A Computational Framework based on Medical Imaging and Random Sampling to Guide Optimal Residual Limb Designs for Individuals with Transfemoral Limb Loss

Background: 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. Objectives: To investigate prosthetic sock use with a customized, self-report questionnaire. Study design: Cross-sectional survey. Methods: Persons with transtibial amputation reported number, thickness, and timing of socks used over a 14-day period. Results: 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. Conclusions: 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. Clinical relevance 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.

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A portable bioimpedance instrument for monitoring residual limb fluid volume in people with transtibial limb loss: A technical note

Medical Engineering & Physics ◽

10.1016/j.medengphy.2019.04.002 ◽

2019 ◽

Vol 68 ◽

pp. 101-107 ◽

Cited By ~ 6

Author(s):

Paul Hinrichs ◽

John C. Cagle ◽

Joan E. Sanders

Keyword(s):

Technical Note ◽

Fluid Volume ◽

Limb Loss ◽

Residual Limb

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

Prosthetics and Orthotics International ◽

10.1177/0309364619864771 ◽

2019 ◽

Vol 43 (5) ◽

pp. 528-539 ◽

Cited By ~ 5

Author(s):

Brian G Larsen ◽

Jake B McLean ◽

Katheryn J Allyn ◽

Jacob T Brzostowski ◽

Joseph L Garbini ◽

...

Keyword(s):

Mobile Phone ◽

Study Design ◽

Repeated Measures ◽

Clinical Relevance ◽

Fluid Volume ◽

Limb Loss ◽

Residual Limb ◽

Limb Volume ◽

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.

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OCT-based microangiography for reactive hyperaemia assessment within residual limb skin of people with lower limb loss

Skin Research and Technology ◽

10.1111/srt.12383 ◽

2017 ◽

Vol 24 (1) ◽

pp. 152-155 ◽

Cited By ~ 4

Author(s):

U. Baran ◽

E. Swanson ◽

J. E. Sanders ◽

R. K. Wang

Keyword(s):

Lower Limb ◽

Limb Loss ◽

Residual Limb ◽

Reactive Hyperaemia

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SELF-MANAGEMENT IN PERSONS WITH LIMB LOSS: A SYSTEMATIC REVIEW

Canadian Prosthetics & Orthotics Journal ◽

10.33137/cpoj.v4i1.35098 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Daniel J Lee ◽

Theresa Repole ◽

Emily Taussig ◽

Stephanie Edwards ◽

Jamie Misegades ◽

...

Keyword(s):

Systematic Review ◽

Limb Loss ◽

Self Management ◽

Residual Limb ◽

Secondary Complications ◽

Long Term Conditions ◽

Prosthetic Socket ◽

Management Interventions ◽

Skin Breakdown

BACKGROUND: Self-management is an integral component of managing long-term conditions and diseases. For a person with limb loss, this self-management process involves caring for the residual limb, the prosthesis, and the prosthetic socket-residual limb interface. Failure to properly self-manage can result in unwanted secondary complications such as skin breakdown, falls, or non-use of the prosthesis. However, there is little evidence on what self-management interventions are effective at preventing secondary complications. To understand the impact of self-management after the loss of a limb, it is necessary to determine what the current evidence base supports. OBJECTIVE(S): The purpose of this study is to examine the available literature on self-management interventions and/or outcomes for persons with limb loss and describe how it may impact residual limb health or prosthesis use. METHODOLOGY: A systematic review of multiple databases was carried out using a variety of search terms associated with self-management. The results were reviewed and selected based on the inclusion criteria: self-management interventions or direct outcomes related to self-management, which includes the skin integrity of the residual limb, problem-solving the fit of the prosthesis, and education in the prevention of secondary complications associated with prosthesis use. The Cincinnati Childrens’ LEGEND (Let Evidence Guide Every New Decision) appraisal forms were used to analyze the articles and assign grades. FINDINGS: Out of the 40 articles identified for possible inclusion in this study, 33 were excluded resulting in seven articles being selected for this review. Three out of the seven articles focused on silicone liner management while the other four articles focused on skin issues. CONCLUSION: Self-management for a person with limb loss is a key component of preventing complications associated with loss of limb and prosthesis use. There is a lack of high-quality experimental studies exploring the most appropriate intervention for teaching self-management when compared to other conditions, specifically diabetes. Further research in the area of self-management is necessary to understand how to best prevent unwanted secondary complications. Layman's Abstract Self-management is an integral component of managing long-term conditions and diseases. Self-management for a person with limb loss involves performing proper hygiene of the residual limb, caring for the prosthesis, and problem-solving the fit between the prosthetic socket and the residual limb. If a person with limb loss fails to correctly self-manage, they may be exposing themselves to the risk of skin breakdown or injury. Other medical diagnoses like diabetes emphasize self-management in the care of persons with the condition and have established a large body of knowledge surrounding this element of lifestyle adaption. However, in the case of limb loss, there is very little evidence to support how self-management is taught or performed. Therefore, the purpose of this study was to explore the body of literature surrounding self-management in persons with limb loss. The results indicate that there is very little evidence supporting self-management related interventions and that further research is required in this area. With the addition of further research, clinical practice can be improved and self-management interventions can become standardized across the spectrum of care, much like in diabetes care. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35098/27909 How To Cite: Lee DJ, Repole T, Taussig E, Edwards S, Misegades J, Guerra J, Lisle A. Self-management in persons with limb loss: A systematic review. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.5. https://doi.org/10.33137/cpoj.v4i1.35098 Corresponding Author: Daniel J. Lee, PT, PhD, DPT, GCS, COMTTouro College, Department of Physical Therapy, Bayshore, NY USA.Email:[email protected] ORCID: https://orcid.org/0000-0003-1805-2936

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Effect of temperature-control liner materials on long-term outcomes of lower limb prosthesis use: a randomized controlled trial protocol

Trials ◽

10.1186/s13063-019-3920-4 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Goeran Fiedler ◽

Anita Singh ◽

Xueyi Zhang

Keyword(s):

Phase Change ◽

Phase Change Material ◽

Temperature Control ◽

Controlled Trial ◽

Limb Loss ◽

Effect Of Temperature ◽

Residual Limb ◽

Double Blind ◽

Prosthetic Socket ◽

Change Material

Abstract Background In people living with limb loss, addressing the resulting functional deficit with prostheses increases the risk for secondary conditions such as pressure sores, impaired blood perfusion, and injuries from accidental falls. Any of those occurrences can render the prosthesis temporarily useless, making it challenging for users to engage in many activities of daily life, including work, exercise, and social participation. Many of the described issues originate at the interface between residual limb and prosthetic socket, where the objectives of sufficient weight distribution and suspension are conflicting with the necessity to facilitate heat exchange and limit contact pressure and friction. Recently, prosthesis liners that contain phase-change material have become commercially available, holding the promise that the micro climate at the interface between the residual limb skin and the prosthetic socket can be regulated to reduce the users’ tendency to sweat. Preliminary studies on these liners indicate that the socket temperatures inside the socket stayed lower and rose slower than in conventional liners. However, the clinical relevance of those findings remains unclear. The purpose of this study is to investigate whether longer (6+ months) periods of use of phase-change material based temperature-control liners have clinically meaningful effects. Methods The protocol is a double-blind longitudinal cross-over research design. A sample of trans-tibial prosthesis users are wearing their regular gel or silicone liners for six months and phase-change material liners for another six months in a randomized sequence. Their prostheses is equipped with activity monitors to detect days when they could not wear their prosthesis. In six-week intervals, individuals’ activity, physical performance, and overall prosthesis assessment is recorded using standardized methods. Discussion Expected results will inform prescription and reimbursement practice of phase-change material-based prosthesis liners and will help improve and economize prosthetic fitting for people with limb loss. The design and duration of the protocol, including randomization, blinding, and within-subject comparison, will generate scientific evidence of a comparably high level. Inclusion of a comparably large sample and different climates, e.g. across all four seasons, will make findings applicable to a large number of prosthesis users. Trial registration Clinicaltrials.gov, NCT03428815. Registered on 12 February 2018.

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Selective Sampling and Orientation of Non-Homogeneous Tissues

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100100238 ◽

1968 ◽

Vol 26 ◽

pp. 98-99

Author(s):

C. C. Clawson ◽

L. W. Anderson ◽

R. A. Good

Keyword(s):

Electron Microscopy ◽

Electron Microscope ◽

Light Microscopy ◽

Random Sampling ◽

New Method ◽

Microscope Examination ◽

Small Areas ◽

Selective Sampling ◽

Large Numbers ◽

Specific Orientation

Investigations which require electron microscope examination of a few specific areas of non-homogeneous tissues make random sampling of small blocks an inefficient and unrewarding procedure. Therefore, several investigators have devised methods which allow obtaining sample blocks for electron microscopy from region of tissue previously identified by light microscopy of present here techniques which make possible: 1) sampling tissue for electron microscopy from selected areas previously identified by light microscopy of relatively large pieces of tissue; 2) dehydration and embedding large numbers of individually identified blocks while keeping each one separate; 3) a new method of maintaining specific orientation of blocks during embedding; 4) special light microscopic staining or fluorescent procedures and electron microscopy on immediately adjacent small areas of tissue.

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Introduction to Medical Imaging

10.1017/cbo9780511760976 ◽

2009 ◽

Cited By ~ 22

Author(s):

Nadine Barrie Smith ◽

Andrew Webb

Keyword(s):

Medical Imaging

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