first reported case using micro-fragmented adipose therapy to treat a chronic prosthesis-related residual limb ulcer.
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11
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Robertson AD, Chiaramonti AM, Nguyen TP, Jaffe DE, Holmes RE, Hanna EL, Rhee JG, Barfield WR, Fourney WB, Stains JP, Pellegrini VD. Failure of Indomethacin and Radiation to Prevent Blast-induced Heterotopic Ossification in a Sprague-Dawley Rat Model. Clin Orthop Relat Res 2019; 477:644-654. [PMID: 30601320 PMCID: PMC6382204 DOI: 10.1097/corr.0000000000000594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 11/13/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although use of nonsteroidal antiinflammatory drugs and low-dose irradiation has demonstrated efficacy in preventing heterotopic ossification (HO) after THA and surgical treatment of acetabular fractures, these modalities have not been assessed after traumatic blast amputations where HO is a common complication that can arise in the residual limb. QUESTIONS/PURPOSES The purpose of this study was to investigate the effectiveness of indomethacin and irradiation in preventing HO induced by high-energy blast trauma in a rat model. METHODS Thirty-six Sprague-Dawley rats underwent hind limb blast amputation with a submerged explosive under water followed by irrigation and primary wound closure. One group (n = 12) received oral indomethacin for 10 days starting on postoperative Day 1. Another group (n = 12) received a single dose of 8 Gy irradiation to the residual limb on postoperative Day 3. A control group (n = 12) did not receive either. Wound healing and clinical course were monitored in all animals until euthanasia at 24 weeks. Serial radiographs were taken immediately postoperatively, at 10 days, and every 4 weeks thereafter to monitor the time course of ectopic bone formation until euthanasia. Five independent graders evaluated the 24-week radiographs to quantitatively assess severity and qualitatively assess the pattern of HO using a modified Potter scale from 0 to 3. Assessment of grading reproducibility yielded a Fleiss statistic of 0.41 and 0.37 for severity and type, respectively. By extrapolation from human clinical trials, a minimum clinically important difference in HO severity was empirically determined to be two full grades or progression of absolute grade to the most severe. RESULTS We found no differences in mean HO severity scores among the three study groups (indomethacin 0.90 ± 0.46 [95% confidence interval {CI}, 0.60-1.19]; radiation 1.34 ± 0.59 [95% CI, 0.95-1.74]; control 0.95 ± 0.55 [95% CI, 0.60-1.30]; p = 0.100). For qualitative HO type scores, the radiation group had a higher HO type than both indomethacin and controls, but indomethacin was no different than controls (indomethacin 1.08 ± 0.66 [95% CI, 0.67-1.50]; radiation 1.89 ± 0.76 [95% CI, 1.38-2.40]; control 1.10 ± 0.62 [95% CI, 0.70-1.50]; p = 0.013). The lower bound of the 95% CI on mean severity in the indomethacin group and the upper bound of the radiation group barely spanned a full grade and involved only numeric grades < 2, suggesting that even if a small difference in severity could be detected, it would be less than our a priori-defined minimum clinically important difference and any differences that might be present are unlikely to be clinically meaningful. CONCLUSIONS This work unexpectedly demonstrated that, compared with controls, indomethacin and irradiation provide no effective prophylaxis against HO in the residual limb after high-energy blast amputation in a rat model. Such an observation is contrary to the civilian experience and may be potentially explained by either a different pathogenesis for blast-induced HO or a stimulus that overwhelms conventional regimens used to prevent HO in the civilian population. CLINICAL RELEVANCE HO in the residual limb after high-energy traumatic blast amputation will likely require novel approaches for prevention and management.
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Affiliation(s)
- Astor D Robertson
- A. D. Robertson, T. P. Nguyen, D. E. Jaffe, J. P. Stains, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA A. M. Chiaramonti, R. E. Holmes, E. L. Hanna, W. R. Barfield, V. D. Pellegrini, Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA J. G. Rhee, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA W. B. Fourney, Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
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12
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Rink C, Wernke MM, Powell HM, Gynawali S, Schroeder RM, Kim JY, Denune JA, Gordillo GM, Colvin JM, Sen CK. Elevated vacuum suspension preserves residual-limb skin health in people with lower-limb amputation: Randomized clinical trial. ACTA ACUST UNITED AC 2018; 53:1121-1132. [PMID: 28355039 DOI: 10.1682/jrrd.2015.07.0145] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 04/13/2016] [Indexed: 11/05/2022]
Abstract
A growing number of clinical trials and case reports support qualitative claims that use of an elevated vacuum suspension (EVS) prosthesis improves residual-limb health on the basis of self-reported questionnaires, clinical outcomes scales, and wound closure studies. Here, we report first efforts to quantitatively assess residual-limb circulation in response to EVS. Residual-limb skin health and perfusion of people with lower-limb amputation (N = 10) were assessed during a randomized crossover study comparing EVS with nonelevated vacuum suspension (control) over a 32 wk period using noninvasive probes (transepidermal water loss, laser speckle imaging, transcutaneous oxygen measurement) and functional hyperspectral imaging approaches. Regardless of the suspension system, prosthesis donning decreased perfusion in the residual limb under resting conditions. After 16 wk of use, EVS improved residual-limb oxygenation during treadmill walking. Likewise, prosthesis-induced reactive hyperemia was attenuated with EVS following 16 wk of use. Skin barrier function was preserved with EVS but disrupted after control socket use. Taken together, outcomes suggest chronic EVS use improves perfusion and preserves skin barrier function in people with lower-limb amputation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; "Evaluation of limb health associated with a prosthetic vacuum socket system": NCT01839123; https://clinicaltrials.gov/ct2/show/NCT01839123?term=NCT01839123&rank=1.
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Affiliation(s)
- Cameron Rink
- Department of Surgery, Comprehensive Wound Center, and Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Heather M Powell
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH
| | - Surya Gynawali
- Department of Surgery, Comprehensive Wound Center, and Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Jayne Y Kim
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH
| | | | - Gayle M Gordillo
- Department of Surgery, Comprehensive Wound Center, and Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH.,Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Chandan K Sen
- Department of Surgery, Comprehensive Wound Center, and Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
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Abstract
Prostheses form an essential part of participation in sport and physical activity for athletes with lower or upper limb amputation. These prostheses come in the form of everyday nonsport-specific prostheses, as well as sport-specific prostheses designed to enable participation in specific sports. Sport-specific prostheses are designed to the requirements of the sport to facilitate the achievement of peak performance without causing significant risk of injury. This article addresses the various factors associated with participation in sport and physical activity for individuals with amputation, including the various prostheses for upper and lower limbs and prostheses for different sports.
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Affiliation(s)
- Lara Grobler
- Institute of Sport and Exercise Medicine, Faculty of Health and Medical Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa; Department of Sport Science, Faculty of Education, Stellenbosch University, Suidwal Street, Coetzenburg, Stellenbosch 7600, South Africa.
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Faculty of Health and Medical Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
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Wong CK, Sheppard J, Williams K. Improving balance and walking ability in community-dwelling people with lower limb loss: a narrative review with clinical suggestions. PHYSICAL THERAPY REVIEWS 2018. [DOI: 10.1080/10833196.2018.1451291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Christopher Kevin Wong
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA
| | - Jeremy Sheppard
- Program in Physical Therapy, Columbia University, New York, NY, USA
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15
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Clinical outcome and complications of thoracic and pelvic limb stump and socket prostheses. Vet Comp Orthop Traumatol 2017. [DOI: 10.3415/vcot-16-09-0127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary
Objectives: To describe the use, quality of life, compliance, complications, and outcome of animals fitted with stump socket prostheses.
Methods: Medical records of dogs fitted with a stump socket prosthesis were reviewed. Functional outcome, quality of life and complications were retrospectively assessed from an owner questionnaire.
Results: Thirteen stump socket prostheses (12 dogs) were fitted for a variety of reasons including trauma, congenital abnormalities, and neoplasia. Eight dogs had a good outcome overall and four a poor outcome. Quality of life (QOL) remained good or excellent in 10/12 dogs. Nine complications were seen in 7/12 dogs, most were manageable; surgical wound complications (n = 2) and pressures sores (n = 4) were the most frequently encountered. One dog suffered multiple complications. Thoracic and pelvic limb stump socket prostheses had a similar complication rate, however all animals with a poor outcome had a thoracic limb stump socket prosthesis; two were small breed dogs (under 10 kg) and two had bilateral thoracic limb abnormalities.
Clinical significance: Stump socket prostheses are feasible and versatile in animals. In correctly selected cases, good to excellent outcomes are possible. However, complications are frequent but often manageable. Further investigations are required into the risk factors for poor outcomes and prospective studies are required to assess changes in biomechanics, function, and QOL before and after fitting of a stump socket prosthesis. Until further evidence is available, careful consideration should be given before fitting bilateral thoracic limb stump socket prostheses or thoracic limb stump socket prostheses to small breed dogs.Supplementary Material to this article is available online at https://doi.org/10.3415/VCOT-16-09-0127
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16
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Boston SE, Skinner OT. Limb shortening as a strategy for limb sparing treatment of appendicular osteosarcoma of the distal radius in a dog. Vet Surg 2017; 47:136-145. [DOI: 10.1111/vsu.12726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 05/01/2017] [Accepted: 05/18/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Sarah E. Boston
- University of Florida Small Animal Hospital; Gainesville Florida
| | - Owen T. Skinner
- University of Florida Small Animal Hospital; Gainesville Florida
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17
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Rink CL, Wernke MM, Powell HM, Tornero M, Gnyawali SC, Schroeder RM, Kim JY, Denune JA, Albury AW, Gordillo GM, Colvin JM, Sen CK. Standardized Approach to Quantitatively Measure Residual Limb Skin Health in Individuals with Lower Limb Amputation. Adv Wound Care (New Rochelle) 2017; 6:225-232. [PMID: 28736682 DOI: 10.1089/wound.2017.0737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/01/2017] [Indexed: 12/29/2022] Open
Abstract
Objective: (1) Develop a standardized approach to quantitatively measure residual limb skin health. (2) Report reference residual limb skin health values in people with transtibial and transfemoral amputation. Approach: Residual limb health outcomes in individuals with transtibial (n = 5) and transfemoral (n = 5) amputation were compared to able-limb controls (n = 4) using noninvasive imaging (hyperspectral imaging and laser speckle flowmetry) and probe-based approaches (laser doppler flowmetry, transcutaneous oxygen, transepidermal water loss, surface electrical capacitance). Results: A standardized methodology that employs noninvasive imaging and probe-based approaches to measure residual limb skin health are described. Compared to able-limb controls, individuals with transtibial and transfemoral amputation have significantly lower transcutaneous oxygen tension, higher transepidermal water loss, and higher surface electrical capacitance in the residual limb. Innovation: Residual limb health as a critical component of prosthesis rehabilitation for individuals with lower limb amputation is understudied in part due to a lack of clinical measures. Here, we present a standardized approach to measure residual limb health in people with transtibial and transfemoral amputation. Conclusion: Technology advances in noninvasive imaging and probe-based measures are leveraged to develop a standardized approach to quantitatively measure residual limb health in individuals with lower limb loss. Compared to able-limb controls, resting residual limb physiology in people that have had transfemoral or transtibial amputation is characterized by lower transcutaneous oxygen tension and poorer skin barrier function.
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Affiliation(s)
- Cameron L. Rink
- Department of Surgery, Comprehensive Wound Center and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Heather M. Powell
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio
| | - Mark Tornero
- Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Surya C. Gnyawali
- Department of Surgery, Comprehensive Wound Center and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Jayne Y. Kim
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio
| | | | | | - Gayle M. Gordillo
- Department of Plastic Surgery, Comprehensive Wound Center and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Chandan K. Sen
- Department of Surgery, Comprehensive Wound Center and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
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18
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Dickinson A, Steer J, Worsley P. Finite element analysis of the amputated lower limb: A systematic review and recommendations. Med Eng Phys 2017; 43:1-18. [DOI: 10.1016/j.medengphy.2017.02.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/17/2017] [Accepted: 02/10/2017] [Indexed: 01/18/2023]
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Gonçalves Junior E, Knabben RJ, Luz SCTD. Portraying the amputation of lower limbs: an approach using ICF. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.001.ao10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Amputation is a trauma that involves important functional, psychological and social sequelae. The International Classification of Functioning, Disability and Health (ICF) is based on the biopsychosocial model and enables understanding functioning and disability through the interaction of its components. Objective: This study’s aim was to depict functioning and disability using the ICF conceptual interaction model from the perspective of individuals who suffered a lower limb amputation. Methods: The qualitative approach was used and included a semi-structured interview held with six participants. Results: All the participants used assistive devices such as crutches, wheelchairs or walkers: three used prostheses and the other three emphasized their difficulty in acquiring prostheses from the Social Security Service or Public Health System. Social support, especially that provided by family and friends, is a major facilitator. The importance of acquiring and adapting prostheses to enable the rehabilitation of amputees became clear; however, rehabilitation is not restricted to the acquisition of prostheses. A rehabilitation program directed to restoring functionality is needed. Conclusion: The multidirectional approach using the ICF’s conceptual interaction model enabled important insights concerning public health issues, such as obstacles related to the access to rehabilitation services and a lack of preparedness on the part of health professionals in relation to care provided to amputees.
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Highsmith MJ, Kahle JT, Klenow TD, Andrews CR, Lewis KL, Bradley RC, Ward JM, Orriola JJ, Highsmith JT. INTERVENTIONS TO MANAGE RESIDUAL LIMB ULCERATION DUE TO PROSTHETIC USE IN INDIVIDUALS WITH LOWER EXTREMITY AMPUTATION: A SYSTEMATIC REVIEW OF THE LITERATURE. TECHNOLOGY AND INNOVATION 2016; 18:115-123. [PMID: 28066521 DOI: 10.21300/18.2-3.2016.115] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with lower extremity amputation (LEA) experience 65% more dermatologic issues than non-amputees, and skin problems are experienced by ≈75% of LEA patients who use prostheses. Continuously referring LEA patients to a dermatologist for every stump related skin condition may be impractical. Thus, physical rehabilitation professionals should be prepared to recognize and manage common non-emergent skin conditions in this population. The purpose of this study was to determine the quantity, quality, and strength of available evidence supporting treatment methods for prosthesis-related residual limb (RL) ulcers. Systematic literature review with evidence grading and synthesis of empirical evidence statements (EES) was employed. Three EESs were formulated describing ulcer etiology, conditions in which prosthetic continuance is practical, circumstances likely requiring prosthetic discontinuance, and the consideration of additional medical or surgical interventions. Continued prosthetic use is a viable option to manage minor or early-stage ulcerated residual limbs in compliant patients lacking multiple comorbidities. Prosthetic discontinuance is also a viable method of residual limb ulcer healing and may be favored in the presence of severe acute ulcerations, chronic heavy smoking, intractable pain, rapid volume and weight change, history of chronic ulceration, systemic infections, or advanced dysvascular etiology. Surgery or other interventions may also be necessary in such cases to achieve restored prosthetic ambulation. A short bout of prosthetic discontinuance with a staged re-introduction plan is another viable option that may be warranted in patients with ulceration due to poor RL volume management. High-quality prospective research with larger samples is needed to determine the most appropriate course of treatment when a person with LEA develops an RL ulcer that is associated with prosthetic use.
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Affiliation(s)
- M Jason Highsmith
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA; Extremity Trauma & Amputation Center of Excellence (EACE), U.S. Department of Veterans Affairs, Tampa, FL, USA; 319 Minimal Care Detachment, U.S. Army Reserves, Pinellas Park, FL, USA
| | - Jason T Kahle
- OP Solutions, Tampa, FL, USA; Prosthetic Design + Research, Tampa, FL, USA
| | - Tyler D Klenow
- Prosthetics and Sensory Aids Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Casey R Andrews
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA; Physical Medicine & Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Katherine L Lewis
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA
| | - Rachel C Bradley
- Physical Medicine & Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Jessica M Ward
- Department of Chemistry, University of South Florida, Tampa, FL, USA
| | - John J Orriola
- Shimberg Health Sciences Library, University of South Florida, Tampa, FL, USA
| | - James T Highsmith
- Dermatology Service, James A. Haley Veterans' Hospital, Tampa, FL, USA; Dermatology Surgery Institute, Lutz, FL, USA
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21
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Features of lymphatic dysfunction in compressed skin tissues – Implications in pressure ulcer aetiology. J Tissue Viability 2016; 25:26-31. [DOI: 10.1016/j.jtv.2015.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/30/2015] [Accepted: 12/22/2015] [Indexed: 11/23/2022]
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22
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Pascale BA, Potter BK. Residual Limb Complications and Management Strategies. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0063-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hoskins RD, Sutton EE, Kinor D, Schaeffer JM, Fatone S. Using vacuum-assisted suspension to manage residual limb wounds in persons with transtibial amputation: a case series. Prosthet Orthot Int 2014; 38:68-74. [PMID: 23685916 DOI: 10.1177/0309364613487547] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Persons with amputation and residual limb wounds would benefit from the ability to continue wearing a prosthesis while healing. Sockets with vacuum-assisted suspension may reduce intra-socket motion and be less disruptive to wound healing. The purpose of this case series was to measure residual limb wound size over time in persons with transtibial amputation while using prostheses with vacuum-assisted suspension. CASE DESCRIPTION AND METHODS Six subjects with residual limb wounds were fit with vacuum-assisted suspension sockets. Wound surface area was calculated using ImageJ software at the time of fit and each subsequent visit until closure. FINDINGS AND OUTCOME: Average wound surface area at initial measurement was 2.17 ± 0.65 cm(2). All subjects were instructed to continue their normal activity level while wounds healed, with a mean of 177.6 ± 113 days to wound closure. CONCLUSION Results suggest that well-fitting sockets with vacuum-assisted suspension in compliant individuals did not preclude wound healing. Further research is required to substantiate these case-based observations. CLINICAL RELEVANCE Residual limb wounds are typically treated by suspension of prosthetic use until healing occurs, increasing the risk of long-term prosthesis nonuse. Our results suggest that vacuum-assisted suspension sockets may be used while healing occurs.
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Pereles BD, DeRouin AJ, Ong KG. A wireless, passive magnetoelastic force-mapping system for biomedical applications. J Biomech Eng 2013; 136:011010. [PMID: 24190576 DOI: 10.1115/1.4025880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Indexed: 11/08/2022]
Abstract
A wireless, passive force–mapping system based on changes in magnetic permeability of soft, amorphous Metglas 2826MB strips is presented for long-term force/stress monitoring on biomedical devices. The presented technology is demonstrated for use in lower-limb prosthetics to ensure proper postoperative fitting by providing real-time monitoring of the force distribution at the body-prosthesis interface. The sensor system consisted of a force-sensitive magnetoelastic sensing strip array that monitored applied loading as an observed change in the peak amplitude of the measured magnetic higher-order harmonic signal of each array element. The change in higher-order harmonic signal is caused by the change in the magnetic permeability of the sensing strips that corresponds to an increase in strip magnetization. After loading, the measured higher-order harmonic signals were fed into an algorithm to determine the applied forces, allowing for determination of the real-time loading profile at the body prosthesis interface.
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Relationship Between Volumetric Measurements of Heterotopic Ossification in Wounded Service Members and Clinically Available Screening Tools. ACTA ACUST UNITED AC 2012. [DOI: 10.1097/jpo.0b013e31825fb080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Latlief G, Elnitsky C, Hart-Hughes S, Phillips SL, Adams-Koss L, Kent R, Highsmith MJ. Patient Safety in the Rehabilitation of the Adult with an Amputation. Phys Med Rehabil Clin N Am 2012; 23:377-92. [DOI: 10.1016/j.pmr.2012.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Portnoy S, Siev-Ner I, Shabshin N, Gefen A. Effects of sitting postures on risks for deep tissue injury in the residuum of a transtibial prosthetic-user: a biomechanical case study. Comput Methods Biomech Biomed Engin 2011; 14:1009-19. [DOI: 10.1080/10255842.2010.504719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Robinson V, Sansam K, Hirst L, Neumann V. Major lower limb amputation – what, why and how to achieve the best results. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.mporth.2010.03.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Isaacson BM, Stinstra JG, MacLeod RS, Pasquina PF, Bloebaum RD. Developing a quantitative measurement system for assessing heterotopic ossification and monitoring the bioelectric metrics from electrically induced osseointegration in the residual limb of service members. Ann Biomed Eng 2010; 38:2968-78. [PMID: 20458630 DOI: 10.1007/s10439-010-0050-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 04/19/2010] [Indexed: 11/25/2022]
Abstract
Poor prosthetic fit is often the result of heterotopic ossification (HO), a frequent problem following blast injuries for returning service members. Osseointegration technology offers an advantage for individuals with significant HO and poor socket tolerance by using direct skeletal attachment of a prosthesis to the distal residual limb, but remains limited due to prolonged post-operative rehabilitation regimens. Therefore, electrical stimulation has been proposed as a catalyst for expediting skeletal attachment and the bioelectric effects of HO were evaluated using finite element analysis in 11 servicemen with transfemoral amputations. Retrospective computed tomography (CT) scans provided accurate reconstructions, and volume conductor models demonstrated the variability in residual limb anatomy and necessity for patient-specific modeling to characterize electrical field variance if patients were to undergo a theoretical osseointegration of a prosthesis. In this investigation, the volume of HO was statistically significant when selecting the optimal potential difference for enhanced skeletal fixation, since higher HO volumes required increased voltages at the periprosthetic bone (p = 0.024, r = 0.670). Results from Spearman's rho correlations also indicated that the age of the subject and volume of HO were statistically significant and inversely proportional, in which younger service members had a higher frequency of HO (p = 0.041, r = -0.622). This study demonstrates that the volume of HO and age may affect the voltage threshold necessary to improve current osseointegration procedures.
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Affiliation(s)
- Brad M Isaacson
- Department of Veterans Affairs, Salt Lake City, UT 84148, USA
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30
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Portnoy S, van Haare J, Geers RP, Kristal A, Siev-Ner I, Seelen HA, Oomens CW, Gefen A. Real-time subject-specific analyses of dynamic internal tissue loads in the residual limb of transtibial amputees. Med Eng Phys 2010; 32:312-23. [DOI: 10.1016/j.medengphy.2009.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 12/20/2009] [Accepted: 12/23/2009] [Indexed: 10/20/2022]
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Fergason J, Keeling JJ, Bluman EM. Recent advances in lower extremity amputations and prosthetics for the combat injured patient. Foot Ankle Clin 2010; 15:151-74. [PMID: 20189122 DOI: 10.1016/j.fcl.2009.10.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Blast-related extremity trauma represents a serious challenge because of the extent of bone and soft tissue damage. Fragmentation and blast injuries account for 56% of all injuries produced within the Iraqi and Afghan theaters where, as of July 2009, 723 combatants have sustained lower extremity limb loss. If limb salvage is not practical, or fails, then amputation should be considered. Amputation can be a reliable means toward pain relief and improvement of function. Optimizing functional outcome is paramount when deciding on definitive amputation level. Preservation of joint function improves limb biomechanics in many cases. Increased limb length also allows for the benefits associated with articular and distal limb proprioception. Amputees with improved lower extremity function also usually exhibit less energy consumption. Function and length are generally directly correlated, whereas energy consumption and length are inversely related. This article discusses the surgical principles of lower extremity amputation and postoperative management of amputees, and the various prosthetic options available.
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Affiliation(s)
- John Fergason
- Brooke Army Medical Centre, 3851 Roger Brooke Drive, DOR, Fort Sam Houston, TX 48234, USA.
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32
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Portnoy S, Siev-Ner I, Yizhar Z, Kristal A, Shabshin N, Gefen A. Surgical and Morphological Factors that Affect Internal Mechanical Loads in Soft Tissues of the Transtibial Residuum. Ann Biomed Eng 2009; 37:2583-605. [DOI: 10.1007/s10439-009-9801-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 09/10/2009] [Indexed: 12/01/2022]
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Traballesi M, Averna T, Delussu AS, Brunelli S. Trans-tibial prosthesization in large area of residual limb wound: Is it possible? A case report. Disabil Rehabil Assist Technol 2009; 4:373-5. [DOI: 10.1080/17483100903038568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Marjolin's ulcers are uncommon malignancies arising from previously traumatized, chronically inflamed or scarred skin. They are usually squamous cell carcinomas and arise most often after burns, and they may present decades after the original insult. Metastases are observed more often than in other cutaneous squamous cell carcinomas. Marjolin's ulcers may occur on stumps in patients using prostheses, in this situation the diagnosis may be delayed because of the false assumption that the ulcer is caused by an ill fitting prosthesis. A case of Marjolin's ulcer is presented occurring on a lower limb stump 68 years following from a burn in infancy. The cause, diagnosis, treatment, and prognosis of Marjolin's ulcer are discussed.
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Meulenbelt HE, Geertzen JHB. Comment on Salawu et al. Prosthet Orthot Int 2007; 31:207-8; author reply 209-10. [PMID: 17520496 DOI: 10.1080/03093640701300928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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