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How does adding and removing liquid from socket bladders affect residual-limb fluid volume?

ABSTRACT: Adding and removing liquid from socket bladders is a means for people with limb loss to accommodate residual-limb volume change. We fit 19 people with transtibial amputation using their regular prosthetic socket with fluid bladders on the inside socket surface to undergo cycles of bladder liquid addition and removal. In each cycle, subjects sat, stood, and walked for 90 s with bladder liquid added, and then sat, stood, and walked for 90 s again with the bladder liquid removed. The amount of bladder liquid added was increased in each cycle. We used bioimpedance analysis to measure residual-limb fluid volume. Results showed that the preferred bladder liquid volume was 16.8 +/- 8.4 mL (mean +/- standard deviation), corresponding with 1.7% +/- 0.8% of the average socket volume between the bioimpedance voltage-sensing electrodes. Residual-limb fluid volume driven out of the residual limb when bladder liquid was added was typically not recovered upon subsequent bladder liquid removal. Of the 19 subjects, 15 experienced a gradual residual-limb fluid volume loss over the test session. Care should be taken when implementing adjustable socket technologies in people with limb loss. Reducing socket volume may accentuate residual-limb fluid volume loss.

SUBMITTER: Sanders JE

PROVIDER: S-EPMC4431595 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Adjustable sockets may improve residual limb fluid volume retention in transtibial prosthesis users.

Project description:BackgroundLoss of residual limb volume degrades socket fit and may require accommodation.ObjectivesTo examine if either of two accommodation strategies executed during resting, socket release with full socket size return and socket release with partial socket size return, enhanced limb fluid volume retention during subsequent activity.Study designTwo repeated-measures experiments were conducted to assess the effects of socket release on limb fluid volume retention.MethodsLimb fluid volume was monitored while participants wore a socket with a single adjustable panel. Participants performed eight activity cycles that each included 10 min of sitting and 2 min of walking. The socket's posterior panel and pin lock were released during the fifth cycle while participants were sitting. In one experiment (Full Return), the socket was returned to its pre-release size; in a second experiment (Partial Return), it was returned to 102% of its pre-release size. Short-term and long-term limb fluid volume retention were calculated and compared to a projected, No Intervention condition.ResultsPartial Return and Full Return short-term retentions and Partial Return long-term retention were greater than those projected under the control condition ( p < 0.05).ConclusionSocket release during resting after activity, particularly when the socket is returned to a slightly larger size, may be an effective accommodation strategy to reduce fluid volume loss in transtibial prosthesis users.Clinical relevanceThis study suggests that existing prosthetic technologies' adjustable sockets and locking pin tethers can be used in novel ways to help maintain residual limb fluid volume in active prosthesis users.

| S-EPMC7447526 | biostudies-literature

A portable bioimpedance instrument for monitoring residual limb fluid volume in people with transtibial limb loss: A technical note.

Project description:People with transtibial limb loss experience daily changes in volume of their residual limb that affect the fit of their prosthetic socket. A portable instrument was developed to monitor fluid volume changes outside of the laboratory setting. The bioimpedance system applied 26 current bursts per second at frequencies between 3 kHz and 1 MHz, and sensed voltage at up to six channels. Among six voltage-controlled current source circuits and five receive-channel amplifier topologies considered, a differential Howland current pump and a single receive-channel instrumentation amplifier proved the best combination of low noise and low power consumption. Mean RMS errors were 0.07% for extracellular fluid resistance, 2.23% for intracellular fluid resistance, and 1.15% for membrane capacitance.

| S-EPMC7417189 | biostudies-literature

An Inductive Sensing System to Measure In-Socket Residual Limb Displacements for People Using Lower-Limb Prostheses.

Project description:The objective of this research was to assess the performance of an embedded sensing system designed to measure the distance between a prosthetic socket wall and residual limb. Low-profile inductive sensors were laminated into prosthetic sockets and flexible ferromagnetic targets were created from elastomeric liners with embedded iron particles for four participants with transtibial amputation. Using insights from sensor performance testing, a novel calibration procedure was developed to quickly and accurately calibrate the multiple embedded sensors. The sensing system was evaluated through laboratory tests in which participants wore sock combinations with three distinct thicknesses and conducted a series of activities including standing, walking, and sitting. When a thicker sock was worn, the limb typically moved further away from the socket and peak-to-peak displacements decreased. However, sensors did not measure equivalent distances or displacements for a given sock combination, which provided information regarding the fit of the socket and how a sock change intervention influenced socket fit. Monitoring of limb⁻socket displacements may serve as a valuable tool for researchers and clinicians to quantitatively assess socket fit.

| S-EPMC6263676 | biostudies-literature

Residual limb volume fluctuations in transfemoral amputees.

Project description:This study constitutes the first attempt to systematically quantify residual limb volume fluctuations in transfemoral amputees. The study was carried out on 24 amputees to investigate variations due to prosthesis doffing, physical activity, and testing time. A proper experimental set-up was designed, including a 3D optical scanner to improve precision and acceptability by amputees. The first test session aimed at measuring residual limb volume at 7 time-points, with 10 min intervals, after prosthesis doffing. This allowed for evaluating the time required for volume stabilization after prosthesis removal, for each amputee. In subsequent sessions, 16 residual limb scans in a day for each amputee were captured to evaluate volume fluctuations due to prosthesis removal and physical activity, in two times per day (morning and afternoon). These measurements were repeated in three different days, a week apart from each other, for a total of 48 scans for each amputee. Volume fluctuations over time after prosthesis doffing showed a two-term decay exponential trend (R2 = 0.97), with the highest variation in the initial 10 min and an average stabilization time of 30 min. A statistically significant increase in residual limb volume following both prosthesis removal and physical activity was verified. No differences were observed between measures collected in the morning and in the afternoon.Clinical Trials.gov ID: NCT04709367.

| S-EPMC8192500 | biostudies-literature

Residual limb fluid volume change and volume accommodation: Relationships to activity and self-report outcomes in people with trans-tibial amputation.

Project description:BACKGROUND:Fluctuations in limb volume degrade prosthesis fit and require users to accommodate changes using management strategies, such as donning and doffing prosthetic socks. OBJECTIVES:To examine how activities and self-report outcomes relate to daily changes in residual limb fluid volume and volume accommodation. STUDY DESIGN:Standardized, two-part laboratory protocol with an interim observational period. METHODS:Participants were classified as "accommodators" or "non-accommodators," based on self-report prosthetic sock use. Participants' residual limb fluid volume change was measured using a custom bioimpedance analyzer and a standardized in-laboratory activity protocol. Self-report health outcomes were assessed with the Socket Comfort Score and Prosthesis Evaluation Questionnaire. Activity was monitored while participants left the laboratory for at least 3 h. They then returned to repeat the bioimpedance test protocol. RESULTS:Twenty-nine people were enrolled. Morning-to-afternoon percent limb fluid volume change per hour was not strongly correlated to percent time weight-bearing or to self-report outcomes. As a group, non-accommodators ( n = 15) spent more time with their prosthesis doffed and reported better outcomes than accommodators. CONCLUSION:Factors other than time weight-bearing may contribute to morning-to-afternoon limb fluid volume changes and reported satisfaction with the prosthesis among trans-tibial prosthesis users. Temporary doffing may be a more effective and satisfying accommodation method than sock addition. Clinical relevance Practitioners should be mindful that daily limb fluid volume change and prosthesis satisfaction are not dictated exclusively by activity. Temporarily doffing the prosthesis may slow daily limb fluid volume loss and should be investigated as an alternative strategy to sock addition.

| S-EPMC7447528 | biostudies-literature

Residual limb volume change: systematic review of measurement and management.

Project description:Management of residual limb volume affects decisions regarding timing of fit of the first prosthesis, when a new prosthetic socket is needed, design of a prosthetic socket, and prescription of accommodation strategies for daily volume fluctuations. This systematic review assesses what is known about measurement and management of residual limb volume change in persons with lower-limb amputation. Publications that met inclusion criteria were grouped into three categories: group I: descriptions of residual limb volume measurement techniques; group II: studies investigating the effect of residual limb volume change on clinical care in people with lower-limb amputation; and group III: studies of residual limb volume management techniques or descriptions of techniques for accommodating or controlling residual limb volume. We found that many techniques for the measurement of residual limb volume have been described but clinical use is limited largely because current techniques lack adequate resolution and in-socket measurement capability. Overall, limited evidence exists regarding the management of residual limb volume, and the evidence available focuses primarily on adults with transtibial amputation in the early postoperative phase. While we can draw some insights from the available research about residual limb volume measurement and management, further research is required.

| S-EPMC4423813 | biostudies-literature

Instrumented socket inserts for sensing interaction at the limb-socket interface.

Project description:The objective of this research was to investigate a strategy for designing and fabricating computer-manufactured socket inserts that were embedded with sensors for field monitoring of limb-socket interactions of prosthetic users. An instrumented insert was fabricated for a single trans-tibial prosthesis user that contained three sensor types (proximity sensor, force sensing resistor, and inductive sensor), and the system was evaluated through a sequence of laboratory clinical tests and two days of field use. During in-lab tests 3 proximity sensors accurately distinguish between don and doff states; 3 of 4 force sensing resistors measured gradual pressure increases as weight-bearing increased; and the inductive sensor indicated that as prosthetic socks were added the limb moved farther out of the socket and pistoning amplitude decreased. Multiple sensor types were necessary in analysis of field collected data to interpret how sock changes affected limb-socket interactions. Instrumented socket inserts, with sensors selected to match clinical questions of interest, have the potential to provide important insights to improve patient care.

| S-EPMC5748260 | biostudies-literature

Effectiveness of elevated vacuum and suction prosthetic suspension systems in managing daily residual limb fluid volume change in people with transtibial amputation.

Project description:BackgroundPrevious studies investigating limb volume change with elevated vacuum have shown inconsistent results and have been limited by out-of-socket volume measurements and short, single-activity protocols.ObjectivesTo evaluate the effectiveness of elevated vacuum for managing limb fluid volume compared to suction suspension with an in-socket measurement modality during many hours of activity.Study designFixed-order crossover design with a standardized out-of-laboratory activity protocol.MethodsTranstibial electronic elevated vacuum users participated in two sessions. Elevated vacuum was used during the first session, and suction suspension in the second. Participants completed a 5.5-h protocol consisting of multiple intervals of activity. In-socket residual limb fluid volume was continuously measured using a custom portable bioimpedance analyzer.ResultsA total of 12 individuals participated. Overall rate of fluid volume change was not significantly different, though the rate of posterior fluid volume change during Cycle 3 was significantly lower with elevated vacuum. Although individual results varied, 11 participants experienced lower overall rates of fluid volume loss in at least one limb region using elevated vacuum.ConclusionElevated vacuum may be more effective as a volume management strategy after accumulation of activity. Individual variation suggests the potential to optimize the limb fluid volume benefits of elevated vacuum by reducing socket vacuum pressure for some users.Clinical relevanceA better understanding of how elevated vacuum (EV) affects residual limb fluid volume will allow prosthetists to make more informed clinical decisions regarding accommodation strategies designed to improve daily socket fit.

| S-EPMC7443051 | biostudies-literature

Influence of Gait Cycle Loads on Stress Distribution at The Residual Limb/Socket Interface of Transfemoral Amputees: A Finite Element Analysis.

Project description:A Finite Element Analysis (FEA) was performed to evaluate the interaction between residual limb and socket when considering the dynamic loads of the gait cycle. Fourteen transfemoral amputees participated in this study, where their residual limbs (i.e., soft tissues and bone), and their sockets were reconstructed. The socket and the femur were defined as elastic materials, while the bulk soft tissues were defined as a hyperelastic material. Each model included the donning, standing, and gait cycle phase, with load and boundary conditions applied accordingly. The influence of adding the dynamic loads related to the gait cycle were compared against the modelling of the static load equivalent to the standing position resulting in changes of 23% ± 19% in the maximum values and in an increase in the size of the regions where they were located. Additionally, the possible correspondence between comfort and the location of peak loadbearing at the residual-limb/socket interface was explored. Consequently, the comfort perceived by the patient could be estimated based on the locations of the maximum stresses (i.e., if they coincide with the pressure tolerant or sensitive regions of the residual limb).

| S-EPMC7081319 | biostudies-literature

Volumeless reagent delivery: a liquid handling method for adding reagents to microscale droplets without increasing volume.

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| S-EPMC8820037 | biostudies-literature

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