Prosthetics and Orthotics International

Literature Review

We estimate that over 29 million people worldwide in resource-limited environments (RLEs) are in need of orthotic and prosthetic (O&P) devices and services.

Our goal was to ascertain the current state of O&P provision in RLEs and identify factors that may lead to more successful O&P provision.

We conducted a comprehensive scoping literature review of all information related to O&P provision in RLEs published from 2000 to 2010. We targeted Vietnam, Cambodia, Tanzania, Malawi, Colombia, and the Navajo Nation, but also included information about developing countries in general. We searched academic databases and grey literature. We extracted information from each article in the areas of design, manufacturing, distribution, service provision, and technology transfer.

We identified commonly reported considerations and strategies for O&P provision from 431 articles. Analysis of expert consensus documents revealed recurring themes for improving O&P provision. We found that some suggestions from the consensus documents are being followed, but many are overlooked or have not yet been implemented.

Areas for improvement include conducting field testing during the design process, providing services to rural environments, offering follow-up services, considering government collaboration, and encouraging an active role of the orthosis/prosthesis user. Outcomes and research studies will be further discussed in Part Two.

Assistive devices that augment arm function were already introduced during the polio era. Devices are still being developed, but a review has not been performed thus far.

To create an overview and categorize assistive devices facilitating arm function in activities of daily living for people with decreased arm function.

Literature review.

A systematic review in three scientific literature databases. Conference proceedings, assistive technology databases, and references were searched and experts consulted. This resulted in a database of dynamic arm supports. Product information was added, and the devices were categorized.

A total of 104 dynamic arm supports were found. These could be categorized as nonactuated devices (N = 39), passively actuated devices (N = 24), actively actuated devices (N = 34), or devices using the functional electrical stimulation principle (N = 7). Functionality analysis resulted in second-level categorization: tremor suppression, facilitation of anti-gravity movement, and assistance of specific joint motion.

All devices could be ordered in a categorization of low complexity. Many have been developed; most have disappeared and have been succeeded by similar devices. Limitations of the devices found mainly concern interfacing and the range of motion facilitated. Future devices could make use of whatever residual strength is available in the users’ arm for control.

The provided overview of devices in this article and the classification developed is relevant for practitioners seeking assistive solutions for their clients as it makes the range of developed solutions both accessible and comprehensible.

Sit-to-stand movement is an essential function for participation in many activities of daily living. Although this movement is one of the most important functional tasks, there is limited research investigating strategies of sit-to-stand movement in transtibial amputees.

To examine movement strategies of the sit-to-stand task in persons with transtibial amputation and healthy non-amputated individuals.

Cross-sectional study.

A total of 12 male unilateral transtibial amputees and 19 healthy male subjects participated in this study. Sit-to-stand movement was evaluated in terms of weight transfer time, weight-bearing symmetry, sway velocity, and rising index by using Balance Master System.

Participants in both groups exhibited similar weight-bearing transfer time (p > 0.05). Transtibial amputees demonstrated significantly greater weight-bearing asymmetry, higher sway velocity, and lower rising index than healthy subjects during the sit-to-stand transfer movement (p < 0.05).

Transtibial amputees were unable to use the same movement strategies during a sit-to-stand task as healthy individuals; therefore, they had to develop new strategies to perform this task.

Little is known about the altered movement strategies during sit-to-stand task in transtibial amputees. The results of the study might provide some new insight into the motor components of the sit-to-stand movement in persons with transtibial amputation for both clinicians and researchers.

Rheumatoid arthritis is a chronic inflammatory joint disease which affects the joints and soft tissues of the foot and ankle. Rocker shoes may be prescribed for the symptomatic foot in rheumatoid arthritis; however, there is a limited evidence base to support the use of rocker shoes in these patients.

The aim of this study was to evaluate the effectiveness of heel-to-toe rocker shoes on pain, disability, and activity limitation in patients with rheumatoid arthritis.

Clinical trial.

Seventeen female patients with rheumatoid arthritis of 1 year or more duration, disease activity score of less than 2.6, and foot and ankle pain were recruited. Heel-to-toe rocker shoe was made according to each patient’s foot size. All the patients were evaluated immediately, 7 and 30 days after their first visit. Foot Function Index values were recorded at each appointment.

With the use of rocker shoes, Foot Function Index values decreased in all subscales. This reduction was noted in the first visit and was maintained throughout the trials.

Rocker shoe can improve pain, disability, and activity limitation in patients with rheumatoid foot pain. All the subjects reported improved comfort levels.

The results of this study showed that high-top, heel-to-toe rocker shoe with wide toe box was effective at reducing foot and ankle pain. It was also regarded as comfortable and acceptable footwear by the patients with rheumatoid foot problems.

The Milwaukee brace is an efficient method for correcting hyperkyphosis before skeletal maturity. However, loss of correction in long-term follow-up is inevitable.

To determine loss of correction and factors affecting the loss of correction.

Retrospective study.

A total of 49 corrected patients by Milwaukee brace participated minimum 2 years after treatment completion. The participants were categorized into two groups based on their roentgenograms: Group 1 (n = 36) had kyphotic curves of 45° or less and Group 2 (n = 13) had kyphotic curves of more than 45°.

The mean loss of corrections for Group 1 and Group 2 were 3.80° (ranges = 0°–13°) and 12.92° (ranges = 8°–22°), respectively. Group 1 showed no significant difference between the average hyperkyphosis of the patients for the part-time and full-time treatment duration (p = 0.02). By contrast, a significant difference was observed between the average hyperkyphosis of patients in Group 2 for the part-time and full-time treatment duration (p < 0.05).

Patients with kyphosis of 60° or less who can save the correction in full-time orthotic treatment in part-time treatment may have the least loss of correction over time.

As the orthotic treatment is a time-consuming method that needs the close collaboration of patient and treatment team, it is possible that clinicians predict the probable result of treatment and efficiency of orthotic treatment. Thus, a clinician can abandon orthotic treatment and refer the patient for an operation.

Daily changes in the shape and size of the residual limb affect prosthetic socket fit. Prosthetic socks are often added or removed to manage changes in limb volume. Little has been published about how persons with transtibial amputations use socks to manage diurnal changes in volume and comfort.

To investigate prosthetic sock use with a customized, self-report questionnaire.

Cross-sectional survey.

Persons with transtibial amputation reported number, thickness, and timing of socks used over a 14-day period.

Data from 23 subjects (16 males and 7 females) were included. On average, socks were changed less than once per day (0.6/day) and ply increased over the day (4.8–5.5 ply). Subjects wore prostheses significantly longer (15.0–14.1 h, p = 0.02) and changed socks significantly more often (0.6/day–0.4/day, p = 0.03) on weekdays compared to weekends. Participants were also divided into two subgroups: those who used socks to manage limb volume and those who used socks for socket comfort. Sock use did not differ (p > 0.05) between subgroups.

Sock changes are infrequent among persons with lower limb loss. Initial, verbal reports of sock use were often inconsistent with data measured by logs. Tools (e.g. sock logs or objective instruments) to better understand sock-use habits among persons with limb loss are needed.

Knowledge of prosthetic patients’ sock use may help practitioners enhance volume management strategies or troubleshoot fitting issues. Results showed that subjects generally added socks to account for volume loss, and end-of-day sock thickness frequently exceeded 5 ply. Use of sock logs in clinical practice may facilitate improved residual limb health.

Stair ascent is a particularly challenging task for transfemoral amputees. The aim of this clinical note was to describe the kinematic features of foot clearance in transfemoral amputee who can ascend stairs using a step-over-step strategy.

The marker trajectories of the first metatarsophalangeal joint (Mt₁) and clearance height were measured in two transfemoral amputees who could (TF1) and could not (TF2) climb stairs using a step-over-step strategy.

The Mt₁ marker trajectories of the TF1 moved backward in the early swing phase, and the trajectory followed an off-centered parabolic arc to achieve a similar clearance height as able-bodied subjects. TF2 could not climb the stairs without tripping in each step. An effective compensatory strategy to avoid tripping during stair climbing may be to use the hip joint for a backward extension and rapid flexion of the prosthetic leg during the early swing phase.

The foot clearance strategy in transfemoral amputees who can climb stairs using a step-over-step strategy will help us better understand adaptive prosthetic control and thus develop more effective gait rehabilitation programs.