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Supplemental material, STROBE-Checklist-v4-MS-Word for Reduced cortical brain activity with the use of microprocessor-controlled prosthetic knees during walking by Saffran MMöllerller, David Rusaw, Kerstin Hagberg and Nerrolyn Ramstrand in Prosthetics and Orthotics International

BACKGROUND: The International Classification of Functioning, Disability and Health is a classification of human functioning and disability and is based on a biopsychosocial model of health. As such, International Classification of Functioning, Disability and Health seems suitable as a basis for constructing models defining the clinical P&O process. The aim was to use International Classification of Functioning, Disability and Health to facilitate development of such a model. Proposed model: A model, the Prosthetic and Orthotic Process (POP) model, is proposed. The Prosthetic and Orthotic Process model is based on the concepts of the International Classification of Functioning, Disability and Health and comprises four steps in a cycle: (1) Assessment, including the medical history and physical examination of the patient. (2) Goals, specified on four levels including those related to participation, activity, body functions and structures and technical requirements of the device. (3) Intervention, in which the appropriate course of action is determined based on the specified goal and evidence-based practice. (4) Evaluation of outcomes, where the outcomes are assessed and compared to the corresponding goals. After the evaluation of goal fulfilment, the first cycle in the process is complete, and a broad evaluation is now made including overriding questions about the patient's satisfaction with the outcomes and the process. This evaluation will determine if the process should be ended or if another cycle in the process should be initiated. CONCLUSION: The Prosthetic and Orthotic Process model can provide a common understanding of the P&O process. Concepts of International Classification of Functioning, Disability and Health have been incorporated into the model to facilitate communication with other rehabilitation professionals and encourage a holistic and patient-centred approach in clinical practice. Clinical relevance The Prosthetic and Orthotic Process model can support the implementation of International Classification of Functioning, Disability and Health in P&O practice, thereby providing a common understanding of the P&O process and a common language to facilitate communication with other rehabilitation professionals.

Background Musculoskeletal disorders are a common problem among uniformed police with lower back pain being most frequently reported (Gyi and Porter, 1998). Wearing mandatory equipment (duty belt and body armour) and sitting for long periods of time in fleet vehicles are characteristic workload factors linked to musculoskeletal disorders in police (Filtness et al., 2014, Holmes et al., 2013). Aim The aim of this study was to determine the prevalence of multi-site musculoskeletal pain among Swedish police and to explore the possible association to physical workload factors with a special focus on mandatory equipment. Method A cross-sectional study was carried out with responses from 4185 uniformed police. Data was collected through a self-administered online survey including questions about work environment, physical workload factors, mandatory equipment and musculoskeletal pain. Multi-site musculoskeletal pain was determined by summing pain sites from four body regions. Binomial logistic regression was performed to explore the association between multi-site musculoskeletal pain and 1) use of mandatory equipment and 2) sitting for long periods in fleet vehicles. Result The prevalence of multi-site musculoskeletal pain at least one day per week within the previous three months was 41.3%. A statistically significant association was found between multi-site musculoskeletal pain and mandatory equipment whereas sitting for long periods of time in fleet vehicles was not found to be significantly associated to multi-site musculoskeletal pain. Conclusion Multi-site musculoskeletal pain is a considerable problem among Swedish police and the association to mandatory equipment should therefore be further investigated including psychosocial factors.

BACKGROUND: The Job Demand Control Support model (JDCS) is one of the most widely used theoretical models relating job characteristics to health and wellbeing. OBJECTIVE: This study aimed to assess the predictive power of the JDCS model for determining job satisfaction and fatigue in uniformed Swedish police. An additional aim was to determine if predictive power of the model would be improved with the addition of two occupation specific items. METHODS: Questionnaire data, based upon the Swedish Work Environment Survey were collected from Swedish police (n = 4244). A hierarchical multiple regression analysis was run to explore the predictive value of the model and to determine if the additional variables improved predictive power with respect to job satisfaction and fatigue. RESULTS: Regression analysis demonstrated that the JDSC model had high predictive power in relation to job satisfaction and fatigue. Job demands was the strongest predictor of fatigue (14%), while support was the strongest predictor of job satisfaction (12%). The addition of exposure to threats significantly improved predictive power for both job satisfaction and fatigue, while addition of shift work did not significantly affect predictive power of the model. CONCLUSIONS: Workplace interventions to address issues related to job satisfaction and fatigue in police should focus on maintaining a bearable level of job demands and provision of adequate support.

Introduction Conflicting evidence exists regarding the effects of knee orthoses on proprioception. One belief is that pressure applied by orthoses heightens kinesthetic awareness and that this affects balance. This study aimed to investigate the effects of two different orthosis designs on kinesthetic awareness and balance in healthy individuals. Methods Twenty individuals (13 women) participated in this case series study. Each was tested wearing 1/no orthosis, 2/soft elastic orthosis and 3/non-elastic jointed orthosis. Pressure under orthoses was recorded. Kinesthetic awareness was investigated by testing joint position sense and threshold to detection of passive motion. Balance was tested using a modified sensory organization test. Results Non-elastic jointed orthoses applied the greatest pressure to the knee. With non-elastic jointed orthoses, threshold to detection of passive motion was significantly poorer for pooled results ( p = 0.02) and when the start position of the knee was 70° (mean threshold = 0.6°, 0.6°, 0.7° for no-orthosis, elastic and jointed-orthoses; p = 0.03). No major differences were observed in JPS or balance and correlation between proprioception and balance was poor. Conclusions There may be a limit to the amount of pressure that should be applied to the knee joint by an orthosis. Exceeding this limit may compromise kinesthetic awareness.

Swedish police officers experience an increased incidence of musculoskeletal injury, but little is known of the underlying cause. This paper explores police officers' own perceptions of the most common types of musculoskeletal injury sustained in the workplace and explores what police themselves feel are the major causes of such injuries. A nominal group process technique was used because of its benefits in generating and prioritising ideas. Six focus group sessions were conducted involving 33 police from three different regions in Sweden. Police perceived lower back pain as the most common musculoskeletal injury sustained in the workplace. Seven specific areas were perceived as contributing to an increased risk of musculoskeletal injury; duty belt, clothing, shoes, working hours, safety vests, physical condition and patrol vehicles.

Introduction: This study aimed to evaluate if use of an activity promoting computer game, used in the home Nintendo Wii Fit; Nintendo Co Ltd, Japan, could influence balance related outcome measures in children with cerebral palsy. Method: Eighteen children with hemiplegic or diplegic cerebral palsy were recruited for the study. A randomised cross-over design was used with children tested at baseline, after five weeks of playing Wii Fit games and after five weeks without any intervention. Outcome measures of interest included: performance on the modified sensory organisation test, reactive balance test and rhythmic weight shift test. Results: No significant difference was observed between testing occasions for any of the balance measures investigated p > 0.05. Conclusion: Our results suggest that use of a Nintendo Wii balance board and Wii Fit software for a minimum of thirty minutes per day in the patient's own home, over a five week period, is not effective as a balance training tool in children with cerebral palsy.

Ankle-foot orthoses (AFOs) are typically designed to limit the motion of the ankle joint in one or more planes. Given that balance may be compromised when joint range of motion is restricted, an un ...

The use of motion analysis techniques in amputee rehabilitation often utilizes kinematic data from the prosthetic limb. A problem with methods currently used is that the joint positions of the prosthetic ankle are assumed to be in the same position as that of an intact ankle. The aim of this study was to identify both traditional anatomical joint centres as well as functional joint centres in a selection of commonly used prosthetic feet. These coordinates were then compared across feet and compared to the contralateral intact ankle joint.Six prosthetic feet were fit to a unilateral trans-tibial amputee on two separate occasions. The subject's intact limb was used as a control. Three-dimensional kinematics were collected to determine the sagittal position of the functional joint centre for the feet investigated.None of the prosthetic feet had a functional joint centre that was within the 95% CI for that of an intact ankle (both x- and y-coordinate position), nor any of the other prosthetic feet investigated. The repeatability of the method was found to be adequate, with 95% CI of the difference (test-retest) of the prosthetic feet similar to that for the intact ankle and within clinically accepted levels of variability.The motion of the prosthetic feet tested is clearly different from that of an intact ankle. Kinematic methods that assume ankle constraints based on an intact ankle are subject to systematic error as this does not reflect the real motion of the prosthetic foot.

Background Shoes with an unstable sole construction are commonly used as a therapeutic tool by physiotherapists and are widely available from shoe and sporting goods retailers. The aim of this study was to investigate the effects of using an unstable shoe (Masai Barefoot Technology) on standing balance, reactive balance and stability limits. Methods Thirty-one subjects agreed to participate in the study and underwent balance tests on three different occasions. After test occasion one (baseline) 20 subjects received Masai Barefoot Technology shoes and were requested to wear them as much as possible for the remaining eight weeks of the study. Three specific balance tests were administered on each test occasion using a Pro Balance Master (NeuroCom International Inc., Oregon, USA). Tests included; a modified sensory organization test, reactive balance test and limits of stability test. Findings Subjects in the intervention group significantly improved their performance on elements of all three tests however results on these variables were not demonstrated to be significantly better than the control group. No significant differences were observed across testing occasions in the control group. Interpretation Results from the present study suggest that, for this group of individuals, use of unstable footwear may improve certain aspects of balance.

Johannesson A, Larsson G-U, Ramstrand N, Lauge-Pedersen H, Wagner P, Atroshi I: Outcomes of a standardized surgical and rehabilitation program in transtibial amputation for peripheral vascular disease: A prospective cohort study. OBJECTIVE:: To study the outcomes of a new surgical and rehabilitation program for initial unilateral transtibial amputation in patients with peripheral vascular disease. The program consists of sagittal incision, rigid dressing, compression therapy using silicone liner, and direct manufacturing prosthetic technique. DESIGN:: A prospective cohort study with 1-yr follow-up. RESULTS:: Of the 217 consecutive patients with peripheral vascular disease who underwent transtibial amputation (mean age, 77 yrs; 51% diabetic; 116 could walk before amputation), 119 (55%) were fitted with a prosthesis at a median time of 41 (range, 12-147) days after amputation. Of the prosthetic recipients, 76 (64%) obtained good function with the prosthesis within 6 mos. Within 1 yr, reamputation was performed on 8.2%, and contralateral amputation was performed on 5.5%. The 90-day mortality was 24% (53 patients). The total 1-yr mortality was 40% (86 patients): 17% among patients who received a prosthesis and 67% among those who did not receive a prosthesis or had undergone reamputation. CONCLUSIONS:: Following this standardized surgical and rehabilitation program, prosthetic fitting was achieved in more than half of transtibial amputees, almost two-thirds of prosthetic recipients obtained good function, and the reamputation rate was low. Comparison with outcomes of alternative strategies is needed. (Less)

OBJECTIVE—The purpose of this study was to compare the incidence of vascular lower-limb amputation (LLA) in the diabetic and nondiabetic general population. RESEARCH DESIGN AND METHODS—A population-based cohort study was conducted in a representative Swedish region. All vascular LLAs (at or proximal to the transmetatarsal level) performed from 1997 through 2006 were consecutively registered and classified into initial unilateral amputation, contralateral amputation, or reamputation. The incidence rates were estimated in the diabetic and nondiabetic general population aged ≥45 years. RESULTS—During the 10-year period, LLA was performed on 62 women and 71 men with diabetes and on 79 women and 78 men without diabetes. The incidence of initial unilateral amputation per 100,000 person-years was 192 (95% CI 145–241) for diabetic women, 197 (152–244) for diabetic men, 22 (17–26) for nondiabetic women, and 24 (19–29) for nondiabetic men. The incidence increased from the age of 75 years. Of all amputations, 74% were transtibial. The incidences of contralateral amputation and of reamputation per 100 amputee-years in diabetic women amputees were 15 (7–27) and 16 (8–28), respectively; in diabetic men amputees 18 (10–29) and 21 (12–32); in nondiabetic women amputees 14 (7–24) and 18 (10–28); and in nondiabetic men amputees 13 (6–22) and 24 (15–35). CONCLUSIONS—In the general population aged ≥45 years, the incidence of vascular LLA at or proximal to the transmetatarsal level is eight times higher in diabetic than in nondiabetic individuals. One in four amputees may require contralateral amputation and/or reamputation.

PURPOSE: To explore areas in which the education at the Pakistan Institute of Prosthetic & Orthotic Science (PIPOS) could be improved or supplemented to facilitate clinical practice of graduates. To describe educational opportunities PIPOS graduates have had since their graduation and explore their further educational needs. METHOD: 15 graduates from PIPOS participated in semi-structured interviews. A qualitative content analysis was applied to the transcripts. FINDINGS: Respondents indicated a need to upgrade the education at PIPOS. This should include upgrading of resources such as literature and internet access as well as providing staff with the opportunity to further their own education. Females experienced inequality throughout their education but were supported by management. Upon entering the workforce graduates reported that they were supported by senior staff but experienced difficulties in determining appropriate prescriptions. They further indicated that a multidisciplinary approach to patient care is lacking. Graduates knowledge of workshop management was identified as a problem when entering the workforce. Limited awareness of the prosthetics and orthotics profession by both the general community and the medical community was also identified as a problem. If offered the opportunity to continue their studies the respondents would like to specialize. "Brain drain" was noted as a risk associated with post graduate education. Interaction from international collaborators and networking within the country was desired. CONCLUSION: The education at PIPOS meets a need in the country. Graduates indicated that P&O services for Pakistan can be better provided by modifying program content, upgrading teachers' knowledge, improving access to information and addressing issues of gender equality. PIPOS graduates have had limited opportunities for professional development and have a desire for further education.

Evidence-based practice has become somewhat of a catchphrase over the past ten years. In this paper evidence-based practice is defined and its importance for the development of the prosthetics and orthotics profession is highlighted. The authors suggest that evidence-based practice needs to be prioritized within the profession and that a cultural change needs to be initiated which supports clinicians in incorporating research findings into their daily practice. In addition, the authors highlight the need for prosthetists/orthotists to become more active in generating research rather than relying on other professional groups to contribute to their professional body of knowledge.

The ability to objectively measure an amputee's walking activity over prolonged periods can provide clinicians with a useful means of evaluating their patients' outcomes. The present study aimed to validate the temporospatial data output from a commercially available ambulatory activity monitor (PAM, Ossur) fitted to trans-tibial and trans-femoral amputees, against data that was simultaneously captured from a three dimensional motion analysis system (Qualisys Medical AB, Gothenburg, Sweden). Results indicate that the PAM monitor provides accurate measures of temporospatial aspects of amputee gait for walking speeds above 0.75 m/s.

This study aimed to examine the effects of two different load carriage systems on gait kinematics, temporospatial gait parameters and self-reported comfort in Swedish police.21 active duty police officers were recruited for this crossover study design. Biomechanical and self-report data was collected on two testing occasions. On occasion 1, three dimensional kinematic data was collected while police wore a/no equipment (control), b/their standard issues belt and ballistic protection vest and c/a load bearing vest with ballistic protection vest. Police then wore the load bearing vest for a minimum of 3 months before the second testing occasion.The load bearing vest was associated with a significant reduction in range of motion of the trunk, pelvis and hip joints. Biomechanical changes associated with the load bearing vest appeared to reduce with increased wear time. In both the standard issue belt condition and the load bearing vest condition, police walked with the arms held in a significantly greater degree of abduction. Self-report data indicated a preference for the load bearing vest.The two load carriage designs tested in this study were found to significantly alter gait kinematics. The load bearing vest design was associated with the greatest number of kinematic compensations however these reduced over time as police became more accustomed to the design. Results from this study do not support selection of one load carriage design over the other and providing individuals with the option to choose a load carriage design is considered appropriate.

Objectives: To investigate patients' mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery in Sierra Leone; to compare groups of patients regarding type and level of assistive device, gender, area of residence, income; and to identify factors associated with satisfaction with the assistive device and service. Methods: A total of 139 patients answered questionnaires, including the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire (QUEST 2.0). Results: Eighty-six percent of assistive devices were in use, but half needed repair. Thirty-three percent of patients reported pain when using their assistive device. Patients had difficulties or could not walk at all on: uneven ground (65%); hills (75%); and stairs (66%). Patients were quite satisfied with their assistive device and the service (mean 3.7 out of 5 in QUEST), but reported 886 problems. Approximately half of the patients could not access services. In relation to mobility and service delivery, women, orthotic patients and patients using above-knee assistive devices had the poorest results. The general condition of the assistive device and patients' ability to walk on uneven ground were associated with satisfaction with the assistive devices and service. Conclusion: Patients reported high levels of mobility while using their device although they experienced pain and difficulties walking on challenging surfaces. Limitations in the effectiveness of assistive devices and limited access to follow-up services and repairs were issues desired to be addressed.

ISPO Consensus Conference on Appropriate Lower Limb Orthotics for Developing Countries : Conclusions and Recommendations

Within the prosthetics profession, there is a lack of evidence to support many clinical practices. It is therefore important that clinicians systematically document and evaluate their daily practices.To record preoperative characteristics and functional outcomes for patients with a lower limb amputation and to investigate variations between prosthetic users and non-prosthetic users.Prospective cohort study.A total of 23 patients (mean age = 80 years, standard deviation = 7.3) who underwent a major lower limb amputation were assessed within 2 weeks of admission and 6 months post-operatively. Locomotor Capabilities Index-5, the Timed-Up-and-Go Test and prosthetic use were used to evaluate functional outcomes.A total of 13 participants (57%) received a prosthesis within 6 months of amputation. Mean time to prosthetic fitting was 48 days (range = 28-97). No statistically significant difference was found between prosthetic users and non-prosthetic users regarding age, time to rehabilitation and Locomotor Capabilities Index-5 (p0.05). Locomotor Capabilities Index-5 basic was significantly lower at 6 months than prior to amputation (p = 0.039).The functional outcome at 6 months indicates a sizable restriction in mobility among lower limb amputees. No variation in preoperative characteristics between prosthetic users and non-prosthetic users could be confirmed in this study.This study highlights the need for prosthetists to better incorporate research findings into their daily practice and presents an example of how to implement a procedure for assessment and documentation of patients' functional outcomes in a clinical setting. Results confirm difficulties in identifying amputees who will become prosthetic users based on preoperative characteristics.

Appropriate muscular response following an exter- nal perturbation is essential in preventing falls. Transtibial prosthesis users lack a foot-ankle complex and associated sen- sorimotor structures on the side with the prosthesis. The effect of this lack on rapid responses of the lower limb to external surface perturbations is unknown. The aim of the present study was to compare electromyogram (EMG) response latencies of otherwise healthy, unilateral, transtibial prosthesis users (n = 23, mean +/- standard deviation (SD) age = 48 +/- 14 yr) and a matched control group (n = 23, mean +/- SD age = 48 +/- 13 yr) following sudden support-surface rotations in the pitch plane (toes-up and toes-down). Perturbations were elicited in various weight-bearing and limb-perturbed conditions. The results indicated that transtibial prosthesis users have delayed responses of multiple muscles of the lower limb following per- turbation, both in the intact and residual limbs. Weight-bearing had no influence on the response latency in the residual limb, but did on the intact limb. Which limb received the perturba- tion was found to influence the muscular response, with the intact limb showing a significantly delayed response when the perturbation was received only on the side with a prosthesis. These delayed responses may represent an increased risk of falling for individuals who use transtibial prostheses.

Objective: To investigate patients’ mobility and satisfaction with their lower limb prosthetic or orthotic device and related service delivery in Malawi and to compare groups of patients regarding type and level of device and demographics. Methods: Questionnaires were used to collect self-report data from 83 patients. Results: Ninety percent of prostheses or orthoses were in use by patients, but approximately half of these needed repair. Thirty-nine percent reported pain when using their assistive device. The majority of patients were able to rise from a chair (77%), move around the home (80%), walk on uneven ground (59%) and travel by bus or car (56%). However, patients had difficulties walking up and down hills (78%) and stairs (60%). In general, patients were quite satisfied with their assistive device (mean of 3.9 out of 5) and very satisfied with the service provided (mean of 4.4 out of 5). Access to repairs and servicing were rated as most important, followed by durability and follow-up services. Lack of finances to pay for transport was a barrier to accessing the prosthetic and orthotic centre. Conclusion: Patients were satisfied with the assistive device and service received, despite reporting pain associated with use of the device and difficulties ambulating on challenging surfaces.

Based on the literature, patients with carpal tunnel syndrome are suggested to wear a custom-made wrist orthosis immobilizing the wrist in a neutral position. Many prefabricated orthoses are available on the market, but the majority of those do not assure neutral wrist position.We hypothesized that the use of orthosis affects grip strength in persons with carpal tunnel syndrome in a way that supports preference for custom-made orthoses with neutral wrist position over prefabricated orthoses.Experimental.Comparisons of grip strength for three types of grips (cylindrical, lateral, and pinch) were made across orthosis types (custom-made, prefabricated with wrist in 20° of flexion, and none) on the affected side immediately after fitting, as well as between affected side without orthosis and nonaffected side.Orthosis type did not significantly affect grip strength (p = 0.661). Cylindrical grip was by far the strongest, followed by lateral and pinch grips (p0.050). The grips of the affected side were weaker than those of the nonaffected side (p = 0.002).In persons with carpal tunnel syndrome, neither prefabricated orthoses with 20° wrist extension nor custom-made wrist orthoses with neutral wrist position influenced grip strength of the affected hand. Compared to the nonaffected side, the grips of the affected side were weaker.The findings from this study can be used to guide application of orthoses to patients with carpal tunnel syndrome.

Evidence-based practice is commonly accepted as a means of improving patient outcomes; however, there is little understanding of the processes required to successfully implement it into prosthetic and orthotic practice.To discuss factors affecting adoption of evidence-based practice and present a theoretical framework for its implementation into prosthetic and orthotic practice.Numerous factors that affect adoption of evidence-based practice are discussed, ranging from individual factors to those that can be attributed to administrative and environmental issues. Specific factors are likely to be context specific and are influenced by the manner in which evidence-based practice is introduced into the working environment. It is argued that successful implementation of evidence-based practice requires consideration of numerous interrelated factors. A formal translating research into practice model is presented as a means of developing a strategic plan that considers all relevant factors and maximizes acceptance of evidence-based practice into prosthetics and orthotics clinical practice.The use of a theoretical model for implementation of evidence-based practice is likely to improve its adoption by prosthetic and orthotic clinicians. Clinical relevance The demand for prosthetists/orthotists to utilize evidence-based practice is increasing. Lack of strategic planning throughout the implementation phase is likely to compromise adoption of evidence-based practices by clinicians.

Three-dimensional motion analysis has been used since the beginning of the 1980s to evaluate many aspects of physical function of transtibial amputees. Despite its common use for clinical research, there is large variability in methods of capturing three-dimensional data, description of these methods, reporting of joint kinematics and interpretation of research findings.The aim of the following review is to critically examine the specific methodologies used by researchers when collecting three-dimensional kinematic data on transtibial amputees and to provide an overview of the methods used.Systematic review.A systematic review of the literature between January 1984 and June 2009 was conducted. A total of 68 papers were identified for review based on the following criteria: experimental research design, collection of three-dimensional kinematic data of lower-extremity joints, and inclusion of transtibial amputees as experimental subjects.A number of methodological shortcomings were identified in the papers reviewed.The authors recommend that future studies more appropriately address the product name and number of prosthetic components used; how the position of reflective markers on the prosthesis is defined; presentation of data from both sound and affected sides; and definition of the neutral position of the ankle when reporting kinematic data. Where possible, the authors recommend use of a control group.This paper has identified numerous sources of discrepancy and potential error in kinematic data collected on trans-tibial amputees. Clinicians and researchers should make themselves aware of these issues when collecting and interpreting gait data.

Height estimations based on security camera footage are often requested by law enforcement authorities. While valid and reliable techniques have been established to determine vertical distances from video frames, there is a discrepancy between a person's true static height and their height as measured when assuming different postures or when in motion (e.g., walking). The aim of the research presented in this report was to accurately record the height of subjects as they performed a variety of activities typically observed in security camera footage and compare results to height recorded using a standard height measuring device. Forty-six able bodied adults participated in this study and were recorded using a 3D motion analysis system while performing eight different tasks. Height measurements captured using the 3D motion analysis system were compared to static height measurements in order to determine relative differences. It is anticipated that results presented in this report can be used by forensic image analysis experts as a basis for correcting height estimations of people captured on surveillance footage.

Ambulation on stairs presents a significant challenge for lower extremity amputees and increases the risk of falling and sustaining a serious injury. This study aimed to compare foot placement and foot clearance during stair ambulation in a group of transtibial amputees and a group of able-bodied subjects. Three-dimensional motion analysis was used to determine foot positioning and to calculate temporospatial parameters during stair ascent and descent of 10 transtibial amputees (mean age = 56) and a control group consisting of 10 healthy able-bodied individuals (mean age = 26.7). No significant difference was observed in foot positioning and foot clearance between the amputee and control groups. Temporospatial data revealed a number of significant differences between the groups, particularly during stair ascent. Amputees were observed to walk with a slower velocity and cadence (p0.01), to increase the time spent in stance phase and double support (p0.01) and to increase their step width during both stair ascent and descent (p0.01). Results suggest that foot placement and clearance are not factors that would contribute to a stumble or fall on stairs in established amputees but that balance related issues, such as relative motion of the centre of mass, require further investigation.

OBJECTIVE—The purpose of this study was to compare the incidence of vascular lower-limb amputation (LLA) in the diabetic and nondiabetic general population. RESEARCH DESIGN AND METHODS—A population-based cohort study was conducted in a representative Swedish region. All vascular LLAs (at or proximal to the transmetatarsal level) performed from 1997 through 2006 were consecutively registered and classified into initial unilateral amputation, contralateral amputation, or reamputation. The incidence rates were estimated in the diabetic and nondiabetic general population aged ≥45 years. RESULTS—During the 10-year period, LLA was performed on 62 women and 71 men with diabetes and on 79 women and 78 men without diabetes. The incidence of initial unilateral amputation per 100,000 person-years was 192 (95% CI 145–241) for diabetic women, 197 (152–244) for diabetic men, 22 (17–26) for nondiabetic women, and 24 (19–29) for nondiabetic men. The incidence increased from the age of 75 years. Of all amputations, 74% were transtibial. The incidences of contralateral amputation and of reamputation per 100 amputee-years in diabetic women amputees were 15 (7–27) and 16 (8–28), respectively; in diabetic men amputees 18 (10–29) and 21 (12–32); in nondiabetic women amputees 14 (7–24) and 18 (10–28); and in nondiabetic men amputees 13 (6–22) and 24 (15–35). CONCLUSIONS—In the general population aged ≥45 years, the incidence of vascular LLA at or proximal to the transmetatarsal level is eight times higher in diabetic than in nondiabetic individuals. One in four amputees may require contralateral amputation and/or reamputation.

This study aimed to investigate if prolonged use of shoes incorporating an unstable sole construction could facilitate improvements of balance in a sample of developmentally disabled children. Ten children (six male and four female) aged between 10 and 17 years participated in the study. Children were fitted with shoes incorporating an unstable sole (Masai Barefoot Technology) and instructed to wear them for a minimum of two hours per day for eight weeks. A within subjects repeated measures design was used. Children were tested prior to receiving the shoes, four weeks after receiving the shoes and eight weeks after receiving the shoes. A force plate capable of rotating about a single axis (NeuroCom International Inc, Oregon) was used to test static balance, reactive balance and directional control. Static balance was not found to be influenced by prolonged use of the footwear; however, significant improvements were noted in children's reactive balance both with the shoes and barefoot. Results suggest that reactive balance can be improved by prolonged and regular use of shoes incorporating an unstable sole construction.

The use of vibration as a feedback modality to convey motion of the body has been shown to improve measures of postural stability in some groups of patients. Because individuals using transtibial prostheses lack sensation distal to the amputation, vibratory feedback could possibly be used to improve their postural stability. The current investigation provided transtibial prosthesis users (n = 24, mean age 48 yr) with vibratory feedback proportional to the signal received from force transducers located under the prosthetic foot. Postural stability was evaluated by measuring center of pressure (CoP) movement, limits of stability, and rhythmic weight shift while participants stood on a force platform capable of rotations in the pitch plane (toes up/toes down). The results showed that the vibratory feedback increased the mediolateral displacement amplitude of CoP in standing balance and reduced the response time to rapid voluntary movements of the center of gravity. The results suggest that the use of vibratory feedback in an experimental setting leads to improvements in fast open-loop mechanisms of postural control in transtibial prosthesis users.