'A whole different ball game': the qualitative experience of older adults with a transtibial amputation and the use of a self-aligning prosthetic ankle-foot on the STEPFORWARD trial.

Background: Older patients with lower limb amputation, categorised as having "limited community mobility", are under-researched. Understanding their experience with a new prosthetic ankle-foot is important when designing clinical trials. The aim of this qualitative study was to explore the adjustments they made after amputation and the acceptability of a self-aligning ankle-foot (SA-AF) to older adults.

Reliability of three different methods for assessing amputee residuum shape and volume: 3D scanners vs. circumferential measurements.

Background: Objective and reliable methods are necessary to monitor and manage amputee residuum shape and volume and design prosthetic residuum-prosthesis interfaces. Portable 3D scanners are potential solutions for digitally recording the amputee residuum characteristics.

Objective: To investigate test-operator reliability when measuring lower limb residuum shape and volume using two different types of 3D laser-free scanners compared with tape measurements generally adopted in clinic.

Improving Competency in Safe Patient Handling Through Online Learning Beyond the Classroom: A Longitudinal Study.

Importance: Safe patient handling is intrinsic in health care provision, yet education in the skills required for safe patient handling is inconsistently delivered, with limited evidence that traditional face-to-face training reduces risk.

Objective: To assess the long-term effectiveness of replacing annual practical handling updates with an online training system, combined with competency assessment of skill and safety.

Design: Quasi-experimental longitudinal 3-yr study to track practical people handling skill development among undergraduate occupational therapy students.

STEPFORWARD study: a randomised controlled feasibility trial of a self-aligning prosthetic ankle-foot for older patients with vascular-related amputations.

Objectives: To determine the feasibility of conducting a full-scale randomised controlled trial (RCT) of the effectiveness and cost-effectiveness of a self-aligning prosthetic ankle-foot compared with a standard prosthetic ankle-foot.

Design: Multicentre parallel group feasibility RCT.

Setting: Five prosthetics centres in England recruiting from July 2018 to August 2019.

Can high-functioning amputees with state-of-the-art prosthetics walk normally? A kinematic and dynamic study of 40 individuals.

Background: Previous work has highlighted the highly functional post-rehabilitation level of military individuals who sustained traumatic amputation. Understanding how these individuals walk with their prosthesis could be key to setting a precedent for what is realistically possible in the rehabilitation of individuals with amputations.

Objective: The aim of this paper is to answer how "normal" should the gait of an individual with an amputation(s) be and can we aspire to mimic able-bodied gait with the most advanced prosthetics in highly functioning individuals?

Methods: This was a cross-sectional study comparing the gait of severely injured and highly functional UK trans-tibial (n=10), trans-femoral (n=10) and bilateral trans-femoral (n=10) military amputees after completion of their rehabilitation programme to that of able-bodied controls (n=10).

Self-aligning prosthetic device for older patients with vascular-related amputations: protocol for a randomised feasibility study (the STEPFORWARD study).

Introduction: The majority of older patients with a transtibial amputation are prescribed a standard (more rigid, not self-aligning) prosthesis. These are mostly suitable for level walking, and cannot adjust to different sloped surfaces. This makes walking more difficult and less energy efficient, possibly leading to longer term disuse.

Performance of Optimized Prosthetic Ankle Designs That Are Based on a Hydraulic Variable Displacement Actuator (VDA).

Current energy storage and return prosthetic feet only marginally reduce the cost of amputee locomotion compared with basic solid ankle cushioned heel feet, possibly due to their lack of push-off at the end of stance. To the best of our knowledge, a prosthetic ankle that utilizes a hydraulic variable displacement actuator (VDA) to improve push-off performance has not previously been proposed. Therefore, here we report a design optimization and simulation feasibility study for a VDA-based prosthetic ankle.

Validity and reliability of a novel 3D scanner for assessment of the shape and volume of amputees' residual limb models.

Background: Objective assessment methods to monitor residual limb volume following lower-limb amputation are required to enhance practitioner-led prosthetic fitting. Computer aided systems, including 3D scanners, present numerous advantages and the recent Artec Eva scanner, based on laser free technology, could potentially be an effective solution for monitoring residual limb volumes.

Purpose: The aim of this study was to assess the validity and reliability of the Artec Eva scanner (practical measurement) against a high precision laser 3D scanner (criterion measurement) for the determination of residual limb model shape and volume.

Temporal Spatial and Metabolic Measures of Walking in Highly Functional Individuals With Lower Limb Amputations.

Objective: To record the temporal spatial parameters and metabolic energy expenditure during walking of individuals with amputation, walking with advanced prostheses, and after completion of comprehensive rehabilitation compared with able-bodied persons.

Design: Cross-sectional.

Setting: Multidisciplinary comprehensive rehabilitation center.

The effects of prosthetic ankle stiffness on stability of gait in people with transtibial amputation.

The ability to control balance during walking is a critical precondition for minimizing fall risk, but this ability is compromised in persons with lower-limb absence because of reduced sensory feedback mechanisms and inability to actively modulate prosthesis mechanical function. Consequently, these individuals are at increased fall risk compared with nondisabled individuals. A number of gait parameters, including symmetry and temporal variability in step/stride characteristics, have been used as estimates of gait stability and fall risk.

Restricting ankle motion via orthotic bracing reduces toe clearance when walking over obstacles.

Background: When trans-tibial amputees cross obstacles leading with their prosthesis, foot clearance is achieved using compensatory swing-phase kinematics. Such compensation would suggest able-bodied individuals normally use swing-phase ankle dorsiflexion to attain adequate obstacle clearance; however, direct evidence of such contribution is equivocal. This study determined the contribution of sagittal plane ankle motion in achieving lead-limb clearance during obstacle negotiation.

A systematic procedure to optimise dose and image quality for the measurement of inter-vertebral angles from lateral spinal projections using Cobb and superimposition methods.

Background: Patients with vertebral column deformations are exposed to high risks associated with ionising radiation exposure. Risks are further increased due to the serial X-ray images that are needed to measure and asses their spinal deformation using Cobb or superimposition methods. Therefore, optimising such X-ray practice, via reducing dose whilst maintaining image quality, is a necessity.

The effects of prosthetic ankle stiffness on ankle and knee kinematics, prosthetic limb loading, and net metabolic cost of trans-tibial amputee gait.

Background: Previous studies of commercially-available trans-tibial prosthetic components have been unable to provide clear insight into the relationships between prosthetic mechanical properties and user performance (i.e., gait quality and energy expenditure), the understanding of which is key to improving prosthesis design and prescription.

Validation of the activPAL activity monitor in children with hemiplegic gait patterns resultant from cerebral palsy.

Background: Current investigation of treatment outcomes by clinicians is currently hampered by a lack of clinically viable tools. The use of activity monitors specifically validated for a population could help resolve this situation.

Objectives: The purpose of the study was to validate an activity monitor for monitoring children with cerebral palsy.

Stance phase mechanical characterization of transtibial prostheses distal to the socket: a review.

Achieving the required functionality of a transtibial prosthesis during the stance phase of gait (e.g., shock absorption, close to normal roll-over characteristics, and smooth transition into swing) depends on the Amputee Independent Prosthesis Properties (AIPPs), defined here as the mechanical properties of the prosthesis that directly influence the performance of the amputee.

The effects of transverse rotation angle on compression and effective lever arm of prosthetic feet during simulated stance.

Background And Aim: Unlike sagittal plane prosthesis alignment, few studies have observed the effects of transverse plane alignment on gait and prosthesis behaviour. Changes in transverse plane rotation angle will rotate the points of loading on the prosthesis during stance and may alter its mechanical behaviour. This study observed the effects of increasing the external transverse plane rotation angle, or toe-out, on foot compression and effective lever arm of three commonly prescribed prosthetic feet.

Amputee Independent Prosthesis Properties--a new model for description and measurement.

A model is presented for describing the Amputee Independent Prosthesis Properties (AIPP) of complete assemblies of trans-tibial prosthetic components distal to the socket. This new AIPP model includes features of both lumped parameter and roll-over models and describes prosthesis properties that are of importance in stance phase, including prosthetic foot geometry, normal stiffness, shear stiffness, and damping (energy dissipation). Methods are described for measuring the parameters of the AIPP model using a custom test-rig, commercial load-cell, and a motion capture system.

Transverse rotation and longitudinal translation during prosthetic gait--a literature review.

Improved technology allows for more accurate gait analysis to increase awareness of nonoptimized prosthetic gait patterns and for the manufacture of sophisticated prosthetic components to improve nonoptimized gait patterns. However, prescriptions are often based on intuition rather than rigorous research findings for evidence-based practice. The number of studies found in the literature that are based on prosthetic research regarding transverse rotation and longitudinal translation is small when compared to topics regarding other types of movements.