Prosthetics and Orthotics International

Variables that influence orthotic and prosthetic patient outcomes beyond direct care are poorly conceptualized for orthotic and prosthetic students. Restructuring educational curricula around important clinical reasoning variables (i.e. factors that may influence outcomes) could improve teaching, learning, and clinical practice.

To propose an orthotic and prosthetic education framework to enhance the development of orthotic and prosthetic students’ clinical reasoning skills.

Scoping review.

We conducted a scoping review, identified variables of orthotic and prosthetic usability, and performed a qualitative thematic analysis through the lens of orthotic and prosthetic clinical educators to develop a conceptual framework for orthotic and prosthetic education.

Sorting of variables identified from the literature resulted in three thematic areas: (1) the state of functioning, disability, and health (International Classification of Functioning, Disability and Health); (2) orthotic and prosthetic technical properties, procedures, and appropriateness; and (3) professional service as part of orthotic and prosthetic interventions. The proposed orthotic and prosthetic education framework includes these three areas situated within the context of patient-centered care.

A conceptual framework was developed from variables identified in peer-reviewed literature. This orthotic and prosthetic education framework provides a structure to explore orthotic and prosthetic clinical reasoning and advance our teaching and assessment of students’ clinical reasoning skills.

The proposed orthotic and prosthetic (O&P) education framework is intended to promote conversation about variables (e.g. health condition, procedures, services, and O&P principles) that influence O&P clinical practice outcomes and further advance our teaching and assessment of students’ clinical reasoning skills.

Custom-contoured wheelchair seating lowers risk of pressure injury and postural deterioration while custom-contoured wheelchair seating lowers risk of pressure injury and postural deterioration while increasing the stability and functional activity of the wheelchair occupant. Producing custom-contoured seating systems has historically been a labour-intensive process custom-contoured seating systems is historically labour-intensive.

Evaluate the strengths and limitations of current manufacturing processes for custom-contoured wheelchair seating to suggest potential future manufacturing processes.

Literature review of the state of the art.

Research conducted through a literature review focused on the performance of different types of custom-contoured wheelchair seating products and processes over the last 40 years. Recent literature in orthotics and prosthetics was also consulted to assess future trends in seating.

There are five main manufacturing processes currently used to produce custom-contoured wheelchair seating systems. No single process is yet suitable for all wheelchair users, but many manufacturers are transitioning to computer numerical controlled (CNC) milling to reduce manual labour. Adjustable micro-modular seating and moulded seat insert manufacturing are also prevalent and offer alternative seating to soft foam carving.

There is a need in the custom wheelchair seating sector for processes that are fast, cost-effective, produce little to no material waste, and that can effectively maintain a comfortable seating micro-climate. Additive manufacturing may meet these criteria, but further evaluation is required.

This review suggests that the custom-contoured wheelchair seating manufacturers are moving away from labour-intensive processes towards digital techniques, like CNC foam milling. Additive manufacturing is a potential new process that may reduce overall costs, the lead time in preparing seats and has the potential to better manage the seating micro-climate.

Few reports have examined the relationship between balance ability and walking ability in people with transfemoral amputation using the Berg Balance Scale.

To assess the construct validity (known groups discrimination, convergent validity, and floor/ceiling effects) of Berg Balance Scale for people with transfemoral amputation.

Cross-sectional study

Thirty people with transfemoral amputation participated (age: 54 ± 19 years; range: 18–78 years). Outcome measures (Berg Balance Scale, Timed Up & Go test, Six-Minute Walk Test, and use of ambulatory aids) were compared between the groups requiring and not requiring ambulatory aids by the Mann–Whitney U test, Student’s t-test or Welch’s t-test. Correlations were assessed using Spearman’s rank correlation coefficients and age-corrected Spearman’s partial rank correlation coefficients.

The group using ambulatory aids had a significantly lower Berg Balance Scale score (41 ± 5 vs 52 ± 3). Berg Balance Scale score was correlated with Timed Up & Go test, use of aids, and Six-Minute Walk Test using Spearman’s rank correlation coefficients (r =−0.85, p < 0.0001; r =−0.82, p < 0.0001; r = 0.81, p < 0.0001) and age-corrected partial rank correlation coefficients (r =−0.66, p < 0.0001; r =−0.56, p = 0.0017; r = 0.57, p = 0.0012). No ceiling effect of Berg Balance Scale was observed.

Balance ability in people with transfemoral amputation could be evaluated using Berg Balance Scale and is correlated with walking ability.

In clinical practice, using Berg Balance Scale for people with transfemoral amputation may adequately enable us to discriminate different groups based on walking ability from the perspective of balance ability. When walking ability is evaluated as low, the improvement of walking ability may be evaluated by Berg Balance Scale improvement during rehabilitation.

Practice effects have been observed among performance-based clinical tests administered to prosthesis-users. Their impact on test applications remains unknown.

To determine whether scoring a clinical balance test using conventional procedures that do not accommodate practice effects reduces its diagnostic accuracy relative to scoring it using recommended procedures that do accommodate practice effects.

Cross-sectional study.

Narrowing Beam Walking Test data from 40 prosthesis users was scored using recommended methods (i.e. average of trials 3–5) and conventional methods applied to other tests (i.e. mean or best of trials 1–3). Area under the receiver operating characteristic curve for each method was compared to 0.50, to determine if it was better than chance at identifying prosthesis-users with a history of falls, and to 0.80, to determine if it surpassed a threshold recommended for diagnostic accuracy.

Receiver operating characteristic curve area decreased when the Narrowing Beam Walking Test was scored using conventional rather than recommended procedures. Furthermore, when scored using conventional procedures, the NBWT no longer discriminated between prosthesis-users with and without a history of falls with a probability greater than chance, or exceeded recommended diagnostic thresholds.

Scoring the Narrowing Beam Walking Test using conventional procedures that do not accommodate practice effects decreased its diagnostic accuracy among prosthesis-users relative to recommended procedures. Conventional scoring procedures may limit the effectiveness of performance-based tests used to screen for fall risk in prosthesis-users because they do not mitigate practice effects. The influence of practice effects on other tests, and test applications (e.g. clinical evaluation and prediction), is warranted.

Scoring a clinical balance test using conventional procedures that do not mitigate practice effects reduced its diagnostic accuracy. Changing administration and scoring procedures to accommodate practice effects should be considered to improve the diagnostic accuracy of other performance-based balance tests.

Epidemiological data for work-related traumatic limb amputations are limited worldwide, particularly incidence trends related to workplace characteristics.

To investigate nationwide incidence rates and trends for amputations according to industry and establishment size.

Retrospective cohort study.

Incidence rates were calculated using workers’ compensation claims in South Korea from 2004 to 2013. Age–sex standardization was conducted, and trends related to workplace characteristics were statistically analyzed using the chi-square test.

The overall incidence rate was 38.8 claims per 100,000 workers. Decreasing trends over time in age–sex standardized incidence were observed. Most claims occurred in manufacturing and construction industries. Incidence within the manufacturing decreased significantly (p < 0.001), but not in the construction (p = 0.130) industry. Small-sized establishments (<50 employees) accounted for 77.8% of claims. Incidence in small establishments significantly decreased between 2004 and 2013 (p < 0.001).

A decreasing incidence rate for traumatic amputations in manufacturing and small establishments may imply that preventive measures have been successful in South Korea. If so, these strategies may be useful for other fast-growing Asian economies. Further research is needed to identify the causes of traumatic amputations according to industry and establishment size.

Trends in the incidence rate of work-related traumatic limb amputations related to workplace characteristics can provide useful information for policy makers to improve prevention strategies.

Sufficient cardiorespiratory fitness has been regarded a prerequisite for prosthetic walking. In order to improve cardiorespiratory fitness, adequate strain ought to be placed on the system during training.

To determine cardiorespiratory fitness at the start and end of inpatient rehabilitation after lower limb amputation and determine the physical strain experienced during conventional prosthetic rehabilitation.

Multicenter prospective cohort study.

Cardiorespiratory fitness was assessed using a peak one-legged cycle exercise test. Physical strain was assessed during a minimum of three full rehabilitation days using heart rate recordings. Physical strain was expressed in the time per day that heart rate exceeded 40% of heart rate reserve.

At the start of rehabilitation, peak aerobic capacity was on average 16.9 (SD, 6.5) mL/kg/min (n = 33). Overall, peak aerobic capacity did not improve over the course of rehabilitation (n = 23, p = 0.464). Fifty percent of the patients experienced a physical strain level that satisfies minimum criteria for maintaining cardiorespiratory fitness (>40% heart rate reserve for 30 min/day).

Cardiorespiratory fitness was low and did not increase during conventional prosthetic rehabilitation. On average, the physical strain during rehabilitation was insufficient to elicit potential improvements in aerobic capacity. Results stress the need for dedicated physical training modules at the individual level.

This study shows that clinicians ought to be aware of the relatively low cardiorespiratory fitness of people who have undergone lower limb amputation and that improvements during rehabilitation are not always obtained. Results stress the need for physical training modules in which intensity is imposed at the individual level.

Asymmetrical stepping patterns are chronic gait impairment for individuals with non-traumatic lower limb amputation. Persistent gait asymmetries contribute to poor gait efficiency, decreased physical function, and development of secondary orthopedic conditions.

Evaluate the feasibility and preliminary responsiveness of a treadmill-based, error-augmentation gait training protocol to improve gait symmetry in patients with non-traumatic transtibial amputation.

Single group, pre- and post-test.

The error-augmentation gait training protocol involved walking on a split-belt treadmill with asymmetrical belt speeds for five 3-min sets. Spatiotemporal gait characteristics during overground walking at self-selected and fast walking speeds were assessed prior to, immediately after, and 20 min following the error-augmentation gait training protocol. Outcomes included practicality, implementation feasibility, safety, participant acceptability, and change in gait asymmetry.

All four participants completed the error-augmentation gait training protocol as prescribed, without adverse events, and found the intervention to be acceptable. Step length and stance time asymmetry during overground walking changed immediately following the error-augmentation gait training protocol with inconsistent changes retained after a 20 min washout period.

A single session of error-augmentation gait training is a feasible and safe intervention to modify gait asymmetry in patients with non-traumatic transtibial amputation. Additional study with larger sample sizes and repeated error-augmentation gait training dosing are warranted.

Gait training using error-augmentation on a split-belt treadmill may modify step length and stance time asymmetry for patients with non-traumatic transtibial amputation, but additional research is needed regarding short- and long-term efficacy. Additional training sessions may be needed to sustain initial changes achieved from a single session.

Despite the common use of braces to prevent curve progression in idiopathic scoliosis, their functional effects on respiratory mechanics have not been widely studied.

The objective was to determine the effects of bracing on pulmonary function in idiopathic scoliosis.

A total of 27 adolescents with a mean age of 14.5 ± 1.5 years and idiopathic scoliosis were included in the study. Pulmonary function evaluation included vital capacity, forced expiratory volume, forced vital capacity, maximum ventilator volume, peak expiratory flow, and respiratory muscle strengths, measured with a spirometer, and patient-reported degree of dyspnea. The tests were performed once prior to bracing and at 1 month after bracing (while the patients wore the brace).

Compared with the unbraced condition, vital capacity, forced expiratory volume, forced vital capacity, maximum ventilator volume, and peak expiratory flow values decreased and dyspnea increased in the braced condition. Respiratory muscle strength was under the norm in both unbraced and braced conditions, while no significant difference was found for these parameters between the two conditions.

The spinal brace for idiopathic scoliosis tended to reduce pulmonary functions and increase dyspnea symptoms (when wearing a brace) in this study. Special attention should be paid in-brace effects on pulmonary functions in idiopathic scoliosis.

Bracing seems to mimic restrictive pulmonary disease, although there is no actual disease when the brace is removed. This study suggests that bracing may result in a deterioration of pulmonary function when adolescents with idiopathic scoliosis are wearing a brace.

Immobilization, using a shoulder abduction brace, may be important after rotator cuff repair to achieve successful tendon-to-bone healing. Compliance with wear time is a concern.

Therefore, the abduction brace wearing time was assessed with temperature-sensitive sensors to objectively measure the abduction brace wearing compliance rate.

Level of evidence I, prospective observational study.

A temperature sensor was implanted into 54 standard shoulder abduction braces, worn by 50 patients (27 women; mean age, 56 years). At 6 weeks post-surgery, patients reported the number of hours they had worn the brace. The patient-reported and sensor data were compared, and the compliance rate (relative to the recommended wearing time) was determined, with compliance being the primary end-point and the discrepancy between the measured and patient-reported wear time being the secondary end-point.

Compliance was ⩾80% in 24 (48%) patients. Sensor-based compliance was lower than self-reported compliance (75% versus 96%, p ⩽ 0.001). Compliance was not predicted by age, sex, smoking, educational, employment, living status, or handedness.

Roughly 50% of patients did not wear the brace at least 80% of the recommended time. Self-reported compliance is significantly lower than sensor-based compliance. Compliance was not predicted by measured demographic variables.

This is the first study in which the abduction brace adherence of patients after rotator cuff repair was assessed by the use of a temperature-sensitive sensor. The postoperative use of these braces is questionable as the patient’s abduction brace adherence is low. The self-reported wearing compliance is unreliable.

Passive dynamic ankle-foot orthoses have potential to facilitate return to running after a lower limb trauma. However, transitioning patients to new movement patterns that enhance passive dynamic ankle-foot orthoses benefits can pose a challenge. The purpose of this case study was to report biomechanical and functional outcomes for a patient utilizing a passive dynamic ankle-foot orthoses following completion of a session-based, midfoot strike run training program.

A patient using a passive dynamic ankle-foot orthoses to run due to surgically reconstructed tibia\fibula fracture underwent eight treadmill running sessions over 2 weeks while viewing continuous visual feedback on measured foot strike.

After treatment, foot strike was changed from rearfoot to midfoot on the affected limb along with an 18% increase in mechanical work ratio of the ankle-foot-brace complex. Similar improvements were retained at one and five months following treatment.

This report provides preliminary evidence that biofeedback-based foot strike training can enhance ankle-foot mechanical performance of patients using a passive dynamic ankle-foot orthoses to run.

For patients using a passive dynamic ankle-foot orthoses to run following lower limb trauma, supplementing standard rehabilitation programs with biofeedback-based footstrike training may improve biomechanical performance and running capability.

Ankle-foot orthoses may be used in pre-ambulatory children with cerebral palsy; however, their effect on the acquisition of walking is unknown. This case report aims to evaluate the effect of an ankle-foot orthosis–footwear combination on the acquisition of walking in a single subject with cerebral palsy.

This study reports the orthotic management of a single child with spastic bilateral cerebral palsy over a 15-month period, during which time the ability to independently stand and walk was acquired. Custom rigid ankle-foot orthoses were prescribed. Gait speed and Edinburgh Visual Gait Score were assessed with and without the orthoses.

The subject developed the ability to stand and walk using an ankle-foot orthosis–footwear combination with a walker frame, and to a limited extent without a walker frame. The subject remained unable to take independent steps unless wearing the ankle-foot orthosis–footwear combination. Clinically significant differences in gait speed and Edinburgh Visual Gait Score were observed.

An ankle-foot orthosis–footwear combination may aid the development of independent walking in some children with cerebral palsy. Further research on the effects of orthoses on the acquisition of walking ability in children with cerebral palsy is needed.

Custom rigid ankle-foot orthoses combined with footwear may aid the development of independent standing and walking in some children with bilateral spastic cerebral palsy. This intervention may be considered in clinical practice and future research in this patient group.

The author designed customized upper-limb prosthetic devices for a 22-year-old man with quadrilateral limb loss. The devices were created to meet his functional requirements, while remaining cost-effective. What made this solution unique was that it utilized low-cost items that were easily sourced and maintained.

Devices with polypropylene sockets, wooden positional fingers from an artist’s wooden hand and a metal extension plate were conceptualized and manufactured. The patient gave written consent to the publication of information and photographs in this report.

The devices allowed the individual to complete tasks he desired to be able to perform independently, which included using a computer mouse, aided by the devices. The devices utilized were low-cost and easily accessible materials, such as polypropylene and wood, to cater to financial constraints. The final design had positional fingers and an extension plate to restore surface area for grip, support, and opposition to enable the execution of daily tasks of living.

A cost-effective method of fabricating partial-hand devices with easily accessible materials is described. The resulting devices were successful at restoring the upper-limb surface area for improved grip, support, and opposition for performance of daily tasks.