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Arnstein T, Buis A. Methodology to Investigate Effect of Prosthetic Interface Design on Residual Limb Soft Tissue Deformation. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2024; 6:42196. [PMID: 38873008 PMCID: PMC11168601 DOI: 10.33137/cpoj.v6i1.42196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/10/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Residual limb discomfort and injury is a common experience for people living with lower limb amputation. Frequently, inadequate load distribution between the prosthetic device and the residual limb is the root cause of this issue. To advance our understanding of prosthetic interface fit, tools are needed to evaluate the mechanical interaction at the prosthetic interface, allowing interface designs to be evaluated and optimised. OBJECTIVE Present a methodology report designed to facilitate comprehension of the mechanical interaction between the prosthetic interface and the residual limb. As a pilot study, this methodology is used to compare a hands-on and hands-off interface for a single transtibial prosthesis user using secondary Magnetic Resonance Imaging (MRI) data. METHODOLOGY MRI data of the residual limb while wearing a prosthetic interface is segmented into a hard tissue and a skin surface model. These models are exported as stereolithography (STL) files. Two methods are used to analyse the interface designs. Firstly, CloudCompare software is used to compute the nearest vertex on the skin surface for every vertex on the compiled internal bony surface for both interface types. Secondly, CloudCompare software is used to compare registered skin surfaces of the residual limb while wearing the hands-on and hands-off interfaces. FINDINGS The maximum and minimum nearest distances between the internal bony surface and skin surface were similar between interface types. However, the distribution of nearest distances was different. When comparing the skin surface while wearing both interfaces, where the fit is more compressive can be visualized. For the dataset used in this study, the classic features of a hands-on Patella Tendon Bearing interface and hands-off pressure cast interface could be identified. CONCLUSION The methodology presented in this report may give researchers a further tool to better understand how interface designs affect the soft tissues of the residual limb.
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Affiliation(s)
- T Arnstein
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, Scotland
| | - A Buis
- Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, Scotland
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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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Olsen J, Turner S, Chadwell A, Dickinson A, Ostler C, Armitage L, McGregor AH, Dupan S, Day S. The Impact of Limited Prosthetic Socket Documentation: A Researcher Perspective. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:853414. [PMID: 36189046 PMCID: PMC9397974 DOI: 10.3389/fresc.2022.853414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022]
Abstract
The majority of limb prostheses are socket mounted. For these devices, the socket is essential for adequate prosthetic suspension, comfort, and control. The socket is unique among prosthetic components as it is not usually mass-produced and must instead be custom-made for individual residual limbs by a prosthetist. The knowledge of what constitutes "good" socket fit is gained by expert prosthetists and technicians over years of experience, and rarely documented. The reliance on tacit knowledge makes it difficult to standardize the criteria for a well-fitting socket, leading to difficulties understanding the impact of socket fit. Despite its importance, the workflow for socket fitting is often overlooked in literature. Due to the customized nature of sockets, if information is provided in literature, generally only the type of socket and suspension mechanism is noted, with information regarding the fitting and manufacturing processes omitted. In this article, the concerns, issues and consequences arising from lack of upper and lower limb socket documentation are discussed from a researcher perspective, supported by healthcare professionals and socket fabrication specialists. Key changes are proposed to the way socket manufacturing and evaluation are documented to assist future research.
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Affiliation(s)
- Jennifer Olsen
- Intelligent Sensing Laboratory, School of Engineering, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Shruti Turner
- Sackler MSk Laboratory, Department of Surgery and Cancer, Sir Michael Uren Hub, Imperial College London, London, United Kingdom
| | - Alix Chadwell
- Intelligent Sensing Laboratory, School of Engineering, Newcastle University, Newcastle upon Tyne, United Kingdom
- Human Movement and Rehabilitation Research Group, University of Salford, Salford, United Kingdom
| | - Alex Dickinson
- Faculty of Engineering and Physical Science, University of Southampton, Southampton, United Kingdom
| | - Chantel Ostler
- Portsmouth Enablement Centre, Portsmouth Hospital University National Health Service (NHS) Trust, St Marys Hospital, Portsmouth, United Kingdom
| | - Lucy Armitage
- School of Mechanical, Materials, Mechatronic and Biomedical Engineering, University of Wollongong, Wollongong, NSW, Australia
| | - Alison H. McGregor
- Sackler MSk Laboratory, Department of Surgery and Cancer, Sir Michael Uren Hub, Imperial College London, London, United Kingdom
| | - Sigrid Dupan
- Edinburgh Neuroprosthetics Laboratory, School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah Day
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
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Investigation of Orthopedic Prosthesis Socket Management after Transfemoral Amputation by Expert Survey. PROSTHESIS 2021. [DOI: 10.3390/prosthesis3020015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prosthesis treatment requires the close interaction of different actors. In fitting prostheses to patients, special attention is given to the manufacturing of the socket. The continuous development of the technologies involved in the fitting and optimization of prostheses is shown in the literature. The assessment of orthopedic technicians and their influence in the process is thus far largely unexplored. Ten orthopedic technicians were interviewed about the socket fitting process after transfemoral amputation. The research goal was to clarify the socket treatment process with regards to the German context. The results showed that the orthopedic technicians focussing on the patient during the fitting process. This study underlines the importance of interaction and empathy. Volume fluctuations are decisive within the treatment process and are interactively influenced by various factors. Furthermore, the research emphasizes the need for appropriate assistive technologies and the potential for the further development of existing systems.
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Olsen J, Day S, Dupan S, Nazarpour K, Dyson M. 3D-Printing and Upper-Limb Prosthetic Sockets: Promises and Pitfalls. IEEE Trans Neural Syst Rehabil Eng 2021; 29:527-535. [PMID: 33587701 DOI: 10.1109/tnsre.2021.3057984] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Modernising the way upper-limb prosthetic sockets are made has seen limited progress. The casting techniques that are employed in clinics today resemble those developed over 50 years ago and there is still a heavy reliance on manual labour. Modern manufacturing methods such as 3D scanning and printing are often presented as ready-to-use solutions for producing low-cost functional devices, with public perceptions being largely shaped by the superficial media representation and advertising. The promise is that modern socket manufacturing methods can improve patient satisfaction, decrease manufacturing times and reduce the workload in the clinic. However, the perception in the clinical community is that total conversion to digital methods in a clinical environment is not straightforward. Anecdotally, there is currently a disconnect between those developing technology to produce prosthetic devices and the actual needs of clinicians and people with limb difference. In this paper, we demonstrate strengths and drawbacks of a fully digitised, low-cost trans-radial diagnostic socket making process, informed by clinical principles. We present volunteer feedback on the digitally created sockets and provide expert commentary on the use of digital tools in upper-limb socket manufacturing. We show that it is possible to utilise 3D scanning and printing, but only if the process is informed by expert knowledge. We bring examples to demonstrate how and why the process may go wrong. Finally, we provide discussion on why progress in modernising the manufacturing of upper-limb sockets has been slow yet it is still too early to rule out digital methods.
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Safari R. Lower limb prosthetic interfaces: Clinical and technological advancement and potential future direction. Prosthet Orthot Int 2020; 44:384-401. [PMID: 33164655 DOI: 10.1177/0309364620969226] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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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Armitage L, Buller A, Rajan G, Prusty G, Simmons A, Kark L. Clinical utility of pressure feedback to socket design and fabrication. Prosthet Orthot Int 2020; 44:18-26. [PMID: 31769736 DOI: 10.1177/0309364619868364] [Citation(s) in RCA: 8] [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 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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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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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] [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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Safari MR, Tafti N, Aminian G. Socket Interface Pressure and Amputee Reported Outcomes for Comfortable and Uncomfortable Conditions of Patellar Tendon Bearing Socket: A Pilot Study. Assist Technol 2015; 27:24-31; quiz 32-3. [PMID: 26132222 DOI: 10.1080/10400435.2014.949016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The objectives of the current study were to compare intra-socket pressure differences between comfortable and uncomfortable socket conditions, and the usefulness of subject perception of satisfaction, activity limitations, and socket comfort in distinguishing between these two socket conditions. Five unilateral trans-tibial amputees took part in the study. They answered the Socket Comfort Score (SCS) and Trinity Amputation and Prosthetic Experience Scale (TAPES) questionnaires before the interface pressure (in standing and walking) was measured for the uncomfortable socket condition at five regions of the residual limb. Participants were then provided with a comfortable socket and wore it for two weeks. Participants who were satisfied with the socket fit after two weeks repeated the SCS and TAPES questionnaires and interface pressure measurements. The differences between the test results of the two conditions were not statistically significant, except for the interface pressure at the popliteal region during the early stance phase, TAPES socket fit subscale, and the SCS. Due to large variability of the data and the lack of statistical significance, no firm conclusion can be made on the possible relationship between the interface pressure values and the patient-reported outcomes of the two socket conditions. A larger sample size and longer acclimation period are required to locate significant differences.
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Affiliation(s)
- Mohammad Reza Safari
- a Department of Orthotics and Prosthetics , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
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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] [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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