Systematic review of studies examining transtibial prosthetic socket pressures with changes in device alignment

Suitable lower-limb prosthetic sockets must provide an adequate distribution of the pressures created from standing and ambulation. A systematic search for articles reporting socket pressure changes in response to device alignment perturbation was carried out, identifying 11 studies. These were then evaluated using the American Academy of Orthotists and Prosthetists guidelines for a state-of-the-science review. Each study used a design where participants acted as their own controls. Results were available for 52 individuals and 5 forms of alignment perturbation. Four studies were rated as having moderate internal and external validity, the remainder were considered to have low validity. Significant limitations in study design, reporting quality and in representation of results and the suitability of calculations of statistical significance were evident across articles. Despite the high inhomogeneity of study designs, moderate evidence supports repeatable changes in pressure distribution for specific induced changes in component alignment. However, there also appears to be a significant individual component to alignment responses. Future studies should aim to include greater detail in the presentation of results to better support later meta-analyses

Pilot study : data-capturing consistency of two trans-tibial casting concepts, using a manikin stump model: a comparison between the hands-on PTB and hands-off ICECAST compact™ concepts

The quality of fit of a trans-tibial patellar tendon bearing (PTB) socket may be influenced by consistency in casting, rectification or alignment. For this study two distinctive different data-capturing concepts were tested in relation to prosthetist performance. The hands-on PTB and hands-off ICECAST compact® concept were studied and compared for inter- and intraprosthetist consistency using a specially designed manikin stump model. A purpose designed digitiser was used to scan a selected surface area of the produced models, 5 for each concept, 10 in total. The extent of casting consistency at each of 936 locations per plaster model was calculated and the level of consistency was quantified. This study has shown that by using the manikin model there is a clear indication that the investigated hands-off concept produces more consistent results than the hands-on concept