Canadian Prosthetics & Orthotics Journal
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2022 ◽  
Vol 5 (1) ◽  
Author(s):  
Stefanie John ◽  
Katja Orlowski ◽  
Kai-Uwe Mrkor ◽  
Jürgen Edelmann-Nusser ◽  
Kerstin Witte

BACKGROUND: Following amputation, patients with lower limb amputations (LLA) are classified into different functional mobility levels (K-levels) ranging from K0 (lowest) to K4 (highest). However, K-level classification is often based on subjective criteria. Objective measures that are able to differentiate between K-levels can help to enhance the objectivity of K-level classification. OBJECTIVE(S): The goal of this preliminary cross-sectional study was to investigate whether differences in hip muscle strength and balance parameters exist among patients with transfemoral amputations (TFA) assigned to different K-levels. METHODOLOGY: Twenty-two participants with unilateral TFA were recruited for this study, with four participants assigned to K1 or K2, six assigned to K3 and twelve assigned to K4. Maximum isometric hip strength of the residual limb was assessed in hip flexion, abduction, extension, and adduction using a custom-made diagnostic device. Static balance was investigated in the bipedal stance on a force plate in eyes open (EO) and eyes closed (EC) conditions. Kruskal-Wallis tests were used to evaluate differences between K-level groups. FINDINGS: Statistical analyses revealed no significant differences in the parameters between the three K-level groups (p>0.05). Descriptive analysis showed that all hip strength parameters differed among K-level groups showing an increase in maximum hip torque from K1/2-classified participants to those classified as K4. Group differences were also present in all balance parameters. Increased sway was observed in the K1/2 group compared to the K4 group, especially for the EC condition. CONCLUSION: Although not statistically significant, the magnitude of the differences indicates a distinction between K-level groups. These results suggest that residual limb strength and balance parameters may have the potential to be used as objective measures to assist K-level assignment for patients with TFA. This potential needs to be confirmed in future studies with a larger number of participants. Layman's Abstract Patients with lower limb amputation (LLA) are classified into different mobility levels, so-called K-levels, which are ranging from K0 (lowest) to K4 (highest). K-level classification is relevant for the patients as it determines the type of prosthetic components available. However, K-level can vary greatly based on the clinician or orthopedic technician individual assessment. Objective data from physical performance tests can help to improve K-level classification. Therefore, muscle strength tests of the amputation stump as well as balance tests were performed in this study to determine whether these parameters have the potential to support K-level classification. Twenty-two participants with a thigh amputation participated in the study (four K1/2-, six K3- and twelve K4-participants). Hip muscle strength on the amputation side was assessed as well as static balance in the double leg stance with eyes open and eyes closed. Analysis of the data showed that all hip strength parameters differed between the K-level groups, with maximum strength increasing from the K1/2 group to the K4 group. Group differences were also seen in the balance parameters with greater body sway for the K1/2 group when compared to the K4 group, especially when participants had their eyes closed. These results show that muscle strength tests of the residual limb and static balance tests may serve as additional measures to improve K-level assignment for patients with LLA. This was only an initial study and further studies with a larger number of participants are required to confirm these results. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/37456/28905 How To Cite: John S, Orlowski K, Mrkor K.U, Edelmann-Nusser J, Witte K. Differences in hip muscle strength and static balance in patients with transfemoral amputations classified at different K-levels: A preliminary cross-sectional study. Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 1, No.5. https://doi.org/10.33137/cpoj.v5i1.37456 Corresponding Author: Stefanie John,Department of Sports Science, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany.E-Mail: [email protected] ID: https://orcid.org/0000-0001-6722-7195


2022 ◽  
Vol 5 (1) ◽  
Author(s):  
Courtney Frengopoulos ◽  
Zaka Zia ◽  
Michael Payne ◽  
Ricardo Viana ◽  
Susan Hunter

BACKGROUND: A relationship between walking ability and self-efficacy has been demonstrated in various rehabilitation patient populations. In experienced prosthetic ambulators, walking ability is related to self-efficacy of balance, however, this relationship has not been quantified for those with newly acquired lower limb amputations (LLA). OBJECTIVE(S): To investigate the association between walking performance (objective) and self-reported walking abilities (subjective) on balance self-efficacy in those with LLA. METHODOLOGY: Cross-sectional study of 27 people (17 men; mean age=63.57±9.33) at discharge from inpatient prosthetic rehabilitation for first major unilateral LLA. Individuals completed 6m straight path walking and the L-Test under single- and dual-task conditions. The Prosthesis Evaluation Questionnaire (PEQ) was administered, and the Ambulation subscale provided subjective measures of walking ability. A single PEQ question on satisfaction with walking (16B) was also used as a proxy for subjective walking ability. The Activities-specific Balance Confidence Scale measured balance self-efficacy. Multivariable linear regression was used to evaluate the strength of association between walking ability (objective and subjective) and balance self-efficacy (dependent variable). FINDINGS: Walking velocity on the 6m straight path under single-task (p=0.011) and dual-task conditions (p=0.039), the single-task L-Test (p=0.035) and self-reported satisfaction with walking (p=0.019) were associated with self-efficacy of balance. CONCLUSION: Objective measures of walking ability that were independently associated with balance self-efficacy included straight path walking velocity under single and dual-task conditions and the single-task L-Test. Satisfaction with walking was also associated with balance self-efficacy. This highlights the interplay between physical and psychological factors during rehabilitation. More research in the area of self-efficacy and walking ability is needed to establish self-efficacy as a target during prosthetic rehabilitation for those with LLA. Layman's Abstract Self-efficacy is a person’s belief in their ability to do a certain task well. Improving self-efficacy can be done by watching others complete a task, by getting praise from experts, or by doing the task yourself. There is a link between how well some people walk and their confidence with walking, however this has not been studied in people learning to use a lower limb prosthesis. The goal of this paper was to study the link between balance self-efficacy, scores on walking tests and self-reported walking ability in those with lower limb amputations (LLA) when they leave rehabilitation. To do this, two walking tests were done (straight path and complex path) in two settings (walking only and walking with distraction). A survey about walking ability and a questionnaire on balance self-efficacy were also done. Results showed that self-efficacy of balance was related to the straight path walking test under both settings and the complex walking test during walking alone. A person’s satisfaction with walking ability was also linked. The only test not related was the complex walking test under distracting conditions. It might be that more time is needed for people with LLA to confidently do this task. This shows the link between physical and mental factors during rehabilitation. More research is needed to find other factors that might impact self-efficacy and walking ability in people with LLA when they leave rehabilitation. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36695/28904 How To Cite: Frengopoulos C, Zia Z, Payne M.W.C, Viana R, Hunter S.W. Association between balance self-efficacy and walking ability in those with new lower limb amputations. Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 1, No.4. https://doi.org/10.33137/cpoj.v5i1.36695 Corresponding Author: Courtney Frengopoulos,University of Western Ontario, Room 1408, Elborn College, London, Ontario, Canada, N6G 1H1.E-Mail: [email protected] ID: https://orcid.org/0000-0002-4131-2727


2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Linda Laakso

The purpose of this letter is to initiate a constructive dialogue, clarify some of the information provided in the CPOJ recent article, “Evolving business models in orthotics” and to highlight our concerns with respect to important context about the orthotic and prosthetic profession in Canada that we feel was missing from the publication (Schneider N. Evolving business models in orthotics. Canadian prosthetics & orthotics journal. 2021; Volume 4, Issue 2, No.3. https://doi.org/10.33137/cpoj.v4i2.35876). Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/37717/28740 How To Cite: Laakso L. Letter to the editor regarding: Evolving business models in orthotics. Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 1, No.3. https://doi.org/10.33137/cpoj.v5i1.37717 Corresponding Author: Linda Laakso, MSc CO(c) FCBC, OPC PresidentOrthotics Prosthetics Canada (OPC), Toronto, Canada.Custom Orthotic Design Group Ltd., Mississauga, Canada.E-Mail: [email protected] ID: https://orcid.org/0000-0002-1636-3717OPC website: https://opcanada.ca/


2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Rafael Escamilla-Nunez ◽  
Harry Sivasambu ◽  
Jan Andrysek

BACKGROUND: Gait symmetry is the degree of equality of biomechanical parameters between limbs within a gait cycle. Human gait is highly symmetrical; however, in the presence of pathology, gait often lacks symmetry. Biofeedback (BFB) systems have demonstrated the potential to reduce gait asymmetry, improve gait function, and benefit overall long-term musculoskeletal health. OBJECTIVE(S): The aim of this study was to develop a BFB system and evaluate three unique BFB strategies, including bidirectional control – constant vibration (BC), bidirectional control – variable vibration (BV), and unidirectional control – variable vibration (UV) relevant to gait symmetry. The assessed feedback strategies were a combination of vibration frequency/amplitude levels, vibration thresholds, and vibrotactile stimuli from one and two vibrating motors (tactors). Learning effect and short-term retention were also assessed. METHODOLOGY: Testing was performed using a custom BFB system that induces stance time asymmetries to modulate temporal gait symmetry. The BFB system continuously monitors specific gait events (heel-strike and toe-off) and calculates the symmetry ratio, based on the stance time of both limbs to provide real-time biomechanical information via the vibrating motors. Overall walking performance of ten (n=10) able-bodied individuals (age 24.8 ± 4.4 years) was assessed via metrics of symmetry ratio, symmetry ratio error, walking speed, and motor's vibration percentages. FINDINGS: All participants utilized BFB somatosensory information to modulate their symmetry ratio. UV feedback produced a greater change in symmetry ratio, and it came closer to the targeted symmetry ratio. Learning or short-term retention effects were minimal. Walking speeds were reduced with feedback compared to no feedback; however, UV walking speeds were significantly faster compared to BV and BC. CONCLUSION: The outcomes of this study provide new insights into the development and implementation of feedback strategies for gait retraining BFB systems that may ultimately benefit individuals with pathological gait. Future work should assess longer-term use and long-term learning and retention effects of BFB systems in the populations of interest. Layman's Abstract Healthy walking is usually highly symmetrical with the same movements occurring on both sides of the body. However, certain disorders can cause abnormal and asymmetrical walking movements. Biofeedback can improve the movements during walking. This study used a custom biofeedback system to test three ways of applying biofeedback including having one and two motors that vibrated in unique ways. The biofeedback system was set up to guide participants to change their normal walking pattern to be less symmetrical. Walking movements of ten young able-bodied individuals were measured while walking with the biofeedback system. The results showed a change in walking symmetry for all participants. Using a single vibrating motor resulted in the greatest changes in walking symmetry. The changes in walking symmetry occurred only when using biofeedback, and walking patterns quickly returned to normal when the biofeedback was turned off. Overall, all feedback methods caused the users to walk slower than their typical walking speed. These findings provide important new information about the changes in walking caused by different biofeedback methods. Future work should evaluate long-term effects of biofeedback methods in the populations of interest. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36744/28677 How To Cite: Escamilla-Nunez R, Sivasambu H, Andrysek J. Exploration of vibrotactile biofeedback strategies to induce stance time asymmetries. Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 1, No.2. https://doi.org/10.33137/cpoj.v5i1.36744 Corresponding Author: Rafael Escamilla-Nunez, Institute of Biomedical Engineering, University of Toronto, Toronto, Canada.E-Mail: [email protected] ID: https://orcid.org/0000-0002-2739-878X


2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Laurent Frossard

Overcoming obstacles to prosthetic fittings requires frequent tryouts of sockets and components. Repetitions of interventions are upsetting for users and place substantial economic burden on healthcare systems. Encouraging prosthetic care innovations capable of alleviating clinical and financial shortcomings of socket-based solutions is essential. Nonetheless, evidence of socio-economic benefits of an innovation are required to facilitate access to markets. Unfortunately, complex decisions must be made when allocating resources toward the most relevant health economic evaluation (HEE) at a given stage of development of an innovation. This paper first, aimed to show the importance and challenges of HEEs of intervention facilitating prosthetic fittings. Next, the main trends in HEEs at various phases of product development and clinical acceptance of prosthetic care innovations were outlined. Then, opportunities for a basic framework of a preliminary cost-utility analysis (CUA) during the mid-stage of development of prosthetic care innovations were highlighted. To do this, fundamental and applied health economic literature and prosthetic-specific publications were reviewed to extract and analyse the trends in HEEs of new medical and prosthetic technologies, respectively. The findings show there is consensus around the weaknesses of full CUAs (e.g., lack of timeliness, resource-intensive) and strengths of preliminary CUAs (e.g., identify evidence gaps, educate design of full CUA, fast-track approval). However, several obstacles must be overcome before preliminary CUA of prosthetic care innovations will be routinely carried out. Disparities of methods and constructs of usual preliminary CUA are barriers that could be alleviated by a more standardized framework. The paper concludes by identifying that there are opportunities for the development of a basic framework of preliminary CUA of prosthetic care innovations. Ultimately, the collaborative design of a framework could simplify selection of the methods, standardise outcomes, ease comparisons between innovations and streamline pathways for adoption. This might facilitate access to economical solutions that could improve the life of individuals suffering from limb loss.   Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36364/28327 How To Cite: Frossard L. Trends and opportunities in health economic evaluations of prosthetic care innovations. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.9. https://doi.org/10.33137/cpoj.v4i2.36364 Corresponding Author: Laurent Frossard, PhD, Professor of BionicsYourResearchProject Pty Ltd, Brisbane, Australia.E-Mail: [email protected] number: https://orcid.org/0000-0002-0248-9589


2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Annelise Petlock ◽  
Keana DiMario

Funding agencies, both public and private, do not adequately meet the needs of Canadian amputees. This often leaves amputees without access to appropriate prosthetic care due to outstanding balances that are to be paid out of pocket, or by charitable organizations. There are several factors that result in these inadequacies. As healthcare is a provincial responsibility in Canada, provinces and territories have the authority to create individual public regimes, each with their own weaknesses. In fact, there are a few provincial regimes which do not include prosthetic funding at all. Private healthcare is meant to offset the remaining balance; however, their lack of knowledge regarding amputation has resulted in the creation of policies with ambiguous language, limiting the funding available for prosthetic care. Attitudinal barriers and missed legislative opportunities further exacerbate the shortcomings of prosthetic funding provided by public and private funding agencies, requiring action. Article PDF Link:https://jps.library.utoronto.ca/index.php/cpoj/article/view/35972/28331 How To Cite: Petlock A, DiMario K. (In) Access to artificial limbs: the patient’s perspective according to the WAR AMPS of Canada. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.13. https://doi.org/10.33137/cpoj.v4i2.35972 Corresponding Author: Annelise PetlockThe War Amps Advocacy Program/ 2827 Riverside Drive Ottawa, Ontario, Canada.E-Mail: [email protected] ID: https://orcid.org/0000-0002-7273-4527


2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Géza Kogler ◽  
Christopher Hovorka

This position paper outlines the important role of academia in shaping the orthotics and prosthetics (O&P) profession and preparing for its future. In the United States, most healthcare professions including O&P are under intense pressure to provide cost effective treatments and quantifiable health outcomes. Pivotal changes are needed in the way O&P services are provided to remain competitive. This will require the integration of new technologies and data driven processes that have the potential to streamline workflows, reduce errors and inform new methods of clinical care and device manufacturing. Academia can lead this change, starting with a restructuring in academic program curricula that will enable the next generation of professionals to cope with multiple demands such as the provision of services for an increasing number of patients by a relatively small workforce of certified practitioners delivering these services at a reduced cost, with the expectation of significant, meaningful, and measurable value. Key curricular changes will require replacing traditional labor-intensive and inefficient fabrication methods with the integration of newer technologies (i.e., digital shape capture, digital modeling/rectification and additive manufacturing). Improving manufacturing efficiencies will allow greater curricular emphasis on clinical training and education – an area that has traditionally been underemphasized. Providing more curricular emphasis on holistic patient care approaches that utilize systematic and evidence-based methods in patient assessment, treatment planning, dosage of O&P technology use, and measurement of patient outcomes is imminent. Strengthening O&P professionals’ clinical decision-making skills and decreasing labor-intensive technical fabrication aspects of the curriculum will be critical in moving toward a digital and technology-centric practice model that will enable future practitioners to adapt and survive. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36673/28349 How To Cite: Kogler GF, Hovorka CF. Academia’s role to drive change in the orthotics and prosthetics profession. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.21. https://doi.org/10.33137/cpoj.v4i2.36673 Corresponding Author: Géza F. KoglerOrthotics and Prosthetics Unit, Kennesaw State University.E-Mail: [email protected] ID: https://orcid.org/0000-0003-0212-5520


2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Manuel Opitz ◽  
Peter Fröhlingsdorf

Digitalisation is the megatrend in healthcare, not only since the pandemic. We are two European digital health experts and industry leaders in the field of orthotics and prosthetics (O&P) and in this article we explored what are the underlying trends driving the adoption of digitalisation for customisation of prosthetics & orthotics. We showed that several trends in 3D image capture (input step), 3D modelling (processing step) and 3D printing (output step) currently converge and thus fuel the rapid transformation of the O&P industry. In short outlooks, we rated the probability and timing of adoption rates across the upcoming couple of years. We furthermore reviewed the impact of boundary conditions set by regulators as well as the reimbursement system. Towards the end of this article, we outlined a digital scenario of the near future by following around an orthotist during her work. We finished with a call-to-action targeting regulators, payors, prosthetists/orthotists, and patients to enable such a desirable future. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36349/28332 How To Cite: Opitz M, Fröhlingsdorf P. The digital O&P workshop. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.15. https://doi.org/10.33137/cpoj.v4i2.36349 Corresponding Author: Manuel Opitz, MECURIS GmbH, Lindwurmstraße 11, 80337 München, Germany.E-Mail: [email protected] number: https://orcid.org/0000-0001-6098-1881


2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Taavy Miller ◽  
Shane Wurdeman

The goal of health economics and outcomes research is to improve healthcare decision making. In the absence of high-value clinical data, the availability and quality of administrative healthcare data could be vital in the generation of evidence for orthotics and prosthetics services. The purpose of this article is to provide a stronger understanding of administrative healthcare data analysis, an area that has been scarcely examined within prosthetics and orthotics despite the wealth of information available within such data. Examples of common datasets in this arena currently available are provided, as well as an overview of the limitations and advantages of studies utilizing such datasets. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35958/28315 How To Cite: Miller TA, Wurdeman S. Value and applicability of large administrative healthcare databases in prosthetics and orthotics outcomes research. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.4. https://doi.org/10.33137/cpoj.v4i2.35958 Corresponding Author: Taavy A Miller, PhD, CPODepartment of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas, USA.E-Mail: [email protected] ID: https://orcid.org/0000-0001-7117-6124


2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Chloe Angus

This paper is both a stakeholder perspectives as well as a ‘case study’ describing a journey from sudden disability to participant and investor in exoskeleton design. It tells of my experiences and opinions, as a successful fashion designer, when my life took a drastic turn on becoming paralysed from the waist down over the course of 24 hours, by a spinal tumour. Getting this diagnosis was ‘the worst day in my life’, and it was quickly followed by the ‘second worst’ when, in my determination to walk again, I received Knee Ankle Foot Orthotics (KAFOs) and was shocked to learn that this appeared to be the best technology solution available on the market ‘suitable’ for use in the community. Initial anger at the system for not being better, at the rehab team for their complacency, and at myself for allowing a feeling of helplessness to take over led to questions such as: what does this say about our society? and what are we all willing to accept, for ourselves and others? This is professional opinion and an essay about how we see ourselves and how others see us. The journey from pre-injury ‘consumer’ to post-injury ‘disabled’ person and learning that being labeled ‘disabled’ leads to the additional handicap of the narrow vision of “cost” taken by the mobility industry where innovative ideas are stripped down to the bare minimum with the excuse that patients are “lucky” to have what they have been “given”. Grappling with these labels and inequities and seeking a better outcome, I became an integral team member of an exoskeleton development team, leading to the design of The Next Generation Exoskeleton! This is MY story, the story of Chloe Angus. It is the story of inclusive, user focused design and is a call to include and respect the end users of all assistive device technology design early in the design process and it is being told from the perspective of a person having experience and success in the world of business. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/37250/28296 How To Cite: Angus C. Exoseketons: a rehab tech consumer’s unexpected march to action. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.2. https://doi.org/10.33137/cpoj.v4i2.37250 Corresponding Author: Chloe AngusChloe Angus Design, Vancouver, BC, Canada.E-Mail: [email protected] ID: https://orcid.org/0000-0002-5468-3121


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