Prosthetics and Orthotics International最新文献

{"title":"Is biomechanical loading reduced in individuals with unilateral transtibial amputation during fast-paced walking when using different ankle/foot prostheses? A pragmatic randomized controlled trial.","authors":"Lizanne Andrag, Wayne Derman, John Cockcroft, Phoebe Runciman","doi":"10.1097/PXR.0000000000000395","DOIUrl":"10.1097/PXR.0000000000000395","url":null,"abstract":"<p><strong>Introduction: </strong>Sound side loading is a risk factor for osteoarthritis development, which has been noted to reduce when using advanced prostheses during normal-paced walking in individuals with unilateral transtibial amputation (UTTA). However, descriptions of loading during fast-paced walking remain relatively unreported. Therefore, the aim of this study was to describe the biomechanical loading of individuals with UTTA while using different ankle/foot prostheses during fast-paced walking.</p><p><strong>Methods: </strong> A blinded, randomized control trial was conducted in a group of K3-K4 ambulators, who used 3 different prosthetic feet (1. a solid ankle cushioned heel foot prosthesis [SACH], 2. a standard energy storage and return foot prosthesis [ESAR], and 3. a novel ESAR foot prosthesis [N-ESAR]) in a 2-week randomized crossover design. The spatiotemporal and kinetic data of the participants' fast walking pace were collected. Data were analyzed using a mixed model and one-way analysis of variances ( p < 0.05) and Cohen d .</p><p><strong>Results: </strong>Twenty individuals with UTTA (age: 40 ± 16 years; height: 1.76 ± 0.09 m; and BMI: 24.72 ± 3.63 kg/m 2 ) participated in this study. There were minimal changes in the spatiotemporal data between the different prosthetic feet. When the participants used the N-ESAR feet, they had a lower peak vertical ground reaction force ( p = 0.02) and external knee adduction moment ( p = 0.02) on the sound side, as well as a higher distal shank power on the prosthetic side ( p < 0.01).</p><p><strong>Conclusion: </strong>Overall fast-paced walking resulted in higher sound side loading forces compared with normal-paced walking. However, use of the N-ESAR prosthesis reduced the biomechanical loading on the sound side in individuals with UTTA while walking at a fast pace compared with the ESAR and SACH prostheses. The percentage change in the biomechanical loading from normal- to fast-paced walking of the N-ESAR foot was also larger compared with the other prostheses, perhaps because of the individuals' ability to achieve a faster walking pace when using the N-ESAR prosthesis. Longitudinal intervention studies should be performed to further investigate the possible benefits of using advanced prostheses.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":"148-158"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11984548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design of a custom metamaterial insert for improved pressure distribution within transtibial prosthetic sockets.","authors":"Meredith K Owen, Brian D Kaluf, John D DesJardins","doi":"10.1097/PXR.0000000000000397","DOIUrl":"10.1097/PXR.0000000000000397","url":null,"abstract":"<p><p>Uneven pressure distribution within a transtibial prosthetic socket can lead to discomfort, skin degradation, and suspended prosthesis use. Current custom interfaces to improve pressure distribution are often costly, time-intensive to fabricate, or cannot be incorporated into standard socket fabrication methods. In this technical note, we describe the design and preliminary clinical evaluation of a novel transtibial prosthetic socket insert with modifiable mechanical properties, which can be incorporated into the current clinical cycle of care. The custom insert (termed \"inlay\") relies on a triangular unit cell, which can be modified based on the desired stiffness profile. Inserts are 3D printed in a soft polymer material and inset into shape-matched voids in a socket creating regions of custom offloading. Preliminary clinical efficacy of the inserts was assessed in a pilot long-term cross-over evaluation. After Institutional Review Board approval, 3 pilot participants wore a shape-matched replica of their habitual socket modified for insert use and a shape-matched socket without. Sockets were worn for 4-week each, and inner socket pressures were measured with thin film pressure sensors at the end of the wear period. Peak pressures within the distal tibial region of interest were decreased for 2 of 3 participants during midstance of level-ground walking when wearing the socket with inlays. The technical methods and results presented provide a new method to address high pressure regions within a transtibial prosthetic socket. The 3D-printed inlays can be rapidly produced allowing for easy modification and replacement without require new socket fabrication.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":"168-172"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An environmental scan of limb loss rehabilitation centers across Canada.","authors":"Sander L Hitzig, Diana Zidarov, Crystal MacKay, Steven Dilkas, Fayez Alshehri, Rachel Russell, Jorge Rios, Colleen O'Connell, Jacqueline S Hebert, Heather A Underwood, Sheena King, Audrey Zucker-Levin, Natalie Habra, Jan Andrysek, Ricardo Viana, Michael W Payne, Susan W Hunter, Nancy L Dudek, Krista L Best, Catherine Mercier, Vanessa K Noonan, Joel Katz, Brittany Mae Pousett, Jan Walker, William C Miller, Amanda L Mayo","doi":"10.1097/PXR.0000000000000405","DOIUrl":"10.1097/PXR.0000000000000405","url":null,"abstract":"<p><strong>Background: </strong>The clinical landscape of limb loss rehabilitation across Canada is poorly delineated, lacks standard rehabilitation guidelines, and is without a shared clinical database.</p><p><strong>Objective: </strong>To address these gaps, the objective of the present study was to undertake an environmental scan of the rehabilitation centers across Canada that provide inpatient and/or outpatient services to the limb loss community.</p><p><strong>Study design: </strong>An environmental scan was conducted to describe the rehabilitation service structure, program services, and outcome measures of sites across Canada.</p><p><strong>Methods: </strong>A survey was sent to 36 rehabilitation centers providing care to people with amputations.</p><p><strong>Results: </strong>Of the 36 centers, 31 completed the survey (11 = Ontario; 8 = Quebec; 6 = British Columbia; 2 = Saskatchewan; 2 = New Brunswick; 1 = Alberta; 1 = Manitoba). Twenty-five provided both inpatient and outpatient services, 1 provided inpatient care only, and 5 provided only outpatient services. Interprofessional services were provided to a wide range of upper extremity amputation and lower extremity amputation patient populations. Range of motion was the most commonly collected outcome for both patients with upper extremity amputation and lower extremity amputation. With regard to prosthetics and orthotics fabrication, 9 of the sites had these services on-site while 15 had off-site fabricators, 6 had both, and 1 provided no response.</p><p><strong>Conclusions: </strong>Our findings highlight that limb loss rehabilitation and prosthetic care delivery is variable across Canada with respect to clinical team members, locations of services, and complementary services such as mental health treatments and peer support groups.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":"248-255"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rehabilitative outcomes with preparatory suction prostheses following traumatic Gritti-Stokes amputation: A case series.","authors":"Samantha Jeanne Stauffer, John Robert Horne, Jaclyn Megan Sions","doi":"10.1097/PXR.0000000000000359","DOIUrl":"10.1097/PXR.0000000000000359","url":null,"abstract":"<p><p>Gritti-Stokes amputation (GSA) is a knee disarticulation variant, where the femur is transected at the level of the epicondyle and the patella is fixated to the distal end. GSA results in a long residual limb with little postoperative swelling and less potential for muscular atrophy, so stable limb volume may allow the use of seal-in suction for suspension for preparatory prostheses. The purpose of this case series was to report on the efficacy of seal-in suction preparatory prostheses for 2 adults with traumatic GSA. Between October and December of 2021, 2 participants with unilateral traumatic Gritti-Stokes amputation, who had received seal-in suction suspension for their preparatory prostheses, were recruited. Information was extracted from medical charts regarding prosthetic care and mobility at preparatory and definitive prosthesis evaluation, and participants underwent standardized measurement of their residual limb and prosthesis. Duration of preparatory prosthesis use was >6 months; neither participant reported loss of suspension nor significant complications with socket fit. Participant 1 required socket replacement because of residual limb pain secondary to osteophyte formation, and Participant 2 required component replacement because of weight gain. At definitive prosthesis evaluations, both participants were unlimited community ambulators; both successfully returned to work before provision of their definitive prostheses. Results indicate that seal-in suction suspension may be viable for preparatory prostheses among adults with traumatic GSA, but knee center height discrepancies persist. GSA may yield highly functional outcomes for adults with traumatic amputation. Further research is required to substantiate these findings.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":"236-240"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: \"Reliability and validity of the Turkish version of the satisfaction module of the Orthotics and Prosthetics Users' Survey\".","authors":"Zeynep Yıldız Kızkın","doi":"10.1097/PXR.0000000000000413","DOIUrl":"10.1097/PXR.0000000000000413","url":null,"abstract":"","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":"147"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing the interaction effects of modular components on transtibial prosthesis stance-phase mechanical behavior.","authors":"Seth Donahue, Miguel Vaca, Wendy A Beattie, Trevor Kingsbury, Kota Z Takahashi, Matthew J Major","doi":"10.1097/PXR.0000000000000411","DOIUrl":"10.1097/PXR.0000000000000411","url":null,"abstract":"<p><strong>Background: </strong>Despite evidence that passive prosthesis mechanical properties can directly affect user experience, prosthetists have access to minimal information regarding the mechanical interactions between a prosthetic foot and proximal modular componentry.</p><p><strong>Objectives: </strong>This study quantified the stance phase mechanical behavior of a transtibial prosthetic system through the addition of passive modular componentry to a dynamic response (DR) foot.Study Design:Repeated measures, mechanical characterization.</p><p><strong>Methods: </strong>Maximum displacement and energy return were measured with a materials test machine simulating initial, mid, and terminal stances. Twelve conditions were tested: a DR foot in combination with a hydraulic ankle at 2 resistance settings and 3 different shock-absorbing pylons (SAPs). The roll-over shape of the DR foot with and without hydraulic ankle was measured using a test rig.</p><p><strong>Results: </strong>Adding modular passive components altered displacement and energy return, displaying independent and interaction effects. Generally, the hydraulic ankle and SAP reduced energy return (up to 18%) but decreased (up to 51%) and increased (up to 88%) displacement, respectively, while the combined properties were more complex. Roll-over shape radii decreased with increasing load for the foot alone but exhibited a nonlinear response with the addition of the ankle.</p><p><strong>Conclusions: </strong>Inclusion of modular components in a transtibial prosthetic system can have complex mechanical interactions that independently affect the system's response to load. It is important for clinicians to be aware of the cumulative effects of these interactions to inform the tuning of transtibial prosthesis mechanical behavior. Combinations of hydraulic ankles and SAPs can help clinicians adjust the prosthesis to achieve a balance between user comfort and energy return.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":"159-167"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design of novel test rig for prosthetic finger distal interphalangeal and phalanx strengths.","authors":"Madhu Mohan R, Subhaschandra Kattimani, Poornesh Kumar Koorata, Girisha C","doi":"10.1097/PXR.0000000000000398","DOIUrl":"10.1097/PXR.0000000000000398","url":null,"abstract":"<p><p>Testing is one of the most significant phases of any engineering process, the last process followed by conceptualization, designing, and fabricating. If the testing outcomes are not genealogy sensible measurables, then eventually it calls for a redesign overhaul. Existing testing equipment to analyze the load and failures are conventional digital universal testing machines with minimum jigs and fixtures. In addition, the existing fixtures cannot be adapted to the anatomy of a human finger. Consequently, the present work explores the best possible design of a jig for testing the naturally articulated movement of a human finger (prosthetic wear-on). Furthermore, the present jig design checks a wide range of parameters such as freedom of motion, a path along with curvature, load, failures, and intermittent positions of applied load, which is adaptable to existing universal testing machines available for broader applications.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":"214-219"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of dynamic elastomeric fabric orthoses in children with cerebral palsy: A single-blind randomized controlled trial.","authors":"Sabiha Bezgin, Iona Novak, Gamze Çobanoğlu, Bülent Elbasan","doi":"10.1097/PXR.0000000000000425","DOIUrl":"10.1097/PXR.0000000000000425","url":null,"abstract":"<p><strong>Background: </strong>The dynamic elastomeric fabric orthoses (DEFOs) are made of neoprene material, providing the right biomechanical alignment and afferent input in the trunk, pelvis, and extremities, potentially allowing individuals to actively participate in daily life.</p><p><strong>Objective: </strong>The aim of this study was to investigate the effects of DEFOs applied to the lower trunk and pelvis, on balance, gait parameters, and pelvic symmetry in children with cerebral palsy (CP).</p><p><strong>Study design: </strong>An evaluator-blinded randomized controlled trial.</p><p><strong>Methods: </strong>Twenty-two children (7 girls, 15 boys) aged 4-10 years, with spastic CP, Gross Motor Function Classification System levels 1 and 2 were included. Thirteen children were randomly assigned to the control group (group 1) and 13 to the orthosis group (group 2), but 4 withdrew before treatment commenced. There were 10 children in group 1 and 12 in group 2. Both groups received a physiotherapy and rehabilitation program twice a week for 8 weeks. Children in group 2 received lower body and pelvis DEFOs in addition to physiotherapy and rehabilitation sessions. Dynamic elastomeric fabric orthoses wearing tolerance was gradually built up over the first week, until the child was wearing the DEFO 8 h per day. The pediatric balance scale and timed up and go test were used to assess balance, while gait parameters and pelvic kinematic values were evaluated using the BTS G-Walk, a wireless mini digital gait analysis system. All of the measurement tools used were validated for CP.</p><p><strong>Results: </strong>Only stride length among the gait parameters changed in the group using DEFO compared with the group not using it ( p = 0.035). There was no change in gait speed and cadence nor were there any differences in the balance scores between the groups. However, the pelvic tilt in the frontal plane of the pelvis improved significantly in the group using DEFOs compared with the group not using it ( p = 0.014).</p><p><strong>Conclusions: </strong>Dynamic elastomeric fabric orthoses used in the lower body and pelvis conferred superior stride length and the pelvic tilt in the frontal plane to conventional physiotherapy. All other outcomes were equally effective between groups.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":"220-227"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacterial comparison study of prosthetic liners.","authors":"Keera L Dupler, Hailey C Miller, Esther C Seeland, Philip M Tan","doi":"10.1097/PXR.0000000000000393","DOIUrl":"10.1097/PXR.0000000000000393","url":null,"abstract":"<p><strong>Background: </strong>Amputee patients in low-resource settings face a heightened risk of skin infections at the skin-liner interface of their residual limb, which can develop into a variety of serious complications. Most research comparing prosthetic liners has focused on mechanical and aesthetic properties. However, the relative propensity of different liner types to host bacterial growth has yet to be explored.</p><p><strong>Methods: </strong>To address this question, we performed a bacterial comparison study across a traditional sock-EVA combination liner, an advanced Ossur Iceross silicone liner, and a novel silicone liner designed for low-resource hospitals in developing nations. We cultured Staphylococcus aureus within a novel physical model of the skin-liner interface, incorporating a replicate skin layer suspended over a self-regulating heat source. After culturing bacteria for 24 h, we collected and quantified cells in solution.</p><p><strong>Results: </strong>Statistical analysis of the bacterial growth concentration from 9 trials revealed relative consistency of growth across the 3 liner types, suggesting that none of the liners pose heightened risks of infection, relative to the others.</p><p><strong>Conclusions: </strong>These results suggest that certain innovative prosthetic materials may safely be considered for fabrication of prosthetic liners in low-resource environments. The in vitro skin-liner model and test method for bacterial growth characterization introduced herein may be useful for future dermatological simulations.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":"201-206"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinguishing retrospective fallers from nonfallers in people who use a unilateral lower-limb prosthesis.","authors":"M G Finco, Cody L McDonald, Sarah C Moudy","doi":"10.1097/PXR.0000000000000439","DOIUrl":"https://doi.org/10.1097/PXR.0000000000000439","url":null,"abstract":"<p><strong>Background: </strong>Over 52% of people who use a lower-limb prosthesis fall once every year, but fall risk is still not effectively screened. Few studies have identified clinical outcome measures that could help screen fall risk. Gait asymmetries between the intact and prosthetic limbs could also potentially help identify fall risk, based on findings in people with stroke. However, no studies have examined the relationship between gait asymmetries and falls in people who use a lower-limb prosthesis. Therefore, we sought to determine if any gait asymmetry parameters could significantly distinguish 12-month retrospective fallers from nonfallers.</p><p><strong>Methods: </strong>People were recruited from private practice and the Amputee Coalition National Conference. Participants completed a 12-month retrospective fall history and 7 clinical outcome measures, as well as level-ground walking at self-selected pace with wearable sensors that collected kinematic (sagittal plane: hip, knee, and ankle range of motion) and kinetic (peak braking and propulsion ground reaction force) data.</p><p><strong>Results: </strong>Twenty-two individuals who use a unilateral prosthesis participated (age 57.6 ± 14.2 years; 15 transtibial, 7 transfemoral). No gait asymmetry parameters significantly distinguished 12-month retrospective fallers from nonfallers. However, the Four Square Step Test did significantly distinguish fallers from nonfallers (P = 0.040, Hedge g = -0.739, area under the curve = 0.725, CI = 50-95%, cutoff time = 13.14 s), irrespective of level of prosthesis use. No parameters significantly distinguished fallers from nonfallers by level of prosthesis use (transtibial, transfemoral).</p><p><strong>Conclusions: </strong>The Four Square Step Test cutoff time may be useful to distinguish fallers from nonfallers in unilateral lower-limb prosthesis users.</p>","PeriodicalId":49657,"journal":{"name":"Prosthetics and Orthotics International","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}