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Johansson R, Jensen L, Barnett CT, Rusaw DF. Quantitative methods used to evaluate balance, postural control, and the fear of falling in lower limb prosthesis users: A systematic review. Prosthet Orthot Int 2023; 47:586-598. [PMID: 37318276 DOI: 10.1097/pxr.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/23/2023] [Indexed: 06/16/2023]
Abstract
Problems with balance, postural control, and fear of falling are highly prevalent in lower limb prosthesis users, with much research conducted to understand these issues. The variety of tools used to assess these concepts presents a challenge when interpreting research outcomes. This systematic review aimed to provide a synthesis of quantifiable methods used in the evaluation of balance, postural control, and fear of falling in lower limb prosthesis users with an amputation level at or proximal to the ankle joint. A systematic search was conducted in CINAHL, Medline, AMED, Cochrane, AgeLine, Scopus, Web of Science, Proquest, PsycINFO, PsycArticles, and PubPsych databases followed by additional manual searching via reference lists in the reviewed articles databases. Included articles used quantitative measure of balance or postural control as one of the dependent variables, lower limb prosthesis users as a sample group, and were published in a peer-reviewed journal in English. Relevant assessment questions were created by the investigators to rate the assessment methods used in the individual studies. Descriptive and summary statistics are used to synthesize the results. The search yielded (n = 187) articles assessing balance or postural control (n = 5487 persons in total) and (n = 66) articles assessing fear of falling or balance confidence (n = 7325 persons in total). The most used test to measure balance was the Berg Balance Scale and the most used test to measure fear of falling was the Activities-specific Balance Confidence scale. A large number of studies did not present if the chosen methods were valid and reliable for the lower limb prosthesis users. Among study limitations, small sample size was common.
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Affiliation(s)
- Robin Johansson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Louise Jensen
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Southern Älvsborg Hospital, Borås, Sweden
| | - Cleveland T Barnett
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - David F Rusaw
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Fanciullacci C, McKinney Z, Monaco V, Milandri G, Davalli A, Sacchetti R, Laffranchi M, De Michieli L, Baldoni A, Mazzoni A, Paternò L, Rosini E, Reale L, Trecate F, Crea S, Vitiello N, Gruppioni E. Survey of transfemoral amputee experience and priorities for the user-centered design of powered robotic transfemoral prostheses. J Neuroeng Rehabil 2021; 18:168. [PMID: 34863213 PMCID: PMC8643009 DOI: 10.1186/s12984-021-00944-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/05/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transfemoral amputees experience a complex host of physical, psychological, and social challenges, compounded by the functional limitations of current transfemoral prostheses. However, the specific relationships between human factors and prosthesis design and performance characteristics have not yet been adequately investigated. The present study aims to address this knowledge gap. METHODS A comprehensive single-cohort survey of 114 unilateral transfemoral amputees addressed a broad range of demographic and clinical characteristics, functional autonomy, satisfaction and attitudes towards their current prostheses, and design priorities for an ideal transfemoral prosthesis, including the possibility of active assistance from a robotic knee unit. The survey was custom-developed based on several standard questionnaires used to assess motor abilities and autonomy in activities of daily living, prosthesis satisfaction, and quality of life in lower-limb amputees. Survey data were analyzed to compare the experience (including autonomy and satisfaction) and design priorities of users of transfemoral prostheses with versus without microprocessor-controlled knee units (MPKs and NMPKs, respectively), with a subsequent analyses of cross-category correlation, principal component analysis (PCA), cost-sensitivity segmentation, and unsupervised K-means clustering applied within the most cost-sensitive participants, to identify functional groupings of users with respect to their design priorities. RESULTS The cohort featured predominantly younger (< 50 years) traumatic male amputees with respect to the general transfemoral amputee population, with pronounced differences in age distribution and amputation etiology (traumatic vs. non-traumatic) between MPK and NMPK groups. These differences were further reflected in user experience, with MPK users reporting significantly greater overall functional autonomy, satisfaction, and sense of prosthesis ownership than those with NMPKs, in conjunction with a decreased incidence of instability and falls. Across all participants, the leading functional priorities for an ideal transfemoral prosthesis were overall stability, adaptability to variable walking velocity, and lifestyle-related functionality, while the highest-prioritized general characteristics were reliability, comfort, and weight, with highly variable prioritization of cost according to reimbursement status. PCA and user clustering analyses revealed the possibility for functionally relevant groupings of prosthesis features and users, based on their differential prioritization of these features-with implications towards prosthesis design tradeoffs. CONCLUSIONS This study's findings support the understanding that when appropriately prescribed according to patient characteristics and needs in the context of a proactive rehabilitation program, advanced transfemoral prostheses promote patient mobility, autonomy, and overall health. Survey data indicate overall stability, modularity, and versatility as key design priorities for the continued development of transfemoral prosthesis technology. Finally, observed associations between prosthesis type, user experience, and attitudes concerning prosthesis ownership suggest both that prosthesis characteristics influence device acceptance and functional outcomes, and that psychosocial factors should be specifically and proactively addressed during the rehabilitation process.
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Affiliation(s)
- Chiara Fanciullacci
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Zach McKinney
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy.
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy.
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
- Institute of Recovery and Care of Scientific Character (IRCCS), Fondazione Don Carlo Gnocchi Florence, Florence, Firenze, Italy
| | - Giovanni Milandri
- Rehab Technologies, Istituto Italiano di Tecnologia (IIT), via Morego, 30, 16163, Genoa, Genoa, Italy
| | - Angelo Davalli
- Centro Protesi INAIL - REPAIR Lab, Via Rabuina, 14, 40054, Vigorso di Budrio, Bologna, Italy
| | - Rinaldo Sacchetti
- Centro Protesi INAIL - REPAIR Lab, Via Rabuina, 14, 40054, Vigorso di Budrio, Bologna, Italy
| | - Matteo Laffranchi
- Rehab Technologies, Istituto Italiano di Tecnologia (IIT), via Morego, 30, 16163, Genoa, Genoa, Italy
| | - Lorenzo De Michieli
- Rehab Technologies, Istituto Italiano di Tecnologia (IIT), via Morego, 30, 16163, Genoa, Genoa, Italy
| | - Andrea Baldoni
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Alberto Mazzoni
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Linda Paternò
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Elisa Rosini
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Luigi Reale
- Healthcare Area, Fondazione ISTUD, Via Paolo Lomazzo, 19, 20154, Milano, Milan, Italy
| | - Fabio Trecate
- Dept. of Physical Medicine and Functional Re-Education, Istituto Palazzolo, Fondazione Don Carlo Gnocchi, Via Don Luigi Palazzolo, 21, 20149, Milano, Milan, Italy
| | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
- Institute of Recovery and Care of Scientific Character (IRCCS), Fondazione Don Carlo Gnocchi Florence, Florence, Firenze, Italy
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
- Institute of Recovery and Care of Scientific Character (IRCCS), Fondazione Don Carlo Gnocchi Florence, Florence, Firenze, Italy
| | - Emanuele Gruppioni
- Centro Protesi INAIL - REPAIR Lab, Via Rabuina, 14, 40054, Vigorso di Budrio, Bologna, Italy
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Andrysek J, Michelini A, Eshraghi A, Kheng S, Heang T, Thor P. Functional outcomes and user preferences of individuals with transfemoral amputations using two types of knee joints in under-resourced settings. Prosthet Orthot Int 2021; 45:463-469. [PMID: 34538819 DOI: 10.1097/pxr.0000000000000043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Information relating to prosthetic performance can inform clinical practice and improve patient outcomes in under-resourced countries. OBJECTIVES The main goal of this study was to compare functional outcomes and user preferences of individuals with transfemoral amputations using common types of knee joints in an under-resourced country. STUDY DESIGN Prospective, longitudinal, before and after trial. METHODS Twenty individuals with unilateral transfemoral amputations from a center in Cambodia transitioned from a commonly used single-axis manually locking knee International Committee of the Red Cross (ICRC) to a more advanced multiaxis knee joint with stance control All-Terrain Knee (ATK). Data were collected for the ICRC knee joint and the ATK immediately after fitting, after acclimation, and as part of a long-term follow-up. A timed walk test assessed walking distance and efficiency. Mobility and user-preferences were evaluated through questionnaires. RESULTS Distance during the timed walk test was significantly higher for the ATK compared with ICRC (P < 0.001), with functional gains retained at follow-up. No differences were found for gait efficiency and the mobility questionnaires. All participants, except one, preferred the ATK prosthesis. Benefits included greater knee stability and fewer perceived knee collapses; however, some disliked the appearance of the ATK. CONCLUSIONS The findings suggest positive outcomes with prosthetic services in under-resourced regions and the ICRC system, as well as the potential for improved functional outcomes with more advanced multiaxis knee components.
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Affiliation(s)
- Jan Andrysek
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Alexandria Michelini
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Arezoo Eshraghi
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Sisary Kheng
- Exceed Worldwide, Lisburn Square, Lisburn, United Kingdon
| | - Thearith Heang
- Exceed Worldwide, Lisburn Square, Lisburn, United Kingdon
| | - Phearsa Thor
- Exceed Worldwide, Lisburn Square, Lisburn, United Kingdon
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Effect of transfemoral prosthetic socket interface design on gait, balance, mobility, and preference: A randomized clinical trial. Prosthet Orthot Int 2021; 45:304-312. [PMID: 33856157 DOI: 10.1097/pxr.0000000000000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 11/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are alternative transfemoral (TF) socket interface designs that have not been compared with the standard of care, ischial ramus containment (IRC). The interface directly affects performance. OBJECTIVES To compare 3 TF interface designs, IRC, dynamic socket (DS), and subischial (Sub-I), regarding gait, balance, mobility, and preference. The authors hypothesized that these more active users may experience gait, mobility, and preference benefits from the less intrusive DS and Sub-I interface designs. STUDY DESIGN Single-blind, repeated-measures, 3-period randomized controlled crossover clinical trial. METHODS People with unilateral TF amputation with 1 year or longer prosthesis use experience, independent community ambulatory status, 18 to 60 years of age, of any race or ethnicity, with a body mass of 45 to 125 kg, and with a self-reported ability to walk for 20 minutes continuously were included in the study. Each participant was fit in all 3 interface designs. RESULTS Thirteen participants completed the clinical trial. Velocity, cadence, mobility, and balance were not statistically different between the 3 socket conditions. The DS demonstrated significantly greater symmetry in swing, stance, single support percentage, and toe angle compared with IRC and Sub-I. Sixty days after study completion, 7 participants changed interfaces, trending away from IRC. CONCLUSIONS Large differences were not observed. Small differences in spatiotemporal gait measures combined with patient preference may make a meaningful difference to individual patients and should be considered.
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Fatone S, Caldwell R, Angelico J, Stine R, Kim KY, Gard S, Oros M. Comparison of Ischial Containment and Subischial Sockets on Comfort, Function, Quality of Life, and Satisfaction With Device in Persons With Unilateral Transfemoral Amputation: A Randomized Crossover Trial. Arch Phys Med Rehabil 2021; 102:2063-2073.e2. [PMID: 34214499 DOI: 10.1016/j.apmr.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare comfort and functional performance of the Northwestern University Flexible Subischial Vacuum (NU-FlexSIV) Socket with the ischial containment (IC) socket in persons with unilateral transfemoral amputation. DESIGN Randomized crossover trial with two 7-week periods. SETTING Private prosthetic clinics and university research laboratory. PARTICIPANTS A total of 30 enrolled (N=30); 25 participants completed the study with full (n=18) or partial data (n=7). INTERVENTIONS Two custom-fabricated sockets (IC and NU-FlexSIV), worn full-time for 7 weeks, with testing at 1, 4, and 7 weeks after socket delivery. MAIN OUTCOME MEASURES The primary outcome was change in Socket Comfort Score (SCS) at 7 weeks. Secondary outcomes at 7 weeks included the Orthotic and Prosthetic Users' Survey (OPUS) to assess lower extremity functional status, health-related quality of life, and satisfaction with device, as well as the 5-Times Rapid Sit-to-Stand Test, Four Square Step Test, and T-Test of Agility to assess functional performance. RESULTS At 7 weeks, the mean SCS for IC (7.0±1.7) and NU-FlexSIV (8.4±1.1) Sockets were significantly different (P<.001; 95% confidence interval, 0.8-2.3). Results from a linear mixed-effects model, accounting for data from all time points, indicated that the SCS was 1.7 (SE=0.45) points higher for the NU-FlexSIV Socket (P<.001). For the secondary outcomes, only OPUS satisfaction with device was significantly better in the NU-FlexSIV Socket after accounting for all data points. CONCLUSIONS The results suggest that after 7 weeks' accommodation, the NU-FlexSIV Socket was more comfortable and led to greater satisfaction with device than the IC socket in persons with unilateral transfemoral amputation and K3/K4 mobility. Other patient-reported outcomes and function were no different between sockets.
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Affiliation(s)
- Stefania Fatone
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | - Ryan Caldwell
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL; Scheck and Siress Prosthetics and Orthotics, Chicago, IL; Hanger Clinic, Austin, TX
| | - John Angelico
- Scheck and Siress Prosthetics and Orthotics, Chicago, IL; Hanger Clinic, Austin, TX
| | | | - Kwang-Youn Kim
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Steven Gard
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL; Jesse Brown VA Medical Center, Chicago, IL
| | - Michael Oros
- Scheck and Siress Prosthetics and Orthotics, Chicago, IL; Hanger Clinic, Austin, TX
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6
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Walker J, Marable W, Smith C, Sigurjónsson B, Atlason I, Johannesson G. Clinical Outcome of Transfemoral Direct Socket Interface (Part 2). CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2021; 4:36065. [PMID: 37614937 PMCID: PMC10443471 DOI: 10.33137/cpoj.v4i1.36065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Amputation at the transfemoral (TF) level reduces the rate of successful prosthetic fitting, functional outcome, and quality of life (QoL) compared with transtibial amputation. The TF socket interface is considered the most critical part of the prosthesis, but socket discomfort is still the most common user complaint. Direct Socket for transfemoral prosthesis users is a novel interface fabrication process where the socket is shaped and laminated directly on the residual limb and delivered in a single visit. OBJECTIVES The aim of this study was to investigate if prosthetic users' quality of life (QoL), comfort, and mobility with a Direct Socket TF interface were comparable to their experience with their previous prostheses. METHODOLOGY The pre/post design prospective cohort study included 47 subjects. From this cohort, 36 subjects completed the 6-months follow-up (mean age 58 years, 27 males). Outcomes at baseline included EQ-5D-5L®, PLUS-M™, CLASS, ABC, AMPPRO, and TUG. At 6-weeks and 6-months, subjects repeated all measures. Seven Certified Prosthetist (CP) investigators performed observations and data collection at six different sites (from July 2018 to April 2020). FINDINGS Results showed significant improvement in all outcome measures for the 36 subjects that completed both 6-weeks and 6-months follow-ups. CLASS sub-scales showed significantly improved stability, suspension, comfort, and socket appearance. Improvement in K-Level and less use of assistive devices were observed with the AMPPRO instrument, indicating improved user mobility and performance. QoL was also increased, as measured in Quality-Adjusted-Life-Years (QALY) from the EQ-5D-5L. CONCLUSIONS Evidence from the findings demonstrate that the Direct Socket TF system and procedure can be a good alternative to the traditional method of prosthetic interface delivery.
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Affiliation(s)
- J. Walker
- Virginia Prosthetic & Orthotics, Roanoke, Virgina, USA
| | - W.R. Marable
- össur HF, Foothill Ranch, California, USA
- össur HF, Reykjavik, Iceland
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Marable W, Smith C, Sigurjónsson B, Atlason I, Johannesson G. Transfemoral Socket Fabrication Method Using Direct Casting: Outcomes Regarding Patient Satisfaction with Device and Services. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2020; 3:34672. [PMID: 37614404 PMCID: PMC10443499 DOI: 10.33137/cpoj.v3i2.34672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Direct Socket for transfemoral (DS-TF) prosthetic user is a novel method of fabricating a laminated interface on to the residual limb but requires different training, production method and service model than what most prosthetists are familiar with. This method and model may improve patient satisfaction by enabling interface fabrication and delivery in one visit. OBJECTIVES Document patient satisfaction regarding DS-TF interface versus the prosthetic users' previous socket in terms of interface function and the clinic service model. METHODOLOGY In this longitudinal study (from July 2018 to April 2020), the DS-TF was implemented in six prosthetic clinics across the United States. Certified prosthetists (CP) and assistants were trained using a standard protocol. 47 prosthetic users participated, both those in need of a new socket and those without need. Two modules from the Orthotics and Prosthetics Users' Survey (OPUS), involving questions related to satisfaction with the Device and Services, was used to evaluate each DS-TF user outcome vs. baseline. The only part of the prosthesis that was replaced was the interface, except in 2 cases. FINDINGS Each DS-TF interface was fabricated, fit and delivered in a single clinic visit. At 6-months follow-up, 38 users reported an average of 29.8% increase in satisfaction with their new interface compared with original, and a 14.8% increase in satisfaction with the services they received from the clinic in providing of the new prosthesis vs. their original prosthesis. The main outcome increases were between baseline (initial fitting) and 6-week follow-up and remained consistent after 6 months. This improvement was consistent irrespective if the user needed a new socket for clinical reasons or not. CONCLUSIONS This study shows that after a standardized training and implementation, the DS-TF fabrication process including a new interface, improves the user's satisfaction with their prosthetic device and services.
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Affiliation(s)
| | - C Smith
- Össur Americas, Foothill Ranch, California, USA
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Mahon CE, Darter BJ, Dearth CL, Hendershot BD. The Relationship Between Gait Symmetry and Metabolic Demand in Individuals With Unilateral Transfemoral Amputation: A Preliminary Study. Mil Med 2020; 184:e281-e287. [PMID: 30690459 DOI: 10.1093/milmed/usy424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/13/2018] [Accepted: 12/10/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Temporal-spatial symmetry allows for optimal metabolic economy in unimpaired human gait. The gait of individuals with unilateral transfemoral amputation is characterized by temporal-spatial asymmetries and greater metabolic energy expenditure. The objective of this study was to determine whether temporal-spatial asymmetries account for greater metabolic energy expenditure in individuals with unilateral transfemoral amputation. MATERIALS AND METHODS The relationship between temporal-spatial gait asymmetry and metabolic economy (metabolic power normalized by walking speed) was retrospectively examined in eighteen individuals with transfemoral amputation walking at a self-selected velocity overground. Pearson's product-moment correlations were used to assess the relationship between: (1) step time symmetry and metabolic economy and (2) step length symmetry and metabolic economy. The retrospective analysis of this data was approved by the Walter Reed National Military Medical Center Institutional Review Board and all individuals provided written consent. Additional insights on this relationship are presented through a case series describing the temporal-spatial and metabolic responses of two individuals with transfemoral amputation who completed a split-belt treadmill walking test. RESULTS For the cohort of individuals, there was no significant relationship between metabolic economy and either step time asymmetry or step length asymmetry. However, the case series showed a positive relationship between step length asymmetry and metabolic power as participants adapted to split-belt treadmill walking. CONCLUSION There is mixed evidence for the relationship between temporal-spatial asymmetries and metabolic energy expenditure. This preliminary study may suggest optimal metabolic energy expenditure in individuals with transfemoral amputation occurs at an individualized level of symmetry and resultant deviations incur a metabolic penalty. The results of this study support the idea that addressing only temporal-spatial gait asymmetries in individuals with transfemoral amputation through rehabilitation may not improve metabolic economy. Nevertheless, future prospective research is necessary to confirm these results and implications for clinical practice.
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Affiliation(s)
- Caitlin E Mahon
- DoD-VA Extremity Trauma and Amputation Center of Excellence, 8901 Wisconsin Ave. NW, Bethesda, MD.,Department of Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Ave. NW, Bethesda, MD
| | - Benjamin J Darter
- Department of Physical Therapy, Virginia Commonwealth University, 1200 E. Broad St., Box 980224, Richmond, VA.,Department of Physical Medicine & Rehabilitation, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd., Richmond, VA
| | - Christopher L Dearth
- DoD-VA Extremity Trauma and Amputation Center of Excellence, 8901 Wisconsin Ave. NW, Bethesda, MD.,Department of Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Ave. NW, Bethesda, MD.,Department of Surgery, Uniformed Services University of the Health Sciences & Walter Reed National Military Medical Center, Bethesda, MD
| | - Brad D Hendershot
- DoD-VA Extremity Trauma and Amputation Center of Excellence, 8901 Wisconsin Ave. NW, Bethesda, MD.,Department of Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Ave. NW, Bethesda, MD.,Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
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9
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Kahle J, Miro RM, Ho LT, Porter M, Lura DJ, Carey SL, Lunseth P, Highsmith J, Highsmith MJ. The effect of the transfemoral prosthetic socket interface designs on skeletal motion and socket comfort: A randomized clinical trial. Prosthet Orthot Int 2020; 44:145-154. [PMID: 32308126 DOI: 10.1177/0309364620913459] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The most crucial aspect of a prosthesis is the socket, as it will directly determine gait stability and quality. The current standard of care ischial ramus containment socket is reported to increase coronal stability through gait; however, socket discomfort is the primary complaint among prosthetic users. OBJECTIVES The purpose of this study is to compare ischial ramus containment to alternatives in the transfemoral amputee population. All subjects were fit with three different sockets: traditional ischial ramus containment, a dynamic socket, and a sub-ischial. In this study, authors hypothesized socket skeletal motion would be equivalent across interventions. STUDY DESIGN Single-blind, repeated-measures, three-period randomized crossover clinical trial. METHODS Outcome measures were socket comfort score and skeletal motion, viewed coronally with X-ray measuring the position of the skeleton in relationship to the socket in full weight-bearing and full un-loading. RESULTS The mean age was 38.2 and mean Amputee Mobility Predictor score was 40. Mean vertical movement, horizontal movement, single limb prosthetic stance, mean femoral adduction in swing and stance, and median socket comfort score were not statistically different. CONCLUSION The socket design did not significantly effect skeletal motion and socket comfort. All socket designs are suitable depending on the patient-centric preferences and prosthetist skill set. CLINICAL RELEVANCE The comfort of the standard of care transfemoral amputation socket has been widely reported as problematic. A comparison of alternative designs in a controlled clinical trial environment will assist the clinician in understanding the impact of design regarding skeletal motion and comfort. Users could benefit from alternatives applied in clinical practice.
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Affiliation(s)
| | | | - Loi T Ho
- Prosthetic Design + Research, Tampa, FL, USA
| | | | - Derek J Lura
- Florida Gulf Coast University, Fort Myers, FL, USA
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10
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Söderberg B, Guerra G, Fagerstrom T, Permpool K, Phaipool S. The SÖderberg Socket 2.0: A Technical Note. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2020; 2:33505. [PMID: 37614769 PMCID: PMC10443462 DOI: 10.33137/cpoj.v2i2.33505] [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: 12/26/2019] [Accepted: 03/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transtibial prosthesis socket trim lines have remained fairly consistent over the past decade, and based on methods such as a supracondylar cuff suspension. However, with vacuum suspension methods, trim lines can change. OBJECTIVE An objective of this technical note was to inform practitioners how to fabricate a socket in a better way. A step-by-step fabrication guide is provided for the prosthetist. METHODS A unilateral transtibial amputee was selected for this technical note. We provide a detailed description of the different steps of fabrication as well as patient feedback. The fabrication involved fabrication of a vacuum socket using Pre-preg carbon fiber and anti-bacterial Ethylene-Vinyl-Acetate (EVA), as a proximal flexible brim. FINDINGS The properties of EVA and Pre-preg carbon fiber allow for fabrication of a transtibial socket with a flexible proximal brim. The new design resulted in greater comfort and increased range of motion in the patient studied. The patient subjectively noted enhanced squatting and cycling capabilities while using the updated socket and flexible proximal brim. CONCLUSION This technical note presented a fabrication guide for a new style of socket and preliminary patient feedback. Clinical studies evaluating functional and biomechanical effects of this new socket design are needed.
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Affiliation(s)
- B Söderberg
- Centre of Excellence for Prosthetics and Orthotics, Scandinavian Orthopaedic Laboratory, Bangkok, Thailand
| | - G Guerra
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - T Fagerstrom
- Centre of Excellence for Prosthetics and Orthotics, Scandinavian Orthopaedic Laboratory, Bangkok, Thailand
| | - K Permpool
- Centre of Excellence for Prosthetics and Orthotics, Scandinavian Orthopaedic Laboratory, Bangkok, Thailand
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Phaipool
- Centre of Excellence for Prosthetics and Orthotics, Scandinavian Orthopaedic Laboratory, Bangkok, Thailand
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Batten HR, McPhail SM, Mandrusiak AM, Varghese PN, Kuys SS. Gait speed as an indicator of prosthetic walking potential following lower limb amputation. Prosthet Orthot Int 2019; 43:196-203. [PMID: 30112982 DOI: 10.1177/0309364618792723] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: The relationship between gait speed and prosthetic potential (K-level classifications) and function has not been explored among people transitioning from hospital rehabilitation to the community. OBJECTIVES: To examine gait speed at discharge from inpatient rehabilitation among people prescribed a prosthetic leg after unilateral lower limb amputation, and associations between gait speed, prosthetic potential and functional ability. STUDY DESIGN: Cohort. METHODS: Gait speed (10-m walk test), K-level (Amputee Mobility Predictor) and Functional Independence Measure motor were compared for 110 people (mean (standard deviation) age: 63 (13) years, 77% male, 71% transtibial amputation, 70% dysvascular causes). RESULTS: Median (interquartile range) gait speed and Functional Independence Measure motor were 0.52 (0.37-0.67) m/s and 84 (81, 85), respectively. Median (IQR) gait speed scores for each K-level were as follows: K1 = 0.17 (0.15-0.19) m/s, K2 = 0.38 (0.25-0.54) m/s, K3 = 0.63 (0.50-0.71) m/s and K4 = 1.06 (0.95-1.18) m/s. Median (IQR) FIM-Motor scores for each K-level were as follows: K1 = 82 (69-84), K2 = 83 (79-84), K3 = 85 (83-87) and K4 = 87 (86-89). Faster gait speed was associated with higher K-level, higher FIM-Motor, being younger, male and having transtibial amputation with nonvascular aetiology. CONCLUSION: Gait speed was faster among each higher K-level classification. However, gait speeds observed across all K-levels were slower than healthy populations, consistent with values indicating high risk of morbidity and mortality. CLINICAL RELEVANCE Factors associated with faster gait speed are useful for clinical teams considering walking potential of people with lower limb prostheses and those seeking to refine prosthetic rehabilitation programmes.
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Affiliation(s)
- Heather R Batten
- 1 Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,3 The University of Queensland, Brisbane, QLD, Australia
| | - Steven M McPhail
- 2 Queensland University of Technology, Brisbane, QLD, Australia.,5 Centre for Functioning and Health Research, Buranda, QLD Australia
| | | | - Paulose N Varghese
- 1 Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,3 The University of Queensland, Brisbane, QLD, Australia
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12
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Paterno L, Ibrahimi M, Gruppioni E, Menciassi A, Ricotti L. Sockets for Limb Prostheses: A Review of Existing Technologies and Open Challenges. IEEE Trans Biomed Eng 2018; 65:1996-2010. [PMID: 29993506 DOI: 10.1109/tbme.2017.2775100] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the prosthetics field, one of the most important bottlenecks is still the human-machine interface, namely the socket. Indeed, a large number of amputees still rejects prostheses or points out a low satisfaction level, due to a sub-optimal interaction between the socket and the residual limb tissues. The aim of this paper is to describe the main parameters (displacements, stress, volume fluctuations and temperature) affecting the stump-socket interface and reducing the comfort/stability of limb prostheses. In this review, a classification of the different socket types proposed in the literature is reported, together with an analysis of advantages and disadvantages of the different solutions, from multiple viewpoints. The paper then describes the technological solutions available to face an altered distribution of stresses on the residual limb tissues, volume fluctuations affecting the stump overtime and temperature variations affecting the residual tissues within the socket. The open challenges in this research field are highlighted and the possible future routes are discussed, towards the ambitious objective of achieving an advanced socket able to self-adapt in real-time to the complex interplay of factors affecting the stump, during both static and dynamic tasks.
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