Medicine and Design Investigate Residual Limb Volume Fluctuations: Three Case Studies

AbstractThis study constitutes the first attempt to systematically quantify residual limb volume fluctuations in transfemoral amputees. The study was carried out on 24 amputees to investigate variations due to prosthesis doffing, physical activity, and testing time. A proper experimental set-up was designed, including a 3D optical scanner to improve precision and acceptability by amputees. The first test session aimed at measuring residual limb volume at 7 time-points, with 10 min intervals, after prosthesis doffing. This allowed for evaluating the time required for volume stabilization after prosthesis removal, for each amputee. In subsequent sessions, 16 residual limb scans in a day for each amputee were captured to evaluate volume fluctuations due to prosthesis removal and physical activity, in two times per day (morning and afternoon). These measurements were repeated in three different days, a week apart from each other, for a total of 48 scans for each amputee. Volume fluctuations over time after prosthesis doffing showed a two-term decay exponential trend (R2 = 0.97), with the highest variation in the initial 10 min and an average stabilization time of 30 min. A statistically significant increase in residual limb volume following both prosthesis removal and physical activity was verified. No differences were observed between measures collected in the morning and in the afternoon.Clinical Trials.gov ID: NCT04709367.

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Fluctuating residual limb volume accommodated with an adjustable, modular socket design: A novel case report

Prosthetics and Orthotics International ◽

10.1177/0309364616679316 ◽

2016 ◽

Vol 41 (5) ◽

pp. 527-531 ◽

Cited By ~ 6

Author(s):

Kay Mitton ◽

Jai Kulkarni ◽

Kenneth William Dunn ◽

Anthony Hoang Ung

Keyword(s):

Case Report ◽

Complex Regional Pain Syndrome ◽

Patellofemoral Instability ◽

Pain Syndrome ◽

Successful Outcome ◽

Residual Limb ◽

Case Description ◽

Limb Volume ◽

Prosthetic Socket ◽

Volume Fluctuations

Background: This novel case report describes the problems of prescribing a prosthetic socket in a left transfemoral amputee secondary to chronic patellofemoral instability compounded by complex regional pain syndrome. Case Description and Methods: Following the amputation, complex regional pain syndrome symptoms recurred in the residual limb, presenting mainly with oedema. Due to extreme daily volume fluctuations of the residual limb, a conventional, laminated thermoplastic socket fitting was not feasible. Findings and Outcomes: An adjustable, modular socket design was trialled. The residual limb volume fluctuations were accommodated within the socket. Amputee rehabilitation could be continued, and the rehabilitation goals were achieved. The patient was able to wear the prosthesis for 8 h daily and to walk unaided indoors and outdoors. Conclusion: An adjustable, modular socket design accommodated the daily residual limb volume fluctuations and provided a successful outcome in this case. It demonstrates the complexities of socket fitting and design with volume fluctuations. Clinical relevance Ongoing complex regional pain syndrome symptoms within the residual limb can lead to fitting difficulties in a conventional, laminated thermoplastic socket due to volume fluctuations. An adjustable, modular socket design can accommodate this and provide a successful outcome.

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Clinical usability, reliability, and repeatability of noncontact scanners in measuring residual limb volume in persons with transtibial amputation

Prosthetics and Orthotics International ◽

10.1097/pxr.0000000000000087 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Rianne Kofman ◽

Raoul E Winter ◽

Cornelis H Emmelot ◽

Jan HB Geertzen ◽

Pieter U Dijkstra

Keyword(s):

Residual Limb ◽

Limb Volume ◽

Transtibial Amputation

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Three-dimensional printing in prosthetics: Method for managing rapid limb volume change

Prosthetics and Orthotics International ◽

10.1177/0309364620934340 ◽

2020 ◽

Vol 44 (5) ◽

pp. 355-358 ◽

Cited By ~ 1

Author(s):

Eric Nickel ◽

Kyle Barrons ◽

Barry Hand ◽

Alana Cataldo ◽

Andrew Hansen

Keyword(s):

Service Life ◽

Three Dimensional ◽

Residual Limb ◽

Volume Loss ◽

Limb Volume ◽

Three Dimensional Printing ◽

Body Mass Change ◽

Prosthetic Socket ◽

Test Distance ◽

Gain Loss

Background and Aim: During post-amputation recovery or rapid body mass change, residual limb volume can change quickly, requiring frequent adjustments or replacement of the socket to maintain fit. The aim of this pilot test was to evaluate the feasibility of using a three-dimensional-printed insert to extend the service life of a prosthetic socket after substantial residual limb volume loss. Technique: One research subject with a well-fitting transtibial prosthetic socket had an oversized socket fabricated to simulate substantial limb volume loss. The digital shapes of the oversized and well-fitting sockets were used to create a three-dimensional-printed insert to restore fit. Discussion: Two-minute walk test distance decreased when using the oversized socket without the insert, but not when using the socket with the insert. Socket comfort score was 8+ under all conditions. These results suggest that three-dimensional-printed inserts may be an effective method of extending the service life of prosthetic sockets when rapid limb volume loss occurs. Clinical relevance Three-dimensional (3D) printing gives prosthetists a new tool to manage large volume changes without refabricating entire sockets. Sockets can be fabricated in anticipation of volume gain/loss, using replaceable 3D-printed inserts to maintain fit and comfort.

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Transfemoral Residual Limb Volume Change Due to Physical Activity

Converging Clinical and Engineering Research on Neurorehabilitation III - Biosystems & Biorobotics ◽

10.1007/978-3-030-01845-0_29 ◽

2018 ◽

pp. 146-150

Author(s):

Linda Paternò ◽

Michele Ibrahimi ◽

Elisa Rosini ◽

Arianna Menciassi ◽

Leonardo Ricotti

Keyword(s):

Physical Activity ◽

Volume Change ◽

Residual Limb ◽

Limb Volume

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Residual Limb Volume Change in the Early Post-operative Phase after Below-the-knee Amputation : A Report of Three Cases

The Japanese Journal of Rehabilitation Medicine ◽

10.2490/jjrmc.54.889 ◽

2017 ◽

Vol 54 (11) ◽

pp. 889-893

Author(s):

Yohei Tanaka ◽

Takaaki Ueno ◽

Kiyokazu Tanaka ◽

Nobuhiko Haga

Keyword(s):

Volume Change ◽

Residual Limb ◽

Limb Volume ◽

Knee Amputation ◽

Below The Knee

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Residual limb volume change: Systematic review of measurement and management

The Journal of Rehabilitation Research and Development ◽

10.1682/jrrd.2010.09.0189 ◽

2011 ◽

Vol 48 (8) ◽

pp. 949 ◽

Cited By ~ 77

Author(s):

Joan E. Sanders ◽

Stefania Fatone

Keyword(s):

Systematic Review ◽

Volume Change ◽

Residual Limb ◽

Limb Volume

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Elevated Vacuum Suspension Influence on Lower Limb Amputeeʼs Residual Limb Volume at Different Vacuum Pressure Settings

JPO Journal of Prosthetics and Orthotics ◽

10.1097/jpo.0b013e3181f903df ◽

2010 ◽

Vol 22 (4) ◽

pp. 252-256 ◽

Cited By ~ 19

Author(s):

Maria J. Gerschutz ◽

Jeffery A. Denune ◽

James M. Colvin ◽

Glenn Schober

Keyword(s):

Lower Limb ◽

Vacuum Pressure ◽

Residual Limb ◽

Limb Volume

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Reliability and validity of the iSense optical scanner for measuring volume of transtibial residual limb models

Prosthetics and Orthotics International ◽

10.1177/0309364618806038 ◽

2018 ◽

Vol 43 (2) ◽

pp. 213-220 ◽

Cited By ~ 1

Author(s):

Lucy Armitage ◽

Li Khim Kwah ◽

Lauren Kark

Keyword(s):

Intraclass Correlation ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Criterion Validity ◽

Residual Limb ◽

Limb Volume ◽

Rater Reliability ◽

Measuring Volume ◽

Intraclass Correlation Coefficients ◽

Optical Scanner

Background: Residual limb volume is often measured as part of routine care for people with amputations. These measurements assist in the timing of prosthetic fitting or replacement. In order to make well informed decisions, clinicians need access to measurement tools that are valid and reliable. Objectives: To assess the reliability and criterion validity of the iSense optical scanner in measuring volume of transtibial residual limb models. Study Design: Three assessors performed two measurements each on 13 residual limb models with an iSense optical scanner (3D systems, USA). Intra-rater and inter-rater reliability were calculated using intraclass correlation coefficients. Bland Altman plots were inspected for agreement. Criterion validity was assessed using a steel rod of known dimensions. Ten repeated measurements were performed by one assessor. A t-test was used to determine differences between measured and true rod volume. Results: Intra-rater reliability was excellent (range of intraclass correlation coefficients: 0.991–0.997, all with narrow 95% confidence intervals). While the intraclass correlation coefficients suggest excellent inter-rater reliability between all three assessors (range of intraclass correlation coefficients: 0.952–0.986), the 95% confidence intervals were wide between assessor 3 and the other two assessors. Poor agreement with assessor 3 was also seen in the Bland-Altman plots. Criterion validity was very poor with a significant difference between the mean iSense measurement and the true rod volume (difference: 221.18 mL; p < 0.001). Conclusions: Although intra-rater reliability was excellent for the iSense scanner, we did not find similar results for inter-rater reliability and validity. These results suggest that further testing of the iSense scanner is required prior to use in clinical practice. Clinical relevance The iSense offers a low cost scanning option for residual limb volume measurement. Intra-rater reliability was excellent, but inter-rater reliability and validity were such that clinical adoption is not indicated at present.

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