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... photos were taken so that the markers and the reference rulers could be seen clearly, and were not at an angle from the stand: 1. Amputee standing full weight bearing on prosthetic limb. This was considered the baseline position which all other were compared with ( Figure 2). 2. Amputee standing with no weight on the prosthesis and straight leg (e.g. on the stairs with the sound leg on the step and the prosthesis freely suspended). ...
Citations
... Another quantitative clinical indicator of patient comfort is pistoning, which is the vertical movement of the residual limb inside the socket. Gholizadeh et al. [98] used a photographic method to quickly measure socket/liner pistoning in full weight bearing, non-weight bearing, and static axial loading conditions. Though many methods are available for quantitatively measuring patient response, many researchers have expressed interest in predictive models to streamline the socket design process. ...
Digital healthcare technologies are transforming the face of prosthetic care. Millions of amputees around the world do not currently have access to any form of prosthetic healthcare. However, digital technologies provide a promising solution. Digital healthcare technologies have the potential to augment the range and efficiency of prosthetists so they can reach more patients. These technologies will enable affordable prostheses to be built on a scale larger than currently possible with today’s clinical practices. In this paper, we explore the social aspects of amputation as a global issue, describe current practices for designing and manufacturing prosthetic sockets, and examine shifting trends towards virtual care models. Importantly, we assess the technologies used in these virtual health workflows to understand their critical needs. Large technological gaps need to be overcome in order to enable the mass production and distribution of prostheses digitally. However, recent advances in computational methods and CAD/CAM technologies are bridging this gap faster than ever before. We foresee that these technologies will return mobility and economic opportunity to amputees on a global scale in the near future.
... The most common techniques that are used to acquire data on the relative movement between residual limb surface and prosthetic socket are: motion capture [3][4][5][6], other optical means [7,8], inductive sensors [9][10][11][12], and vacuum pressure fluctuations of elevated vacuum suspension systems [11,13]. These approaches are subject to different drawbacks. ...
The relative motion between residual limb and prosthetic socket could be a relevant factor in quantifying socket fit. The measurement of these movements, particularly in dynamic gait situations, poses a challenging task. This paper presents the realization of a measurement concept based on multiple optical 2D-motion sensors. The performance of the system was evaluated on a test rig considering accuracy and precision as well as accomplished measurement frequency and reliability of the system. Additionally, results of a pilot study measuring the relative motion between residual limb and prosthetic socket at seven specific locations of one individual with transtibial amputation during straight level walking are presented. The sensor functionality of the array was confirmed and the test rig experiments were comparable to the previously tested functional model ( e r r rel = 0.52 ± 1.87 %). With a sampling frequency of 1.3 kHz to be distributed among the number of sensor units, the developed system is suitable for investigating the relative movement between residual limb and prosthetic socket in dynamic gait situations. Results of the pilot study show the majority of relative motion occurring during the second half of the gait cycle. The measured relative motions show the residual limb sinking deeper into the socket, extending in the Sagittal plane and rotating internally in the Transverse plane during stance phase. Data captured during swing phase indicate a lower limb extension in the Sagittal plane as well as an external rotation in the Transverse plane.
... The main roles of the suspension systems incorporated into lower-limb prostheses are to hold the prosthesis on the residual limb and to decrease the motion that takes place at the bone-skin-liner-socket interface during ambulation like pistoning (vertical movements) within the socket. 13 The seal-in liner has been found to be the most effective suspension system in reducing the vertical movement during level walking in the study conducted by Gholizadeh et al. 16 Researchers have also studied the effects of prosthetic liner on the gait of transtibial amputees and revealed that liner thickness can affect the gait variables. 17 However, among various suspension systems for transtibial amputees, the Iceross system was favored by the majority of users in terms of function and comfort in the study conducted by Gholizadeh et al. 16 The results of our pilot study shows no significant difference in walking speed, percentage of stance, swing, single limb support, and normalized stride length, indicating that the addition of sleeve suspension does not alter the walking pattern and stays within the normative range. ...
... However, measuring relative movement between residual limb and prosthesis is still a remarkable challenge and approaches suggested in the literature vary distinctly regarding geometrical definitions, measurement principles, and the considered load conditions. The most common techniques that are used to acquire relative movement data at the interface are: radiography [8][9][10][11][12][13][14][15][16], ultrasound [17][18][19], motion capture [20][21][22], and other optical means [23][24][25][26]. Recently, the correlation between fluctuations in vacuum pressure of elevated vacuum suspension systems and the amount of distal displacement have been investigated and shown to be correlated [27,28]. ...
A sensor system for measuring the relative movement between prosthetic socket and residual limb based on a 2D-motion sensor is introduced and thoroughly tested experimentally. The quantitative analysis of test rig evaluation is used to identify advantageous sensor settings and liner configurations. Considering these favorable settings, sensor functionality is quantified to errrel=0.52±1.78%. Advancing to convex measurement surfaces, the sensor shows absolute errors of errabs≤1 mm in an observable measurement scenario. The feasibility of measuring gait-induced relative movement with the proposed 2D-motion sensor is shown via a biomechanical plausibility study. Overall, the findings suggest that the proposed sensor system is suitable for investigating the relative movement between residual limb and prosthetic socket in dynamic gait situations.
... 16,18 Recently, a simple and accurate method was used to measure pistoning inside the socket using a high-resolution camera and dead weights in static positions. 21 The weights were intended to mimic the centrifugal force created during the swing phase of gait. 15,16,19,21 Based on the literature, comfort, safety, function, easy donning/doffing and durability are the main factors that should be considered when designing a prosthetic suspension system. ...
... 21 The weights were intended to mimic the centrifugal force created during the swing phase of gait. 15,16,19,21 Based on the literature, comfort, safety, function, easy donning/doffing and durability are the main factors that should be considered when designing a prosthetic suspension system. 2,3,5,22 To solve some of the problems of the existing prosthetic suspension systems, a suspension system that incorporates silicone liner (with loop fabric) and hook fastener was introduced by researchers at the Department of Biomedical Engineering, Faculty of Engineering, University of Malaya. ...
... The following equipment used to measure pistoning movement inside the prosthetic socket: 21 1. Markers; 2. A digital camera (12-megapixel resolution); 3. A reference ruler fixed to the lateral socket to measure the actual displacement; 4. 30, 60, and 90 N loads. ...
Objectives:
This study aimed to evaluate and compare a newly designed suspension system with a common suspension in the market.
Study design:
Prospective study.
Methods:
Looped liners with hook fastener and Iceross Dermo Liner with pin/lock system were mechanically tested using a tensile testing machine in terms of system safety. A total of 10 transtibial amputees participated in this study and were asked to use these two different suspension systems. The pistoning was measured between the liner and socket through a photographic method. Three static axial loading conditions were implemented, namely, 30, 60, and 90 N. Furthermore, subjective feedback was obtained.
Results:
Tensile test results showed that both systems could safely tolerate the load applied to the prosthesis during ambulation. Clinical evaluation confirmed extremely low pistoning in both systems (i.e. less than 0.4 cm after adding 90 N traction load to the prosthesis). Subjective feedback also showed satisfaction with both systems. However, less traction at the end of the residual limb was reported while looped liner was used.
Conclusion:
The looped liner with hook fastener is safe and a good alternative for individuals with transtibial amputation as this system could solve some problems with the current systems. Clinical relevance The looped liner and hook fastener were shown to be good alternative suspension for people with lower limb amputation especially those who have difficulty to use and align the pin/lock systems. This system could safely tolerate centrifugal forces applied to the prosthesis during normal and fast walking.
... With the static photographic method, a mean displacement of 0.9 and 1.3 cm was found in the shuttle lock prosthesis during non-weight-bearing and when 30 N was applied, respectively. 12 Using a motion analysis system to investigate the Seal-In ® X5 liners, Gholizadeh et al. reported 0.0, 0.1, 0.1, and 0.2 cm of pistoning in non-weight-bearing, 30, 60, and 90 N conditions, respectively. 1 Many studies have compared different suspension systems. ...
... To measure differences between the SSS and the HIS, several PTs were carried out in each evaluation session as follows: first, to obtain a baseline measure, the patient was requested to stand only on the prosthetic limb and second, two measures were obtained when 0 and 30 N forces were applied to the prosthesis in the longitudinal direction while the TTA held the prosthetic leg straight in the air. We calculated the displacements (in mm) of the markers located on the greater trochanter (GT), proximal lateral end of the liner (PL), proximal lateral end of the socket (PS), and distal end of the socket (DS), as in the procedure described by Gholizadeh et al. 12 To minimize measurement errors, we calculated the means of the following displacements in each measure: GT-PS, GT-DS, and PL-DS. The amount of displacement from the baseline identifies the pistoning movement: lesser the displacement, lesser is the pistoning. ...
... The importance of a proper suspension system to guarantee amputees' comfort and prosthetic function has been widely indicated in the literature, and vertical displacement or pistoning within the socket has been suggested to be one of the main indicators of suspension system efficacy in lower-limb prostheses. 1,4,12,14,30 We found a Table 3. TUGT, HSQ, and LCI results (mean ± SD). ...
Background:
The two passive vacuum suspension systems currently available in total surface-bearing sockets are the hypobaric Iceross Seal-In(®) and the suction suspension system.
Objectives:
The purpose of this study was to compare the effect of the hypobaric Iceross Seal-In(®) liner with that of the suction suspension system for quality of life, pistoning, and prosthesis efficiency in unilateral transtibial amputees.
Study design:
Single-group repeated measures.
Methods:
Ten amputees were enrolled. The pistoning test, used to compare vertical movement of the stump within the socket, and the energy cost of walking test were carried out when the amputees were wearing the suction suspension system and after 2, 5, and 7 weeks of Seal-In® X5 use. The Prosthesis Evaluation Questionnaire and the Houghton Scale Questionnaire of perceived mobility and quality of life with the prosthesis, and the Timed Up&Go Test and the Locomotor Capability Index for functional mobility were also administered at the beginning and end of the study.
Results:
The hypobaric Iceross Seal-In® X5 led to significant pistoning reduction and improvement on the Houghton Scale Questionnaire and 3 of 9 domains of the Prosthesis Evaluation Questionnaire. No statistical changes were observed in functional mobility or the energy cost of walking tests.
Conclusion:
Replacing the suction suspension system with the hypobaric Iceross Seal-In® X5 improves quality of life in transtibial amputees.
... 20 A recent method used a photographic technique for evaluation of piston motion between the liner and the socket. 21,22 Finally, the use of motion analysis systems by reflective markers was recently introduced to measure pistoning. 7 The very same method was adopted in this study to evaluate the effect of the newly designed suspension system on pistoning. ...
The objectives of this study were to compare the effects of a newly designed magnetic suspension system with that of two existing suspension methods on pistoning inside the prosthetic socket and to compare satisfaction and perceived problems among transtibial amputees.
In this prospective study, three lower limb prostheses with three different suspension systems were fabricated for ten transtibial amputees. The participants used each of the three prostheses for 1 mo in random order. Pistoning inside the prosthetic socket was measured by motion analysis system. The Prosthesis Evaluation Questionnaire was used to evaluate satisfaction and perceived problems with each suspension system.
The lowest pistoning motion was found with the suction system compared with the other two suspension systems (P < 0.05). The new suspension system showed peak pistoning values similar to that of the pin lock system (P = 0.086). The results of the questionnaire survey revealed significantly higher satisfaction rates with the new system than with the other two systems in donning and doffing, walking, uneven walking, stair negotiation, and overall satisfaction (P < 0.05).
The new suspension system has the potential to be used as an alternative to the available suspension systems. The pistoning motion was comparable to that of the other two systems. The new system showed compatible prosthetic suspension with the other two systems (suction and pin lock). The satisfaction with donning and doffing was high with the magnetic system. Moreover, the subjects reported fewer problems with the new system.
... [20][21][22][23][24][25][26][27] Researchers have been working on the development of new suspension systems that can increase the options available to clinicians. 4,[28][29] The ability to measure pistoning helps when evaluating the quality of a suspension system in a lower limb prosthesis. [30][31][32][33] Many different methods have been utilized for measuring pistoning movement of the stump or the position of the bone. ...
... The literature review revealed that the majority of researchers measured the displacement between the bone and the socket, the liner and socket or the soft tissue, by using different techniques in static position 19,29,32,[34][35][36][37][38]53,55 or during dynamic tasks 33,35,54,[60][61] to check pistoning inside the socket. Therefore, the methods available were classified according to whether they utilized static or dynamic pistoning. ...
... Photographic method by the use of a camera and markers was recently introduced as a new approach for the pistoning measurement. 29,[36][37] Photos were taken in five loading conditions. Then the images were analyzed on the computer to measure the pistoning. ...
... [20][21][22][23][24][25][26][27] Researchers have been working on the development of new suspension systems that can increase the options available to clinicians. 4,[28][29] The ability to measure pistoning helps when evaluating the quality of a suspension system in a lower limb prosthesis. [30][31][32][33] Many different methods have been utilized for measuring pistoning movement of the stump or the position of the bone. ...
... The literature review revealed that the majority of researchers measured the displacement between the bone and the socket, the liner and socket or the soft tissue, by using different techniques in static position 19,29,32,[34][35][36][37][38]53,55 or during dynamic tasks 33,35,54,[60][61] to check pistoning inside the socket. Therefore, the methods available were classified according to whether they utilized static or dynamic pistoning. ...
... Photographic method by the use of a camera and markers was recently introduced as a new approach for the pistoning measurement. 29,[36][37] Photos were taken in five loading conditions. Then the images were analyzed on the computer to measure the pistoning. ...
Objectives:
To develop a questionnaire that specifically evaluates the ability of trans-tibial amputees to don and doff a prosthesis and to investigate the psychometric properties of the newly developed questionnaire.
Background:
Prosthesis should be donned and doffed few times during the day and night; thus, it is important to measure ease of donning and doffing.
Study design:
A cross-sectional study.
Methods:
The questionnaire was designed and evaluated by a group of experts. The final questionnaire was administered to 50 individuals with trans-tibial amputation. A test-retest study was also conducted on 20 amputees to assess the repeatability of questionnaire items.
Results:
The prosthesis donning and doffing questionnaire was developed and tested through a pilot study. Based on Kappa index, the questionnaire items showed correlation coefficients greater than 0.7, which indicate good reliability and repeatability. The majority of the participants had good hand dexterity (80%) and could perform all types of grasps. The mean satisfaction scores with donning and doffing were 69.9 and 81.4, respectively. Most of the respondents needed to don and doff the prosthesis 3.44 times per day. Based on a 7-point score, the total scores ranged between 3 and 7.
Conclusion:
The prosthesis donning and doffing questionnaire items showed good psychometric properties. A scoring method was suggested based on the pilot sample, which requires further evaluation to be able to differentiate between more suspension types. A larger international multicenter evaluation is required in the future to measure the responsiveness of the scales. This questionnaire will be useful in the evaluation of the ability of amputees to don and doff a trans-tibial limb prosthesis. Clinical relevance Donning and doffing of prostheses are challenging tasks for many lower limb amputees. The prosthesis donning and doffing questionnaire, on its own or combined with other prosthetic evaluation questionnaires, has the potential to help manufacturers, clinicians, and researchers gain knowledge and improve the donning and doffing qualities of prostheses.
