ARTICLE INFO

Article Type

Original Research

Authors

Jahani   A. (*)
Aminiyan   Gh. (1)
Safari   M.R (1)
Nabavi   H. (2)
Mardani   M.R. (1)






(*) Orthotics & Prosthetics Department, Rehabilitation Faculty, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
(1) 1Orthotics & Prosthetics Department, Rehabilitation Faculty, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
(2) Ergonomics Department, Rehabilitation Faculty, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

Correspondence

Address: Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Koodakyar Street, Student Boulevard, Evin, Tehran
Phone: +98 (21) 33656818
Fax: +98 (21) 22180010
at.jahani@uswr.ac.ir

Article History

Received:  June  25, 2016
Accepted:  September 14, 2016
ePublished:  November 21, 2016

BRIEF TEXT


According to figures reported in the United States, annually approximately 105-115 thousand people go under amputation that 30 thousand of amputations occur below the knee [1].

… [2-7]. In the reports, convenience and fitting of the prosthesis are among the most important functional characteristics of a prosthesis, and of the goals of the rehabilitation should be maintenance of the convenience and performance of the fitting [8]. … [9-11].

The aim of this study was to evaluate the effect of fitting socket on energy consumption during walking in individuals will lower limb amputation.

This is a semi-experimental research.

This study was conducted in 2015.

9 unilateral below knee amputee who had referred to Tehran Foundation of Veterans Affairs because of discomfort caused by improper fit and tended to replace the socket, were selected by convenient sampling method and they were studied. Inclusion criteria included the age range of 40 to 60 years, the use of PBT (Patella Bulwark Tendon), stamp length of 12 to 18 cm, spending at least 6 months from the final prosthesis, the complete health of stamp in terms of related tissues (skin, blood vessels and nerves, and lining muscles and muscles and soft tissue) and the lack of peripheral vascular disease. People who had decided to replace other components such as knuckles or support devices such as Karachi along with the prosthesis were excluded from the study.

To evaluate the results related to comfort and socket fitting, the TAPES questionnaire (Trinity Amputation and Prostheses Experience Scales) and SCS scale (Socket Comfort Scale) were used. People scored zero to 10 to the rate of socket comfort and fitting. Zero and 10 indicate the lowest and highest comfort respectively. This scale has been validated by Hanspal et al. (2003) and has reproducibility, content validity and sensitivity to change [12]. TAPES is also a specialized questionnaire for amputees which has 37 items and evaluates the life quality of amputees in three social-psychological, functional limitation and satisfaction of prosthesis dimensions. This questionnaire, also, is applicable in evaluating the life quality of amputees [13]. This questionnaire has been localized and its reliability, validity and repeatability have been approved, and it has been widely used in the studies [14]. To measure energy consumption, Physiological Consumption Index (PSI) was used based on the heart beat per minute that was calculated through the formula “difference between heart beat rate during walking and resting divided by walking speed in meter per minute”. Polar electro device was used to record the heart rate that its reliability and validity have been investigated in the previous studies [15]. Receiver and recorder of heart rate has been placed in the special wrist watch. Electrodes are placed on a strap that is closed on the chest. The transmitter of heart rate from the chest to watch has been embedded in the electrodes. The heart rate is being transferred to the watch by the electrodes. The accuracy of this system in collecting heart rate is ±1 beat per minute [15]. In this study, Polar Electro_ Machine model PM62 (BEURER, Finland) was used to record heart rate. People were asked not to smoke and eat at least 2 hours before the test [16]. First, the thoracic belt was closed around the chest and its proper working was verified by special wrist watch. At this time, heart beats were transferred from electrodes to the watch and the clock display showed it. Firstly the person was asked to rest on the prepared armchair for 5 minutes, and then walk on a treadmill with his own chosen speed. Then, the heart rate was recorded during the rest and walking every 15 minutes. The average of heart rate in the PCI formula along with speed walk were recorded as well. After that, a new socket was built for the person. After at least 2 weeks of wearing a new prosthesis and the person’s satisfaction of the socket, the socket fitting was again evaluated and then the person’s consumed energy was assessed. Also, in both steps, the heel was in accordance with the height of prosthetic foot. The alignment of the prosthesis in both stages, was evaluated by an experienced prosthetist to eliminate walking disorders as an intervening factor. For data analysis, Fist the normality of data distribution was investigated by Kolmogrov-Smirnov test and final analysis of data was done by paired t-test using SPSS 19 software.

The mean walking speed of people and physiological indices of energy consumption was significantly different between proper fit and improper fit. However, the difference between resting heart rate and while walking heart rate in the two stages was not significant (Table 1). Also, after using prosthesis with proper fit, the rate of social-psychological adaption of a person with the prosthesis and rate of person’s satisfaction of the prosthesis were increased and the individualistic functional limitations were decreased (p<0.05).

… [17-24]. In a study it was found out that in two methods of making prosthesis i.e. when reformation occurs in the frame for balancing the appropriate weight and removing the pressure from the bone points, and when no reformation is done, no significant change was observed in the rate of consuming oxygen that is not consistent with the results of this study [25].

It is recommended to repeat the study on a larger population and the current research is being examined with the changes in the walking speed in three levels of slow, medium and fast.

The limitations of the present study were the small number of subjects and commuting of the amputees to the University for carrying out the research in the two steps.

People with lower limb amputation, will face lower energy consumption and improvement in the walking performance with proper fitting.

The authors of this article appreciate all the subjects and the personnel of the Tehran Foundation of Veterans for their sincere cooperation.

There is no conflict of interests.

The written consent was taken from all the participants in this study.

The Research has been sponsored by Research Deputy of Welfare and Rehabilitation Sciences University.

TABLES and CHARTS

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