A clinical standard of stump measurement and classification in lower limb amputees

Persson, Bertil; Liedberg, E.

doi:10.3109/03093648309146710

Cited by 28 publications

(13 citation statements)

References 6 publications

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“…Residual limb quality and the presence of a wound were explored in this analysis due to the potential influence of prosthesis fit on walking activity. [33][34][35] Residual limb quality and presence of a wound was determined using the Chakrabarty scale. 36 Construct validity of the Chakrabarty scale was determined using expert consensus of rehabilitation consultants, surgeons, and professors (n = 66) about meaningful aspects of residual limb quality after LLA and consists of 12 items assessing residual limb edema, scar, tenderness, length, shape, joint contracture, bone end, skin sensation, presence of redundant tissue, shape, and additional factors.…”

Section: Lla Characteristicsmentioning

confidence: 99%

Physical Function and Pre‐Amputation Characteristics Explain Daily Step Count after Dysvascular Amputation

Miller¹,

Cook

Kline³

et al. 2019

PM&R

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Background People with dysvascular lower limb amputation (LLA) achieve one‐third of the recommended steps per day and experience severe disability. Although physical function improves with rehabilitation after dysvascular LLA, physical activity remains largely unchanged, and factors contributing to limited daily step count are unknown. Objectives To identify factors that contribute to daily step count after dysvascular LLA. Design Cross‐sectional, secondary data analysis. Setting Outpatient rehabilitation facilities. Participants Fifty‐eight patients with dysvascular major LLA (age: 64 ± 9 years, body mass index: 30 ± 8 kg/m2, male: 95%, transtibial LLA: 95%). Methods Data were collected by a blinded assessor after dysvascular LLA. Candidate explanatory variables included (1) demographics, (2) LLA characteristics, (3) comorbidities and health behaviors, and (4) physical function. Variables with univariate associations with log steps/day (transformed due to non‐normality) were included in a multiple linear regression model using backward elimination to identify factors that explained significant variability in log steps/day. Primary Outcome Measure The primary outcome, daily step count, was measured with accelerometer‐based activity monitors worn by participants for 10 days. Results Participants took an average (± SD) of 1450 ± 1309 steps/day. After backward elimination, the final model included four variables explaining 62% of the overall daily step count (P < .0001): 2‐minute walk distance (32%), assistive device use (11%), cardiovascular disease (10%), and pre‐amputation walking time (11%). Conclusions Average daily step count of 1450 steps/day reflects the lowest category of sedentary behavior. Physical function, cardiovascular disease, and pre‐amputation walking time explain 62% of daily step count after dysvascular LLA. Although physical rehabilitation commonly focuses on improving physical function, interventions to increase daily step count after dysvascular LLA should also consider chronic disease and health behaviors that predate LLA. Level of Evidence III.

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Section: Lla Characteristicsmentioning

confidence: 99%

Physical Function and Pre‐Amputation Characteristics Explain Daily Step Count after Dysvascular Amputation

Miller¹,

Cook

Kline³

et al. 2019

PM&R

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“…The reason lower curvatures were not considered is that they were not expected to have considerable effects on sensors' responses [48]. As this was a preliminary study, it did not consider double curvatures which would be more important for the conical and club-shaped stumps which account for about 20% of the stumps according to the above study [47]. This should be considered in future work.…”

Section: Test Setupmentioning

confidence: 99%

“…Each structure was part of a cylinder with a different radius, namely 5, 7, 9, 11, and 13 cm, with corresponding curvatures of approximately 0.20, 0.14, 0.11, 0.091, and 0.077 m −1 , respectively. As transtibial amputations account for majority of the major lower limb amputations [45,46], and transhumeral amputations account for majority of the upper limb amputations [45], chosen curvatures are based on measurements of the lower transtibial residual limb reported by Persson et al [47] and the average circumference of the arm reported by Holzbaur et al [48]. Persson et al studied dimensions of 93 lower residual limbs to construct a standard formula of their classification into cylindrical (ordinary), conical, and club-shaped as well as short, ordinary (breadth < length < 2 * breadth), or long.…”

Section: Test Setupmentioning

confidence: 99%

“…In this study, they tested the constructed classification formula on 96 residual limbs of 86 volunteers in 135 examinations and determined that 80% of them were ordinary in both size and shape. Measurements of the breadth of the residual limbs were not reported, however, considering the ordinary length of the majority of the residual limbs and the range reported for their length, breadth of the stump of majority of participants can be approximated to be larger than 9 cm which corresponds to the curvature of about 0.2 m −1 [47].…”

Section: Test Setupmentioning

confidence: 99%

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Investigation of Regression Methods for Reduction of Errors Caused by Bending of FSR-Based Pressure Sensing Systems Used for Prosthetic Applications

Ahmadizadeh

Menon

2019

Sensors

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The pressure map at the interface of a prosthetic socket and a residual limb contains information that can be used in various prosthetic applications including prosthetic control and prosthetic fitting. The interface pressure is often obtained using force sensitive resistors (FSRs). However, as reported by multiple studies, accuracies of the FSR-based pressure sensing systems decrease when sensors are bent to be positioned on a limb. This study proposes the use of regression-based methods for sensor calibration to address this problem. A sensor matrix was placed in a pressure chamber as the pressure was increased and decreased in a cyclic manner. Sensors' responses were assessed when the matrix was placed on a flat surface or on one of five curved surfaces with various curvatures. Three regression algorithms, namely linear regression (LR), general regression neural network (GRNN), and random forest (RF), were assessed. GRNN was selected due to its performance. Various error compensation methods using GRNN were investigated and compared to improve instability of sensors' responses. All methods showed improvements in results compared to the baseline. Developing a different model for each of the curvatures yielded the best results. This study proved the feasibility of using regression-based error compensation methods to improve the accuracy of mapping sensor readings to pressure values. This can improve the overall accuracy of FSR-based sensory systems used in prosthetic applications.

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“…Bones were simulated using aluminum, which represents a worst-case scenario because it is stiffer than bone and will deflect less before transmitting force to the soft tissue. The simulated bone was selected as the longest length recorded in a representative study of 93 subjects, to give the largest moment arm [7].…”

Section: Figure 6: Simulated Residual Limbmentioning

confidence: 99%

Design, Characterization, and Evaluation of a Dynamic Soft Robotic Prosthetic Socket Interface

Holmes

Zhang

2019

2019 Design of Medical Devices Conference

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Prosthetic sockets are static interfaces for dynamic residual limbs. As the user’s activity level increases, the volume of the residual limb can decrease by up to 11% and increase by as much as 7% after activity. Currently, volume fluctuation is addressed by adding/removing prosthetic socks to change the profile of the residual limb. However, this is impractical and time consuming. These painful/functional issues demand a prosthetic socket with an adjustable interface that can adapt to the user’s needs. This paper presents a prototype design for a dynamic soft robotic interface which addresses this need. The actuators are adjustable depending on the user’s activity level, and their structure provides targeted compression to the soft tissue which helps to limit movement of the bone relative to the socket. Testing of the prototype demonstrated promising potential for the design with further refinement. Work on embedded sensing and intelligent feedback control should be continued in future research in order to create a viable consumer product which can improve a lower limb amputee’s quality of life.

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A clinical standard of stump measurement and classification in lower limb amputees

Abstract: The dimensions and healing of 93 consecutive below-knee stumps were studied and based on observations a standard formula of stump classification was constructed (and discussed at the ISPO Meeting in Bologna 1980).

Cited by 28 publications

References 6 publications

Physical Function and Pre‐Amputation Characteristics Explain Daily Step Count after Dysvascular Amputation

Physical Function and Pre‐Amputation Characteristics Explain Daily Step Count after Dysvascular Amputation

Investigation of Regression Methods for Reduction of Errors Caused by Bending of FSR-Based Pressure Sensing Systems Used for Prosthetic Applications

Design, Characterization, and Evaluation of a Dynamic Soft Robotic Prosthetic Socket Interface

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