Avian extremity reconstruction via osseointegrated leg-prosthesis for intuitive embodiment.
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ABSTRACT:
SUBMITTER: Hochgeschurz S
PROVIDER: S-EPMC8195993 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Percutaneous osseointegrated (OI) implants are increasingly viable as an alternative to socket suspension of prosthetic limbs. Upper extremity prostheses have also become more complex to better replicate hand and arm function and attempt to recreate pre-amputation functional levels. With more functionality comes heavier devices that put more stress on the bone-implant interface, which could be an issue for implant stability. This study quantified transhumeral loading at defined amputation levels using four simulated prosthetic limb-types: (1) body powered hook, (2) myoelectric hook, (3) myoelectric hand, and (4) advanced prosthetic limb. Computational models were constructed to replicate the weight distribution of each prosthesis type, then applied to motion capture data collected during Advanced Activities of Daily Living (AADLs). For activities that did not include a handheld weight, the body powered prosthesis bending moments were 13-33% (range of means for each activity across amputation levels) of the intact arm moments (reference 100%), torsional moments were 12-15%, and axial pullout forces were 30-40% of the intact case (p?0.001). The myoelectric hook and hand bending moments were 60-99%, torsional moments were 44-97%, and axial pullout forces were 62-101% of the intact case. The advanced prosthesis bending moments were 177-201%, torsional moments were 164-326%, and axial pullout forces were 133-185% of the intact case (p?0.001). The addition of a handheld weight for briefcase carry and jug lift activities reduced the overall impact of the prosthetic model itself, where the body powered forces and moments were much closer to those of the intact model, and more complex prostheses further increased forces and moments beyond the intact arm levels. These results reveal a ranked order in loading magnitude according to complexity of the prosthetic device, and highlight the importance of considering the patient's desired terminal device when planning post-operative percutaneous OI rehabilitation and training.
| S-EPMC7410272 | biostudies-literature
Project description:Background and purposeOsseointegrated implants are an alternative for prosthetic attachment in individuals with amputation who are unable to wear a socket. However, the load transmitted through the osseointegrated fixation to the residual tibia and knee joint can be unbearable for those with transtibial amputation and knee arthritis. We report on the feasibility of combining total knee replacement (TKR) with an osseointegrated implant for prosthetic attachment.Patients and methodsWe retrospectively reviewed all 4 cases (aged 38-77 years) of transtibial amputations managed with osseointegration and TKR in 2012-2014. The below-the-knee prosthesis was connected to the tibial base plate of a TKR, enabling the tibial residuum and knee joint to act as weight-sharing structures. A 2-stage procedure involved connecting a standard hinged TKR to custom-made implants and creation of a skin-implant interface. Clinical outcomes were assessed at baseline and after 1-3 years of follow-up using standard measures of health-related quality of life, ambulation, and activity level including the questionnaire for transfemoral amputees (Q-TFA) and the 6-minute walk test.ResultsThere were no major complications, and there was 1 case of superficial infection. All patients showed improved clinical outcomes, with a Q-TFA improvement range of 29-52 and a 6-minute walk test improvement range of 37-84 meters.InterpretationIt is possible to combine TKR with osseointegrated implants.
| S-EPMC4750776 | biostudies-literature
Project description:BackgroundPercutaneous osseointegrated (OI) docking of prosthetic limbs returns loading directly to the residual bone of individuals with amputations. Lower limb diaphyseal biomechanics have not been studied during the wide range of daily activities performed by individuals with lower extremity amputations; therefore, little is known about the loads experienced at the bone-endoprosthetic interface of a percutaneous OI device.Research questionDoes residual limb length and/or gender influence loading magnitudes in the diaphysis of the femur or tibia during daily activities?MethodsThis observational study used motion capture data from 40 non-amputee volunteers performing nine activities ranging from low to high demand, to virtually simulate residual limbs of amputees. To simulate diaphyseal bone loading in individuals with lower limb amputations, virtual joints were defined during post-processing at 25, 50, and 75 % of residual limb length of both the femur and the tibia, representing six clinically relevant residual limb lengths for OI device placement. Peak axial distractive and compressive forces, torsional moments, and bending moments were calculated for each activity. Comparisons were made between genders and between different levels of the simulated residual limb.ResultsFor simulated above and below knee amputations, short residual limbs showed the highest average bending, torsion, and axial distractive loads, while axial compressive loads were highest for long residual limbs. Absolute maxima for all subjects showed this same trend, except in below knee torsion, where 75 % residual tibia length showed the maximum. The highest demand activities yielding peaks in all directions were cutting with right leg planted, jump, run, and fall.SignificanceOverall, individuals with shorter residual limbs experienced higher diaphyseal forces. This should be taken into consideration during surgical implantation of percutaneous OI devices where residual limb length can potentially be shortened, and during rehabilitation of percutaneous OI patients.
| S-EPMC7417188 | biostudies-literature
Project description:Prosthesis embodiment, the perception of a prosthesis as part of one's body, may be an important component of functional recovery for individuals with upper limb absence. This work determined whether embodiment differs between body-powered and myoelectric prosthesis users. In a sample of nine individuals with transradial limb absence, embodiment was quantified using a survey regarding prosthesis ownership and agency. The extent to which the prosthesis affected the body schema, the representation of the body's dimensions, was assessed using limb length estimation. Because body-powered prostheses offer proprioceptive feedback that myoelectric prostheses do not, it was hypothesized that both measures would reveal stronger embodiment of body-powered prostheses. However, our results did not show differences across the two prosthesis designs. Instead, body schema was influenced by several patient-specific characteristics, including the cause of limb absence (acquired or congenital) and hours of daily prosthesis wear. These results indicate that regular prosthesis wear and embodiment are connected, regardless of the actual prosthesis design. Identifying whether embodiment is a direct consequence of regular prosthesis use would offer insight on how individuals with limb absence could modify their behavior to more fully embody their prosthesis.
| S-EPMC7508812 | biostudies-literature
Project description:Existing prosthetic limbs do not provide amputees with cutaneous feedback. Tactile feedback is essential to intuitive control of a prosthetic limb and it is now clear that the sense of body self-identification is also linked to cutaneous touch. Here we have created an artificial sense of touch for a prosthetic limb by coupling a pressure sensor on the hand through a robotic stimulator to surgically redirected cutaneous sensory nerves (targeted reinnervation) that once served the lost limb. We hypothesize that providing physiologically relevant cutaneous touch feedback may help an amputee incorporate an artificial limb into his or her self image. To investigate this we used a robotic touch interface coupled with a prosthetic limb and tested it with two targeted reinnervation amputees in a series of experiments fashioned after the Rubber Hand Illusion. Results from both subjective (self-reported) and objective (physiological) measures of embodiment (questionnaires, psychophysical temporal order judgements and residual limb temperature measurements) indicate that returning physiologically appropriate cutaneous feedback from a prosthetic limb drives a perceptual shift towards embodiment of the device for these amputees. Measurements provide evidence that the illusion created is vivid. We suggest that this may help amputees to more effectively incorporate an artificial limb into their self image, providing the possibility that a prosthesis becomes not only a tool, but also an integrated body part.
| S-EPMC3044830 | biostudies-literature
Project description:Prostheses are used to at least partly restore the body after limb amputation. Making the user accepting the prosthetic device as part of his or her body, i.e., inducing prosthesis embodiment, has been identified as major aim of prosthetic treatment. However, up to now, there is no consensus about the psychometric nature of prosthesis embodiment in limb amputees. In the present study, 118 unilateral lower limb amputees using a prosthesis were asked to complete an online questionnaire targeting prosthesis embodiment. Principal axis factoring revealed the factor structure of prosthesis embodiment, i.e., Ownership/Integrity, Agency, and Anatomical Plausibility, which resembles the embodiment structure previously identified for normally-limbed participants. The majority of amputees achieved prosthesis embodiment as assessed with the final version of the newly developed Prosthesis Embodiment Scale. Internal consistency was excellent, and test-retest reliability was satisfying, while the instrument was also sensitive for new prosthetic equipment. Validation on the basis of relationships to prosthesis satisfaction and adjustment to prosthesis use was performed. The Prosthesis Embodiment Scale could be a valuable tool for the assessment of perceptual correlates of successful body-prosthesis interaction in rehabilitative and research contexts, the latter which might further benefit from the comparability of psychometrically evaluated data.
| S-EPMC7450092 | biostudies-literature
Project description:This article describes a study protocol, which aims to explore and describe the feasibility of a mobile-phone application for initiating intuitive eating and intuitive exercising in patients who are following an ambulatory treatment for obesity. Intuitive eating refers to one's ability to make food choices based on one's awareness of his/her body's response. Intuitive exercising encourages people in finding enjoyable ways of being physically active. These two components will be trained using an implementation intention procedure, that is, behavioral plans that aim at creating a strong link between a specified situation and a response. We aim to recruit up to 80 overweight and obese patients over a period of 2?years. The smartphone application will be assessed on the basis of (i) data obtained through a 4-week use period, (ii) self-report measures taken before and after the use of the mobile application, and (iii) feedbacks from participants after the use of the mobile application. This pilot study will allow us to better understand the applicability of the use of mobile application within ambulatory treatment settings, and to adapt the design of the app necessary for building cross-sectional studies investigating its efficacy.
| S-EPMC5702316 | biostudies-literature
Project description:Fifteen patients underwent surgical insertion of titanium plasma sprayed screws in the mandible ridge over the symphysis region. In 3 patients, along with the screws in the symphysis region, hollow basket implant type 'H', one each in the mandible first/second molar region were inserted. Implants were fixed only in those patients who had retention and stability problems of mandibular artificial denture. Indication, technique and biocompatibility of titanium implants and tissue supported over denture have been discussed.
| S-EPMC5530981 | biostudies-other
Project description:Perceptual integration of a prosthesis into an amputee's body representation, that is, prosthesis embodiment, has been proposed to be a major goal of prosthetic treatment, potentially contributing to the user's satisfaction with the device. However, insufficient knowledge about individual or prosthetic factors associated with prosthesis embodiment challenges basic as well as rehabilitation research. In the present study, hierarchical multiple regression analyses on prosthesis embodiment-as assessed with the recently introduced Prosthesis Embodiment Scale-were applied to the survey data of a large sample of prosthesis-using lower limb amputees, entering relevant objective-descriptive (i.e., unbiased characteristics of the amputation or the prosthesis) and subjective-evaluative variables (i.e., the amputee's perceptions related to the amputation or the prosthesis) as first- or second-level regressors, respectively. Significant regressors identified in these analyses together explained R 2 = 36.3% of prosthesis embodiment variance in the present sample, with a lower level of amputation, less intense residual limb pain, more realistic visual appearance of the device, higher prosthetic mobility, and more positive valence of prosthesis-induced residual limb stimulations representing significantly associated factors. Using the identical set of regressors hierarchically complemented by prosthesis embodiment on measures of prosthetic satisfaction-as assessed with the Trinity Amputation and Prosthesis Experience Scales-revealed that prosthesis embodiment was significantly and positively associated with aesthetic as well as functional prosthesis satisfaction. These findings emphasize the importance of psychological factors for the integration of a prosthesis into the amputee's body representation, which itself represents a crucial factor associated with prosthesis satisfaction. The results might have important implications for future prosthetic treatment; however, replication of the findings in an independent sample is required, as well as sophisticated experimental designs in order to elucidate the causality of effects.
| S-EPMC7843383 | biostudies-literature
Project description:The ideal reconstruction of lower limb defects should replace like with like and minimize morbidity to the donor site, achieving the best possible esthetic and functional outcome. The goal is to obtain stable healing and to resume daily life in an efficient manner. Although the classical local flaps such as gastrocnemius, soleus muscle flap, and the reverse sural flap have allowed to achieve those goals, perforator flaps are now added on to the armamentarium in lower extremity reconstruction using local flaps. A perforator-based local flap, such as a propeller or keystone flap, has made reconstruction efficient while further reducing donor-site morbidity. This article aims to provide a useful review of the best available local flaps for lower limb defects.
| S-EPMC7209892 | biostudies-literature