Assessment of localized pain sensitivity over the transtibial residual limb and its variability among male veterans with amputation

Localization of pain sensitization has clinical importance, however, rarely been assessed in amputees. The objective of this study was to investigate the sensitivity of pain over the residual limb and its variability among veterans with transtibial amputation. Pain sensitivity in 12 locations was explored twice in 19 veteran amputees using pressure algometry. The lowest pressure pain threshold (PPT) and pressure tolerance (PT) was recorded at the distal end of the residual limb (20.5 and 33 Ncm⁻², p=0.13), and the highest PPT and PT was recorded at the mid-patellar tendon (73.4 and 94.3 Ncm⁻², p=0.03). There was a significant moderate correlation (r=0.48-0.52) between pressure pain and daily hours of prosthesis use. A localized pattern for sensitivity to pain over the transtibial residual limb was obtained that can be used to improve the transtibial socket design and fit as well as the selection of prevention, evaluation, and treatment methods

The prototype of a thermoregulatory system for measurement and control of temperature inside prosthetic socket

Thermal related problems with prostheses are common complaints of amputee people. This article aims to introduce a thermoregulatory technique as a potential solution for those problems in prostheses wearers. A smart thermoregulatory system was designed, manufactured, and installed on a phantom model of a prosthetic socket. It captured temperature data from 16 sensors positioned at the interface between the phantom model and a silicone liner and used their average for comparison with a defined set temperature to select required heating or cooling functions for thermal equilibrium. A thin layer of Aluminum was used to transfer temperature between thermal pump and different sites around the phantom model. The feasibility of this thermoregulatory technique was confirmed by its ability to provide thermal equilibrium. Further investigations to improve the design of thermoregulatory system are necessary including temperature transfer element and power consumption based on thermal capacity and thermal inertia of the residual limb. The smart thermoregulatory system by providing thermal equilibrium between two sides of a prosthetic silicone liner can control residual limb skin temperature and sweating. Consequently, it can improve quality of life in amputee people.N/

Long-term locked knee ankle foot orthosis use: A perspective overview of iatrogenic biomechanical and physiological perils

A knee ankle foot orthosis (KAFO) may be prescribed to the person with severe neuromusculoskeletal impairment of the lower limb to promote walking stability. The locked knee ankle foot orthosis (L-KAFO) is among the KAFO's routinely prescribed; however, long-term use of the L-KAFO is associated with musculoskeletal (arthrogenic and myogenic) and integumentary changes, and gait asymmetry with increased energy expenditure. Consequently, the risk of developing low back pain, osteoarthritis of the lower limbs and spinal joints, skin dermatitis, and ulceration increases, all of which impact quality of life. This article synthesizes the iatrogenic biomechanical and physiological perils of long-term L-KAFO use. It promotes using recent advances in rehabilitation engineering to improve daily activities and independence for proper patient groups

Temperature measurement and control system for transtibial prostheses: single subject clinical evaluation.

The snug fit of a prosthetic socket over the residual limb can disturb thermal balance and put skin integrity in jeopardy by providing an unpleasant and infectious environment. The prototype of a temperature measurement and control (TM&C) system was previously introduced to resolve thermal problems related to prostheses. This study evaluates its clinical application in a setting with reversal, single subject design. The TM&C system was installed on a fabricated prosthetic socket of a man with unilateral transtibial amputation. Skin temperature of the residual limb without prosthesis at baseline and with prosthesis during rest and walking was evaluated. The thermal sense and thermal comfort of the participant were also evaluated. The results showed different skin temperature around the residual limb with a temperature decrease tendency from proximal to distal. The TM&C system decreased skin temperature rise after prosthesis wearing. The same situation occurred during walking, but the thermal power of the TM&C system was insufficient to overcome heat build-up in some regions of the residual limb. The participant reported no significant change of thermal sense and thermal comfort. Further investigations are warranted to examine thermography pattern of the residual limb, thermal sense, and thermal comfort in people with amputation.N/

Temperature measurement and control system for transtibial prostheses: functional evaluation.

The accumulation of heat inside the prosthetic socket increases skin temperature and fosters perspiration, which consequently leads to high tissue stress, friction blister, discomfort, unpleasant odor, and decreased prosthesis suspension and use. In the present study, the prototype of a temperature measurement and control (TM&C) system was designed, fabricated, and functionally evaluated in a phantom model of the transtibial prosthetic socket. The TM&C system was comprised of 12 thermistors divided equally into two groups that arranged internal and external to a prosthetic silicone liner. Its control system was programmed to select the required heating or cooling function of a thermal pump to provide thermal equilibrium based on the amount of temperature difference from a defined set temperature, or the amount of difference between the mean temperature recorded by inside and outside thermistors. A thin layer of aluminum was used for thermal conduction between the thermal pump and different sites around the silicone liner. The results showed functionality of the TM&C system for thermoregulation inside the prosthetic socket. However, enhancing the structure of this TM&C system, increasing its thermal power, and decreasing its weight and cost are main priorities before further development.The Hong Kong Polytechnic University supported all expenses of functional evaluation. Moreover, The ST&G Corporation, South Korea, has donated silicone liners for functional evaluation. The authors received no more support for conduction of this stud

Effects of Using the Vibratory Orthosis on Standing Balance in Patients With Parkinson ’s Disease

Objectives: The authors of this paper hypothesized that vibration stimulation applied by a vibratory orthosis improves balance in patients with Parkinson’s disease (PD). In this study we evaluate this hypothesis. Methods & Materials: Fourteen PD patients (12 male and 2 female) with mean age of 59.9±9.1 (±SD) years were participated in this cross- sectional study. Using Biodex balance system, the overall stability index in two conditions of eyes-open and eyes-close, each with two situations of motors On and motors Off of the vibratory orthosis were evaluated. Analysis of variance and paired t statistics were used separately to determine the existence of difference and to compare mean values of overall stability index in all four test situations. Results: Analysis of variance test showed a significant difference in mean values of overall stability index in all four test situations (P=0.000). The findings of the study showed that balance improved in all situations that compares eyes-open with eyes-close (P=0.000). Balance was better in eyes-open model with motors On rather than motors Off (P=0.013). In eyes-close model balance was lower inmotors On than that of motors Off (P=0.934). Conclusion: A new orthosis in rehabilitation of PD patients was introduced that can promote new ideas in orthotic design and application. Results showed that vibratory orthosis was effective in enhancing balance in PD patients in eyes-open condition. However, in eyes-close condition, we are not sure of its effectiveness

EVALUATION OF LOCALIZED PAIN IN THE TRANSTIBIAL RESIDUAL LIMB

PURPOSE The socket is the main component of a prosthesis which surrounds the residual limb and transfers loads and motions between the residual limb and prosthesis. A misfit socket may lead to excessive stresses on the residual limb, pistoning of the prosthesis during walking, patient discomfort, pain, and skin damage. The quality of socket-skin interface directly affects quality of life, prosthesis use, and satisfaction from prosthesis in amputees. Pain is a devastating condition that prohibits prosthesis use1-4. The present study aimed to evaluate pain threshold and tolerance of the transtibial residual limb to improve its socket design and fit.   Abstract PDF  Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32028/24445 How to cite: Ghoseiri K, Rastkhadiv M.Y, Allami M. EVALUATION OF LOCALIZED PAIN IN THE TRANSTIBIAL RESIDUAL LIMB. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32028                                                                          Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee.  http://www.aopanet.org

EVALUATION OF LOCALIZED PAIN IN THE TRANSTIBIAL RESIDUAL LIMB

PURPOSE The socket is the main component of a prosthesis which surrounds the residual limb and transfers loads and motions between the residual limb and prosthesis. A misfit socket may lead to excessive stresses on the residual limb, pistoning of the prosthesis during walking, patient discomfort, pain, and skin damage. The quality of socket-skin interface directly affects quality of life, prosthesis use, and satisfaction from prosthesis in amputees. Pain is a devastating condition that prohibits prosthesis use1-4. The present study aimed to evaluate pain threshold and tolerance of the transtibial residual limb to improve its socket design and fit.   Abstract PDF  Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32028/24445 How to cite: Ghoseiri K, Rastkhadiv M.Y, Allami M. EVALUATION OF LOCALIZED PAIN IN THE TRANSTIBIAL RESIDUAL LIMB. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32028                                                                          Abstracts were Peer-reviewed by the AOPA 2018 National Assembly Scientific Committee

Assessment of orthotic needs in Iranian veterans with ankle and foot disorders

Abstract Background War-related traumas can lead to orthopedic and neurological disorders in victims. However, the scope of such disorders may expand months or even years after the trauma. Orthotic treatment as a rehabilitation process aims to enable people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological, and social functional levels. This study aimed to investigate the rate of using orthoses among Iranian veterans with neuromuscular and skeletal disorders of the ankle and foot. Furthermore, the priorities of orthotic treatment in those veterans were explored. Methods This qualitative study was a national health needs assessment conducted in 11 provinces of Iran during 2011–2016. A stakeholder research group was established to survey the veterans in respect to their demographic variables, activities of daily living, current health conditions, and rate of using orthoses. Results Overall, 907 of the 1124 veteran participants completed the survey (response rate: 80.7%). Most of the veterans were men (97.7%), and their age and disability rate were 52.07 ± 8.13 years and 31.92% ± 14.93%, respectively. Nearly 42% of the veterans had experience in using orthoses on a daily and weekly basis. As physical ambulation was the main problematic activity in veterans, most of them were using medical shoes and foot orthoses. Nearly 37% of veterans were in need of some type of lower limb orthoses on the contralateral side to compensate for their hip inequality. In sequential order, the most in need orthoses for veterans were foot orthoses (n = 538), medical shoes (n = 447), lower limb orthoses on the contralateral side (n = 320), spinal orthoses (n = 273), and upper limb orthoses (n = 86). Conclusions In spite of the high demands for orthoses among Iranian veterans with ankle and foot disorders, the use of orthoses is insufficient. Hence, there is a discrepancy between the current rate of orthoses use and its ideal situation, and more resources should be provided for service providers to be able to serve veterans. Moreover, veterans should be educated regarding orthoses, their use, and their impacts on the user’s health status. The findings of a needs assessment of orthoses can be used in strategic planning and decision making to improve health care services for Iranian veterans

Assistive technologies for pain management in people with amputation: a literature review

Abstract The prevalence of limb amputation is increasing globally as a devastating experience that can physically and psychologically affect the lifestyle of a person. The residual limb pain and phantom limb pain are common disabling sequelae after amputation surgery. Assistive devices/technologies can be used to relieve pain in people with amputation. The existing assistive devices/technologies for pain management in people with amputation include electrical nerve block devices/technologies, TENS units, elastomeric pumps and catheters, residual limb covers, laser systems, myoelectric prostheses and virtual reality systems, etc. There is a great potential to design, fabricate, and manufacture some portable, wireless, smart, and thin devices/technologies to stimulate the spinal cord or peripheral nerves by electrical, thermal, mechanical, and pharmaceutical stimulus. Although some preliminary efforts have been done, more attention must be paid by researchers, clinicians, designers, engineers, and manufacturers to the post amputation pain and its treatment methods