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CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 4; doi:10.33137/cpoj.v4i1.35132

Abstract:
BACKGROUND: Balance impairment is a contributing factor to falls. Falls are a leading cause of injury and death in older adults. An ankle-foot orthosis (AFO) is a device that can be prescribed as an intervention to help individuals with compromised balance to ambulate safely. OBJECTIVE: The purpose of this review was to investigate the role ankle-foot orthoses have in affecting balance in community-dwelling older adults. METHODOLOGY: A scoping review was conducted searching MEDLINE, CINAHL, EMBASE, and REHABDATA databases to obtain the appropriate literature to meet the following criteria: 1) quantitative research design; 2) studies with participants over age 65; 3) studies with participants with drop-foot or sensory deficits in the lower extremity; 4) the treatment intervention was unilateral or bilateral AFOs; 5) the outcome measure was balance or stability. The retrieved articles were assessed based on the internal validity, external validity, objectivity, and reliability of the study design and the interpretation of results. FINDINGS: 11 articles were identified that met the inclusion criteria. Four major themes emerged in the analysis about the impact that ankle-foot orthoses have on balance in older adults: (1) AFOs improved lateral stability, (2) AFOs improved balance under static conditions, (3) AFOs provided a reduction in postural sway and (4) AFOs increased walking speed in community-dwelling older adults. CONCLUSIONS: The evidence from the findings of the review indicate that ankle-foot orthoses have a generally positive affect on balance in older adults. Clinicians can consider the ankle-foot orthosis an effective intervention that can improve balance in some older adult patient populations. Layman's Abstract Falls are a serious cause of injury and death in older adults over age 65. Poor balance can lead to an increased number of falls in the older population. The use of a brace, called an ankle-foot orthosis, can be prescribed to community living older adults to augment their balance. Ankle-foot orthoses can improve the stability and positioning of the ankle joint and foot to aid in balance during walking and standing, however ankle-foot orthoses have also been found to restrict natural movements and interrupt sensory feedback from the lower leg and foot. The purpose of this article was to investigate how the balance of older adults living in the community is impacted by wearing ankle-foot orthoses. Through conducting a database search to obtain appropriate literature on the topic, four trends were identified for how ankle-foot orthoses impact the balance of older adult wearers. Based on the findings of this review, ankle-foot orthoses were found to improve stability and standing balance, decrease bodily sway, and increase the walking speed of older adult wearers. These findings suggest that ankle-foot orthoses have a largely positive impact on the balance of older adults and can be considered to help improve balance in certain patient populations. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35132/27291 How To Cite: Laidler J.L. The impact of ankle-foot orthoses on balance in older adults: A scoping review. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.1. https://doi.org/10.33137/cpoj.v4i1.35132 Corresponding Author: Jenna LaidlerAging and Health Program, School of Rehabilitation Therapy,Queen’s University, Kingston, Canada.E-mail: [email protected]
, Mostafa Allami, Justin R. Murphy, ,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 4; doi:10.33137/cpoj.v4i1.35070

Abstract:
BACKGROUND: Interventions to resolve thermal discomfort as a common complaint in amputees are usually chosen based on the residual limb skin temperature while wearing prosthesis; whereas, less attention has been paid to residual limb skin temperature while outside of the prosthesis. The objective of this study was to explore the localized and regional skin temperature over the transtibial residual limb (TRL) while outside of the prosthesis. METHODOLOGY: Eight unilateral transtibial adults with traumatic amputation were enrolled in this cross-sectional study. Participants sat to remove their prostheses and rested for 30 minutes. Twelve sites were marked circumferentially in four columns (anterolateral, anteromedial, posteromedial, and posterolateral) and longitudinally in three rows (proximal, middle, and distal) over the residual limb and used for attachment of analog thermistors. Skin temperature was recorded and compared for 11 minutes. Furthermore, the relationship of skin temperature with participants’ demographic and clinical characteristics was explored. FINDINGS: The whole temperature of the TRL was 27.73 (SD=0.83)°C. There was a significant difference in skin temperature between anterior and posterior columns. Likewise, the distal row was significantly different from the proximal and middle rows. The mean temperature at the middle and distal zones of the anteromedial column had the highest and lowest skin temperatures (29.8 and 26.3°C, p0.05) with participants’ demographic and clinical characteristics. CONCLUSIONS: An unequal distribution of temperature over the TRL was found with significantly higher and lower temperatures at its anterior column and distal row, respectively. This temperature pattern should be considered for thermoregulation strategies. Further investigation of the residual limb temperature with and without prosthesis, while considering muscles thickness and blood perfusion rate is warranted. Layman's Abstract The socket is a plastic hard-shell interface between the residual limb, the remaining part of the amputated limb, and a prosthesis. Heat buildup inside the prosthetic socket and perspiration of the residual limb are major discomforts in amputees when wearing a prosthesis. The majority of prior research measured residual limb skin temperature while the prosthesis was worn. However, less attention has been paid to skin temperature without prostheses. Skin temperature of eight adults with one-sided traumatic below-knee amputation was measured. Participants sat and removed their prostheses. Twelve anatomical sites were marked circumferentially in four columns and longitudinally in three rows over the residual limb and used for temperature recording using temperature sensors. The whole temperature of the residual limb was 27.73 (SD=0.83)°C. Skin temperature was higher at anterior columns compared to posterior columns. Similarly, the distal row of the residual limb had the lowest temperature compared to its middle and proximal rows. From a localized standpoint, the middle part at the anterior medial surface of the residual limb had the highest temperature, whereas the distal part at the anterior-medial surface had the lowest skin temperature. There was no noticeable relationship between the average of the residual limb skin temperature and participants’ demographic and clinical characteristics. Some strategies need to be developed to regulate and control heat dissipation over the residual limb's surface when amputees do not wear prostheses. Further temperature recording research by considering muscle thickness and arterial blood flow rate of the residual limb with and without prosthesis is suggested. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35070/27313 How To Cite: Ghoseiri K, Allami M, Murphy J.R, Page P, Button D.C. Investigation of localized skin temperature distribution across the transtibial residual limb. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.2. https://doi.org/10.33137/cpoj.v4i1.35070 Corresponding Author: Duane C Button, PhDSchool of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada.E-mail: [email protected]: https://orcid.org/0000-0001-6402-8545
Joel Walker, W. Russ Marable, Christian Smith, Benedikt Þorri Sigurjónsson, Ingi Freyr Atlason,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 4; doi:10.33137/cpoj.v4i1.36065

Abstract:
BACKGROUND: Amputation at the transfemoral (TF) level reduces the rate of successful prosthetic fitting, functional outcome, and quality of life (QoL) compared with transtibial amputation. The TF socket interface is considered the most critical part of the prosthesis, but socket discomfort is still the most common user complaint. Direct Socket for transfemoral prosthesis users is a novel interface fabrication process where the socket is shaped and laminated directly on the residual limb and delivered in a single visit. OBJECTIVE(S): The aim of this study was to investigate if prosthetic users' quality of life (QoL), comfort, and mobility with a Direct Socket TF interface were comparable to their experience with their previous prostheses. METHODOLOGY: The pre/post design prospective cohort study included 47 subjects. From this cohort, 36 subjects completed the 6-months follow-up (mean age 58 years, 27 males). Outcomes at baseline included EQ-5D-5L®, PLUS-M™, CLASS, ABC, AMPPRO, and TUG. At 6-weeks and 6-months, subjects repeated all measures. Seven Certified Prosthetist (CP) investigators performed observations and data collection at six different sites (from July 2018 to April 2020). FINDINGS: Results showed significant improvement in all outcome measures for the 36 subjects that completed both 6-weeks and 6-months follow-ups. CLASS sub-scales showed significantly improved stability, suspension, comfort, and socket appearance. Improvement in K-Level and less use of assistive devices were observed with the AMPPRO instrument, indicating improved user mobility and performance. QoL was also increased, as measured in Quality-Adjusted-Life-Years (QALY) from the EQ-5D-5L. CONCLUSION: Evidence from the findings demonstrate that the Direct Socket TF system and procedure can be a good alternative to the traditional method of prosthetic interface delivery. Layman's Abstract After lower limb amputation, the goal for most people is to regain mobility and independence and return to normal daily activities. Typically, people with transfemoral amputation are less likely to receive a prosthesis or fully use a prosthesis as compared to people with transtibial amputation. Moreover, their quality of life is also lower. The Direct Socket TF method is a new way of fabricating a prosthetic socket for users with above-knee amputation, enabling fabrication directly onto the residual limb and delivery of the socket in a single visit. In this study, we wanted to understand how the effect of Direct Socket TF on prosthetic 'user's quality of life, health, mobility level, and balance would compare to their previous prosthesis. This new Direct Socket TF procedure was implemented in six different prosthetic clinics across the United States and used by 36 prosthetic users for six months. Our first article on this study describes increased user satisfaction with their new interface and the single visit service model. This second article on the same clinical investigation documents the significant improvement in outcomes compared to their original interface in terms of quality of life, confidence, mobility, comfort, stability, and activity level. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36065/27923 Direct Socket TF – Summary (YouTube): https://www.youtube.com/watch?v=-fvVFqjgxjo How To Cite: Walker J, Marable W.R, Smith C, Sigurjónsson B.Þ, Atlason I.F, Johannesson G.A. Clinical outcome of transfemoral direct socket interface (part 2). Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.6. https://doi.org/10.33137/cpoj.v4i1.36065 Corresponding Author: Anton Johannesson, PhDTeamOlmed, Kistagången 12, 164 40 Kista, Stockholm, Sweden.E-mail: [email protected]: https://orcid.org/0000-0001-8729-458X
Björn Altenburg, , Pawel Maciejasz, Thomas Schmalz, Frank Braatz, Henrik Gerke, Malte Bellmann
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 4; doi:10.33137/cpoj.v4i1.35206

Abstract:
BACKGROUND: Walking on cross-slopes is a common but challenging task for persons with lower limb amputation. The uneven ground and the resulting functional leg length discrepancy in this situation requires adaptability of both user and prosthesis. OBJECTIVE(S): This study investigated the effects of a novel prosthetic foot that offers adaptability on cross-slope surfaces, using instrumented gait analysis and patient-reported outcomes. Moreover, the results were compared with two common prosthetic feet. METHODOLOGY: Twelve individuals with unilateral transtibial amputation and ten able-bodied control subjects participated in this randomized cross-over study. Participants walked on level ground and ±10° inclined cross-slopes at a self-selected walking speed. There were three prosthetic foot interventions: Triton Side Flex (TSF), Triton LP and Pro-Flex LP. The accommodation time for each foot was at least 4 weeks. The main outcome measures were as follows: frontal plane adaptation of shoe and prosthetic foot keel, mediolateral course of the center of pressure, ground reaction force in vertical and mediolateral direction, external knee adduction moment, gait speed, stance phase duration, step length and step width. Patient-reported outcomes assessed were the Activities Specific Balanced Confidence (ABC) scale, Prosthetic Limb Users Survey of Mobility (PLUS M) and Activities of Daily Living Questionnaire (ADL-Q). FINDINGS: The TSF prosthetic foot adapted both faster and to a greater extent to the cross-slope conditions compared to the Triton LP and Pro-Flex LP. The graphs for the mediolateral center of pressure course and mediolateral ground reaction force showed a distinct grouping for level ground and ±10° cross-slopes, similar to control subjects. In the ADL-Q, participants reported a higher level of perceived safety and comfort when using the TSF on cross-slopes. Eight out of twelve participants preferred the TSF over the reference. CONCLUSION: The frontal plane adaptation characteristics of the TSF prosthetic foot appear to be beneficial to the user and thus may enhance locomotion on uneven ground – specifically on cross-slopes. Layman's Abstract Walking on cross-slopes is a common but challenging task for persons with lower limb amputation. The adaptability of prostheses is limited. Users alter gait strategies to cope with uneven ground. The prosthetic foot is a central component of a lower limb prosthesis. This study investigated if a novel prosthetic foot with greater adaptability is beneficial on cross-slopes. Twelve individuals with transtibial amputation (ITTAs) took part in the study. In addition, ten abled-bodied persons were measured as controls. The ITTAs were fitted with the novel foot and a reference foot. The accommodation time for each foot was four weeks at least. Afterwards gait data and patient-reported outcomes were assessed. The analyzed gait data showed clear differences in terrain compliance for the measured feet. The novel foot adapts both faster and to a greater extent to the cross-slope conditions. The self-reported outcome measures revealed better comfort and perceived safety when using the adaptive foot concept in comparison to the commercial reference. These results suggest that the adaptation characteristics of the novel foot concept are beneficial to the user. Thus, it may enhance locomotion on uneven ground such as cross-slopes. Article PDF Link: How To Cite: Altenburg B, Ernst M, Maciejasz P, Schmalz T, Braatz F, Gerke H, Bellmann M. Effects of a prosthetic foot with increased coronal adaptability on cross-slope walking. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.7. https://doi.org/10.33137/cpoj.v4i1.35206 Corresponding Author: Björn Altenburg,Research Biomechanics, Ottobock SE & Co. KGaA, Göttingen, Germany.E-Mail: [email protected] ID: https://orcid.org/0000-0002-3484-4346
, Seval Kutlutürk,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 4; doi:10.33137/cpoj.v4i1.35297

Abstract:
BACKGROUND: Clinical outcome assessments provide important input for the rehabilitation of individuals with transfemoral amputation. Differences in prosthetic knee designs may influence clinical outcomes. OBJECTIVE(S): The aim of this study was to compare functional mobility, balance, prosthetic satisfaction and quality of life in individuals with unilateral transfemoral amputation with microprocessor-controlled (MPK) and non-microprocessor knee designs (Non-MPK). METHODOLOGY: The study included ten experienced MPK (Rheo Knee) users (Group 1) and ten experienced Non-MPK (Total Knee® 2000) users (Group 2). For mobility; the 6 Minute Walk Test (6MWT), for balance; the Berg Balance Scale (BBS), Single Leg Stand Test (SLST) and Four Square Step Test (FSST), for quality of life; the Nottingham Health Profile (NHP) and for prosthetic satisfaction; the Satisfaction with Prosthesis Questionnaire (SATPRO) were administered. FINDINGS: 6MWT results of the MPK group were significantly higher than Non-MPK group (p 0.05) comparing balance, prosthesis satisfaction and quality of life values. CONCLUSION: The findings will inform about the patient’s prognosis and the expected clinical outcomes when prescribing an MPK or an Non-MPK. Individuals with unilateral transfemoral amputation covered longer distances using an MPK compared to Non-MPK. Layman's Abstract Individuals living with an amputation above the knee are limited in mobility which effects their quality of life. Specific prosthetic knee designs may have a long-term impact on the quality of life. This study showed that prosthetic users can walk further with the Rheo knee as compared to those who are using the Total Knee® 2000. However, both groups seemed to be equally happy with their quality of life, equally satisfied with their prosthesis, and their balance capabilities appeared to be similar. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35297/28053 How To Cite: Yazgan A, Kutlutürk S, Lechler K. Clinical outcomes comparing two prosthetic knee designs in individuals with unilateral transfemoral amputation in Turkey. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.8. https://doi.org/10.33137/cpoj.v4i1.35297 Corresponding Author: Ayse Yazgan,1) Össur Turkey Academy, Istanbul, Turkey; 2) İstanbul Medipol University Orthotics - Prosthetics Master of Science Program, Istanbul, Turkey.E-Mail: [email protected] ORCID ID: https://orcid.org/0000-0003-0744-503X
, , Ana Gallego, Piotr Laszczak, Jinghua Tang, Saeed Zahedi, David Moser
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 4; doi:10.33137/cpoj.v4i1.35213

Abstract:
BACKGROUND: Lab-based simulators can help to reduce variability in prosthetics research. However, they have not yet been used to investigate the effects of sweating at the residuum-liner interface. This work sought to create and validate a simulator to replicate the mechanics of residual limb perspiration. The developed apparatus was used to assess the effects of perspiration and different liner designs. METHODOLOGY: By scanning a cast, an artificial residuum was manufactured using a 3D-printed, transtibial bone model encased in silicone, moulded with pores. The pores allowed water to emit from the residuum surface, simulating sweating. Dry and sweating cyclic tests were performed by applying compressive and tensile loading, while measuring the displacement of the residuum relative to the socket. Tests were conducted using standard and perforated liners. FINDINGS: Although maximum displacement varied between test setups, its variance was low (coefficient of variation
, Theresa Repole, Emily Taussig, Stephanie Edwards, Jamie Misegades, Jorge Guerra, Amira Lisle
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 4; doi:10.33137/cpoj.v4i1.35098

Abstract:
BACKGROUND: Self-management is an integral component of managing long-term conditions and diseases. For a person with limb loss, this self-management process involves caring for the residual limb, the prosthesis, and the prosthetic socket-residual limb interface. Failure to properly self-manage can result in unwanted secondary complications such as skin breakdown, falls, or non-use of the prosthesis. However, there is little evidence on what self-management interventions are effective at preventing secondary complications. To understand the impact of self-management after the loss of a limb, it is necessary to determine what the current evidence base supports. OBJECTIVE(S): The purpose of this study is to examine the available literature on self-management interventions and/or outcomes for persons with limb loss and describe how it may impact residual limb health or prosthesis use. METHODOLOGY: A systematic review of multiple databases was carried out using a variety of search terms associated with self-management. The results were reviewed and selected based on the inclusion criteria: self-management interventions or direct outcomes related to self-management, which includes the skin integrity of the residual limb, problem-solving the fit of the prosthesis, and education in the prevention of secondary complications associated with prosthesis use. The Cincinnati Childrens’ LEGEND (Let Evidence Guide Every New Decision) appraisal forms were used to analyze the articles and assign grades. FINDINGS: Out of the 40 articles identified for possible inclusion in this study, 33 were excluded resulting in seven articles being selected for this review. Three out of the seven articles focused on silicone liner management while the other four articles focused on skin issues. CONCLUSION: Self-management for a person with limb loss is a key component of preventing complications associated with loss of limb and prosthesis use. There is a lack of high-quality experimental studies exploring the most appropriate intervention for teaching self-management when compared to other conditions, specifically diabetes. Further research in the area of self-management is necessary to understand how to best prevent unwanted secondary complications. Layman's Abstract Self-management is an integral component of managing long-term conditions and diseases. Self-management for a person with limb loss involves performing proper hygiene of the residual limb, caring for the prosthesis, and problem-solving the fit between the prosthetic socket and the residual limb. If a person with limb loss fails to correctly self-manage, they may be exposing themselves to the risk of skin breakdown or injury. Other medical diagnoses like diabetes emphasize self-management in the care of persons with the condition and have established a large body of knowledge surrounding this element of lifestyle adaption. However, in the case of limb loss, there is very little evidence to support how self-management is taught or performed. Therefore, the purpose of this study was to explore the body of literature surrounding self-management in persons with limb loss. The results indicate that there is very little evidence supporting self-management related interventions and that further research is required in this area. With the addition of further research, clinical practice can be improved and self-management interventions can become standardized across the spectrum of care, much like in diabetes care. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35098/27909 How To Cite: Lee DJ, Repole T, Taussig E, Edwards S, Misegades J, Guerra J, Lisle A. Self-management in persons with limb loss: A systematic review. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.5. https://doi.org/10.33137/cpoj.v4i1.35098 Corresponding Author: Daniel J. Lee, PT, PhD, DPT, GCS, COMTTouro College, Department of Physical Therapy, Bayshore, NY USA.Email:[email protected] ORCID: https://orcid.org/0000-0003-1805-2936
Megan Hamilton, Harry Sivasambu, ,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 4; doi:10.33137/cpoj.v4i1.36059

Abstract:
BACKGROUND: Pressure sensing at the body-device interface can help assess the quality of fit and function of assistive devices during physical activities and movement such as walking and running. However, the dynamic performance of various pressure sensor configurations is not well established. OBJECTIVE(S): Two common commercially available thin-film pressure sensors were tested to determine the effects of clinically relevant setup configurations focusing on loading areas, interfacing elements (i.e. ‘puck’) and calibration methods. METHODOLOGY: Testing was performed using a customized universal testing machine to simulate dynamic, mobility relevant loads at the body-device interface. Sensor performance was evaluated by analyzing accuracy and hysteresis. FINDINGS: The results suggest that sensor calibration method has a significant effect on sensor performance although the difference is mitigated by using an elastomeric loading puck. Both sensors exhibited similar performance during dynamic testing that agree with accuracy and hysteresis values reported by manufacturers and in previous studies assessing mainly static and quasi-static conditions. CONCLUSION: These findings suggest that sensor performance under mobility relevant conditions may be adequately represented via static and quasi-testing testing. This is important since static testing is much easier to apply and reduces the burden on users to verify dynamic performance of sensors prior to clinical application. The authors also recommend using a load puck for dynamic testing conditions to achieve optimal performance. Layman's Abstract Pressure sensors can be used in prosthetics to provide clinicians with data about how well a device fits and functions. However, pressure sensors are unproven when it comes to use during activities such as walking or running. This study tested two common pressure sensors in a setup that applied forces similar to walking. These findings indicate that sensor calibration affects sensor accuracy. Accuracy can be improved by applying a small puck to the sensor to spread the load more evenly. With the puck, the performance of the sensors was found to be acceptable for potential use in clinical applications. These findings also show that dynamic testing of pressure sensors may not be needed prior to clinical usage. Instead, performance can be based on static testing which is easier to do. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36059/27891 How To Cite: Hamilton M, Sivasambu H, Behdinan K, Andrysek J. Evaluating the dynamic performance of interfacial pressure sensors at a simulated body-device interface. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.4. https://doi.org/10.33137/cpoj.v4i1.36059 Corresponding Author: Jan Andrysek, PhD,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.Email: [email protected]: https://orcid.org/0000-0002-4976-1228
, Michelle G. Marquez, Matthew Kowgier
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 3; doi:10.33137/cpoj.v3i2.34471

Abstract:
BACKGROUND: Lower extremity amputation due to complications from peripheral vascular disease and/or diabetes are common and these patients often have multiple comorbidities. Patients with end-stage renal disease receiving hemodialysis (ESRD/HD) are a particularly vulnerable group at risk for amputation. After lower extremity amputation (LEA) surgery, many patients undergo post-operative inpatient rehabilitation to improve their pre-prosthetic functional independence. Given the increased complexity of dysvascular patients living with ESRD/HD compared to those without ESRD/HD, the association of HD with pre-prosthetic inpatient functional outcomes warrants further study. OBJECTIVE: The objective of this study was to compare the pre-prosthetic functional outcomes and Length of Stay (LOS) among patients with recent dysvascular LEA with and without ESRD/HD. METHODOLOGY: A retrospective cohort design was used to analyze a group of 167 patients with unilateral, dysvascular limb loss who were admitted to inpatient rehabilitation with 24 of these patients in the ESRD/HD group. Age, gender, amputation level, amputation side, length of stay (LOS), time since surgery, Functional Independence Measure (FIM) scores (admission and discharge), and Charlson Comorbidity Index (CCI) were collected. FINDINGS: There was no difference between patients with dysvascular amputation with and without ESRD/HD in the association of functional outcomes or LOS in this cohort and rehabilitation model. The CCI score was higher in the ESRD/HD group. Multivariate analysis indicated an inverse relationship with age and FIM scores, where increased age was associated with lower Total and Motor FIM at admission and discharge. There were no associations with FIM change. Age was positively associated with LOS. Being female was inversely associated to motor FIM scores at admission and discharge CONCLUSION: Among patients with recent dysvascular LEA, ESRD/HD is not associated with different functional outcomes or LOS in the pre-prosthetic inpatient rehabilitation setting. This suggests that despite added comorbidity that patients with ESRD/HD may still benefit from inpatient rehabilitation to optimize pre-prosthetic function. Layman's Abstract Lower extremity limb loss caused by blood vessel disease and/or diabetes is common. Patients who need amputation often have additional medical conditions that may impact their recovery after surgery. One such condition, is diabetes-related poor kidney function requiring hemodialysis. Patients who attend hemodialysis are particularly vulnerable to limb amputation. After amputation surgery many individuals undergo inpatient rehabilitation to improve self-care and mobility prior to discharge from hospital and before being considered for a prosthesis. In patients who are admitted to rehabilitation hospitals after amputation we understand very little about how the demands of hemodialysis may impact their rehabilitation and how long they stay in a rehabilitation hospital. The objective of this study was to compare patients with amputation due to blood vessel disease and/or diabetes with patients who also require hemodialysis. We studied their functional outcomes and inpatient rehabilitation length of stay in hospital. 167 patients with unilateral, limb loss who were admitted to an inpatient rehabilitation hospital were included in the analysis with 24 of these patients attending hemodialysis. Age, sex, amputation level, amputation side, length of stay, time since surgery, Functional Independence Measure scores (measure of a patient’s function) and Charlson Comorbidity Index (measure of multiple medical conditions) were collected. We concluded that in patients with recent limb amputation, hemodialysis was not related to different functional outcomes or time in hospital in the inpatient rehabilitation setting. This suggests that despite receiving hemodialysis, patients with recent limb loss may still benefit from inpatient rehabilitation before being considered for a prosthesis. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/34471/26580 How To Cite: Journeay W.S., Marquez M.G., Kowgier M. Hemodialysis is not associated with pre-prosthetic inpatient rehabilitation outcomes after dysvascular lower extremity amputation: a retrospective cohort study. Canadian Prosthetics & Orthotics Journal. 2020; Volume 3, Issue 2, No.2. https://doi.org/10.33137/cpoj.v3i2.34471 Corresponding Author: Dr. W. Shane Journeay, PhD, MD, MPH, FRCPC, BC-Occ MedProvidence Healthcare – Unity Health Toronto, 3276 St Clair Avenue East, Toronto ON M1L 1W1E-mail: [email protected]: https://orcid.org/0000-0001-6075-3176
, Barbara Silver-Thorn,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 3; doi:10.33137/cpoj.v3i2.34481

Abstract:
BACKGROUND: A number of individuals with unilateral transfemoral amputation (TFA) run in a prosthesis with an unlocked prosthetic knee, while others choose to run with a locked prosthetic knee to increase stability. Research regarding running with an unlocked knee (UK) versus a locked knee (LK), with respect to energy efficiency, is limited and might be enhanced by characterization of the impact of knee condition on kinematics. OBJECTIVE: To investigate the effect of an UK versus LK on hip kinematics, energy efficiency, and running speed. METHODOLOGY: Five male novice runners with unilateral TFA completed one three-minute self-selected running speed (SSRS) trial and three peak speed trials per knee condition. Hip kinematics, energy efficiency, and running speed were compared between conditions. FINDINGS: Four of the five subjects exhibited a fast walk, rather than a consistent run. Hip flexion increased for all subjects and hip abduction decreased for four subjects during swing phase for the UK condition. Hip kinematic asymmetry was reduced for the UK condition in the sagittal plane for four individuals; hip kinematic asymmetry was also reduced in the frontal plane for the UK condition for three of these individuals. Mean energy efficiency was better for the UK condition (UK: 0.282 mLO2/kg/m, LK: 0.328 mLO2/kg/m). Peak running speed did not differ significantly between knee conditions (UK: 1.47 m/s, LK:1.32 m/s). CONCLUSIONS: For novice recreational runners with unilateral transfemoral amputation, the UK condition resulted in improved energy efficiency and enhanced kinematic symmetry, despite comparable peak speed relative to the LK condition. Therefore the UK condition may be advantageous for mid-range distance running. Layman's Abstract Runners with above-knee amputation may run with a prosthetic leg. Some runners prefer to run with their prosthetic knee unlocked, able to flex and extend, while others prefer to run with the prosthetic knee locked. The purpose of this study was to determine the effects of unlocked and locked knee conditions on hip motion, energy efficiency, and running speed during attempted running. Five male novice runners with an amputation above the knee attempted running for three-minutes at a comfortable speed, followed by three fast walks/sprints with the prosthetic knee unlocked and then locked. Most of the novice runners exhibited more symmetric hip motion while fast walking/running with an unlocked prosthetic knee. All our subjects were more energy efficient or exerted less energy with the unlocked prosthetic knee. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/34481/26590 How To Cite: Blakeley N., Silver-Thorn B., Cross J.A. Investigation of the effects of prosthetic knee condition for individuals with transfemoral amputation during attempted running. Canadian Prosthetics & Orthotics Journal. 2020; Volume 3, Issue 2, No.3. https://doi.org/10.33137/cpoj.v3i2.34481 Corresponding Author:Natalie Blakeley, Department of Biomedical Engineering, Marquette University, Milwaukee, USA. E-mail: [email protected]: https://orcid.org/0000-0002-2066-4096
W. Russ Marable, Christian Smith, Benedikt Þorri Sigurjónsson, Ingi Freyr Atlason,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 3; doi:10.33137/cpoj.v3i2.34672

Abstract:
BACKGROUND: Direct Socket for transfemoral (DS-TF) prosthetic user is a novel method of fabricating a laminated interface on to the residual limb but requires different training, production method and service model than what most prosthetists are familiar with. This method and model may improve patient satisfaction by enabling interface fabrication and delivery in one visit. OBJECTIVES: Document patient satisfaction regarding DS-TF interface versus the prosthetic users’ previous socket in terms of interface function and the clinic service model. METHODOLOGY: In this longitudinal study (from July 2018 to April 2020), the DS-TF was implemented in six prosthetic clinics across the United States. Certified prosthetists (CP) and assistants were trained using a standard protocol. 47 prosthetic users participated, both those in need of a new socket and those without need. Two modules from the Orthotics and Prosthetics Users’ Survey (OPUS), involving questions related to satisfaction with the Device and Services, was used to evaluate each DS-TF user outcome vs. baseline. The only part of the prosthesis that was replaced was the interface, except in 2 cases. FINDINGS: Each DS-TF interface was fabricated, fit and delivered in a single clinic visit. At 6-months follow-up, 38 users reported an average of 29.8% increase in satisfaction with their new interface compared with original, and a 14.8% increase in satisfaction with the services they received from the clinic in providing of the new prosthesis vs. their original prosthesis. The main outcome increases were between baseline (initial fitting) and 6-week follow-up and remained consistent after 6 months. This improvement was consistent irrespective if the user needed a new socket for clinical reasons or not. CONCLUSION: This study shows that after a standardized training and implementation, the DS-TF fabrication process including a new interface improves the user’s satisfaction with their prosthetic device and services. Layman's Abstract The connection between an amputee’s remaining limb and their prosthesis is called the interface and is the most critical part in a prosthetic system for the user satisfaction, comfort and mobility. Interfaces commonly consist of two parts; a flexible “liner” rolled onto the limb, which then goes into a hard socket custom-made by the prosthetist. The assembled interface then provides a secure connection between the users remaining limb and the prosthesis. Historically the prosthetist’s fabrication and fitting procedure required many hours of time and multiple visits to the prosthetic clinic before the interface was delivered to the user. Direct Socket for above knee prosthetic users is a new method of fabricating laminated sockets directly on the residual limb that enables fabrication and delivery in a single visit. However, Direct Socket require different training and methods than what most prosthetists are familiar with. This new procedure was implemented in six different prosthetic clinics across the United States. Seven CP’s were trained, each in their clinic and the method was tested on 38 users for a period of 6 months. The users filled in questionnaires about their experience and satisfaction using their existing socket, as well as their satisfaction of using their new socket. Overall, the Direct Socket prosthetic users reported after the 6-months follow-up significantly greater (29.8%) satisfaction with their new socket compared to their previous socket. They also reported 14.8% increase in satisfaction with the services they obtained from the clinic when receiving the new socket, compared to their satisfaction with receiving their original socket. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/34672/26933 How To Cite: Marable W.R, Smith C, Sigurjónsson B.Þ, Atlason I.F, Johannesson G.A. Transfemoral socket fabrication method using direct casting: outcomes regarding patient satisfaction with device and services. Canadian Prosthetics & Orthotics Journal. 2020;Volume 3, Issue 2, No.6. https://doi.org/10.33137/cpoj.v3i2.34672 Corresponding Author: G. Anton Johannesson, PhDTeamOlmed, Kistagången 12, 164 40 Kista, Stockholm, Sweden.E-mail: [email protected]: https://orcid.org/0000-0001-8729-458X
, Wei Hou, Laura Goyarts, James Galassi,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 3; doi:10.33137/cpoj.v3i2.34609

Abstract:
BACKGROUND: Individuals with transtibial amputation (TTA) typically walk with an asymmetrical gait pattern, which may predispose them to secondary complications and increase risk of fall. Gait asymmetry may be influenced by prosthesis mass. OBJECTIVE: To explore the effects of prosthesis mass on temporal and limb loading asymmetry in people with TTA following seven days of acclimation and community use. METHODS: Eight individuals with transtibial amputation participated. A counterbalanced repeated measures study, involving three sessions (each one week apart) was conducted, during which three load conditions were examined: no load, light load and heavy load. The light load and heavy load conditions were achieved by adding 30% and 50% of the mass difference between legs, at a proximal location on the prosthesis. Kinematic and ground reaction force data was captured while walking one week after the added mass. Symmetry indices between the prosthetic and intact side were computed for temporal (Stance and Swing time) and limb loading measures (vertical ground reaction force Peak and Impulse). FINDINGS: Following seven days of acclimation, no significant differences were observed between the three mass conditions (no load, light load and heavy load) for temporal (Stance time: p=0.61; Swing time: p=0.13) and limb loading asymmetry (vertical ground reaction force Peak: p=0.95; vertical ground reaction force Impulse: p=0.55). CONCLUSION: Prosthesis mass increase at a proximal location did not increase temporal and limb loading asymmetry during walking in individuals with TTA. Hence, mass increase subsequent to replacing proximally located prosthesis components may not increase gait asymmetry, thereby allowing more flexibility to the clinician for component selection. Layman's Abstract People with a below the knee amputation typically have an asymmetrical walking style, i.e., they spend more time and put more body weight on their non-amputated leg. This may result in development of knee or hip osteoarthritis of the non-amputated leg, over time. Further, an asymmetrical walking style may also predispose people to a greater number of falls. It is believed that the weight of a prosthesis may influence the walking asymmetry. It is, however, unclear if changing the weight of a prothesis during routine clinical visits (for example, switching or replacing prosthesis parts) would increase walking asymmetry. To explore this, eight individuals with a below the knee amputation had two different weights added to the top half of their prosthesis. After the addition of the weight, participants went home to use the device in their communities for seven days. Subsequently, they returned to the lab to record their walking. We observed that walking with the heavier prosthesis, using either load, did not increase the amount of time spent and body weight applied by our participants on their non-amputated side. Hence, adding mass to the top half of a prosthesis may not increase walking asymmetry. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/34609/26769 How To Cite: Seth M, Hou W, Goyarts L.R, Galassi J.P, Lamberg E.M. Effect of transtibial prosthesis mass on gait asymmetries. Canadian Prosthetics & Orthotics Journal. 2020;Volume 3, Issue 2, No.5. https://doi.org/10.33137/cpoj.v3i2.34609 Corresponding Author: Mayank Seth, PhDDelaware Limb Loss Studies Lab, University of Delaware, Newark, USA.E-mail: [email protected]: https://orcid.org/0000-0003-3526-7058
Hamid Bateni
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 3; doi:10.33137/cpoj.v3i2.33804

Abstract:
BACKGROUND: Falls can be detrimental to overall health and quality of life for lower extremity amputees. Most previous studies of postural steadiness focus on quantification of time series variables extracted from postural sway signals. While it has been suggested that frequency domain variables can provide more valuable information, few current studies have evaluated postural sway in amputees using frequency domain variables. OBJECTIVE: To determine time and frequency domain variables of postural sway among lower extremity amputees vs. healthy young and older adult controls. METHODOLOGY: Participants were assigned to 3 groups: lower extremity amputation (n=6), healthy young adults (n=10), and healthy older adults (n=10). Standing barefoot on a force platform, each individual completed 3 trials of each of 3 standing conditions: eyes open, eyes closed, and standing on a foam balance pad. Time and frequency domain variables of postural sway were computed and analyzed. RESULTS: Comparison of older adults, younger adults, and amputees on the three conditions of standing eyes open, eyes closed, and on foam revealed significant differences between groups. Mean mediolateral (ML) sway distance from the center of pressure (COP), total excursions and sway velocity was significantly higher for amputees and older adults when compared to young adults (p
, , Alison Stenson, Zoe Savage, David Moser, Saeed Zahedi
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 3; doi:10.33137/cpoj.v3i2.34610

Abstract:
BACKGROUND: Excessive sweating of the residual limb has a substantial effect on the daily activities of people with lower limb amputation. Prosthetic liners offer protection and comfort to sensitive areas but often exacerbate perspiration. They act as insulators, trapping sweat on the skin’s surface to the detriment of skin health. Recently, liners with perforations have been developed, allowing the moisture to escape. The goal of this study was to assess the impact of such liners. METHODS: A sample group of 13 patients with unilateral transtibial amputation, who wore a perforated liner (PL) as part of their current prescription, was compared to 20 control patients who wore non-perforated liners (NPL). During their routine appointments, they completed a survey of scientifically validated outcome measures relating to their limb health, pain and the impact on daily life over a 12-month period. RESULTS: Patients using the PL had healthier residual limbs, reporting higher scores on questions relating to limb health, experiencing fewer skin issues (p
Ihsan Balkaya, Eric Altschuler
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 3; doi:10.33137/cpoj.v3i1.34528

Abstract:
This professional opinion describes the use of an off the shelf knee orthotic to correct the gait and functional mobility of a patient with hemisensory loss including proprioception following a stroke and provides supporting video. Interestingly, this case corrects a human analogue of a functional deficit found experimentally in monkeys in the 19th century by Mott and Sherrington. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/34528/26530 Video 1 Link: https://online-publication.com/wp/wp-content/uploads/2020/07/VIDEO-1-CPOJ.mov Video 2 Link: https://online-publication.com/wp/wp-content/uploads/2020/07/VIDEO-2-CPOJ.mov How To Cite: Balkaya I, Altschuler E.L. Correcting sherrington’s gait dysfunction with an off the shelf knee orthotic. Canadian Prosthetics & Orthotics Journal. 2020;Volume3, Issue1, No.4. https://doi.org/10.33137/cpoj.v3i1.34528 Corresponding Author: Eric L Altschuler, MD, PhDMetropolitan Hospital,1901 First Avenue, New York, NY, 10029, USA.E-Mail: [email protected]: (212) 423-6448Fax: (212) 423-6326ORCID: https://orcid.org/0000-0002-3575-6954
Michelle G. Marquez, Matthew Kowgier,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 3; doi:10.33137/cpoj.v3i1.33916

Abstract:
BACKGROUND: Dysvascular amputations arising from peripheral vascular disease and/or diabetes are common. Patients who undergo amputation often have additional comorbidities that may impact their recovery after surgery. Many individuals undergo post-operative inpatient rehabilitation to improve their non-prosthetic functional independence. Thus far, our characterization of comorbidity in this population and how it is associated with non-prosthetic inpatient functional recovery remains relatively unexplored. OBJECTIVE: The objective of this study was to describe comorbidities, using the Charlson Comorbidity Index (CCI), and to examine associations between comorbidity and functional outcomes in a cohort of patients with dysvascular limb loss undergoing non-prosthetic inpatient rehabilitation. METHODOLOGY: A retrospective cohort design was used to analyze a group of 143 patients with unilateral, dysvascular limb loss who were admitted to inpatient rehabilitation. Age, sex, amputation level, amputation side, length of stay (LOS), time since surgery, Functional Independence Measure (FIM) scores (Total and Motor at admission and discharge), and CCI scores were collected. FINDINGS: The data showed that neither total or specific comorbidities were associated with functional outcomes or LOS in this cohort and rehabilitation model. Multivariate analysis demonstrated an inverse relationship with age and FIM scores, where increased age was associated with lower Total and Motor FIM at admission and discharge. Comorbidities were not associated with functional outcomes. Dementia was negatively associated with FIM scores, however this requires more study given the low number of patients with dementia in this cohort. CONCLUSION: These data suggest that regardless of burden of comorbidity or specific comorbidities that patients with dysvascular limb loss may derive similar functional benefit from post-operative non-prosthetic inpatient rehabilitation. Layman’s Lower extremity limb loss arising from peripheral vascular disease and/or diabetes is common. Patients who require amputation often have multiple medical conditions that may impact their recovery after surgery. Moreover, many individuals undergo inpatient rehabilitation after surgery to improve self-care and mobility before discharge from hospital. We understand very little about how multiple medical conditions in patients with recent limb loss who are admitted to rehabilitation hospitals are impacted. Specifically, whether individuals with multiple medical conditions have negative functional consequences and do they stay in a rehabilitation hospital for a longer period of time. The objective of this study was to describe the types of medical conditions that patients with recent limb loss have and to examine the relationship between these conditions with functional outcomes and length of stay in hospital while undergoing inpatient rehabilitation. 143 patients with unilateral, dysvascular limb loss who were admitted to an inpatient rehabilitation hospital were included in the analysis. Age, gender, amputation level, amputation side, length of stay, time since surgery, Functional Independence Measure scores (measure of a patient’s function) and Charlson Comorbidity Index (measure of multiple medical conditions) scores were collected. This study suggests that regardless of the burden of multiple medical conditions or specific medical problems, that patients with recent limb loss may derive similar benefit after surgery at an inpatient rehabilitation hospital prior to consideration for a prosthesis. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33916/26327 How To Cite: Marquez M.G., Kowgier M., Journeay W.S. Comorbidity and non-prosthetic inpatient rehabilitation outcomes after dysvascular lower extremity amputation. Canadian Prosthetics & Orthotics Journal. 2020;Volume3, Issue1, No.1. https://doi.org/ 10.33137/cpoj.v3i1.33916 Corresponding Author: Dr. W. Shane Journeay, PhD, MD, MPH, FRCPC, BC-Occ MedProvidence Healthcare – Unity Health Toronto, 3276 St Clair Avenue East, Toronto ON M1L 1W1E-mail: [email protected]: https://orcid.org/0000-0001-6075-3176
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 3; doi:10.33137/cpoj.v3i1.33640

Abstract:
BACKGROUND: Several reviews have been published regarding quality of life (QoL) and Health Status (HS) in persons with lower limb amputation (LLA). However, little has been discussed in the literature with respect to older populations (i.e. age>60 years) with trans-tibial amputation. Furthermore, the perceived satisfaction with prosthesis is another important aspect for consideration in the amputees’ life. OBJECTIVE: The purpose of this review was to evaluate the impact of trans-tibial amputation on the QoL, HS and prosthesis satisfaction, in order to determine the appropriate intervention to improve these aspects in older population of trans-tibial amputees (TTA). METHODS: Research articles, published between January 2000 to March 2019, were found using Scopus, PubMed and Google Scholar databases. The methodological quality of the selected articles was assessed using the Critical Review Form-Quantitative Studies checklist. RESULTS: Ten articles that met the inclusion criteria were selected. In these papers, we can summarize that people with trans-tibial amputation have a better QoL compared to those with above knee amputation. Moreover, physical functioning and mobility are the most influencing factors for QoL and HS in older people with lower limb amputation. Finally, the prosthesis weight reduction may improve satisfaction with the prosthetic limb. CONCLUSION: Efforts have to be made in order to improve mobility in older population with transtibial amputation for better QoL and HS. This can be accomplished by means of adequate rehabilitation, pain management and an accurate choice of appropriate prosthetic components. We observed that the quality of evidence in the literature available is inadequate and future research would benefit from more prospective observational cohort studies with appropriate inclusion criteria and larger sample sizes to better understand the QoL and HS in this population. Layman’s Few studies have deeply investigated the effect of aging on Quality of Life, perceived Health Status and satisfaction with the prosthesis on older trans-tibial amputees. This review focuses on these aspects, which can guide professionals on how to improve prosthetic and rehabilitative intervention in this particular amputees’ population. The results of this review indicate that the Quality of Life and Health Status seem to be influenced by adequate rehabilitation, pain management and an accurate choice of appropriate prosthetic components. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33640/26354 How To Cite: Brunelli S., Bonanni C., Foti C., Traballesi M. A literature review of the quality of life, health status and prosthesis satisfaction in older patients with a trans-tibial amputation. Canadian Prosthetics & Orthotics Journal. 2020;Volume3, Issue1, No.3. https://doi.org/10.33137/cpoj.v3i1.33640 Corresponding Author: Stefano Brunelli, MDSanta Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care, Rome, Italy.E-Mail: [email protected]: https://orcid.org/0000-0002-5986-1564
, Malte Bellmann, Siegmar Blumentritt
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 3; doi:10.33137/cpoj.v3i1.33768

Abstract:
BACKGROUND: An often assumed advantage of polycentric knee joints compared to monocentric ones is the improved ground clearance during swing phase due to the geometric shortening of the lower leg segment (LLS). OBJECTIVE: To investigate whether polycentric knee joints considerably improve ground clearance and to evaluate the influence of prosthetic alignment on the extent of ground clearance. METHODOLOGY: 11 polycentric and 2 monocentric knee joints were attached to a rigid, stationary testing device. Shortening of the LLS and the resulting ground clearance during knee flexion were measured. Prosthetic components were mounted at the same height and the anterior-posterior position was in accordance with the manufacturer's alignment recommendations. FINDINGS: Shortening of up to 14.7 (SD=0.0) mm at the instance of minimal ground clearance during swing phase was measured. One knee joint elongated by 4.4 (SD=0.0) mm. Measurements of the ground clearance demonstrated differences up to 25.4 (SD=0.0) mm. One monocentric knee joint provided more ground clearance when compared to 8 of the polycentric knee joints investigated. CONCLUSION: Only some polycentric knee joints shorten appreciably during swing phase. With an optimized prosthetic alignment and a well-designed swing phase control, a monocentric knee joint may generate greater ground clearance compared to a polycentric knee joint. LAYMAN’S ABSTRACT Tripping is a safety risk for amputees and it is mainly affected by ground clearance during swing phase. An often assumed advantage of polycentric knee joints compared to monocentric ones is the improved ground clearance during swing phase due to the geometric shortening of the lower leg segment (LLS). Based on this statement safety benefits for above knee-amputees due to reduced danger of stumbling are discussed commonly for the entire group of polycentric knee joints. We believe that this statement is not true for all polycentric knee joint designs. Therefore, we analyzed 11 polycentric and two monocentric knee joints in a rigid, stationary testing device with their individual prosthetic alignments according to the manufacturer’s alignment recommendations. Shortening of the LLS and the resulting ground clearance during knee flexion were measured. The results showed shortening effects of up to 15 mm. One knee joint elongated by 4 mm. One monocentric knee joint provided more ground clearance when compared to 8 of the polycentric knee joints investigated. We conclude, that only some polycentric knee joints shorten appreciably during swing phase. With an optimized prosthetic alignment a monocentric knee joint may generate greater ground clearance compared to a polycentric knee joint. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33768/26547 How To Cite: Köhler T.M, Bellmann M, Blumentritt S. Polycentric Exoprosthetic Knee Joints – Extent of Shortening during Swing Phase. Canadian Prosthetics & Orthotics Journal. 2020;Volume3, Issue1, No.5. https://doi.org/10.33137/cpoj.v3i1.33768 Corresponding Author: Thomas Maximilian Köhler, MScOttobock: Hermann-Rein-Straße 2a, 37075, Göttingen.E-mail: [email protected]: https://orcid.org/0000-0002-5063-121X
Alexander Jamieson, Laura Murray,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 3; doi:10.33137/cpoj.v3i1.33931

Abstract:
BACKGROUND: Interventions which have focused on improving the physical activity of individuals with lower limb amputation can be mostly categorized into behavioural-based and prosthetic-based interventions. The aim of this review was to assess the quality of these interventions, and to identify the key gaps in research in this field. METHODOLOGY: The databases of Scopus, Pubmed, Embase, Medline and Web of Science were searched between September and December of 2019 for articles relating to physical activity, amputees and interventions. Articles were assessed quantitively based on internal validity, external validity and intervention intensity. FINDINGS: Sixteen articles (5 behavioural, 11 prosthetic) were assessed. Both approaches had comparable methodological quality and mixed efficacy for producing a significant change in physical activity outcomes. Almost all interventions used a simplistic measurement of activity as their outcome. CONCLUSIONS: There is an insufficient amount of studies to assess the overall efficacy of behavioural interventions in regard to how they impact on physical activity behaviour. However, the increase of quality of the methodology in the more recent studies could indicate that future interventions will retain similar levels of quality. Prosthetic interventions have shown no major improvement in efficacy compared to similar reviews and may need to utilise more advanced prosthetic components to attain significant changes in physical activity. Activity outcomes should expand into more complex activity measurements to properly understand the physical activity profile of people with lower limb amputation. Layman’s The purpose of this review was to identify original research which tried to improve the physical activity behaviours of individuals with lower extremity amputation. Through multiple databases, the review article identified a mixture of 5 behavioural and 11 prosthetic-based interventions which aligned with the search criteria of the review. The behavioural-based interventions used behavioural change techniques controlled by healthcare professionals to try and promote a change in physical activity behaviours. The prosthetic-based interventions employed a prosthetic component, with the intention being that if the prosthetic component had superior design, the individual would feel more encouraged to be physically active. This review article concludes that, prosthetic interventions do not appear to have a consistent significant impact on the physical activity behaviours, and though behavioural interventions also had mixed efficacy, there were not enough interventions of their design to make a conclusive statement. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33931/26330 How To Cite: Jamieson A.G., Murray L., Buis A. The use of physical activity outcomes in rehabilitation interventions for lower limb amputees: A systematic review. Canadian Prosthetics & Orthotics Journal. 2020;Volume3, Issue1, No.2. https://doi.org/ 10.33137/cpoj.v3i1.33931 Corresponding Author: Dr. Arjan Buis,Department of Biomedical Engineering, University of Strathclyde, Wolfson Centre, 106 Rottenrow, Glasgow, G4 0NW, Scotland, UK.E-Mail: [email protected]: https://orcid.org/0000-0003-3947-293X
, Dave K. Saraswat, Graham McLeod, Albert Yeung, Danielle Jeong, Jack Lam
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 2; doi:10.33137/cpoj.v2i2.33489

Abstract:
The Canadian healthcare system serves as an example of equity and federal service to citizens across the world. However, it is not without its challenges. Prosthetic coverage across Canada is highly variable and largely unable to provide equal coverage for Canadian persons living with amputation. Many persons with limb loss are forced to rely upon personal resources, fundraising, or the charity of non-governmental organizations in order to meet this basic healthcare need. This disparity in the Canadian healthcare system is unusual and largely undescribed in the literature. We thus explore the nature of Canadian healthcare prosthetic coverage across Canada, investigating the variability in coverage, presence of prosthetic coverage policies, clarity of policy, eligibility criteria, and interval of prosthetic replacement. Our findings highlight potential areas for improvement within current Canadian healthcare policy. Article PDF Link: How to Cite: Howard C.W, Saraswat D.K, McLeod G, Yeung A, Jeong D, Lam J. Canada’s prosthetic coverage: a review of provincial prosthetic policy. Canadian Prosthetics & Orthotics Journal. 2019;Volume2, Issue2, No.4. https://doi.org/10.33137/cpoj.v2i2.33489 CORRESPONDING AUTHOR:Calvin W. Howard, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.Phone: +1 (587) 987-7723E-mail: [email protected]: https://orcid.org/0000-0001-5576-9608
, , Rasool Salekrostam
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 2; doi:10.33137/cpoj.v2i2.32941

Abstract:
BACKGROUND: Small residual limb-socket displacement is a good indicator of prosthetic suspensionsystem quality. Active vacuum suspension systems can decrease vertical movement inside the socket,compared to non-active suction systems. This study mechanically evaluated limb-socket displacementwith 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 vacuumconditions (active vacuum, inactive vacuum, no suction with valve open). An Instron 4428 test machineapplied 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, theload 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 forinactive vacuum, and 0.39±0.22mm for no suction. Across all trials, active vacuum systems toleratedsignificantly (p
Eva Pröbsting, Malte Bellmann, Thomas Schmalz,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 2; doi:10.33137/cpoj.v2i2.32955

Abstract:
STUDY DESIGN: Retrospective analysis BACKGROUND: The gait characteristics of transtibial amputees (TTs) have been described many times. In general, the literature reported nearly consistent results for the kinematic and kinetic parameters of the prosthetic side. However, the literature revealed inconsistent findings on kinetic parameters for determining the risk of developing knee osteoarthritis, such as the peak knee adduction moment, knee flexion moment and vertical ground reaction forces. OBJECTIVES: The objective of our study was to describe the sagittal kinetic and kinematic gait characteristics of the ankle and residual knee joint of the prosthetic limb and the knee loading parameters of the sound side of unilateral TTs. This specific consideration may contribute to resolving the controversy of these parameters in the literature. METHODS: We analysed our database containing gait analyses from 53 unilateral TTs and compared data to a control group (CG), also taken from our database. The sagittal kinetic and kinematic gait characteristics of the ankle and residual knee joint of the prosthetic limb, and selected knee loading parameters of the sound side (the peak knee adduction moment, knee flexion moment and vertical ground reaction forces) were evaluated. Beside these parameters we reported typical spatiotemporal gait parameters as gait velocity, step length, step length asymmetry, stance phase duration and asymmetry of stance phase duration. RESULTS: The TTs walked slower and more asymmetrically than the CG. The kinematic pattern of the prosthetic ankle differed from that found in the CG. The largest difference was observed for the range of motion of the plantarflexion at push-off, which was significantly reduced for the prosthetic foot. The residual knee joint was generally affected with respect to decreased moments and reduced knee flexion during stance phase. The peaks of the vertical ground reaction forces and knee adduction moments showed no differences between the sound side of amputees and the CG. The peak knee flexion moment at midstance was significantly reduced for the sound side of amputees in comparison with the CG. CONCLUSION: The biomechanical data measured for the prosthetic side in a cohort of 53 unilateral TT amputees conformed with the literature. The parameters determining the risk of developing knee osteoarthritis investigated in our retrospective analysis were not increased on the sound side in comparison with non-amputees. We deem it reasonable to assume that an appropriate prosthesis will reduce the likelihood of overloading the knee on the sound side during normal walking. LAYMAN’S The gait characteristics of a transtibial amputee (TT) with a prosthesis significantly deviate from normal gait patterns as shown in the literature. In general, the kinematic and kinetic parameters of the prosthetic side are described nearly consistently. However, literature revealed inconsistent results with respect to the sound...
Bengt Söderberg, , Teddy Fagerstrom, Kwannate Permpool, Sarawanee Phaipool
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 2; doi:10.33137/cpoj.v2i2.33505

Abstract:
BACKGROUND: Transtibial prosthesis socket trim lines have remained fairly consistent over the past decade, and based on methods such as a supracondylar cuff suspension. However, with vacuum suspension methods, trim lines can change. OBJECTIVE: An objective of this technical note was to inform practitioners how to fabricate a socket in a better way. A step-by-step fabrication guide is provided for the prosthetist. METHODS: A unilateral transtibial amputee was selected for this technical note. We provide a detailed description of the different steps of fabrication as well as patient feedback. The fabrication involved fabrication of a vacuum socket using Pre-preg carbon fiber and anti-bacterial Ethylene-Vinyl-Acetate (EVA), as a proximal flexible brim. FINDINGS: The properties of EVA and Pre-preg carbon fiber allow for fabrication of a transtibial socket with a flexible proximal brim. The new design resulted in greater comfort and increased range of motion in the patient studied. The patient subjectively noted enhanced squatting and cycling capabilities while using the updated socket and flexible proximal brim. CONCLUSION: This technical note presented a fabrication guide for a new style of socket and preliminary patient feedback. Clinical studies evaluating functional and biomechanical effects of this new socket design are needed. Layman’s The lower limb prosthetic socket is crucial for comfort and function of a lower limb amputee. A socket which is well-fitting and which adjusts to the user’s unique needs is an important shared goal for the prosthetist and user. Traditional types of prosthetic sockets might not always fit the needs of the user. Our patient desired a socket that would allow him to bend his knee in a greater range of motion than a traditional type of socket was permitting him to do. We provided a prosthetic socket which had a flexible top portion that could allow a greater range of motion and vacuum suction suspension with his limb. This socket combined a flexible type material with a specialty carbon fiber to meet the patient’s needs. These two technical improvements to his socket evidenced a reported increase in recreational activity of the patient. Future work can evaluate the underlying biomechanical mechanisms during walking and recreational activities for patients fit with our style of socket. This work could further our understanding of patient function in the studied prosthetic socket. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33505/25944 How to Cite: Söderberg B, Guerra G, Fagerstrom T, Permpool K, Phaipool S. The Söderberg socket 2.0: A technical note. Canadian Prosthetics & Orthotics Journal. 2019;Volume2, Issue2, No.3. https://doi.org/10.33137/cpoj.v2i2.33505 CORRESPONDING AUTHOR:Gary Guerra, Ph.D Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.Email: [email protected]: https://orcid.org/0000-0002-0161-4616
, , Piotr Laszczak, Beata Rek, Joe McCarthy, Saeed Zahedi, David Moser
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, Volume 2; doi:10.33137/cpoj.v2i2.33517

Abstract:
BACKGROUND: Lower limb amputees have a high incidence of comorbidities, such as osteoarthritis, which are believed to be caused by kinetic asymmetries. A lack of prosthetic adaptation to different terrains requires kinematic compensations, which may influence these asymmetries. METHOD: Six SIGAM grade E-F trans-tibial amputees (one bilateral) wore motion capture markers while standing on force plates, facing down a 5° slope. The participants were tested under three prosthetic conditions; a fixed attachment foot (FIX), a hydraulic ankle (HYD) and a microprocessor foot with a ‘standing support’ mode (MPF). The resultant ground reaction force (GRF) and support moment for prosthetic and sound limbs were chosen as outcome measures. These were compared between prosthetic conditions and to previously captured able-bodied control data. RESULTS: The distribution of GRF between sound and prosthetic limbs was not significantly affected by foot type. However, the MPF condition required fewer kinematic compensations, leading to a reduction in sound side support moment of 59% (p=0.001) and prosthetic side support moment of 43% (p=0.02) compared to FIX. For the bilateral participant, only the MPF positioned the GRF vector anterior to the knees, reducing the demand on the residual joints to maintain posture. CONCLUSION: For trans-tibial amputees, loading on lower limb joints is affected by prosthetic foot technology, due to the kinematic compensations required for slope adaptation. MPFs with ‘standing support’ might be considered reasonable and necessary for bilateral amputees, or amputees with stability problems due to the reduced biomechanical compensations evident. LAYMAN’S Lower limb prostheses work well on flat ground but often don’t adapt well to uneven ground or slopes. As a result, amputees tend to put more of their weight through their healthy leg. This can lead to problems like back pain and arthritis. In this study, the posture and weight distribution of below knee amputees were analysed while they stood facing down a slope. They did this with three different prosthetic feet; one with no ‘ankle’ joint, one with an ‘ankle’ (which could always move) and one with a computer-controlled ‘ankle’ (which could adapt to the slope but then resist movement when the wearer was stood still). Changing the prosthetic feet did not affect the amount of weight put through each limb, but when they had ‘ankle’ joints, the amputees were able to stand up straight, with a better posture. This meant that the demand on their joints was reduced, particularly on the healthy limb. One participant had below knee amputations on both legs. For this participant, only the computer-controlled device allowed her to stand up straight and well balanced. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33517/25933 How to Cite: McGrath M, Davies KC, Laszczak P, Rek B, McCarthy J, Zahedi S, Moser D. The influence of hydraulic ankles and microprocessor-control on the biomechanics of trans-tibial amputees during quiet standing on a 5° slope. Canadian Prosthetics & Orthotics Journal. 2019;Volume2, Issue2, No.2. https://doi.org/10.33137/cpoj.v2i2.33517 CORRESPONDING AUTHOR Dr. Michael McGrath,Research Scientist–Clinical EvidenceBlatchford Group, Unit D Antura, Bond Close, Basingstoke, RG24 8PZ, United KingdomEmail: [email protected]: https://orcid.org/0000-0003-0195-970X
, , Marco Iosa, Anna Sofia Delussu, Noemi Gentileschi, Cinzia Bonanni, Calogero Foti,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v2i1.32953

Abstract:
BACKGROUND: Physiological Cost Index (PCI) is a simple method used to estimate energy expenditure during walking. It is based on a ratio between heart rate and self-selected walking speed. Previous studies reported that PCI is reliable in individuals with lower limb amputation but only if there is an important walking impairment. No previous studies have investigated the correlation of PCI with the Energy Cost Walking (ECW) in active individuals with traumatic unilateral trans-tibial amputation, considering that this particular category of amputees has an ECW quite similar to healthy individual without lower limb amputation. Moreover, it is important to determine if PCI is also correlated to ECW in the treadmill test so as to have an alternative to over-ground test. OBJECTIVES: The aim of this study was to evaluate the correlation between PCI and ECW in active individuals with traumatic trans-tibial amputation in different walking conditions. The secondary aim was to evaluate if this correlation permits to determine ECW from PCI values. METHODOLOGY: Ninety traumatic amputees were enrolled. Metabolic data, heart rate and walking speed for the calculation of ECW and for PCI were computed over-ground and on a treadmill with 0% and 12% slopes during a 6-minute walking test. FINDINGS: There is a significant correlation between ECW and PCI walking over-ground (p=0.003; R2=0.10) and on treadmill with 12% slopes (p=0.001; R2=0.11) but there is only a poor to moderate correlation around the trendline. No significant correlation was found walking on treadmill with 0% slope. The Bland-Altman plot analysis suggests that is not possible to evaluate ECW directly from PCI. CONCLUSIONS: PCI is a reliable alternative measure of energy expenditure during walking in active individuals with trans-tibial amputation when performing over-ground or at high intensity effort on treadmill. PCI is therefore useful only for monitoring a within subject assessment. LAYMAN’S ABSTRACT The knowledge of the energy cost of walking in disabled people is important to improve strategies of rehabilitation or fitness training and to develop new prosthetic and orthotic components. The “gold standard” for the evaluation of the energy cost of walking is the oxygen consumption measurement with a metabolimeter, but the testing procedure is expensive and time consuming, hardly practicable in many rehabilitation centers. The Physiological Cost Index (PCI) is an indirect tool that evaluates the oxygen consumption during walking. PCI considers heart rate during walking, in relation to the speed, as an indicator of energy expenditure. The formula is “walking heart rate – resting heart rate /speed”. PCI is widely used in literature but there is not a solid evidence of a direct correlation between PCI and energy cost of walking. In particular, for individuals with unilateral trans-tibial amputation without comorbidities, no previous studies have been conducted about this correlation. It has to be noticed that individuals with unilateral trans-tibial amputation have an energy cost of walking quite similar to healthy people. Previous studies reported that in healthy people such correlation does not exist. For this reason, the aim of this study was to evaluate if and in which walking condition a linear correlation exists between PCI and Energy Cost Walking in individuals with unilateral trans-tibial amputation. Oxygen consumption measurement with a metabolimeter and PCI were computed over-ground and on a treadmill with 0% and 12% slopes during a 6-minute walking test in 90 participants. We have found that PCI is an alternative measure of energy cost of walking when performing over-ground or with high intensity effort on treadmill (12% slope). These findings could be useful when PCI is used for monitoring a fitness training or for evaluation tests. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32953/25717 How to Cite: Brunelli S, Sancesario A, Iosa M, Delussu A.S, Gentileschi N, Bonanni C, Foti C, Traballesi M. Which is the best way to perform the Physiological Cost Index in active individuals with unilateral trans-tibial amputation? Canadian Prosthetics & Orthotics Journal. Volume2, Issue1, No.5, 2019. https://doi.org/10.33137/cpoj.v2i1.32953. CORRESPONDING AUTHOR: Dr. Stefano Brunelli,Fondazione Santa Lucia, IRCCS, Via Ardeatina 306, 00179 Rome, Italy.ORCID: https://orcid.org/0000-0002-5986-1564Tel. +39 0651501844; Fax +39 0651501919E-MAIL: [email protected]
, Ramy Mansour, David Henderson Slater
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v2i1.33061

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BACKGROUND: Residual limb neuromas are a significant cause of post-amputation pain. There is little knowledge concerning ultrasound-guided (US) radiofrequency ablation (RFA) as treatment. OBJECTIVE: To investigate US-guided RFA for neuroma associated pain in individuals with limb amputation. METHODOLOGY: The notes of nine consecutive patients were retrospectively reviewed. Information obtained included neuroma size and nerve, RFA duration/temperature, pain scores, analgesic requirements and ease/comfort of prosthetic use. Eight patients had lower-limb amputations and one had a trans-radial amputation. All except one, underwent diagnostic US-guided steroid injection to confirm the neuroma as the source of pain, prior to RFA. RESULTS: Six patients reported significant reduction in pain scores (defined as at least 50% reduction) and an improvement in comfort/ease of wearing their prosthetic limb, with no adverse effects. Three of these six patients also reported a reduction in analgesic requirements. Of the three remaining patients – one had a large sciatic nerve neuroma that was eventually surgically excised, another had confounding pain from an adjacent bony spur, whilst the third patient did not receive a routine diagnostic steroid injection prior to RFA. CONCLUSIONS: Our findings suggest that US-guided RFA is safe and effective for small to medium-sized residual limb neuroma associated pain in individuals with limb amputation. It can reduce pain and analgesic requirements, improve comfort/ease of wearing the prosthesis and potentially avoid surgical excision. We recommend patients should undergo a diagnostic steroid injection prior to RFA to confirm that the neuroma is the source of pain. LAYMAN’S ABSTRACTAfter amputation, many patients can get a neuroma which can cause significant pain leading to discomfort wearing the prosthetic limb. Ultrasound-guided radiofrequency ablation can successfully treat painful residual limb neuromas in individuals with limb amputation which in turn can reduce the patient’s pain medications and improve the comfort of wearing the prosthetic limb. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33061/25509 How to Cite: Guo S, Mansour R, Henderson Slater D. Ultrasound-guided continuous radiofrequency ablation of painful residual limb neuroma in individuals with limb amputation- A retrospective case series. Canadian Prosthetics & Orthotics Journal. 2019; volume2, Issue1, No.4. https://doi.org/10.33137/cpoj.v2i1.33061 CORRESPONDING AUTHOR:Shigong Guo,LLM MSc(Orth Eng) MRCS, Specialty Registrar in Rehabilitation MedicineOxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK.Email: [email protected]
, Joseph McCarthy, Ana Gallego, Alan Kercher, Saeed Zahedi, David Moser
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v2i1.32723

Abstract:
CASE DESCRIPTION: Good residual limb skin health is vital to successful prosthetic prescription. Unnatural loading profiles and excessive sweating can lead to skin and soft tissue problems. Perforated liners allow the transport of moisture away from the skin and allow negative pressure (a condition that has been shown to aid wound healing) to act directly on the residuum surface. AIM: Assess the effects of perforated prosthetic liner use, particularly with respect to wound healing. METHOD: Three patient histories were retrospectively reviewed following prescription of perforated prosthetic liners due to excessive sweating or prolonged residual limb health concerns. Photographic records from patient files were used to document changes in residual limb condition. Patients also provided subjective feedback regarding their experiences. FINDINGS: Two cases described active amputees with persistent blistering irritated during exercise. Another case described a patient of low mobility level with a history of residual limb skin infections. All saw their conditions heal and reported a reduction in problematic sweating. Two patients reported cancelling surgical interventions after substantial improvements with the perforated liner. DISCUSSION: These findings provide evidence that the use of perforated prosthetic liners allow improvements in residual limb health, while still permitting prosthetic use. LAYMAN’S ABSTRACT For lower limb amputees, excessive sweating is a common issue affecting their quality of life. It is particularly problematic for the skin of the amputated limb, which may be scarred and is loaded unnaturally by the prosthetic socket. Silicone liners are often worn to provide a close fit and for cushioning but they create a warm environment that traps sweat against the skin, leading to bacterial growth. Additionally, sweat on the skin can increase the amount of movement between the amputated limb and the socket, affecting prosthetic control. In order to address this problem, silicone liners have been designed with perforations in them to allow warm air and sweat to move away from the skin. This report describes three cases of patients who suffered from long-standing wounds, blisters or skin infections on their amputated limbs. Each was prescribed with a perforated silicone liner and changes in their skin conditions were observed. In all cases, the wounds healed and each patient reported a noticeable reduction in problematic sweating on their residual limb, without limiting their prosthetic use. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32723/25281 How to Cite: McGrath M, McCarthy J, Gallego A, Kercher A, Zahedi S, Moser D. The influence of perforated prosthetic liners on residual limb wound healing: a case report. Canadian Prosthetics & Orthotics Journal. 2019; volume2, Issue1, No.3. https://doi.org/10.33137/cpoj.v2i1.32723 CORRESPONDING AUTHOR:Dr. Michael McGrath, Research Scientist–Clinical Evidence Blatchford Group, Unit D Antura, Bond Close, Basingstoke, RG24 8PZ, United Kingdom Email: [email protected]
, Aimee Lizcano, Silvia Ursula Raschke
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v2i1.31008

Abstract:
BACKGROUND: Rapid Prototyping is becoming an accessible manufacturing method but before clinical adoption can occur, the safety of treatments needs to be established. Previous studies have evaluated the static strength of traditional sockets using ultimate strength testing protocols outlined by the International Organization for Standardization (ISO). OBJECTIVE: To carry out a pilot test in which 3D printed sockets will be compared to traditionally fabricated sockets, by applying a static ultimate strength test. METHODOLOGY: 36 sockets were made from a mold of a transtibial socket shape,18 for cushion liners with a distal socket attachment block and 18 for locking liners with a distal 4-hole pattern. Of the 18 sockets, 6 were thermoplastic, 6 laminated composites & 6 3D printed Polylactic Acid. Sockets were aligned in standard bench alignment and placed in a testing jig that applied forces simulating individuals of different weight putting force through the socket both early and late in the stance phase. Ultimate strength tests were conducted in these conditions. If a setup passed the ultimate strength test, load was applied until failure. FINDINGS: All sockets made for cushion liners passed the strength tests, however failure levels and methods varied. For early stance, thermoplastic sockets yielded, laminated sockets cracked posteriorly, and 3D printed socket broke circumferen-tially. For late stance, 2/3 of the sockets failed at the pylon. Sockets made for locking liners passed the ultimate strength tests early in stance phase, however, none of the sockets passed for forces late in stance phase, all broke around the lock mechanism. CONCLUSION: Thermoplastic, laminated and 3D printed sockets made for cushion liners passed the ultimate strength test protocol outlined by the ISO for forces applied statically in gait. This provides initial evidence that 3D printed sockets are statically safe to use on patients and quantifies the static strength of laminated and thermoplastic sockets. However, all set-ups of sockets made for locking liners failed at terminal stance. While further work is needed, this suggests that the distal reinforcement for thermoplastic, laminated and 3D printed sockets with distal cylindrical locks may need to be reconsidered. LAYMAN’S ABSTRACT 3D printing is a new manufacturing method that could be used to make prosthetic sockets (the part of the prosthesis connected to the individual). However, very little is known about the strength of 3D printed sockets and if they are safe to use. As Prosthetists are responsible for providing patients with safe treatments, the strength of 3D printed sockets needs to be established before they can be used in clinical practice. The strength of sockets made using current manufacturing methods was compared to those made using 3D printing. Strength was tested using the static portion of the ISO standard most applicable for this situation which outlines the forces a socket must take at 2...
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v2i1.31950

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BACKGROUND: The majority of lower limb amputations (LLA) in Canada are dysvascular due to complications of diabetes and/or vascular disease. Traditionally dysvascular amputations have occurred in the elderly. With younger onset of adult diabetes, amputations are now occurring in non-geriatric populations. An understanding of younger patients with dysvascular LLA is needed to determine their risk factors, and unique health and psychosocial challenges. OBJECTIVES: To obtain a depiction of the key demographic and impairment characteristics of adults 65 years and younger with dysvascular LLA undergoing inpatient rehabilitation. METHODOLOGY: A retrospective chart review was completed on inpatient adult amputation rehabilitation patients over a five year period. Data extracted included socio-demographics, Functional Independence Measure (FIM) scores, co-morbidities, and discharge outcomes. FINDINGS: One hundred and forty-three patients who were 65 years and younger were included, which represented almost a quarter of all admissions. Most patients were male (79%) with an average age of 55 years old (SD=8). The majority (72%) were unemployed. The mean number of co-morbidities was 5.2 (SD=8.2). Individuals discharged home (n=122) had higher (p
Matthew Tomkin, , Emily Sinitski, Edward D Lemaire
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32003

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INTRODUCTION The Össur Pro-Flex is a 3-blade carbon fiber prosthetic foot designed to provide greater ankle range of motion compared to conventional energy storing and returning prosthetic feet1,2. To provide knowledge on Pro-Flex biomechanical performance, kinematic and kinetic gait parameters were evaluated and compared with the Össur Pro-Flex XC prosthetic foot. Outcomes from this study provide clinical professionals with important decision-making knowledge about two innovative energy storing and returning prosthetic feet. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32003/24424 How to cite: Tomkin M, Gholizadeh H, Sinitski E, Lemaire E.D. TRANSTIBIAL AMPUTEE GAIT WITH THE PRO-FLEX FOOT DURING LEVEL, DECLINE, AND INCLINE WALKING. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32003 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
Julie Burke, Goeran Fiedler
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32010

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INTRODUCTION The successful implementation of Evidence Based Practice (EBP) depends significantly on practitioners’ access to relevant research articles. It has been argued that the time consuming nature of EBP is a major detriment to its acceptance and widespread use,1 and the logistical difficulties, like having to retrieve research publications of interest from the local university library, are likely to exacerbate this issue. In recognizing the associated adverse effects that this problem could present for knowledge generation and dissemination, the idea to make all research findings publicly available online led to the conception of the world wide web in the early 1990s.2 However, many scientific journals that are slow to abandon their subscription-based business models hide their online content behind paywalls, charging article fees that are usually in the range between $20 and $40. Acknowledging the barriers to EBP that these fees can impose, we have previously compared different strategies for prosthetists and orthotists to maximize their free online access to relevant research literature. The respective data collection in the Spring of 2017 resulted in the finding that approximately 40% of search results in Google Scholar linked to freely available full papers, whereas the remaining 60% links offered only the abstract, but not the full paper, free-of-charge.3 In light of the ever progressing efforts to improve public availability of research, such as the open-access publishing movement or the respective requirements mandated by research funding agencies, we hypothesized that the ratio of freely available online articles is increasing over time, and we repeated our data collection one year after the initial study. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32010/24429 How to cite: Burke J, Fiedler G. ONLINE ACCESS TO RESEARCH PAPERS – CHANGES OVER TIME. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018, ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
, Michael McGrath, Piotr Laszczak, Alan Kercher, Saeed Zahedi, David Moser
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32012

Abstract:
INTRODUCTION Lower limb amputees have different biomechanics to able-bodied people when walking on slopes1,2, often struggling to negotiate different gradients safely. Loss of proprioception and muscular control contributes to this issue, which is a particular problem for trans-femoral amputees, where both ankle and knee joints are absent. Studies have shown that prosthetic technologies can have benefits for slope negotiation. The aim of this study was to isolate the specific effects of different trans-femoral prosthetic technologies, by applying each additional mechanism incrementally. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32012/24431 How to cite: Stech N, McGrath M, Laszczak P, Kercher A, Zahedi S, Moser D. BIOMECHANICAL ANALYSIS OF DIFFERENT PROSTHETIC TECHNOLOGIES FOR TRANS-FEMORAL AMPUTEES DURING SLOPE DESCENT. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32012 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32044

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INTRODUCTION A typical gait pattern includes a heel strike, followed by a smooth transition to foot flat through loading response. Children with poor postural control and related gait deficits often present with anterior weight lines, which result in loss of first rocker and/or a fast transition from initial contact to footflat. The foot has many important jobs, including providing proprioceptive feedback. There are 104 cutaneous mechanoreceptors on the plantar surface of the foot.1 While most of the sensors are in the metatarsal/tarsal and toe regions, we cannot forget the role of the mechanoreceptors in the heel. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32044/24458 How to cite: Smith M. WHAT IN THE “HEEL” DO THEY FEEL? 15303. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32044 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
, Cynthia L Bennett, Daniela K Rosner, Katherine M Steele
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32001

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INTRODUCTION Upper limb prostheses are commonly prescribed for people with upper limb absence (ULA) to restore function, cosmesis, and assist with activities of daily living. However, nearly one in five people with ULA chooses not to use a prosthesis1 and instead turns to alternative technology and adaptations, pointing to factors beyond prostheses that shape perceptions of ability and quality of life. We examined through interviews the lived experiences of people with ULA framed around their perceptions of ability, device use, and quality of life. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32001/24423 How to cite: McDonald C.L, Bennett C.L, Rosner D.K, Steele K.M. I AM THE BOY WITH ONE HAND WHO CAN DO ANYTHING”: PERCEPTIONS OF ABILITY AMONG PEOPLE WITH UPPER LIMB ABSENCE. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32001 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
, Oa Alexander Krebs, Frank Braatz, Thomas Schmalz, Andreas Kranzl, Christian Breuer
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32020

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INTRODUCTION By enabling users to flex the orthotic leg during swing phase and safely lock it during stance phase, stance control orthosis (SCO) offers clear benefits compared to locked knee-ankle-foot-orthosis (KAFO)1. Since such orthoses do not offer dampened knee flexion in the weight-bearing condition, this represents a limitation in everyday activities such as ramp and stair descent. C-Brace, a microprocessor controlled stance and swing orthosis (SSCO), overcomes many of those problems. Maximum knee flexion angle in stance and swing phase during level walking are closer to physiological values with C-Brace compared to conventional KAFOs2. The patients are with C-Brace able to descend stairs and ramps reciprocally2. Furthermore, patients report of safer and easier ability to perform activities of daily living3. The main aim of next generation C-Brace is a reduction in size and an increase of adaptability to the patient’s anatomic structure. Due to technological changes, improvements especially for difficult ADLs (e.g. walking on uneven ground) are expected. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32020/24438 How to cite: Wismer N, Krebs A, Braatz F, Schmalz T, Kranzl A, Breuer C. PERFORMANCE, PATIENT BENEFITS AND ACCEPTANCE OF A NEW GENERATION OF MICROPROCESSOR-CONTROLLED STANCE AND SWING CONTROL ORTHOSIS. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018.DOI: https://doi.org/10.33137/cpoj.v1i2.32020 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
, J. Chad Duncan
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32046

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BACKGROUND Healthcare professionals have certain professional, legal, and ethical obligations that they must fulfill with each patient interaction. Though professional and legal obligations may vary between fields of practice, the core ethical responsibility remains the same: provide just health care1. This requires that healthcare professionals are aware of systemic and institutional factors that lead to disparity and discrimination in the provision of health services1. Disability is a complex construct that can be related to various factors related to health condition as well as social and environmental factors that influence participation. This complexity results in varying definitions; the ICF model of disability was used in this research2. Abstract PDF Link:https://jps.library.utoronto.ca/index.php/cpoj/article/view/32046/24460 How to cite: Senczyszyn A, Duncan J.C. HEALTH CARE ACCESSIBILITY FOR INDIVIDUALS WITH DISABILITIES: BARRIERS AND RISK FACTORS IMPACTING CARE. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32046 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
, Mohammad Yusuf Rastkhadiv, Mostafa Allami
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32028

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PURPOSE The socket is the main component of a prosthesis which surrounds the residual limb and transfers loads and motions between the residual limb and prosthesis. A misfit socket may lead to excessive stresses on the residual limb, pistoning of the prosthesis during walking, patient discomfort, pain, and skin damage. The quality of socket-skin interface directly affects quality of life, prosthesis use, and satisfaction from prosthesis in amputees. Pain is a devastating condition that prohibits prosthesis use1-4. The present study aimed to evaluate pain threshold and tolerance of the transtibial residual limb to improve its socket design and fit. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32028/24445 How to cite: Ghoseiri K, Rastkhadiv M.Y, Allami M. EVALUATION OF LOCALIZED PAIN IN THE TRANSTIBIAL RESIDUAL LIMB. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32028 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
Douglas Henness, Arianna Medema, Kendra Steinhorst, Robert Moauro, Michael Reuland, Robert Whelan, Shawna Kester,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32014

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INTRODUCTION Increased risk of falling following amputation is well documented in literature.1 As the amputee population ages, accidental falls become a greater problem. Trans- tibial amputations are one of the most common levels of amputation. We hypothesized that postural steadiness is deteriorated following trans-tibial amputation as compared to age matched younger adults. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32014/24433 How to cite: Henness D, Medema A, Steinhorst K, Moauro R, Reuland M, Whelan R, Kester S, Bateni H. CHANGES IN POSTURAL STEADINESS FOLLOWING TRANS-TIBIAL AMPUTATIONS. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32014 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
, Dioscaris R Garcia, Christopher T Born
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32016

Abstract:
INTRODUCTION The conventional use of a prosthetic device by amputees involves contact of the residual limb tissue with the prosthetic socket using an intermediate elastomer liner. Roll-on gel liners are applied directly to the limb, and slide into the rigid hard socket; the gels are generally silicone or plastic. Regardless of the material, or the liner system used on a residual limb, problems occur because of direct skin and socket or liner contact.1 The skin tissue of the residual limb is subject to compressive, shear, and tensile forces through weight bearing against the interface wall. In addition the skin is subject to heat/sweat issues that may be seasonal and related to the insulation properties of the interface material. A common problem encountered by the prosthetic user is socket odor, or odor emanating from socket liners.2 Proper hygiene does not guarantee the reduction of strong socket or liner odor over time. In addition, skin problems among amputees include rashes, blistering, mold/fungal infections and other skin irritations. The socket/wall interface (regardless of material composition) is subject to local skin sloughing, sweat, and skin oils in a warm/moist dark environment over hours of use providing an ideal environment for fungal and bacterial growth.3 To address this problem, our team evaluated a titanium and silicone hybrid cleaning and coating technology containing a silver fatty acid complex against the odor producing, Gram-negative, facultative anaerobe, Pseudomonas aeruginosa.4 Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32016/24435 How to cite: Jarrell J.D, Garcia D.R, Born C.T. INHIBITING PSEUDOMONAS AERUGINOSA GROWTH ASSOCIATED WITH PROSTHETIC LINERS. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32016 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32040

Abstract:
INTRODUCTION Studies report that after lower-limb amputation, patients have high levels of pain in the form of chronic low back pain, residual limb pain, and phantom pain leading to restrictions in functional activity1. Patients with high levels of pain and disability may develop avoidance behaviors. Vlaeyen et al. presents the fear-avoidance model, which suggests that after an injury there are two pathways a patient will take based on their interpretation of acute pain 2. Pain that is perceived as non-threatening leads to the patient’s recovery and return to normal activities of daily life. Pain that is perceived as threatening, or pain catastrophizing, causes anxiety and induces mobility apprehension which leads to avoidance behaviors. Avoidance behaviors may then lead to greater pain, depression, and disability3 . Factors described in the literature that are related to mobility apprehension were measured in a sample of lower limb amputees. The purpose was to determine which of pain intensity, interference, and catastrophizing lead to increased mobility apprehension. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32040/24454 How to cite: Mathis S.L. FACTORS ASSOCIATED WITH MOBILITY APPREHENSION IN AMPUTEES. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32040 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
Shadi Sabeti, , Johanne Mattie
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32160

Abstract:
INTRODUCTION The most important aspect of a lower extremity prosthesis is the socket. The socket is the interface between the human and the mechanical support system1. There are different methods for producing prosthetic sockets. The traditional method requires a skilled prosthetist and is time consuming 2, 3. Using 3D printing technology for manufacturing prosthetic sockets promises to speed up the fabrication process and reduce materials and time cost significantly. 3D Printed prosthetic sockets have to potential to increase socket strength and durability. This paper investigates the effect of material choices and printing process parameters on the mechanical strength of 3D printed trans-tibial sockets. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32160/24510 How to cite: Sabeti S, Raschke S.U, Mattie J. THE EFFECT OF MATERIAL CHOICE AND PROCESS PARAMETERS ON THE MECHANICAL STRENGTH OF 3D-PRINTED TRANSTIBIAL PROSTHETIC. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32160 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
Arianna Medema, Douglas Henness, Kendra Steinhorst, Robert Moauro, Michael Reuland, Robert Whelan, Shawna Kester,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32015

Abstract:
INTRODUCTION Increased rate of fall, reduced balance confidence and increased fear of falling is reported for lower extremity amputees.1 Fall rate also increases at higher levels of amputation1. This study aims to compare postural steadiness of different levels of lower extremity amputees through comparison of time and frequency domain variables of postural sway. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32015/24434 How to cite: Medema A, Henness D, Steinhorst K, Moauro R, Reuland M, Whelan R, Kester S, Bateni H. EFFECT OF LEVEL OF AMPUTATION ON POSTURAL STEADINESS AMONG LOWER EXTREMITY AMPUTEES. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32015 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32022

Abstract:
INTRODUCTION This case series presents prescription, evaluation, fitting and initial functional benefits of a myoelectric elbow- wrist-hand orthosis with active grasp. Custom fit, myoelectric orthoses are now also being provided to patients with upper extremity paresis due conditions such as stroke, brachial plexus injury, spinal cord injury, multiple sclerosis and amyotrophic lateral sclerosis to enable them to self-initiate and control movement of a partially paretic limb using their own volitional myoelectric signals. A recent study of 18 chronic stroke participants demonstrated functional improvements on the Fugl-Meyer Impairment Scale (FM) and a battery of functional tasks with this device.1 Abstract PDF Link:https://jps.library.utoronto.ca/index.php/cpoj/article/view/32022/24440 How to cite: Shoemaker E. MYOELECTRIC ELBOW-WRIST-HAND ORTHOSIS WITH ACTIVE GRASP FOR PATIENTS WITH STROKE: A CASE SERIES. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32022 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
, Gary Trexler
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32043

Abstract:
INTRODUCTION Winging scapula is a rare condition that can be painful and debilitating to the upper extremity involved1. This condition can affect the functional ability of the upper extremity, resulting in loss of range of motion, decreased power, and pain.1 The purpose of this study was to introduce and determine the clinical applicability of a custom thermoplastic scapulothoracic orthosis to aid in management of winging scapula. The thermoplastic scapulothoracic orthosis offers total contact and provides anterior-posterior compressive forces to stabilize the winging scapula. This design provides a semi-rigid structure that is lightweight and allows user adjustability. The study highlights the potential applicability of the custom thermoplastic scapulothoracic orthosis in the categories of pain, active range of motion at the shoulder, and overall self-reported activities of daily living. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32043/24457 How to cite: Brown S, Trexler G. CASE STUDY: THERMOPLASTIC SCAPULOTHORACIC ORTHOSIS FOR TREATMENT OF WINGING SCAPULA. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32043 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
, Nadine Stech, Piotr Laszczak, Alan Kercher, Saeed Zahedi, David Moser
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32013

Abstract:
INTRODUCTION Using microprocessor-control to dynamically adapt hydraulic ankles, by changing the resistances to dorsiflexion and plantarflexion (DF/PF) movements, has been shown to have beneficial biomechanical effects during slope descent1. Another, more recent case study also showed that the level walking biomechanical effects of microprocessor-feet (MPF) persist, and the same trends can be observed in repeated gait analysis sessions, over a year apart2. This work looks to expand on both of these concepts, analysing repeated gait analysis sessions to see if the biomechanical changes of MPF during slope descent are reproducible over time. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32013/24432 How to cite: McGrath M, Stech N, Laszczak P, Kercher A, Zahedi S, Moser D. HOW REPRODUCIBLE ARE THE EFFECTS OF A MICROPROCESSOR FOOT? CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32013 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
Ana Gallego, Joe McCarthy, Michael McGrath, Alan Kercher, Saeed Zahedi, David Moser
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32011

Abstract:
INTRODUCTION Among amputees, the most commonly reported problem affecting daily quality-of-life is excessive sweating1,2. Some studies report that as many as seven out of ten amputees are affected1,3. Compared to able-bodied people, trans-tibial amputees expend up to 40% more energy during every-day activities, which contributes to excess perspiration4. Particularly common is localised sweating on the residual limb. This could be due to the use prosthetic liners made from non-porous, cushioning materials, such as TPE Gel, Polyurethane or silicones. With these problems in mind, a type of silicone liner has been produced that contains perforations along the length and at the distal end. These perforations permit the warm air to move away from the residuum, allowing better air circulation and, if sweating does occur, the perforations allow moisture to escape. The result is drier, cooler skin and a healthier environment for the residual limb. This study reports prosthetist and patient feedback data from trials of the pin-lock version of these liners. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32011/24430 How to cite: Ana Gallego A, McCarthy J, McGrath M, Kercher A, Zahedi S, Moser D. PATIENT TRIAL EVALUATION OF A PERFORATED, PIN-LOCK PROSTHETIC LINER FOR SWEAT MANAGEMENT. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32011 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
, Ignacio Gaunaurd, Jennifer Lucarevic, Glenn Klute, Neva Kirk-Sanchez, Christopher Bennett, Robert Gailey
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32036

Abstract:
INTRODUCTION Studies suggest that brief bouts of activity consisting of sit-to-stand transitions, gait initiation, turning and negotiation of obstacles, are essential tasks of daily mobility, as well as prosthetic mobility1,2. Using outcome measures deemed reliable for use in the amputee population is ideal3,4. The purpose of this study was to investigate the reliability and validity of a component timed-up-and-go test (cTUG), using a mobile application (App), to evaluate basic prosthetic mobility tasks in people with lower limb amputation (LLA). The cTUG captures time required to perform the subtask components of sit to stand transitions, linear gait, and a 180˚ turn that are requisites of the standard TUG test. It was hypothesized that the cTUG would demonstrate test-retest reliability, differentiate between groups based on anatomical level of amputation, and exhibit convergent validity with other measures of prosthetic mobility and balance. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32036/24452 How to cite: Clemens S, Gaunaurd I, Lucarevic J, Klute G, Kirk-Sanchez N, Bennett C, Gailey R. ESTABLISHING THE RELIABILITY AND VALIDITY OF THE COMPONENT TIMED-UP-AND-GO TEST TO DETERMINE BASIC PROSTHETIC MOBILITY IN PEOPLE WITH LOWER LIMB AMPUTATION. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32036 Abstracts were Peer-reviewed by the AOPA 2018 National Assembly Scientific Committee.
, Mostafa Allami, Mohammad Reza Soroush, Mohammad Yusuf Rastkhadiv
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32008

Abstract:
INTRODUCTION The prevalence of limb amputation is increasing globally as a devastating experience that can physically and psychologically affect the lifestyle of a person. The residual limb pain and phantom limb pain are common disabling sequelae after amputation surgery. Assistive devices/technologies can be used to relieve pain in people with amputation. The present review aimed to introduce the existing assistive devices/technologies for pain management in people with amputation. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32008/24427 How to cite: Ghoseiri K, Allami M, Soroush M.R, Rastkhadiv M.Y. ASSISTIVE TECHNOLOGIES FOR PAIN MANAGEMENT IN AMPUTEES: A REVIEW. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32008 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
, , Thomas Schmalz
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32029

Abstract:
INTRODUCTION Real-life outdoor walking of amputees is challenged by uneven ground. Uneven ground requires either a component adaptation in the sagittal plane or in frontal plane or both. The lack of adaptability of prosthetic components requires compensational movement strategies by the user. Common energy storing and returning (ESR) feet have some basic flexibility through the carbon structure allowing for some limited adaptation in both planes. For the frontal plane the split toe feature adds some functionality. However, even with split toe the ROM is clearly limited and needs high force impact for minor adaptations. Now there is a novel foot module allowing for 10° inversion/eversion through a dedicated joint. This study investigates the hypothesis that such a foot module with easily accessible frontal plane adaptation enhances the locomotion on uneven ground. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32029/24446 How to cite: Altenburg B, Ernst M, Schmalz T. AN INNOVATIVE FOOT MODULE WITH EASILY ACCESSIBLE FRONTAL PLANE ADAPTATION ENHANCES THE LOCOMOTION ON UNEVEN GROUND. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32029 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
, Lena Rettinger, Michael Jason Highsmith,
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32033

Abstract:
INTRODUCTION Several years ago, a new microprocessor controlled knee (MPK), Genium, was introduced containing sensors, algorithms and technical solutions that enable a range of new functions to lower limb amputees. We conducted a systematic review to evaluate the effect of the knee on ambulation, mobility, activities of daily living (ADLs) and quality of life (QoL). Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32033/24449 How to cite: Mileusnic M, Rettinger L, Highsmith M.J, Hahn A. BENEFITS OF GENIUM MICROPROCESSOR CONTROLLED KNEE ON AMBULATION, MOBILITY, ACTIVITIES OF DAILY LIVING AND QUALITY OF LIFE: A SYSTEMATIC REVIEW. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32033 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
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