ARTICLE INFO

Article Type

Case Report

Authors

Haji Aghayi   B (*)
Anoushe   S.Z (1)
Sa’eidi   H (1)
Gholizadeh   H (2)






(*) Rehabilitation Department, Rehabilitation Sciences Faculty, Iran University of Medical Sciences, Tehran, Iran
(1) Rehabilitation Department, Rehabilitation Sciences Faculty, Iran University of Medical Sciences, Tehran, Iran
(1) Rehabilitation Department, Rehabilitation Sciences Faculty, Iran University of Medical Sciences, Tehran, Iran
(2) Biomedical Engineering Department, Engineering Faculty, Malaya University, Kuala Lampur, Malaysia

Correspondence

Address: Rehabilitation Department, Rehabilitation Sciences Faculty, Iran University of Medical Sciences, Nezam Street, Shahid Shahnazari Street, Madar Square, Mirdamad Boulevard, Tehran, Iran. Postal Code: 13487-15495
Phone: +982122220946(254)
Fax: +982122220946
bhajiaghaei@yahoo.com

Article History

Received:  June  24, 2014
Accepted:  August 26, 2014
ePublished:  November 6, 2014

BRIEF TEXT


Prosthesis in persons with amputations is a part of rehabilitation and treatment process [1]. The suspension system of a transtibial prosthesis is an important part of the prosthesis [2]. A good suspension system improves fitness and function of the socket and leads to more efficient prosthesis and reliable and independent gait [3-5]. Limb size reduction due to daily utilization of the prosthesis endangers socket fitness and suspension. The size change leads to piston movement or vertical displacement in the remaining limb that has unpleasant effects such as shear stresses on the skin, gait disorders, and pain at the end of the remaining limb [1, 5-7]. Theappropriate suspension system can reduce such movements in order to reduce their undesirable effects [8].

In this study, an auxiliary pneumatic suspension system in PTB supracondylar prosthesis was introduced that can be used in the transtibial prostheses for the first time.

The aim of this study was to compare the piston movement of two types of prostheses including "conventional supracondylar PTB" and "supracondylar PTB with pneumatic suspension" in the unilateral below the knee amputee.

This is a simple quasi-experimental study.

The study was done in the Rehabilitation Clinic of Orthotics and Prosthetics Department of Iran Rehabilitation Sciences School in 2014. Inclusion criteria were 20-55 years old amputees with unilateral below the knee amputation, activity level, K2 and K3 activity level [9], passing at least one year from receiving the first prosthesis, and 5-7 inches length of the remaining limb [1, 9]. Exclusion criteria were the incidence of cardiovascular diseases such as diabetes, and severe pain and numbness in the remaining limb during the test.

A person with the unilateral below the knee amputee was invited.

First, based on the size of the end of the remaining limb, silicon socks (Liner), which was proportional to the volume of the limb was covered on it and was molded with supracondylar method. After making a positive mold and correction, the air cushion was made. Positive wax mold of the air cushion was made based on the anatomical form of the supracondylar inner part of the plaster mold.Pouring the material into the waxy air cushion was done with 3 layers of Perlon socks with 2.4mm thickness and each layer was coated with a silicone adhesive. To produce PTB supracondylar socket, the upper part of the artificial positive plaster mold, which was made previously appropriate to the size of air cushion was put into its location in the inner upper part of the positive mold, so that the air chamber on the axial inclined ridge was on the bone (Tubercle Adductor) (Fig. 1) [1]. Then, pouring the material was done by Acrylic Lamination Resin.No air cushion in a manufactured single socket showed conventional PTB supracondylar prosthesis usage. The piston movement between Liner and socket was measured by digital photography from the marker and using the reference ruler in the static mode; and a sinker was used for gait simulation [10-13]. Before the test stages, the participant was asked to walk with arbitrary speed on treadmill. After 10minthe speed was fixed and he asked to continue to walk for 20min. This was done to achieve the volume reduction usually occurred during daily activities [14]. Then, he was asked to stand on a platform which was half a meter in height from ground level.Then, 4-stage static test was done including full weight bearing on the prosthesis (FWB), semi-weight bearing on the prosthesis (SWB), non-weight bearing on the prosthesis (NWB), and 30N loading (Fig. 1). All the stages were done three times. Mean value of the stages was used to determine the piston movement. FWB was considered as the baseline to compare that of other test conditions.The four stages were repeated after wearing pneumatic supracondylar PTB prosthesis. The mean values of the results of NWB and 30N loading stages in conventional prosthesis usage were compared with the same results in pneumatic prosthesis usage. They were evaluated using One-sample T test and SPSS 19 software.

The mean vertical movement of the markers in conventional prosthesis in NWB case was ±15mm, whereas this value decreased in the pneumatic prosthesis (±5mm).The mean vertical movement of the markers following 3kg loading in the conventional prosthesis was ±20mm, while it decreased in the pneumatic prosthesis (±10mm). None of the differences was significant.

In FWB, SWB, and NWB cases, tibia displacement has been reported the same for both neoprenelining and silicone suction suspensions, while in the former, distal displacement of the soft tissue has been reported 1.8cm more than the latter [15]. Changes in the piston movement in the different test cases are consistent with the resultsof the present study. In Seal in and Dermo suspensions, piston movements have been measured and compared with each other [9], and changes in piston movement from FWB to NWB and from NWB to 30N loading are consistent with the present results. In the two suspensions, piston movements of the Liner with socket from FWB to NWB have been reported the same [9], which is inconsistent with the present results. With 30N loading, piston movement has been observed in Dermo suspension only and there has been no difference between two cases in Seal in suspension [9], while with 30N loading, piston movement was observed in both prostheses; however, in PTB with pneumatic suspension, it was less than conventional PTB (±5mm). In Suction and Seal in suspensions, piston movements have been measured and compared with each other in persons with below the knee amputee in static states [13], which are confirmed the present results. Piston movement between FWB and SMB has not been observed in the used suspensions, which are similar to the present results.

To obtain more accurate information, more samples in dynamic state ought to be studied.

Low sample size and merely consideration of static state were of limitations of this study.

Piston movement decreased using the supracondylar PTB prostheses with pneumatic suspension.

The researchers feel grateful to the personnel of the Rehabilitation Clinic of Orthotics and Prosthetics Department of Iran Rehabilitation Sciences School.

Non-declared

All procedures were approved by Research Ethics Committee of Iran University of Medical Sciences.

Non-declared

TABLES and CHARTS

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CITIATION LINKS

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