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Published: 15 December 2018
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,
Published: 15 December 2018
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/
Published: 15 December 2018
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
Published: 15 December 2018
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
Published: 15 December 2018
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
Published: 15 December 2018
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
Published: 15 December 2018
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.
Published: 15 December 2018
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
Published: 15 December 2018
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, Andreas Hahn
Published: 15 December 2018
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/
Eva Pröbsting, Andreas Kannenberg, Siegmar Blumentritt
Published: 15 December 2018
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32034

Abstract:
INTRODUCTION Long-term damages after lower extremity amputation have previously been analysed in three systematic reviews 5–7 showing that amputees have a higher risk for developing knee and hip osteoarthritis on the sound side. The altered gait pattern appears to increase the load on the sound side.1–3 This paper analysed the extent to which the above described assumption is supported by the scientific literature with specific focus on the risk of developing back pain and osteoarthritis in amputees. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32034/24450 How to cite: Pröbsting E, Kannenberg A, Blumentritt S. BACK PAIN AND OSTEOARTHRITIS AS SECONDARY DISABILITIES OF 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.v1i2.32034 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
Timothy R Dillingham, , Frances S Shofer, Jim Marschalek
Published: 15 December 2018
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.32025

Abstract:
INTRODUCTION Limb loss rates globally are rising and there is a large unmet need for an affordable and accessible prosthetic system for this growing US and International population. The purpose of this prospective cohort study was to assess the feasibility and utility of a novel immediate fit modular prosthetic system (IFIT Prosthetics, LLC™ prosthesis) for transtibial amputees. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32025/24442 How to cite: Dillingham T.R, Kenia J, Shofer F.S, Marschalek J. AN IMMEDIATE FIT AND ADJUSTABLE TRANSTIBIAL PROSTHETIC SYSTEM; A PROSPECTIVE FEASIBILITY AND EFFICACY STUDY. 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.v1i2.32025 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/
, Luciann Ferrada, Tanya Quincey, Brendan Burkett, Debra Berg
Published: 12 December 2018
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.31326

Abstract:
BACKGROUND: Evidences of sustainable clinical benefits of bone-anchored prosthesis (BAP) using osseointegrated fixation over typical socket-suspended prostheses are becoming more probing. This influx of individuals to be fitted with BAP has pressed government organisations to adjust their policies. However, the appraisal of consumer’s experience for the provision of BAP founded by government organisation is yet to be developed. This descriptive study shares the experience gained by a government organisation, namely the Queensland Artificial Limb Service (QALS), while developing a specific BAP-inclusive continuous quality improvement (CQI) procedure. OBJECTIVE(S): The primary objective was to present the methods and outcomes of key steps required to plan and create this CQI procedure. The secondary objective was to highlight key barriers and facilitators of the transition from a socket-focused to the proposed BAP-inclusive CQI procedure. METHODOLOGY: The re-design process of the CQI procedure for 65 current QALS’s consumers with BAP involved a two-step process for the planning (e.g., case-mix, stakeholder) and creation (e.g., diagnosis, technical options, cost). FINDINGS: Prosthetists labour toward CQI procedure represented 1.3 hrs out of 22 hrs and AUD$213 out of AUD$3,300 or 6% of the whole procedure for the provision of BAP. The time spent by a prosthetist, consumer and QALS staff represented 24%, 24% and 53% of the time of the CQI procedure, respectively. The cost of prosthetist and QALS staff labour represented 70% and 30% of the CQI procedure, respectively. CONCLUSIONS: This descriptive study shares the workings and methodology that government organisations, such as QALS, can use to re-design a CQI procedure for comprehensive appraisal of the provision of prosthesis that could be inclusive of BAP and affordable while minimally time-consuming for prosthetists. The transition from a socket-focused to the proposed minimally disruptive BAP-inclusive CQI procedure was facilitated by prior knowledge of BAP treatment, early identification of the stakeholders and adaptation of current CQI procedure. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/31326/24425 LAYMAN’S ABSTRACT There is evidence supporting the long term clinical benefits of bone-anchored prosthesis (BAP) using an osseointegrated fixation over typical socket-suspended prostheses. The increasing number of individuals treated with osseointegrated fixation has pressed government organisations to adjust their policies for fair and equitable provision of prosthetic care. However, the appraisal of consumer’s experience for the provision of BAP by government organisation is yet to be developed. This descriptive study has fulfilled this need by sharing the experience gained by a QALS while developing a specific BAP-inclusive continuous quality improvement (CQI) procedure. This study revealed that government organisations can design a CQI procedure for comprehensive appraisal of the provision of prosthesis that could be inclusive of BAP and affordable while minimally time-consuming for prosthetists. The transition from a socket-focused to the proposed minimally disruptive BAP-inclusive CQI procedure was facilitated by prior knowledge of BAP treatment, early identification of the stakeholders and adaptation of current CQI procedure. How to Cite: Frossard L, Ferrada L, Quincey T, Burkett B, Berg D. Development of a government continuous quality improvement procedure for assessing the provision of bone anchored limb prosthesis: a process re-design descriptive study. Canadian Prosthetics & Orthotics Journal, Volume 1, Issue 2, No 4, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.31326
, Terry J Supan, Marlo Ortiz
Published: 31 October 2018
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.31371

Abstract:
Over the past decade, essential documents and agreements have emerged to help improve the lives of people with physical disabilities. These include Convention on the Rights of Persons with Disabilities (CRPD), ratified by more than 170 countries, and the World Health Organization (WHO) global disability action plan. While the principles in these broad agreements can be applied to people who would benefit from assistive technology, specific service standards are required to operationalize the CRPD and WHO objectives. Therefore, WHO, in partnership with the International Society for Prosthetics and Orthotics (ISPO) and the United States Agency for International Development (USAID), prepared global standards and an implementation manual to assist Member States in setting up, improving, or transforming their systems for delivering appropriate prosthetic and orthotic services. Article PDF Link:https://jps.library.utoronto.ca/index.php/cpoj/article/view/31371/23745 How to cite: Lemaire ED, Supan T, Ortiz M. Global Standards for Prosthetics and Orthotics. Canadian Prosthetics & Orthotics Journal. Volume1, Issue2, No.3, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.31371
Leah Campbell, , Brittany Pousett, Ernie Janzen, Silvia U Raschke
Published: 28 September 2018
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.30843

Abstract:
BACKGROUND: 3D printing is becoming more popular across many industries. The first step to safely introducing 3D printed sockets in to prosthetics is to conduct strength testing on these sockets. PURPOSE: This study tests how changing the infill percentage (the percentage of material between the internal and external socket wall) affects the strength of 3D-printed transtibial sockets. METHODS: A Fused Deposition Modelling (FDM) printer was used to print a total of nine transtibial (TT) sockets (three sockets at 30% infill, three sockets at 40% infill, and three sockets at 50%) using polylactic acid (PLA). A strength-testing apparatus measured, in Newtons (N), the maximum load the 3D-printed transtibial sockets could withstand at initial contact of the gait cycle. RESULTS: Based on the specific criteria outlined in this research project, all nine sockets exceeded the 4480N threshold set by ISO Standard 10328. Eight out of nine sockets failed at approximately double the force required with one socket (socket #2) failing at 5360N. Seven out of nine sockets failed at the medial popliteal region and two out of nine sockets failed at lateral mid socket region. Differences in infill percentage from 30%, 40%, 50% did not appear to influence strength of sockets. CONCLUSION: Strength of 3D-printed TT sockets needs rigorous testing to be deemed safe for patient use. More definitive research and a higher number of samples are required to investigate how a larger range of infill percentage can affect strength. Until all the requirements of ISO Standard 10328 are satisfied, the safety of using 3D-printed TT sockets in clinical practice are uncertain. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/30843/23262 LAYMAN’S ABSTRACT 3D printing is beginning to be used in prosthetics because it has the potential to be less expensive and more customizable to individual needs and styles. Unfortunately, there are companies using this technology to print prosthetic sockets for people without the proper education and training. Before people can start using this new technology safely, testing needs to be done to determine the strength of these 3D printed prosthetic sockets. Our project investigates how strong a 3D printed prosthetic socket is for an amputee below the knee. This is challenging because the entire weight will be put through the socket and it needs to be strong enough that it will not break. There is an international standard that gives instructions and information on testing the strength of a prosthetic socket. Our project will follow a part of these instructions and see how much weight can be put through a socket before it breaks. Our project printed nine identical prosthetic sockets, but the infill percentage of each socket was different. The infill percentage is the amount of material between the walls of an object. We put each socket in a machine and applied a compressive force until it broke and measured that force. Our tests showed the infill percentage did not change the strength of the sockets. They all passed the force measurement given by the international standard. Because our project only tested a part of the standard, there are many more tests that need to be done before the public can start using 3D-printed prosthetic sockets safely. How to Cite: Campbell L, Lau A, Pousett B, Janzen E, Raschke S.U. How infill percentage affects the ultimate strength of 3D-printed transtibial sockets during initial contact. Canadian Prosthetics & Orthotics Journal, Volume 1, Issue 2, No 2, 2018. https://doi.org/10.33137/cpoj.v1i2.30843
, Kristleifur Kristjansson
Published: 25 September 2018
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i2.30813

Abstract:
Increased prosthetic hip to toe distance and insufficient mid swing toe clearance of a prosthetic foot is a well-recognized inadequacy for lower limb prosthesis users with wide and possible grave consequences on their ambulation capabilities. Most important are increased risk of falls and abnormal compensatory gait patterns with secondary unwanted physical effect like generally deceased mobility, muscular-skeletal pain and joint degeneration, i.e. osteoarthritis, with possible significant health economic effect. Even though insufficient toe clearance can be device related and technically or even intentionally induced for attaining equal length of the lower extremities in a neutral standing position or the stance phase, it is important to be aware of available technical solutions that can counteract the problem, like swing phase dorsiflexing feet, vacuum suspension systems, polycentric axis knees rather than single-axis knees and adequate knee flexion in early swing and swing-flexion assistance in the case of bionic knees. Article PDf Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/30813/23259 How to cite: Lechler K, and Kristjansson K. The importance of additional mid swing toe clearance for amputees. Canadian Prosthetics & Orthotics Journal. Volume1, Issue2, No.1, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.30813
Published: 1 September 2018
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i1.30450

Abstract:
This paper reviewed 11 publications on non-MP controlled ankles with active dorsiflexion feature, 15 publications on passive MP controlled ankles, and 12 publications on powered MP controlled ankle-foot mechanisms. Methodological quality of publications was low to moderate. The evidence found was mostly biomechanical and generated in gait lab studies. Non-MP ankles may increase toe clearance and reduce braking forces during level walking, thus supporting propulsion with increase in walking speed. Passive MP controlled ankles may also increase toe clearance and reduce the likelihood of stumbling over an unseen obstacle. They may reduce energy expenditure during level walking and facilitate slope and stair ambulation. Non-MP and passive MP controlled ankles have been also been shown to reduce residual limb-socket interface pressures. Powered ankles may increase walking speed to the level of and decrease energy expenditure to be no longer significantly different from that of able-bodied individuals. Also, at higher walking speeds the sound knee loading may be reduced by up to 15-20%. However, it remains unclear to what extent the gait lab results for all advanced ankle-foot mechanisms can be transferred to real-life benefits in the free-living environment. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/30450/23055 How to cite: Kannenberg A. Evidence On Prosthetic Feet With Active Dorsiflexion Feature, Passive Microprocessor Control And Active Ankle Power Generation: A Mini Literature Review. Canadian Prosthetics & Orthotics Journal, Volume 1, Issue 1, No 6, 2018, DOI: https://doi.org/10.33137/cpoj.v1i1.30450
, Francesco Guarato, Jason Law, Zoe Ralston, Anna Courtney
Published: 28 August 2018
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i1.30354

Abstract:
Julie Burke,
Published: 10 August 2018
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i1.30009

Abstract:
BACKGROUND: Evidence-based practice (EBP) is an important cornerstone of responsible clinical decision-making, and by extension, of high quality care provision in prosthetics and orthotics. However, many clinicians have been reluctant to embrace EBP, citing barriers such as high costs and time demands that are associated with obtaining pertinent published evidence for individual care scenarios.OBJECTIVES: The purpose of this study was to determine how accessible peer-reviewed research articles are to prosthetists who seek to implement EBP techniques into their clinical work without expending unreasonable amounts of time and money. METHODOLOGY: Two approaches were utilized. An academic approach entailed a search through five peer-reviewed research journals, including the Journal of Prosthetics and Orthotics and Prosthetics and Orthotics International. A practical approach simulated a typical evidence search as it might occur in the field, using a number of different clinical questions to inform search terms in Google Scholar. The ratio of freely accessible articles was computed and compared for both approaches. FINDINGS: Out of a total of 796 prosthetics-relevant articles published in the analysed journals over the last years, 600 (75.4%) were found to be accessible to the public without any cost incurred. The practical approach showed that, among the top twenty search results for each search query, on average 40% to 75% of articles were freely available.CONCLUSIONS: A majority of pertinent research papers is already publicly available to anybody with internet access. Prosthetists would not be required to invest in journal subscriptions or have to spend time at an academic library to obtain these articles. However, it is a concern that evidence-based decision making may be flawed if not all literature on a topic is considered. There is still a substantial fraction of articles that are not freely available to practitioners, motivating a continued expansion of open-access policies in the field.LAYMAN’S ABSTRACT Medical care, including the provision of prostheses to people with limb loss, needs to be informed by scientific evidence. In order to reduce the risk of making decisions that are not ideal for a given patient and scenario, clinicians have to find out what the latest research on the topic suggests. While finding, reading, and appraising the published literature is an important aspect of Evidence Based Practice (EBP), it can be a time consuming task that interferes with the other duties of busy clinicians. Searching for literature over the internet can reduce the associated burden, as no physical copies of research articles have to be retrieved and stored anymore. However, not all research is freely available online, and accessing the full text versions of some papers can incur substantial fees.We wanted to find out how much of the scientific literature in the area of limb prosthetics is accessible free of charge on the internet. To...
, Saiph Savage, Jon Schull, Jennifer Mankoff
Published: 10 August 2018
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i1.29970

Abstract:
The emergence of 3D-printed upper limb prosthetic devices a couple of years ago, spearheaded substantially by the e-NABLE community (1, 2), has triggered a variety of reactions, ranging from euphoric press coverage predicting a new age of low-cost universally obtainable prosthetic solutions to anxious reluctance by clinicians fearing the demise of high-quality professional health care provision (3, 4). The circumstance that untrained volunteers produce e-NABLE devices on their hobby-grade 3D-printers (5) was both hailed as a revolutionary paradigm shift suited to address a host of current challenges in health care economics, and derided as inappropriate intrusion into long-standing training and certification standards of a well-regulated profession. That many of the early generation e-NABLE devices targeted young patients with partial hand amputation (6) was interpreted by proponents as finally offering this neglected population long-desired solutions, whereas skeptics felt that many of the recipients of such devices would traditionally have been deemed to have a residual functional enough to be a contra-indication for a prosthesis (7).Article PDF file: https://jps.library.utoronto.ca/index.php/cpoj/article/view/29970/22869 How to cite: Fiedler G, Savage S, Schull J, Mankoff J. The Case For Broad-Range Outcome Assessment Across Upper Limb Device Classes. Canadian Prosthetics & Orthotics Journal. Volume1, Issue1, No4, 2018. DOI: https://doi.org/10.33137/cpoj.v1i1.29970
Marie O'byrne, Angus K McFadyen, Dominic Hannett,
Published: 14 July 2018
CANADIAN PROSTHETICS & ORTHOTICS JOURNAL; doi:10.33137/cpoj.v1i1.30006

Abstract: