A scoping review of digital fabrication techniques applied to prosthetics and orthotics: Part 1 of 2—Prosthetics

Background: Traditionally, the manufacture of prostheses is time-consuming and labor-intensive. One possible route to improving access and quality of these devices is the digitalizing of the fabrication process, which may reduce the burden of manual labor and bring the potential for automation that could help unblock access to assistive technologies globally. Objectives: To identify where there are gaps in the literature that are creating barriers to decision-making on either appropriate uptake by clinical teams or on the needed next steps in research that mean these technologies can continue on a pathway to maturity. Study design: Scoping literature review. Methods: A comprehensive search was completed in the following databases: Allied and Complementary Medicine Database, MEDLINE, Embase, Global Health Archive, CINAHL Plus, Cochrane Library, Web of Science, Association for Computing Machinery, Institute of Electrical and Electronics Engineers, and Engineering Village, resulting in 3487 articles to be screened. Results: After screening, 130 lower limb prosthetic articles and 117 upper limb prosthetic articles were included in this review. Multiple limitations in the literature were identified, particularly a lack of long-term, larger-scale studies; research into the training requirements for these technologies and the necessary rectification processes; and a high range of variance of production workflows and materials which makes drawing conclusions difficult. Conclusions: These limitations create a barrier to adequate evidence-based decision-making for clinicians, technology developers, and wider policymakers. Increased collaboration between academia, industry, and clinical teams across more of the pathway to market for new technologies could be a route to addressing these gaps

Prosthetist/Orthotist Educational Experience & Professional Development in Pakistan

PURPOSE: To explore areas in which the education at the Pakistan Institute of Prosthetic & Orthotic Science (PIPOS) could be improved or supplemented to facilitate clinical practice of graduates. To describe educational opportunities PIPOS graduates have had since their graduation and explore their further educational needs. METHOD: 15 graduates from PIPOS participated in semi-structured interviews. A qualitative content analysis was applied to the transcripts. FINDINGS: Respondents indicated a need to upgrade the education at PIPOS. This should include upgrading of resources such as literature and internet access as well as providing staff with the opportunity to further their own education. Females experienced inequality throughout their education but were supported by management. Upon entering the workforce graduates reported that they were supported by senior staff but experienced difficulties in determining appropriate prescriptions. They further indicated that a multidisciplinary approach to patient care is lacking. Graduates knowledge of workshop management was identified as a problem when entering the workforce. Limited awareness of the prosthetics and orthotics profession by both the general community and the medical community was also identified as a problem. If offered the opportunity to continue their studies the respondents would like to specialize. "Brain drain" was noted as a risk associated with post graduate education. Interaction from international collaborators and networking within the country was desired. CONCLUSION: The education at PIPOS meets a need in the country. Graduates indicated that P&O services for Pakistan can be better provided by modifying program content, upgrading teachers' knowledge, improving access to information and addressing issues of gender equality. PIPOS graduates have had limited opportunities for professional development and have a desire for further education

A model to facilitate implementation of the International Classification of Functioning, Disability and Health into prosthetics and orthotics

BACKGROUND: The International Classification of Functioning, Disability and Health is a classification of human functioning and disability and is based on a biopsychosocial model of health. As such, International Classification of Functioning, Disability and Health seems suitable as a basis for constructing models defining the clinical P&O process. The aim was to use International Classification of Functioning, Disability and Health to facilitate development of such a model. Proposed model: A model, the Prosthetic and Orthotic Process (POP) model, is proposed. The Prosthetic and Orthotic Process model is based on the concepts of the International Classification of Functioning, Disability and Health and comprises four steps in a cycle: (1) Assessment, including the medical history and physical examination of the patient. (2) Goals, specified on four levels including those related to participation, activity, body functions and structures and technical requirements of the device. (3) Intervention, in which the appropriate course of action is determined based on the specified goal and evidence-based practice. (4) Evaluation of outcomes, where the outcomes are assessed and compared to the corresponding goals. After the evaluation of goal fulfilment, the first cycle in the process is complete, and a broad evaluation is now made including overriding questions about the patient's satisfaction with the outcomes and the process. This evaluation will determine if the process should be ended or if another cycle in the process should be initiated. CONCLUSION: The Prosthetic and Orthotic Process model can provide a common understanding of the P&O process. Concepts of International Classification of Functioning, Disability and Health have been incorporated into the model to facilitate communication with other rehabilitation professionals and encourage a holistic and patient-centred approach in clinical practice. Clinical relevance The Prosthetic and Orthotic Process model can support the implementation of International Classification of Functioning, Disability and Health in P&O practice, thereby providing a common understanding of the P&O process and a common language to facilitate communication with other rehabilitation professionals

Malawian prosthetic and orthotic users' mobility and satisfaction with their lower limb assistive device

OBJECTIVE: To investigate patients’ mobility and satisfaction with their lower limb prosthetic or orthotic device and related service delivery in Malawi and to compare groups of patients regarding type and level of device and demographics. METHODS: Questionnaires were used to collect self-report data from 83 patients. RESULTS: Ninety percent of prostheses or orthoses were in use by patients, but approximately half of these needed repair. Thirty-nine percent reported pain when using their assistive device. The majority of patients were able to rise from a chair (77%), move around the home (80%), walk on uneven ground (59%) and travel by bus or car (56%). However, patients had difficulties walking up and down hills (78%) and stairs (60%). In general, patients were quite satisfied with their assistive device (mean of 3.9 out of 5) and very satisfied with the service provided (mean of 4.4 out of 5). Access to repairs and servicing were rated as most important, followed by durability and follow-up services. Lack of finances to pay for transport was a barrier to accessing the prosthetic and orthotic centre. CONCLUSION: Patients were satisfied with the assistive device and service received, despite reporting pain associated with use of the device and difficulties ambulating on challenging surfaces

Bilateral electromyogram response latency following platform perturbation in unilateral transtibial prosthesis users : Influence of weight distribution and limb position

Appropriate muscular response following an external perturbation is essential inpreventing falls. Transtibial prosthesis users lack a foot-ankle complex and associatedsensorimotor structures on the side with a prosthesis. Its effect on rapid responses ofthe lower-extremity to external surface perturbations is unknown. The aim of thepresent study was to compare electromyographic (EMG) response latencies of otherwisehealthy unilateral transtibial prosthesis users (n=23, mean age 48 years [standarddeviation 14]) and a matched control group (n=23, mean age 48 years [standard deviation13]) following sudden support surface rotations in the pitch plane (toes-up and toesdown).Perturbations were elicited in various weight-bearing and limb-perturbedconditions. The results indicated that transtibial prosthesis users have delayed responsesof multiple muscles of the lower-extremity following perturbation, both in the intact limband the residual limb. Weight-bearing had no influence on the response latency in theresidual limb, but did on the intact limb. Which limb received the perturbation wasfound to influence the muscular response, with the intact limb showing a significantlydelayed response when the perturbation was received only on the side with a prosthesis.These delayed responses may represent an increased risk of falling for individuals thatuse a transtibial prosthesis