Influences and trends of various shape-capture methods on outcomes in trans-tibial prosthetics

Abstract

Introduction: In trans-tibial prosthetics, shape-capture methods are employed to create a representation of the residuum. Shape-capture methods can be grouped into the categories of ‘hands-on’, ‘hands-off’ and computer-aided design. Objective: This review examines the influences and trends of shape-capture methods on the outcomes of quality, comfort of user and clinical efficiency, in the population of trans-tibial prosthesis users. Study Design: Systematic Review Method: Databases and relevant journals were searched. Participants included trans-tibial prosthetics users/limb models. Interventions included shape-capture methods. Outcomes included quality, comfort of user and clinical efficiency. Results: Overall, 22 papers were evaluated; 8 papers evaluated hands-on and hands-off methods, 2 evaluated computer-aided design and 12 evaluated measurement systems used with shape capture. No papers relating to clinical efficiency were found. Conclusion: Overall evidence was weak in suggesting that effects on outcomes were due to the sole influences of shape capture. However, studies suggest that hands-on methods are dependent on a prosthetist’s skill. Hands-off methods, although repeatable, might still require experience to attain a good fit. Computer-aided design studies were mostly done on theoretical models. Shape-capture measurements require more consistent ‘gold standards’. The relation between socket fit and comfort is still unclear. Overall, more research is required in each area. Clinical relevance A good fitting prosthetic socket is crucial for efficient and comfortable use of a prosthesis. To attain the best chances of a good fit, it is important that the characteristics of the residuum are captured as accurately as possible during the initial “shape capture” stage. This paper attempts to categorize and evaluate the existing shape capture methods on their influence and trends on various outcomes - Quality of shape capture, comfort of user and clinical efficiency.

Technology for monitoring everyday prosthesis use: a systematic review

“…Body postures, such as sitting versus standing, also affect residual limb shape and volume. Understanding these changes better could improve socket fitting processes and the measurement of outcomes [ 111 ]. The ability to detect donning and doffing is also useful for understanding whether a prosthesis is meeting the user’s needs and may give more specific indications, such as physical and/or thermal comfort [ 39 , 45 , 112 ].…”

Selecting Appropriate 3D Scanning Technologies for Prosthetic Socket Design and Transtibial Residual Limb Shape Characterization

“…Indeed, it should be noted that the presented data are relevant to transtibial residual limb casting only, and may not be directly applied to other amputation levels or orthoses that have greater reliance upon bony prominences. A recent review 31 20 and ultimately prosthesis user outcome measures 10,33 and acceptability scoring 34 . This study presents one element of the data to support such appraisal and selection of appropriate technologies.…”

“…The presented data are intended for use in appraisal of other shape capture methods; consistency of subsequent rectifications may be compared to the results presented by Convery et al4 . As a final key limitation, it is acknowledged that the relationship between socket comfort and socket fit is not understood31 , and assessing user satisfaction with sockets produced by the different approaches was outside this study's remit.In an LMIC clinical context, important discussion should consider the specific use of3D scanning and other CAD/CAM technologies. There are risks associated with embedding these digital technologies in established manual plaster-based socket design and fabrication workflows, and with present CAD/CAM technologies the crucial sustainable maintenance, servicing and replaceability factors of Appropriate Technologies may not yet be met32 .…”

Silicone soft socket system for the treatment of geriatric transtibial amputees

“…Silicone liners as a gold standard of prosthetic to limb interface, are still under development. For example, existing problems with heat dissipation and consecutive sweating and compromised skin are topics of current research [17] as well as further improvement of prosthetic fitting [15].…”