ARTICLE INFO

Article Type

Case Report

Authors

Naseri   M. (1 )
Kheyri   F. (2 )
Nabavi   H. (3 )
Safari   M.R. (* )






(* ) Orthotics and Prosthetics Department, Rehabilitation Faculty, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
(1 ) Orthotics and Prosthetics Department, Rehabilitation Faculty, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
(2 ) Omid Technical Orthopedic Clinic, Tehran, Iran
(3 ) Ergonomics Department, Rehabilitation Faculty, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

Correspondence

Article History

Received:  October  27, 2014
Accepted:  December 22, 2014
ePublished:  February 19, 2015

BRIEF TEXT


… [1-4] The prosthetic socket plays an important role in proper weight transfer and pressure distribution on the stamp, as well as to help the amputee to return to daily activities [5-7]. The socket balance disturbance can affect the amputee’s independency [8]. Volume fluctuations can lead to socket fitness disturbance [8]. … [9-11] The socket fitness is usually evaluated via the prosthetist’s experiences and due to the patient’s complaints [12].

Reliabilities and validities of different methods such as using signs at the stamp and socket ends, pressure investigation, and instability of the stamp, performed to investigate the socket fitness have not yet been confirmed and the patient is the best source to ask about the socket fitness [13]. Gait abnormalities in the blow knee amputees, any correlation between different prosthetic pieces and gait and the prosthetic socket direction and its effects on gait, and different prosthetic socket designing and its effects on gait have been investigated [3, 14-20]. Ways to measure prosthetic fitness, pressure distribution in the socket, and removal of the problems disturbing the prosthetic fitness (such as volume fluctuations) have been studied [9, 11, 15, 21-24]. The correlation between gait and prosthetic fitness and their mutual impact have not yet been studied.

The aim of this study was to investigate the correlation between fit situation of prosthesis socket and gait, performance, and satisfaction parameters in below the knee amputees.

Convenience (simple non-probability) sampling was used.

Persons with amputees due to incidents (accident, burn, etc.) were studied from the beginning of October 2013 to mid-January 2014 at the Red Crescent Society and the University of Social Welfare and Rehabilitation, Iran.

The sample size was estimated 25persons using n=(Zα/2+Zβ)2/α2 formula. However, 64 persons were excluded after 3 months due to some operational limitations and lack of inclusion criteria. 6 persons were studied. The inclusion criteria were unilateral below-knee amputation, using PTB socket, a firm decision on replacement of the prosthesis socket due to disturbed fitness (due to stamp volume change), at least one year utilization of the current prosthesis, and full health of the stamp. The non-inclusion criteria were psychiatric disorders, skin ulcers, and fixed folding contraction in the hip joints or knee.

The results of socket convenience were investigated using Trinity Amputation and Prosthesis Experience Scales (TAPES) and Socket Comfort Score (SCS). TAPES questionnaire is a valid and reliable assessment tools among persons. The questionnaire has been localized in Iran and its validity and reliability have been confirmed [25-27]. SCS is a reliable scale from zero to 10, in which the lowest comfortable level of the socket receives zero score and the best comfortable situation of the socket receives 10 scores [28]. Every person was asked to complete TAPES questionnaire alone or with the aid of the sampler. Then, the persons were asked to score the convenience level of their prostheses regularly in use from zero to 10 scores. The persons were asked about the number of the socks layers they used to make their socket fitter. The participant was asked to walk on a 10m path with his prosthesis that had a socket without a proper fitness. The path had been equipped with cameras of Vicon motion analysis system (Oxford Metrics; England). The test was done 3 times for every participant. The markers were attached to the body of the participant according to Helen-Heys method [29, 30]. The markers were attached to metacarpophalangeal joints of the left and right feet, inside and outside of the ankles of right and left feet, behind the heels of the left and right feet, on the internal and external epicondyles of the femurs of left and right legs, superior iliac spines of left and right legs, and Sacrum. Data were analyzed using VMware Workstation 460 software and the Plug in Gait model by the motion of the knee during walking. Spatial-temporal markers of gait speed, the maximum bending angle of the hip joints and knee in the static and oscillating phases, step length, and the pace were investigated in healthy and prosthetic organs. The movement variables were normalized and investigated based on the walking cycle. After the participant had received a new socket and used it for 2 weeks, in the case of satisfaction, all the tests were repeated in the University of Social Welfare and Rehabilitation. The prostheses before and after socket replacement were manufactured by an expert. The prostheses situations were investigated by the researcher. The movement parameters of the amputated organ were measured 2 times. Finally, the mean values of the measured values at each test were investigated and compared. The inter class correlation coefficient (ICC) between the results of the repeated tests was computed to investigate the introverted reliability of Vicon motion analysis system. The coefficient was computed for step length of the prosthetic and healthy legs, walking speed, the pace, the maximum bending angle of the knee in the static and oscillating phases, and the maximum bending angle of the thigh in the static and oscillating phases. The results of the test were investigated as symmetry index percentage to investigate the numerical variables of the movement and spatial-temporal walking variables. In the formula, zero shows no difference between variables of the healthy and prosthetic sides. Therefore, it shows high symmetry in the variable. Positive symmetry index shows grater and higher healthy side variable. Negative symmetry index shows higher prosthetic side variable. Shapiro-Wilk Test was used to investigate data normalization. Data were analyzed using SPSS 19 software and Non-parametric Wilcoxon Test (to compare two correlated samples in the repeated tests).

The mean age was 35.5 ±9.9years. The mean weight was 81.66±19.72Kg. The mean amputation length was 13.3 ±7.2years. The mean utilization length of the previous prosthesis was 5.5±2.9years. Persons’ satisfactions from the utilization of the fitted and non-fitted prosthetic sockets were 28.5±1.97 and 22.66±3.55, respectively. Performance constraints in the utilization of fitted and non-fitted prosthetic socket were 2.50±2.07 and 8.33±1.86, respectively. Showing no significant difference, psycho-social adaptation of the person in the utilization of fitted and non-fitted prosthetic socket were 15.5±5.16 and 14.33±4.08, respectively. There was a significant difference between the utilization of fitted (8.16±0.75) and non-fitted (5.33±0.82) prosthetic sockets regarding the amputee’s convenience. There was no significant difference between the mean symmetry indices of spatial-temporal variables in the utilization of fitted and non-fitted prosthetic sockets. The step length symmetry indices of the utilization of fitted and non-fitted prosthetic socket were 9.25±4.45 and 13.79±10.32, respectively. The gait speeds with the utilization of the fitted and non-fitted prosthetic sockets were 1.06±0.217m/s and 1.016±0.222m/s, respectively. The pace values with the utilization of the fitted and non-fitted prosthetic socket were 71.75±15.70steps and 74.266±13.380steps, respectively. Knee bending degrees at the standing phase (weight admission stage) with the utilization of fitted and unfit prosthetic sockets were 32.041±23.487degrees and 65.946±8.781degrees, respectively. There were no significant differences between other symmetry indices of hip joints and knee angles with the utilization of fitted and non-fitted prosthetic sockets.

Compared to other studies, the participants selected lower selective speed. In addition, the participants had lower cadence in their selective speed, than other below knee amputees participated in other studies; in such a case that the gait speed has been 1.17m/s and mean cadence with different claws has been 99steps per minute [31]. It seems that movement parameters of walking are affected by many factors such as prosthetic parts, alignment, and the amputee’s solutions to maintain stability [3, 32]. … [33-39]

Sockets ought to be designed by computers to reduce the errors in making prostheses.

Funding limitations led to exclusion of 8 participants was the limitation of this study.

There is a direct relationship between patient's feeling comfortable during gaiting and convenience and the fitting of prosthetic socket. Nevertheless, there is no correlation between fitted and non-fitted sockets in spatial-temporal parameters and speed of walking, except maximum knee bending symmetry index in the static phase.

The researchers feel grateful to Deputy of Rehabilitation of Tehran Red Crescent Society and the Blow Knee Prosthesis Unit.

Non-declared

Non-declared

The study was funded by University of Social Welfare and Rehabilitation.


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