Design, development and clinical evaluation of a new prosthetic suspension system for lower limb amputees / Arezoo Eshraghi

Momentum, gravity, and other ambulation forces tend to displace lower limb prosthesis on residual limb. Thus, suspension systems have considerable effects on the amputee’s mobility, comfort, and satisfaction with prosthesis. Negative effects of poor suspension on rehabilitation, as well as the comfort and activity level of lower limb amputees, were previously stated. This research aimed to develop a prosthetic suspension system and to explore the biomechanics of prosthesis that incorporates the new system for transtibial amputees. A prosthetic suspension system was designed and fabricated based on magnetic field. Factors that were influenced by the prosthetic suspension were derived through an extensive literature review, and an experimental protocol was subsequently developed. The mechanical properties of the designed suspension system were tested using the universal testing machine. The magnetic suspension system (MPSS) could withstand 350.9 N of tensile loading before the coupling failed. The system was equipped with an acoustic alarm system as an added safety feature: the safety alarm system would buzz a micro-controller unit if the suspension is going to fail. For validation, the MPSS was compared with two other common suspension systems, i.e. the pin/lock and the Seal-In suspension for validation. The MPSS and pin/lock caused comparable amounts of pistoning, whereas the least pistoning resulted from the Seal-In system. Interface pressure was evaluated by the Tekscan F-Socket transducers during level walking, as well as stair and ramp negotiation. The findings indicate that the mean peak pressure (in kilopascal) was lower with the MPSS than with the pin/lock over the anterior and posterior aspects during one gait cycle (P < 0.05). Overall, the average peak pressure values were higher with the Seal-In system than the MPSS and the pin/lock system. Particularly important was that the MPSS may reduce the pain and discomfort at the distal residual limb by decreasing iv the pressure within the prosthetic socket in comparison to the pin/lock system during gait. The MPSS caused significantly different peak pressures at the anterior proximal region compared with the pin/lock (P = 0.022) and Seal-In (P = 0.001) during the stair ascent and descent, and ramp negotiation. Motion analysis showed that several kinetic and kinematic variables were affected by the suspension type. The ground reaction force data revealed that lower load was applied to the joints with the MPSS compared with the pin/lock suspension. The resulting gait deviation index was considerably different from the normal with all the systems, although the index did not significantly differ among the systems. Main significant effects of the suspension type were evident in the vertical and fore-aft ground reaction forces, knee, and ankle angles. The MPSS showed comparable effects in the remaining kinetic and kinematic gait parameters. Finally, the results of the questionnaire survey revealed significantly high satisfaction rates with the MPSS, especially for donning and doffing, walking, uneven walking, and stair negotiation (P < 0.05). The MPSS may be used as an alternative suspension system for lower limb amputees because the biomechanical findings fell within the ranges found in the literature and were comparable to two other common suspension systems

Walking and Balance in Children and Adolescents with Lower-limb Amputation: A Review of Literature

Background Children with lower limb loss face gait and balance limitations. Prosthetic rehabilitation is thus aimed at improving functional capacity and mobility throughout the developmental phases of the child amputee. This review of literature was conducted to determine the characteristics of prosthetic gait and balance among children and adolescents with lower-limb amputation or other limb loss. Methods Both qualitative and quantitative studies were included in this review and data were organized by amputation etiology, age range and level of amputation. Findings The findings indicated that the structural differences between children with lower-limb amputations and typically developing children lead to functional differences. Significant differences with respect to typically developing children were found in spatiotemporal, kinematic, and kinematic parameters and ground-reaction forces. Children with transtibial amputation place significantly larger load on their intact leg compared to the prosthetic leg during balance tasks. In more complex dynamic balance tests, they generally score lower than their typically developing peers. Interpretation There is limited literature pertaining to improving physical therapy protocols, especially for different age groups, targeting gait and balance enhancements. Understanding gait and balance patterns of children with lower-limb amputation will benefit the design of prosthetic components and mobility rehabilitation protocols that improve long-term outcomes through adulthood

Research Paper: Evaluation of the Effects of Two Types of Foot Rockers on the Temporal-Spatial Gait Parameters in Diabetic Patients

Objective Foot ulcer is one of the main challenges of diabetic patients influencing their abilities to stand and walk. Various methods have been suggested to decrease the loads applied to the foot in this group of patients; most methods were not deemed successful and could only be used temporarily. Rocker shoes are recommended for foot ulcer treatment. Based on the available literature, it is still controversial whether or not the forces applied to the foot differ between diabetic and normal subjects. &nbsp;Moreover, it is not well understood which kind of rocker (heel or toe rocker) is more successful in decreasing the applied forces to the foot. Therefore, this study aimed to compare the loads applied on the foot in diabetic subjects and normal subjects and to determine the influence of rockers on the load of foot. The main hypothesis associated with this study was that heel and toe rockers had similar effects on the force applied on the foot in diabetic subjects.&nbsp; Materials & Methods In this interventional, and quasi-experimental study, 20 healthy and 20 diabetic subjects were recruited. The sample size was determined based on the average number of the subjects in the previous similar studies. The diabetic subjects were selected from the patients referred to foot clinics in Rehabilitation School of Isfahan University of Medical Sciences. A qualysis motion analysis system with a Kistler force plate (50&times;60 cm) was used to record the temporal-spatial gait parameters and forces applied on the leg during walking. The subjects were asked to walk with a comfortable speed along a level surface in a gait lab. &nbsp;The parameters such as temporal-spatial gait parameters, peaks of ground reaction forces, and force-time integral were used for analysis. The difference between the mean values of the parameters and between the subjects&rsquo; effects were evaluated by use analysis of variance with repeated measures test. The statistical analysis was done by SPSS17 and with significant level of 0.05. Results There was a significant difference between normal and diabetic foot subjects regarding cadence, stride length, and percentage of stance phase (P 0.06). There was a significant difference between the peak of the forces (anteroposterior [fy1, fy2], medio lateral [fx], and vertical [fz1, fz2, fz3]) applied on the leg in normal and diabetic foot. The type of rocker did not affect the spatiotemporal gait parameters (P < 0.05), while exhibited significant effect on the peak anteroposterior forces applied to the leg (P < 0.04). The mean value of the force-time integral of vertical component of ground reaction force varied based on the side and group (P < 0.04). Conclusion The results of this study showed that the force-time integral of vertical component of the ground reaction force increased significantly in subjects with diabetes, which is the main cause of foot ulcers. Although, heel and toe rockers did not influence the force applied to the foot or the force-time integral, it is recommended to use rocker shoes with wide base of support to increase the dynamic stability while decreasing the foot pressure. The main limitation is that the immediate effect of use of rocker was studies in this study . It is recommended to check the effect of rockers interventions after a certain period of their use

RESEARCH PRODUCTIVITY TRENDS IN PROSTHETICS AND ORTHOTICS IN CANADA

INTRODUCTION The Canadian Survey on Disability reported about 3.8 million Canadians between 15 and 64 years lived with a disability in 20121, and more than 80% used an assistive device. Innovation, research, and unrestricted access to knowledge in prosthetics and orthotics is vital to improve a person’s quality of life, removing barriers, and integrating people with functional and mobility limitations into their society. Therefore, this study examined trends in prosthetics and orthotics research in Canada. Abstract PDF  Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32027/24444 How to cite: Gholizadeh H , Ale Ebrahim N, Eshraghi A, Lemaire E.D. RESEARCH PRODUCTIVITY TRENDS IN PROSTHETICS AND ORTHOTICS IN CANADA. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018.                                                                           Abstracts were Peer-reviewed by the AOPA 2018 National Assembly Scientific Committee

RESEARCH PRODUCTIVITY TRENDS IN PROSTHETICS AND ORTHOTICS IN CANADA

INTRODUCTION The Canadian Survey on Disability reported about 3.8 million Canadians between 15 and 64 years lived with a disability in 20121, and more than 80% used an assistive device. Innovation, research, and unrestricted access to knowledge in prosthetics and orthotics is vital to improve a person’s quality of life, removing barriers, and integrating people with functional and mobility limitations into their society. Therefore, this study examined trends in prosthetics and orthotics research in Canada. Abstract PDF&nbsp; Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32027/24444 How to cite:&nbsp;Gholizadeh H , Ale Ebrahim N, Eshraghi A, Lemaire E.D. RESEARCH PRODUCTIVITY TRENDS IN PROSTHETICS AND ORTHOTICS IN CANADA. CANADIAN PROSTHETICS &amp; ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018.&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee.&nbsp; http://www.aopanet.org

The Effects of Suction and Pin/Lock Suspension Systems on Transtibial Amputees’ Gait Performance

<div><p>Background</p><p>The suction sockets that are commonly prescribed for transtibial amputees are believed to provide a better suspension than the pin/lock systems. Nevertheless, their effect on amputees’ gait performance has not yet been fully investigated. The main intention of this study was to understand the potential effects of the Seal-in (suction) and the Dermo (pin/lock) suspension systems on amputees’ gait performance.</p><p>Methodology/Principal Findings</p><p>Ten unilateral transtibial amputees participated in this prospective study, and two prostheses were fabricated for each of them. A three-dimensional motion analysis system was used to evaluate the temporal-spatial, kinematics and kinetics variables during normal walking. We also asked the participants to complete some part of Prosthesis Evaluation Questionnaire (PEQ) regarding their satisfaction and problems with both systems. The results revealed that there was more symmetry in temporal-spatial parameters between the prosthetic and sound limbs using the suction system. However, the difference between two systems was not significant (<i>p</i><0.05). Evaluation of kinetic data and the subjects’ feedback showed that the participants had more confidence using the suction socket and the sockets were more fit for walking. Nevertheless, the participants had more complaints with this system due to the difficulty in donning and doffing.</p><p>Conclusion</p><p>It can be concluded that even though the suction socket could create better suspension, fit, and gait performance, overall satisfaction was higher with the pin/lock system due to easy donning and doffing of the prosthesis.</p><p>Trial Registration</p><p>irct.ir <a href="http://www.irct.ir/searchresult.php?id==16395&number==1" target="_blank">IRCT2014012816395N1</a></p></div

Gait Performance of Friction-Based Prosthetic Knee Joint Swing-Phase Controllers in Under-Resourced Settings

Gait quality can influence walking ability and mobility outcomes making it an important part of prosthetic rehabilitation. Prosthetic knee joint designs can influence gait quality, and limited data exists to guide component selection in under-resourced settings. This study compared spatiotemporal and kinematic gait parameters for two common types of friction-based swing-phase controlled prosthetic knee joints. Two-dimensional optical gait analysis was conducted as part of a cross-over study design involving 17 individuals with unilateral transfemoral amputations. Two prosthetic knee joints were compared. One utilized constant-friction (CF) and the other a variable cadence controller (VCC) for swing-phase control. Gait was analyzed at normal and fast walking speeds. Primary gait parameters included swing-phase time, step length, and knee flexion. Swing-phase time and peak knee flexion angles, as well as their related symmetry indices, were lower for the VCC compared to the CF (p &lt; 0.01), by 11.1 to 94.1%. The VCC resulted in faster walking speeds by approximately 15% compared to the CF (p = 0.002). Friction-based swing-phase knee control mechanisms can facilitate an appropriate and cost-effective prosthetic knee joint solution in under-resourced settings. The findings suggest that friction-based mechanism can be designed to improve gait quality, and in turn overall walking performance

Gait Performance of Friction-Based Prosthetic Knee Joint Swing-Phase Controllers in Under-Resourced Settings

Gait quality can influence walking ability and mobility outcomes making it an important part of prosthetic rehabilitation. Prosthetic knee joint designs can influence gait quality, and limited data exists to guide component selection in under-resourced settings. This study compared spatiotemporal and kinematic gait parameters for two common types of friction-based swing-phase controlled prosthetic knee joints. Two-dimensional optical gait analysis was conducted as part of a cross-over study design involving 17 individuals with unilateral transfemoral amputations. Two prosthetic knee joints were compared. One utilized constant-friction (CF) and the other a variable cadence controller (VCC) for swing-phase control. Gait was analyzed at normal and fast walking speeds. Primary gait parameters included swing-phase time, step length, and knee flexion. Swing-phase time and peak knee flexion angles, as well as their related symmetry indices, were lower for the VCC compared to the CF (p &lt; 0.01), by 11.1 to 94.1%. The VCC resulted in faster walking speeds by approximately 15% compared to the CF (p = 0.002). Friction-based swing-phase knee control mechanisms can facilitate an appropriate and cost-effective prosthetic knee joint solution in under-resourced settings. The findings suggest that friction-based mechanism can be designed to improve gait quality, and in turn overall walking performance