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An editorial is presented that focuses on advancements in technology-assisted rehabilitation, highlighting the growing need for effective rehabilitation solutions due to the increasing prevalence of disabilities and chronic diseases worldwide. It discusses the development and application of assistive technologies, such as prosthetics, orthoses, and wearable sensors, which aim to improve the quality of life for individuals with motor impairments.

Introduction: The C-Brace microprocessor stance and swing control orthosis was designed to overcome safety and functional limitations of traditional knee-ankle-foot orthoses (KAFOs) for individuals with lower limb paresis. However, a systematic comparison to established KAFO types has not been performed in a bigger sample. Methods: International multicenter, randomized, controlled, cross-over clinical trial. Legacy KAFO users at risk of falling were randomized to KAFO/C-Brace or C-Brace/KAFO use for three months with each orthosis. Primary outcome was balance assessed with the Berg Balance Scale (BBS). Secondary outcomes were falls, mobility, function, and quality of life. Results: Intention-to-treat analysis with 102 participants. With the C-Brace, the BBS improved by 3.3 ± 6.3 points (p < 0.0001). Significantly fewer participants presented BBS scores <40 indicative of increased fall risk (16 vs. 36, p = 0.018). Mean falls reduced from 4.0 ± 16.8 to 1.1 ± 3.3 (p = 0.002). Outcomes for function, mobility, and quality of life showed significant improvements with the C-Brace. Discussion: The improvements in fall risk and mobility can be attributed to the stumble recovery and controlled knee flexion during weight bearing of the C-Brace and have a positive impact on the quality of life of users. Conclusion: The C-Brace represents an option for KAFO users with increased fall risk and reduced mobility. IMPLICATIONS FOR REHABILITATION: When prescribing traditional knee-ankle-foot orthoses (KAFOs), their known limitations, such as limited function and mobility, and the requirement to walk with compensatory mechanisms, especially on non-level terrains, should be considered. For patients with compromised balance and increased risk of falling when using a traditional KAFO, a microprocessor stance and swing control orthosis (MP-SSCO) may be considered as an orthotic option to reduce their fall risk. For patients with mobility restrictions using a traditional KAFO, a MP-SSCO may be considered to improve function, mobility, reintegration into normal living, and quality of life. [ABSTRACT FROM AUTHOR]

Background: Early mobility, functional independence, and ambulation are associated benefits after lower limb amputation (LLA), whereas an increased risk of clinical complications is associated with no prosthesis. Objective: To describe time to prosthesis receipt after amputation and to assess the impact of patient demographic and health factors on the rate of prosthesis receipt within 12 months post LLA. Design: A retrospective cohort analysis using commercial administrative claims data. Kaplan‐Meier and Cox proportional‐hazards models were applied to assess time to prosthesis receipt. Setting: Watson/Truven administrative database 2014‐2016. Participants: Adults aged 18‐64 years with LLA who maintained their current insurance enrollment for 12 months after amputation. Interventions: Independent variables included diabetes/vascular disease status, amputation level, age, gender, and region. Main Outcome Measures: Prosthesis receipt was defined based on the presence of codes billed for prosthesis services. Time was measured in days from date of amputation surgery. Results: Among the sample, 510 individuals maintained insurance enrollment for 12 months after amputation, of which 443 individuals received a prosthesis within that period (79% below knee and 21% above knee). The adjusted average rate of time to prosthesis receipt was 138 (95% confidence interval [CI]: 113–185) days. Individuals with diabetes/vascular disease were 22% (hazard ratio: 1.22, 95% CI: 1.02–1.49) more likely to receive a prosthesis earlier than individuals without diabetes/vascular disease and women received a prosthesis later than men at 141 (95% CI: 126–162) days versus 106 (95% CI: 96–119) days, respectively. Conclusions: This study expands the understanding of factors that influence the likelihood of receiving a prosthesis along with the timing of prosthesis receipt after LLA among commercially insured adults. At least half of this sample received a prosthesis within 5 months or less. Disparities in timing and access to a prosthesis based on amputation level and gender were noted; future efforts are needed to address these issues. [ABSTRACT FROM AUTHOR]

Introduction: Adverse events after a lower limb amputation (LLA) can negatively affect the rehabilitation process and may lead to emergency department (ED) visits. Earlier receipt of a prosthesis, as compared to delayed or not receiving a prosthesis, may decrease or moderate the risk of increased ED utilization. In addition, adverse events (ie, fall‐related injury [FRI]) may be associated with increased health care utilization as measured by ED use. The implication of the timing of prosthesis provision after amputation and reduced ED use is not well established. Obtaining data about ED utilization early post‐LLA could assist the rehabilitation team in ensuring timely and appropriate access to improve outcomes. Objective: To determine the role that timing of prosthesis receipt has in ED utilization and the association of fall/FRI with health care utilization. Design: Retrospective observational cohort using commercial claims data. A logistic regression model was used to assess factors that influence ED utilization post‐LLA. Setting: Watson/Truven administrative database 2014 to 2016. Participants: The study sample consisted of 510 adults age 18 to 64 years with continuous enrollment for 3 years. Interventions: Independent variables included age, sex, diabetes status, amputation level, fall diagnosis, and prosthesis receipt. Fall was defined as presence of a diagnosis code in any outpatient procedure after the amputation date. Main Outcome Measure: ED use after amputation was defined as the presence of procedure codes that billed for ED services (99281 to 99285). Results: Individuals who receive a prosthesis early, within 0 to 3 months, post‐LLA were 48% (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.28 to 0.97) less likely to use the ED compared to those who did not receive a prosthesis. Individuals who experienced a fall/FRI had 2.8 (OR 2.86, 95% CI 1.23 to 6.66) times the odds of ED utilization. Conclusion: Receipt of a prosthesis reduces the risk of ED use. The current study underscores the value of prostheses during the rehabilitation process after LLA. [ABSTRACT FROM AUTHOR]

The objective of this cross-sectional observational study was to determine whether the use of a microprocessor knee for individuals with an above-the-knee amputation results in improved functional mobility compared to their peers of matched comorbid-health with a non-microprocessor knee, and to inform how this compares to the mobility observed in below-knee prosthesis users. A sample of 450 individuals with lower limb amputation were divided into three groups (n = 150 each). The groups included: nonmicroprocessor knee users (NMPK, age: 57.6 ± 17.2 years), microprocessor knee users (MPK, age: 56.5 ± 13.8 years), and below-knee prosthesis users (BKA, age: 58.4 ± 12.2 years). Primary outcome measure was functional mobility measured through Prosthetic Limb Users' Survey of Mobility (PLUS-M®). Results showed MPK mobility (48.49 ± 0.86) was greater than NMPK (43.49 ± 0.86, p < 0.001), but less than BKA (52.11 ± 0.86, p = 0.003). These results persisted when removing potential confounding effects of age, body mass index, cause of amputation, and comorbid health (MPK: 47.15 ± 0.97; NMPK: 43.47 ± 0.88; BKA: 52.61 ± 0.91). In conclusion, these results show the use of a MPK can improve functional mobility for individuals with an above-knee amputation. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to determine the impact of comorbidities on mobility in patients with lower limb prostheses. Design: Cohort database chart review was conducted to examine mobility in lower limb prosthesis users grouped according to comorbidities. Regression modelswere used to determine significant predictor comorbidities for mobility. General linear univariate modelswere implemented to investigate differences in mobility among cohorts (N = 596). Results: Patient age and history of stroke, peripheral vascular disease, and anxiety/panic disorders were predictors of decreased mobility. After adjusting for covariates, the differences in mobility reported by patients older than 65 yrs was compared with those younger than 65 yrs; in addition, we compared those with a history of peripheral vascular disease with those without. The comparative analyses for both categories did not satisfy the minimal clinically important difference. Therewere no significant differenceswhen comparing overall comorbid health after adjusting for covariates. Conclusions: Clinicians should consider patient age and history of stroke, peripheral vascular disease, or anxiety/panic disorderswhen optimizing a lower limb prosthesis users' mobility because these variables may be predictive of modest but clinically meaningful decreased prosthetic mobility. By contrast, common comorbid health conditions such as arthritis, chronic obstructive pulmonary disease, congestive heart failure, and diabetes do not seem predictive of decreased mobility among lower limb prosthesis users. [ABSTRACT FROM AUTHOR]

Stride-to-stride fluctuations of joint kinematics during walking reflect a highly structured organization that is characteristic of healthy gait. The organization of stride-to-stride fluctuations is disturbed in lower-limb prosthesis users, yet the factors contributing to this difference are unclear. One potential contributor to the changes in stride-to-stride fluctuations is the altered push-off mechanics experienced by passive prosthesis users. The purpose of our study was to determine if changes in push-off mechanics affect stride-to-stride fluctuations in transtibial amputees. Twenty-two unilateral transtibial amputees were enrolled in the 6-week cross-over study, where High and Low Activity (based on the Medicare Functional Classification System) prostheses were worn for three weeks each. Data collection took place at the end of the third week. Participants walked on a treadmill in a motion capture laboratory to quantify stride-to-stride fluctuations of the lower extremity joint angle trajectories using the largest Lyapunov Exponent, and over floor-embedded force platforms to enable calculating push-off work from the prosthesis and the sound limb. Push-off work was 140% greater in the High Activity prosthesis compared to the Low Activity prosthesis (p < 0.001), however no significant change was observed in stride-to-stride fluctuations of the ankle between the two prosthesis types (p = 0.576). There was no significant correlation between changes in prosthesis push-off work and the largest Lyapunov exponent. Though differences in push-off work were observed between the two prosthesis types, stride-to-stride fluctuations remained similar, indicating that prosthesis propulsion mechanics may not be a strong determinant of stride-to-stride fluctuations in unpowered transtibial prosthesis users. [ABSTRACT FROM AUTHOR]

Background: While rehabilitation professionals are historically trained to place emphasis on the restoration of mobility following lower limb amputation, changes in healthcare dynamics are placing an increased emphasis on the limb loss patient's quality of life and general satisfaction. Thus, the relationship between these constructs and mobility in the patient with lower limb loss warrants further investigation.Objectives: To determine the relationship between mobility of the patient with lower limb loss and both (1) general satisfaction and (2) quality of life.Study Design: Retrospective chart analysis.Methods: A retrospective chart review of the Prosthetic Limb Users Survey of Mobility and the Prosthesis Evaluation Questionnaire-Well-Being subsection. Pearson correlations were used to test relationships.Results: Data from 509 patients with a lower limb prosthesis were included. Mobility was found to be positively correlated with quality of life ( r = 0.511, p < 0.001, 95% confidence interval (0.443, 0.569)) and general satisfaction ( r = 0.475, p < 0.001, 95% confidence interval (0.403, 0.542)), as well as their arithmetic mean (i.e. Prosthesis Evaluation Questionnaire-Well-Being) ( r = 0.533, p < 0.001, 95% confidence interval (0.466, 0.592)).Conclusion: This study provides evidence of a strong positive correlation between mobility and both quality of life and general satisfaction. Thus, in the holistic care of a patient with lower limb loss, maximizing mobility would correlate with greater quality of life and general satisfaction. Clinical relevance There is growing emphasis on the quality of life and general satisfaction experienced by patients undergoing prosthetic rehabilitation. The results of this study underscore the importance of providing prosthetic rehabilitation that maximizes the patient's mobility, noting that these individuals also report greater quality of life and general satisfaction. [ABSTRACT FROM AUTHOR]

Objective: To determine changes in average daily step count (ADSC) and 6-minute walk test (6MWT) due to use of low-activity feet (LA) and high-activity energy-storage-and-return (ESAR) feet, and examine the sensitivity of these measures to properly classify different prosthetic feet. Design: Individuals with transtibial amputations (n = 28) participated in a 6-week, randomized crossover study. During separate 3-week periods, participants wore either a LA foot (eg, solid-ankle-cushioned-heel) or an ESAR foot. Differences in 6MWT and ADSC at the end of the 3-week period were recorded. Results: Subjects performed similarly in the 6MWT with the LA and ESAR foot (P = 0.871) and ADSC (P = 0.076). The correct classification of ESAR is only 51.9% and 61.5% with 6MWT and ADSC, respectively. For the LA foot, correct classification is less than 50% for both tests. Conclusions: Neither ADSC or 6MWT are responsive to changes in prosthetic feet. The pitfalls and shortcomings of these instruments with regard to their ability to detect differences in prosthetic feet are outlined. Based on these results, it is not recommended that the 6MWT and ADSC are used as a means to assess outcomes for different prosthetic feet. [ABSTRACT FROM AUTHOR]

Twenty-four individuals with transtibial amputation were recruited to a randomized, crossover design study to examine stride-to-stride fluctuations of lower limb joint flexion/extension time series using the largest Lyapunov exponent (λ). Each individual wore a “more appropriate” and a “less appropriate” prosthesis design based on the subject's previous functional classification for a three week adaptation period. Results showed decreased λ for the sound ankle compared to the prosthetic ankle (F1,23 = 13.897, p = 0.001) and a decreased λ for the “more appropriate” prosthesis (F1,23 = 4.849, p = 0.038). There was also a significant effect for the time point in the adaptation period (F2,46 = 3.164, p = 0.050). Through the adaptation period, a freezing and subsequent freeing of dynamic degrees of freedom was seen as the λ at the ankle decreased at the midpoint of the adaptation period compared to the initial prosthesis fitting (p = 0.032), but then increased at the end compared to the midpoint (p = 0.042). No differences were seen between the initial fitting and the end of the adaptation for λ (p = 0.577). It is concluded that the λ may be a feasible clinical tool for measuring prosthesis functionality and adaptation to a new prosthesis is a process through which the motor control develops mastery of redundant degrees of freedom present in the system. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the relationship between stride-to-stride fluctuations and prosthesis preference. Thirteen individuals with unilateral, transtibial amputation consented to participate. Individuals walked on a treadmill for 3 min with their prescribed and an alternate prosthesis. Stride-to-stride fluctuations were quantified with the largest Lyapunov exponent (LyE) of each joint flexion/extension time series. The change in the LyE was calculated for each major lower-limb joint for both conditions. Participants indicated preference between the prostheses on a continuous visual analog scale. The change in the LyE was correlated with the degree of preference between the two prostheses at the prosthetic ankle. The change in the LyE of the prosthetic ankle was strongly related to the degree of preference (r = 0.629, p = 0.02). Thus, stride-to-stride fluctuations, quantified by the LyE, are strongly related to the patient's perception of the prosthesis. As a result, the LyE is the first objective measure to detect changes in gait that relate to the patient's perception of the prosthesis. The LyE should be further examined as a potentially effective prescriptive and outcome measure in prosthetic rehabilitation. [ABSTRACT FROM AUTHOR]

Materials: N/A Methods: The guideline is based upon the best available evidence as it relates to socket design, interface, and suspension of definitive transtibial prostheses. Where possible, recommendations are drawn from systematic review and meta-analysis. Where this standard is unavailable, alternate academic literature has been used to support individual recommendations. Results: Recommendation 1: The static and dynamic pressure distribution of the residual limb within the socket are essential considerations in patient comfort, function and well-being. Recommendation 2: Total surface bearing sockets are indicated to decrease fitting times and enable higher activity levels. Recommendation 3: Compared to traditional foam-based interfaces, viscoelastic interface liners are indicated to decrease dependence on walking aides, improve suspension, improve load distribution, decrease pain and increase comfort. Recommendation 4: Among modern suspension options, vacuum assisted suspension (VAS) sockets permits the least amount of pistoning within the socket, followed by suction suspension and then pin-lock suspension. The traditional suspension options of supracondylar, cuff and sleeve suspension provide comparatively compromised suspension. Recommendation 5: VAS sockets are indicated to decrease daily limb volume changes of the limb in the socket while facilitating more favorable pressure distribution during gait. Recommendation 6: VAS sockets require both awareness and compliance on the part of the end user and are not universally indicated. Conclusions: These clinical practice guidelines summarize the available evidence related to the socket design, interface, and suspension of definitive transitibial prostheses. The noted clinical practice guidelines are meant to serve on as "guides." They may not apply to all patients and clinical situations. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to assess the validity of a customized nine-item Patient-Reported Outcomes Measurement Information System Upper Extremity instrument being used with individuals with upper extremity amputation to inform potential modifications for clinical efficiency. Design: A sample of 239 adults with upper extremity amputation (mean age = 48 ± 16 yrs; female = 69; prosthesis users = 150) were included. After clinical implementation of the nine-item Patient-Reported Outcomes Measurement Information System Upper Extremity, the following psychometric properties were examined: structural and known-groups validity, differential item functioning, and reliability. Results: The nine-item Patient-Reported Outcomes Measurement Information System Upper Extremity short form demonstrated satisfactory psychometric properties. convincing evidence of structural validity included no violation of unidimensionality, local independence (all local dependence χ²< 10), monotonicity (Hij > 0, Hi > 0.3, and H = 0.57), and adequate model fit (P > 0.006). Known-groups analysis demonstrated that the nine-item Patient-Reported Outcomes Measurement Information System Upper Extremity instrument was able to discriminate between prosthesis users and nonprosthesis users and amputation level. The Cronbach's a and item response theory reliability at the selected range of T scores were greater than 0.9 indicating high reliability. No items were flagged for age in differential item functioning. Conclusions: The customized nine-item Patient-Reported Outcomes Measurement Information System Upper Extremity met the minimum criteria, according to the Patient-Reported Outcomes Measurement Information System plan, for psychometric validity supporting its use within the population of individuals with upper extremity amputation. [ABSTRACT FROM AUTHOR]

• A low functional mobility level is associated with a history of injurious falls. • Maintaining or improving mobility post-amputation may reduce risk of injurious falls. • PLUS-M is an accessible and useful tool to guide prosthetic rehabilitation. • Continued need to explore modifiable clinical factors relative to prosthesis use. Injurious falls have a high cost and economic impact on an individual and the health system. Several studies have assessed performance-based functional mobility in lower limb prosthesis (LLP) users and fall risk including fall history. However, limited data exist regarding the relationship between functional mobility and a history of injurious falls in individuals who use a LLP. Such information could inform clinical practice and decision making from prosthesis design to policy. The purpose of this study was to identify factors associated with a history of injurious falls among LLP users using a clinical outcomes database. Retrospective (2016-2018) observational study. Logistic regression applied. A final sample of 12,044 LLP users was included for analysis. Within the sample, 1,529 individuals reported a history of an injurious fall within the previous 6 months. Self-reported functional mobility was stratified into low, middle, and high levels: differences were found between levels for history of an injurious fall. The lowest mobility level was associated with 2.29 higher odds of a history of an injurious fall (95% CI: 1.96-2.69) indicating a potentially greater serious fall risk compared to those with higher mobility levels while controlling for covariates (sex, cause of amputation and level of amputation). Self-reported functional mobility was associated with a history of injurious falls in LLP users. The Prosthetic Limb Users Survey of Mobility is an accessible tool that prosthetists could use to identify individuals with a high risk of falls; this can inform care planning. Rehabilitation plans and prosthesis designs that target LLP users who report low functional mobility may positively impact health outcomes. [ABSTRACT FROM AUTHOR]