Search Results (93)

Background: This study compared performance-based function and self-report function in lower-limb prosthesis users. Methods: Twenty-two lower-limb prosthesis users (aged 52.1 ± 14.2) were administered the Orthotic Prosthetic User Survey (OPUS) Lower Extremity Functional Status (LEF), Satisfaction With Devices (SWD), alongside the Godin Leisure-Time Exercise Questionnaire (GLTQ), Timed Up and Go (TUG) test, two-minute walk test (2MWT), and six-minute walk test (6MWT). Body composition and standing postural sway displacement and velocity were also measured. Pearson’s Product Moment coefficients were used to assess relationships between the OPUS and other outcome variables. ANOVAs were used to identify differences in all outcome variables between lower unilateral (LU) and all other (AO) amputees. Results: There was a moderate correlation between LEF and center of pressure (CoP) path length with eyes open (r₍₁₉₎ = −0.43, p = 0.048) and eyes closed (r₍₁₉₎ = −0.43, p = 0.049). While the relationship between LEF and TUG was significant (r₍₂₀₎ = −0.49, p = 0.021), this was not so with SWD and TUG (r₍₂₀₎ = −0.17, p = 0.456). Both the 2MWT (r₍₂₀₎ = 0.48, p = 0.023) and 6MWT (r₍₂₀₎ = 0.47, p = 0.028) were moderately correlated with LEF. GLTQ was significantly correlated with LEF (r₍₂₀₎ = 0.70, p = 0.001). The LU group outperformed the AP group during the TUG and 6MWT (p < 0.05). LU group scored significantly higher on LEF compared to the AO group (p < 0.05). The reliability of LEF between the measurement on day 1 (54.3 ± 12.0) and day 2 (53.6 ± 12.8) was high (α = 0.94). Conclusions: This study provides an insight into associations of balance and self-reported function in lower limb prosthesis users. Future work can target rehabilitation strategies to address challenges faced by multiple limb prosthesis users. Full article

This study investigated the efficacy of Augmented Reality (AR) in the rehabilitation of lower limb amputees by comparing movement accuracy and subjective satisfaction with and without AR. Ten individuals with unilateral lower limb amputations participated. Joint range of motion during exercises was measured using a 3D motion capture system. Subjective satisfaction was assessed via a 5-point Likert scale. Movement accuracy was evaluated by analyzing changes and variability (standard deviation) in joint angles across eight selected movements. Results showed that AR feedback significantly increased average joint angles in specific movements: standing arm raise to the side, standing trunk lateral flexion, and standing knee flexion to maximum height. Furthermore, AR feedback led to a significant reduction in the standard deviation of joint angles for most exercises, indicating improved movement consistency. Subjective satisfaction scores for interest, motivation, exercise effectiveness, movement accuracy, and overall satisfaction were significantly higher with AR. Full article

Background/Objectives: Lower-limb amputation profoundly affects individuals and their family caregivers, particularly during home transition after hospital discharge. Understanding the needs, challenges, and emotions during this period is essential for designing effective family centered empowerment interventions. This study aimed to explore the lived experiences of amputees and their caregivers, identify their needs and challenges, and identify strategies to foster empowerment, resilience, and adaptation after amputation. Methods: This qualitative, descriptive-exploratory study involved semi-structured interviews with 37 dyads, each comprising an amputee who has undergone major dysvascular lower-limb amputation and their primary caregiver, who provided home care. The participants attended follow-up consultations post-amputation. Data were collected over a 13-month period and analyzed using qualitative content analysis based on Bardin’s methodology, with support from ATLAS.ti 23.3.4 software for coding and data organization. Results: Four categories emerged: (i) difficulties faced, including loss of autonomy, mobility challenges, architectural barriers, and emotional strain; (ii) home discharge, emphasizing functional training for amputees and caregivers and the need for community support; (iii) impact of amputation, highlighting acceptance difficulties, psychological distress, social isolation, and lifestyle changes; and (iv) empowerment strategies, focusing on psychological support, skills training, assistive devices, and coordinated care. Tailored interventions such as peer support, home adaptations, and multidisciplinary care are essential for resilience, independence, and improved quality of life. Conclusions: Family centered empowerment strategies are vital for improving the outcomes of amputees and caregivers. Interventions that prioritize caregiver education, psychological support, and enhanced accessibility promote resilience, autonomy, and quality of life. These findings highlight the need for integrated hospital-to-community programs. Full article

As the field of prosthetic engineering advances, questions around whether these new prosthetics hold the ability to outperform biological limbs become more relevant. To further clarify such a debate and discover gaps in our understanding, a narrative review of the present literature on this topic is needed. The purpose of the present review was to explore whether prosthetic legs grant amputee athletes an unfair advantage over traditional athletes by reviewing 11 articles pertaining to the running performance and potential among athletes with transtibial amputations. The findings of the included articles were categorized into three domains of running performance, chosen due to their precedence in the current literature: propulsion forward, limb repositioning, and physiological limitations. Our review indicated that the present literature alludes to transtibial amputee runners having a potential competitive advantage over able-bodied runners, with the caveat that some performance domains appear not to be differentiated. The present findings offer a unique perspective on understanding the impact of prosthetics on the running performance among para-athletes and suggest future research directions. As the depth of this area of literature increases, future systematic reviews and meta-analyses may be able to answer with greater certainty whether transtibial prosthetics allow for supra-biological running performances. Full article

Background and Objectives: Amputation poses a significant clinical and therapeutic challenge, with over 90.0% of amputations involving the lower limbs, of which 75.0% are associated with diabetes and peripheral artery disease. Individuals with lower limb amputations often experience secondary disabilities. This study aimed to compare the frequency and intensity of lower back pain and phantom pain in individuals with unilateral lower limb amputations who were amputee football players with those who did not participate in adaptive sports. Materials and Methods: This study included 30 men who had undergone unilateral lower limb amputation and were divided into two groups: 15 amputee football players and 15 men who did not participate in adapted sports. Testing included proprietary surveys, questionnaires, the Oswestry Disability Index (ODI), and the visual analog scale (VAS) for pain intensity. The Amputee Mobility Predictor (AMPnoPRO) was used to assess motor function. Statistical analysis was performed using Statistica software (Version 13, StatSoft, Inc., Tulsa, OK, USA) by applying Student’s t-test, the Mann–Whitney U test, correlation coefficients, and analysis of covariance (ANCOVA). Phantom pain was reported in 53.3% of individuals in the study group and in 66.7% of individuals in the control group, with average median pain intensities of 5.5 (IQR: 2) and 5.5 (IQR: 3), respectively. Lower back pain was significantly higher in the control group (86.7%) than for the football players (33.3%), with median pain intensities of 4 (IQR: 2) and 3 (IQR: 2), respectively. The median disability score was 3 (IQR: 3) in the player group and 10 (IQR: 7) in the control group. The median score in the amputee football player group was 35 (IQR: 2), while that in the control group was only 18 (IQR: 19). Conclusions: Amputee football training did not have a significant impact on the frequency or intensity of phantom pain but was associated with lower occurrence and intensity of pain in the lower back. The players exhibited significantly better motor function and lower levels of disability. Preoperative limb pain was a significant risk factor for phantom pain in the study group. Adaptive sports can not only support the development of motor and social skills but also contribute to reducing the severity of lower back pain, which leads to a decrease in the level of disability. Full article

Background: Research on sensory feedback systems for prosthetic devices aims to enhance sensory capabilities to better meet user needs. Feedback systems for lower limb amputees (LLA) have been shown to reduce cognitive efforts, metabolic cost and phantom limb pain. This study evaluated the effect of a non-invasive, gait-synchronized, vibrotactile feedback system (VTFS) on the gait parameters of LLA. Methods: Four stimulators applied vibrotactile stimulation to the thigh of LLA during walking, corresponding to four pressure sensors located at the fore- and hindfoot embedded in a sock worn on the prosthetic foot. Standardized gait tests, such as the Timed “Up and Go” Test (TUG), the Four Square Step Test (FSST), the 10 Meter Walk Test (10 MWT) and the 2 Minute Walk Test (2 MWT), were performed to assess the risk of falling, coordination, walking speed and endurance before and after intervention. Results: After an average of 61.5 days using the VTFS, gait stability (TUG) improved significantly. Coordination (FSST) improved in 36% of subjects, while 45% showed a clinically relevant increase in gait speed (10 MWT). Conclusions: The results suggest an improved gait performance in the cohort. Though FSST lacked statistical significance, a p-value near 0.05 indicates a trend toward meaningful improvement. Notably, the participant with Targeted Sensory Reinnervation demonstrated the most favorable outcomes. Full article

Background/Objectives: A high number of patients who suffer the amputation of a lower limb will present psychological problems such as anxiety, depression, and post-traumatic stress disorder after surgery. This study embodies participants in a self-avatar with a right lower-limb amputation in a virtual reality environment. The aim was to determine if this experience increases anxiety levels compared to embodiment in a normal avatar. The study also examines whether body appreciation is related to anxiety levels. Methods: Subjects completed the Body Appreciation Scale (BAS) questionnaire before being immersed in the virtual environment, the Visual Analogue Scale for Anxiety (VAS-A) after each condition, and the Embodiment Questionnaire at the end of the experiment. Results: Univariate analysis showed that participants reported significantly higher levels of anxiety when exposed to the virtual avatar with an amputation compared to the full virtual body avatar. These results indicate that lower levels of body appreciation were associated with higher levels of anxiety across conditions, suggesting that participants with lower body appreciation experienced greater psychological maladjustment (measured by anxiety) in response to the virtual scenarios. Conclusions: The results suggest that the virtual avatar with a lower-limb amputation elicited significantly greater anxiety, and that body appreciation plays a key role in moderating this psychological response. Future research could focus on developing virtual exposure-based therapy for amputees using virtual reality to help reduce the anxiety experienced by patients during this process. Full article

Friction and wear characteristics play a critical role in the functionality and durability of prosthetic sockets, which are essential components in lower-limb prostheses. Traditionally, these sockets are manufactured from bulk polymers or composite materials reinforced with advanced carbon, glass, and Kevlar fibres. However, issues of accessibility, affordability, and sustainability remain, particularly in less-resourced regions. This study investigates the potential of self-reinforced polymer composites (SRPCs), including poly-lactic acid (PLA), polyethylene terephthalate (PET), glass fibre (GF), and carbon fibre (CF), as sustainable alternatives for socket manufacturing. The tribological behaviour of these self-reinforced polymers (SrPs) was evaluated through experimental friction tests, comparing their performance to commonly used materials like high-density polyethylene (HDPE) and polypropylene (PP). Under varying loads and rotational speeds, HDPE and PP exhibited lower coefficients of friction (COF) compared to SrPLA, SrPET, SrGF, and SrCF. SrPLA recorded the highest average COF of 0.45 at 5 N and 240 rpm, while SrPET demonstrated the lowest COF of 0.15 under the same conditions. Microscopic analysis revealed significant variations in wear depth, with SrPLA showing the most profound wear, followed by SrCF, SrGF, and SrPET. In all cases, debris from the reinforcement adhered to the steel ball surface, influencing the COF. While these findings are based on friction tests against steel, they provide valuable insights into the durability and wear resistance of SRPCs, a crucial consideration for socket applications. This study highlights the importance of tribological analysis for optimising prosthetic socket design, contributing to enhanced functionality and comfort for amputees. Further research, including friction testing with skin-contact scenarios, is necessary to fully understand the implications of these materials in real-world prosthetic applications. Full article

Background/Objectives: The number of individuals with lower limb loss (LLL) is rising. Therefore, identifying the walking potential in individuals with LLL and prescribing adequate prosthetic systems are crucial. Various factors can influence participants’ walking ability, to different extents. The aim of the present study was to apply machine learning methods to develop a predictive mode. This model can assist rehabilitation and limb loss care teams in making informed decisions regarding prosthesis prescription and predicting walking ability in individuals with LLL. Methods: The present study was designed as a prospective cross-sectional study encompassing 104 consecutively recruited participants with LLL (average age 62.1 ± 10.9 years, 80 (76.9%) men) at the Medical Rehabilitation Clinic. Demographic, physical, psychological, and social status data of patients were collected at the beginning of the rehabilitation program. At the end of the treatment, K-level estimation of functional ability, a Timed Up and Go Test (TUG), and a Two-Minute Walking Test (TMWT) were performed. Support vector machines (SVM) were used to develop the prediction model. Results: Three decision trees were created, one for each output, as follows: K-level, TUG, and TMWT. For all three outputs, there were eight significant predictors (balance, body mass index, age, Beck depression inventory, amputation level, muscle strength of the residual extremity hip extensors, intact extremity (IE) plantar flexors, and IE hip extensors). For the K-level, the ninth predictor was The Multidimensional Scale of Perceived Social Support (MSPSS). Conclusions: Using the SVM model, we can predict the K-level, TUG, and TMWT with high accuracy. These clinical assessments could be incorporated into routine clinical practice to guide clinicians and inform patients of their potential level of ambulation. Full article

Ballet is a discipline that combines art and sport in a harmonious way. It is a practice that has high physical and mental demands to achieve the proper body precision. During this activity, numerous muscles, including those in the legs, need to be exercised. Therefore, individuals who have lost part of their lower limb due to amputation face numerous significant challenges when it comes to practicing ballet. Throughout this article, the key aspects that influence the design of a lower limb prosthesis specifically adapted for ballet practice will be analyzed. New materials will be explored with the goal of designing an optimal model that ensures maximum performance and comfort for the users. Additionally, the prosthesis will be customized using 3D-printing technology, and a prototype will be presented. This study will merge biomechanics, ergonomics, and design. Its goal is to find a solution that improves the quality of life for lower limb amputees whose passion is ballet. The aim is to overcome physical and emotional barriers and provide a way to reintegrate amputee dancers into the world of dance. It is important to highlight the novelty of this work: combining different disciplines to provide a solution for individuals who engage in dance as a hobby rather than professionally. The proposed methodology aims to enable users with disabilities to access a personalized, complex, and potentially costly product. Full article

Life expectancy and overall function of amputated patients have improved significantly over the last few decades; for this reason, amputees are more exposed to primary or secondary degenerative disease of the hip, requiring total hip arthroplasty (THA) surgery. However, during training, not all the surgeons acquire adequate skills to manage these patients, and only a few studies and case reports describe technical pearls and outcomes of THA in patients with ipsilateral lower limb amputation, either above or below the knee. The objective of this narrative review is to present current evidence and surgical tips for performing THA in ipsilateral amputated patients, with a focus on the differences between patients with above- (AKA) and below-knee amputation (BKA). We reviewed manuscripts in major scientific databases, cross-referencing to retrieve adjunctive manuscripts, and summarized all relevant cases. We found 17 manuscripts, spanning 70 years of literature, collecting a total of 39 patients who underwent THA on an ipsilateral amputated limb: 13 AKA, 23 BKA, and 3 through-knee-amputation (TKA). The cohort primarily consists of patients with post-traumatic hip arthritis, often associated with sequelae such as fractures to other bones, soft tissue compromise and heterotopic calcifications. Managing with amputated patients requires careful planning, which includes the study of the residual bone, muscle anatomy, and the level of femoral amputation, as these factors present significant surgical challenges, especially in patients without a knee joint. In dealing with the post-traumatic and multi-comorbidity patients, rehabilitation goals should be considered prior to surgery and should drive the surgical strategy. We found that BKA patients typically have high functional demands, necessitating precise positioning of the components and an aggressive post-operative physiotherapy regimen to avoid unsatisfactory outcomes. AKA patients, on the other hand, often present with altered anatomy, and typically require more surgical instruments and expertise to achieve intraoperative dislocation of the hip joint. Full article

Dissatisfaction among upper limb prosthetic users is high, reaching over 70%, and 52% of upper limb amputees abandon their prosthetic devices due to limitations such as limited functionality, poor design/aesthetic, and improper fit. The conventional procedure of making prosthetics is time-consuming and expensive. This study was conducted to provide an alternative solution for the several issues of current prosthetic devices. 3D printing technology offers a promising alternative, providing greater accuracy, reduced labor time, and improved fit and comfort. This research explores the application of 3D printing for creating custom silicone prosthetic fingers, using Fused Deposition Modelling (FDM) for the mold. A high-resolution 3D scanner was employed to capture the precise anatomy of the patient’s hand, and CAD software was used to design molds that satisfied the patient preference and were reusable. The resulting prosthetics demonstrated good fit and patient satisfaction, though exact color matching remains a challenge, but still, it did demonstrate that it is possible to fabricate colored prosthetics. Performance tests, such as the Jebsen–Taylor Hand Function Test, indicated that while initial performance with the prosthetic was slightly lower, patient satisfaction and potential for improved functionality over time were high. This study underscores the potential of 3D printing to enhance the customization, cost-effectiveness, and overall quality of prosthetic devices, contributing to Sustainable Development Goals related to health and industry innovation. Full article

Background. Assessing the patient’s perceived body image is essential to measure the impact of lower limb amputation on quality of life and psychological well-being. Objective. The aim of this study was to develop a Spanish version of the Amputee Body Image Scale (ABIS-E) for Spanish-speaking lower limb amputees. Methods. A cross-sectional study was conducted including amputee patients in Madrid, Spain. Clinical outcomes of body image (Amputee Body Image Scale, ABIS), health-related quality of life (EuroQol-5D-5L), depression and anxiety (Hospital Anxiety and Depression Scale, HADS), pain (Brief Pain Inventory-Short Form, BPI-SF), and functional capacity (Prosthesis Evaluation Questionnaire, PEQ) were collected. Results. Seventy-three participants were assessed. Excellent test–retest reliability (ICC = 0.847) and good internal consistency (Cronbach’s alpha = 0.753) were obtained. Factor analyses extracted three factors. Convergent validity with Pearson’s and Spearman’s correlation coefficients were calculated for depression and anxiety questionnaires (HADS) (values between 0.57 and 0.67), functional capacity (PEQ) (values between −0.35 and 0.71), and quality of life (EQ-5D-5L) (values between −0.37 and 0.61). Conclusions. The ABIS-E is a reliable and valid instrument to measure body image in the Spanish population with lower limb amputation, potentially useful in primary care to identify psychosocial problems. Full article

Functional mobility tests, such as the L test of functional mobility, are recommended to provide clinicians with information regarding the mobility progress of lower-limb amputees. Smartphone inertial sensors have been used to perform subtask segmentation on functional mobility tests, providing further clinically useful measures such as fall risk. However, L test subtask segmentation rule-based algorithms developed for able-bodied individuals have not produced sufficiently acceptable results when tested with lower-limb amputee data. In this paper, a random forest machine learning model was trained to segment subtasks of the L test for application to lower-limb amputees. The model was trained with 105 trials completed by able-bodied participants and 25 trials completed by lower-limb amputee participants and tested using a leave-one-out method with lower-limb amputees. This algorithm successfully classified subtasks within a one-foot strike for most lower-limb amputee participants. The algorithm produced acceptable results to enhance clinician understanding of a person’s mobility status (>85% accuracy, >75% sensitivity, >95% specificity). Full article

Background: The company Ethnocare has developed the Overlay, a new pneumatic solution for managing volumetric variations (VVs) of the residual limb (RL) in transtibial amputees (TTAs), which improves socket fitting. However, the impact of the Overlay during functional tasks and on the comfort and pain felt in the RL is unknown. Methods: 8 TTAs participated in two evaluations, separated by two weeks. We measured compensatory strategies (CS) using spatio-temporal parameters and three-dimensional lower limb kinematics and kinetics during gait and sit-to-stand (STS) tasks. During each visit, the participant carried out our protocol while wearing the Overlay and prosthetic folds (PFs), the most common solution to VV. Between each task, comfort and pain felt were assessed using visual analog scales. Results: While walking, the cadence with the Overlay was 105 steps/min, while it was 101 steps/min with PFs (p = 0.021). During 35% and 55% of the STS cycle, less hip flexion was observed while wearing the Overlay compared to PFs (p = 0.004). We found asymmetry coefficients of 13.9% with the Overlay and 17% with PFs during the STS (p = 0.016) task. Pain (p = 0.031), comfort (p = 0.017), and satisfaction (p = 0.041) were better with the Overlay during the second visit. Conclusion: The Overlay’s impact is similar to PFs’ but provides less pain and better comfort. Full article