Prosthetics and Orthotics International

The authors examined the rollover shape alignment hypothesis, which states that prosthetic feet are aligned by matching their rollover shapes with an “ideal” shape. The “ideal” shape was considered to be the rollover shape of the ablebodied footankle system. An alignment algorithm and computational alignment system were developed to set transtibial alignments based on this hypothesis. Three prosthetic feet with considerably different rollover shapes were either aligned using the alignment system or not aligned (i.e. used previous foot's alignment), and then were aligned by a team of prosthetists. No significant differences were found between rollover shapes aligned by the computational alignment system and those based on standard clinical techniques (p = 0.944). Significant differences were found between the “no alignment” shapes and the prosthetist alignment shapes (p = 0.006), and between the “no alignment” shapes and the computational alignment system shapes (p = 0.024). The results of the experiment support the hypothesis that the goal of alignment is to match the prosthetic foot's rollover shape, as closely as possible, with an “ideal” shape. The hypothesis is also supported by its ability to explain the results of previous studies. Using an “ideal” rollover shape or surface as a goal for prosthetic alignment could lead to a priori alignment, eliminating the need for alignment hardware in some cases. Being able to build the alignment into a prosthesis without special hardware could be beneficial in lowincome countries and in the fabrication of lightweight prostheses for the elderly.

The quality of fit of a transtibial patellar tendon bearing (PTB) socket may be influenced by consistency in casting, rectification or alignment.

For this study two distinctive different datacapturing concepts were tested in relation to prosthetist performance. The handson PTB and handsoff ICECAST compact® concept were studied and compared for inter and intraprosthetist consistency using a specially designed manikin stump model.

A purpose designed digitiser was used to scan a selected surface area of the produced models, 5 for each concept, 10 in total. The extent of casting consistency at each of 936 locations per plaster model was calculated and the level of consistency was quantified.

This study has shown that by using the manikin model there is a clear indication that the investigated handsoff concept produces more consistent results than the handson concept.

Gains in stump volume have been documented in transtibial amputees while walking in custom made undersized, total surfacebearing, vacuumassisted sockets (Board et al., 2001). These gains raised doubts as to whether the sockets were truly undersized and concerns that using an oversized socket with vacuumassist could lead to swelling, resulting, in discomfort or pain. The purposes of the present study were to determine if: (a) walking in a vacuumassisted socket causes the stump to retain or gain volume in excess of the available socket volume and (b) the resulting increase in stump volume with an oversized socket causes discomfort, pain, and/or the skin to redden. The results of this study showed the stump retained or gained volume in excess of the available socket volume while walking in vacuumassisted sockets of various sizes. The stump lost less volume than predicted, or gained volume, in undersized sockets. It also gained more volume than predicted in oversized sockets. No discomfort, pain, or skin reddening, resulting from the volume gain was reported by any of the subjects after walking in an oversized socket. This change in fluid balance towards a net gain supports the findings by Board et al. (2001) that vacuumassist ensures a good fit during the day in ambulatory transtibial traumatic amputees with mature stumps.

Osseointegration for the transfemoral amputee has been used in the United Kingdom since 1997. To date, 11 candidates have undergone the procedure. The rehabilitation programme for the osseointegration candidate is a long and intensive programme following two surgical operations. This paper outlines the importance of a preosseointegration assessment to explore candidates’ suitability and expectations for the procedure. The physical and prosthetic advantages of direct skeletal attachment have led to improvements in candidates’ comfort, function and quality of life. However, some aspects of this promising developmental procedure for the management of the transfemoral amputee need to be critically evaluated before it becomes a routine clinical procedure in the United Kingdom.

Scoliosis is a threedimensional spinal deformity. Although orthotic treatment for moderate adolescent idiopathic scoliosis (AIS) has been well recognized, there are few studies documenting the effectiveness of different casting methods in the fabrication of thoracolumbosacral orthoses (TLSO). The current study was a retrospective clinical evaluation of the effectiveness of two commonly used casting methods namely, the frame casting method and the supine with traction casting method in the treatment of AIS. Eighty (80) female patients with AIS were recruited and they were all treated by TLSOs. The frame casting method was used in 37 patients while the remaining 43 patients were under the supine with traction casting method. The responses of spinal deformities under the two different casting methods were analyzed for the period from prebrace to 2 years after bracing. The studied parameters included the AP Cobb's angle, the apical vertebral rotation and the trunk listing (cervicosacral lateral offset).

The results of the current study showed that the orthoses manufactured from the two casting methods could provide an effective control of AIS (change of Cobb's angle within (±5°). For the frame casting, the Cobb's angles at prebrace and 2 years after offbrace were 36.0° and 33.8° respectively while for the supine with traction casting, the corresponding Cobb's angles were 32.7° and 34.0°. The frame casting method could give a better control of the apical vertebral rotation at the early stage of treatment (prebrace=18.2° and the 4th month=13.8° while the supine with traction casting method was more effective in the longterm control of the trunk listing (prebrace=10mm and 2 years after offbrace=3.3mm).

Swivel walkers were commonly prescribed for children with complete thoracic lesion myelomeningocele in the 1970s and 80s, when the incidence of spina bifida in the UK was of the order of 3 per 100,000 live births. The advent of reciprocal walking orthoses provided a more suitable alternative for those with good upper limb and trunk function, and swivel walkers were then used primarily for very young or more severely disabled patients.

Prenatal screening has dramatically reduced the incidence of spina bifida in the UK and subsequently swivel walkers have been used in a wider range of pathology, including spinal muscular atrophy, multiple sclerosis, muscular dystrophy and other neurological conditions that lead to lower limb dysfunction. The detail design of these devices has been adapted to accommodate the specific problems encountered in these conditions. In particular the designs have been updated to:

enable very young patients to be more readily fitted at the age of 1 year;

To underpin appropriate prescription and safe supply the NHS Procurement Agency have encouraged the development of a common course for all types of swivel walker.

Between the years 1986–2001, 135 patients who have had traumatic radial nerve injury, were supplied with dynamic wristhand orthoses (WHOs). The aim of this study is to examine the applied splints, considering aspects such as apperance, practicality of use, function, comfort and endurance.

The author's assessments show that the biggest problem was due to the unaesthetic appearance of the finger extensor spring of the splints. For this reason, modification of these finger extensor outriggers has been attempted. Also, aspects of the splints such as the problems faced and regeneration of the nerve, have been considered and modifications made in order to eliminate any disfunction.

This study reflects the reactions and satisfaction of 83 patients concerning the splints they have used. Conventional wire springs have been used in the splints of 71 patients, and 12 had modifications done on their outriggers. In terms of appearance, there were significant differences between modified outriggers and conventional outrigger (p<0.05). Also, when the modified outriggers were compared in terms of appearance and durability, there was a statistically significant opinion in favour of them (p<0.01).

The authors have developed a transtibial socket fabrication system based on the “dilatancy” principle, a process that has been commonly used in forming wheelchair Seating. The CIR Sand Casting System replaces plaster of Paris with sand for forming both a negative sand mould and a positive sand model, which can be modified for either thermoplastic socket formation or resin lamination. Initial clinical trials suggest that fabrication times are approximately 90 minutes from patient evaluation and casting to dynamic alignment. Compatibility with all existing prosthetic components is retained. It is believed the CIR socket fabrication system may be a competitive alternative for prosthetic service providers in developing countries.

The length of a stump plays an important role when using a prosthesis. It is essential to have an adequate length in the stump in order to apply the prosthesis. Therefore, it is necessary to attempt to lengthen short stumps. The authors have reviewed the results in 2 patients who had such lengthening of stumps one due to traumatic amputation of the forearm at 6.25cm distally from the elbow and the other due to congenital deficiency of the radius and ulna treated by the Ilizarov techinque to improve the fitting of prostheses. Sixty percent (60%) and 40% lengthening was achieved respectively. At the end of the lengthening process, sufficient stump length for the prosthesis was achieved. There were no major complications. As a result, it is believed stump lengthening is a valuable method for cosmetic and functional use of the prosthesis. The Ilizarov Technique is an effective method of lengthening of a stump and it does not require a tissue expander in selected patients. Patients have been able to use their prosthesis 6 months after surgery.

A new technical system, CAREN (computer assisted rehabilitation environment), is described, which makes it possible to do a total body movement analysis in a virtual environment. The virtual environment is reproducible and as close to natural environment as possible. In a case study it proved possible with this system to test different shoes and get insight in the movement problems. The importance of whole body analysis is demonstrated in this case study. The adjustments made in the shoes could be tested for their efficacy.