Post-doffing residual limb fluid volume change in people with trans-tibial amputation

Background: Residual limb volume may change after doffing, affecting the limb shape measured and used as a starting point for socket design. Objectives: The purpose of this study was to compare residual limb fluid volume changes after doffing for different test configurations. Study Design: The study was a repeated measures experimental design with three conditions ( Sit, Liner, and Walk). Methods: Residual limb fluid volume on 30 people with trans-tibial amputation was measured using bioimpedance analysis. Three tests were conducted – Sit: sit for 10 minutes, remove the prosthesis, socks and liner, sit for 10 minutes; Liner: sit for 10 minutes, remove the prosthesis and socks but not the liner, sit for 10 minutes; Walk: conduct sit, stand and walk activities for 30 minutes, remove the prosthesis, socks and liner, sit for 10 minutes. Results: The percentage fluid volume increase after doffing was significantly higher for Walk (2.8%) than for Sit (1.8%) ( p = 0.03). The time to achieve a maximum or stable fluid volume was shorter for Liner (4.3 min) than for Sit (6.6 min) ( p = 0.03). Conclusions: Activity before doffing intensified the post-doffing limb fluid volume increase. Maintaining a liner after doffing caused limb fluid volume to stabilize faster than removing the liner. Clinical relevance To minimize residual limb volume increase before casting or imaging, practitioners should have patients sit with their prosthesis donned for 10 minutes. Leaving a liner on the residuum will not reduce the post-doffing volume increase, but it will help to more quickly achieve a consistent limb fluid volume.

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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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How Does Physical Activity Affect Residual Limb Volume Change, Comfort and Gait Symmetry on Traumatic Transfemoral Amputees?

Volume 5: Biomedical and Biotechnology ◽

10.1115/imece2020-23418 ◽

2020 ◽

Author(s):

Sara Salazar-Salgado ◽

Fanny Valencia ◽

Alejandro Uribe ◽

Elizabeth Rendón-Vélez

Keyword(s):

Physical Activity ◽

Volume Change ◽

Treadmill Walking ◽

Residual Limb ◽

Limb Volume ◽

Volume Changes ◽

Gait Symmetry ◽

Symmetry Index ◽

Transfemoral Amputees ◽

Almost All

Abstract There is a considerable amount of young adults who become amputees due to war and violence. For this population, a successful adaptation to their prosthesis depends on the socket fit, which in turn is caused by the volume change of the residual limb during the day. The literature reports several investigations on this topic, most of which use subjects walking on a treadmill to simulate their daily activity. However, this studies are focused on transtibial amputees and do not mention the relationship between this physical activity and other variables such as comfort, volume changes and gait. Therefore, the objective of this paper is to determine the effect of physical activity on the volume of the residual limb, the comfort and the symmetry of gait in traumatic transfemoral amputees. Plaster positive molds of the residual limb, the comfort perception and the gait data of five individuals were obtained at the first time of the day and after three sessions of treadmill walking of 15, 30 and 45 minutes. The positive molds of each individual were scanned and then, the volume was calculated. The gait data was acquired using a marker-based motion capture system and processed to obtain spatio-temporal, kinematic and kinetic parameters, including the Gait Deviation Index (GDI). Based on the literature, specific points of the gait data were selected and the symmetry index was obtain for each of them. A short comfort test was used after each session of treadmill walking. Data was analyzed throughout the tests within each subject. Statistical analysis was performed for the volume and the gait variables to check for statistical significance. After physical activity, a tendency towards residual limb volume decrease was found on almost all subjects, although it was not significant. The percentage of volume change obtained on almost all subjects are within the range considered “good socket fit” according to previous authors. Our results suggest that transfemoral amputees may have smaller volume changes than transtibial after treadmill walking. Significant difference was found on the symmetry index of “Swing phase” between the baseline and the 45-minute test. The values of gait symmetry on the gait parameters were consistent with previous findings regarding transfemoral amputees. The difference that arise may be due to the sample difference (cause of amputation, difference in prosthetic elements and use of walking aids). The lowest symmetry was noticed on the ankle kinematics. The comfort did not significantly change with the selected amount of physical activity. In subsequent research, it is recommended to increase the intensity or time of physical activity and/or increase the number of participants. This results can help the understanding of how the socket/residual limb interface behaves which can improve the design and prescription of prosthetic components.

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Effectiveness of elevated vacuum and suction prosthetic suspension systems in managing daily residual limb fluid volume change in people with transtibial amputation

Prosthetics and Orthotics International ◽

10.1177/0309364620909044 ◽

2020 ◽

Vol 44 (3) ◽

pp. 155-163 ◽

Cited By ~ 1

Author(s):

Robert T Youngblood ◽

Jacob T Brzostowski ◽

Brian J Hafner ◽

Joseph M Czerniecki ◽

Katheryn J Allyn ◽

...

Keyword(s):

Volume Change ◽

Management Strategy ◽

Fluid Volume ◽

Residual Limb ◽

Limb Volume ◽

Laboratory Activity ◽

Suspension Systems ◽

Volume Management ◽

Volume Measurements ◽

Fixed Order

Background: Previous studies investigating limb volume change with elevated vacuum have shown inconsistent results and have been limited by out-of-socket volume measurements and short, single-activity protocols. Objectives: To evaluate the effectiveness of elevated vacuum for managing limb fluid volume compared to suction suspension with an in-socket measurement modality during many hours of activity. Study design: Fixed-order crossover design with a standardized out-of-laboratory activity protocol. Methods: Transtibial electronic elevated vacuum users participated in two sessions. Elevated vacuum was used during the first session, and suction suspension in the second. Participants completed a 5.5-h protocol consisting of multiple intervals of activity. In-socket residual limb fluid volume was continuously measured using a custom portable bioimpedance analyzer. Results: A total of 12 individuals participated. Overall rate of fluid volume change was not significantly different, though the rate of posterior fluid volume change during Cycle 3 was significantly lower with elevated vacuum. Although individual results varied, 11 participants experienced lower overall rates of fluid volume loss in at least one limb region using elevated vacuum. Conclusion: Elevated vacuum may be more effective as a volume management strategy after accumulation of activity. Individual variation suggests the potential to optimize the limb fluid volume benefits of elevated vacuum by reducing socket vacuum pressure for some users. Clinical relevance A better understanding of how elevated vacuum (EV) affects residual limb fluid volume will allow prosthetists to make more informed clinical decisions regarding accommodation strategies designed to improve daily socket fit.

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Adjustable sockets may improve residual limb fluid volume retention in transtibial prosthesis users

Prosthetics and Orthotics International ◽

10.1177/0309364618820140 ◽

2019 ◽

Vol 43 (3) ◽

pp. 250-256 ◽

Cited By ~ 4

Author(s):

Jacob T Brzostowski ◽

Brian G Larsen ◽

Robert T Youngblood ◽

Marcia A Ciol ◽

Brian J Hafner ◽

...

Keyword(s):

Repeated Measures ◽

Fluid Volume ◽

Residual Limb ◽

Short Term ◽

Transtibial Prosthesis ◽

Activity Cycles ◽

Long Term Retention ◽

Volume Retention ◽

Intervention Condition

Background: Loss of residual limb volume degrades socket fit and may require accommodation. Objectives: To examine if either of two accommodation strategies executed during resting, socket release with full socket size return and socket release with partial socket size return, enhanced limb fluid volume retention during subsequent activity. Study design: Two repeated-measures experiments were conducted to assess the effects of socket release on limb fluid volume retention. Methods: Limb fluid volume was monitored while participants wore a socket with a single adjustable panel. Participants performed eight activity cycles that each included 10 min of sitting and 2 min of walking. The socket’s posterior panel and pin lock were released during the fifth cycle while participants were sitting. In one experiment (Full Return), the socket was returned to its pre-release size; in a second experiment (Partial Return), it was returned to 102% of its pre-release size. Short-term and long-term limb fluid volume retention were calculated and compared to a projected, No Intervention condition. Results: Partial Return and Full Return short-term retentions and Partial Return long-term retention were greater than those projected under the control condition ( p < 0.05). Conclusion: Socket release during resting after activity, particularly when the socket is returned to a slightly larger size, may be an effective accommodation strategy to reduce fluid volume loss in transtibial prosthesis users. Clinical relevance This study suggests that existing prosthetic technologies’ adjustable sockets and locking pin tethers can be used in novel ways to help maintain residual limb fluid volume in active prosthesis users.

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Residual limb fluid volume change and volume accommodation: Relationships to activity and self-report outcomes in people with trans-tibial amputation

Prosthetics and Orthotics International ◽

10.1177/0309364617752983 ◽

2018 ◽

Vol 42 (4) ◽

pp. 415-427 ◽

Cited By ~ 6

Author(s):

Joan E Sanders ◽

Robert T Youngblood ◽

Brian J Hafner ◽

Marcia A Ciol ◽

Katheryn J Allyn ◽

...

Keyword(s):

Volume Change ◽

Weight Bearing ◽

Management Strategies ◽

Fluid Volume ◽

Self Report ◽

Residual Limb ◽

Strongly Correlated ◽

Test Protocol ◽

Laboratory Activity ◽

Percent Time

Background: Fluctuations in limb volume degrade prosthesis fit and require users to accommodate changes using management strategies, such as donning and doffing prosthetic socks. Objectives: To examine how activities and self-report outcomes relate to daily changes in residual limb fluid volume and volume accommodation. Study design: Standardized, two-part laboratory protocol with an interim observational period. Methods: Participants were classified as “accommodators” or “non-accommodators,” based on self-report prosthetic sock use. Participants’ residual limb fluid volume change was measured using a custom bioimpedance analyzer and a standardized in-laboratory activity protocol. Self-report health outcomes were assessed with the Socket Comfort Score and Prosthesis Evaluation Questionnaire. Activity was monitored while participants left the laboratory for at least 3 h. They then returned to repeat the bioimpedance test protocol. Results: Twenty-nine people were enrolled. Morning-to-afternoon percent limb fluid volume change per hour was not strongly correlated to percent time weight-bearing or to self-report outcomes. As a group, non-accommodators ( n = 15) spent more time with their prosthesis doffed and reported better outcomes than accommodators. Conclusion: Factors other than time weight-bearing may contribute to morning-to-afternoon limb fluid volume changes and reported satisfaction with the prosthesis among trans-tibial prosthesis users. Temporary doffing may be a more effective and satisfying accommodation method than sock addition. Clinical relevance Practitioners should be mindful that daily limb fluid volume change and prosthesis satisfaction are not dictated exclusively by activity. Temporarily doffing the prosthesis may slow daily limb fluid volume loss and should be investigated as an alternative strategy to sock addition.

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