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Aims This research investigated the relationships between self-efficacy and social support among users of prostheses post-lower limb amputation. Understanding these relationships is crucial for comprehending how individuals adapt to life post-amputation and how their perceived capabilities and social interactions influence their rehabilitation and overall well-being. Instrument & Methods This descriptive correlational study was conducted in Baghdad City at the Rusafa Health Department from October 1, 2023, to March 24, 2024. The study sample comprised 200 patients selected through the non-probability sampling method. The used questionnaire was validated by experts, and its reliability was confirmed through a pilot study. Data were gathered through interviews and analyzed using descriptive and inferential statistics. Findings A notable percentage of lower limb amputees utilizing prostheses exhibited low self-efficacy (60%) and moderate social support (40.5%). Furthermore, a positive correlation was observed between social support and self-efficacy, particularly in managing fatigue (r=0.133), coping with pain (r=0.198), handling emotional distress (r=0.172), addressing other symptoms (r=0.180) and health issues, and overall self-efficacy (r=0.173). Conclusion Interventions focused on enhancing social support networks significantly enhance self-efficacy and overall well-being in this demographic, ultimately fostering improved adjustment and quality of life post-amputation. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTo evaluate client satisfaction with prosthetic and orthotic services in Sweden, determine if satisfaction differs between clients using different devices and identify factors which influence client satisfaction.A cross-sectional design was used to survey 7318 clients. The survey included items related to demographics, quality of life, device comfort, device use, the extent to which clients’ needs were met and satisfaction with services. Ethics approval was provided by the Swedish Ethical Review Authority.A total of 2925 surveys were returned reflecting a response rate of 41%. Mean OPUS-CSS point score was 61.9(SD 16.8) with differences observed between device categories (p < 0.001). Factors that were identified as most positively influencing client satisfaction were, being a limb prosthesis user and being under 65 years. When analysing scores for individual OPUS items breast prosthesis users scored higher than users of other devices. Clients were most satisfied with the level of respect they were shown by staff (mean = 2.72/3) and less satisfied with coordination of services with other therapists/doctors(mean = 1.88/3).Prosthetic and orthotic users are reasonably satisfied with the services they receive. Attention should be directed towards understanding why prosthetic users are more satisfied than orthotic users and why clients under 65 years report higher satisfaction scores.Prosthetic and orthotic clients are generally satisfied with prosthetic and orthotic service delivery.Users of prosthetic limbs are more satisfied than orthosis users.Quality improvement initiatives should prioritise clinicians’ clinical communication skills.Issues related to coordination of treatment within multidisciplinary teams need to be addressed.Prosthetic and orthotic clients are generally satisfied with prosthetic and orthotic service delivery.Users of prosthetic limbs are more satisfied than orthosis users.Quality improvement initiatives should prioritise clinicians’ clinical communication skills.Issues related to coordination of treatment within multidisciplinary teams need to be addressed. [ABSTRACT FROM AUTHOR]

Many transtibial amputees rate the fit between their residual limb and prosthetic socket as the most critical factor in satisfaction with using their prosthesis. This study aims to address the issue of prosthetic socket fit by reconfiguring the socket shape at the interface of the residual limb and socket. The proposed reconfigurable socket shifts pressure from sensitive areas and compensates for residual limb volume fluctuations, the most important factors in determining a good socket fit. Computed tomography scan images are employed to create the phantom limb of an amputee and to manufacture the reconfigurable socket. The performance of the reconfigurable socket was evaluated both experimentally and numerically using finite element modelling. The study showed that the reconfigurable socket can reduce interface pressure at targeted areas by up to 61%. [ABSTRACT FROM AUTHOR]

In the quest to advance the material science underpinning prosthetic limb technology, this study explores the mechanical fortification of unsaturated polyester-based composites via the incorporation of unidirectional carbon fibers and micro-scale copper oxide (CuO) particulates. The mechanical attributes scrutinized include hardness, impact resistance, compressive and tensile strengths, and flexural robustness. The fabrication process entailed manual molding techniques to yield homogenized composite samples. It was observed that the integration of carbon fibers markedly augmented the composite's mechanical performance. Specifically, the carbon fiber-reinforced specimens demonstrated a maximum hardness of 85.4 N/mm², an impact strength cresting at 6.27 KJ/m², a compressive strength peaking at 24.5 MPa, a tensile strength apex of 20 MPa, and a superior bending strength of 39.09 MPa. Conversely, the incorporation of CuO particles yielded mixed outcomes. While there was a notable increment in hardness strength to 83.5 N/mm² and a modest rise in impact strength to 0.70 KJ/m², a diminution was witnessed in compressive, tensile, and bending strengths, which dwindled to 8.33 MPa, 5.07 MPa, and 9.54 MPa, respectively. The findings underscore the efficacy of carbon fiber reinforcements in significantly bolstering the structural integrity of composite materials destined for prosthetic applications, outperforming the enhancements provided by CuO particles. This research underscores the potential for carbon fiber to act as a pivotal reinforcement agent in the development of high-performance prosthetic limbs, providing a robust framework for future material innovation. The study's implications extend to the design of lightweight, durable prosthetic components that can endure the multifaceted demands placed on them during use. Future investigations could pivot towards optimizing fiber-matrix interfaces and exploring hybrid reinforcement strategies to further push the boundaries of prosthetic material capabilities. [ABSTRACT FROM AUTHOR]

People with lower limb amputations struggle through difficulties during locomotion in their daily activities. People with transtibial amputations take support from prosthetic legs for systematic movement. During motion, they experience some mobility issues while using general prosthetic limbs regarding gait pattern. The design of a prosthetic-controlled lower limb with gait synchronization for physically disabled persons is the main goal of the present research work, which can provide an improved walking experience. The design and performance analysis of prosthetic lower limbs for people with transtibial amputations is performed in the present paper. The designed rehabilitation system shows synchronization between the normal and the prosthetic limbs achieved with gait coordination. The dynamics of the lower extremities in different postural activities are used for design purpose utilizing Euler–Lagrange motion theory. The artificial motion of the knee and the ankle joints function through the angular movement of the servo motors according to the movements of the rotary encoders placed on the sound limb joints. The range of motion of both the sound and prosthetic limbs are compared for different steps during a gait cycle. The prosthetic electronic system design of the artificial lower limb is able to show the gait style of human being with body kinesics. The nonlinear domain stability analysis of the designed prosthetic limb is presented through the Lyapunov method. A PIDF2 controller tuning process is implemented for the designed limb’s performance improvement. The designed prosthetic system is beneficial for people with unilateral transtibial amputations with a great societal impact.

The elbow position and movement (PM) feedback can help amputees control the prosthetic limbs more flexibly. This study attempts to explore whether electrotactile stimulation can help amputees identify the elbow PM information of prosthesis, due to valuable potential of electrotactile stimulation. This study designed an encoding scheme by relating the elbow PM information with amplitudes, and it tested the scheme on four able-bodied subjects and two transhumeral amputees. After two stimulation positions on the upper limb were determined using sensory sensitivity experiment, four sets of amplitudes (A m , A n) were encoded four positions of prosthetic elbow (0°, 45°, 90°, and 135°) and changes in sets of amplitudes were encoded flexion and extension (FE) movements of prosthetic elbow. All subjects were required to identify the prosthetic elbow PM during the experiment, and the success rate and discrimination reaction time were recorded. The average success rates of the position and movement experiments among the four subjects were 76.25% and 91.17% respectively. For the two transhumeral amputees, the position feedback success rates were 86.38% and 75%, respectively, and the movement feedback success rates were 80.5% and 75%, respectively. These results indicate that subjects can learn the mapping relationship of this sensory feedback after training. This method potentially in future provides amputees with PM sensory information of elbow FE during the actual control of prosthetic elbows. [ABSTRACT FROM AUTHOR]

People with lower limb amputations struggle through difficulties during locomotion in their daily activities. People with transtibial amputations take support from prosthetic legs for systematic movement. During motion, they experience some mobility issues while using general prosthetic limbs regarding gait pattern. The design of a prosthetic-controlled lower limb with gait synchronization for physically disabled persons is the main goal of the present research work, which can provide an improved walking experience. The design and performance analysis of prosthetic lower limbs for people with transtibial amputations is performed in the present paper. The designed rehabilitation system shows synchronization between the normal and the prosthetic limbs achieved with gait coordination. The dynamics of the lower extremities in different postural activities are used for design purpose utilizing Euler–Lagrange motion theory. The artificial motion of the knee and the ankle joints function through the angular movement of the servo motors according to the movements of the rotary encoders placed on the sound limb joints. The range of motion of both the sound and prosthetic limbs are compared for different steps during a gait cycle. The prosthetic electronic system design of the artificial lower limb is able to show the gait style of human being with body kinesics. The nonlinear domain stability analysis of the designed prosthetic limb is presented through the Lyapunov method. A PIDF2 controller tuning process is implemented for the designed limb's performance improvement. The designed prosthetic system is beneficial for people with unilateral transtibial amputations with a great societal impact. [ABSTRACT FROM AUTHOR]

Upper limb amputation can result in significant functional impairment necessitating a comprehensive rehabilitation approach throughout the continuum of care. In 2022, the Departments of Veteran Affairs and Defense completed an updated clinical practice guideline for the management of upper limb amputation rehabilitation. This practice guideline was developed by a workgroup of subject-matter experts from a variety of disciplines. Twelve key questions were developed by the workgroup using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) format to establish the scope of the literature review. Eighteen recommendations were developed through extensive review of the available literature and use of the Grading of Recommendations, Assessment, Development and Evaluation criteria. The strength of each recommendation was determined based on the quality of the research evidence and the additional domains of the Grading of Recommendations, Assessment, Development and Evaluation criteria. Of the 18 recommendations, 4 were found to have sufficient evidence to suggest for use of a particular rehabilitation management strategy. Thus, the 2022 Department of Veteran Affairs and Department of Defense clinical practice guideline provides updated, evidence-based information on the care and rehabilitation of persons with upper limb amputation. However, a significant lack of high-quality evidence in upper limb amputation rehabilitation limited evidence-based clinical guidance to assist healthcare providers in managing this population. [ABSTRACT FROM AUTHOR]

The generation of an internal body model and its continuous update is essential in sensorimotor control. Although known to rely on proprioceptive sensory feedback, the underlying mechanism that transforms this sensory feedback into a dynamic body percept remains poorly understood. However, advances in the development of genetic tools for proprioceptive circuit elements, including the sensory receptors, are beginning to offer new and unprecedented leverage to dissect the central pathways responsible for proprioceptive encoding. Simultaneously, new data derived through emerging bionic neural machine–interface technologies reveal clues regarding the relative importance of kinesthetic sensory feedback and insights into the functional proprioceptive substrates that underlie natural motor behaviors. [ABSTRACT FROM AUTHOR]

Due to the recent development of additive manufacturing technologies, it is now possible to achieve rapid fabrication of fully functional customized products with high geometric complexity and without the constraints of traditional manufacturing techniques, such as machining. In the current paper, a lower prosthetic limb with the knee joint was designed according to the international standards and the recommendations from existing literature. Finite element analyses were performed to investigate the mechanical behavior of the prosthetic limb and detect the stress concentration regions under realistic operation conditions. For this analysis, Nickel alloy 718 was employed as a construction material. The applied loads were derived for a human body weight of 75kg after an extensive literature review. Then, design optimization was applied, employing design for additive manufacturing (DfAM) techniques in order to minimize the number of assembly parts and improve the shape of the object. Moreover, topology optimization processes were performed in order to develop a lightweight prosthetic limb and achieve a mass reduction of 67% compared to the original design. It is worth mentioning that, this remarkable weight reduction was attained without compromising the structural integrity of the part, as the factor of safety was calculated at 1.22. [ABSTRACT FROM AUTHOR]

Walking behaviour in amputees with lower-limb loss is absent from shock-absorbing properties. A damper can be used to reduce the impact of ground reaction force (GRF) during heel strikes. Magnetorheological fluid (MRF) damper is deemed the best option for this application as it includes the advantages of both passive and active dampers. An enhanced MRF damper is essential in supplying the appropriate current and damping force levels. Therefore, an energy-efficient design is required to prolong the battery life used by MRF dampers in prosthetic limbs. This paper investigates two fluids of different properties and magnetic particle volume content. A bypass damper was used to observe the response of both fluids. The findings highlighted that an MRF with a higher percentage of solid weight could produce a more significant damping force with a lesser amount of applied current. This work presents a simulation study on implementing the energy-efficient MRF damper utilizing a Fuzzy-PID controller in a prosthetic limb.

Introduction: This study aimed to quantify the relationship between prosthetic users' emotional response to prosthesis aesthetics and specific product properties. Methods: Words representing prosthesis users' emotional response (Kansei) to different aesthetic designs of prostheses were identified via interviews and mood boards. A group of experts consolidated the words into thematic groups, each represented by a single, high-level 'Kansei' word. 53 lower limb prosthesis users completed a questionnaire, rating their perception of 13 aesthetic designs using the 'Kansei' words. Quantification Theory Type 1 was applied to explore the relationship between words and product properties. Sub-analyses assessed for differences based on sex, age and level of extroversion. Results: 5 high-level Kansei words were identified ('Natural', 'Technological', 'Cool', 'Unique' and 'Functional'). The Kansei word 'Natural' had a strong association with realistic looking prostheses while the words 'Technological', 'Cool' and 'Unique' were strongly associated with expressive designs which incorporate hard, colourful covers. The word 'Functional' was not a reliable predictor of product properties. No major differences were observed within sub-grouped categories. Conclusion: Kansei words identified in this study can be used to help guide clients in their aesthetic design choices and to assist designers in achieving the desired response from their products., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: In-kind funding for this project was provided by TeamOlmed, Aktivortopedteknik and UNYQ. Representatives of these companies were not involved in data collection, analysis or writing of the manuscript. None of the authors are employed or receive financial benefits from any of these companies., (© The Author(s) 2024.)

This paper presents an approach for designing a prosthetic limb using SolidWorks. The process of stereolithography helped manufacture the prosthetic limb due to the flexibility in the provided parameters. The designed leg weighs 4kg approx. The entire weight acts on the sole of the leg. The sole again underwent a SolidWorks simulation with the application of a 1200N load. The preferred material - TPU - was selected after considering all the factors. The manuscript proceeds with a financial analysis to get a price estimate for the manufacturing of each part of the limb, which is a crucial factor.

People who have lost their limbs to amputation and neurological disorders confront this loss every morning. As per the literature review, nearly 30% of the Indian population suffered from upper extremity amputation. As a coping-up measure, a force-controlled prosthetic limb has been developed to improve their self-reliance, quality of lifestyle and mental strength. The current prosthetic limb operation is done by residual muscle contraction, which contributes to the activation of the sensor and the motor. But there are some cons, the amputee does not know how much pressure needs to be exerted for holding various objects. Also, the amputee still has to undergo the surgical procedure. However, this paper proposes a way to predict the force which is needed to regulate the voltage for the servomotors using different Machine Learning (ML) regression approaches. Support Vector Regressor (SVR), Linear Regression and Random Forest models have been used to predict that force requirement. After comparing the results, the Random Forest model gave a highly accurate prediction of the force needed to control the voltage for the DC servomotors [ABSTRACT FROM AUTHOR]

Functional, comfortable prosthetic limbs depend on personalised sockets, currently designed using an iterative, expert-led process, which can be expensive and inconvenient. Computer-aided design and manufacturing (CAD/CAM) offers enhanced repeatability, but far more use could be made from clinicians’ extensive digital design records. Knowledge-based socket design using smart templates could collate successful design features and tailor them to a new patient. Based on 67 residual limb scans and corresponding sockets, this paper develops a method of objectively analysing personalised design approaches by expert prosthetists, using machine learning: principal component analysis (PCA) to extract key categories in anatomic and surgical variation, and k-means clustering to identify local ‘rectification’ design features. Rectification patterns representing Total Surface Bearing and Patella Tendon Bearing design philosophies are identified automatically by PCA, which reveals trends in socket design choice for different limb shapes that match clinical guidelines. Expert design practice is quantified by measuring the size of local rectifications identified by k-means clustering. Implementing smart templates based on these trends requires clinical assessment by prosthetists and does not substitute training. This study provides methods for population-based socket design analysis, and example data, which will support developments in CAD/CAM clinical practice and accuracy of biomechanics research.

This comment addresses the incomplete presentation and incorrect conclusion offered in the recent manuscript of Beck et al. (R. Soc. Open Sci. 9, 211799 (doi:10.1098/rsos.211799)). The manuscript introduces biomechanical and performance data on the fastest-ever, bilateral amputee 400 m runner. Using an advantage standard of not faster than the fastest non-amputee runner ever (i.e. performance superior to that of the intact-limb world record-holder), the Beck et al. manuscript concludes that sprint running performance on bilateral, lower-limb prostheses is not unequivocally advantageous compared to the biological limb condition. The manuscript acknowledges the long-standing support of the authors for the numerous eligibility applications of the bilateral-amputee athlete. However, it does not acknowledge that the athlete's anatomically disproportionate prosthetic limb lengths (+15 cm versus the World Para Athletics maximum) are ineligible in both Olympic and Paralympic track competition due to their performance-enhancing properties. Also not acknowledged are the slower sprint performances of the bilateral-amputee athlete on limbs of shorter length that directly refute their manuscript's primary conclusion. Our contribution here provides essential background information and data not included in the Beck et al. manuscript that make the correct empirical conclusion clear: artificially long legs artificially enhance long sprint running performance.

BACKGROUND: The design, provision, and assessment of prosthetic arm technologies and related services are all dependent on an understanding of how prosthetic arms are used in everyday life. This research examines the scientific literature on prosthetic arm technologies and approaches that have been used to evaluate upper limb prosthetic arms in daily life use. OBJECTIVE: The purpose of this review paper is to give an outline of current literature, which covers the selection, design, and choices of prosthetic arm technologies. METHODS: A structural search for the available technologies on the prosthetic arm was carried out. A research database search was carried out in PubMed, Web of Science, Scopus, Crossref, Google Scholar, and questionnaires were evaluated based on available prosthetic arm technologies, material, methodology, comfortability. RESULTS: From the proposed review, it is concluded that not all prosthetic technologies suit the patients because of the difference in injuries. Every prosthetic arm technology has its advantages and limitations depending on end-user requirements and comfortability. Based on the available literature, it is observed that amputees have been given equal importance to comfortability along with functionality. Consequently, amputees may opt for a prosthetic arm technology that is easy to use and comfortable rather than an advanced technology-based prosthetic arm but less with comfortability. CONCLUSION: An attempt has been made for extensive reviews for the various types of prosthetic systems, materials, usability, methodologies, comfortability, etc. Comparative studies on various types of available prosthetic arm technologies have been also carried out with pros and cons. More specifically, the proposed paper provides a significant review of the upper limb prosthetic arm's current developments and their impacts. [ABSTRACT FROM AUTHOR]

BACKGROUND: Small residual limb-socket displacement is a good indicator of prosthetic suspension system quality. Active vacuum suspension systems can decrease vertical movement inside the socket, compared to non-active suction systems. This study mechanically evaluated limb-socket displacement with the Össur Unity active vacuum system. METHOD: Forty-eight conditions were evaluated: four cylindrical and four conical sockets (polypropylene, polyethylene terephthalate glycol-modified (PETG), thermoset resin (acrylic), Thermolyn soft materials); two Iceross Seal-In V liners (standard, high profile); three vacuum conditions (active vacuum, inactive vacuum, no suction with valve open). An Instron 4428 test machine applied 0-100N linear ramped tensile loads to each positive mold, with the socket secured in place, while displacement between the mold and socket was recorded. Following the displacement tests, the load before failure (i.e., 10 mm displacement) was measured. RESULTS: Average and standard deviations for movement between the mold and sockets were small. The displacement average for all conditions was 0.30±0.16mm for active vacuum, 0.32±0.16mm for inactive vacuum, and 0.39±0.22mm for no suction. Across all trials, active vacuum systems tolerated significantly (p

Study Design: Experimental study. Objectives: Research is lacking on the Unity suspension system's effect on gait performance. The purpose of this study was to evaluate the effects of the Unity elevated vacuum system on level walking performance while the vacuum was active (ON) and inactive (OFF). Methods: Twelve unilateral transtibial amputees were fit with the Ossur elevated vacuum suspension system (Unity) and Pro-flex XC foot. After one month accommodation period, 3D motion analysis was performed using the CAREN-Extended system. Temporal-spatial, kinematics, and kinetics were examined during level walking to understand the effect of the elevated vacuum, separate trials were completed with the vacuum active (ON) or inactive (OFF). Results: Significant differences were found between vacuum conditions (ON and OFF) for some temporal-spatial gait parameters, but differences were very small and may not be clinically significant. Differences between vacuum conditions on most kinetic and kinematic gait parameters were also low. However, step length symmetry between intact and prosthetic limbs improved with active elevated vacuum (ON). Conclusions: Elevated vacuum suspension's effect on level walking gait is small if a well-fitting liner-based socket is provided. Step length symmetry between intact and prosthetic limbs improved with an active vacuum system. Differences between vacuum conditions on most gait parameters were small during level walking. Subjective feedback showed improved proprioception and comfort with an active vacuum system. [ABSTRACT FROM AUTHOR]

Introduction: Military service members with limb loss have unrestricted access to physical therapy (PT) services. Identifying PT interventions used based on clinical rationale and patient needs/goals can provide insight towards developing best practice guidelines. The purpose of this study was to identify preferred PT practice patterns for military service members with lower limb loss.Materials and Methods: This was a retrospective cohort study and was approved by the Naval Health Research Center (NHRC) Institutional Review Board. Data for 495 service members with lower limb loss was analyzed. Frequency of PT visits and units of treatment received were quantified in 3-month increments during the first year after injury and compared for individuals with unilateral limb loss distal to the knee (DIST), unilateral limb loss proximal to the knee (PROX), and bilateral limb loss (BILAT).Results: A total of 86,145 encounters occurred during the first year after injury. Active treatments were included in 94.0% of all treatments, followed by manual therapy (15.1%), patient education (11.5%) and modalities (2.4%). The highest number of encounters, consisting of active and manual therapy, was received by the DIST group within the first 3 months, while after the first 3 months, the BILAT group had higher encounters and received more active and manual therapy. Utilization of patient education was higher in the PROX and BILAT groups compared to the DIST group throughout the first year after injury.Conclusions: Service members with limb loss utilize PT services often within the first year after injury. Trends of PT practice are most likely influenced by comorbidities and healing time variance between levels of amputation. [ABSTRACT FROM AUTHOR]

The damping characteristic of a healthy limb changes throughout the gait cycle. However, for amputees who are wearing mechanically passive damping prosthesis, the lack of ability to change the damping values might expose them to injuries and health problems. The use of magnetorheological fluid damper in prosthetic limb, which provides wide dynamic range, seems to be able to prevent these conditions from happening, due to its response to the magnetic field. The magnetorheological fluid, a type of smart material that is capable of altering its rheological property, changes its viscosity subjected to the intensity of the external magnetic field. Thus, due to this property, magnetorheological fluid damper covers the advantages of both passive and active dampers. This work explores the implementation of magnetorheological fluid damper in transtibial (below knee) prosthetic limb utilizing adaptive control techniques via simulation studies. An experimental study was done to observe the relationship of the force generated by the damper to the applied current. In addition, fuzzy-proportional–integral–derivative controller was implemented to ensure that the damper performs well, even at varying frequencies. [ABSTRACT FROM AUTHOR]

Background: People with lower limb amputation may experience walking limitations on slopes because of missing musculoskeletal and neuromuscular systems. Elevated vacuum suspension could benefit transtibial amputee gait for slope walking, but research is lacking to inform clinical practice.Methods: Twelve people with unilateral transtibial amputation were fitted with the Unity elevated vacuum suspension system (Össur) and Pro-Flex XC foot. 3D motion analysis was performed for 7° incline, 7° decline, and level walking within a CAREN-Extended system virtual Park environment. Randomized and blinded walking trials were completed with the vacuum active or inactive.Results: Statistically significant differences (p < 0.05) were found between vacuum conditions when walking uphill or downhill for temporal spatial, kinematic, and kinetic gait parameters; however, effect sizes were small (r≤0.35). Prosthetic step length decreased for both vacuum conditions on downhill compared to uphill walking. Symmetry index was <10% for step length, step time, and stance time for both vacuum condition during downhill walking, indicating acceptable symmetry. During incline walking, step length was only symmetrical with active vacuum. Knee range of motion was not restricted, for both conditions.Conclusion: Active vacuum improved gait symmetry for incline walking, but the other differences between vacuum conditions were small and may not be clinically significant. Therefore, the Unity system approach for elevated vacuum suspension had a positive, but small, effect on walking and should maintain appropriate walking even with vacuum failure, until limb volume changes adversely affect socket fit (i.e., elevated vacuum helps control limb volume fluctuations over time). [ABSTRACT FROM AUTHOR]

Introduction: Prosthetic socks are typically used to accommodate volume fluctuations throughout the day. Clinically, prosthetists often use sock ply thickness to assess the fit of a prosthetic socket and the amount of volume reduction necessary for the next socket iteration. This is done by using various sock plies to determine the proper socket fit. The amount of volume reduction needed for a specific sock ply fit is unclear. Objective: This preliminary study aimed to measure the relationship between sock ply and percentage of volume change. Methods: The Rodin4D scanner was used to scan three transtibial sample foam models. Each model had an appropriately sized liner, which was scanned as a baseline measurement. Each sock ply combination (one, two, three, five, one + one, one + two, two + three, two + one, and three + two) was scanned six times per model. Scan order was randomly assigned for each model. Results: Significant differences in volume change were found between one-ply (5.188%) and three-ply (10.42%) and five-ply (8.83%) socks, but not two-ply socks (7.15%). A significant volume increase was shown for the use of multiple socks (three + two ply, 18.33%, or two + three ply, 18.33%) compared with a single five-ply sock (8.83%). However, no significant differences were found in a similar comparison of a single three-ply sock (10.42%) versus the one + two–ply (11.68%) or two + one–ply (11.57%) socks. Conclusion: Our results showed that the use of multiple socks for the same ply, specifically the order of socks donned for the two + three ply and three + two ply, resulted in greater volume than a single sock of the same ply (i.e., five ply). The volumetric change for five-ply is significantly different from one-ply, but not from two-ply and three-ply socks. A limitation of this study was that the scans were completed on foam models with the point of measurement at the distal patella causing potential for the posterior wall to be outside of the socket. This may change on a human subject. The percentage of volume changes based on sock ply thickness that were determined from this study may be used as a starting point for prosthetists during modifications, but further research is needed to determine how this volume changes within the socket. [ABSTRACT FROM AUTHOR]

Purpose:To measure self-efficacy in a group of individuals who have undergone a lower-limb amputation and investigate the relationship between self-efficacy and prosthetic-specific outcomes including prosthetic use, mobility, amputation-related problems and global health. A second purpose was to examine if differences exist in outcomes based upon the type of prosthetic knee unit being used. Method:Cross-sectional study using the General Self-Efficacy (GSE) Scale and the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA). Forty-two individuals participated in the study. Twenty-three used a non-microprocessor-controlled prosthetic knee joint (non-MPK) and 19 used a microprocessor-controlled prosthetic knee joint (MPK). Results:The study sample had quite high GSE scores (32/40). GSE scores were significantly correlated to the Q-TFA prosthetic use, mobility and problem scores. High GSE scores were related to higher levels of prosthetic use, mobility, global scores and negatively related to problem score. No significant difference was observed between individuals using a non-MPK versus MPK joints. Conclusions:Individuals with high self-efficacy used their prosthesis to a higher degree and high self-efficacy was related to higher level of mobility, global scores and fewer problems related to the amputation in individuals who have undergone a lower-limb amputation and were using a non-MPK or MPK knee.Implications for rehabilitationPerceived self-efficacy has has been shown to be related to quality of life, prosthetic mobility and capability as well as social activities in daily life.Prosthetic rehabilitation is primary focusing on physical improvement rather than psychological interventions.More attention should be directed towards the relationship between self-efficacy and prosthetic related outcomes during prosthetic rehabilitation after a lower-limb amputation. [ABSTRACT FROM PUBLISHER]

Background Recent developments of prosthetic arm are based on the use of electromyography (EMG) signals. To provide improvements, such as coordinated movement of multiple joints and greater control intuitiveness, higher variability of EMG signals is needed. By splitting a nerve lengthwise, connecting each half to new target muscles, and employing a program to assign each biosignal pattern to a specific movement, we hope to enrich the number of biosignal sites on amputees' stump. Methods We split the gastrocnemius muscle of 12 Sprague-Dawley rats into two muscle heads, searched for the peroneal nerve, divided them lengthwise, and connected one half of the nerve to the tibial nerve innervating both muscle heads (SN_50, n = 8). In another group, we connected the undivided peroneal nerve to the nerve of a single muscle head (non-SN_100, n = 6), while the other muscle head received different innervation (non-SN_0, n = 6). After 10 weeks, we stimulated the peroneal nerve and measured the EMG amplitude. Results Mean EMG amplitude of the muscle head innervated by one half of the nerve (SN_50; 1.77 [range: 0.71-3.24] mV) and by the undivided nerve (non-SN_100; 3.45 mV [range: 1.13-5.34]) was not significantly different. However, the mean EMG amplitude produced by SN_50 was significantly different from that of the other innervation (i.e., non-SN_0; 0.76 mV [range: 0.41-1.35]), indicating the presence of noise. Conclusion Split nerve in combination with split-muscle procedure can yield a meaningful EMG signal that might be used to convey the intention of living organism to a machine. [ABSTRACT FROM AUTHOR]