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Sanders JE, Vamos AC, Mertens JC, Allyn KJ, Larsen BG, Ballesteros D, Wang H, DeGrasse NS, Garbini JL, Hafner BJ, Friedly JL. An adaptive prosthetic socket for people with transtibial amputation. Sci Rep 2024; 14:11168. [PMID: 38750086 PMCID: PMC11096356 DOI: 10.1038/s41598-024-61234-9] [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: 01/20/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024] Open
Abstract
It is essential that people with limb amputation maintain proper prosthetic socket fit to prevent injury. Monitoring and adjusting socket fit, for example by removing the prosthesis to add prosthetic socks, is burdensome and can adversely affect users' function and quality-of-life. This study presents results from take-home testing of a motor-driven adaptive socket that automatically adjusted socket size during walking. A socket fit metric was calculated from inductive sensor measurements of the distance between the elastomeric liner surrounding the residual limb and the socket's inner surface. A proportional-integral controller was implemented to adjust socket size. When tested on 12 participants with transtibial amputation, the controller was active a mean of 68% of the walking time. In general, participants who walked more than 20 min/day demonstrated greater activity, less doff time, and fewer manual socket size adjustments for the adaptive socket compared with a locked non-adjustable socket and a motor-driven socket that participants adjusted with a smartphone application. Nine of 12 participants reported that they would use a motor-driven adjustable socket if it were available as it would limit their socket fit issues. The size and weight of the adaptive socket were considered the most important variables to improve.
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Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA.
| | - Andrew C Vamos
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Joseph C Mertens
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Daniel Ballesteros
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Horace Wang
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Nicholas S DeGrasse
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Joseph L Garbini
- Department of Mechanical Engineering, University of Washington, 3900 E Stevens Way NE, Box 352600, Seattle, WA, 98195, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, Box 356490, Seattle, WA, 98195, USA
| | - Janna L Friedly
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Ave, Box 359612, Seattle, WA, 98104, USA
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Baldock M, Pickard N, Prince M, Kirkwood S, Chadwell A, Howard D, Dickinson A, Kenney L, Gill N, Curtin S. Adjustable prosthetic sockets: a systematic review of industrial and research design characteristics and their justifications. J Neuroeng Rehabil 2023; 20:147. [PMID: 37926807 PMCID: PMC10626671 DOI: 10.1186/s12984-023-01270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The prosthetic socket is a key component that influences prosthesis satisfaction, with a poorly fitting prosthetic socket linked to prosthesis abandonment and reduced community participation. This paper reviews adjustable socket designs, as they have the potential to improve prosthetic fit and comfort through accommodating residual limb volume fluctuations and alleviating undue socket pressure. METHODS Systematic literature and patent searches were conducted across multiple databases to identify articles and patents that discussed adjustable prosthetic sockets. The patents were used to find companies, organisations, and institutions who currently sell adjustable sockets or who are developing devices. RESULTS 50 literature articles and 63 patents were identified for inclusion, representing 35 different designs used in literature and 16 commercially available products. Adjustable sockets are becoming more prevalent with 73% of publications (literature, patents, and news) occurring within the last ten years. Two key design characteristics were identified: principle of adjustability (inflatable bladders, moveable panels, circumferential adjustment, variable length), and surface form (conformable, rigid multi-DOF, and rigid single DOF). Inflatable bladders contributed to 40% of literature used designs with only one identified commercially available design (n = 16) using this approach. Whereas circumferential adjustment designs covered 75% of identified industry designs compared to only 36% of literature devices. Clinical studies were generally small in size and only 17.6% of them assessed a commercially available socket. DISCUSSION There are clear differences in the design focus taken by industry and researchers, with justification for choice of design and range of adjustment often being unclear. Whilst comfort is often reported as improved with an adjustable socket, the rationale behind this is not often discussed, and small study sizes reduce the outcome viability. Many adjustable sockets lack appropriate safety features to limit over or under tightening, which may present a risk of tissue damage or provide inadequate coupling, affecting function and satisfaction. Furthermore, the relationship between design and comfort or function are rarely investigated and remain a significant gap in the literature. Finally, this review highlights the need for improved collaboration between academia and industry, with a strong disconnect observed between commercial devices and published research studies.
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Affiliation(s)
- Michael Baldock
- School of Health and Society at the University of Salford, Salford, UK.
| | - Nicolaas Pickard
- School of Health and Society at the University of Salford, Salford, UK.
| | - Michael Prince
- School of Health and Society at the University of Salford, Salford, UK
| | - Sarah Kirkwood
- School of Health and Society at the University of Salford, Salford, UK
| | - Alix Chadwell
- School of Health and Society at the University of Salford, Salford, UK
- School of Engineering at Newcastle University, Newcastle upon Tyne, UK
| | - David Howard
- School of Health and Society at the University of Salford, Salford, UK
| | - Alex Dickinson
- School of Engineering at the University of Southampton, Southampton, UK
| | - Laurence Kenney
- School of Health and Society at the University of Salford, Salford, UK
| | - Niamh Gill
- School of Health and Society at the University of Salford, Salford, UK
| | - Sam Curtin
- School of Health and Society at the University of Salford, Salford, UK.
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Gnyawali SC, Denune JA, Hockman B, Kristjánsdóttir JV, Ragnarsdóttir MS, Timsina LR, Ghatak S, Lechler K, Sen CK, Roy S. Moisture mitigation using a vented liner and a vented socket system for individuals with transfemoral amputation. Sci Rep 2023; 13:16557. [PMID: 37783779 PMCID: PMC10545693 DOI: 10.1038/s41598-023-43572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023] Open
Abstract
Sweating and heat buildup at the skin-liner interface is a major challenge for persons with limb loss. Liners made of heat-non-conducting materials may cause sweating of the residual limb and may result in liners slipping off the skin surface especially on a warm day or during high activity, causing skin breakdown and affecting limb health. To address this, we evaluated the efficacy of the vented liner-socket system (VS, Össur) compared to Seal-In silicone liner and non-vented socket (nVS, Össur) in reducing relative humidity (RH) during increased sweat. Nine individuals with limb loss using nVS were randomized to VS or nVS and asked for activity in a 20-min treadmill walk. RH was significantly attenuated (p = 0.0002) and perceived sweating, as reported by prosthesis users, improved (p = 0.028) with VS, patient-reported comprehensive lower limb amputee socket survey (CLASS) outcomes to determine the suspension, stability, and comfort were not significantly different between VS and nVS. There are limited rigorous scientific studies that clearly provide evidence-based guidelines to the prosthetist in the selection of liners from numerous available options. The present study is innovative in clearly establishing objective measures for assessing humidity and temperatures at the skin-liner interface while performing activity. As shown by the measured data and perceived sweat scores provided by the subjects based on their daily experience, this study provided clear evidence establishing relative humidity at the skin-liner interface is reduced with the use of a vented liner-socket system when compared to a similar non-vented system.
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Affiliation(s)
- Surya C Gnyawali
- McGowan Institute for Regenerative Medicine (MIRM), Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Jeffrey A Denune
- Indiana Centre for Regenerative Medicine and Engineering (ICRME), Indiana University Health Comprehensive Wound Centre, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bryce Hockman
- Indiana Centre for Regenerative Medicine and Engineering (ICRME), Indiana University Health Comprehensive Wound Centre, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Lava R Timsina
- Indiana Centre for Regenerative Medicine and Engineering (ICRME), Indiana University Health Comprehensive Wound Centre, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Subhadip Ghatak
- McGowan Institute for Regenerative Medicine (MIRM), Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Indiana Centre for Regenerative Medicine and Engineering (ICRME), Indiana University Health Comprehensive Wound Centre, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Knut Lechler
- Össur Ehf., R&D, Medical Office, Reykjavik, Iceland
| | - Chandan K Sen
- McGowan Institute for Regenerative Medicine (MIRM), Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Indiana Centre for Regenerative Medicine and Engineering (ICRME), Indiana University Health Comprehensive Wound Centre, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sashwati Roy
- McGowan Institute for Regenerative Medicine (MIRM), Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Indiana Centre for Regenerative Medicine and Engineering (ICRME), Indiana University Health Comprehensive Wound Centre, Indiana University School of Medicine, Indianapolis, IN, USA.
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Klotz R, Emile G, Daviet JC, De Sèze M, Godet J, Urbinelli R, Krasny-Pacini A. Daily socket comfort in transtibial amputee with a vacuum-assisted suspension system: study protocol of a randomized, multicenter, double-blind multiple N-of-1 trial. BMC Sports Sci Med Rehabil 2023; 15:85. [PMID: 37452356 PMCID: PMC10347726 DOI: 10.1186/s13102-023-00694-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The main aim of this paper is to present the feasibility of rigorously designed multiple N-of-1 design in prosthetics research. While research of adequate power and high quality is often lacking in rehabilitation, N-of-1 trials can offer a feasible alternative to randomized controlled group trials, both increasing design power at group level and allowing a rigorous, statistically confirmed evaluation of effectiveness at a single patient level. The paper presents a multiple N-of-1 trial protocol, which aim is to evaluate the effectiveness of Unity, a prosthetic add-on suspension system for amputees, on patient-reported comfort during daily activities (main outcome measure), prosthesis wearing time, perception of limb-prosthesis fitting and stump volume and functional walking parameters. METHODS Multicenter, randomized, prospective, double-blind multiple N-of-1 trial using an introduction/withdrawal design alternating Unity connected/disconnected phases of randomized length on twenty patients with unilateral transtibial amputation. The primary outcome measure is the Prosthetic Socket Comfort Score (SCS), a validated measure of comfort, administered daily by an phone app designed for the study. Secondary outcomes measures will be collected during the 50 days period of the N-of-1 trial: (1) by the same app, daily for patient-reported limb-prosthesis fitting, stump volume variation, and daily wearing time of the prosthesis; (2) by a pedometer for the number of steps per day; (3) by blind assessors in the rehabilitation center during adjustment visits for functional walking parameter (L-Test, 6-minute walk test), and by the patient for the QUEST, and ABC-S. Effectiveness of the Unity system regarding SCS and daily secondary outcome measures will be tested by randomization test. The secondary outcome measures assessed during visits in the rehabilitation center will be analyzed by Non Overlap of All pairs. An estimate of the effect on the amputee population will be generated by aggregating each individual clinical trial (N-of-1 trial) by Hierarchical Bayesian methods. DISCUSSION This study protocol was designed to answer the question "which device is best for THIS patient" and to conclude at a group level on the effectiveness of a new devic, using a Multiple N-of-1 trial, which is promising but underused in prosthetics research so far. TRIAL REGISTRATION N° ID-RCB 2020-A01309-30 Clintrial.gov : NCT04804150 - Retrospectively registered March 20th 2021.
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Affiliation(s)
- Rémi Klotz
- La Tour de Gassies Centre for Physical Medicine and Rehabilitation, UGECAM, Rue de la Tour de Gassies, Bruges, 33523, France
| | - Guilhem Emile
- Department of Physical and Rehabilitation Medicine, Centre Hospitalier d'Arcachon, Avenue Jean Hameau, 33260, La Teste de Buch, France
| | - Jean-Christophe Daviet
- Department of Physical and Rehabilitation Medicine, Limoges University, Jean Rebeyrol Hospital, Avenue du Buisson, 87170, Limoges, France
| | - Mathieu De Sèze
- Physical and Rehabilitation Medicine Unit, Bordeaux University Hospital, University of Bordeaux, EA4136, Bordeaux, France
| | - Julien Godet
- Clinical Research Methods Group, Laboratory of Bioimaging and Pathologies, UMR CNRS 7021, University Hospitals of Strasbourg, Illkirch, Strasbourg, France
| | | | - Agata Krasny-Pacini
- Department of Physical and Rehabilitation Medicine, UF 4372, CHU de Strasbourg, Institut Universitaire de Réadaptation Clémenceau, 45 Boulevard Clémenceau, Strasbourg, 67000, France
- Department of Psychiatry, Hôpital civil, INSERM 1114, Strasbourg University Hospital, Strasbourg, France
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5
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An Instrumented Printed Insert for Continuous Monitoring of Distal Limb Motion in Suction and Elevated Vacuum Sockets. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4040056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
A suction or elevated vacuum prosthetic socket that loses vacuum pressure may cause excessive limb motion, putting the user at risk of skin irritation, gait instability and injury. The purpose of this research was to develop a method to monitor distal limb motion and then test a small group of participants wearing suction sockets to identify variables that strongly influenced motion. A thin plastic insert holding two inductive sensor antennae was designed and printed. Inserts were placed in suction sockets made for four participants who regularly used suction or elevated vacuum suspension. Participants wore a liner with a trace amount of iron powder in the elastomer that served as a distance target for the sensors. In-lab testing demonstrated that the sensed distance increased when participants added socks and decreased when they removed socks, demonstrating proper sensor performance. Results from take-home testing (3–5 days) suggest that research investigation into cyclic limb motion for sock presence v. absence should be pursued, as should the influence of bodily position between bouts of walking. These variables may have an important influence on suspension. Long-term monitoring may provide clinical insight to improve fit and to enhance suction and elevated vacuum technology.
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6
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Youngblood RT, Hafner BJ, Czerniecki JM, Larsen BG, Allyn KJ, Sanders JE. Mechanically and physiologically optimizing prosthetic elevated vacuum systems in people with transtibial amputation: a pilot study. JOURNAL OF PROSTHETICS AND ORTHOTICS : JPO 2022; 34:194-201. [PMID: 36582938 PMCID: PMC9793861 DOI: 10.1097/jpo.0000000000000396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction The most suitable elevated vacuum (EV) pressure may differ for each individual prosthesis user depending on suspension needs, socket fit, prosthetic components, and health. Mechanical and physiological effects of EV were evaluated in an effort to determine the optimal vacuum pressure for three individuals. Methods Instrumented EV sockets were created based on the participants' regular EV sockets. Inductive distance sensors were embedded into the wall of the socket at select locations to measure limb movement relative to the socket. Each participant conducted an activity protocol while limb movement, limb fluid volume, and user-reported comfort were measured at various socket vacuum pressure settings. Results Increased socket vacuum pressure resulted in reduced limb-socket displacement for each participant; however, 81-93% of limb movement was eliminated by a vacuum pressure setting of 12 (approximately -9 inHg). Relative limb-socket displacement by sensor location varied for each participant, suggesting distinct differences related to socket fit or residual limb tissue content. The rate of limb fluid volume change and the change in socket comfort did not consistently differ with socket vacuum pressure, suggesting a more complex relationship unique to each individual. Conclusions Practitioners may use individual responses to optimize socket vacuum pressure settings, balancing mechanical and physiological effects of EV for improved clinical outcomes.
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Affiliation(s)
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Czerniecki
- VA Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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7
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Ballesteros D, Youngblood RT, Vamos AC, Garbini JL, Allyn KJ, Hafner BJ, Larsen BG, Ciol MA, Friedly JL, Sanders JE. Cyclic socket enlargement and reduction during walking to minimize limb fluid volume loss in transtibial prosthesis users. Med Eng Phys 2022; 103:103787. [DOI: 10.1016/j.medengphy.2022.103787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/14/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
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8
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Weathersby EJ, Vamos AC, Larsen BG, McLean JB, Carter RV, Allyn KJ, Ballesteros D, Wang H, deGrasse NS, Friedly JL, Hafner BJ, Garbini JL, Ciol MA, Sanders JE. Performance of an auto-adjusting prosthetic socket during walking with intermittent socket release. J Rehabil Assist Technol Eng 2022; 9:20556683221093271. [PMID: 35558157 PMCID: PMC9087223 DOI: 10.1177/20556683221093271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 03/24/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction A challenge in the engineering of auto-adjusting prosthetic sockets is to
maintain stable operation of the control system while users change their
bodily position and activity. The purpose of this study was to test the
stability of a socket that automatically adjusted socket size to maintain
fit. Socket release during sitting was conducted between bouts of
walking. Methods Adjustable sockets with sensors that monitored distance between the liner and
socket were fabricated. Motor-driven panels and a microprocessor-based
control system adjusted socket size during walking to maintain a target
sensed distance. Limb fluid volume was recorded continuously. During eight
sit/walk cycles, the socket panels were released upon sitting and then
returned to position for walking, either the size at the end of the prior
bout or a size 1.0% larger in volume. Results In six transtibial prosthesis users, the control system maintained stable
operation and did not saturate (move to and remain at the end of the
actuator’s range) during 98% of the walking bouts. Limb fluid volume changes
generally matched the panel position changes executed by the control
system. Conclusions Stable operation of the control system suggests that the auto-adjusting
socket is ready for testing in users’ at-home settings.
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Affiliation(s)
- Ethan J Weathersby
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Andrew C Vamos
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Jake B McLean
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Ryan V Carter
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Daniel Ballesteros
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Horace Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | | | - Janna L Friedly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph L Garbini
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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9
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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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10
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Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020; 17:1840-1856. [PMID: 32830443 PMCID: PMC7949456 DOI: 10.1111/iwj.13474] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
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Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of MedicineUniversity of Southern California, Los AngelesCaliforniaCaliforniaCanada
| | - Keith Harding
- School of MedicineCardiff UniversityWalesUK
- A*STARSingapore
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11
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Hobusch GM, Döring K, Brånemark R, Windhager R. Advanced techniques in amputation surgery and prosthetic technology in the lower extremity. EFORT Open Rev 2020; 5:724-741. [PMID: 33204516 PMCID: PMC7608512 DOI: 10.1302/2058-5241.5.190070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bone-anchored implants give patients with unmanageable stump problems hope for drastic improvements in function and quality of life and are therefore increasingly considered a viable solution for lower-limb amputees and their orthopaedic surgeons, despite high infection rates.Regarding diversity and increasing numbers of implants worldwide, efforts are to be supported to arrange an international bone-anchored implant register to transparently overview pros and cons.Due to few, but high-quality, articles about the beneficial effects of targeted muscle innervation (TMR) and regenerative peripheral nerve interface (RPNI), these surgical techniques ought to be directly transferred into clinical protocols, observations and routines.Bionics of the lower extremity is an emerging cutting-edge technology. The main goal lies in the reduction of recognition and classification errors in changes of ambulant modes. Agonist-antagonist myoneuronal interfaces may be a most promising start in controlling of actively powered ankle joints.As advanced amputation surgical techniques are becoming part of clinical routine, the development of financing strategies besides medical strategies ought to be boosted, leading to cutting-edge technology at an affordable price.Microprocessor-controlled components are broadly available, and amputees do see benefits. Devices from different manufacturers differ in gait kinematics with huge inter-individual varieties between amputees that cannot be explained by age. Active microprocessor-controlled knees/ankles (A-MPK/As) might succeed in uneven ground-walking. Patients ought to be supported to receive appropriate prosthetic components to reach their everyday goals in a desirable way.Increased funding of research in the field of prosthetic technology could enhance more high-quality research in order to generate a high level of evidence and to identify individuals who can profit most from microprocessor-controlled prosthetic components. Cite this article: EFORT Open Rev 2020;5:724-741. DOI: 10.1302/2058-5241.5.190070.
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Affiliation(s)
- Gerhard M Hobusch
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - Kevin Döring
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - Rickard Brånemark
- Gothenburg University, Gothenburg, Sweden.,Biomechatronics Group, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Reinhard Windhager
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
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12
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Hall PT, Bratcher SZ, Stubbs C, Rifkin RE, Grzeskowiak RM, Burton BJ, Greenacre CB, Stephenson SM, Anderson DE, Crouch DL. Fully Implanted Prostheses for Musculoskeletal Limb Reconstruction After Amputation: An In Vivo Feasibility Study. Ann Biomed Eng 2020; 49:1012-1021. [PMID: 33034786 DOI: 10.1007/s10439-020-02645-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
Previous prostheses for replacing a missing limb following amputation must be worn externally on the body. This limits the extent to which prostheses could physically interface with biological tissues, such as muscles, to enhance functional recovery. The objectives of our study were to (1) test the feasibility of implanting a limb prosthesis, or endoprosthesis, entirely within living skin at the distal end of a residual limb, and (2) identify effective surgical and post-surgical care approaches for implanting endoprostheses in a rabbit model of hindlimb amputation. We iteratively designed, fabricated, and implanted unjointed endoprosthesis prototypes in six New Zealand White rabbits following amputation. In the first three rabbits, the skin failed to heal due to ishemia and dehiscence along the sutured incision. The skin of the final three subsequent rabbits successfully healed over the endoprotheses. Factors that contributed to successful outcomes included modifying the surgical incision to preserve vasculature; increasing the radii size on the endoprostheses to reduce skin stress; collecting radiographs pre-surgery to match the bone pin size to the medullary canal size; and ensuring post-operative bandage integrity. These results will support future work to test jointed endoprostheses that can be attached to muscles.
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Affiliation(s)
- Patrick T Hall
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, 1512 Middle Dr, Knoxville, TN, 37966, USA.
| | - Samantha Z Bratcher
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, 1512 Middle Dr, Knoxville, TN, 37966, USA
| | - Caleb Stubbs
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, 1512 Middle Dr, Knoxville, TN, 37966, USA
| | - Rebecca E Rifkin
- Department of Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
| | - Remi M Grzeskowiak
- Department of Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
| | - Bryce J Burton
- Office of Laboratory Animal Care, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
| | - Cheryl B Greenacre
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
| | | | - David E Anderson
- Department of Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
| | - Dustin L Crouch
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, 1512 Middle Dr, Knoxville, TN, 37966, USA
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Youngblood RT, Hafner BJ, Czerniecki JM, Brzostowski JT, Allyn KJ, Sanders JE. Modeling the mechanics of elevated vacuum systems in prosthetic sockets. Med Eng Phys 2020; 84:75-83. [PMID: 32977925 DOI: 10.1016/j.medengphy.2020.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
Elevated vacuum (EV) is suggested to improve suspension and limb volume management for lower limb prosthesis users. However, few guidelines have been established to facilitate configuration of EV sockets to ensure their safe and proper function. A benchtop model of an EV socket was created to study how prosthetic liner tensile elasticity, socket fit, and socket vacuum pressure affect liner displacement and subsequent pressure on the residual limb. A domed carbon fiber layup was used to represent an EV socket. Inserts were used to simulate various air gaps between the socket and liner. Various prosthetic liner samples were placed under the carbon fiber layup. Liner displacement and the corresponding pressure change underneath the liner were measured as vacuum was applied between the liner sample and socket wall. Tissue vacuum pressure increased linearly with socket vacuum pressure until the liner contacted the socket wall. Predicted tissue vacuum pressure matched well with experimental results. Findings suggest that the effect of vacuum pressure on the residual limb is primarily determined by air gap distance. The developed model may be used to assess effects of EV on residual limb tissues based on an individual's socket fit, liner characteristics, and applied vacuum. Understanding the physiological effects of EV on the residual limb could help practitioners avoid blister formation and improve EV implementation.
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Affiliation(s)
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Czerniecki
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; VA Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, WA, USA
| | | | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle WA, USA
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle WA, USA
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14
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Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020. [PMID: 32830443 DOI: 10.1111/iwj.13474.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
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Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, California, California, Canada
| | - Keith Harding
- School of Medicine, Cardiff University, Wales, UK.,A*STAR, Singapore
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McLean JB, Larsen BG, Weathersby EJ, Carter Bs RV, Allyn KJ, Garbini JL, Sanders JE. Fluid Volume Management in Prosthesis Users: Augmenting Panel Release with Pin Release. PM R 2020; 12:1236-1243. [PMID: 32103634 DOI: 10.1002/pmrj.12349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/03/2020] [Accepted: 02/12/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Management of fluid in the limbs is a challenge faced by people with disabilities. In prosthetics, a means for transtibial prosthesis users to stabilize their residual limb fluid volume during the day may improve socket fit. OBJECTIVE To determine if releasing the panels and locking pin of a cabled-panel adjustable socket during socket release significantly improved limb fluid volume recovery and retention over releasing the panels alone. DESIGN Repeated-measures experiment to assess the effects on limb fluid volume retention. SETTING Participants were tested in a laboratory setting while walking on a treadmill. INTERVENTION Release of a locking pin tether during sitting as a limb volume accommodation strategy. MAIN OUTCOME MEASURE Percent limb fluid volume retention for panel and pin release compared with panel release alone at 2 minutes (short term) and 50 minutes (long term) after subsequent activity. Limb fluid volume was monitored using bioimpedance analysis. RESULTS Median percent limb fluid volume retention for the panel and pin release was significantly greater than panel release alone for both anterior and posterior regions for the long term (P = .0499 and .0096, respectively) but not the short term (P = .0712 and .1580, respectively). CONCLUSION Augmenting panel release with pin release may be an effective accommodation strategy for prosthesis users with transtibial amputation to better retain limb fluid volume.
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Affiliation(s)
- Jake B McLean
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Ethan J Weathersby
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Ryan V Carter Bs
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Joseph L Garbini
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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Schoepp KR, Schofield JS, Home D, Dawson MR, Lou E, Keri M, Marasco PD, Hebert JS. Real time monitoring of transtibial elevated vacuum prostheses: A case series on socket air pressure. PLoS One 2018; 13:e0202716. [PMID: 30346953 PMCID: PMC6197629 DOI: 10.1371/journal.pone.0202716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/09/2018] [Indexed: 12/03/2022] Open
Abstract
Prosthetic elevated vacuum is a suspension method used to reduce daily volume changes of the residual limb. Evaluation of the effectiveness of these systems is limited due to a lack of correlation to actual socket air pressure, particularly during unconstrained movements. This may explain some of the variability in functional outcomes reported in the literature. Our objective was to develop a light-weight portable socket measurement system to quantify internal socket air pressure, temperature, and acceleration; and to present preliminary results from implementation with three transtibial prosthesis users with mechanical elevated vacuum pumps. Participants completed five functional tasks with and without the vacuum pumps actively connected, including the 2-Minute Walk test, 5-Times Sit-to-Stand test, 4-Square Step test, L-Test, and Figure-8 test. Results demonstrated different gait profiles and pressure ranges for each user. Two of the participants demonstrated substantially lower air pressure (higher vacuum) over time while the pump was active compared to inactive. The minimum air pressure measured for all participants was -34.6 ± 7.7 kPa. One participant did not show substantial changes in pressure over time for either pump condition. Functional task performance was not significantly different between pump conditions. Correlation with accelerometer readings indicated peak positive pressures occurred just following initial contact of the foot in early stance, and the most negative pressures (highest vacuum) were observed throughout swing. This study has demonstrated the use of a portable data logging tool that may serve the clinical and research communities to quantify the operation of elevated vacuum systems, and better understand the variability of mechanical pump operation and overall system performance.
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Affiliation(s)
- Katherine R. Schoepp
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathon S. Schofield
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland, Ohio, United States of America
| | - David Home
- Prosthetics and Orthotics Department, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Michael R. Dawson
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Edmond Lou
- Department of Electrical & Computer Engineering, Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - McNiel Keri
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Paul D. Marasco
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland, Ohio, United States of America
- Advanced Platform Technology Center of Excellence, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Jacqueline S. Hebert
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Wernke MM, Schroeder RM, Haynes ML, Nolt LL, Albury AW, Colvin JM. Progress Toward Optimizing Prosthetic Socket Fit and Suspension Using Elevated Vacuum to Promote Residual Limb Health. Adv Wound Care (New Rochelle) 2017; 6:233-239. [PMID: 28736683 DOI: 10.1089/wound.2016.0719] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/07/2017] [Indexed: 11/13/2022] Open
Abstract
Objective: Prosthetic sockets are custom made for each amputee, yet there are no quantitative tools to determine the appropriateness of socket fit. Ensuring a proper socket fit can have significant effects on the health of residual limb soft tissues and overall function and acceptance of the prosthetic limb. Previous work found that elevated vacuum pressure data can detect movement between the residual limb and the prosthetic socket; however, the correlation between the two was specific to each user. The overall objective of this work is to determine the relationship between elevated vacuum pressure deviations and prosthetic socket fit. Approach: A tension compression machine was used to apply repeated controlled forces onto a residual limb model with sockets of different internal volume. Results: The vacuum pressure-displacement relationship was dependent on socket fit. The vacuum pressure data were sensitive enough to detect differences of 1.5% global volume and can likely detect differences even smaller. Limb motion was reduced as surface area of contact between the limb model and socket was maximized. Innovation: The results suggest that elevated vacuum pressure data provide information to quantify socket fit. Conclusions: This study provides evidence that the use of elevated vacuum pressure data may provide a method for prosthetists to quantify and monitor socket fit. Future studies should investigate the relationship between socket fit, limb motion, and limb health to define optimal socket fit parameters.
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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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