Physical activity guidelines and promotion: An online survey of United Kingdom's prosthetic rehabilitation healthcare professionals.

BACKGROUND: Healthcare professionals play a key role in supporting physical activity participation for people with lower limb absence. OBJECTIVES: The objectives of this study were to survey healthcare professionals' views of people with lower limb absence in the United Kingdom, explore their awareness and knowledge of physical activity recommendations and investigate their current and desirable practice towards physical activity promotion. STUDY DESIGN: Cross-sectional study. METHODS: Potential participants were identified from open-access health-related databases, educational institution databases, and the authors' professional networks. An online 40-item questionnaire was distributed electronically and by post. Survey items were multiple choice, Likert-type scale or open-ended questions to explore the characteristics of healthcare professionals, awareness/knowledge of physical activity guidelines, current and desired practice and views on physical activity promotion. RESULTS: In total, 106 people responded. Physiotherapists had greater awareness/knowledge of physical activity guidelines compared to prosthetists/orthotists and other respondents. Awareness/knowledge of guidelines decreased as age, experience and time since qualification increased. The most common source of knowledge was self-directed learning. CONCLUSION: Continuing and improving education on the content of physical activity guidelines may be helpful for healthcare professionals in promoting physical activity to those with lower limb absence. CLINICAL RELEVANCE: This research aims to inform prosthetic rehabilitation professionals and academics about an under-researched area within physical activity for health. This knowledge could help develop interventions with the aim of improving physical activity promotion and participation, and ultimately the health and well-being of people with limb absence.

A custom, functional and lifelike passive prosthetic hand for infants and small toddlers: Clinical note.

BACKGROUND AND AIM: For infants and small toddlers with congenital upper limb deficiencies, terminal devices mainly provide either cosmesis or functionality. We report a clinical note about fitting a child with a low-cost passive hand targeting both functionality and cosmesis. TECHNIQUE: An elastomeric, alloy-wire-reinforced hand was fabricated using additive manufacturing to allow independent positioning of the digits. A clinical pilot in-home evaluation was conducted on a child with upper limb loss. DISCUSSION: The fabricated hand met the functional requirements but required a cover for cosmesis due to a poor surface finish associated with the fabrication technique. The participant child was comfortable using the prosthesis for various tasks. The parents were satisfied with the hand's function and cosmesis when covered with a cosmetic glove. This work demonstrated a new design and process that may in the future improve the utilization of prosthetic hands to promote early prosthesis use and a child's development. CLINICAL RELEVANCE: Early prosthesis use is important for infants and toddlers. Additive manufacturing may enable the fabrication of custom passive prosthetic hands that provide both cosmesis and functionality.

Reported physical activity and quality of life in people with lower limb amputation using two types of prosthetic suspension systems.

BACKGROUND: Vacuum-assisted suspension systems provide better suspension than non-vacuum systems, but data are limited on whether they improve physical activity levels and quality of life for people with amputation. OBJECTIVES: To compare the physical activity and quality of life levels of people with transtibial amputation using PIN/LOCK suspension system or vacuum-assisted suspension systems with those of able-bodied controls and to investigate parameters associated with physical activity levels. STUDY DESIGN: A cross-sectional observational study. METHODS: Fifty-one people with amputation and 51 controls participated. The International Physical Activity Questionnaire Short Form and Short Form 36 were used to measure the physical activity and quality of life, respectively. RESULTS: The total physical activity and Short Form 36 scores were significantly lower in the participants with amputation than the controls. There were no significant differences between the two types of suspension systems in terms of physical activity levels and quality of life. The vacuum-assisted suspension system users reported significantly more bodily pain on the Short Form 36 questionnaire than the controls (p = 0.003). The only parameter that correlated significantly with the total physical activity was the Short Form 36 physical functioning subscale (r = 0.302, p = 0.031). CONCLUSION: Contrary to our expectations, vacuum-assisted suspension system users compared to PIN/LOCK users did not report greater levels of physical activity or improved quality of life or levels closer to comparable controls. CLINICAL RELEVANCE: A better understanding of the effects of different prosthetic suspension systems on physical activity and quality of life may help clinicians when prescribing prostheses, as well as setting appropriate prosthetic expectations. This study suggests that vacuum-assisted suspension systems and PIN/LOCK suspension systems provide equal benefit to users with regards to physical activity and quality of life.

How do transtibial residual limbs adjust to intermittent incremental socket volume changes?

BACKGROUND: Strategies to maintain prosthesis users' daily limb volume are needed. OBJECTIVES: Test how intermittent incremental socket volume adjustments affect limb fluid volume and limb-socket distance. STUDY DESIGN: Repeated measures. METHODS: People with transtibial limb loss walked on an outdoor trail wearing a motor-driven adjustable socket that they adjusted a small amount, approximately 0.3% socket volume, every 2 min using a mobile phone app. Limb fluid volume and sensed distance between the socket and a target in their elastomeric liner were monitored. A gradual socket enlargement phase was followed by a gradual socket reduction phase. RESULTS: An incremental socket enlargement significantly increased limb fluid volume (p < 0.001) but not sensed distance (p = 0.063). An incremental socket reduction significantly decreased both limb fluid volume (p < 0.001) and sensed distance (p < 0.001). CONCLUSION: Participants' residual limb fluid volume increases during ambulation compensated for incremental socket volume increases. For incremental socket volume decreases, residual limb fluid volume decreases did not compensate and the socket fit became tighter. CLINICAL RELEVANCE: Results support the hypothesis that for people without co-morbidities, intermittent incremental socket volume enlargements are an effective accommodation strategy to increase limb fluid volume while maintaining socket fit. Intermittent incremental socket volume reductions decreased limb fluid volume but also made the socket fit tighter.

Prosthetic use by persons with unilateral transfemoral amputation in a South African setting.

BACKGROUND: Due to limitations in provision of prosthetic care in South Africa, a screening tool to select transfemoral prosthetic candidates has been implemented. OBJECTIVE: To describe prosthetic services, use and mobility of people with transfemoral amputation, identified as prosthetic candidates through the Guidelines for Screening of Prosthetic Candidates: Lower Limb, and to identify variables that might influence prosthetic use and mobility. DESIGN: Cross-sectional survey. METHODS: The study population included all adults who received their first prosthesis from the Orthotic and Prosthetic Centre in the Western Cape between 1 June 2011 and 31 December 2014. Data were collected, with an adapted version of the Prosthetic Profile of the Amputee, from 43 participants, through telephonic interviews. Descriptive and inferential analysis, with the chi-square test, was done. RESULTS: The majority of participants were older than 50 years (77%). Most participants (35; 81%) used their prosthesis; however, only 42% (18) used it daily. A significant association ( p = 0.000) was found between prosthetic rehabilitation and self-reported prosthetic walking distance. Less than half of participants received prosthetic rehabilitation and only 10 (30%) could walk 500 steps and more without resting. CONCLUSION: Participants used their prosthetic leg, but experienced limitations in frequency of wear and mobility. CLINICAL RELEVANCE: Current findings showed that participants' prosthetic mobility was curtailed. In less-resourced settings, carefully selecting prosthetic candidates may be necessary to provide access to services. Prosthetic provision is advised to be followed up with prosthetic rehabilitation for favourable mobility outcomes.

Dietary intakes and prevalence of overweight/obesity in male non-dysvascular lower limb amputees.

BACKGROUND: Lower limb amputees are at higher risk of cardiovascular disease compared to non-amputees. Dietary intake, a major determinant of cardiovascular disease risk, has not previously been studied in this group. OBJECTIVE: The aim of this study was to investigate dietary intakes and prevalence of overweight/obesity in adult lower limb amputees. STUDY DESIGN: A cross-sectional survey was used to investigate the dietary intake and prevalence of overweight/obesity in adults with lower limb amputations living in the United Kingdom. METHOD: Dietary intakes of male adult lower limb amputees ( n = 46, non-dysvascular) were assessed using food frequency questionnaires and results were compared to dietary reference values in the United Kingdom. Prevalence of overweight/obesity was assessed through body mass index and waist-to-hip ratio and compared to the general population according to the Health Survey for England 2011. RESULTS: Dietary intake risk factors for cardiovascular disease such as sugars (22.01%), total fat (34.87%), saturated fat (12.72%) and sodium (2660.10 mg/day) were significantly higher ( p < 0.001, p < 0.001, p = 0.043, p < 0.001; p < 0.001; respectively) than the dietary reference values. A high prevalence (82.8%) of overweight/obesity was found with a significantly higher body mass index and waist-to-hip ratio ( p = 0.027; p = 0.001; respectively) compared to the Health Survey for England 2011. CONCLUSION: High intakes of sugars, dietary fats, sugars and salts, combined with high prevalence of overweight/obesity observed in lower limb amputees are concerning. These findings suggest that greater emphasis on dietary intakes should be considered for rehabilitation programmes. CLINICAL RELEVANCE: Findings highlight poor dietary habits in lower limb amputees with respect to fat, sugar and salt intake, also high levels of overweight/obesity. Considering greater emphasis on dietary intake and including lifestyle changing interventions in rehabilitation programmes for lower limb amputees may lower the risk of obesity and CVD.

The relationship between lumbar lordosis angle and low back pain in individuals with transfemoral amputation.

BACKGROUND:: Low back pain is a common secondary disabling condition in the transfemoral amputee population. Transfemoral amputees are at risk of excessive lumbar lordosis; it has been suggested that increased lumbar lordosis may be associated with low back pain. However, the relationship between lumbar lordosis angle and low back pain has not yet been studied in this population. OBJECTIVE:: To determine whether the extent of lumbar lordosis is associated with low back pain in transfemoral amputees. STUDY DESIGN:: Case-control observational study. METHODS:: Participants included eight transfemoral amputees without low back pain and nine transfemoral amputees with low back pain. Etiology of amputation was primarily trauma. All participants underwent lateral view radiographs of the lumbar spine, from which lumbar lordosis angle and sacral inclination angle were measured. RESULTS:: Lumbar lordosis angle mean ± standard deviation was 46.1° ± 12.4° in participants with low back pain and 51.0° ± 12.6° in those without. Sacral inclination angle mean ± standard deviation was 38.3° ± 8.7° in participants with low back pain and 39.1° ± 7.5° in those without. There was no significant difference in lumbar lordosis angle or sacral inclination angle between participants with and without low back pain. CONCLUSION:: This study suggests that increased lumbar lordosis angle and sacral inclination angle are not significantly associated with low back pain in transfemoral amputees of a primarily traumatic etiology. CLINICAL RELEVANCE: Low back pain (LBP) is a common, disabling condition in transfemoral amputees. In the clinical setting, increased lumbar lordosis is implicated in LBP. This study does not support an association between increased lumbar lordosis and LBP; further study is needed to understand the increased prevalence of LBP in this population.

Mobility, prosthesis use and health-related quality of life of bilateral lower limb amputees from the 2008 Sichuan earthquake.

BACKGROUND:: The 2008 Sichuan Earthquake resulted in many amputees, yet due to the rare incidence, few studies have explored the rehabilitation outcomes and quality of life of bilateral lower limb amputees after major natural disasters. OBJECTIVES:: To evaluate rehabilitation outcomes of 17 young and adult bilateral lower limb amputees under the StandTall rehabilitation programme and to identify factors associated with successful functional recovery of bilateral amputees after large-scale disasters. STUDY DESIGN:: Cross-sectional study. METHODS:: Mobility (amputee mobility predictor), prosthesis use (Houghton Scale) and health-related quality of life (Trinity Amputation and Prosthesis Experience Scale, Short Form 12) were evaluated through questionnaires and performance-based assessments. Means of scores were compared using T-tests. RESULTS:: Subjects with bilateral through-knee or transtibial amputations had less activity restriction ( p < 0.01) and higher mobility ( p = 0.03). Subjects using prostheses more than 50% waking time had better general adjustment ( p = 0.02) and less functional restriction ( p = 0.01). Exercise and education were associated with higher mobility ( p = 0.06) and mental quality of life, respectively ( p = 0.09). CONCLUSIONS:: Amputation level and knee joint salvage, prosthesis use, exercise and education were associated with better rehabilitation outcomes including ambulation, adjustment and quality of life in bilateral lower limb amputees from the 2008 Sichuan Earthquake. CLINICAL RELEVANCE: The study examined a unique group of traumatic bilateral lower limb amputees who were young and healthy before having traumatic amputations from a single episode of natural disaster. The factors associated with better functional recovery after the earthquake were investigated and may support future development of post-disaster rehabilitation strategies for bilateral lower limb amputees.

Experiences of lower limb prosthetic users in a rural setting in the Mpumalanga Province, South Africa.

BACKGROUND:: Ambulation with a prosthesis is the ultimate goal of rehabilitation for a person with a major lower limb amputation. Due to challenges with prosthetic service delivery in rural settings, many patients with amputations are not benefitting from prosthetic interventions. Inaccessibility to prosthetic services results in worse functional outcomes and quality of life. Learning from the experiences of current prosthetic users in this setting can assist to improve prosthetic service delivery. OBJECTIVES:: To explore the experiences of lower limb prosthetic users and to understand the importance of a lower limb prosthesis to a prosthetic user in a rural area of South Africa. STUDY DESIGN:: A generic qualitative approach and an explorative design were utilised in this study. METHODS:: A semi-structured interview guide was used to collect data from nine prosthetic users in a rural area in the Mpumalanga province of South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Demographic details and information related to acute in-patient rehabilitation were analysed descriptively. RESULTS:: All participants were independent in activities of daily living with their prosthesis and participated actively in their community. Participants reported that their prosthesis was essential to their functioning. High travel cost was highlighted as a barrier to the maintenance of their prosthesis. Patients were dissatisfied with being unemployed. CONCLUSION:: Prosthetic intervention positively influences function, independence and community participation. Challenges relating to the accessibility, cost and maintenance of prosthetics should be a priority to ensure continued functional independence for prosthetic users. CLINICAL RELEVANCE: Understanding the importance of a prosthesis to a prosthetic user validates prosthetic intervention for persons living with an amputation in a rural setting and is vital in establishing and remodelling effective systems for prosthetic service delivery.

Step count accuracy of StepWatch and FitBit One™ among individuals with a unilateral transtibial amputation.

BACKGROUND: Step counts, obtained via activity monitors, provide insight into activity level in the free-living environment. Accuracy assessments of activity monitors are limited among individuals with lower-limb amputations. OBJECTIVES: (1) To evaluate the step count accuracy of both monitors during forward-linear and complex walking and (2) compare monitor step counts in the free-living environment. STUDY DESIGN: Cross-sectional study. METHODS: Adult prosthetic users with a unilateral transtibial amputation were equipped with StepWatch and FitBit One™. Participants completed an in-clinic evaluation to evaluate each monitor's step count accuracy during forward linear and complex walking followed by a 7-day step count evaluation in the free-living environment. RESULTS: Both monitors showed excellent accuracy during forward, linear walking (intraclass correlation coefficients = 0.97-0.99, 95% confidence interval = 0.93-0.99; percentage error = 4.3%-6.2%). During complex walking, percentage errors were higher (13.0%-15.5%), intraclass correlation coefficients were 0.88-0.90, and 95% confidence intervals were 0.69-0.96. In the free-living environment, the absolute percentage difference between monitor counts was 25.4%, but the counts had a nearly perfect linear relationship. CONCLUSION: Both monitors accurately counted steps during forward linear walking. StepWatch appears to be more accurate than FitBit during complex walking but a larger sample size may confirm these findings. FitBit consistently counted fewer steps than StepWatch during free-living walking. Clinical relevance The StepWatch and FitBit are acceptable tools for assessing forward, linear walking for individuals with transtibial amputation. Given the results' consistenty in the free-living enviorment, both tools may ultimiately be able to be used to count steps in the real world, but more research is needed to confirm these findings.

The impact a surgeon has on primary amputee prosthetic rehabilitation: A survey of residual lower limb quality.

BACKGROUND: Substantial improvements have been perceived in surgical results following major lower limb amputation, but there remains observed variation in amputation quality for patients referred for prosthetic rehabilitation from different hospitals. OBJECTIVES: To assess various elements that influence residual limb quality and evaluate their impact on progress through initial prosthetic rehabilitation and mobility outcome after rehabilitation. STUDY DESIGN: Clinical survey. METHODS: A revised 10-item residual limb scoring system was used to survey a succession of 95 primary amputees with transtibial and transfemoral amputations (100 residual limbs) presenting for rehabilitation. RESULTS: The majority of residual limbs scored highly, supporting the perception of generally good amputation quality. There were significant differences in average residual limb scores between some hospitals. The overall scores showed weak or minimal correlation to progress through rehabilitation and mobility outcome but residual limbs scoring higher in seven of the items of the score showed significant advantages in key aspects of progress or mobility at discharge. CONCLUSION: There is need for continued collaboration between surgeons and rehabilitation centres to ensure consistent high standards. The revised residual limb score used in this survey needs further refinement for future use. Clinical relevance Residual limb quality is an important component influencing prosthetic rehabilitation. This survey of residual limbs at one Rehabilitation Centre suggests encouragingly good surgical results but highlights differences between hospitals. A particular issue is the need for effective collaboration between surgeons and prosthetic rehabilitation professionals to optimise residual limb preparation.

Prosthesis Prescription Protocol of the Arm (PPP-Arm): The implementation of a national prosthesis prescription protocol.

BACKGROUND AND AIM: In order to create more uniformity in the prescription of upper limb prostheses by Dutch rehabilitation teams, the development and implementation of a Prosthesis Prescription Protocol of the upper limb (PPP-Arm) was initiated. The aim was to create a national digital protocol to structure, underpin, and evaluate the prescription of upper limb prostheses for clients with acquired or congenital arm defects. TECHNIQUE: Prosthesis Prescription Protocol of the Arm (PPP-Arm) was developed on the basis of the International Classification of Functioning and consisted of several layers. All stakeholders (rehabilitation teams, orthopedic workshops, patients, and insurance companies) were involved in development and implementation. A national project coordinator and knowledge brokers in each team were essential for the project. DISCUSSION: PPP-Arm was successfully developed and implemented in nine Dutch rehabilitation teams. The protocol improved team collaboration, structure, and completeness of prosthesis prescriptions and treatment uniformity and might be interesting for other countries as well. Clinical relevance A national protocol to prescribe upper limb prostheses can be helpful to create uniformity in treatment of patients with upper limb defects. Such a protocol improves quality of care for all patients in the country.

Enhancement of a prosthetic knee with a microprocessor-controlled gait phase switch reduces falls and improves balance confidence and gait speed in community ambulators with unilateral transfemoral amputation.

BACKGROUND: Despite the evidence for improved safety and function of microprocessor stance and swing-controlled prosthetic knees, non-microprocessor-controlled prosthetic knees are still standard of care for persons with transfemoral amputations in most countries. Limited feature microprocessor-control enhancement of such knees could stand to significantly improve patient outcomes. OBJECTIVES: To evaluate gait speed, balance, and fall reduction benefits of the new 3E80 default stance hydraulic knee compared to standard non-microprocessor-controlled prosthetic knees. STUDY DESIGN: Comparative within-subject clinical study. METHODS: A total of 13 young, high-functioning community ambulators with a transfemoral amputation underwent assessment of performance-based (e.g. 2-min walk test, timed ramp/stair tests) and self-reported (e.g. falls, Activities-Specific Balance Confidence scale, Prosthesis Evaluation Questionnaire question #1, Satisfaction with the Prosthesis) outcome measures for their non-microprocessor-controlled prosthetic knees and again after 8 weeks of accommodation to the 3E80 microprocessor-enhanced knee. RESULTS: Self-reported falls significantly declined 77% ( p = .04), Activities-Specific Balance Confidence scores improved 12 points ( p = .005), 2-min walk test walking distance increased 20 m on level ( p = .01) and uneven ( p = .045) terrain, and patient satisfaction significantly improved ( p < .01) when using the 3E80 knee. Slope and stair ambulation performance did not differ between knee conditions. CONCLUSION: The 3E80 knee reduced self-reported fall incidents and improved balance confidence. Walking performance on both level and uneven terrains also improved compared to non-microprocessor-controlled prosthetic knees. Subjects' satisfaction was significantly higher than with their previous non-microprocessor-controlled prosthetic knees. The 3E80 may be considered a prosthetic option for improving gait performance, balance confidence, and safety in highly active amputees. Clinical relevance This study compared performance-based and self-reported outcome measures when using non-microprocessor and a new microprocessor-enhanced, default stance rotary hydraulic knee. The results inform rehabilitation professionals about the functional benefits of a limited-feature, microprocessor-enhanced hydraulic prosthetic knee over standard non-microprocessor-controlled prosthetic knees.

A clinical survey about commercial games in lower limb prosthetic rehabilitation.

BACKGROUND: Despite the popularity of commercial games in lower limb prosthetic rehabilitation, data about their prevalence of use as well as therapists' perspectives about these games are still lacking. OBJECTIVES: To learn about the prevalence of use of commercial games in lower limb prosthetic rehabilitation and therapists' perspectives about these games. STUDY DESIGN: Cross-sectional. METHODS: An online survey was sent to physical and occupational therapists across prosthetic rehabilitation facilities in Canada. The survey had questions about the use of commercial games and therapists' perspectives. RESULTS: Data were collected from 82 therapists. Overall, 46.3% (38/82) reported that they use commercial games; of those, 94.7% (36/38) used the Nintendo Wii Fit. The most reported perceived benefits were the Wii Fit helping to improve weight shifting ( n = 76/82, 92.7%) and balance ( n = 75/82, 91.5%), and being motivating and complementing traditional therapy ( n = 75/82, 91.5%). The most reported perceived barriers/challenges were lack of time and familiarity with the games ( n = 58/82, 70.7%). CONCLUSION: Commercial games, particularly the Wii Fit, are commonly used in lower prosthetic rehabilitation in Canada. Most of the queried therapists view the Wii Fit positively. Knowledge translation activities and developing standard treatment protocols would be helpful in minimizing the barriers identified in this study. Clinical relevance The Wii Fit is prevalent in lower limb prosthetic rehabilitation in Canada and it is viewed positively by therapists as having the potential to improve balance and weight bearing, making rehabilitation more motivating, and complementing traditional therapy. Future studies should investigate the efficacy of the Wii Fit in prosthetic rehabilitation.

The influence of traumatic transfemoral amputation on metabolic cost across walking speeds.

BACKGROUND: Recent literature indicates equivalent costs of walking can be achieved after a transtibial amputation when the individual is young, active, and/or has extensive access to rehabilitative care. It is unknown if a similar cohort with transfemoral amputation can also achieve lower metabolic costs of walking than previously reported. OBJECTIVE: Compare metabolic cost in individuals with a transfemoral amputation to controls and to the literature across a range of walking speeds. STUDY DESIGN: Cross-sectional. METHODS: A total of 14 individuals with a unilateral transfemoral amputation (27 ± 5 years, N = 4 mechanical knee, N = 10 microprocessor knee) and 14 able-bodied controls (26 ± 6 years) walked at self-selected and four standardized speeds. Heart rate, metabolic rate (mL O2/kg/min), metabolic cost (mL O2/kg/m), and rating of perceived exertion were calculated. RESULTS: Self-selected speed was 8.6% slower in the transfemoral amputation group ( p = 0.031). Across standardized speeds, both metabolic rate and metabolic cost ranged from 44%-47% greater in the transfemoral amputation group ( p < 0.001), heart rate was 24%-33% greater ( p < 0.001), and perceived exertion was 24%-35% greater ( p < 0.009). CONCLUSION: Although the transfemoral amputation group was relatively young, physically fit, and had extensive access to rehabilitative care, the metabolic cost of walking fell within the ranges of the literature on older or presumably less fit individuals with transfemoral amputation. Clinical relevance Developments in prosthetic technology and/or rehabilitative care may be warranted and may reduce the metabolic cost of walking in individuals with a transfemoral amputation.

Relation between capacity and performance in paediatric upper limb prosthesis users.

BACKGROUND: The International Classification of functioning, disability and health refers capacity to what an individual can do in a standardised environment and describes performance as what an individual really does and whether the individual encounters any difficulty in the real-life environment. Measures of capacity and performance can help to determine if there is any gap between them that may restrict participation. The aim of this study was to explore the relationship between capacity scores obtained in a standardised clinical setting and proportional ease of performance obtained from a real-life environment. METHODS: The Assessment of Capacity for Myoelectric Control and the Prosthetic Upper Extremity Functional Index were used to assess capacity and performance in 62 prosthetic users (age 3-17). Spearman coefficient and generalised linear model were used to examine the association between these measures. RESULTS: A strong correlation (Spearman = 0.75) was found between the capacity scores and the ease of performance. In both unadjusted and adjusted models, capacity was significantly associated with proportional ease of performance. The adjusted model showed that, by 1 unit increase in the Assessment of Capacity for Myoelectric Control score, the ratio of proportional ease of performance increases by 45%. CONCLUSION: This implies that Assessment of Capacity for Myoelectric Control can be a predictor for ease of performance in real-life environment. Clinical relevance The ACMC scores may serve as an indicator to predict the difficulties that the children may encounter in their home environment. This prediction can help the clinician to make decisions, such that if the child requires more control training or is ready to move on to learn more complex tasks.

The effects of common footwear on stance-phase mechanical properties of the prosthetic foot-shoe system.

BACKGROUND: Prosthetic feet are prescribed based on their mechanical function and user functional level. Subtle changes to the stiffness and hysteresis of heel, midfoot, and forefoot regions can influence the dynamics and economy of gait in prosthesis users. However, the user's choice of shoes may alter the prosthetic foot-shoe system mechanical characteristics, compromising carefully prescribed and rigorously engineered performance of feet. OBJECTIVES: Observe the effects of footwear on the mechanical properties of the prosthetic foot-shoe system including commonly prescribed prosthetic feet. STUDY DESIGN: Repeated-measures, Mechanical characterization. METHODS: The stiffness and energy return was measured using a hydraulic-driven materials test machine across combinations of five prosthetic feet and four common shoes as well as a barefoot condition. RESULTS: Heel energy return decreased by an average 4%-9% across feet in all shoes compared to barefoot, with a cushioned trainer displaying the greatest effect. Foot designs that may improve perceived stability by providing low heel stiffness and rapid foot-flat were compromised by the addition of shoes. CONCLUSION: Shoes altered prosthesis mechanical characteristics in the sagittal and frontal planes, suggesting that shoe type should be controlled or reported in research comparing prostheses. Understanding of how different shoes could alter certain gait-related characteristics of prostheses may aid decisions on footwear made by clinicians and prosthesis users. Clinical relevance Shoes can alter function of the prosthetic foot-shoe system in unexpected and sometimes undesirable ways, often causing similar behavior across setups despite differences in foot design, and prescribing clinicians should carefully consider these effects on prosthesis performance.

The influence of environment: Experiences of users of myoelectric arm prosthesis-a qualitative study.

BACKGROUND: Prostheses are used to varying degrees; however, little is known about how environmental aspects influence this use. OBJECTIVES: To describe users' experiences of how environmental factors influence their use of a myoelectric arm prosthesis. STUDY DESIGN: Qualitative and descriptive. METHODS: A total of 13 patients previously provided with a myoelectric prosthetic hand participated. Their age, sex, deficiency level, etiology, current prosthesis use, and experience varied. Semi-structured interviews were audiotaped, transcribed, and analyzed through inductive content analysis. RESULTS: Four categories were created from the data: "Prosthesis function," "Other people's attitudes," "Support from family and healthcare," and "Individual's attitude and strategies." The overarching theme, "Various degrees of embodiment lead to different experiences of environmental barriers and facilitators," emerged from differences in individual responses depending on whether the individual was a daily or a non-daily prosthesis user. Environmental facilitators such as support from family and healthcare and good function and fit of the prosthesis seemed to help the embodiment of the prosthesis, leading to daily use. This embodiment seemed to reduce the influence of environmental barriers, for example, climate, attitudes, and technical shortcomings. CONCLUSION: Embodiment of prostheses seems to reduce the impact of environmental barriers. Support and training may facilitate the embodiment of myoelectric prosthesis use. Clinical relevance For successful prosthetic rehabilitation, environmental factors such as support and information to the patient and their social network about the benefits of prosthesis use are important. Local access to training in myoelectric control gives more people the opportunity to adapt to prosthesis use and experience less environmental barriers.

Reliability and construct validity of a new Danish translation of the Prosthesis Evaluation Questionnaire in a population of Danish amputees.

BACKGROUND: Most amputees live with their prostheses for a long time. Therefore, quality of life is an important outcome for lower limb amputees. OBJECTIVE: To translate the Prosthesis Evaluation Questionnaire (PEQ) and evaluate psychometric properties. STUDY DESIGN: Methodological research. METHODS: Lower limb amputees responded to electronic versions of the PEQ and SF-36v2 at baseline (n=64), after two weeks (n=51), and after 12 weeks (n=50). Reliability was assessed using Cronbach's alpha and intraclass correlation coefficient (ICC) analyses of the baseline and two weeks test-retest data. Estimates for standard error of measurement (SEM) were calculated based on reliability estimates. Construct validity was evaluated by testing using hypotheses testing. RESULTS: Reliability estimates (ICC/Cronbach's alpha) for the nine subscales were: Social Burden (0.85/0.76), Appearance (0.85/0.72), Residual Limb Health (0.80/0.69), Well-Being (0.78/0.90), Utility (0.76/0.89), Frustration (0.74/0.90), Perceived Response (0.62/0.80), Ambulation (0.61/0.94), Sounds (0.51/0.65). Construct validity was supported in three out of four subscales evaluated. CONCLUSIONS: The subscales Social Burden, Appearance, Well-Being, Utility and Frustration had consistent high reliability, supporting their use in assessing the prosthesis related quality of life in lower limb amputees. Results were mixed on three other scales (Residual Limb Health, Perceived Response, and Ambulation), while one scale, Sounds, had consistent low reliability. Clinical relevance For the first time a patient reported disease specific quality of life measure for lower limb amputees is available in Danish. Health care providers can now identify patients with reduced quality of life and measure treatment and rehabilitation effects over time.

Effect of foot and ankle immobilization on able-bodied gait as a model to increase understanding about bilateral transtibial amputee gait.

BACKGROUND: The anatomical foot-ankle complex facilitates advancement of the stance limb through foot rockers and late-stance power generation during walking, but this mechanism is altered for persons with bilateral transtibial amputation when using passive prostheses. OBJECTIVES: To study the effects of bilateral foot and ankle immobilization on able-bodied gait to serve as a model for understanding gait of persons with bilateral transtibial amputation and associated compensatory mechanisms. STUDY DESIGN: Comparative analysis. METHODS: Nine able-bodied persons walked at self-selected slow, normal, and fast speeds. They performed trials unaltered and when fitted with bilateral foot and ankle-immobilizing casts. Data from 10 individuals with bilateral transtibial amputation walking at self-selected fast speeds were used for qualitative comparison. RESULTS: The average speeds for the able-bodied fast speed cast and normal speed no-cast trials were similar and were compared with bilateral transtibial amputation data. The able-bodied cast condition data more closely matched bilateral transtibial amputation data than the no-cast data. Ankle range-of-motion and power generation at pre-swing in the cast condition were markedly decreased, while trunk lateral flexion and transverse rotation range-of-motion and peak hip power generation increased. CONCLUSION: Results suggest that the absence of active ankle range-of-motion and power generation contributes to the development of characteristic compensatory gait mechanisms displayed by persons with bilateral transtibial amputation. Clinical relevance This study helps to improve understanding of compensatory mechanisms resulting from reduced foot and ankle joint motion to inform lower limb prosthesis design and function for improving gait quality of individuals with bilateral transtibial amputation.