Background The prosthetic and orthotic industry typically provides an artisan “hands-on” approach to the assessment and fitting of orthopedic devices. Despite growing interest in digital technology for prosthetic and orthotic service provision, little is known of the quantum of use and the extent to which the current pandemic has accelerated the adoption. Objective This study’s aim is to assess the use of digital technology in prosthetics and orthotics, and whether its use can help overcome challenges posed by the current COVID-19 pandemic. Methods A web-based survey of working prosthetists, orthotists, and lower limb patients was conducted between June and July 2020 and divided into three sections: lower limb amputees, prosthetist and orthotist (P&O) currently using digital technologies in their practice, and P&O not using any digital technology. Input was sought from industry and academia experts for the development of the survey. Descriptive analyses were performed for both qualitative (open-ended questions) and quantitative data. Results In total, 113 individuals responded to the web-based survey. There were 83 surveys included in the analysis (patients: n=13, 15%; prosthetists and orthotists: n=70, 85%). There were 30 surveys excluded because less than 10% of the questions were answered. Out of 70 P&Os, 31 (44%) used digital technologies. Three dimensional scanning and digital imaging were the leading technologies being used (27/31, 88%), primarily for footwear (18/31, 58%), ankle-foot orthoses, and transtibial and transfemoral sockets (14/31, 45%). Digital technology enables safer care during COVID-19 with 24 out of 31 (77%) respondents stating it improves patient outcomes. Singapore was significantly less certain that the industry's future is digital (P=.04). The use of virtual care was reported by the P&O to be beneficial for consultations, education, patient monitoring, or triaging purposes. However, the technology could not overcome inherent barriers such as the lack of details normally obtained during a physical assessment. Conclusions Digital technology is transforming health care. The current pandemic highlights its usefulness in providing safer care, but digital technology must be implemented thoughtfully and designed to address issues that are barriers to current adoption. Technology advancements using virtual platforms, digitalization methods, and improved connectivity will continue to change the future of health care delivery. The prosthetic and orthotic industry should keep an open mind and move toward creating the required infrastructure to support this digital transformation, even if the world returns to pre–COVID-19 days.

Background: Upper limb, in particular forequarter amputations, require highly customised devices that are often expensive and underutilised. Objectives: The objective of this study was to design and develop a comfortable 3D-printed cosmetic forequarter prosthetic device, which was lightweight, cool to wear, had an elbow that could lock, matched the appearance of the contralateral arm and was completely free of metal for a specific user’s needs. Study Design: Device design. Technique: An iterative user-centred design approach was used for digitising, designing and developing a functional 3D-printed prosthetic arm for an acquired forequarter amputation, while optimising the fit and function after each prototype. Results: The cost of the final arm was 20% less expensive than a traditionally-made forequarter prostheses in Singapore. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0 survey was administered, with results indicating that the 3D-printed arm was preferred due to its overall effectiveness, accurate size, ease of use and suspension. However, durability had a lower score, and the weight of the arm was 100 g heavier than the user’s current prosthesis. The technique described resulted in a precise fitting and shaped forequarter prosthesis for the user. Using the user’s feedback in the iterations of the design resulted in improved QUEST survey results indicating the device was effective, easy to use, perceived as lighter and more secure than the user’s traditionally-made device. Conclusion: A fully customised cosmetic forequarter prosthesis was designed and developed using digital scanning, computer-aided design modelling and 3D printing for a specific user. These technologies enable new avenues for highly complex prosthetic design innovations.

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SPM is a statistical method of analysis of time-varying human movement gait signal, depending on the random field theory (RFT). MovementRx is our inhouse-developed decision-support system that depends on SPM1D Python implementation of the SPM (spm1d.org). We present the potential application of MovementRx in the prediction of increased joint forces with the possibility to predispose to osteoarthritis in a sample of post-surgical Transtibial Amputation (TTA) patients who were ambulant in the community. We captured the three-dimensional movement profile of 12 males with TTA and studied them using MovementRx, employing the SPM1D Python library to quantify the deviation(s) they have from our corresponding reference data, using “Hotelling 2” and “T test 2” statistics for the 3D movement vectors of the 3 main lower limb joints (hip, knee, and ankle) and their nine respective components (3 joints × 3 dimensions), respectively. MovementRx results visually demonstrated a clear distinction in the biomechanical recordings between TTA patients and a reference set of normal people (ABILITY data project), and variability within the TTA patients’ group enabled identification of those with an increased risk of developing osteoarthritis in the future. We conclude that MovementRx is a potential tool to detect increased specific joint forces with the ability to identify TTA survivors who may be at risk for osteoarthritis.

BACKGROUND The prosthetic and orthotic (P&O) industry typically provides an artisan "hands-on" approach to assessment and fitting of orthopedic devices. Despite growing interest in digital technology for P&O service provision, little is known of the quantum of use and the extent to which the current pandemic has accelerated the adoption. OBJECTIVE This study's objective is to assess the use of digital technology in P&O and whether its use can help overcome challenges posed by the current COVID-19 pandemic. METHODS A Web-based survey of working Prosthetists/Orthotists and lower limb patients was conducted between June-July 2020 and divided into three sections: Lower limb amputees, Prosthetist/Orthotist currently using digital technologies in their practice and Prosthetist/Orthotist not using any digital technology. The input was sought from industry and academia experts for the development of the survey. Descriptive analyses were performed for both qualitative (open-ended questions) and quantitative data. RESULTS In total, 113 individuals responded to the Web-based survey. 83 surveys were included in the analysis (patients: 15%; prosthetists/orthotists: 85%). 30 surveys were excluded because less than 10% of the questions were answered. 44% of the prosthetist/orthotists utilizes digital technologies. 3D scanning and imaging were the leading digital technologies being used, primarily for footwear, AFOs, transtibial and transfemoral sockets. Digital technology is particularly suitable for scanning of prosthetics during COVID-19. The use of virtual care was reported by the prosthetists/orthotists to be beneficial. However, the technology could not overcome inherent barriers such as the lack of details normally obtained during a physical assessment. Virtual care could be useful for education, monitoring, or triaging purposes or in rural settings. CONCLUSIONS Digital technology is transforming healthcare. The current pandemic highlights its usefulness, but digital technology must be implemented thoughtfully and designed to address issues that are barriers to current adoption. Technology advancements utilizing virtual platforms, digitalization methods, and improved connectivity will continue to change the future healthcare delivery. The prosthetic and orthotic industry should keep an open mind and move towards creating the required infrastructure to support this digital transformation, even if the world returns to pre-COVID-19 days.

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Background Prosthetic socket coupling with the residual limb should be comfortable without causing skin breakdown or excessive pressure. However, users report socket discomfort, and there is a scarcity of objective measurements available to assess this feeling of discomfort. Quantifying the specific pressure may enable clinicians and users to determine and improve comfort levels objectively. Objectives (1) To evaluate if a peak pressure reduction assists in resolving wounds, redness, and pain inside prosthetic sockets in people with transtibial amputation. (2) To determine if peak pressures measured inside the prosthetic socket due to external forces could be used to quantify the level of improvement in socket discomfort. Design In this cohort study, we used a pressure sensor to quantify and facilitate adjustments to the prosthetic socket, correlating this information to the userʼs socket comfort. Setting Outpatient clinic in a tertiary hospital in Singapore. Participants People (N = 16) with unilateral transtibial lower limb amputation using a prosthesis. Interventions NA. Main Outcome Measures Peak pressure and socket comfort score (SCS). Results The peak pressure value showed a statistically significant reduction across all participants following adjustments at a 50% delta change in pressure (p = .001). This was achieved with a mean number of 2.6 ± 1.4 adjustments per participant. Following the adjustments, the paired t‐test results showed a mean increase between the first SCS and final SCS was 2.6 (p = .001). Conclusion The wound, redness, and pain resolved in 15 of 16 participants regardless of diabetic status following socket adjustments. Although the peak pressures values did not correlate to the SCS score, the reduction in peak pressure saw significant improvement to the SCS. The use of a portable sensor is a fast and efficient means to quantify adjustments inside the prosthetic socket and could potentially be considered as part of future care delivery.