Fluid Volume Management in Prosthesis Users: Augmenting Panel Release with Pin Release

Abstract

Background: Management of fluid in the limbs is a challenge faced by people with disabilities. In prosthetics, a means for transtibial prosthesis users to stabilize their residual limb fluid volume during the day may improve socket fit. Objective: To determine if releasing the panels and locking pin of a cabled-panel adjustable socket during socket release significantly improved limb fluid volume recovery and retention over releasing the panels alone. Design: Repeated-measures experiment to assess the effects on limb fluid volume retention. Setting: Participants were tested in a laboratory setting while walking on a treadmill. Intervention: Release of a locking pin tether during sitting as a limb volume accommodation strategy. Main Outcome Measure: Percent limb fluid volume retention for panel and pin release compared with panel release alone at 2 minutes (short term) and 50 minutes (long term) after subsequent activity. Limb fluid volume was monitored using bioimpedance analysis. Results: Median percent limb fluid volume retention for the panel and pin release was significantly greater than panel release alone for both anterior and posterior regions for the long term (P = .0499 and .0096, respectively) but not the short term (P = .0712 and .1580, respectively). Conclusion: Augmenting panel release with pin release may be an effective accommodation strategy for prosthesis users with transtibial amputation to better retain limb fluid volume.

An adaptive prosthetic socket for people with transtibial amputation

“…Using this system in a prior study, the controller maintained stable operation during 98% of the walking bouts tested 31 . We also found in the same study that releasing the socket panels during sitting facilitated limb fluid volume stabilization, a result also shown for partial and full doffing 31 , 35 – 37 , 39 , 40 . The findings from this prior work were implemented in the design of the present controller.…”

“…Doffing, one form of socket release, has been shown to facilitate fluid volume stabilization for prosthesis users who otherwise tended to lose fluid volume over the day 35 – 37 . Socket release without doffing, releasing socket panels with or without pulling the residual limb a few cm out of the socket, has also been shown to facilitate limb fluid volume stabilization 31 , 39 , 40 and is much easier to execute than full doffing. If prosthesis users were to integrate temporary socket panel release into their everyday routine or it were to be executed automatically by the controller, they may experience less limb volume fluctuation and need to doff their prosthesis less often.…”

Scoping review to evaluate existing measurement parameters and clinical outcomes of transtibial prosthetic alignment and socket fit

“…All but three of the 22 studies that evaluated socket fit by self-report (satisfaction, self-perception, comfort, or pain) included an objective or clinician-measured assessment. Objective parameters for fit included socket volume pressure (n 5 11), 4,[30][31][32]35,36,40,60,66,71,73 socket pressure (n 5 7), 12,13,33,59,75,76,81 and radiographic parameters (n 5 1). 83 Nonquantitative clinical observations of gait mechanics (n 5 10), skin condition (n 5 7), and perspiration (n 5 7) were also used in assessment of fit.…”

“…1 Early and successful transition to prosthetic use greatly affects rehabilitation outcomes after lower extremity amputation. [2][3][4] Prosthetic use is also a vital predictor of quality of life and is positively associated with return to work after amputation. [5][6][7][8] Although most patients with a lower extremity amputation who are prescribed a prosthesis will successfully don one, up to 60% report dissatisfaction with the comfort of their devices.…”

Performance of an auto-adjusting prosthetic socket during walking with intermittent socket release

“…Conducting socket release between walking bouts would also be expected to accentuate instability since it has been shown that releasing socket pressures on a transtibial residual limb by partially or fully doffing the socket, or by releasing socket panels increases limb fluid volume. [22][23][24] An increase in limb fluid volume would be expected to disturb the sensed distance and challenge the control system at the outset of the next walking bout.…”