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1.
Sci Prog ; 105(3): 368504221117895, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35938190

RESUMO

The aim of the prosthetic devices is to replicate the able-bodied angle-torque profile of a healthy human during locomotion. A lightweight and energy-efficient ankle joint is able to lower the actuator peak power and/or energy consumption per gait cycle, while adequately fulfilling the profile matching constraints. This study presents the design optimization of the prosthetic ankle joint containing an elastic element and actuator coupled with a rigid triangular part. The dimensions of the ankle joint triangular part were optimized to minimize actuator peak power and maximize spring energy within its elastic limits. As a result of series simulation tests, at 1.1 and 1.6 m/s walking speeds, the simulation of dorsi/plantar flexion shows up to 78.8% and 66.98% reduction in motor peak power compared to a direct drive system, respectively. Low power ankle-prosthetic device that closely matches the angle-torque profile of a healthy human's ankle, is one of the key parameters for the cost-effectiveness of lower limb prostheses.


Assuntos
Tornozelo , Membros Artificiais , Fenômenos Biomecânicos , Marcha , Humanos , Caminhada
2.
Sensors (Basel) ; 22(14)2022 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-35890905

RESUMO

(1) Background: A sustainable casting system that combines the use of a polystyrene bag, a prosthetic liner and a vacuum system was developed to reduce fabrication time while maintaining comfort for the trans-tibial prosthesis user. (2) Methods: Eight prosthetists (28.7 ± 8.25 years old) fit ten trans-tibial prosthesis wearers (46 ± 12.4 years old) with two types of total surface bearing (TSB) prostheses; a polystyrene bead (PS) prosthesis and a plaster of paris (POP) prosthesis. Duration of casting and combined mean peak pressure was measured at six locations on the residual limb using Force Sensing Resistors (FSR). A pressure uniformity score (%) was determined. Socket Comfort Scale (SCS) was also measured. (3) Results: Duration of casting for the POP method was 64.8 ± 9.53 min and 7.8 ± 2 min for the PS method, (p = 0.006). Pressure uniformity in the POP prosthesis was 79.3 ± 6.54 and 81.7 ± 5.83 in the PS prosthesis (p = 0.027). SCS in both prosthesis types were equivalent. (4) Conclusion: A rapid fit PS prosthesis was developed, with significantly shorter duration than the traditional POP method. Socket pressure uniformity was confirmed and improved in the PS method. Socket comfort was equal between the two prothesis types.


Assuntos
Membros Artificiais , Poliestirenos , Cotos de Amputação , Desenho de Prótese , Tíbia , Caminhada
3.
J Neuroeng Rehabil ; 19(1): 80, 2022 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-35870940

RESUMO

BACKGROUND: Upper-limb prostheses are regularly abandoned, in part due to the mismatch between user needs and prostheses performance. Sensory feedback is among several technological advances that have been proposed to reduce device abandonment rates. While it has already been introduced in some high-end commercial prostheses, limited data is available about user expectations in relation to sensory feedback. The aim of this study is thus to use a mixed methods approach to provide a detailed insight of users' perceptions and expectations of sensory feedback technology, to ensure the addition of sensory feedback is as acceptable, engaging and ultimately as useful as possible for users and, in turn, reduce the reliance on compensatory movements that lead to overuse syndrome. METHODS: The study involved an online survey (N = 37) and video call interviews (N = 15) where adults with upper-limb differences were asked about their experience with limb difference and prosthesis use (if applicable) and their expectations about sensory feedback to prostheses. The survey data were analysed quantitatively and descriptively to establish the range of sensory feedback needs and their variations across the different demographics. Reflexive thematic analysis was performed on the interview data, and data triangulation was used to understand key behavioural issues to generate actionable guiding principles for the development of sensory feedback systems. RESULTS: The survey provided a list of practical examples and suggestions that did not vary with the different causes of limb difference or prosthesis use. The interviews showed that although sensory feedback is a desired feature, it must prove to have more benefits than drawbacks. The key benefit mentioned by participants was increasing trust, which requires a highly reliable system that provides input from several areas of the hand rather than just the fingertips. The feedback system should also complement existing implicit feedback sources without causing confusion or discomfort. Further, the effect sensory feedback has on the users' psychological wellbeing was highlighted as an important consideration that varies between individuals and should therefore be discussed. The results obtained were used to develop guiding principles for the design and implementation of sensory feedback systems. CONCLUSIONS: This study provides a mixed-methods research on the sensory feedback needs of adults with upper-limb differences, enabling a deeper understanding of their expectations and worries. Guiding principles were developed based on the results of a survey and interviews to inform the development and assessment of sensory feedback for upper-limb prostheses.


Assuntos
Membros Artificiais , Adulto , Retroalimentação Sensorial , Mãos , Humanos , Desenho de Prótese , Extremidade Superior
4.
Artigo em Inglês | MEDLINE | ID: mdl-35886131

RESUMO

Bilateral amputees are disadvantaged as they lack healthy leg support. We present the rare case of a bilateral transtibial amputee (BTA), in which we compared the first South Korean-made microprocessor-controlled prosthesis (MPA) to a conventional prosthetic ankle (CPA) with gait analysis and a patient questionnaire for long-term outcomes. A 70-year-old man presented with bilateral transtibial amputations from injury. Assessments were performed after wearing an MPA for 1 month and 1 year with three-dimensional gait analysis. Satisfaction, mobility, and pain were evaluated using the Korean version of the Prostheses Evaluation Questionnaire (K-PEQ). The spatiotemporal parameters of both sides showed increased stability from the CPA to 1 month (mMPA) and 1 year (yMPA). We observed an increased single support time, decreased step width, and almost normal stance-swing time ratio. In kinematic parameters, the ankle range of motion (ROM) was bilaterally increased at mMPA and yMPA. Unfortunately, the MPA gait showed insufficient ankle plantarflexion during the terminal stance that failed to generate push-up power. As the MPA adaptation time increased, the symmetry ratio improved to a balanced value. The questionnaire-based investigations of satisfaction, mobility, and pain revealed excellent results. The MPA proved helpful for ankle mobility in the BTA, and the questionnaire showed good satisfaction and mobility in varied terrain.


Assuntos
Amputados , Membros Artificiais , Idoso , Marcha , Análise da Marcha , Humanos , Masculino , Microcomputadores , Dor , Caminhada
5.
JBJS Case Connect ; 12(3)2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35833643

RESUMO

CASE: A 38-year-old man developed a nonunion of a comminuted distal phalanx fracture, which resulted in gross instability of the fingertip. To restore stability, a patient-specific 3D-printed distal phalangeal prosthesis was implanted, and the patient was able to return to his occupation with excellent 2-year outcomes. CONCLUSION: This case highlights the application of 3D printing technology in the development of a patient-specific solution and discusses 6 important considerations for the design and planning process: Patient, Priorities, Point of fixation, Procedure, Problems, and People.


Assuntos
Membros Artificiais , Traumatismos dos Dedos , Falanges dos Dedos da Mão , Fraturas Cominutivas , Adulto , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/lesões , Falanges dos Dedos da Mão/cirurgia , Fraturas Cominutivas/cirurgia , Humanos , Masculino , Impressão Tridimensional
6.
PLoS One ; 17(7): e0272082, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35901056

RESUMO

Despite their importance to fall prevention research, little is known about the details of real-world fall events experienced by lower limb prosthesis users. This gap can be attributed to the lack of a structured, population-specific fall survey to document these adverse health events. The objective of this project was to develop a survey capable of characterizing the circumstances and consequences of fall events in lower limb prosthesis users. Best practices in survey development, including focus groups and cognitive interviews with diverse samples of lower limb prosthesis users, were used to solicit input and feedback from target respondents, so survey content would be meaningful, clear, and applicable to lower limb prosthesis users. Focus group data were used to develop fall event definitions and construct a conceptual fall framework that guided the creation of potential survey questions and response options. Survey questions focused on the activity, surroundings, situation, mechanics, and consequences of fall events. Cognitive interviews revealed that with minor revisions, survey definitions, questions, and response options were clear, comprehensive, and applicable to the experiences of lower limb prosthesis users. Administration of the fall survey to a national sample of 235 lower limb prosthesis users in a cross-sectional preliminary validation study, found survey questions to function as intended. Revisions to the survey were made at each stage of development based on analysis of participant feedback and data. The structured, 37-question lower limb prosthesis user fall event survey developed in this study offers clinicians and researchers the means to document, monitor, and compare fall details that are meaningful and relevant to lower limb prosthesis users in a standardized and consistent manner. Data that can be collected with the developed survey are essential to establishing specific goals for fall prevention initiatives in lower limb prosthesis users.


Assuntos
Membros Artificiais , Acidentes por Quedas/prevenção & controle , Estudos Transversais , Grupos Focais , Humanos , Inquéritos e Questionários
7.
Medicine (Baltimore) ; 101(26): e29811, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35777021

RESUMO

RATIONALE: A solution revision prosthesis has a multilayer microporous Porocoat coating, and the availability of multiple stem body sizes ensures that the prosthesis is adapted to each patient's anatomical structure so that there a firm attachment with the bone cortex in the middle of the femur. Therefore, the Solution prosthesis is one of the most commonly used and most effective prostheses in total hip arthroplasty worldwide. PATIENT CONCERNS: We reported a case of a 54-year-old female patient with periprosthetic femoral fractures after hip arthroplasty. DIAGNOSIS: The case was identified as type B2 prosthesis loosening according to the Vancouver classification. INTERVENTIONS: We performed revision surgery on her using the Solution prosthesis. Seven months after the surgery, the patient developed a mid-femoral prosthesis fracture for no apparent reason. We performed a second revision surgery of the hip joint and allogeneic bone plate fixation. OUTCOMES: The patient was satisfied with the treatment. LESSONS: For patients with type B2 prosthesis loosening and prosthesis fracture, hip arthroplasty revision and an allogeneic bone plate could be used to ensure more stable support.


Assuntos
Artroplastia de Quadril , Membros Artificiais , Fraturas do Fêmur , Fraturas Periprotéticas , Artroplastia de Quadril/efeitos adversos , Feminino , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Humanos , Pessoa de Meia-Idade , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/cirurgia , Falha de Prótese
8.
BMC Musculoskelet Disord ; 23(1): 635, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35787280

RESUMO

BACKGROUND: The purpose of this study was to investigate the feasibility of using a three-dimensional (3D)-printed arthrodesis prosthesis for reconstruction of the proximal humeral defect after tumor resection. METHODS: A novel proximal humeral prosthesis was designed to restore bone continuity and shoulder arthrodesis and was fabricated via 3D printing technology. Ten patients with primary malignancies in the proximal humerus underwent intra-articular resection and replacement with this prosthesis from 2017 to 2019. Baseline and operative data, oncological and prosthetic survival, and functional status were summarized. RESULTS: This cohort consisted of 9 males and 1 female with a mean age of 32.1 ± 16.1 years. Diagnoses included 5 cases of osteosarcoma, 3 cases of chondrosarcoma and 1 each case of undifferentiated pleomorphic sarcoma and malignant myoepithelioma. The mean operative duration, intraoperative hemorrhage and postoperative length of hospitalization were 151.5 ± 61.0 min, 410.0 ± 353.4 ml and 5.3 ± 1.9 d, respectively. The mean follow-up duration was 29.3 ± 6.4 months, with a minimum of 24 months for the surviving patients. Two patients experienced local recurrence, and four patients developed distant metastases. Detachment of the taper occurred in two patients. One was managed conservatively, and the other received amputation due to concurrent tumor recurrence. The mean MSTS-93 and ASES scores and ranges of forwards flexion and abduction were 24.9 ± 3.1, 79.4 ± 8.3, 71.3 ± 19.4°, and 61.3 ± 16.4°, respectively. The functional outcomes were independent of the preservation of the axillary nerve. Histological study of the glenoid component showed evidence of bone ingrowth at the bone-prosthesis porous interface. CONCLUSION: Application of the 3D-printed arthrodesis prosthesis might be a safe and efficacious method for functional reconstruction in patients who underwent resection of the proximal humerus, especially for those without preservation of the axillary nerve.


Assuntos
Membros Artificiais , Neoplasias Ósseas , Adolescente , Adulto , Artrodese/efeitos adversos , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Feminino , Seguimentos , Humanos , Úmero/diagnóstico por imagem , Úmero/patologia , Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Impressão Tridimensional , Ombro/patologia , Adulto Jovem
9.
J Neuroeng Rehabil ; 19(1): 68, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35787721

RESUMO

BACKGROUND: Cybathlon championship aims at promoting the development of prosthetic and assistive devices capable to meet users' needs. This paper describes and analyses possible exploitation outcomes of our team's (REHAB TECH) experience into the Powered Arm Prosthesis Race of the Cybathlon 2020 Global Edition, with the novel prosthetic system Hannes. In detail, we present our analysis on a concurrent evaluation conducted to verify if the Cybathlon training and competition positively influenced pilot's performance and human-technology integration with Hannes, with respect to a non-runner Hannes user. METHODS: Two transradial amputees were recruited as pilots (Pilot 1 and Pilot 2) for the Cybathlon competition and were given the polyarticulated myoelectric prosthetic hand Hannes. Due to COVID-19 emergency, only Pilot 1 was trained for the race. However, both pilots kept Hannes for Home Use for seven weeks. Before this period, they both participated to the evaluation of functionality, embodiment, and user experience (UX) related to Hannes, which they repeated at the end of the Home Use and right after the competition. We analysed Pilot 1's training and race outcomes, as well as changes in the concurrent evaluation, and compared these results with Pilot 2's ones. RESULTS: The Cybathlon training gradually improved Pilot 1's performances, leading to the sixth place with a single error in task 5. In the parallel evaluation, both pilots had an overall improvement over time, whereas Pilot 2 experienced a deterioration of embodiment. In detail, Pilot 1, who followed the training and raced the Cybathlon, improved in greater way. CONCLUSION: Hannes demonstrated to be a valuable competitor and to perform grasps with human-like behaviors. The higher improvements of Pilot 1, who actively participated in the Cybathlon, in terms of functionality, embodiment and UX, may depend on his training and engagement in the effort of achieving a successful user-prosthesis interaction during the competition. Tasks based on Cybathlon's ones could improve the training phase of a prosthetic user, stimulating dexterity, prosthetic integration, and user perception towards the prosthesis. Likewise, timed races or competitions could facilitate and accelerate the learning phase, improving the efficiency and efficacy of the process.


Assuntos
Amputados , Membros Artificiais , COVID-19 , Mãos , Humanos , Extremidade Superior
10.
Sci Rep ; 12(1): 12624, 2022 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-35871204

RESUMO

Patients with lower limb amputation experience "embodiment" while using a prosthesis, perceiving it as part of their body. Humans control their biological body parts and receive appropriate information by directing attention toward them, which is called body-specific attention. This study investigated whether patients with lower limb amputation similarly direct attention to prosthetic limbs. The participants were 11 patients with lower limb amputation who started training to walk with a prosthesis. Attention to the prosthetic foot was measured longitudinally by a visual detection task. In the initial stage of walking rehabilitation, the index of attention to the prosthetic foot was lower than that to the healthy foot. In the final stage, however, there was no significant difference between the two indexes of attention. Correlation analysis revealed that the longer the duration of prosthetic foot use, the greater the attention directed toward it. These findings indicate that using a prosthesis focuses attention akin to that of an individual's biological limb. Moreover, they expressed that the prosthesis felt like a part of their body when they could walk independently. These findings suggest that the use of prostheses causes integration of visual information and movement about the prosthesis, resulting in its subjective embodiment.


Assuntos
Amputação , Membros Artificiais , Amputação/reabilitação , Pé/cirurgia , Humanos , Desenho de Prótese , Implantação de Prótese , Caminhada
11.
PLoS One ; 17(7): e0270753, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35797375

RESUMO

Participation in valued interpersonal and community activities is a key component of rehabilitation for Veterans with amputation. The purpose of this study was to identify specific factors that promote or inhibit participation to inform development of interventions that may facilitate participation in desired life activities. A convenience sample of 408 Veterans with at least one lower limb amputation and who had received outpatient care from the Regional Amputation Center (RAC) completed a mailed survey. Participation was measured using the Community Participation Indicators (CPI) Importance, Control, and Frequency scales and the Patient Reported Outcome Measurement Information System (PROMIS) Ability to Participate in Social Roles and Satisfaction with Social Participation scales. Multiple imputation procedures were used to address missing data. Correlates of participation were examined through multiple linear regression. A total of 235 participants completed the survey, a response rate of 58%. Levels of participation, measured with the PROMIS instruments, were 43.2 (SD = 8.1) for Ability and 46.4 (SD = 8.6) for Satisfaction. Regression analyses found robust amputation-specific correlates for participation, including body image and balance confidence. Generic (non-amputation specific) correlates for participation included depression and pain interference. Development of treatment approaches and devices that can address body image, balance confidence, pain, and mental health concerns such as depression have the potential to enhance the participation and rehabilitation of Veterans with lower limb amputation.


Assuntos
Amputados , Membros Artificiais , Veteranos , Amputação/reabilitação , Amputados/reabilitação , Humanos , Extremidade Inferior/cirurgia , Dor
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(7): 796-803, 2022 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-35848173

RESUMO

Objective: To explore the surgical skills of modified Gibson combined with modified ilioinguinal (MGMII) approach in the treatment of Enneking Ⅱ+Ⅲ pelvic malignant tumors in the three-dimensional (3D) printed customized integrated hemipelvic prosthesis, and to evaluate the convenience and accuracy of the surgical approach and the short-term effectiveness. Methods: Between January 2017 and March 2019, 7 patients with Enneking Ⅱ+Ⅲ pelvic malignant tumors were treated with tumor resection and 3D printed hemipelvic prosthesis replacement via MGMII approach. There were 6 males and 1 female. The age ranged from 23 to 68 years, with an average of 43.7 years. There was 1 chondrosarcoma, 1 Ewing's sarcoma, 1 osteosarcoma, 1 malignant Schwannoma, 2 metastatic renal clear cell carcinoma, and 1 metastatic hepatocellular carcinoma. The Enneking stage of 4 cases of primary malignant tumor was stage ⅡB. The disease duration was 6-12 months, with an average of 9.5 months. The preoperative Harris hip score (HHS) was 82.1±1.4 and the Musculoskeletal Tumor Society (MSTS) score was 21.4±1.1. The tumor size by imaging examination was 5.1-9.1 cm, with an average of 6.9 cm. The operation time, intraoperative blood loss, postoperative blood transfusion volume, and postoperative complications were recorded. Postoperative pathological examination confirmed tumor residue according to R classification criteria. The lower limb length, acetabular height, acetabular eccentricity, abduction angle, and anteversion angle were measured and the bone integration was observed by imaging review. Bilateral abductor muscle strengths were measured, and joint function was evaluated by MSTS score and HHS score. Results: All operations were successfully completed. The operation time was 210-360 minutes (mean, 280.0 minutes); the intraoperative blood loss was 1 300-2 500 mL (mean, 1 785.7 mL); the postoperative blood transfusion volume was 0-11 U (mean, 6.1 U). Postoperative pathological examination confirmed R0 resection assisted by osteotomy guide plate. All incisions healed by first intention. All patients were followed up 30-48 months (mean, 41.3 months). At last follow-up, the imaging review showed the good osseointegration in all 7 cases. There was no significant difference in the lower limb length, acetabular height, acetabular eccentricity, abduction angle, and anteversion angle between the affected side and the healthy side ( P>0.05), all of which met the requirements of anatomical reconstruction. At 3 months after operation, the ratios of muscle strength between the affected side and the healthy side was 68.29%±7.41% at 3 months and 89.86%±2.79% at 12 months, showing a significant difference between the two time points ( t=8.242, P=0.000). At last follow-up, the MSTS score and HHS score were 27.3±0.8 and 96.6±1.4, respectively, which significantly improved when compared with those before operation ( P<0.05). None of the patients had assisted walking at last follow-up. There was no recurrence, death, or complications such as deep infection, dislocation of the prosthesis, or fracture of the prosthesis or screw. Conclusion: MGMII approach can expose the posterior column of the acetabulum, especially the ischial tubercle, which is helpful to avoid tumor rupture during tumor resection and preserve the muscle functions such as gluteus medius and iliac muscle while ensuring the resection scope.


Assuntos
Artroplastia de Quadril , Membros Artificiais , Neoplasias Ósseas , Acetábulo/cirurgia , Adulto , Idoso , Artroplastia de Quadril/métodos , Neoplasias Ósseas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(7): 811-816, 2022 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-35848175

RESUMO

Objective: To investigate the mid-term effectiveness of three-dimensional (3D) printed osteotomy guide plate and personalized prosthesis in knee-preserving tumor resection. Methods: The clinical data of 12 patients who underwent knee-preserving tumor resection and reconstruction with 3D printed osteotomy guide plate and personalized prosthesis between September 2016 and October 2018 were retrospectively analyzed. There were 7 males and 5 females. The age ranged from 7 to 59 years, with a median of 44.5 years. There were 11 cases of osteosarcoma and 1 case of fibrosarcoma, all of which were Enneking grade ⅡB. The distance from the tumor to the joint surface was 5.5-8.2 cm, with an average of 6.94 cm. Incision healing, tumor recurrence, periprosthetic fracture, and aseptic loosening were observed after operation. The Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate the function of the patients, and the knee flexion range of motion was measured. Results: The 12 patients were followed up 41-66 months, with an average of 54.5 months. The length of osteotomy ranged from 14 to 26 cm, with an average of 22.08 cm. Except for 2 patients with superficial infection of incision tissue, no deep infection involving the prosthesis occurred, no patient underwent revision surgery because of prosthesis infection. During the follow-up, local recurrence occurred in 2 cases and distant metastasis occurred in 3 cases. The overall disease-free survival rate was 58.3%. Two patients died of lung metastasis, and the overall survival rate was 83.3%. One patient underwent amputation due to local recurrence, and 1 patient underwent total knee arthroplasty due to prosthesis rupture. No aseptic loosening of the prosthesis and periprosthetic fracture occurred during the follow-up, and the overall prosthesis survival rate was 83.3%. At last follow-up, 10 patients obtained satisfactory knee flexion range of motion that ranged from 95° to 125°, with an average of 110°. Two children could not cooperate with early rehabilitation treatment due to pain, and the knee flexion range of motion was not ideal (50°, 75°). All patients achieved acceptable lower limb function with MSTS scores ranged from 26 to 30, with an average of 28. All patients walked without crutches. Conclusion: The treatment of malignant bone tumors around the knee joint with 3D printed osteotomy guide plate and personalized prosthesis can preserve the articular surface, obtain good limb function, reduce the risk of aseptic loosening of prosthesis, and achieve better mid-term effectiveness.


Assuntos
Artroplastia do Joelho , Membros Artificiais , Neoplasias Ósseas , Prótese do Joelho , Fraturas Periprotéticas , Adolescente , Adulto , Neoplasias Ósseas/cirurgia , Criança , Feminino , Humanos , Articulação do Joelho/cirurgia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia , Fraturas Periprotéticas/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(7): 822-827, 2022 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-35848177

RESUMO

Objective: To investigate the effectiveness of LARS ligament and three-dimensional (3D) printed prosthesis on the combined reconstruction of radial hemicarpal joint after distal radius tumor resection. Methods: The clinical data of 12 patients with combined reconstruction of radial hemicarpal joint with LARS ligament and 3D printed prosthesis after distal radius tumor resection between September 2017 and March 2021 were retrospectively analyzed. There were 7 males and 5 females with an average age of 41.8 years (range, 19-63 years). There were 8 cases on the left side and 4 cases on the right side, and 10 cases of giant cell tumor of bone and 2 cases of osteosarcoma. The disease duration ranged from 1 to 20 months, with an average of 8.1 months. The osteotomy length, operation time, and intraoperative blood loss were recorded, and the wrist function was evaluated by Mayo wrist score and Musculoskeletal Tumor Society (MSTS) score before and after operation. The grip strength of the affected limb was expressed by the percentage of grip strength of the healthy upper limb, and the range of motion (ROM) of the wrist joint was measured, including extension, flexion, radial deviation, and ulnar deviation; the bone ingrowth and osseointegration at the bone-prosthesis interface of the wrist joint were observed by radiographic follow-up; the possible wrist complications were recorded. Results: All 12 patients successfully completed the operation. The osteotomy length was 5.0-10.5 cm (mean, 6.8 cm), and the operation time was 180-250 minutes (mean, 213.8 minutes). The intraoperative blood loss was 30-150 mL (mean, 61.7 mL). All patients were followed up 11-52 months (mean, 30.8 months). Radiographic follow-up showed that bone ingrowth and osseointegration at the bone-prosthesis interface were observed in all patients, and biological fixation was gradually achieved. During the follow-up, the stability, motor function, and ROM of the wrist joint were good. There was no complication such as arthritis, subluxation, prosthesis loosening, and infection, and no tumor recurrence and metastasis. At last follow-up, the Mayo score was 82.1±5.4, and MSTS score was 27.5±1.5, which were significantly improved when compared with those before operation (48.8±13.5, 16.4±1.4; t=-10.761, P<0.001; t=-26.600, P<0.001). The grip strength of the affected side was 59%-88% of that of the healthy side, with an average of 70.5%. The ROM of wrist joint were 55°-80° (mean, 65.42°) in extension, 35°-60° (mean, 44.58°) in flexion, 10°-25° (mean, 17.92°) in radial deviation, 10°-25° (mean, 18.33°) in ulnar deviation. Conclusion: The combined application of LARS ligament and 3D printed prosthesis is an effective way to reconstruct bone and joint defects after distal radius tumor resection. It can improve the function of wrist joint, reduce the incidence of complications, and improve the stability of wrist joint.


Assuntos
Membros Artificiais , Neoplasias Ósseas , Tumor de Células Gigantes do Osso , Fraturas do Rádio , Adulto , Perda Sanguínea Cirúrgica , Neoplasias Ósseas/cirurgia , Transplante Ósseo/métodos , Feminino , Tumor de Células Gigantes do Osso/cirurgia , Humanos , Ligamentos , Masculino , Rádio (Anatomia)/patologia , Rádio (Anatomia)/cirurgia , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Articulação do Punho/cirurgia
15.
Clin Biomech (Bristol, Avon) ; 97: 105713, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35809535

RESUMO

BACKGROUND: People with upper limb absence use compensatory movements to accommodate lack of motion in the prosthetic hand. The purpose of this study was to determine if the type of prosthesis used (i.e. body-powered or myoelectric) affects compensatory movements during activities of daily living. METHODS: Twelve transradial body-powered and/or myoelectric prosthesis users performed up to six unimanual and bimanual activities of daily living. Trunk range of motion and peak upper limb angles for each task were compared between prostheses. FINDINGS: Compensatory movement generally did not differ based on prosthesis type. However, body-powered users had increased trunk lateral lean compared to myoelectric users during a deodorant application task (P = 0.025). Body-powered users also had increased trunk axial rotation (P = 0.048) and decreased shoulder elevation (P = 0.046) when transferring a box between shelves. Compensatory movements were not systematically correlated with duration of prosthesis ownership, socket comfort, or terminal device type. INTERPRETATION: A prosthesis user's compensatory movements may depend on other factors beyond whether the prosthesis terminal device is actuated through body-powered or myoelectric mechanisms. Further exploration of the factors that influence joint kinematics in prosthesis users may inform future prosthesis prescription practices and help patients become successful users.


Assuntos
Amputados , Membros Artificiais , Atividades Cotidianas , Humanos , Movimento , Desenho de Prótese , Implantação de Prótese , Extremidade Superior
16.
J Biomech Eng ; 144(11)2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-35722979

RESUMO

Prosthetic foot selection for individuals with lower limb amputation relies primarily on clinician judgment. The prosthesis user rarely has an opportunity to provide experiential input into the decision by trying different feet. A prosthetic foot emulator (PFE) is a robotic prosthetic foot that could facilitate prosthesis users' ability to trial feet with different mechanical characteristics. Here, we introduce a procedure by which a robotic PFE is configured to emulate the sagittal plane effective ankle stiffness of a range of commercial prosthetic forefeet. Mechanical testing was used to collect data on five types of commercial prosthetic feet across a range of foot sizes and intended user body weights. Emulated forefoot profiles were parameterized using Bezier curve fitting on ankle torque-angle data. Mechanical testing was repeated with the PFE, across a subset of emulated foot conditions, to assess the accuracy of the emulation. Linear mixed-effects regression and Bland-Altman Limits of Agreement analyses were used to compare emulated and commercial ankle torque-angle data. Effective ankle stiffness of the emulated feet was significantly associated with the corresponding commercial prosthetic feet (p <0.001). On average, the emulated forefeet reproduced the effective ankle stiffness of corresponding commercial feet within 1%. Furthermore, differences were independent of prosthetic foot type, foot size, or user body weight. These findings suggest that commercial prosthetic foot properties can be effectively mimicked by a PFE, which is the important first step toward enabling prosthesis users to quickly trial different feet using a PFE as part of prosthetic foot prescription.


Assuntos
Membros Artificiais , Procedimentos Cirúrgicos Robóticos , Tornozelo/cirurgia , Fenômenos Biomecânicos , Marcha , Humanos , Extremidade Inferior , Desenho de Prótese , Caminhada
17.
Int J Rehabil Res ; 45(3): 253-259, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35754349

RESUMO

The purpose of this web-based survey study was to comprehensively evaluate subdomains of concern for falling and its association with quality of life (QoL) among people with lower-limb amputations (PLLA). Forty-eight adults (mean 61.8 ± 11.6 years) with a major (i.e. transtibial or transfemoral) amputation participated. Individuals were currently using a prosthesis for ambulation, completed a prosthetic rehabilitation program, had functional use of English and had access to an internet-connected device (e.g. laptop). Five standardized scales assessed a concern for falling: Modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Activities-specific Balance Confidence (ABC) Scale, Prosthetic Limb Users Survey - Mobility (PLUS-M), Consequences of Falling Scale and Perceived Ability to Manage Falls Scale. QoL was evaluated using the WHO QoL-100 questionnaire. Spearman correlation analysis evaluated the relationship between the five concerns for falling scales. Five independent linear regression modeling evaluated the association of each concern for falling measure on QoL. Strong statistically significant correlations were found between mSAFFE and PLUS-M (r s = -0.87; P < 0.05). Three scales were significantly associated with QoL: mSAFFE [-1.16 (95% CI, -2.04 to -0.29)], ABC [0.36 (95% CI, 0.11-0.61)] and PLUS-M [0.50 (95% CI, 0.05-0.95)]. This is the first study to evaluate multiple concerns for falling subdomains among PLLA. Concern for falling should be addressed in prosthetic rehabilitation to improve community re-integration and QoL.


Assuntos
Membros Artificiais , Qualidade de Vida , Adulto , Idoso , Amputação/reabilitação , Medo , Humanos , Extremidade Inferior/cirurgia
18.
Medicine (Baltimore) ; 101(25): e29182, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35758347

RESUMO

RATIONALE: The most common upper limb amputations are finger amputations, resulting in functional limitations that lead to problems with activities of daily living or job loss. For many years, prosthetic options for finger amputations have been limited to passive prostheses. In many countries including South Korea, body-powered finger prostheses have rarely been prescribed due to high cost, lack of experience of physicians and prosthetists, low interest and no coverage by insurance benefits. We report 2 cases of work-related finger amputations in patients who received body-powered 3D-printed finger prostheses. PATIENT CONCERNS AND DIAGNOSIS: Patient 1 was a 25-year-old woman with second and third finger amputations at the proximal interphalangeal level. Patient 2 was a 26-year-old man who sustained a second finger amputation at proximal interphalangeal level. INTERVENTIONS: We created body-powered 3D-printed finger prostheses that mimicked distal interphalangeal joint motion through patient-driven metacarpophalangeal joint motion using a string connected to a wrist strap and a linkage system. The source code "Knick Finger" was downloaded from e-NABLE. OUTCOMES: After 1 month of prosthesis training, both patients were satisfied with the prostheses and showed improved performance in patient-derived goals of cooking (patient 1) and typing on a computer (patient 2). LESSONS: Over the past decade, significant advances have been made in 3D-printed prosthetics owing to their light weight, low cost, on-site fabrication, and easy customization. Although there are still several limitations in the general application of 3D-printed finger prostheses, our study suggests that for patients with finger amputations, body-powered 3D-printed finger prostheses have high potential as an additional prosthetic option to the existing passive cosmetic prostheses.


Assuntos
Atividades Cotidianas , Membros Artificiais , Adulto , Amputação , Feminino , Humanos , Masculino , Impressão Tridimensional , Desenho de Prótese
19.
Sci Rep ; 12(1): 10947, 2022 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-35768457

RESUMO

Individuals with below-knee amputation (BKA) experience increased physical effort when walking, and the use of a robotic ankle-foot prosthesis (AFP) can reduce such effort. The walking effort could be further reduced if the robot is personalized to the wearer using human-in-the-loop (HIL) optimization of wearable robot parameters. The conventional physiological measurement, however, requires a long estimation time, hampering real-time optimization due to the limited experimental time budget. This study hypothesized that a function of foot contact force, the symmetric foot force-time integral (FFTI), could be used as a cost function for HIL optimization to rapidly estimate the physical effort of walking. We found that the new cost function presents a reasonable correlation with measured metabolic cost. When we employed the new cost function in HIL ankle-foot prosthesis stiffness parameter optimization, 8 individuals with simulated amputation reduced their metabolic cost of walking, greater than 15% (p < 0.02), compared to the weight-based and control-off conditions. The symmetry cost using the FFTI percentage was lower for the optimal condition, compared to all other conditions (p < 0.05). This study suggests that foot force-time integral symmetry using foot pressure sensors can be used as a cost function when optimizing a wearable robot parameter.


Assuntos
Membros Artificiais , Dispositivos Eletrônicos Vestíveis , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos , Marcha/fisiologia , Humanos , Caminhada/fisiologia
20.
J Neuroeng Rehabil ; 19(1): 59, 2022 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-35690860

RESUMO

BACKGROUND: Current myoelectric prostheses lack proprioceptive information and rely on vision for their control. Sensory substitution is increasingly developed with non-invasive vibrotactile or electrotactile feedback, but most systems are designed for grasping or object discriminations, and few were tested for online control in amputees. The objective of this work was evaluate the effect of a novel vibrotactile feedback on the accuracy of myoelectric control of a virtual elbow by healthy subjects and participants with an upper-limb amputation at humeral level. METHODS: Sixteen, healthy participants and 7 transhumeral amputees performed myoelectric control of a virtual arm under different feedback conditions: vision alone (VIS), vibration alone (VIB), vision plus vibration (VIS + VIB), or no feedback at all (NO). Reach accuracy was evaluated by angular errors during discrete as well as back and forth movements. Healthy participants' workloads were assessed with the NASA-TLX questionnaire, and feedback conditions were ranked according to preference at the end of the experiment. RESULTS: Reach errors were higher in NO than in VIB, indicating that our vibrotactile feedback improved performance as compared to no feedback. Conditions VIS and VIS+VIB display similar levels of performance and produced lower errors than in VIB. Vision remains therefore critical to maintain good performance, which is not ameliorated nor deteriorated by the addition of vibrotactile feedback. The workload associated with VIB was higher than for VIS and VIS+VIB, which did not differ from each other. 62.5% of healthy subjects preferred the VIS+VIB condition, and ranked VIS and VIB second and third, respectively. CONCLUSION: Our novel vibrotactile feedback improved myoelectric control of a virtual elbow as compared to no feedback. Although vision remained critical, the addition of vibrotactile feedback did not improve nor deteriorate the control and was preferred by participants. Longer training should improve performances with VIB alone and reduce the need of vision for close-loop prosthesis control.


Assuntos
Amputados , Membros Artificiais , Cotovelo , Eletromiografia , Retroalimentação Sensorial , Voluntários Saudáveis , Humanos , Propriocepção , Desenho de Prótese
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