Background:

Knee-ankle-foot orthoses are utilized for walking by patients with lower limb weakness. However, they may be rejected by patients due to the lack of knee flexion available when using them for walking activities.

Aim:

The aim of this study was to perform a pilot study investigating the effect of a new powered knee-ankle-foot orthosis on walking in healthy persons before testing with patients with lower limb weakness.

Methods:

Walking evaluation was performed on five healthy subjects (mean age: 26 ± 5.6 years). Walking trials were randomly performed in three test conditions: normal walking without an orthosis, walking with a conventional knee-ankle-foot orthosis unilaterally, and also with a new powered knee-ankle-foot orthosis applied to the same leg.

Results:

The means of walking speed, cadence, and knee flexion during swing and step length were all decreased. Compensatory motions were increased by both orthoses compared to normal walking. More knee flexion was observed in both swing and stance phases when walking with the powered knee-ankle-foot orthosis compared to the conventional knee-ankle-foot orthosis.

Conclusion:

The results demonstrated the potential of a powered orthosis in providing improvements in gait parameters compared to a conventional device in healthy subjects but are yet untested in subjects with lower limb weakness.Clinical relevanceThe results of this study demonstrated that a powered knee-ankle-foot orthosis could lock the knee during stance and provide active knee flexion during swing to potentially reduce the tripping during ambulation.

Background:

The Orthotics and Prosthetics Users' Survey consists of five modules to assess outcomes of orthotic and prosthetic interventions: lower extremity functional status, upper extremity functional status, client satisfaction with device, client satisfaction with services and health-related quality of life.

Objectives:

To investigate the test-retest reliability and calculate the smallest detectable difference for all modules of the Swedish Orthotics and Prosthetics Users' Survey.

Study design:

Test-retest reliability study design.

Methods:

A total of 69 patients at a Department of Prosthetics and Orthotics completed Orthotics and Prosthetics Users' Survey on two occasions separated by a 2-week interval, giving 18 answers on lower extremity functional status, 41 on upper extremity functional status, 53 on client satisfaction with device, 12 on client satisfaction with services and 67 answers on health-related quality of life. Raw scores were converted into Orthotics and Prosthetics Users' Survey units on a 0-100 scale. Intra-class correlation coefficients, Bland-Altman plots, common person linking plots and t-tests of person mean measures were used to investigate the reliability. The 95% confidence level smallest detectable differences were calculated.

Results:

The intra-class correlation coefficients ranged from 0.77 to 0.96 for the modules, and no systematic differences were detected between the response occasions. The smallest detectable differences ranged from 7.4 to 16.6 units.

Conclusions:

The test-retest reliability was satisfactory for all Orthotics and Prosthetics Users' Survey modules. The smallest detectable difference was large on all modules except the health-related quality of life module.Clinical relevanceThe Orthotics and Prosthetics Users' Survey modules are reliable and, thus, can be recommended for repeated measurements of patients over time. Relatively large changes are needed to achieve statistical significance when assessing individual patients.

Background and aim:Mid-facial defect is one of the most disfiguring and impairing defects. A design of prosthesis that is aesthetic and stable can be precious to a patient who has lost part of his face due to surgical excision. Prosthesis can restore the patients' self-esteem and confidence, which affects the patients and their life style. The aim of this case report is to describe a technique of mid-facial silicone prosthesis fabrication.Technique:To provide an aesthetic and stable facial prosthesis, the extra-oral prosthesis was fabricated using silicone material, while the intra-oral defect was restored with obturator prosthesis, and then both prostheses were connected and attached to each other using magnets.Discussion:This clinical report describes the rehabilitation of a large mid-facial defect with a two-piece prosthesis. The silicone facial prosthesis was made hollow and lighter by using an acrylic framework. Two acrylic channels were included within the facial prosthesis to provide the patient with clean and patent airways.Clinical relevanceA sectional mid-facial prosthesis was made and retained in place by using magnets, which resulted in a significant improvement in the aesthetical and functional outcome without the need for plastic surgery. Silicone prostheses are reliable alternatives to surgery and should be considered in selected cases.

Background:

The incidence of foot amputations increased in the Netherlands to 3.3/100,000 people up to 1994. Despite these numbers, only a few basic prosthetic and orthotic devices are available, and all lack functionality to restore ankle and foot mobility.

Objectives:

The aim of this explorative study was to design and test a unique prosthesis for Syme or Pirogoff amputees with the necessary low installation height but restoring ankle and foot mobility.

Study design:

A case study was performed.

Methods:

The new prosthesis was designed and numerically analyzed on aspects concerning strength and deformation. A prototype was tested in a case study to assess the biomechanical behavior of the new foot. As a reference, six Syme/Pirogoff amputees were measured. Additionally, all volunteers filled out a questionnaire to evaluate their prosthetic feet.

Results:

The self-selected and maximum walking speed of the case subject at 0° and 5° slopes was higher using the new foot (0.36 m/s and 0.53 m/s, respectively) comparing to the Low Rider (Otto Bock HealthCare) (0.31 m/s and 0.31 m/s, respectively). Using the new foot, a more symmetrical walking pattern was achieved.

Conclusion:

The case study shows that this new prosthetic foot could be an improvement compared to existing prosthetic feet.Clinical relevanceFoot amputees with low available installation height still experience daily the inconvenience of missing ankle and foot mobility. Their low velocity and cosmetically poor walking pattern influence on their sound leg and overall walking functionality. A more functional prosthesis would have a great impact on their daily activities.

Background and aim:Turning is an inherent problem in all lower limb amputees and more so in older dysvascular amputees. This study aimed to compare the turning performance of dysvascular amputees with that of the traumatic amputees.Technique:Six dysvascular transtibial amputees (69.83 ± 6.3 years) and six traumatic transtibial amputees (68.3 ± 6.6 years) completed the Step Quick Turn test of the NeuroCom(®) Balance Master and the Timed Up and Go Test. The measures used for comparison were as follows: turn time and turn sway of Step Quick Turn test, turning 180° to both the prosthetic and sound side and time taken to complete the Timed Up and Go Test.Discussion:The Mann-Whitney U test demonstrated a significant difference (p < 0.05) between the dysvascular and traumatic groups in turn sway to the prosthetic (70.7 ± 14.2 and 43.3 ± 9.7) and sound sides (72.5 ± 16.1 and 43.5 ± 8.2). Similar results were observed in turn time to the prosthetic (4.1 ± 1.4 and 1.7 ± 0.46) and sound sides (4.0 ± 1.3 and 2.1 ± 0.5). No significant difference was observed for the Timed Up and Go Test.Clinical relevanceThe observed differences suggest that dysvascular amputees are less able to adapt to the challenges associated with turning. More attention is required in the rehabilitation of dysvascular amputees in turning tasks particularly towards the prosthetic side.

Background and aim:To our knowledge, the technique of molding orthoses to the non-load-bearing foot is still not widely investigated. The aim of this work is, therefore, first, to describe an off-loading custom-made technique and, second, to explain how it can be specifically adapted to treat Sever's disease.Techniques:A technique of directly molding orthoses to the non-load-bearing foot by vacuum forming an insole to the foot fabricated with a combination of polyvinyl chloride and polyester resins, 30 Shore A hardness and 148 kg/m(3) density polyethylene-ethylene-vinyl-alcohol, and a cushioning heel cup of 22 Shore A polyurethane, using a directly molding orthoses technique to the non-load-bearing foot by vacuum.Discussion:Results show that this new technique could be a good alternative to traditional insoles in the management of Sever's disease pain.Clinical relevanceManufacturing the insole directly on the patient's foot could lead to a better individual adaptation in general, and to manage Sever's pain disease in particular.

Background:

We report our experiences of prosthetic fitting in quadruple amputees. Two patients underwent quadruple amputation after suffering from disseminated intravascular coagulation in conjunction with pneumococcemia with purpura fulminans.Case description and methods:The first patient, a 52-year-old man, underwent bilateral transradial, left transtibial, and right transfemoral amputation, and the second patient, a 62-year-old man, underwent bilateral transradial and bilateral transfemoral amputation, both for symmetrical peripheral gangrene subsequent to septic shock.Findings and outcomes:The amputations were accompanied by skin damage due to ischemic tissue changes both on the stumps and on the nose and/or lips. The combination of the intensive prosthetic rehabilitation program and supportive medical care led to completely independent functioning, including driving a car, with the use of four prosthetic limbs and a wheelchair in both cases.

Conclusion:

Early initiation of a multidisciplinary approach can properly address impairments and minimize future disability.Clinical relevanceWe have reported our experience of limb fitting in two patients who had undergone quadruple amputation after suffering peripheral gangrene. Appropriate limb fitting that provides support in daily activities can address impairments and minimize disability.

Background:

Technological advances in prosthetic design include the use of microprocessors that adapt device performance based on user motion. The Proprio ankle unit prepositions the foot to adjust for walking on slopes and increases foot clearance during swing to minimize gait deviations.

Study design:

Comparative analysis.

Objectives:

To investigate the effect of a prosthesis with adaptive ankle motion on physiological gait performance during slope walking.

Methods:

Six persons with a unilateral transtibial amputation completed treadmill walking tests at three slopes (-5°, 0°, and 5°). The participants were tested wearing a customary device, active Proprio (Pon), and an identical inactivated Proprio (Poff).

Results:

Metabolic energy expenditure, energy cost for walking, and rating of walking difficulty were not statistically different between the Pon and Poff for all tested slopes. However, for slope descent, energy expenditure and energy cost for walking improved significantly by an average of 10%-14% for both the Pon and Poff compared to the customary limb. Rating of walking difficulty also showed an improvement with slope descent for both the Pon and Poff compared to the customary device. An improvement with slope ascent was found for Pon compared to the customary limb only.

Conclusions:

Adaptive ankle motion provided no meaningful physiological benefit during slope walking. The Proprio was, however, less demanding than the customary device for slope descent. Differences in the mechanical properties of the prosthetic feet likely contributed to the changes.Clinical relevanceWhile the adaptive ankle motion did not affect metabolic energy expenditure or energy cost for walking, the results suggest close attention should be paid to the mechanical properties of the foot component. Assessment of gait on nonlevel surfaces is recommended to better understand the implications of different prosthetic design features.