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

ABSTRACT: BACKGROUND:Loss of residual limb volume degrades socket fit and may require accommodation. OBJECTIVES:To 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 DESIGN:Two repeated-measures experiments were conducted to assess the effects of socket release on limb fluid volume retention. METHODS:Limb 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. RESULTS:Partial Return and Full Return short-term retentions and Partial Return long-term retention were greater than those projected under the control condition ( p?

SUBMITTER: Brzostowski JT

PROVIDER: S-EPMC7447526 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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

Brzostowski Jacob T JT Larsen Brian G BG Youngblood Robert T RT Ciol Marcia A MA Hafner Brian J BJ Gurrey Clement J CJ McLean Jake B JB Allyn Katheryn J KJ Sanders Joan E JE

Prosthetics and orthotics international 20190110 3

<h4>Background</h4>Loss of residual limb volume degrades socket fit and may require accommodation.<h4>Objectives</h4>To 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.<h4>Study design</h4>Two repeated-measures experiments were conducted to assess the effects of socket release on limb fluid volume retention.<h4> ...[more]

PMID: 30628522

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Project description:BackgroundThere exists a need for an adjustable socket to accommodate residual limb volume and shape changes. Further, limb loss rates globally are rising and there is a large unmet need for affordable and accessible prosthetic systems.ObjectiveTo assess the utility of an immediate fit modular prosthetic system (iFIT Prosthetics, LLC).DesignProspective feasibility study involving a 2-week single-group pre-post intervention study.SettingPhysical Medicine and Rehabilitation gait laboratory.ParticipantsParticipants were at least 6 months post amputation and walking with a conventional prosthesis. They were free of skin wounds, other neurological disorders, and severe pain conditions.MethodsParticipants were fit with an immediate fit prosthesis and instructed to wear it for a 2-week evaluation period. They were given a progressive wearing schedule and they completed outcome measurements at the 2-week follow-up.Main outcome measurementsSelf-reported satisfaction, gait biomechanics, and intrasocket peak pressures.ResultsTwenty-six participants entered the study, with 22 completing the single group pre-post study. They averaged 50 years (SD ±10.2) of age; four were female. Sixteen were dysvascular and 10 were traumatic in etiology. Significant differences (P = .03) in self-reported satisfaction were found in favor of the iFIT device 29.33 (SD ± 4.51) versus the conventional device 25.52 (SD ± 6.8). No falls or limb ischemia were reported. Gait biomechanics revealed no differences across any temporal characteristics. Intrasocket peak pressures were significantly lower for the iFIT prostheses overall (P = .0014), at the anterior tibia (P = .0002), and the lateral side of the residual limb (P = .013).ConclusionsThe iFIT transtibial prosthetic system appears to be safe in this short-term single-group pre-post study. This study provided preliminary evidence to support the feasibility of the iFIT system. It compared favorably to participants' conventional prostheses across all outcome measures. With its cost, adjustability, and accessibility advantages, this device may prove useful for persons with transtibial amputations. A larger multicenter study is needed to confirm these results.Level of evidenceIII.

Project description:BackgroundHip muscles play a prominent role in compensating for the loss of ankle and/or knee muscle function after lower limb amputation. Despite contributions to walking and balance, there is no consensus regarding hip strength deficits in lower limb prosthesis (LLP) users. Identifying patterns of hip muscle weakness in LLP users may increase the specificity of physical therapy interventions (i.e., which muscle group(s) to target), and expedite the search for modifiable factors associated with deficits in hip muscle function among LLP users. The purpose of this study was to test whether hip strength, estimated by maximum voluntary isometric peak torque, differed between the residual and intact limbs of LLP users, and age- and gender-matched controls.MethodsTwenty-eight LLP users (14 transtibial, 14 transfemoral, 7 dysvascular, 13.5 years since amputation), and 28 age- and gender-matched controls participated in a cross-sectional study. Maximum voluntary isometric hip extension, flexion, abduction, and adduction torque were measured with a motorized dynamometer. Participants completed 15 five-second trials with 10-s rest between trials. Peak isometric hip torque was normalized to body mass × thigh length. A 2-way mixed-ANOVA with a between-subject factor of leg (intact, residual, control) and a within-subject factor of muscle group (extensors, flexors, abductors, adductors) tested for differences in strength among combinations of leg and muscle group (α = 0.05). Multiple comparisons were adjusted using Tukey's Honest-Difference.ResultsA significant 2-way interaction between leg and muscle group indicated normalized peak torque differed among combinations of muscle group and leg (p < 0.001). A significant simple main effect of leg (p = 0.001) indicated peak torque differed between two or more legs per muscle group. Post-hoc comparisons revealed hip extensor, flexor, and abductor peak torque was not significantly different between the residual and control legs (p ≥ 0.067) but torques in both legs were significantly greater than in the intact leg (p < 0.001). Peak hip abductor torque was significantly greater in the control and residual legs than the intact leg (p < 0.001), and significantly greater in the residual than control leg (p < 0.001).ConclusionsOur results suggest that it is the intact, rather than the residual limb, that is weaker. These findings may be due to methodological choices (e.g., normalization), or biomechanical demands placed on residual limb hip muscles. Further research is warranted to both confirm, expand upon, and elucidate possible mechanisms for the present findings; and clarify contributions of intact and residual limb hip muscles to walking and balance in LLP users.Clinical trial registrationN/A.

Project description:The prosthetic socket, which transfers load from the residual limb to the prosthesis, is an integral part of the prosthesis. 3D printing has emerged as a potentially viable alternative to traditional fabrication for producing sockets that effectively transfer loads. We conducted a systematic review to better understand the current state of this newer fabrication method, with a focus on the structural integrity of 3D printed sockets and factors that can affect the strength of 3D printed sockets when tested using ISO 10328 standards. Literature searches were carried out in five databases (PubMed, Scopus, CINAHL, Web of Science and Google Scholar). Two reviewers independently performed the literature selection, quality assessment, and data extraction. A total of 1023 unique studies were screened in accordance with inclusion and exclusion criteria. Of 1023 studies, 12 studies met all inclusion criteria, with failure data for 15 3D-printed sockets and 26 standard laminated sockets. Within 3D printed sockets, the addition of composite materials such as carbon fiber particles and distal reinforcement using a compositing infill technique appears to improve socket strength. In light of the considerable amount of heterogeneity between studies in terms of materials and alignment used, the absolute values for failure could not be established for 3DS nor directly compared between 3DS and LCS. However, there is some evidence that the probability of a failure at a given load may be comparable between 3DS and LCS up to the P8 level. For all sockets, whether a laminated composite socket or a 3D printed socket, failure mainly occurred at the distal end of the socket or the pyramid attachment, which is consistent with the ISO testing protocol. Improving the strength of the 3D printed sockets through design modifications at the distal end and implementing emerging printing technologies could help to promote 3D printed sockets as a viable option, particularly when cost or access to care is limited.

Dataset Information

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

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

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