Background:

Positive adjustments to amputation and an artificial limb play important roles in the rehabilitation process.

Objectives:

To study the different facets of adjustments to amputation and an artificial limb in lower limb amputees and to assess the possible role of different background and amputation-related factors that could potentially influence these adjustments.

Study design:

Cross-sectional.

Methods:

Adult unilateral and non-congenital lower limb amputees (n = 368) met the inclusion/exclusion criteria. Face-to-face interviews were conducted using structured questionnaires including patient's background, amputation and the Trinity Amputation and Prosthesis Experience Scales.

Results:

Amputees were on average satisfied with the functioning of the prosthesis, moderately psychosocially adjusted and not restricted in performing functional and social activities, except for athletic activities. Age, employment, daily use of prosthesis and assistive device use were the most important factors associated with adjustments to amputation and prosthesis, followed by gender, co-morbidity and amputation level.

Conclusions:

Evaluation of employment status and measures to curb unemployment through vocational rehabilitation and providing assistance for placement should be intrinsic to the rehabilitation programme. Future studies are envisaged to understand the underlying factors determining the extent of daily use of prosthesis and the reasons for the use of assistive devices by the amputees.Clinical relevanceProper appraisal and measures to alleviate employment and co-morbidity, related issues, routine evaluation of daily use of prosthesis and providing appropriate gait training might facilitate immediate and long-term adjustment.

Background:

In patients with amyotrophic lateral sclerosis, the atrophy of hand muscles often causes impairment of thumb/finger motion and disabilities in their activities of daily living. Hand orthoses are effective for such impairment and disabilities; however, there are some difficulties in their application.Case description and methods:In this case report, we present the timely application of hand orthoses and introduce our clinical algorithm for the application of hand orthoses to patients with amyotrophic lateral sclerosis.Findings and outcomes:Our clinical algorithm was applied to 11 patients. The numbers of applications and the durations of the use of orthoses were as follows: 4, web spacer; 4, short thumb spica; 8, long thumb spica; and 2, cock-up splint; and 2.75, 2.0, 0.63, and 2.0 months, respectively.

Conclusions:

The clinical algorithm for the application of hand orthoses is helpful in choosing the optimal orthoses and contributes to maximizing patients' function, independence, and quality of life.Clinical relevanceHand orthoses are useful for improving the activities of daily living of patients with amyotrophic lateral sclerosis. The clinical algorithm might be helpful for many physicians in choosing the optimal orthoses in a timely manner.

Background:

Kinetic data provide important information about the mobility performance of individuals with lower limb impairments and their assistive devices; however, there is limited understanding of this in real-life environments.

Objective:

To evaluate the effect of real-life irregular surfaces on forces and moments in knee-ankle-foot orthoses.

Methods:

In this case series study, a load cell was used to measure the forces and moments at the knee joint of knee-ankle-foot orthoses of individuals with unilateral muscle weakness as a result of poliomyelitis while walking on different ground surfaces and at different speeds.

Results:

Significantly higher shear forces and external peak knee flexion moments were found when walking on irregular surfaces. In individual cases, certain irregular ground conditions elicited large increases in peak flexion moments (>50%) when compared to walking on smooth level ground. Forces and moments were significantly higher at faster walking speeds.

Conclusions:

Higher external peak knee flexion moments during the stance phase suggest that greater demands for support and stability are placed on individuals and their assistive devices when negotiating real-life ground surfaces.Clinical relevanceThis study demonstrates that walking on irregular surfaces alters the loads placed on knee-ankle-foot orthoses and that the requirements for knee stabilization increase. This has important clinical implications on the design, prescription, and use of such devices given the structural and functional demands placed on them.

Background:

Cosmetic gloves that cover a prosthetic hand have a parasitic positive stiffness that counteracts the flexion of a finger joint.

Objectives:

Reducing the required input torque to move a finger of a prosthetic hand by compensating the parasitic stiffness of the cosmetic glove.

Study design:

Experimental, test bench.

Methods:

The parasitic positive stiffness and the required input torques of a polyvinyl chloride glove and a silicone glove were measured when flexing a metacarpophalangeal finger joint for 90°. To compensate this positive stiffness, an adjustable compensation mechanism with a negative stiffness was designed and built. A MATLAB model was created to predict the optimal settings of the mechanism, based on the measured stiffness, in order to minimize the required input torque of the total system. The mechanism was tested in its optimal setting with an applied glove.

Results:

The mechanism reduced the required input torque by 58% for the polyvinyl chloride glove and by 52% for the silicone glove. The total energy dissipation of the joint did not change significantly.

Conclusions:

This study shows that the undesired positive stiffness in the joint can be compensated with a relatively simple negative stiffness mechanism, which fits inside a finger of a standard cosmetic glove.Clinical relevanceThis study presents a mechanism that compensates the undesired stiffness of cosmetic gloves on prosthetic hands. As a result, it requires less input force, torque and energy to move the fingers. Application of this mechanism in body-powered hands will reduce the control effort of the user.

Background:

Heel clearance and ankle status (free or locked) are of major determinants affecting peak plantar pressures and contact area in patellar tendon bearing brace and have been separately studied by many researchers. This study investigated the combined effect of ankle status and heel clearance on contact area and peak plantar pressure in different areas of foot (hindfoot, midfoot, and forefoot).

Study design:

Before-after repeated measurement trial.

Methods:

Nine healthy male volunteers walked 8 m with normal shoe and four conditions of patellar tendon bearing brace wear. Repeated-measure analysis of variance test was used to compare contact area and plantar pressure changes in three areas of the foot.

Results:

Application of patellar tendon bearing brace significantly reduced overall plantar pressure and contact area (p < 0.01). Although both contact area and plantar pressure significantly decreased in hindfoot and midfoot, plantar pressure increased in forefoot area (p < 0.05).

Conclusions:

Application of the patellar tendon bearing brace can reduce the overall peak plantar pressure in the foot but increases focal plantar pressure in forefoot. Excessive lifting of the heel seems to minimize the contact area, thus increase focal pressure in forefoot. Overall, plantar pressure seems to be more effectively off-loaded by combining maximum heel clearance and restriction of the ankle joint.Clinical relevanceAlthough effective parameters of patellar tendon bearing brace have been separately addressed in previous studies, no study was found that investigated the combined effect of ankle status and heel clearance. This study investigates the combined effect of these parameters and provides detailed information on clinical application of the patellar tendon bearing brace.

Background:

Contractures of Achilles tendons and gastrocnemius muscle deteriorate the performance in daily living activities of patients with neuromuscular diseases. Ankle-foot orthoses help to prevent the progression of deformities and to obtain optimal position of the joints to support standing and walking.

Objective:

To investigate the relationship between orthotic usage and functional activities in pediatric patients with different neuromuscular diseases.

Study design:

Retrospective study.

Methods:

A total of 127 subjects' physical assessment forms were analyzed. Functional level, type of orthoses, falling frequencies, ankle joint range of motion, and timed performance tests were examined in two consecutive dates with an interval of 3 months.

Results:

A total of 91 patients were using orthoses while 36 patients were not within assessment dates. A total of 64 of 91 (70.3%) patients were diagnosed with Duchenne muscular dystrophy. A total of 81 (89.0%) subjects were using plastic ankle-foot orthoses for positioning at nights and 10 (11%) were using different types of the orthoses (knee-ankle-foot orthoses, dynamic ankle-foot orthoses, and so on) for gait in the study group.

Conclusions:

Night ankle-foot orthoses were not found to be effective directly on functional performance in children with neuromuscular diseases, although they protect ankle from contractures and may help to correct gait and balance.Clinical relevanceThis retrospective study shows that the positive effects of using an ankle-foot orthosis at night are not reflected in the functional performance of children with neuromuscular diseases. This may be due to the progressive deteriorating nature of the disease.

Background:

It is clinically known that shape is important when selecting or designing a wheelchair support surface for the prevention of pressure ulcers (a £2 billion annual cost to the National Health Service, UK); however, the effect of different levels of shape contouring has not been adequately studied.

Objectives:

To investigate the effect of seat shape on the risk of pressure ulcers using discomfort and interface pressure measurements.

Study design:

Randomised, repeated trial.

Methods:

Thirty able-bodied participants sat with restricted movement for 30 min in three sessions to evaluate two cushion shapes against a flat baseline surface. Visual Analog Scaling and pressure mapping were used to measure surrogates for pressure ulcer risk, discomfort and interface pressures, respectively.

Results:

Linear regression revealed a reduction in discomfort (p < 0.05) on the custom contoured shapes. Interface pressures measured were also lower (p < 0.05) on the custom contoured shapes, and a negative Pearson's correlation (p < 0.05) indicated an association between smaller hip widths and increased discomfort for the commercially shaped cushion.

Conclusions:

The results of this study confirm that custom contoured shapes were effective at reducing pressure ulcer surrogate measures in the participants of this study and therefore suggests that the contribution of a cushion's three-dimensional contours on pressure ulcer risk should be further researched.Clinical relevanceThe measurement of seat shape, discomfort and interface pressure in surrogate participants can help inform the design of wheelchair seating for individuals who are insensate or otherwise at risk of developing pressure ulcers. This knowledge can now be implemented using modern three-dimensional shape acquisition, analysis and fabrication technologies.

Background and aim:Patients with mild to moderate first carpometacarpal joint osteoarthritis report pain, a reduction in pinch and grip strength and hand function. The purpose of this study was to analyze the effect of a custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization on pain, function, grip strength, and key pinch in these patients.Technique:A total of 11 volunteer patients participated in this study. All the above-mentioned parameters were evaluated at baseline and also 30, 60, and 90 days after using the splint.Discussion:A decrease in pain was observed after 30 days, and this continued to improve during treatment with the splint. After 90 days of using the splint, grip strength was improved. Function and pinch strength also increased significantly and was maintained during the study period compared to baseline.Clinical relevanceA custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization may be a suitable conservative approach for the treatment of first carpometacarpal joint osteoarthritis.

Background:

Traditionally, clinical protocols for the treatment of young children who require a knee prosthesis have favored stability, with the prosthetic knee locked into full extension until after the child has learned to walk. Recently, an Early Knee protocol has been investigated, in which children receive an articulating knee in their first prosthesis and use it while learning to crawl and walk.

Objectives:

This study investigated the presence of swing phase clearance adaptations in the walking gait of seven young children aged 18-92 months, who had been fitted according to the Early Knee protocol.

Study design:

Before-and-after experimental design.

Methods:

Each subject completed walking trials with the knee freely flexing and trials with the knee locked into full extension to mimic a traditional knee protocol.

Results:

Subjects utilized the articulating knee in walking, with an average of 70.4° of peak swing phase knee flexion. Some clearance adaptations were present with the flexing knee; more were present and their magnitude was increased when the knee was locked. In particular, there was a statistically significant increase in circumduction.

Conclusions:

These results suggest that the Early Knee protocol can reduce the adoption of clearance adaptations while walking is developing.Clinical relevanceTreatment of young children who require a knee prosthesis is inconsistent. Traditionally, no knee is provided until independent walking is achieved. A newer Early Knee protocol provides an articulating knee in the first prosthesis. This study found that children use the articulating knee in walking and develop fewer clearance adaptations.

Background:

Persons with amputation and residual limb wounds would benefit from the ability to continue wearing a prosthesis while healing. Sockets with vacuum-assisted suspension may reduce intra-socket motion and be less disruptive to wound healing. The purpose of this case series was to measure residual limb wound size over time in persons with transtibial amputation while using prostheses with vacuum-assisted suspension.Case description and methods:Six subjects with residual limb wounds were fit with vacuum-assisted suspension sockets. Wound surface area was calculated using ImageJ software at the time of fit and each subsequent visit until closure.Findings and outcome:Average wound surface area at initial measurement was 2.17 ± 0.65 cm(2). All subjects were instructed to continue their normal activity level while wounds healed, with a mean of 177.6 ± 113 days to wound closure.

Conclusion:

Results suggest that well-fitting sockets with vacuum-assisted suspension in compliant individuals did not preclude wound healing. Further research is required to substantiate these case-based observations.Clinical relevanceResidual limb wounds are typically treated by suspension of prosthetic use until healing occurs, increasing the risk of long-term prosthesis nonuse. Our results suggest that vacuum-assisted suspension sockets may be used while healing occurs.