Prosthetics and Orthotics International

The International Classification of Functioning, Disability and Health (ICF) has been recommended as a framework for evaluation of aspects of health. The aim of this study was to compare the contents of outcome measures for upper limb prosthesis users by using the ICF. Measurement focus and psychometric properties of these measures were also investigated. Outcome measures that used upper limb prosthesis users as subjects in their development and psychometric evaluations were selected. The psychometric studies (n = 14) were reviewed and scored and the items in the measures were linked to the ICF. One measure for all ages (ACMC), five paediatric measures (CAPP-FSI, CAPP-PSI, PUFI, UBET and UNB) and two adult measures (OPUS and TAPES) were selected. The concepts extracted (n = 393) were linked to 54 categories in the ICF. The ACMC, CAPP-FSI, UBET, UNB and PUFI measure categories mostly under the ICF component ‘Activity and participation’. The TAPES and OPUS also measure ICF categories that describe the emotional and social status of a person. The main conclusion is that the use of a mixture of outcome measures would give a better picture on the aspects of our clients. Measures that focus on the social interaction in paediatric users are required.

Studies which have examined the effects of ankle-foot orthoses (AFOs) on children with cerebral palsy (CP) often report insufficient detail about the participants, devices and testing protocols. The aim of this systematic review was to evaluate the level and quality of detail reported about these factors in order to generate best practice guidelines for reporting of future studies. A systematic search of the literature was conducted to identify studies which examined any outcome measure relating to AFO use in children with CP. A customized checklist was developed for data extraction and quality assessment. There was substantial variability in the level and quality of detail reported across the 41-paper yield. Many papers reported insufficient detail to allow synthesis of outcomes across studies. The findings of this review have been used to generate guidelines for best practice of reporting for AFO intervention studies. It is important to ensure homogeneity of gait pattern in a subject sample or to subdivide a sample to investigate the possibility that heterogeneity affected results. It is also important to describe the orthosis in sufficient detail that the device can be accurately replicated because differences in designs have been shown to affect outcomes. These guidelines will help researchers provide more systematic and detailed reports and thereby permit future reviewers to more accurately assess both the reporting and quality of orthotic interventions, and will facilitate synthesis of literature to enhance the evidence base.

Prosthetic liners exist to improve amputee safety and comfort by adding a cushioning layer between the residual limb and the prosthetic socket. Many choices in liner technology are available, and clinicians often rely on personal intuition and experience to choose which liners are appropriate for which patients. The purpose of this study was to examine the literature to find what scientific evidence exists to inform prescription practices. ‘Prosthetic liner’ was used as a search term in the Web of Science and PubMed research databases. Fourteen scientific articles met the eligibility criteria and are discussed in this review. The results of this review suggest that there is little scientific evidence to inform prosthetic liner prescription practices. Liner material properties have been well-studied, but their influence on in vivo performance is not well understood. Understanding liner effect on function would be an area of great usefulness.

Tone-reducing ankle-foot orthoses (TRAFOs) are said to improve the control and functioning of spastic lower limbs by their biomechanic and neurophysiologic effects. Unfortunately, there is limited evidence in literature to support the theory that TRAFOs can effectively decrease spasticity in the foot and ankle neurophysiologically. The primary purpose of this investigation was to determine the neurophysiologic effect of TRAFOs on soleus muscle reflex excitability in subjects with spasticity following stroke while standing. A repeated-measures intervention study was conducted on 15 adult subjects with stroke who were recruited from the community. Custom-made articulated ankle-foot orthoses (AFOs) and TRAFOs with orthokinetic compression garments (OCGs) were fabricated for each subject. Five conditions were tested: (1) Shoes only, (2) AFO, (3) TRAFO, (4) TRAFO with OCG, (5) shoes only, to determine if the TRAFOs were most effective in decreasing spasticity as assessed by the ratio of maximum Hoffmann reflex amplitude to maximum muscle response amplitude (Hmax:Mmax ratio) of the soleus. The results found that there were no significant treatment effects for the interventions (F = 0.992, df = 2.167, p = 0.388), however, when analysed subject-by-subject, four subjects displayed significant increases in their Hmax:Mmax ratios to at least one treatment condition. Overall, the results demonstrated that the tone-reducing devices had no significant neurophysiologic effect on soleus reflex excitability in subjects with spasticity, however individual responses showed that the TRAFOs increased spasticity in some individuals.

The objective of this study was to evaluate whether prosthetic fitting before the age of one year is associated with better outcomes in children with unilateral congenital below-elbow deficiency compared to children fitted after the age of one. Twenty subjects aged 6–21 years were recruited (five prosthetic users and 15 non-users). The Child Amputee Prosthetics Project-Prosthesis Satisfactory Inventory (CAPP-PSI) and the Prosthetic Upper Extremity Functional Index (PUFI) were used to assess patient satisfaction and functional use of the prosthesis. Videotapes were used to assess motor performance. Initial prosthetic fitting before one year of age was related to use of a prosthesis for at least four years. Age at first fitting was not associated with satisfaction with the prosthesis, functional use of the prosthesis or motor skills. Discrepancies between ease of performance with prosthesis and usefulness of the prosthesis as well as between capacity and performance of activities were found. The video assessments showed impaired movement adaptation to some tasks in six subjects. In conclusion, early prosthetic fitting seems to have a limited impact on prosthesis use during later stages of life.

This study compared the outcomes of an interim mechanical prosthesis program for lower limb amputees operated under a public and private model of service. Over a two-year period, 60 transtibial amputees were fitted with an interim prosthesis as part of their early amputee care. Thirty-four patients received early amputee care under a public model of service, whereby a prosthetist was employed to provide the interim mechanical prosthesis service. The remaining 26 patients received early amputee care under a private model of service, where an external company was contracted to provide the interim mechanical prosthesis service. The results suggested comparable clinical outcomes between the two patient groups. However, the public model appeared to be less expensive with the average labour cost per patient being 29.0% lower compared with the private model. The results suggest that a public model of service may provide a more comprehensive and less expensive interim prosthesis program for lower limb amputees.

Transfemoral amputees often report that walking on tilted pavements or on terrain with the prosthesis on the side of higher elevation is quite strenuous. This study investigates the energy expenditure of transfemoral amputees (n = 8) on a motorized treadmill, simulating different strenuous outdoor walking conditions.

Oxygen uptake at self-selected speed of gait was measured during walking at three different treadmill positions: (i) Horizontal treadmill, (ii) 3% tilt in the sagittal plane and (iii) 3% tilt in both the sagittal and frontal plane of the treadmill.

The difference in median values of oxygen uptake between position (i) and (ii) was 4.3%, and 16.4% between position (ii) and (iii) (p ≤ 0.05, for both comparisons). The subjects utilized about 50% of their VO_2max when walking in position (i) and (ii), with an increase to about 60% of their VO_2max when walking in position (iii).

Transfemoral amputees use significantly more energy when walking on a moderately tilted surface in the frontal plane compared to walking with a tilt in the sagittal plane. This is probably because the prosthetic leg becomes functionally too long when the walking surface is tilted sideways, and the transfemoral amputees adopt a more energy consuming gait pattern.

This paper presents an implementation of a practical and low-cost hardware-based control system for multifunctional myoelectric hand prostheses. The model utilizes a mode-switching technique in order to voluntarily control the operation of a dual-mode prosthetic device in two degrees of freedom: grasp/release and pronation/supination. This system was designed specifically to cater to the increasing needs of patients in developing countries, where myoelectric prostheses are scarce and extremely expensive. The design relied entirely on locally-available commercial components and aimed at allowing small prosthetics producers the freedom to utilize and modify the design according to their clients' preferences and requirements. Evaluation tests revealed excellent control and ability to execute basic hand and wrist functions even with short training periods, although results varied with the underlying level of muscular activity.

Stance Control knee-ankle foot orthoses (SCO) differ from their traditional locked knee counterparts by allowing free knee flexion during swing while providing stability during stance. It is widely accepted that free knee flexion during swing normalizes gait and therefore improves walking speed and reduces the energy requirements of walking. Limited research has been carried out to evaluate the benefits of SCOs when compared to locked knee-ankle foot orthoses (KAFOs). The purpose of this study was to evaluate the effectiveness of SCOs used for patients with lower limb pathology. Energy expenditure and walking velocity were measured in 10 subjects using an orthosis incorporating a Horton Stance Control knee joint. A GAITRite walkway was used to measure temporospatial gait characteristics. A Cosmed K4b2 portable metabolic system was used to measure energy expenditure and heart rate during walking. Two conditions were tested: Walking with stance control active (stance control) and walking with the knee joint locked. Ten subjects completed the GAITRite testing; nine subjects completed the Cosmed testing. Walking velocity was significantly increased in the stance control condition (p < 0.001). There was no difference in the energy cost of walking (p = 0.515) or physiological cost index (PCI) (p = 0.093) between conditions. This study supports previous evidence that stance control knee-ankle foot orthoses increase walking velocity compared to locked knee devices. Contrary to expectation, the stance control condition did not decrease energy expenditure during walking.

The i-LIMB hand is a novel upper limb myoelectric prosthetic hand with several joints in the fingers and thumb. This study aimed to determine whether this new device had more functionality than a more conventional myoelectric prosthetic hand with only a single joint between the thumb and two fingers. Therefore, a 45-year-old man with a wrist disarticulation used the i-LIMB hand and the widely used Dynamic Mode Control hand (DMC plus hand) in a test procedure that covered all functional levels of the International Classification of Function (ICF). Functional outcomes of the i-LIMB seemed to be lower than or equal to the DMC plus hand. The patient's satisfaction tended to be in favor of the i-LIMB. Compared to the DMC plus hand, the i-LIMB was more reliable when holding objects but had a lack of power and was less robust. We concluded that the i-LIMB hand has limited additional functionality compared to the DMC plus hand.