Priorities in lower limb prosthetic service delivery based on an international survey of prosthetists in low- and high-income countries

Wyss, Dominik; Lindsay, Sally; Cleghorn, W.L.; Andrysek, Jan

doi:10.1177/0309364613513824

Cited by 41 publications

(35 citation statements)

References 22 publications

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“…The prosthesis enables the amputee to realize the able-bodied normal gait kinematics and meets the functional, socio-economic, and aesthetic needs of a trans-femoral amputee and is affordable even in low-income economies. The paper also focuses on essential design features and requirements of a prosthesis to assess its commercial viability in these countries such as low cost, light-weight, functionality, biomechanically appropriate, durable, using locally available materials etc., based on the recommendations of ISPO Consensus Conference on Appropriate Prosthetic Technology in Developing Countries and elsewhere [ 19 , 20 , 21 , 22 ]. The details are discussed later in Section 5.7 .…”

Section: Introductionmentioning

confidence: 99%

An Affordable Insole-Sensor-Based Trans-Femoral Prosthesis for Normal Gait

Pandit

Godiyal

Vimal

et al. 2018

Sensors

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This paper proposes a novel and an affordable lower limb prosthesis to enable normal gait kinematics for trans-femoral amputees. The paper details the design of a passive prosthesis with magneto-rheological (MR) damping system and electronic control. A new control approach based on plantar insole feedback was employed here. Strategically placed sensors on the plantar insole provide required information about gait cycle to a finite state controller for suitable action. A proportional integral (PI) based current controller controls the required current for necessary damping during gait. The prosthesis was designed and developed locally in India keeping in view the cost, functionality, socio-economic, and aesthetic requirements. The prototype was experimentally tested on a trans-femoral amputee and the results are presented in this work. The implementation of the proposed design and control scheme in the prototype successfully realizes the notion that normal gait kinematics can be achieved at a low cost comparable to passive prostheses. The incurring cost and power expenditure of the proposed prosthesis are evaluated against passive and active prostheses, respectively. The commercial implications for the prosthesis were explored on the basis of recommendations of ISPO Consensus Conference on Appropriate Prosthetic Technology in Developing Countries. The key objective of this work is to enable lucid design for development of an affordable prosthesis in a low-resource setting.

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Section: Introductionmentioning

confidence: 99%

An Affordable Insole-Sensor-Based Trans-Femoral Prosthesis for Normal Gait

Pandit

Godiyal

Vimal

et al. 2018

Sensors

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“…Prosthetic and orthotic services are limited in low-income countries and need to be scaled up, as they have the potential to improve mobility and facilitate increased inclusion in society for amputees and persons with physical impairments. Factors important for patients’ satisfaction with prosthetic and orthotic devices used in low-income countries need to be identified in order to clarify which areas need prioritising in further, low-cost technology development [ 5 ] and improvements in service-delivery programmes.…”

Section: Introductionmentioning

confidence: 99%

Patients’ Satisfaction with Lower-limb Prosthetic and Orthotic Devices and Service delivery in Sierra Leone and Malawi

Magnusson

Ahlström

2017

BMC Health Serv Res

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BackgroundPeople with disabilities have the right to personal mobility and available and affordable assistive technology, according to the Convention of Rights of Persons with Disabilities. The aims were to investigate similarities and differences between Sierra Leone and Malawi concerning participants’ mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery, and to identify variables associated with patients’ satisfaction with assistive devices and associated services in the entire study group from these two low-income countries.MethodsQuestionnaires, including QUEST, were answered by 222 patients in Sierra Leone and Malawi.ResultsEighty-six per cent of assistive devices were in use, but half needed repair. One third of participants reported pain when using their assistive device. A higher percentage (66%) of participants in Sierra Leone had difficulties or could not walk at all on uneven ground compared with 42% in Malawi. The majority in both countries had difficulties or could not walk at all up and down hills, or on stairs. Participants in both countries were quite satisfied (mean 3.7–3.9 of 5) with their assistive device. Participants were most dissatisfied with: comfort (46%), dimensions (39%), and safety (38%) of their assistive device. In Sierra Leone participants were less satisfied than in Malawi with service delivery (mean 3.7; 4.4, p < .001). Access to repairs and servicing of their assistive device was considered the most important item. In Sierra Leone patients were less satisfied with follow-up services (41%) than patients in Malawi were (22%). The strongest association with satisfaction with assistive device was pain, and for satisfaction with service, country. The general condition of devices and the ability to walk on uneven ground were associated with both satisfaction with assistive devices and service received.ConclusionsParticipants reported high levels of use and mobility with their assistive device, in spite of pain and difficulties walking on uneven ground, which were also associated with the level of satisfaction with the assistive device. Access to repairs and follow-up services were the most important to patients, and should be addressed. Country was associated with satisfaction with service, with participants in Sierra Leone significantly less satisfied.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2044-3) contains supplementary material, which is available to authorized users.

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“… 42 43 44 Factors limiting the use and success of prosthetics extend beyond availability to the cost to the patient for the prosthetic, lack of proper manufacturing materials, lack of personnel for rehabilitation programs, inadequate public relations campaigns to finance and maintain programs, insufficient knowledge to implement logistical elements, and inadequate practitioner training. 45 46 47 In rural environments, prosthetics must be affordable, durable, easy to fabricate and repair, culturally acceptable, and able to be used in local conditions which often involves heat, humidity, and manual labor. 43 , 47 48 49 50 In the future, three-dimensional printing may make low-cost, custom, simple prosthetic limbs a possibility, but improvements in technology are needed to increase functionality and affordability.…”

Section: Amputations and Prostheticsmentioning

confidence: 99%

Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls

2020

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Although there is literature discussing the treatment of acute and chronic trauma in austere environments, no literature or guidelines for the treatment of musculoskeletal tumors exist. This series discusses case examples with considerations and pitfalls of performing limb-salvage surgery in an underserved location. Cases of limb-salvage surgery performed by the same orthopaedic oncologist in Haiti and the Dominican Republic are discussed with a review of the literature on limb salvage for musculoskeletal tumors in developing nations. All patients successfully underwent limb-salvage surgery after considering multiple factors including tumor type and location. Patients with metastatic disease, likelihood of substantial blood loss, and poor health were not candidates for limb-salvage surgery. Medical missions and the development of partnerships with established training programs make limb salvage a greater possibility. Knowledge of the facility, anesthesia support, and instrumentation available is vital. Advanced imaging, blood products, and allograft are likely unavailable or difficult to obtain. Established continuity of care is necessary, and training of the local surgeon should be provided. Surgery should only be considered if it is safe and provides more of a benefit to the patient than an amputation.

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Priorities in lower limb prosthetic service delivery based on an international survey of prosthetists in low- and high-income countries

Cited by 41 publications

References 22 publications

An Affordable Insole-Sensor-Based Trans-Femoral Prosthesis for Normal Gait

An Affordable Insole-Sensor-Based Trans-Femoral Prosthesis for Normal Gait

Patients’ Satisfaction with Lower-limb Prosthetic and Orthotic Devices and Service delivery in Sierra Leone and Malawi

Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls

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