A method for performance comparison of polycentric knees and its application to the design of a knee for developing countries

2016 ◽  
Vol 41 (4) ◽  
pp. 402-411 ◽  
Author(s):  
TS Anand ◽  
S Sujatha
Keyword(s):  
Developing Countries ◽  
Study Design ◽  
Clinical Relevance ◽  
Performance Comparison ◽  
User Testing ◽  
Uneven Terrain ◽  
Maximum Flexion ◽  
Prosthetic Knees

Background:Polycentric knees for transfemoral prostheses have a variety of geometries, but a survey of literature shows that there are few ways of comparing their performance.Objectives:Our objective was to present a method for performance comparison of polycentric knee geometries and design a new geometry.Study design:In this work, we define parameters to compare various commercially available prosthetic knees in terms of their stability, toe clearance, maximum flexion, and so on and optimize the parameters to obtain a new knee design.Methods:We use the defined parameters and optimization to design a new knee geometry that provides the greater stability and toe clearance necessary to navigate uneven terrain which is typically encountered in developing countries.Results:Several commercial knees were compared based on the defined parameters to determine their suitability for uneven terrain. A new knee was designed based on optimization of these parameters. Preliminary user testing indicates that the new knee is very stable and easy to use.Conclusion:The methodology can be used for better knee selection and design of more customized knee geometries.Clinical relevanceThe method provides a tool to aid in the selection and design of polycentric knees for transfemoral prostheses.

‘It’s . . . forward-focused’: Experiences of a mobility clinic for people with limb loss

2019 ◽  
Vol 43 (6) ◽  
pp. 601-608 ◽  
Author(s):  
Sarah Anderson ◽  
Lisa Chaffey ◽  
Michael Dillon
Keyword(s):  
Study Design ◽  
Clinical Relevance ◽  
Qualitative Methodology ◽  
Peer Education ◽  
Limb Loss ◽  
Structured Interviews ◽  
Mobility Training ◽  
Daily Function ◽  
Fitness Levels

Background: Mobility clinics are designed to extend gait and mobility training beyond rehabilitation programmes. No research has been undertaken into participants’ experiences of attending these multidisciplinary, experience-based clinics. Research in this area is needed to ensure clinics meet intended goals, including understanding the motivation and experience of attendees. Insights may improve mobility clinics and inform strategies to encourage greater participation. Objectives: To explore the motivation of people with limb loss to attend a mobility clinic, the experience of participation and their perception of the clinic’s benefits. Study design: Qualitative methodology, naturalistic enquiry. Methods: Semi-structured interviews were conducted with nine clinic attendees during the clinic. Interviews were transcribed verbatim, data thematically analysed and emergent themes underwent member checking. Results: Three themes emerged from the data: facing the challenge captured how participants’ have adapted to amputation, valuing peers highlights the important role of peers in learning and support and improving mobility described the ongoing quest to improve mobility. Conclusion: The mobility clinic was attractive to those who liked challenges and was an invaluable source of learning for those wishing to improve their mobility. Future clinics should ensure that peer education is supported, and activities cater for a range of skills and fitness levels. Clinical relevance Findings of this study indicate that those who attended the mobility clinic liked to challenge themselves. Participation with peers was an important source of learning and support. Those participants who had previously attended a mobility clinic reported improvements in their overall daily function.

scholarly journals Threshold concepts in prosthetics

2016 ◽  
Vol 41 (6) ◽  
pp. 548-555 ◽  
Author(s):  
Sophie Hill
Keyword(s):  
Study Design ◽  
Curriculum Design ◽  
Clinical Relevance ◽  
Interpretative Phenomenological Analysis ◽  
Phenomenological Analysis ◽  
Analysis Approach ◽  
Threshold Concepts ◽  
Key Concepts ◽  
The Individual ◽  
Potential Threshold

Background:Curriculum documents identify key concepts within learning prosthetics. Threshold concepts provide an alternative way of viewing the curriculum, focussing on the ways of thinking and practicing within prosthetics. Threshold concepts can be described as an opening to a different way of viewing a concept. This article forms part of a larger study exploring what students and staff experience as difficult in learning about prosthetics.Objectives:To explore possible threshold concepts within prosthetics.Study design:Qualitative, interpretative phenomenological analysis.Methods:Data from 18 students and 8 staff at two universities with undergraduate prosthetics and orthotics programmes were generated through interviews and questionnaires. The data were analysed using an interpretative phenomenological analysis approach.Results:Three possible threshold concepts arose from the data: ‘how we walk’, ‘learning to talk’ and ‘considering the person’.Conclusion:Three potential threshold concepts in prosthetics are suggested with possible implications for prosthetics education. These possible threshold concepts involve changes in both conceptual and ontological knowledge, integrating into the persona of the individual. This integration occurs through the development of memories associated with procedural concepts that combine with disciplinary concepts. Considering the prosthetics curriculum through the lens of threshold concepts enables a focus on how students learn to become prosthetists.Clinical relevanceThis study provides new insights into how prosthetists learn. This has implications for curriculum design in prosthetics education.

scholarly journals Assessment of body-powered upper limb prostheses by able-bodied subjects, using the Box and Blocks Test and the Nine-Hole Peg Test

2014 ◽  
Vol 40 (1) ◽  
pp. 109-116 ◽  
Author(s):  
Liz Haverkate ◽  
Gerwin Smit ◽  
Dick H Plettenburg
Keyword(s):  
Study Design ◽  
Upper Limb ◽  
Clinical Relevance ◽  
Functional Performance ◽  
Reference Value ◽  
Functional Tests ◽  
Second Best ◽  
Terminal Device ◽  
Upper Limb Prostheses ◽  
Nine Hole Peg Test

Background: The functional performance of currently available body-powered prostheses is unknown. Objective: The goal of this study was to objectively assess and compare the functional performance of three commonly used body-powered upper limb terminal devices. Study design: Experimental trial. Methods: A total of 21 able-bodied subjects ( n = 21, age = 22 ± 2) tested three different terminal devices: TRS voluntary closing Hook Grip 2S, Otto Bock voluntary opening hand and Hosmer Model 5XA hook, using a prosthesis simulator. All subjects used each terminal device nine times in two functional tests: the Nine-Hole Peg Test and the Box and Blocks Test. Results: Significant differences were found between the different terminal devices and their scores on the Nine-Hole Peg Test and the Box and Blocks Test. The Hosmer hook scored best in both tests. The TRS Hook Grip 2S scored second best. The Otto Bock hand showed the lowest scores. Conclusion: This study is a first step in the comparison of functional performances of body-powered prostheses. The data can be used as a reference value, to assess the performance of a terminal device or an amputee. Clinical relevance The measured scores enable the comparison of the performance of a prosthesis user and his or her terminal device relative to standard scores.

Trial designs, including observational to interventional

2020 ◽  
pp. 57-64
Author(s):  
Edo Richard
Keyword(s):  
Study Design ◽  
Treatment Effect ◽  
Clinical Relevance ◽  
Observational Studies ◽  
Research Question ◽  
Sample Size Calculation ◽  
Target Population ◽  
Ethical Considerations ◽  
Neuropsychiatric Diseases ◽  
The Right

Observational studies have taught us a lot about the origin of neurological and neuropsychiatric diseases. This chapter describes how we can translate this knowledge into action. Before engaging in a large RCT, several steps have to be taken. First, the potential for a treatment effect has to be compelling. The target population in the RCT has to resemble the population in which observational studies described an association. Second, the outcome of an RCT has to be chosen, and has to have clinical relevance or at least have the potential of clinical relevance in the future. Third, the right study design has to be decided on. Each research question will require a specific study design with accompanying sample size calculation. Lastly, specific ethical considerations have to be taken into account when designing and executing an intervention study. This chapter presents an overview of these issues.

scholarly journals Exploring the effect of pelvic belt configurations upon athletic lumbopelvic pain

2012 ◽  
Vol 37 (2) ◽  
pp. 124-131 ◽  
Author(s):  
Leanne Sawle ◽  
Jennifer Freeman ◽  
Jonathan Marsden ◽  
Martin John Matthews
Keyword(s):  
Outcome Measures ◽  
Study Design ◽  
Repeated Measures ◽  
Clinical Relevance ◽  
Return To Sport ◽  
Repeated Measures Anova ◽  
Repeated Measures Design ◽  
New Approaches ◽  
And Function ◽  
Straight Leg Raise

Background: Lumbopelvic injuries are often refractory to treatment and can limit return to sport. Research shows that 50 Newtons (N) of force applied transversely to the pelvis improves lumbopelvic stability and pain. This study applies transverse and diagonal forces to the pelvis in athletes with lumbopelvic pain, and investigates effects on pain and function. Objective: To investigate the effects of transverse and diagonal compressive forces applied to the pelvis of athletes with lumbopelvic pain Study Design: A randomized, repeated measures design using 20 athletes with lumbopelvic pain. Methods: No belt and four pelvic belt configurations (50 N force) were tested. Outcome measures were: resting pain, pain on active straight leg raise (ASLR), resisted hip adduction force and pain on 1-metre broad jump. Force on the adduction test was determined via load cell. Results: Data were analyzed using repeated measures ANOVA. Squeeze test showed significant effect of condition F (4, 76) = 2.7, P < 0.05. On ASLR ipsilateral to the side of pain, pain decreased across conditions ( F (4, 76) = 2.5 P = 0.05). Conclusion: Results suggest application of diagonal forces towards the site of pain may have additional benefits in improving pain and function. Such information may inform the development of an orthosis. Clinical relevance The results may be used clinically to determine the effectiveness of different belt placements (with belts or straps) in managing athletic lumbopelvic pain. The results offer an alternative to the application of transverse belts, and may inform new approaches in the development of orthotics.

scholarly journals When to biomechanically examine a lower-limb amputee: A systematic review of accommodation times

2016 ◽  
Vol 41 (5) ◽  
pp. 431-445 ◽  
Author(s):  
Andrea B Wanamaker ◽  
Rebecca R Andridge ◽  
Ajit MW Chaudhari
Keyword(s):  
Systematic Review ◽  
Study Design ◽  
Lower Limb ◽  
Clinical Relevance ◽  
Biomechanical Testing ◽  
High Variability ◽  
Systematic Search ◽  
Lower Limb Amputee ◽  
Lower Limb Amputees

Background:Hundreds of investigations examining biomechanical outcomes of various prostheses have been completed, but one question remains unanswered: how much time should an amputee be given to accommodate to a new prosthesis prior to biomechanical testing?Objective:To examine the literature for accommodation time given during biomechanical investigations to determine whether consensus exists.Study design:Systematic review.Methods:A systematic search was completed on 7 January 2016 using PubMed and Scopus.Results:The search resulted in 156 investigations. Twenty-eight studies did not provide an accommodation or were unclear (e.g. provided a “break in period”), 5 studies tested their participants more than once, 25 tested only once and on the same day participants received a new prosthesis (median (range): above-knee: 60 (10–300) min; below-knee: 18 (5–300) min), and 98 tested once and gave a minimum of 1 day for accommodation (hip: 77 (60–180) days; above-knee: 42 (1–540) days; below-knee: 21 (1–475) days).Conclusion:The lack of research specifically examining accommodation and the high variability in this review’s results indicates that it remains undecided how much accommodation is necessary. There is a need for longitudinal biomechanical investigations to determine how outcomes change as amputees accommodate to a new prosthesis.Clinical relevanceThe results of this review indicate that little research has been done regarding lower-limb amputees accommodating to a new prosthesis. Improper accommodation could lead to increased variability in results, results that are not reflective of long-term use, and could cause clinicians to make inappropriate decisions regarding a prosthesis.

scholarly journals Amputee socks: Sock thickness changes with normal use

2015 ◽  
Vol 40 (3) ◽  
pp. 329-335 ◽  
Author(s):  
John C Cagle ◽  
Krittika J D’Silva ◽  
Brian J Hafner ◽  
Daniel S Harrison ◽  
Joan E Sanders
Keyword(s):  
Standard Deviation ◽  
Direct Measurement ◽  
Study Design ◽  
Clinical Relevance ◽  
Weight Bearing ◽  
Mean Difference ◽  
Initial Thickness ◽  
Reduced Volume ◽  
The Mean ◽  
Over Time

Background: Prosthetic socks are expected to decrease in thickness and have reduced volume accommodation with normal use. It is unknown, however, to what degree they reduce in thickness over time. Objective: The goal of this study was to determine a correlation between the age of a prosthetic sock (defined as the out-of-package time) and the resulting change in thickness under standardized weight-bearing and non-weight-bearing conditions. Study design: Experimental, mechanical assessment. Methods: Used prosthetic socks were donated by donors with transtibial amputation. Sock thickness was measured on a custom instrument under conditions representative of normal use. Stress-thickness response was compared to that of equivalent new socks to quantify the effects of use on sock performance. Results: Sock thickness changed non-linearly over time. On average, socks were 75% ± 17% of their initial thickness after 1 month, while socks older than 1 month were 72% ± 18% of their initial thickness. The elasticity of socks did not change with age. Conclusion: The volume accommodation provided by used socks cannot be reliably predicted by ply or age. Direct measurement of total sock thickness may provide meaningful insight to quantify prosthetic users’ socket fit and guide volume accommodation recommendations. Clinical relevance The mean difference in thickness between 3-ply and 5-ply used socks was equal to the standard deviation of each ply group (0.3mm). Therefore, it is possible that a 3-ply sock worn for as a little as 1 month could have a greater thickness than a 5-ply sock worn for a month.

scholarly journals The experiences of mothers and caregivers on feeding practices of children under the age of five years with undernutrition in Oshikoto region, Namibia

2018 ◽  
Vol 4 (2) ◽  
pp. 20
Author(s):  
Ester Mulenga ◽  
Hans Amukugo ◽  
Anna Shilunga
Keyword(s):  
Developing Countries ◽  
Qualitative Study ◽  
Study Design ◽  
Nutritional Assessment ◽  
Feeding Practices ◽  
Age Group ◽  
Community Members ◽  
Support Programme ◽  
Lack Of Information ◽  
Study Population

Background: Undernutrition in children under the age of five years is prevalent in the developing countries which increase the risk of morbidity and mortality among such age group. Lack of information related to nutrition and feeding practices as well as other factors such as employment and pressure from family and community members cause mothers and caregivers of children under the age of five years to use inappropriate methods of feeding which contribute to undernutrition.Purpose: The aim of this article is to relate the experiences of mothers and caregivers on feeding practices of children under the age of five years in Oshikoto region, Namibia.Methods: A qualitative study design was utilized to explore and describe the experiences of mothers and caregivers on feeding practices of children under the age of five years. The study population comprised of mothers and caregivers of children diagnosed with undernutrition either severe or moderate, admitted in pediatric units or registered on Nutritional Assessment Counseling and Support programme. A purposive sampling was used to select participants and a total number of fifteen mothers/caregivers were interviewed. The data were transcribed verbatim and analysed using Tesch steps.Results: The study revealed that mothers and caregivers experienced lack of information related to nutrition and feeding practices and other contextual constraints which resulted in the utilization of suboptimal feeding practices of children under the age of five years.Conclusions: Due to challenges experienced by mothers and caregivers, they need to be empowered with knowledge on nutrition and feeding practices of children under the age of five years.

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