USING PERFORATED LINERS TO COMBAT THE DETRIMENTAL EFFECTS OF EXCESSIVE SWEATING IN LOWER LIMB PROSTHESIS USERS

BACKGROUND: Excessive sweating of the residual limb has a substantial effect on the daily activities of people with lower limb amputation. Prosthetic liners offer protection and comfort to sensitive areas but often exacerbate perspiration. They act as insulators, trapping sweat on the skin’s surface to the detriment of skin health. Recently, liners with perforations have been developed, allowing the moisture to escape. The goal of this study was to assess the impact of such liners. METHODS: A sample group of 13 patients with unilateral transtibial amputation, who wore a perforated liner (PL) as part of their current prescription, was compared to 20 control patients who wore non-perforated liners (NPL). During their routine appointments, they completed a survey of scientifically validated outcome measures relating to their limb health, pain and the impact on daily life over a 12-month period. RESULTS: Patients using the PL had healthier residual limbs, reporting higher scores on questions relating to limb health, experiencing fewer skin issues (p<0.001) and estimating a 61.8% lower rating in perceived sweat (p=0.004). Perhaps consequentially, there was a lower incidence of residual (p=0.012) and phantom (p=0.001) limb pain when compared to the control group. The prevalence of individual issues affecting the residual limbs of PL users was also lower. Of the issues that remained, only 23% were attributed to sweating in PL users, compared to 49% for the NPL group (p=0.066). PL users missed fewer days of work in the year (2.4 vs 11.6, p=0.267) and were also limited on fewer days (1.4 vs 75.4, p=0.009). CONCLUSION: The use of perforated liners shows much promise within prosthetic care, significantly improving the health of the residual limb. The observed effects on perceived sweat reduction, residual skin health, pain levels and patient limitation suggest that perforated liners are highly beneficial to patients. Layman's Abstract Individuals with amputation often find that they sweat more as they exert more energy when walking and because the total surface area of their body is reduced. Silicone liners are used to cushion the residual limb and as a way of attaching a prosthetic leg, but they act as insulators causing the residual limb to get hot and sweaty. The material isn’t breathable, so the sweat is not able to escape, instead staying on the skin’s surface and causing discomfort or leading to the development of skin conditions. Liners that have small holes in them allow sweat to travel away from the body and preserve skin health. Patients who wore a perforated liner, as well as patients who wore a liner without holes, filled in questionnaires about their experience, the results of which were compared. Generally, patients who wore the perforated liner had healthier skin on their residual limbs and experienced fewer skin conditions than the other patient group. Out of the issues they did experience, fewer were attributed to sweating. The study group experienced less frequent pain both in their physical and phantom limbs. They also considered themselves less limited by their prosthetic device and missed fewer days of work. These observations suggest that perforated liners are highly beneficial to patients within the prosthetic field. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/34610/26579 How To Cite: Davies K.C, McGrath M, Savage Z, Stenson A, Moser D, Zahedi S. Using perforated liners to combat the detrimental effects of excessive sweating in lower limb prosthesis users. Canadian Prosthetics & Orthotics Journal. 2020;Volume 3, Issue 2, No.1. https://doi.org/10.33137/cpoj.v3i2.34610 Corresponding Author: K.C Davies, Blatchford Group, Unit D Antura, Bond Close, Basingstoke, RG24 8PZ, UK.E-mail: [email protected]: https://orcid.org/0000-0003-2933-4365

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A low-cost easily implementable physiotherapy intervention clinically improves gait implying better adaptation to lower limb prosthesis: a randomized clinical trial

Scientific Reports ◽

10.1038/s41598-021-00686-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Leticia Vargas Almeida ◽

Claudiane Arakaki Fukuchi ◽

Tania Emi Sakanaka ◽

Alberto Cliquet

Keyword(s):

Lower Limb ◽

Low Cost ◽

Intervention Group ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Control Group ◽

Post Intervention ◽

Physiotherapy Intervention ◽

Lower Limb Prosthesis ◽

Limb Prosthesis

AbstractLower limb amputation highly impacts the lives of individuals. The inability to walk due to difficulties in adapting to wearing prosthesis can potentially result in physical degeneration and comorbidity in this population. In this randomized clinical trial study, we investigated if a low-cost and easily implementable physiotherapy intervention was effective in improving gait performance and adaptation to lower limb prosthesis in individuals with an amputation. A total of 26 individuals participated in the study, 16 with lower limb amputation and 10 without amputation. Participants with amputation were further divided in intervention and control groups. The intervention group underwent a rehabilitation protocol aimed at strengthening muscles and improving prosthesis adaptation. Muscle strengthening targeted the hip segment, prioritizing the abdominal muscles, hip flexors, extensors, adductors and abductors, followed by cicatricial mobilization and weight-bearing on the stump for desensitization. Assessment and measures were performed across the kinetic and kinematic parameters of gait. In the comparison between pre-and post-intervention, a significant increase in gait speed (0.68—2.98, 95% CI, 1.83, effect size ES) and cadence (0.56—2.69, 95% CI, 1.63, ES) was found between groups and time points. Step (0.73—3.11, 95% CI, 1.92, ES) and stride length (0.62—2.84, 95% CI, 1.73) increased between pre- and post-intervention, while in the control group both variables remained smaller. The intervention group decreased stance phase as a percentage of gait cycle between pre- and post-intervention (− 1.33—0.62, 95% CI, − 36, ES), while it increased in the control group. Improvement in a combination of important gait parameters indicates that the intervention protocol promoted the adaptation to prosthesis and the functional independence of individuals with lower limb amputation. It is recommended that the participants continue receiving follow-up assessments and rehabilitation interventions.

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Reduced cortical brain activity with the use of microprocessor-controlled prosthetic knees during walking

Prosthetics and Orthotics International ◽

10.1177/0309364618805260 ◽

2018 ◽

Vol 43 (3) ◽

pp. 257-265 ◽

Cited By ~ 6

Author(s):

Saffran Möller ◽

David Rusaw ◽

Kerstin Hagberg ◽

Nerrolyn Ramstrand

Keyword(s):

Cognitive Processes ◽

Lower Limb ◽

Brain Activity ◽

Control Group ◽

Healthy Controls ◽

Prosthetic Knee ◽

Level Walking ◽

Lower Limb Prosthesis ◽

Prosthetic Knees ◽

Limb Prosthesis

Background: Individuals using a lower-limb prosthesis indicate that they need to concentrate on every step they take. Despite self-reports of increased cognitive demand, there is limited understanding of the link between cognitive processes and walking when using a lower-limb prosthesis. Objective: The objective was to assess cortical brain activity during level walking in individuals using different prosthetic knee components and compare them to healthy controls. It was hypothesized that the least activity would be observed in the healthy control group, followed by individuals using a microprocessor-controlled prosthetic knee and finally individuals using a non-microprocessor-controlled prosthetic knee. Study design: Cross-sectional study. Methods: An optical brain imaging system was used to measure relative changes in concentration of oxygenated and de-oxygenated haemoglobin in the frontal and motor cortices during level walking. The number of steps and time to walk 10 m was also recorded. The 6-min walk test was assessed as a measure of functional capacity. Results: Individuals with a transfemoral or knee-disarticulation amputation, using non-microprocessor-controlled prosthetic knee ( n = 14) or microprocessor-controlled prosthetic knee ( n = 15) joints and healthy controls ( n = 16) participated in the study. A significant increase was observed in cortical brain activity of individuals walking with a non-microprocessor-controlled prosthetic knee when compared to healthy controls ( p < 0.05) and individuals walking with an microprocessor-controlled prosthetic knee joint ( p < 0.05). Conclusion: Individuals walking with a non-microprocessor-controlled prosthetic knee demonstrated an increase in cortical brain activity compared to healthy individuals. Use of a microprocessor-controlled prosthetic knee was associated with less cortical brain activity than use of a non-microprocessor-controlled prosthetic knee. Clinical relevance Increased understanding of cognitive processes underlying walking when using different types of prosthetic knees can help to optimize selection of prosthetic components and provide an opportunity to enhance functioning with a prosthesis.

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Obesity and Skin Problems in Persons With a Lower Limb Amputation: An Observational Study

10.21203/rs.3.rs-332506/v1 ◽

2021 ◽

Author(s):

Terezka S. Mollee ◽

Pieter U. Dijkstra ◽

Rienk Dekker ◽

Jan H.B. Geertzen

Keyword(s):

Body Mass Index ◽

Body Weight ◽

Confidence Interval ◽

Body Mass ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Residual Limb ◽

Prevalence Of Obesity ◽

The Impact

Abstract Background: A lower limb amputation can lead to weight gain and obesity. However, data regarding the prevalence of obesity in the Dutch population with a lower limb amputation are lacking. Furthermore, the impact of obesity on skin problems of the residual limb and the need of prosthetic repairs is unknown. The aim of this study was to determine the prevalence of obesity in Dutch persons with a lower limb amputation and to investigate the relationship between body weight, body mass index and skin problems of the residual limb and the frequency of prosthetic repairs. Methods: A survey was performed among adults with a unilateral lower limb amputation due to any cause, and who are user of a prosthesis. The survey consisted of measurement of the subjects’ body height and weight, a questionnaire which assessed self-reported skin problems in the previous month and factors potentially associated with these skin problems, and assessment of the frequency of visits to the orthopedic workshop. Results: In total, 413 persons were enrolled. Of them, 39% (95% confidence interval 35%−44%) was overweight and 28% (95% confidence interval 24%−33%) was obese. A total of 77% (95% confidence interval 73%−81%) reported one or more skin problems in the past month. Body weight and body mass index were neither associated with the presence of skin problems in general nor with the number of prosthetic repairs. Persons with severe skin problems had a slightly lower body mass index (26.6 kg/m2 vs. 28.0 kg/m2, p = 0.012). Persons with skin problems were younger than those without (difference in means 6.0 years (95% confidence interval 3.0−8.9)). Conclusion: Our findings show that obesity is common in the ambulant population with a lower limb amputation, with a prevalence being higher than in the general Dutch adult population. However, its negative impact on the presence of skin problems and the frequency of prosthetic repairs may be limited.

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Prosthetics for Lower Limb Amputation

10.5772/intechopen.95593 ◽

2021 ◽

Author(s):

P. Senthil Selvam ◽

M. Sandhiya ◽

K. Chandrasekaran ◽

D. Hepzibah Rubella ◽

S. Karthikeyan

Keyword(s):

Gait Analysis ◽

Lower Limb ◽

Lower Limb Amputation ◽

Complete Picture ◽

Limb Amputation ◽

Advantages And Disadvantages ◽

Diagrammatic Representation ◽

Mechanical Component ◽

Lower Limb Prosthesis ◽

Limb Prosthesis

The Chapter will include a brief note on Amputation, Particularly Lower Limb Amputation (LLA), Levels and Causes of LLA. Importance of Prosthetics for LLA are explained in detail. The types of Prosthesis, Application (Donning & Doffing) of prosthesis are included in this chapter. Diagrammatic representation of the prosthesis are added too. Bio mechanical component is explained in detail within this chapter. The advantages and disadvantages of each and every Lower limb Prosthesis are clearly mentioned. Moreover, the Gait analysis & Training after the application of prosthesis are discussed. The reader will get a complete picture of Prosthetics for Lower limb Amputation by going through this chapter for lower limb prosthesis.

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The association between body mass index and skin problems in persons with a lower limb amputation: an observational study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04646-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Terezka S. Mollee ◽

Pieter U. Dijkstra ◽

Rienk Dekker ◽

Jan H.B. Geertzen

Keyword(s):

Body Mass Index ◽

Body Weight ◽

Confidence Interval ◽

Body Mass ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Residual Limb ◽

Prevalence Of Obesity ◽

The Impact

Abstract Background Obesity is common in persons with a lower limb amputation, an amputation can also lead to further weight gain. Data regarding the prevalence of obesity in the Dutch population with a lower limb amputation are lacking. Furthermore, the impact of obesity on skin problems of the residual limb and the need of prosthetic repairs is unknown. The aim of this study was to determine the prevalence of obesity in Dutch persons with a lower limb amputation and to investigate the relationship between body weight, body mass index and skin problems of the residual limb and the frequency of prosthetic repairs. Methods A survey was performed among adults with a unilateral lower limb amputation due to any cause, and who are user of a prosthesis. The survey consisted of measurement of the subjects’ body height and weight, a questionnaire which assessed self-reported skin problems in the previous month and factors potentially associated with these skin problems, and assessment of the frequency of visits to the orthopedic workshop. Results In total, 413 persons were enrolled. Of them, 39% (95 % confidence interval 35;44) were overweight and 28% (95% confidence interval 24;33) were obese. A total of 77% (95% confidence interval 73;81) reported one or more skin problems in the past month. Body weight and body mass index were neither associated with the presence of skin problems in general nor with the number of prosthetic repairs. Persons with severe skin problems had a slightly lower body mass index (26.6 kg/m2 vs. 28.0 kg/m2, p = 0.012). Persons with skin problems were younger than those without (difference in means 6.0 years (95% confidence interval 3.0;8.9)). Conclusions Our findings show that obesity is common in the Dutch ambulant population with a lower limb amputation, with a prevalence being higher than in the general Dutch adult population. However, its negative impact on the presence of skin problems and the frequency of prosthetic repairs may be limited.

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Patient’s satisfaction with a lower limb prosthesis: a longitudinal study

Fisioterapia e Pesquisa ◽

10.1590/1809-2950/20014728032021 ◽

2021 ◽

Vol 28 (3) ◽

pp. 276-283

Author(s):

Isaias Pimentel dos Santos ◽

Alana das Mercês Silva ◽

Graziella Santos Furtado ◽

Rosarly Maria Marques de Menezes ◽

Kionna Oliveira Bernardes dos Santos ◽

...

Keyword(s):

Older Adults ◽

Longitudinal Study ◽

Lower Limb ◽

Limb Amputation ◽

Patient’S Satisfaction ◽

Lower Limb Prosthesis ◽

Level Of Significance ◽

Ambulatory Rehabilitation ◽

Limb Prosthesis ◽

Over Time

ABSTRACT This is a descriptive longitudinal study that aimed to verify prosthesis satisfaction of older adults with lower-limb amputation (LLA). In total, This study was composed of 34 older adults with LLA participated of this study. Participant’s satisfaction about the lower-limb prosthesis (LLP), the discomforts, and the embarrassment when use it were evaluated through an interview composed of five questions. The occurrence of falls and the independence in prosthesis management were also evaluated. All variables were collected at the last week of ambulatory rehabilitation discharge and after one and three months. A descriptive and inferential statistical analysis was performed. The level of significance was set at 5% (p <0.05). In total, 80% of participants with transtibial amputation and 78.6% of participants with transfemoral amputation were satisfied with the LLP after three months. Tight prosthesis, walking pain, the embarrassment of using LLP, and the occurrence of falls decreased over time. The independence in prosthesis handling did not change significantly after three months. Participants that used manual locking knee (p=0.040) and/or Solid-Ankle Cushion Heel foot (p=0.017) were more satisfied with LLP. The occurrence of falls reduced (p=0.039) after transfemoral participants started to use the prosthesis. Participant’s satisfaction with the LLP was high and did not change significantly over time.

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A Lower Limb Prosthesis Haptic Feedback System for Stair Descent

2017 Design of Medical Devices Conference ◽

10.1115/dmd2017-3409 ◽

2017 ◽

Cited By ~ 2

Author(s):

Astrini Sie ◽

Jonathan Realmuto ◽

Eric Rombokas

Keyword(s):

Lower Limb ◽

Haptic Feedback ◽

The Body ◽

Lower Limbs ◽

Prosthetic Limbs ◽

Stair Descent ◽

Lower Limb Prosthesis ◽

Limb Prosthesis ◽

Flat Ground ◽

Lower Limb Prostheses

Though there are a variety of prosthetic limbs that address the motor deficits associated with amputation, there has been relatively little progress in restoring sensation. Prosthetic limbs provide little direct sensory feedback of the forces they encounter in the environment, but “closing the loop” between sensation and action can make a great difference in performance [1]. For users of lower limb prostheses, stair descent is a difficult and dangerous task. The difficulty in stair descent can be attributed to three different factors: 1) Absence of tactile and haptic sensations at the bottom of the foot. Although force on the prosthetic socket provides some haptic feedback of the terrain being stepped on, this feedback does not provide information on the location of the staircase edge. 2) Insufficient ankle flexion of lower limb prostheses. Dorsiflexion of the physiological ankle during stair descent is about 27°. Even prostheses that provide active dorsiflexion provide less than this number, and regular prostheses provide almost no ankle dorsiflexion. The first two factors are analogous to the sensation of stair descent for someone without amputation wearing ski boots. 3) Prosthetic feet are optimized for flat-ground walking, offering undesirable energy storage at ankle flexion and energy return at toe-off. This can result in unwanted extra energy at the end of stance phase, propelling the user forward down the stairs. Most lower limb prosthesis designs focus on flat ground walking, but there has been less progress in addressing the challenges of stair descent. One technique that users of prosthetic lower limbs can use for addressing these challenges is to employ an “overhanging toe” foot placement strategy. Under this strategy, the edge of the staircase is used as a pivot point for the foot to roll over the stair. This reduces the need for ankle flexion by allowing the knee and hip to compensate, and avoids storing energy in the prosthetic spring. This strategy is dynamic, and requires the user to know the amount of toe overhang to adjust the movement of the rest of the body. Most haptic devices built to assist individuals wearing prostheses focus on upper extremity tasks [2–4] or standing and walking [5,6]. Whereas previous lower limb sensory replacement systems have targeted standing measures, here we focus on stair descent. The system provides cues of the stair edge location via vibrotactile stimulations on the thigh.

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Feasibility and Validity of a Graded One-Legged Cycle Exercise Test to Determine Peak Aerobic Capacity in Older People With a Lower-Limb Amputation

Physical Therapy ◽

10.2522/ptj.20110125 ◽

2012 ◽

Vol 92 (2) ◽

pp. 329-338 ◽

Cited By ~ 9

Author(s):

Daphne Wezenberg ◽

Arnold de Haan ◽

Lucas H. van der Woude ◽

Han Houdijk

Keyword(s):

Older People ◽

Aerobic Capacity ◽

Exercise Test ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Lower Limb Prosthesis ◽

Valid Assessment ◽

Peak Aerobic Capacity ◽

Limb Prosthesis

BackgroundInformation concerning exercise tolerance and aerobic capacity is imperative for generating effective and safe exercise programs. However, for older people with a lower-limb amputation, a standard exercise test is not available.ObjectiveThe primary aim of the present study was to determine whether a graded 1-legged peak exercise test is feasible and provides a valid assessment of peak aerobic capacity in older people walking with a lower-limb prosthesis.DesignThis was a quasi-experimental case-control study.MethodsA total of 36 older people with a lower-limb prosthesis and 21 people who were able-bodied (controls) (overall mean age=61.7 years, SD=6.1) performed a discontinuous graded 1-legged exercise test. The peak respiratory exchange ratio was used as an indicator of maximal effort. The controls performed an additional 2-legged exercise test to provide insight into differences between the testing modes.ResultsAll participants were able to perform the exercise test. Electrocardiographic tracings and blood pressure were adequately monitored. The controls and the people with a lower-limb amputation were able to stress the cardiovascular system to a similar extent. Analyses of construct validity revealed that the peak aerobic capacity measured with the 1-legged exercise test was able to distinguish between participants on the basis of age, body mass index, and sex to a similar extent as the conventional 2-legged exercise test.LimitationsThe results can be generalized only to people who are able to ambulate with their prosthesis.ConclusionsThe graded 1-legged exercise test was feasible and provided a valid assessment of peak aerobic capacity and exercise tolerance in older people walking with a lower-limb prosthesis.

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INFLUENCE OF REHABILITATION MEASURES ON THE QUALITY AND FULL-VALUE OF THE LIFE OF PATIENTS WITH LOWER LIMB PROSTHESES

Ukrainian Scientific Medical Youth Journal ◽

10.32345/usmyj.3(125).2021.44-51 ◽

2021 ◽

Vol 125 (3) ◽

pp. 44-51

Author(s):

Danylo Intelehator ◽

Igor Khudetsky ◽

Yulia Antonova-Rafi

Keyword(s):

Lower Limb ◽

Lower Extremities ◽

Economic Benefits ◽

Limb Amputation ◽

Important Indicator ◽

Professional Activities ◽

Reduced Body ◽

Lower Limb Prosthesis ◽

Rehabilitation Measures ◽

The Impact

Quality and value of life are often recognized as an important indicator for assessing the effectiveness of rehabilitation measures for people with amputation defects of the lower extremities. However, although the topic itself is quite relevant and important, the number of studies that would be devoted to the multiplicity of these factors that directly affect this issue is still quite limited. Such assessments are becoming more and more necessary every year to demonstrate the changes associated with surgical intervention in the anatomical integrity of the human body and the consequences that inevitably occur over time. According to statistics, more than 10,000 amputations are performed in various segments in Ukraine. Analysis of the reasons why people need this operation revealed that most of them (75%) are performed in connection with cardiovascular disease, and more precisely: diabetes, chronic ischemia of the lower extremities, atherosclerosis and endarteritis obliterans. Such grounds for amputation are typical for middle-aged and elderly people. That is why the rehabilitation of these categories of patients after amputation of the lower extremities is determined by significant locomotor disorders that limit a person's independent movement, self-care, posture disorders, reduced body tolerance to exercise and, consequently, severe limitation of life. Rehabilitation measures for this contingent of persons should be evaluated in terms of social and moral benefits, both for the person with amputation and for people close to him and others. Timely and effective physical rehabilitation also provides significant economic benefits, as it frees up significant costs of resources for the care of special staff, as well as relatives, often forced to leave their professional activities due to the need to care for a loved one. In order to assess the quality of life of patients with lower limb amputation and the impact of rehabilitation measures on these indicators, a study of 32 patients was observed in the rehabilitation center on the basis of the Kyiv State Experimental Prosthetic and Orthopedic Enterprise. In addition to the SF-36 functional assessment questionnaire, the developed Prosthesis Movement Index was tested. The results showed that an individual approach to the rehabilitation process is more effective than working on a typical program without changes in it, as well as the possible convenience of using the index of walking on a prosthesis to assess the effectiveness of mastering the lower limb prosthesis by the patient.

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Research on the Improved CNN Deep Learning Method for Motion Intention Recognition of Dynamic Lower Limb Prosthesis

Journal of Healthcare Engineering ◽

10.1155/2021/7331692 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Qiulin Wang

Keyword(s):

Deep Learning ◽

Lower Limb ◽

Learning Algorithm ◽

Recognition Rate ◽

Limb Amputation ◽

Deep Learning Algorithm ◽

The Disabled ◽

Lower Limb Prosthesis ◽

Movement Intention ◽

Limb Prosthesis

Objective. In order to study the motion recognition intention of lower limb prosthesis based on the CNN deep learning algorithm. Methods. A convolutional neural network (CNN) model was established to reconstruct the motion pattern. Before the movement mode of the affected side was converted, the sensor was bound to the healthy side. The classifier was employed to extract and classify the features, so as to realize the accurate description of the movement intention of the disabled. Results. The method proposed in this research can achieve 98.2% recognition rate of the movement intention of patients with lower limb amputation under different terrains, and the recognition rate can reach 97% after the pattern converted between the five modes was added. Conclusion. The deep learning algorithm that automatically recognized and extracted features can effectively improve the control performance on the intelligent lower limb prosthesis and realize the natural and seamless conversion of the intelligent prosthesis in a variety of motion modes.

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