ISPO World Congress Abstracts Book

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Main Table of Contents
ISPO 2013 Scientific Committee
Acknowledgement of Reviewers
Acknowledgement of Free Paper Session Chairs
How to use this Book Summary Programme
Knud Jansen & Keynote Speakers
Free Papers Detailed Schedule -cum- Table of Contents
Free Papers Texts
Posters Detailed Schedule -cum- Table of Contents
Posters Texts
Instructional Courses Detailed Schedule -cum- Table of Contents
Instructional Courses Texts
Symposia Detailed Schedule -cum- Table of Contents
Symposia Texts
Exhibitor’s Workshops
Index of Presenters
3
4
8
9
10
17
23
39
301
308
417
421
449
452
473
476
1
This book is designed and produced by KW Conferences Pvt Ltd
for the 14th International Congress of the International
Society of Prosthetics and Orthotics – ISPO 2013 from
February 4 -7, 2013 at Hyderabad, India.
2
ISPO 2013 Scientific Committee
Ashok Johari
Harmen van der Linde
Chair
Vice-Chair
C. N. Satish
Member
Vibhor Agarwal
Member
Tarit Kumar Datta
Member
Achille Otou Essono
Member
M. Mehdikhani
Member
Mukesh M. Doshi
Member
ISPO Scientific Committee
H. van der Linde
Chair
J. Harlaar
Member
E. Lemaire
Member
M. Lilja
Member
M. S. Wong
Member
3
Acknowledgement of Reviewers
The Scientific Committee of the ISPO 2013 World Congress wishes to thank the following reviewers of abstracts,
whose time and expertise made possible the Free Papers and Posters programmes.
Reviewers Name
Affiliation
Achille Otou Essono
International Committee Of Red Cross
Afsoon Hassani Mehraban
Tehran University Of Medical Sciences
Al Ingersoll
Independent Consultant
Alberto Esquenazi
Mossrehab Einstein Healthcare Network
Ali Akbar Kameli
Tehran University Of Medical Sciences
Alireza Khaghani
Behbood Teb Co Andrew H. Hansen
Minneapolis VA Health Care System
Anton Johannesson
OTAB Ortopedteknik AB
Behnam Hajiaghaei
Tehran University Of Medical Sciences
Brian J. Hafner
University Of Washington
Carolyn Hirons
Pace Rehabilitation
Daniel H. K. Chow
The Hong Kong Polytechnic University
Deepak Sharan
RECOUP Neuromusculoskeletal Rehabilitation
Centre
Dick H. Plettenburg
Delft University Of Technology
Farzam Farahmand
Sharif University Of Technology
Gert-Uno Larsson
Hässleholms Sjukhusorganisation
Gholamreza Aminian
The University Of Social Welfare And Rehabilitation
Sciences
Gordon Ruder
George Brown College
Harmen Van Der Linde
ISPO
Hasan Saeedi
Tehran University Of Medical Sciences
Helena Burger
University Rehabilitation Institute, Republic Of
Slovenia
Ignacio Gaunaurd
Miami Veterans Affairs Healthcare System
J. S Rietman
Roessingh Research And Development / University
Of Twente
Jaap Harlaar
VU University Medical Center
Jan HB Geertzen
ISPO
Jan Stokosa
American Prosthetic Institute
Jason Highsmith
School Of Physical Therapy & Rehabilitation Sciences. University Of South Florida
Jasper Den Boer
UMCN St Radboud
4
Jenny Kent
Defence Medical Rehabilitation Centre Headley Court
Joan E Sanders
Department Of Bioengineering, University Of Washington
Johan Borg
Division Of Social Medicine And Global Health, Lund
University, Sweden
Keith Smith
Orthotic And Prosthetic Lab, Inc., St. Louis, MO USA
Kenton Richard Kaufman
Mayo Clinic
Kerstin Hagberg
Dept Prosthetics And Orthotics, Sahlgrenska University Hospital
Kevin Murray
University Of Strathclyde
Laurent Frossard
University of Quebec in Montreal, Montreal, Canada
Liselotte Norling Hermansson
Örebro County Council
M. A. Sanjari
Tehran University Of Medical Sciences
M. K. Mathur
Bhagwan Mahaveer Viklang Sahayata Samiti
M. S Wong
The Hong Kong Polytechnic University
Mahboobeh Mehdikhani
Faculty Of Biomedical Engineering, University Of
Malaya
Marco Cavallaro
Politecnico Di Milano
Maria Grazia Benedetti
Istituto Ortopedico Rizzoli
Merel Brehm
Academic Medical Center, Amsterdam
Mohammad Kamali
Tehran University Of Medical Sciences
Mojtaba Kamyab
Tehran University Of Medical Sciences
Mukesh M Doshi
Pocl& Jaya Rehab. Center
Mukul Talaty
School Of Biomedical Engineering, Science & Health
Systems
Nachiappan Chockalingam
Staffordshire University
Pamela Gallagher
Dublin City University
Peter J Kyberd
University of New Brunswick's, Institute of Biomedical
Engineering
Peter Vee Sin Lee
University Of Melbourne
Prassana Lenka
National Institute For The Orthopaedically Handicapped, Kolkata
Richa Sinha
University Medical Center Groningen (UMCG), Groningen, The Netherlands
Rickard Brånemark
Sahlgrenska University Hospital
Robert Gailey
University Of Miami Miller School Of Medicine
Saffran Moeller
Ossur Nordic
Sam YC Law
Queen Elizabeth Hospital
Satish Nagabushnam Chittoor
Artificial Limb Centre
5
Sisary Kheng
Cambodian School Of Prosthetics And Orthotics
Soikat Ghosh Moulic
Mobility India
Steven Allen Gard
Northwestern University Prosthetics-Orthotics Center
Steven Hale
Kawartha Regional Orthopedic Specialists
Sumiko Yamamoto
Internation University Of Health & Welfare
Susan Kapp
University Of Texas Southwestern Medical Center
Tarit Kumar Datta
National Institute For The Orthopaedically Handicapped
Thomas V. Dibello
Dynamic Orthotics & Prosthetics, Houston, Texas
Toru Ogata
Research Institute, National Rehabilitation Center For
Persons With Disabilities, Japan
Vijay Gulati
Mangalam
William C Miller
University Of British Columbia, Vancouver, British
Columbia, Canada
Yasuo Suzuki
Rosai Rehabilitation Engineering Center, Nagoya,
Japan
6
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7
Acknowledgement of Free Paper Chairs
The ISPO 2013 Scientific Committee wishes to thank the following individuals for serving as Chairs for the Free
Paper sessions.
A.N Nanda
Henk Evert Jan Meulenbelt
Rajesh Tiwari
Agapito Raul Nario
Hiroaki Kimura
Ramesh Munjal
Alberto Esquenazi
Jan HB Geertzen
Raoul M. Bongers
Amit Mukerji
Jason Highsmith
Rienk Dekker
Andrew H. Hansen
Jette Schack
Ritu Ghosh
Arezoo Eshraghi
Jim Richards
Robert Gailey
Arun Jayaraman
Juan David Martina
Roy Bowers
Bengt Soderberg
Kenton Richard Kaufman
Robert Kistenberg
Caroline Eileen Roffman
Kerstin Hagberg
Rune Kristian Nilsen
Carolyn Ann Hirons
Kevin Murray
S.R. Sarkar
Chapal Khasnabis
Knut Karl Lechler
Sarah Anderson
Corry K. Van Der Sluis
Kyle Bennett
Serap Alsancak
David Francis Rusaw
Laura Alison Burgess
Sisary Kheng
Dhiren Joshi
M.V Raghavan
Sohan Pal
Dirk Van Kuppevelt
Marco Troncossi
Steven A. Hale
Edmond Hok Ming Lou
Meta Nystöm Eek
Sudhir Vaidya
Edward S Neumann
Neeraj Saxena
Tarun Kulshrestra
Franz Landauer
Nur Azah Hamzaid
Thomas Schmalz
Fred Hotlkamp
Peter Holmberg Jørgensen
Timothy M. Bach
Harmen Van Der Linde
Peter J Kyberd
Tjerk De Ruiter
Harold H. Sears
Prakash Mehta
Vibhor Agrawal
Helen Cochrane
Rajeev Verma
Vijay Gulati
Helena Burger
Rajendra Sharma
Vinod Bhanti
Virendra Shandilya
8
How to use this book
Congress Summary Programme gives the overall Technical Schedule of the Congress, and may be all you
need to choose the sessions you will attend.
For further detail, refer to the individual sections on Free papers, Posters, Instructional Courses and Symposia.
They are colour-coded as shown
Free Papers
Posters
Instructional Courses
Symposia
Each section has a detailed schedule as its first part. This schedule is arranged in order of date and time, and lists
the individual authors / chairs. The rightmost column of the schedule gives the page number where the abstract
text or details of the Instructional Course or Symposium can be found.
The Abstract texts, Instructional Course and Symposia details are also arranged sequentially in date/time order.
You can also locate the page of your choice by rapidly thumbing through the relevant section till you find the date
and time of your choice, and then examining the titles one-by-one.
If you are looking for the presentations by specific persons, there is an Index of Presenters at the end of the book
which lists them in alphabetical order.
Other Sections
Knud Jansen and Keynote Speakers gives the biographies of those speakers.
Exhibitor’s Workshops are where speakers from reputed companies will present. The speakers and their presentations are listed here.
Date of Last Update
This book contains all updates concerning added/deleted/replaced presenters & chairs received by January 19,
2013, the date the book was sent for printing.
9
Registrations in Lobby
Sun, Feb 3:
Mon, Feb 4:
Time
& Room No.
Summary Congress Program
13.15 hours to 19.00 hours
07.00 hours to 17.30 hours
Tues, Feb 5 & Wed, Feb 6: 08.15 hours to 17.30 hours
Thur, Feb 7:
08.15 hours to 16.15 hours
Monday, Feb 4
09:00 - 10:15
Hall 3
Symposium: Prosthetics Lower Limb
ICS Code 35- ICF Core Set for amputees
09:00 - 10:15
G.01
Exhibitor's Workshop
Otto Bock Healthcare: Lean
development of prosthetic components –
challenges, tools and solving strategies
09:00 - 10:15
G.02 & G.03
Symposium: Orthotics Lower Limb
ICS Code 24- From Stable Standing to
“Rock’n’Roll” Walking
09:00 - 10:15
G.04 & G.05
Symposium: Spinal Orthotics
ICS Code 49- Orthotic Management of
Adolescent Idiopathic Scoliosis
Instructional Course: Pedorthics
-Footwear & Shoes
ICS Code 56- Pedorthic Footcare
Orthopaedic Shoe Technique
International
09:00 - 10:15
MR 1.01 & 1.02
09:00 - 10:15
MR 1.03
Free Papers
Prosthetics : Lower Limb - 4
09:00 - 10:15
MR 1.05
Free Papers
Quality Of Life Issues - 1
09:00 - 10:15
MR 1.06
Free Papers
Paediatrics - 1
10:15 - 10:45
Break / Exhibition / Posters
10:45 - 11:30
Hall 3
10
Tuesday, Feb 5
10:15 - 11:30
Opening Ceremony-Hall 3 & Knud
Jansen Lecture by Carson Harte
Keynote - Hall 3
Technology and P&O services in India
by Surinder Mehta
11:30 - 12:00
Exhibition Opening
Break / Exhibition / Posters
12:00 - 13.15
Hall 3
Symposium: Rehab Medicine &
Surgery
ICS Code 18- Psychological and Social
Issues in Amputation
Symposium: Prosthetics Lower Limb
ICS Code 5- Osseointegration and
biomechanics: future solutions
12:00 - 13.15
G.01
Exhibitor's Workshop
DIERS Int: Rasterstereography - a tool
in clinical decision making
Medi: Discussion on phantom limb pain
in lower extremity
Exhibitor's Workshop
Össur: The OA Epidemic – An overview
of prevalence and causes of Knee
Osteoartritis and treatment options, with
specific focus on the Unloader One knee
brace
Time
& Room No.
Monday, Feb 4
Tuesday, Feb 5
12:00 - 13.15
G.02 & G.03
Instructional Course: Education
ICS Code 3- Advancing O&P Education
in Emerging Economies exemplified by
Latin America"
Symposium: Pedorthics- Footwear &
Shoes
ICS Code 59 - An Update of research in
footwear
12:00 - 13.15
G.04 & G.05
Symposium: Technology
ICS Code 6- Direct measurement of
loading for evidence-based practice
Symposium: Technology
ICS Code 25- What do stump-socket
interface pressures tells us?"
Instructional Course: Prosthetics
Upper Limb
ICS Code 7- Evaluation of interventions
for individuals with upper limb
amputation or reduction deficiency
present at birth – implementation of
outcome measures in clinical practice
Symposium: Developing Countries
ICS Code 46- Capacity building and
technologies transfer between North
and South programmes in physical
rehabilitation-a model of professional
exchanges
12:00 - 13.15
MR 1.03
Free Papers
Prosthetics : Lower Limb - 1
Free Papers
Prosthetics : Lower Limb - 5
12:00 - 13.15
MR 1.05
Free Papers
Orthotics: Lower Limb - 1
Free Papers
Rehab Medicine & Surgery - 2
12:00 - 13.15
MR 1.06
Free Papers
Evidence Based Practices - 1
Free Papers
Evidence Based Practices - 2
13:15 - 14:30
Lunch / Exhibition / Live Posters-1
Lunch / Exhibition / Live Posters-1
14:30 - 15:45
Hall 3
Symposium: Rehab Medicine &
Surgery
ICS Code 19- Bone-anchored
prostheses – considerations regarding
prosthetic supply, rehabilitation and
efficacy data
Instructional Course: Orthotics Lower
Limb
ICS Code 11- Biomechanics of medial
compartment knee osteoarthritis:
Implications for orthotic treatment
14:30 - 15:45
G.01
Exhibitor's Workshop
Wagner Polymertechnik: SALARM
liner, socketless solution for upper
extremity
DARCO (Europe):Orthopedic Footwear
and the Diabetic Foot. A challenge - not
only but also in India
Exhibitor's Workshop
Rodin 4D: Improve your work and
patient care with CADCAM
14:30 - 15:45
G.02 & G.03
Symposium: Technology
ICS Code 17- Body powered
prostheses: they are old school, right?
Instructional Course: Spinal Orthotics
ICS Code 39- A key biomechanical
corrective principle based on the specific
goals and techniques used in a Gillette
custom molded TLSO for idiopathic
scoliosis
12:00 - 13.15
MR 1.01 & 1.02
11
Time
& Room No.
Tuesday, Feb 5
14:30 - 15:45
G.04 & G.05
Instructional Course: Education
Symposium: Prosthetics Lower Limb
ICS Code 28- Essential Physiotherapy – ICS Code 20- National Quality
what all Prosthetists should know"
Registries of Amputation, Prostheses
and Outcome after Lower Limb
Amputation
14:30 - 15:45
G.06
Free Papers
Orthotics: Lower Limb - 2
Free Papers
Sports And Physical Activity - 1
14:30 - 15:45
MR 1.01
Instructional Course: Rehab Medicine
& Surgery
ICS Code 60 - How to prevent
amputation in severe diabetic foot
deformities
Free Papers
Prosthetics : Upper Limb - 2
14:30 - 15:45
MR 1.03
Free Papers
Prosthetics : Lower Limb - 2
Free Papers
Prosthetics : Lower Limb - 6
14:30 - 15:45
MR 1.05
Free Papers
Developing Countries - 1
Free Papers
Developing Countries - 2
14:30 - 15:45
MR 1.06
Free Papers
Orthotics: Upper Limb - 1
Free Papers
Rehab Medicine & Surgery - 3
14:30 - 15:45
MR 1.02
Free Papers
Innovations - 1
15:45 -16:15
Break / Exhibition / Live Posters-1
Break / Exhibition / Live Posters-1
16:15 - 17:30
Hall 3
Instructional Course: Prosthetics
Lower Limb
ICS Code 14- Prosthetic alignment:
Biomechanical basics and clinical
approach for lower limb prostheses
Instructional Course: Rehab Medicine
& Surgery
ICS Code 2- The postoperative
management after transtibial amputation
16:15 - 17:30
G.01
Exhibitor's Workshop
Touch Bionics: I-Limb Ultra
Exhibitor's Workshop
Medi: medi Panthera CF, Evolution
in Dynamics; Spinomed: New options
for treatment of osteoporotic vertebral
fractures; Gonarthrosis treatment with
functional OA-braces
16:15 - 17:30
G.02 & G.03
Symposium: General
ICS Code 41- Experiences in disaster
management & rehabilitation
Instructional Course: Orthotics Lower
Limb
ICS Code 34- Stance Control Orthotics
16:15 - 17:30
G.04 & G.05
Symposium: Technology
ICS Code 23- Use of robotics in upper
limb stroke rehabilitation
Instructional Course: Spinal Orthotics
ICS Code 57- Biomechanical aspect
of idiopathic scoliosis and Orthotic
management
16:15 - 17:30
G.06
Free Papers
Rehab Medicine & Surgery - 1
Free Papers
Education - 1
16:15 - 17:30
MR 1.01
Instructional Course: Orthotics Spinal
ICS 58 - Alignment, balance and stability:
The Key for Orthotic Treatment of Spine
Deformities
Free Papers
Paediatrics - 2
16:15 - 17:30
MR 1.02
12
Monday, Feb 4
Free Papers
Prosthetics : Lower Limb - 7
Time
& Room No.
Monday, Feb 4
Tuesday, Feb 5
16:15 - 17:30
MR 1.03
Free Papers
Prosthetics : Lower Limb - 3
Free Papers
Prosthetics : Lower Limb - 8
16:15 - 17:30
MR 1.05
Free Papers
Prosthetics : Upper Limb - 1
Free Papers
Prosthetics : Upper Limb - 3
16:15 - 17:30
MR 1.06
Free Papers
Orthotics: Lower Limb - 3
Free Papers
Pedorthics- Footwear & Shoes - 1
17:30 - 18:30
Welcome Reception till 18:30
Live Posters-1 till 18:00
Time
& Room No.
Wednesday, Feb 6
Thursday, Feb 7
09:00 - 10:15
Hall 3
Instructional Course: Rehab Medicine Instructional Course: Education
& Surgery
ICS Code 54- How to Write an Article
ICS Code 12- Neuroprosthesis for drop
foot in upper motor neuron syndrome
09:00 - 10:15
G.01
Exhibitor's Workshop
Vorum: CANFIT: Transforming P&O
Practices using CAD/CAM solutions
Exhibitor's Workshop
Tekscan: Usefulness of Pressure
mapping in the Prescription of P&O
09:00 - 10:15
G.02 & G.03
Symposium: Prosthetics Upper Limb
ICS Code 52- Advances in Upper Limb
Prosthetics
Instructional Course: Paediatrics
ICS Code 44- Advanced Dynamic
Orthotic Management for the Child with
Cerebral Palsy
09:00 - 10:15
G.04 & G.05
Instructional Course: Education
Symposium: Orthotics Lower Limb
ICS Code 38- ISPO Accredited Distance ICS Code 36- AFO biomechanics
Learning Blended Prosthetic and
Orthotic Education
Instructional Course: Rehab Medicine
& Surgery
ICS 61- Treatment Options for Charcot
Arthropathy (not yet confirmed)
09:00 - 10:15
G.06
09:00 - 10:15
MR 1.01 & 1.02
Symposium: Technology
Symposium: Technology
ICS Code 29- Robotic Exoskeletons and ICS Code 33- Manufacturing
Orthotics
Technologies: the digital approach to
design and production of Prostheses
and Orthoses
09:00 - 10:15
MR 1.03
Free Papers
Prosthetics : Lower Limb - 9
Free Papers
Prosthetics : Lower Limb - 13
09:00 - 10:15
MR 1.05
Free Papers
Education - 2
Free Papers
Rehab Medicine & Surgery - 4
09:00 - 10:15
MR 1.06
Free Papers
Orthotics: Lower Limb - 4
Free Papers
Innovations - 2
13
Time
& Room No.
14
Wednesday, Feb 6
Thursday, Feb 7
10:15 - 10:45
Break / Exhibition / Posters
Break / Exhibition / Posters
10:45 - 11:30
Hall 3
Keynote - Hall 3
Belts, Braces & Bones
by Ashok Johari
Keynote - Hall 3
Intelligent Biomechanical Machines
by Edward Lemaire
11:30 - 12:00
Break / Exhibition
Break / Exhibition
12:00 - 13.15
Hall 3
ISPO World Assembly for Members
Exhibition for other participants
Instructional Course: Rehab Medicine
& Surgery
ICS Code 50- Advances in Functional
Rehabilitation of Cerebral Palsy
12:00 - 13.15
G.01
Exhibitor’s Workshop
Freedom Innovations - Advanced
Lower Limb Prosthetics
Exhibitor's Workshop
Fillauer: Upper Extremity: Advances for
Elbow, Wrist and Terminal Devices
12:00 - 13.15
G.02 & G.03
Instructional Course: Education
ICS Code 26- Developing Prosthetic and
Orthotic Case Studies Using Applied
Biomechanics in Less Resourced
Settings for Demonstrating Clinical
Outcomes
12:00 - 13.15
G.04 & G.05
Symposium: Developing Countries
ICS Code 43- Haiti 2010 Earthquake:
Lessons Learned after 3 years
12:00 - 13.15
MR 1.01 & 1.02
Instructional Course: Prosthetics
Lower Limb
ICS Code 15- Subischial Sockets
with Vacuum Assisted Suspension for
Persons with Transfemoral Amputation
12:00 - 13.15
MR 1.03
Free Papers
Prosthetics : Lower Limb - 14
12:00 - 13.15
MR 1.05
Free Papers
Orthotics: Lower Limb - 5
12:00 - 13.15
MR 1.06
Free Papers
Evidence Based Practices - 3
13:15 - 14:30
Lunch / Exhibition / Live Posters-2
Lunch / Exhibition / Live Posters-2
14:30 - 15:45
Hall 3
Instructional Course: Rehab Medicine
& Surgery
ICS Code 27- Reduced walking
distance: does AFO treatment benefit?
Practical application of clinical energy
cost and fitness assessments in children
with cerebral palsy
Instructional Course: Orthotics Lower
Limb
ICS Code 48- Osteoarthritis creates a
heavy disease burden
14:30 - 15:45
G.01
Exhibitor's Workshop
Exhibitor's Workshop
Össur: Outcome Focused Solutions for Fillauer: Lower Extremity: Foot
Low Active Users
Advances in Performance and Comfort
Time
& Room No.
Wednesday, Feb 6
Thursday, Feb 7
14:30 - 15:45
G.02 & G.03
Symposium: Wheelchair & Seating
ICS Code 53- Wheelchair Consensus
Conference, Guidelines and Training
Packages
Instructional Course: Developing
Countries
ICS Code 30- Jaipur Limb Technology
14:30 - 15:45
G.04 & G.05
Symposium: Orthotics Lower Limb
ICS Code 22- Can orthoses enhance
postural stability? Implications for fall
prevention
Instructional Course: Prosthetics
Lower Limb
ICS Code 1- Biomechanical and
functional principles of transfemoral
socket designs
14:30 - 15:45
G.06
Free Papers
Orthotics : Spinal - 1
Free Papers
Rehab Medicine & Surgery - 5
14:30 - 15:45
MR 1.01
Free Papers
Prosthetics : Upper Limb - 4
Free Papers
Prosthetics : Upper Limb - 6
14:30 - 15:45
MR 1.02
Free Papers
Paediatrics - 3
Free Papers
Sports And Physical Activity - 2
14:30 - 15:45
MR 1.03
Free Papers
Prosthetics : Lower Limb - 10
Free Papers
Prosthetics : Lower Limb - 15
14:30 - 15:45
MR 1.05
Free Papers
Developing Countries - 3
Free Papers
Quality Of Life Issues - 2
14:30 - 15:45
MR 1.06
Free Papers
Prosthetics : Lower Limb - 11
Free Papers
General- 1
15:45 -16:15
Break / Exhibition / Live Posters-2
Break / Exhibition / Live Posters-2
16:15 - 17:30
Hall 3
Instructional Course: Prosthetics
Lower Limb
ICS Code 13- Microprocessor knees,
How to maximize functional ability
Closing Ceremony
16:15 - 17:30
G.01
Exhibitor's Workshop
DIERS Int: New standard in functional
analysis of the musculoskeletal system
16:15 - 17:30
G.02 & G.03
Instructional Course: Rehab Medicine
& Surgery
ICS Code 32- Rehabilitative and
prosthetic approach to patients
with amputation for lower limb
musculoskeletal tumors
16:15 - 17:30
G.04 & G.05
Instructional Course: Orthotics
Lower Limb
ICS Code 55- Orthotics for Clubfoot
16:15 - 17:30
G.06
Free Papers
Developing Countries - 4
16:15 - 17:30
MR 1.01
Free Papers
Seating & Wheelchair - 1
15
Time
& Room No.
16
Wednesday, Feb 6
16:15 - 17:30
MR 1.02
Free Papers
Orthotics : Spinal - 2
16:15 - 17:30
MR 1.03
Free Papers
Prosthetics : Lower Limb - 12
16:15 - 17:30
MR 1.05
Free Papers
Prosthetics : Upper Limb - 5
16:15 - 17:30
MR 1.06
Free Papers
Technology - 1
17:30 - 18:30
Live Posters - 2 till 18:00
Thursday, Feb 7
Knud Jansen & Keynote Speakers
17
KEYNOTES
Feb 4, 10:15 – 11:30
Session name and Room: Opening Ceremony
Title: Knud Jansen Lecture
Presenter: Carson Harte
Hall 3
Carson Harte has worked as a Prosthetist Orthotist in the Rehabilitation Engineering Centre of Musgrave Park
Hospital, Belfast through the 1980s. In 1993, he joined The Cambodia Trust as the founder Director of the
Cambodia School of Prosthetics and Orthotics. In 2000, in partnership with The Nippon Foundation, he moved to
Singapore, as Cambodia Trust International Director, and developed a strategic plan for P&O training in SE Asia.
The plan developed by Carson Harte has led to the establishment of training schools in different Asian countries
- Sri Lanka (2004), Indonesia (2008) Philippines (2011) and Myanmar (2013). Working in partnership with the
schools in Thailand, Vietnam and Pakistan, and encouraging regional developments through the Alliance of P&O
schools in Asia (APOS), the Cambodia Trust is coordinating the largest group of P&O training providers in the
world.
Throughout his career, Harte has actively campaigned alongside disabled people for the rights of people with
disabilities throughout the region. Harte has helped co-found the Disability Action Council of Cambodia, which
confronts discrimination against disabled individuals, advocates equality in the workplace, coordinates services to
the country’s extensive disabled population. His efforts have helped enact new legislation bringing increased legal
rights to people with disability.
Carson, living in Northern Ireland, supports electronically and physically, a network of highly motivated and
professional staff across the region. Carson is now developing, with partner organizations a sustainable model of
service delivery, suitable for this fast growing economic powerhouse that is Asia. He has been and remains, an
active ISPO education committee member.
18
Feb 5, 10:45 - 11:30
Hall 3
KEYNOTES
Session name and Room: Keynote Lecture
Title: Technology and P&O Services in India
Presenter: Surinder Mehta
Surinder Mehta, Padma Shri, is the Founder and President of International Society for Human Welfare and
Rehabilitation “ISHWAR” and Founder Chairman Prime Group of Companies. Being an above-knee amputee since
childhood has not been an impediment to his vision. He started ISHWAR as a non-profit organization to assist
the needy and disabled persons to regain independence and confidence. ISHWAR runs artificial limb centres and
camps in remote areas and has a mobile P&O workshop for free services to the needy at their doorstep even in
far-flung rural areas.
He heads the 23 Companies conglomerate Prime Group, with varied interests worldwide, focusing on technology
based businesses relating to power & energy, precision engineering, aviation & aerospace, IT, EHV Transformer
manufacturing, Investment castings, EPC projects and others. A unique technology for quick restoration of power
in disaster-affected areas has been developed through the Emergency Restoration Systems.
His flair for high technology and his compassionate feelings for amputees and the disabled prompted Mr. Mehta
to lay the foundations of an organization called Endolite India Ltd. with the intent to bring the world’s latest
advancements in this field to the doorsteps of the needy people in India at affordable prices. In addition, the lack of
professional education and training in India has been addressed by setting up the ISHWAR Institute of Prosthetics
and Orthotics to provide short term and degree courses.
19
KEYNOTES
Feb 6, 10:45 - 11:30
Session name and Room: Keynote Lecture
Title: Belts, Braces and Bones
Presenter: Dr Ashok Johari
Hall 3
Dr Ashok Johari is a Paediatric Orthopaedic and Spine surgeon and has specialized in pediatric orthopaedics. He
has worked and trained in various countries. He started a pediatric orthopaedic unit at one of Mumbai’s medical
colleges in end 1985 and then went on for specialized pediatric orthopaedic practice including pediatric disabilities
and spinal deformities in addition to routine pediatric orthopaedics.
His current research interests include use of Botulinum in the second decade and below the age of 3 years,
surgery in neglected Cerebral Palsy patients and spinal deformities in the growing spine. Many workshops have
been conducted by him on paediatric orthopaedics, spinal deformities, cerebral palsy, spasticity management, and
on surgery in Cerebral Palsy.
Dr Johari has many distinctions, fellowships, awards and numerous papers and publications to his credit. He
has been the Founder and President of various orthopedic and pediatric societies. He is a fellow member of
the American Academy of Cerebral Palsy and Developmental Medicine and is an Active Fellow of the Scoliosis
Research Society and was awarded its prestigious International Traveling Fellowship. The London College
awarded the FRCS to Dr Johari. He also has the distinction of being the Editor in Chief of the prestigious Journal
of Pediatric Orthopaedics (B) and is on the Editorial and Reviewer Boards of many others.
He is a pioneer and innovator in many fields of orthopaedics and his contributions have been widely recognised.
20
Feb 7, 10:45 - 11:30
Hall 3
KEYNOTES
Session name and Room: Keynote Lecture
Title: Intelligent Biomechanical Machines
Presenter: Dr Edward Lemaire
Dr Lemaire is an Associate Professor in the Ottawa Faculty of Medicine, Member of the Ottawa Hospital Research
Institute, and the Ottawa-Carleton Institute for Biomedical Engineering. He is President of the Canadian National
Society for the International Society for Prosthetics and Orthotics (ISPO) and serves on the ISPO International
Scientific Committee.
His focus has been on Technology and its immense sustained impact on human mobility and delivery of physical
rehabilitation services. His research focusses on the application of computing and mobility technologies to enhance
the quality of life for people with disabilities and the elderly.
Dr Lemaire’s achievements include the Rehabilitation Intelligent Mobility Systems (RIMS) initiative that focuses
on developing, evaluating, and implementing intelligent assistive device and related technologies to improve
the lives of people with disabilities. Wearable robotics is another achievement that applies robotic technology to
devices that augment or replace human motor tasks by integrating the human and robot into a single system. The
Intelligent Virtual Reality Systems for Physical Rehabilitation replace the physical world with a virtual environment
and also enhances the rehabilitation process in a manner that is difficult to replicate in the typical clinic.
The Mobility Research Network – MoRe – developed by Dr Lemaire brings together experts from a variety of fields
to develop innovative solutions that enhance human mobility in the community and thereby improve quality of life.
21
22
FREE PAPERS
FREE PAPERS
23
FREE PAPERS
Mon, Feb 4 / 12:00 - 13.15
Prosthetics : Lower Limb - 1 / Room 1.03
Presenter Name
Page No.
Predictors of prosthetic use in individuals with lower limb amputation
at 6 and 12 months after discharge from rehabilitation.
C. Roffman
39
Biomechanical advantages of a new microprocessor-controlled
prosthetic knee joint
M. Bellmann
40
Fall Prevention Training Program for Persons with Lower Extremity
Amputations: Early Results
K. Kaufman
41
C-leg vs. mechanical knee: Impact on functional outcomes in K2
transfemoral dysvascular amputees
A. Jayaraman
42
Socket/Liner Interface Volume and Vacuum Pressure Decay in
Persons with Transfemoral Amputations
S. Fatone
43
Do orthotic walkers affect knee and hip function during gait?
J. Richards
44
A Microprocessor Stance and Swing Control Orthosis improves the
walking ability of traditional KAFO users
A. Kannenberg
45
Immediate biomechanical effects of a new microprocessor controlled
stance and swing phase KAFO system
T. Schmalz
46
Timing of ankle-foot orthoses after stroke: first Results of a
randomized longitudinal study
C. Nikamp
47
Mediolateral Foot Placement During Post-Stroke Ambulation With and
Without an Ankle-Foot Orthosis
A. Zissimopoulos
48
Large-scale administration of shortened versions of the Prosthesis
Evaluation Questionnaire - Mobility Subscale (PEQ-MS) and Activities
Specific Balance Confidence Scale (ABC) in persons with lower limb
loss
B. Hafner
49
Effective factors influencing Evidence Based Practice in Prosthetics
and Orthotics
S. Gautam
50
Guidance on the management of post operative residuum oedema in
lower limb amputees.
M. Cole
51
The Amputee Mobility Predictor for People with Bilateral Lower-limb
Loss.
R. Gailey
52
Expectations of Rehabilitation following lower limb amputation: A
qualitative analysis
C. Ostler
53
Orthotics: Lower Limb - 1 / Room 1.05
Evidence Based Practices - 1 / Room 1.06
24
Mon, Feb 4 / 14:30 - 15:45
Presenter Name
Development of a Rear-Locking Prosthetic Knee Mechanism with
Improved Stability Characteristics
J. Andrysek
54
The effect of alignment on the balance and confidence of trans
femoral prosthetic users: A literature review.
D. Fisher
55
What advantages do energy return feet offer the lower limb prosthetic
user?
A. Crimin
56
Efficacy of Genium versus C-Leg on Functional Level, Standing and
Walking Exertion, and Heart Beats
J. Highsmith
57
Clinical assessment of two common suspension systems for transtibial H. Gholizadeh
amputees
Page No.
FREE PAPERS
Prosthetics : Lower Limb - 2 / Room 1.03
58
Developing Countries - 1 / Room 1.05
Moving Toward Culturally Sensitive Organization Practice: Three
cross- cultural perspectives
J. Odeyo
59
Re-Examining Project Sustainability- Lessons Learned in Haiti
J. Batzdorff
60
Disability and gender inclusion in prosthetics and orthotics professionChallenges in Asia and the Pacific region
S. Kheng
61
Leveraged Freedom Chair Indian Trial and Partnerships for
Dissemination
N. Scolnik
62
Living as a Person requiring Prosthetics in Nepal - A qualitative
investigation in accordance with the Convention on the Rights of
Persons with Disabilities
A. Fransson
63
Hand-and-wrist exoskeleton device for the rehabilitation of grasping
function.
M. Troncossi
64
Patients’ perceptions on the use of prefabricated wrist-hand orthoses
in the management of rheumatoid arthritis
K. Ross
65
The effect of prefabricated wrist-hand orthoses on grip strength
M. O'Hare
66
The effect of prefabricated wrist-hand orthoses on performing activities M. O'Hare
of daily living
67
Orthotics: Upper Limb - 1 / Room 1.06
Orthotics: Lower Limb - 2 / Room G.06
Superior efficacy of Low-Load Prolonged Strech Dynamic Orthosis
(Ultraflex) in cerebral palsy : application for knee flexion contractures
I. Heymann
68
Effectiveness of different configuration of Ankle Foot Orthoses in
Spastic Diplegic Cerebral Palsy: Literature Review
H. Trivedi
69
Gait efficiency of healthy persons and polio survivors while walking
with carbon fiber-reinforced plastic, weight-added carbon fiberreinforced plastic and conventional knee-ankle-foot orthoses
Y. Nakanishi
70
The conservative management of Plantarfasciitis, a literature review
and clinical trial of assessement Methods for dorsiflexion ROM
A. McGarry
71
25
FREE PAPERS
Mon, Feb 4 / 16:15 - 17:30
Prosthetics : Lower Limb - 3 / Room 1.03
Presenter Name
Page No.
Implementation of Combined Advanced Technologies to Assess
Multiple and Different Qualities of a Hydraulic Prosthetic Foot
I. Siev-Ner
72
The Outcomes of Lower Limb Amputee Rehabilitation are Changing
H. Batten
73
The prosthesis and weight-bearing contributions on EMG response
latency subsequent to rapid platform perturbation in transtibial
prosthesis users
D. Rusaw
74
The Effects of Transtibial prosthesis on correction of knee Flexion
Contracture
F. Kazemi
75
Understanding residual limb volume loss; utilising a physical model
(Manikin)
A. Buis
76
Functional differences between standard and multigrip myoelectric
hands in performing activities of daily living
A. Kannenberg
77
Learning curves of Southampton Hand Assessment Procedure tasks
in novice prosthetic users
E. Vasluian
78
Sensibility of upper limb stumps in children and adults
C. Van Der Sluis
79
An improved approach to anchoring surface-EMG sensor for TMR
patients
J. Kalmar
80
A comparative assessment of the Functionality of Multi-function
Prosthetic hands
P. Kyberd
81
Clinical application of robotic orthosis for patients with lower limb
paralysis
H. Kimura
82
Effect of ankle-foot orthoses on gait biomechanics of early stroke
patients.
S. Solomonidis
83
The Effects of Foot Orthoses and Knee Orthoses on Gait Pattern
and Muscular Activation of Patients with Medial Compartment Knee
Osteoarthritis.
C. Lin
84
Care pathways in the lower limb orthotic management of children with
cerebral palsy in the NHS
S. Lalor
85
Effect of carbon-fiber-reinforced plastic knee-ankle-foot orthosis on
gait: a gait analysis study on polio survivors
F. Wada
86
Prosthetics : Upper Limb - 1 / Room 1.05
Orthotics: Lower Limb - 3 / Room 1.06
26
Presenter Name
The Endo-Exo-Prosthesis for Rehabilitation of Amputees
D. Juhnke
Page No.
87
Opinion of certified prosthetists orthotists on the International
Classification of Functioning, Disability and Health (ICF)
M. Mlakar
88
The Results of simplified AFO after minimum invasive surgery (MIS)
for spastic foot deformity in patients with stroke hemiplegia
Y. Konishi
89
Knee disarticulation in orthopaedic patients: surgical technique and
experience over 13 years
S. Sooriakumaran
90
Failed open reduction in Charcot´s arthropathy of the foot
U. Illgner
91
The use of vibratory feedback to improve postural stability of
individuals with transtibial amputation
D. Rusaw
92
Transverse Cross Sectional Surface Area and Circularity Consistency
for Hands-off and Hands-on Casting of below Knee Residual Limb
Using MRI
A. Buis
93
Management of Diurnal Residual Limb Volume Change.
E. Brannigan
94
Additional value of a Microprocessor Controlled prosthetic Knee in
starting and stopping gait- pilot Results
M. Nederhand
95
Adaptation strategies of the lower extremities of patients with a
transtibial or transfemoral amputation during walking: A systematic
review.
E. Prinsen
96
Quantifying community mobility and social interaction in individuals
with lower limb amputations
A. Jayaraman
97
Quality of Life of Women with disabilities using Orthotic and Prosthetic
Devices in South India
K. Göbel & K.
Jensen
98
Health profiles of persons with lower limb loss
B. Hafner
99
The use of focus groups to aid in the development of a mobility
outcome measure
D. Amtmann
100
Poliomyelitis patients in south India – a study measuring quality of life
J. Jonasson
101
The use of defo's shorts in the treatment of abduction contracture of
the hipjoint
A. Suzuki
102
Exploring the views of children, parents and clinicians to contribute
towards the development of upper limb prostheses
T. Sims
103
Gait pattern in children with cp and leg length discrepancy, effects of
an extra sole.
R. Zugner
104
Estimation of recurrence with Dennis brown splint and to describe the
issues related to non-compliance in patients with club foot.
Z. Zahid
105
Effect of custom molded rigid foot orthosis on the functional lumbar
scoliosis in children
B. Kim
106
FREE PAPERS
Rehab Medicine & Surgery - 1 / Room G.06
Tue, Feb 5 / 09:00 - 10:15
Prosthetics : Lower Limb - 4 / Room 1.03
Quality of Life Issues - 1 / Room 1.05
Paediatrics - 1 / Room 1.06
27
FREE PAPERS
Tue, Feb 5 / 12:00 - 13:15
Prosthetics : Lower Limb - 5 / Room 1.03
Presenter Name
Effect of Prosthetic Ankle Units on Roll-Over Shape Characteristics
During Walking in Persons with Bilateral Transtibial Amputations
S. Gard
Page No.
107
A preliminary evaluation of a Hydro-cast trans-femoral prosthetic
socket design, a proof of concept
A. Buis
108
Influence of a microprocessor controlled prosthetic knee on
biomechanics of gait initiation, preliminary Results.
E. Prinsen
109
Effects of variable stiffness prosthesis on walking kinematics during
load carriage
A. Kregling
110
Long-term experiences with a hydraulic ankle capable of selfalignment – a review and development roadmap
J. Ross
111
Car adaptations for subjects following upper limb amputation
H. Burger
112
Osteoporosis Among Adult Filipinos with Unilateral Lower Limb
Amputation
J. Montes
113
AKAN®: an improvement for the trans-femoral amputee?
A. Lacraz
114
Effect of Diabetes on postoperative ambulation following below knee
amputation
A. Saraf
115
Roehampton Stump Score - a method of estimating quality of stump
for prostheticrehabilitation
S. Sooriakumaran
116
Effects on user mobility and safety when changing from a dynamic
prosthetic footto a bionic foot
A. Ludviksdottir
117
Clinical Application of Self-Report and Performance Based Outcome
Measures toDetermine Clinical Effectiveness.
R. Gailey
118
Rehab Medicine & Surgery - 2 / Room 1.05
Evidence Based Practices - 2 / Room 1.06
Evaluation of Dynamic Prosthetic Alignment Techniques for Individuals J. Andrysek
withTranstibial Amputation
119
Factors influencing the reliability of different designs ofgoniometer: A
literature review
120
28
F. Mohsin
Tue, Feb 5 / 14:30 - 15:45
Presenter Name
Page No.
Requirements for effective use of pattern recognition controlled
multipledegrees of freedom (DoF) transradial prostheses in the
habitual environment
J. Kalmar
121
Mechanical Testing and Design Refinement of a Low Cost MultiFunctional TerminalDevice - The UNB Hand
P. Kyberd
122
Intermanual Transfer in Upper-Limb Myoelectric Prosthetic Training in
Childrenand Adults using a prosthetic simulator
S. Romkema
123
Influence of tasks on the validity of the Assessment of Capacity for
MyoelectricControl (ACMC)
H. Lindner
124
Universal Coupler for Upper-Limb Prostheses
J. Sensinger
125
Self-management training for prosthetic rehabilitation: a
participativeinnovation study
S. Van Twillert
126
Prosthetic ankle-foot system that adapts to ramps on every step
A. Hansen
127
Pro-mouse
Paulas. R
128
A novel research and clinical approach to using gel liners for collection
ofsurface emg data for myoelectric control
L. Miller
129
Influence of a microprocessor controlled prosthetic knee on
biomechanics of gaittermination, preliminary Results
E. Prinsen
130
DXA evaluation of femoral amputees with osseointegrated prosthesis
P. Jørgensen
131
Movement Optimisation Approach of an Integrated Microprocessor
ControlledIntelligent Biomimetic Limb
J. Ross
132
Development of the Transfemoral Fitting Predictor - a Functional
Measure toPredict Prosthetic Potential in Transfemoral Amputees
L. Whitehead
133
Energy expenditure of transfemoral amputees walking with different
speeds on different walking surfaces
I. Starholm
134
Competencies and development of graduates of an African regional
training centreworking in low-income countries
S. Sexton
135
The revised Shape&Roll Prosthetic Foot for use in low-income
countries -Implementation in Haiti
V. Agrawal
136
Creating a gait analysis laboratory in Venezuela: a combination of
local andinternational efforts
R. Torrealba
137
A Low Cost Orthosis NAZH For Developmental Dysplasia Of the Hip
(DDH)
A. Ali
138
Cost effective clubfoot braces for low-income countries: Defining the
need.
M. Steenbeek
139
FREE PAPERS
Prosthetics : Upper Limb - 2 / Room 1.01
Innovations - 1 / Room 1.02
Prosthetics : Lower Limb - 6 / Room 1.03
Developing Countries - 2 / Room 1.05
29
FREE PAPERS
Rehab Medicine & Surgery - 3 / Room 1.06
Presenter Name
Factors related to overuse syndromes in subjects following upper limb
amputation
H. Burger
Page No.
140
The Roehampton experience of transfemoral bone anchored
prosthetic rehabilitation
S. Sooriakumaran
141
Comparison of co-morbidities in a lower limb amputee population nine
years apart.
N. Ryall
142
Effect of intensive rehabilitation on functional outcome after single
eventmultilevel surgery in cerebral palsy
D. Sharan
143
The role of neural prostheses in rehabilitation of patients with disability
M. Sayyadfar
144
Training for older people with a femuramputation. A study of exercise
importantfor mobility and confidence in coping
J. Schack
145
Gross mechanical efficiency (GE) and physical strain of the combined
arm-leg(Cruiser) ergometer in healthy subjects
R. Dekker
146
Long-term step activity in persons with transfemoral amputation
B. Hafner
147
The Comprehensive High-level Activity Mobility Predictor (CHAMP) a
Measure ofHigher Level Prosthetic Performance in Service Members
with Traumatic Lower LimbLoss
R. Gailey
148
Management of children with a congenital deficiency of the leg: N1
case study
O. Teap
149
A Novel Concept of Correction of CTEV by Serial AFO's Using
PONSETI Methodology
N. Singh
150
Biomechanical Analysis Of Plantar Loading Pattern When Walking
With FootOrthoses For Juvenile Hallux Valgus
S. Law
151
Orthotic Variance in the Conservative Management of Congenital
TalipesEquinovarus CTEV: a Literature Review.
R. Bowers
152
A literature review on paediatric idiopathic flat feet
R. Bowers
153
Arm Forces during Assisted Sit-To-Stand and Stand-To-Sit Activities
inunilateral lower-limb amputees
M. Stalin
154
Effects of the hypobaric Iceross Seal-In® X-5 Membrane on prosthetic
suspensionand quality of life: comparison with the standard suction
socket system.
A. Ludviksdottir
155
A prosthesis design platform centred on digital amputee
C. Rizzi
157
An Interim Analysis of the Effect of the Genium Knee on Balance and
Stability
J. Kahle
157
Sports And Physical Activity - 1 / Room G.06
Tue, Feb 5 / 16:15 - 17:30
Paediatrics - 2 / Room 1.01
Prosthetics : Lower Limb - 7 / Room 1.02
30
Presenter Name
Investigation of In Vivo Prosthesis/Residual Limb Stiffness using a
Novel ImpactTest Apparatus
S. Gard
Page No.
158
Factors influencing rehabilitation outcome for lower limb amputees at
the RedCross Hospital, Sweden
H. Sundgren
159
Prosthetic use with transfemoral osseointegrated prostheses - long
termprospective Results from the OPRA-study
K. Hagberg
160
Documenting the rehabilitation process of patients with lower limb
prosthesis
D. Heitzmann
161
Malawian Prosthetic and Orthotic Users’ Performance and Satisfaction L. Magnusson
with theirLower Limb Assistive Device
162
FREE PAPERS
Prosthetics : Lower Limb - 8 / Room 1.03
Prosthetics : Upper Limb - 3 / Room 1.05
The Use of Multiple Sensors in the Control of Prosthetic Arms
P. Kyberd
163
Searching for optimal channel configuration and number in
multichannelmyoelectric prosthesis control
D. Boere
164
Functional Comparison of Voluntary Opening and Voluntary Closing
Body-poweredProstheses
J. Sensinger
165
Type of feedback while learning to control force with a myoelectric
prosthesis.
R. Bongers
166
Measuring physical and psychosocial outcomes of patients usingmultiarticulating hand prostheses
A. Goodwin
167
U. Tang
168
Pedorthics - Footwear - 1 / Room 1.06
Effectiveness of insoles in preventive treatment of diabetic patients
The Role a Total Contact Insole in diminishing foot pressures following R. El-Hilaly
Firstray amputation in diabetics
169
A proximally placed rocker bar and external ankle moments during
walking andslow-speed running
K. Postema
170
Traditional vs Digital in the design and manufacture of custom orthotic
insoles
D. Swatton
171
Smart materials inspiring innovation in p & o field
S. Rout
172
Embedding Engineering Skills into Prosthetics and Orthotics Degree
Education:Examples of Approaches Implemented and Outcomes
N. Hamzaid
173
Training of orthopaedic technologists in Francophone Africa: a
challenge
K. Aklotsoe
174
Alliance of prosthetics and orthotics schools-asia (APOS)
T. Heang
175
Four Different Trial Knee Disarticulation Prosthesis for Teaching
Prosthetistsand Physicians
B. Kim
176
Education - 1 / Room G.06
31
FREE PAPERS
Wed, Feb 6 / 09:00 - 10:15
Orthotics: Lower Limb - 4 / Room 1.06
Presenter Name
Page No.
Outcome of 23h Bracing for Tip-toe-walking Children with Cerebral
Palsy
C. Grasl
177
Mechanical properties of a spring-hinged floor reaction orthosis
Y. Kerkum
178
A Systematic Literature Review Comparing Ankle-Foot Orthoses and
Functional Electrical Stimulation in the Treatment of Patients with
Multiple Sclerosis.
E. Davidson
179
Walker braces improve gait compared to traditional walking casts
A. Ludviksdottir
180
Orthotic treatment using shoe inserts for talipes planovalgus in
children
T. Asami
181
Spinal Motion During Walking in Persons with Transfemoral
Amputation with and without Low Back Pain
S. Gard
182
Gait strategies of transfemoral amputees walking downhill
D. Heitzmann
183
Experiences of Providing Prosthetic and Orthotic Services in Sierra
Leone — theLocal Staff’s Perspective
L. Magnusson
184
A methodological approach to integrate psychological factors to lower
limb prosthetic functional design
J. Wojtusch
185
Secondary posterior keel in carbon fiber prosthesis changes the footground kinetic interactions during walking
A. Kregling
186
ISPO Cat 1 Pathway for a P&O program in Japan
M. Uchida
187
Strengthening Prosthetics and Orthotics schoolResearch Strategy:
Case Study
M. Samala
188
PIPOS Academic Clinical Placement for semester VII and VIII
students
U. Jabeen
189
The conceptual foundations of modern educational standard of
trainingprosthetics specialists
E. Shataeva
190
Assessing learning-style References of rehabilitation professional
students attending Mobility India training Institute in Bangalore, India.
V. Masilamani
191
Prosthetics : Lower Limb - 9 / Room 1.03
Education - 2 / Room 1.05
32
Wed, Feb 6 / 14:30 - 15.45
Presenter Name
Page No.
Changes in movement characteristics while learning to use a
myoelectric prosthetic simulator
R. Bongers
192
Body structures and physical complaints in Upper Limb Reduction
Deficiency: a 24year follow up study
S. Postema
193
Force Perception during Ipsilateral Scapular Cutaneous Anchor
System versusFigure of 9 Shoulder Harness Operation
M. Hichert
194
Assessment of Prosthesis Use by Visual Attention Analysis
A. Hussaini
195
Acceptance of Powered Prosthesis in Upper Limb Congenital
Deficiency
R. Munjal
196
The Orthotic Management of Deformational Plagiocephaly: A Review
of the CurrentLiterature
R. Kakaiya
197
Outcome of Single Event Multilevel Lever Arm Restoration and Anti
SpasticitySurgery for Cerebral Palsy
D. Sharan
198
Distribution of gait abnormalities in very young children with bilateral
spasticCP according to the Modified Amsterdam Gait Classification.
Implication fororthotic management.
M. Bonikowski
199
A Bionic Foot - Compliance Control Supports a Broad Range of ADLs
in Real Time
P. Kampas
200
Performance and Satisfaction with Assistive Devices among
Amputees and PolioPatients in Sierra Leone
L. Magnusson
201
Functional Significance of a Biomimetic Hydraulic Ankle/Foot System
E. Iversen
202
A systematic and methodical approach for the development of
powered knee prostheses
B. Budaker
203
The Development of a Knee Joint NAL-Knee, and Evaluation of a Gait
Test about Using it
M. Ninomiya
204
Aiming technology in developing countries to obtain high quality
prostheses atlow cost
R. Torrealba
205
Living with a Physical Disability in Malawi: A Prosthetic and Orthotic
PatientPerspective
E. Berg Lissel
206
Assessment of Functional Capability and Self-esteem of Haiti
Earthquake Victimswith Lower-limb Loss
R. Gailey
207
The Hispaniola Island Prosthetic and Orthotic Education Program
(HIPOE) – AnOverview
D. Lawrence
208
Implementing national programmes for clubfoot in 20 low income
countries:progress over 2 years
M. Steenbeek
209
FREE PAPERS
Prosthetics : Upper Limb - 4 / Room 1.01
Paediatrics - 3 / Room 1.02
Prosthetics : Lower Limb - 10 / Room 1.03
Developing Countries - 3 / 1.05
33
FREE PAPERS
Prosthetics : Lower Limb - 11 / Room 1.06
Presenter Name
Clinical experiences with temporary socket and modular socket
system in patients with lower limb amputation
H. Hashimoto
Page No.
210
Stress Analysis of Different Rigid Frame Designs within a Flexible
Transfemoral Prosthetic Socket
S. Fatone
211
Assessing gait adaptability longitudinally in rehabilitation after a
transtibial amputation.
K. Schenkeveld
212
The role of quadratus lumborum muscle in asymmetrical loading
condition inunilateral transtibial amputee
A. Vimal &
S. Sharma
213
Moisture Management Within A Prosthetic Socket
J. McCarthy
214
Use of 3D Volume Rendered CT Scans in the Design and Fabrication
of TLSO
P. Ammanath
215
The effect of spinal bracing on sitting function in children with scoliosis
andneuromuscular impairment
A. Blomkvist
216
The application of asymmetric loading for spine curvature correction in
subjectswith adolescent idiopathic scoliosis
H. Cheng
217
A case study of biomechanical effect of spinal orthosis on scoliotic
spineversus time domain
M. Li
218
A study of size classification using K-means clustering applying to the
BostonBrace in Japan
B. Masuhara
219
V. Agrawal
220
Orthotics : Spinal - 1 / Room G.06
Wed, Feb 6 / 16:15 - 17:30
Seating & Wheelchair - 1 / Room 1.01
Design And Development Of A Wheelchair Having An Integral
Transfer Board.
The rapid provision of appropriate wheelchairs in emergency situations D. Constantine
221
A project on Prefabricated Special Chair
M. Kumari
222
Design of a Standing Wheelchair
S. Veer
223
The Effectiveness of Milwaukee Brace on thoracic Hyperkyphosis in
Patient Referred to the Iranian Red Crescent Society
M. Marashian
224
The clinical investigation of wireless posture monitoring system in
treating patients with Osteoporotic Vertebral Fracture
L. Wang
225
Development of a new cervico thoracic orthoses Its design & pilot
evaluation
T. Hanajima
226
The ReWalk Powered Exoskeleton: a powered orthosis to Restore
Ambulatory Function to Individuals with Thoracic-Level MotorComplete Spinal Cord Injury
A. Esquenazi
227
Orthotics : Spinal - 2 / Room 1.02
34
Presenter Name
A Biomechanical Model for the Estimation of Dynamic Interactions at
theTransfemoral Socket Interface
J. Wojtusch
Page No.
228
Analysis of ankle biomechanics with an advanced microprocessor
controlledankle-foot prosthesis
J. McCarthy
229
Service and Cost of Transfemoral Osseointegrated prostheses
compared toSocket-suspended prostheses
E. Häggström
230
Does a Mechanically-Demanding Task Exaggerate the Effect of
Prosthetic Alignmentfor Persons with Transfemoral Amputation?
S. Koehler
231
Biomechanical analysis of a new prosthetic suspension system for
lower limbamputees
A. Eshraghi
232
Arm Prosthesis Control:Perception of Cable Activation Forces and
Displacements
M. Hichert
233
Compensatory motions observed when performing bimanual Activities
of Daily Living
A. Hussaini
234
A Comparison Of Direct Control And Pattern Recognition Control Of A
SevenDegree-of-Freedom Hand Wrist System.
L. Miller
235
Rehabilitation and Outcome of Osseointegrated Amputation
Prostheses on Upper Limbs
K. CaineWinterberger
236
An indigenious design of shoulder disarticulation prosthesis
N. Ojha
237
Assessing the Prosthetics Needs of Farmers and Ranchers in the
U.S.A.:Interview Results
S. Fatone
238
Charcot Arhtropathy of hand and knee
U. Illgner
239
A Pilot Study Investigating The Intra and Inter-rater Reliability
OfSiliconcoach Within The Field Of Gait Analysis
E. Davidson
240
A potential design&manufacturing alternative at the service of
individual andfunctional orthotics production
M. Cavallaro
241
Description of a System for Wear Time Measurement for Orthopedic
Devices basedon Radio Frequency Identification (RFID) Technology
M. Roller
242
Prosthetics and Orthotics services in Afghanistan
M. Zia
243
A strategy to implement the locally maintainable limbs polycentric
knee in thedeveloping world on a large scale
R. Gonzalez
244
Exploring the Prosthetic and Orthotic Service and Barriers for
Receiving theService in Malawi, Based on Interviews with Patients.
G. Omarsdottir
245
A Descriptive Review of Lower Limb Amputation Cases in Benazir
Bhutto HospitalRawalpindi, Pakistan of Last Five Years
S. Muhammad
246
The impact of training personnel for prosthetic and orthotic services
indeveloping countries: an overview
S. Sexton
247
FREE PAPERS
Prosthetics : Lower Limb - 12 / Room 1.03
Prosthetics : Upper Limb - 5 / Room 1.05
Technology - 1 / Room 1.06
Developing Countries - 4 / Room G.06
35
FREE PAPERS
Thu, Feb 7 / 09:00 - 10:15
Prosthetics : Lower Limb - 13 / Room 1.03
Presenter Name
Page No.
Weight distribution symmetry during sit-to-stand and stand-to-sit
activities in transfemoral amputees
V. Agrawal
248
Transtibial Prosthetic Gait with Backpack Loads
E. Lemaire
249
The Influence of Polyurethane Cosmeses on the Mechanical
Performance of Transfemoral Prostheses
N. Cairns
250
Influence of ankle motion in reducing sit-to-stand and stand-to-sit
asymmetry of unilateral transtibial amputees
V. Agrawal
251
Ambulation and its support in patients with fibrodysplasia ossificans
progressiva
N. Haga
252
Functional Outcome of a New Surgical Approach in Severe Cerebral
Palsy (GMFCS IV and V)
D. Sharan
253
Recurrence in the Treatment of Charcot Foot Arthropathy
M. Berli
254
Is there a difference in the characteristics of an amputee population
when divided into outcome?
F. Smith
255
Locking single-axis prosthetic ankle for stability during standing
A. Hansen
256
Development of a Low-Cost Dilatancy-based Casting System for
Fabrication of Ankle-Foot Orthoses: A preliminary report
Y. Wu
257
Osseointegration in Transfemoral Amputees. The Gothenburg
Experience.
Ö. Berlin
258
Utilizing emg from individuals with lower limb amputations to control
powered prostheses
L. Miller
259
Improved Energy Management – A combination of Energy Efficient
structures and Optimised dynamic alignment.
J. McCarthy
260
Comparing prosthetic feet on ramps and stairs using the symmetry in
external work meassure
V. Agrawal
261
The Effect of Dermo and Seal-In X5 liner on Transtibial Amputees’
Satisfaction and Perceived Problems
S. Ali
262
Empirical support for distinct mobility groups of prosthetic users
D. Amtmann
263
Development of Mechanically Controlled Prosthetic Knee Unit for Stair
Ascent
K. Inoue
264
Rehab Medicine & Surgery - 4 / Room 1.05
Innovations - 2 / Room 1.06
Thu, Feb 7 / 12:00 - 13:15
Prosthetics : Lower Limb - 14 / Room 1.03
36
Presenter Name
A comparison of fibreglass casting and functional ankle brace for
ankle fractures
G. Omarsdottir
Page No.
265
Comparison of Anterior and Posterior AFO In Foot Drop Patients
Using Metabolic And Gait Analysis
H. Uppal
266
Use of Stance Control Knee- Ankle- Foot Orthoses: A Review of the
Literature.
P. McGeachan
267
Orthotic corrections of infantile tibia vara
S. Alsancak
268
Design of research studies in Prosthetics
A. Jayaraman
269
Intensive training camp for children with a myoelectric prosthetic hand
L. Hermansson
270
Improving the Quality of Prosthetic and Orthotic Services with Process
and Outcome Information
A. Heinemann
271
Mobility India Gait Training Approach for Unilateral Lower Limb
Amputee.
S. Moulic
272
BioPatRec: A Modular Research Platform for Prosthetic Control
Algorithms based on Bioelectric Pattern Recognition
M. Ortiz Catalan
273
Hand opening and grasping force feedback through vibrotactile
stimulation for users of myoelectric forearm prostheses
J. Rietman
274
Improving Outcomes for High Level Upper Limb Amputees
J. Miguelez
275
Design for Function:The Electric Terminal Device (ETD)– A 10-year
Review
H. Sears
276
The Osseointegrated Human-Machine Gateway: A Permanent
Bidirectional Interface for the Natural Control of Artificial Limbs
M. Ortiz-Catalan
277
Relative activity variations in persons with transfemoral amputation
B. Hafner
278
Using sports and peer mentoring to improve outcomes for disabled
children in northern Uganda
B. Humphrey
279
The advent of sprint prosthesis in Kenya
P. Ongubo
280
Motivations & Barriers to Prosthesis Users Participation in Physical
Activity, Exercise & Sport: A 2011 Review of the Literature
A. McGarry
281
FREE PAPERS
Orthotics: Lower Limb - 5 / Room 1.05
Evidence Based Practices - 3 / Room 1.06
Thu, Feb 7 / 14:30 - 15:45
Prosthetics : Upper Limb - 6 / Room 1.01
Sports And Physical Activity - 2 / Room 1.02
37
FREE PAPERS
Prosthetics : Lower Limb - 15 / Room 1.03
Presenter Name
The development of the PLUS-M, a new measure of mobility for
prosthetic limb users
D. Amtmann
Page No.
282
Mathematical analysis of prosthetic shank
M. Dash
283
Microprocessor-controlled Prosthetic Knees – A Review of the
Literature
T. Quake
284
New thermoplastic woven fabrics as the material of prosthetic sockets
S. Lee
285
An International Questionnaire on the Delivery of Lower-Limb
Prosthetic Treatment
J. Andrysek
286
Resection of proximal femur improves Quality of Life in Cerebral Palsy
patients with painful hip dislocations
C. Dussa
287
Quality of life measures differ between female and male young adults
with lower limb reduction defects
T. Kaastad
288
Impact of prosthetics and orthotics services on the Quality of Life
(QOL) of people with disabilities in India.
C. Khasnabis
289
Skin problems of the stump in lower limb amputees; influence on
functioning in daily life
H. Meulenbelt
290
Quality Of Life Issues - 2 / Room 1.05
General - 1 / Room 1.06
Birth prevalence and possible risk factors for congenital limb defects in E. Vasluian
the Northern Netherlands
291
Work-related musculoskeletal disorders in the Prosthetics and
Orthotics Profession
S. Anderson
292
Infections in Charcot´s arthropathy of the foot due to Pseudomonas
aeroginosa - the underestimated threat
U. Illgner
293
Infections with Pseudomonas aeruginosa in Charcot´s arthropathy of
the foot – the underestimated threat
U. Illgner
294
Prevalence of Flat Feet among School Children’s between 6-10 Years
M. Ali
295
Conversion of Hip Disarticulation into Above knee amputation and
Prosthetic Management
B. Dhar
296
Krukenberg Procedure - Revival of a Independence for Upper Limb
Amputees.
S. Chittoor
297
Geriatric Rehabilitation of lower limb amputees; A Dutch multicenter
cohort study
M. Spruit- Van Eijk
298
Bone anchored prostheses in upper arm amputees: Radiologic
outcomes.
R. Brånemark
299
Rehab Medicine & Surgery - 5 / Room G.06
38
Monday, Feb 4 / 12:00 - 13:15
Introduction
The study objective was to develop a clinical prediction rule(CPR) for individuals with lower limb amputation that
identifies variables predictive of prosthetic non-use following discharge from rehabilitation.
Design: Retrospective cohort study
Setting: Royal Perth Hospital - Shenton Park Campus
Participants: 135 consecutive rehabilitation patients (103 males, age 56.1(15.1) years)
Method
Medical records were audited for potential predictor variables of prosthetic use and non-use. Subjects were
interviewed at 1.9 (0.7) years after discharge to record if they were users or non-users and the time they stopped
using their prosthesis after discharge. Prosthetic use was determined for 6 and 12 months post-discharge.
Receiver operator curves were generated to determine the thresholds for continuous variables. Univariate analysis
(p < .1) identified the association between predictor variables and non-use. A stepwise logistic regression model
reduced these variables to a set of flags that were most accurate at predicting non-use. Likelihood ratios of a set
of parsimonious variables were generated as CPRs for each time frame.
Results
Prevalence of prosthetic non-use were 11% (15) and 19% (25) at 6 and 12 months. Significant predictors and
probability of predicting prosthetic non-use for the time frames were:
6 months: Amputation level above transtibial, mobility aid use, inability to walk on concrete, having > 19
comorbidities and Type II diabetes. If 4 out of 5 of these variables were present (LR+ = 32.0, CI = 3.61 to 748) the
probability of non-use increased to 80% (p < .0001).
12 months: Amputation level above transtibial, mobility aid use and delay to interim prosthesis > 156 days. If all
3 of these variables were present (LR+ = 74.8, CI = 12.6 to 1500) the probability of non-use increased to 94% (p
<.0001).
Discussion and Conclusion
These CPRs have implications for patient rehabilitation and service model development.
39
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 1
Room 1.03
Abstract Title: Predictors Of Prosthetic Use In Individuals With Lower Limb Amputation At 6 And 12 Months
After Discharge From Rehabilitation.
Abstract number: 13
Authors: C. Roffman, J. Buchanan, G. Allison
Presenter: C. Roffman
FREE PAPERS
Monday, Feb 4 / 12:00 - 13:15
Session Name and Room: Prosthetics : Lower Limb - 1
Room 1.03
Abstract Title: Biomechanical Advantages Of A New Microprocessor-Controlled Prosthetic Knee Joint
Abstract number: 47
Authors: M. Bellmann, S. Blumentritt, T. Schmalz, E. Ludwigs
Presenter: M. Bellmann
Objective
To investigate the immediate biomechanical effects after transition from an established microprocessor-controlled
knee (C-mpk) to a new microprocessor-controlled knee (G-mpk) an interventional cross-over study with
repeated measures was conducted in a motion analysis laboratory. Only prosthetic knee joints were changed. 11
men (mean age ± SD: 36.7 ± 10.2 years; Medicare functional classification level: 3 - 4) with unilateral transfemoral
amputation participated in the study.
Measurement techniques: optoelectronical six camera system (VICON 460, Oxford Metrics, GB) in combination
with two force plates (Typ 9287 A, Kistler, CH), L.A.S.A.R. Posture static analysis system (Otto Bock HealthCare
GmbH). Main outcome measures: Static prosthetic alignment, kinematic and kinetic parameters, time-distance
parameters, centre of pressure.
Results
After a one-day accommodation, significantly improved biomechanical outcomes were demonstrated by the G-mpk
compared to the C-mpk such as: lower ground reaction forces at weight acceptance during level walking at various
velocities, increased swing phase flexion angles during walking on a ramp and level walking with small steps,
nearly consistent maximum knee flexion angle during swing phase at various velocities, a more physiological load
distribution between the prosthetic and contralateral side as well as a more natural gait pattern during step-overstep stair ascent, increased knee flexion moments when descending stairs and ramps, reduced loading of the
prosthetic side hip joint as well as reduced postural sway during quiet stance on a decline.
Conclusions:
The G-mpk demonstrated immediate biomechanical advantages during various daily ambulatory activities for
people with above knee amputations. The Results showed that the use of the G-mpk facilitated more natural
gait biomechanics and load distribution throughout the affected and sound musculoskeletal structure. This was
observed during quiet stance on a decline, walking on level ground, and walking up and down ramps and stairs.
40
Monday, Feb 4 / 12:00 - 13:15
Introduction
Key factors limiting patients with amputations to achieve maximum functional capabilities are falls and fear
of falling. This research program focuses on rehabilitating lower extremity amputees to increase trust in their
prosthesis and reduce falls using a novel training method.
Methods
Three male service members with unilateral transtibial amputations (24+2 years, walking without an assistive device
for 7+2 months) were recruited at the Naval Medical Center San Diego and, prior to participation, signed informed
consent. The fall prevention training program utilized a microprocessor-controlled treadmill (Simbex, Lebanon,
NH, USA) designed to deliver task specific training perturbations. The training consisted of six, 30 minute sessions
where task difficulty increased as the patient’s ability progressed. Static and dynamic perturbations were used.
Training effectiveness was assessed using a perturbation test in an immersive virtual environment (MotekMedical,
Amsterdam). Trunk motion was assessed, since trunk kinematics at recovery step has been shown to determine
fall likelihood. Subjects also completed outcome questionnaires.
Results
Mean trunk flexion angle of the subjects at recovery step improved after participating in the fall prevention training
program (31º±9º pretest vs 15º±2º posttest on prosthetic limb trip; 27º±15º pretest vs 12º±2º posttest on nonprosthetic limb trip). Subjects reported increased confidence and heightened awareness of their ability to recover
from a stumble or trip.
Discussion
This novel rehabilitation method increased the ability of patients with lower extremity amputations to trust their
prostheses during challenging perturbations. This training has also been shown to reduce falls in older
adults.
Conclusions
These early Results indicate that task-specific training is an effective rehabilitation method to reduce falls in
persons with lower limb amputations.
Funding
DoD Grant DM090896; BUMED Wounded Ill & Injured Views expressed in the article are those of the authors and
do not necessarily reflect the official policy of DON, DOD or the US Government.
41
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 1
Room 1.03
Abstract Title: Fall Prevention Training Program For Persons With Lower Extremity Amputations: Early
Results
Abstract number: 52
Authors: K. Kaufman, M. Wyatt, P. Sessoms, M. Grabiner
Presenter: K. Kaufman
FREE PAPERS
Monday, Feb 4 / 12:00 - 13:15
Session Name and Room: Prosthetics : Lower Limb - 1
Room 1.03
Abstract Title: C-Leg Vs. Mechanical Knee: Impact On Functional Outcomes In K2 Transfemoral Dysvascular
Amputees
Abstract number: 61
Authors: A. Jayaraman, G. Mathur, R. Lipschultz, T. Kuiken
Presenter: A. Jayaraman
Introduction
Currently, dysvascular amputees are given a prosthetic knee based on the basic expectation that they will be
functionally stable. This consideration does not address higher levels of function like walking at multiple speeds and
over different terrains; a requirement for community ambulation and social interaction like non-injured individuals.
Newer microprocessor knees enable patients with transfemoral amputations to walk on different surfaces and at
multiple cadences. The jury is still out on the mechanical knee or the microprocessor knee’s capabilities to help
dysvascular amputees have a healthy lifestyle. The purpose of this study is to compare the functional outcomes
with the traditional mechanical knee (M-knee) versus the microprocessor knee (C-leg) in transfemoral amputees.
Methods
Ten individuals with K2 unilateral transfemoral amputations were randomly assigned either to the C-leg with
standard foot or M-knee with standard foot. Participants were given a 3 month acclimation period and then allowed
to use their knees in ever day life for 3 months. After six months, clinical and functional tests were performed to
test the impact of M-knee vs. C-leg on functional outcomes and community mobility in dysvascular amputees. All
participants crossed over to the other treatment group and acted as their own controls.
Results
C-leg helped individuals gain significant improvements in community mobility and social interaction compared to
when they were wearing the M-knee and own foot or M-knee and new standard foot.
Conclusions:
Microprocessor controlled knees help transfemoral amputees improve their quality of life. The components of the
prosthesis in addition to getting acclimated to device usage in real-life environments might have contributed to
these functional improvements.
Discussion
The regular use of the C-leg in K2 dysvascular amputees could lead to a life style with reduced co-morbidities and
better quality of life with lowered health care costs.
42
Monday, Feb 4 / 12:00 - 13:15
Introduction
Vacuum-assisted suspension (VAS) is becoming a popular system for use in lower-limb prostheses. However, little
is known about socket/liner interface volume in persons with transfemoral amputations (TFA) or the rate of vacuum
pressure decay during regular activity. We measured changes in vacuum pump pressures on human subjects,
empirically obtaining evacuation curves and gaining insights into volume and pressure decay.
Methods
Persons with unilateral TFA using VAS, sub-ischial sockets and silicone liners participated. Otto Bock Harmony®
e-pulse and Ohio WillowWood LimbLogic® VS pumps were tested. Each subject donned their prosthesis and
stood quietly while the space between socket and liner was evacuated to ~17 inHg (5 evacuation trials per pump).
Between trials, air was allowed into the system by disconnecting the tubing attaching pump to socket. Vacuum
pressure data and time were recorded during evacuation using a digital gauge. Some subjects also walked for 10
minutes with each pump at a comfortable pace on a treadmill while vacuum pressure was monitored. Interface
volume was calculated from the relationship between time to evacuation in the human subjects and time to
evacuate sealed canisters of known volume which were assessed for the same pumps.
Results
Twelve subjects (age = 56±14 years; height = 174±7cm; mass = 82±25kg) were tested. Calculated average
interface volume was 97.8±47.4cm3 and 103.3±49.2cm3 for the e-pulse and LimbLogic, respectively. During
treadmill walking (4 subjects) the average rate of vacuum decay was 0.0045 ± 0.0021 and 0.0061 ± 0.0047 inHg/
sec for the e-pulse and LimbLogic, respectively. Evacuation curves for some human subjects differed in shape
from those of fixed volume canisters, resembling s-shaped curves.
Discussion/Conclusion
S-shaped curves may represent a change in the initial volume for those people with “soft” tissue who are pulled
into the socket by vacuum. Testing on a greater number of subjects is needed.
43
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 1
Room 1.03
Abstract Title: Socket/Liner Interface Volume And Vacuum Pressure Decay In Persons With Transfemoral
Amputations
Abstract number: 157
Authors: S. Fatone, S. Wood, R. Caldwell, O. Komolafe, W. Chen, C. Sun, A. Hansen
Presenter: S. Fatone
FREE PAPERS
Monday, Feb 4 / 12:00 - 13:15
Session Name and Room: Orthotics: Lower Limb - 1
Abstract Title: Do Orthotic Walkers Affect Knee And Hip Function During Gait?
Abstract number: 6
Authors: J. Richards, K. Payne, D. Myatt, A. Chohan
Presenter: J. Richards
Room 1.05
Introduction
The majority of previous studies that have involved orthotic walkers have been concerned with their application
in the management of specific conditions such as; higher risk diabetic patients with ulcerative or pre-ulcerative
conditions, foot and ankle fractures and acute achilles tendon rupture. The focus has generally been on their
ability to off load the structures in the foot and ankle, however little is known about the effects on lower limb
biomechanics. The aim of this study was to determine the effects of two designs orthotic walker on the knee and
hip joints compared to normal footwear.
Methods
Ten subjects with no history of lower limb problems were asked to walk under three randomised conditions; Össur
Rebound, Aircast FP and normal footwear. Kinematic and kinetic data were collected using a ten camera infrared Qualisys motion analysis system and four AMTI force plates and analysed using the Calibrated Anatomical
System Technique.
Results
Significant differences in kinematics were seen in hip extension between both walkers and normal footwear, and in
knee coronal and transverse plane ranges of motion between the Össur Rebound and normal footwear. Significant
differences were also seen in peak knee adduction moments between both walkers and normal footwear, and
in the knee extension moments between all the conditions, with the Össur Rebound showing the greatest knee
extension moment.
Discussion
Both walkers show significant differences compared with normal footwear, however the Össur Rebound appears
to produce the greatest deviation which includes a greater hyperextension moment at the knee which could be
damaging over long term usage.
Conclusion
Further research is needed into the effects of orthotic walkers on the knee and hip joint mechanics, which should
help to inform future designs of walker, with a greater focus on obtaining a more normal gait pattern.
44
Monday, Feb 4 / 12:00 - 13:15
Introduction
Knee Ankle Foot Orthoses (KAFO) allow for ambulation with a stiff orthotic leg. Stance Control Orthoses (SCO)
enable the user to freely swing the leg forward but are locked (stiff) during stance. A hydraulic microprocessor
stance and swing control orthosis (MP-SSCO) may allow for knee flexion under weight bearing and therefore more
physiologic knee movements during stance.
Methods
3 KAFO and SCO users each were enrolled. For KAFO/SCO use no validated outcome measures exist. Therefore
the Prosthesis Evaluation Questionnaire (PEQ) was modified creating an Orthosis Evaluation Questionnaire (OEQ)
which was administered at baseline for the existing orthosis and after 3 months of use of the MP-SSCO (C-Brace®,
Otto Bock HealthCare, Germany). In addition, a questionnaire rating the importance and comparative safety and
difficulty to perform 45 activities of daily living (ADL) with both orthoses was filled out at this final follow-up.
Results
Five males and one female, four poliomyelitis survivors, one incomplete paraplegic at T10, and one femoral nerve
lesion with a mean age of 59.2±18.0 years were enrolled. The average rating of all OEQ questions did not differ
significantly between the orthoses, however, significant benefits of the MP-SSCO were seen in the OEQ subscores for ambulation (p=.003), diseased limb health (p=.0006), sounds (p=.006), and well-being (p=.01). The
Results of the ADL questionnaire showed that 69% of ADLs were rated safer and 51% less difficult with the MPSSCO, whereas no ADL was rated safer and only one less difficult with the traditional orthoses.
Discussion
Knee flexion under weight bearing is absolutely necessary for alternate stair and slope descending. Stance
yielding contributes to shock absorption and appears to offer something to patients beyond a mere mechanical
improvement. The Results of this pilot study indicate that the hydraulic MP-SSCO may overcome the functional
limitations of the current KAFO and SCO systems.
45
FREE PAPERS
Session Name and Room: Orthotics: Lower Limb - 1
Room 1.05
Abstract Title: A Microprocessor Stance And Swing Control Orthosis Improves The Walking Ability Of
Traditional Kafo Users
Abstract number: 30
Authors: A. Kannenberg, B. Zacharias, D. Fish, D. Lindsey
Presenter: A. Kannenberg
FREE PAPERS
Monday, Feb 4 / 12:00 - 13:15
Session Name and Room: Orthotics: Lower Limb - 1
Room 1.05
Abstract Title: Immediate Biomechanical Effects Of A New Microprocessor Controlled Stance And Swing
Phase Kafo System
Abstract number: 76
Authors: T. Schmalz, E. Ludwigs, R. Auberger, C. Breuer
Presenter: T. Schmalz
Conventional KAFOs with stance control (SCO) do not support knee flexion under load. Thus, it is impossible to
walk down ramps and stairs step over step in a safe manner. A new KAFO system with microprocessor controlled
stance and swing phase (MPC-SSCO) has been developed, allowing these everyday movements. Six patients
[44±16 yr, 79±17 kg, 179±7 cm] using conventional KAFOs due to lower limb muscle weakness were included in
the investigation. Biomechanical tests were performed in a gait lab with the patients’ conventional KAFOs. Motion
analysis while walking on level ground, descending ramps (10°) and descending stairs was conducted. The
patients were then fitted with the MPC-SSCO, instructed in its functions and allowed to accommodate for several
hours. The biomechanical testing was repeated and the data analyzed and compared.
Results show that 4 of 6 patients use the stance phase flexion of the MPC-SSCO during level walking. Compared
to their conventional KAFO, the hip moments were reduced immediately prior to the initiation of the swing phase.
With the MPC-SSCO, 5 of 6 patients could descend ramps step over step. With the conventional KAFO, only one
patient was able to do so (at full knee extension in stance phase). For all 5 patients, continual knee flexion was
measured in stance phase using the MPC-SSCO. Also 5 of 6 patients were able to descend stairs step over step.
No patient had been able to do this with their previous orthosis.
The Results suggest that knee flexion under load allowed by the MPC-SSCO enables patients to perform, for the
first time, demanding everyday movement patterns in an approximate physiological manner. The sensor control
allowed for intuitive use of the functions after an adaptation period of a few hours.
46
Monday, Feb 4 / 12:00 - 13:15
Introduction
Since scientific evidence about long-term use of ankle-foot orthoses (AFOs) after stroke is lacking, no generally
accepted guidelines for AFO-provision after stroke are available. Therefore, we started a longitudinal trial studying
the effects of providing AFOs at different moments in time in the rehabilitation after stroke.
Methods
Acute stroke patients with AFO-indication admitted to a rehabilitation centre were included and measured biweekly. Two groups with different randomized moments of AFO-provision were compared: “early” (provision at
inclusion) and “late” (provision 8 weeks later). Among others, scores on the activity level (including Berg Balance
Scale, Functional Ambulation Categories, 10-m walking test, 6-min walking test and Timed Up&Go test) were
measured. Results over time of both groups were compared using a general linear model with repeated measures.
Results
Fifteen subjects (9 early, 6 late AFO provision) completed the first 18 weeks of measurements so far. Both groups
have shown progress over time on activity level tests, with higher scores in the early AFO-group. However, the
differences between both groups at any time were not statistically significant (p>0.05).
Discussion
The first analyses were performed with a limited number of subjects in both groups. Furthermore, not all subjects
were able to perform all tests from the start of the study because of limited walking function. Therefore, future
analysis will include more subjects. Besides outcomes measures at the activity level the measurement protocol
also includes quality-of-life questionnaires, fall-registration and 3D gait analysis (including EMG). Further analysis
of this data should elucidate if the timing of AFO-provision influences these outcome measures.
Conclusions
There are no significant differences in outcome measures on activity level between subjects provided with AFOs
early or late after stroke, but early AFO-provision shows a positive trend. Future analysis including more subjects
should reveal whether or not early AFO-provision after stroke is beneficial.
47
FREE PAPERS
Session Name and Room: Orthotics: Lower Limb - 1
Room 1.05
Abstract Title: Timing Of Ankle-Foot Orthoses After Stroke: First Results Of A Randomized Longitudinal
Study
Abstract number: 101
Authors: C. Nikamp, J. Buurke, M. Nederhand, H. Hermens, J. Rietman
Presenter: C. Nikamp
FREE PAPERS
Monday, Feb 4 / 12:00 - 13:15
Session Name and Room: Orthotics: Lower Limb - 1
Room 1.05
Abstract Title: Mediolateral Foot Placement During Post-Stroke Ambulation With And Without An AnkleFoot Orthosis
Abstract number: 159
Authors: A. Zissimopoulos, S. Gard, R. Stine, S. Fatone
Presenter: A. Zissimopoulos
Introduction
Common post-stroke swing-phase gait deficits include foot drop and reduced knee flexion, resulting in a functionally
longer limb. Compensatory actions, such as affected-side hip hiking and increased lateral motion of the affectedside foot are often used to create ground clearance but may negatively affect mediolateral (ML) foot placement.
An ankle-foot orthosis (AFO), which reduces the need for swing-phase compensatory actions, may positively
affect ML foot placement accuracy. ML foot placement has been identified as one strategy for controlling ML body
center of mass motion during ambulation and affording dynamic balance (forward progression without falling).
The chronic post-stroke population has a high incidence of falls that frequently occur while walking and are often
attributed to intrinsic characteristics such as poor balance. ML foot placement may provide insight into impaired
balance post-stroke. The purpose of this study was to investigate ML foot placement with and without an AFO to
better understand dynamic balance post-stroke.
Methods
Gait analysis was used to investigate ML foot placement during locomotion in a chronic post-stroke population.
Target step placement (step width) was randomly varied between 0 and 45% leg length and subject’s accuracy in
achieving the target step placement with each foot was measured.
Results
Data have been collected from 10 subjects. Foot placement accuracy was reduced on the affected side compared
to the sound side, and preliminary Results suggest modest improvements in affected side accuracy with AFO
use. Data analysis is ongoing to determine whether reduced frontal plane compensations mediate changes in foot
placement accuracy.
Discussion/Conclusions
ML foot placement accuracy is impaired during post-stroke ambulation with the affected side demonstrating lower
accuracy than the sound side. While AFO use reduces the need for hip hiking, this may not significantly improve
foot placement accuracy given the modest improvement demonstrated in initial Results.
48
Monday, Feb 4 / 12:00 - 13:15
Introduction
Restoration of balance and mobility are key objectives of post-amputation rehabilitation and prosthetic prescription.
Self-report instruments like the Prosthesis Evaluation Questionnaire (PEQ) and Activities Specific Balance
Confidence Scale (ABC) are available to assess these clinically-meaningful domains, but are not commonly
used in clinical practice or research. Shortened versions of the PEQ and ABC have been proposed to address
practical and psychometric limitations associated with these instruments. Although these scales show improved
psychometric properties, cross-sectional data is needed to help with interpretation.
Methods
Short-form versions of PEQ-MS and ABC were administered to lower limb prosthetic users via survey. Respondents
were recruited via clinics, consumer magazines, list-servs, websites, and social networks. Selection criteria
included 18+ years of age, ability to read English, unilateral lower limb amputation, traumatic or dysvascular
etiology, and use of a prosthesis to ambulate. Population and subgroup (transtibial-trauma, transtibial-dysvascular,
transfemoral-trauma, and transfemoral-dysvascular) summary scores were calculated according to developers’
instructions. Differences among groups were tested with independent t-tests, corrected for multiple comparisons
(alpha=0.0083).
Results
PEQ-MS and ABC scales were administered to 650 persons with lower limb loss (age, M=53, SD=14). Overall,
respondents scored 33.8 (SD=10.4) on the PEQ-MS and 2.7 (SD=1.0) on the ABC. Persons with dysvascular,
transfemoral amputations reported significantly worse mobility (M=25.6, SD=11.0, p=0.001) and worse balance
(M=1.9, SD=1.0) than other subgroups. Conversely, persons with traumatic, transtibial amputations reported
significantly better mobility (M=37.7, SD=9.4, p=0.000) and balance (M=3.0, SD=0.8).
Discussion
Mobility and balance are affected by level and etiology of amputation. PEQ-MS and ABC quantify this relationship
and may be used to evaluate clinical interventions.
Conclusion
The PEQ-MS and ABC are designed to measure constructs of interest to lower limb prosthetic users. Means and
variances from this large study may aid interpretation of PEQ-MS and ABC scores and encourage their use in
clinical practice and research.
49
FREE PAPERS
Session Name and Room: Evidence Based Practices - 1
Room 1.06
Abstract Title: Large-Scale Administration Of Shortened Versions Of The Prosthesis Evaluation
Questionnaire - Mobility Subscale (Peq-Ms) And Activities Specific Balance Confidence Scale (Abc) In
Persons With Lower Limb Loss
Abstract number: 223
Authors: B. Hafner, D. Amtmann, D. Abrahamson, S. Morgan, A. Kajlich, R. Salem
Presenter: B. Hafner
FREE PAPERS
Monday, Feb 4 / 12:00 - 13:15
Session Name and Room: Evidence Based Practices - 1
Room 1.06
Abstract Title: Effective Factors Influencing Evidence Based Practice In Prosthetics And Orthotics
Abstract number: 273
Authors: S. Gautam, R. Mohanty, P. Lenka, M. Pathak
Presenter: S. Gautam
Introduction
Evidence based practice EBP refers to the process of ‘integrating individual clinical expertise with the best available
external clinical evidence from systematic research so as to provide the best clinical care possible.
Methods
A cross-sectional email, questionnaire forms /internet survey study is conducted of Rehabilitation council of India
(RCI) recognised prosthetists and orthotists providing services in India. A web-based questionnaire was prepared
based on an initial review of literature and pilot testing, and the consideration of protocols outlined. An internet
survey is developed and distributed to about 250-300 Prosthetists and Orthotists currently practicing in India.
Results
A principal component factor analysis of the survey Results revealed ten effective primary factors affecting
evidence-based practice from prosthetist and orthotist by means of Demographics data, Information sources,
Barriers and
beliefs. These include time constraints, workload and system demands, limited relevant evidence from research,
and gaps in skills and knowledge required to perform evidence-based practice.
Discussion
This study represents one of the first attempts to evaluate the multi-faceted nature of EBP as it pertains to P&O
using a mass-distributed questionnaire survey. The Results indicate that while clinicians value research as a
means of improving clinical practice, they are faced with a number of practical barriers in performing EBP, including
time constraints, Limitations, Relevance, Presentation, Knowledge, Skills, Access, Facility, Value, Financial.
Conclusions
Data about existing EBP will essential in order to inform those involved in improving existing clinical practices,
including educators, professional organizations and governing bodies. This study represents one of the initial steps
in acquiring empirical data to gain a better understanding of the underlying barriers and facilitators relating to EBP
in P&O.Clinicians value research as a means of improving clinical practice, but they are faced with a number of
practical barriers in performing evidence-based practice.
50
Monday, Feb 4 / 12:00 - 13:15
Introduction
As part of the 2009 Post Graduate Certificate in Amputee Rehabilitation, Bradford University, guidance for the multi
disciplinary team on the management of post operative residuum oedema in lower limb amputees was developed.
The literature states there are large variations in practice with the regards to the management of post operative
residuum oedema with selection of modality based on clinical experience rather than current best evidence. The
aim of the guidance was to identify the evidence supporting the modalities available.
Methods
A literature search was completed in November 2010, 44 articles were appraised using the Scottish Intercollegiate
Guidelines Network (SIGN) methodology checklists. Evidence was collated for five modalities of oedema control;
rigid dressings, Pneumatic Post Amputation Mobility Aid (PPAM aid), compression socks, stump boards and
elastic bandage wrapping. The guidance was developed based on the strength of the evidence for each modality.
Results
Available evidence suggests rigid dressings should be used to control oedema. More commonly used modalities
such as PPAM aid, compression socks and wheelchair stump boards were supported by the literature, however,
methodological quality was poor with key details not addressed.
Discussion
Additional benefits of rigid dressings are documented in the evidence. Early application is advised although no
evidence compared timings of application. The evidence suggested the use of elastic bandage wrapping should
not be used due to the possible inaccuracies in application.
Conclusion
Rigid dressings should be used in clinical practice when expertise, time and clinical resources allow. Other forms
of oedema control recommended by the guidance have been shown to have some evidence base and may be
used in the absence of or in conjunction with rigid dressings. Further research is required to establish the optimum
timing of application for each of the available modalities and to clarify the optimum design of the rigid dressing.
51
FREE PAPERS
Session Name and Room: Evidence Based Practices - 1
Room 1.06
Abstract Title: Guidance On The Management Of Post Operative Residuum Oedema In Lower Limb
Amputees
Abstract number: 303
Authors: E. Bouch, E. Geer, K. Burns, M. Fuller, A. Rose
Presenter: M. Cole
FREE PAPERS
Monday, Feb 4 / 12:00 - 13:15
Session Name and Room: Evidence Based Practices - 1
Abstract Title: The Amputee Mobility Predictor For People With Bilateral Lower-Limb Loss.
Abstract number: 352
Authors: M. Raya, R. Gailey, I. Gaunaurd
Presenter: R. Gailey
Room 1.06
Introduction
The Amputee Mobility Predictor (AMP) is an objective performance-based measure designed to assess the
unilateral lower limb amputees’ (LLA) mobility and functional capabilities prior to and following prosthetic fitting. To
date there is no comparable measure for bilateral lower limb amputees. The purpose of this study was to develop
and examine the utility of the AMP- Bilateral (AMP-B) to measure functional mobility in BLLA and to determine
whether AMP-B scores correlated with performance on the AMP and six minute walk test (6MWT).
Methods
Twenty-six male subjects, mean age 28.6 years participated, including 12 bilateral transtibial amputees (BTTA), 7
bilateral transfemoral amputees (BTFA) and 7 with combination transtibial and transfemoral (TTA/TFA) limb loss.
All subjects performed the AMP, AMP-B and the 6MWT. Item analysis was performed to determine which AMP
items were inappropriate for specific populations.
Results
ANOVA analysis revealed significant differences between the AMP-B (P<.0001) scores, AMP (P<.0001) scores,
and 6MWT (P<.05) distance for those subjects with BTTA and TTA/TFA as well as those with BTTA and BTFA but
not between those with BTFA and TTA/TFA.
Discussion
The scoring of five items were modified to account for absence of an intact knee joint which diminishes the ability
of the knee extensors to generate the necessary torque required to control knee motion during ascending and
descending from a chair and stairs without upper-limb assistance. Without modifications, even an extremely high
functioning BTFA would be unable to obtain the maximal AMP score.
Conclusion
It was determined that minor modifications in scoring of the AMP does not alter total score and allows clinicians to
determine the functional mobility of those with BTFA and TFA/TTA. No modifications are necessary for people
with BTTA.
52
Monday, Feb 4 / 12:00 - 13:15
Introduction
Lower limb amputation can be a traumatic and life changing event that involves adjusting to both physical and
psychosocial challenges. Patient expectations can have an impact on the way that patients adjust to a new
disability (Wiles et al. 2004). Positive expectations can increase a patient’s motivation and serve as a coping
mechanism. However, unmet expectations may result in dissatisfaction lead to increased stress levels (Holzner et
al, 2001). This study aimed to investigate the expectations of lower limb amputees in relation to the rehabilitation
process, the prosthesis and their final outcome.
Methods
The design of the study involved a qualitative approach employing semi-structured interviews. Participants were
recruited from two district general hospitals. Interviews were conducted within the first two weeks of amputation.
Participants were included if they were over 18 and had been referred for prosthetic rehab. Six male and two
female patients were included.
Results
Data were analysed using thematic analysis and resulted in five key themes. It was found that patients’ lives
remained uncertain following amputation and that information is required to offer security and reduce anxiety.
Participants knew little about the services and professionals they were about to encounter, especially the
prosthetist. Participants were consistently expecting to return to normal, but did raise contradictions to this normal.
This may be the beginnings of adapting to a new normal and should be explored as part of the adjustment process
in order to promote realist expectations and satisfaction.
Discussion and Conclusion
Patient Expectations may be an important part of coping following amputation and time within rehabilitation should
be dedicated to shaping expectations as part of the long term adjustment process.
53
FREE PAPERS
Session Name and Room: Evidence Based Practices - 1
Room 1.06
Abstract Title: Expectations Of Rehabilitation Following Lower Limb Amputation: A Qualitative Analysis
Abstract number: 234
Authors: C. Ostler, C. Ellis-Hill, M. Donnovan-Hall
Presenter: C. Ostler
FREE PAPERS
Monday, Feb 4 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 2
Room 1.03
Abstract Title: Development Of A Rear-Locking Prosthetic Knee Mechanism With Improved Stability
Characteristics
Abstract number: 363
Authors: J. Andrysek, D. Wyss, W. Cleghorn
Presenter: J. Andrysek
In regions where resources for prosthetic treatment are limited, both in terms of expertise and wealth, most highend prosthetic knee devices are neither available nor appropriate. Furthermore, devices which are designed to
withstand harsh environmental demands at appropriate costs for under-resourced regions often do not provide
acceptable levels of biomechanical function. To address this need, a durable, automatic, rear-locking (RL)
prosthetic knee joint was designed to meet the biomechanical requirements of physically active transfemoral
amputees functioning in demanding environments. Biomechanical modeling was used to assess reliable stancephase stability using a commercially viable, high-tech, polycentric knee joint as a benchmark for comparison.
Computer modelling and finite element analyses led to the construction of a functional prototype which was
structurally tested and clinically validated in a single-subject pilot study. The 6MWT, physiological cost index (PCI),
and Borg RPE scale were used to assess the energy expenditure and perceived exertion, kinetic and temporal data
was collected in a 7-camera gait laboratory. The RL design uses a simplified mechanism allowing small amounts
of rotation about a control axis. This rotation, caused by ground force reactions initiated at terminal stance-phase,
operates the rear lock allowing the knee to safely support weight during stance-phase and flex during swingphase. The prototype was shown to yield similarly tight zones of instability as a six-bar polycentric knee with
positive locking, suggesting the prototype exhibits similar stability characteristics while being less expensive to
manufacture and less sensitive to moisture. The clinical assessment shows the prototype knee operates near the
same level of functionality as the benchmark compassion knee. This study represents the initial development and
assessment of a technology that has potential to improve the quality of life for transfemoral amputees around the
world who have previously been limited in the participation of socio-economic activities due to inadequate
prosthetic function.
54
Monday, Feb 4 / 14:30 - 15:45
Introduction
The alignment of a trans femoral prosthesis is crucial and may affect socket pressures, stability and the function of
lower limb components. Traditionally this procedure is performed using observational techniques with successful
outcome reliant upon clinician experience and feedback from the individual prosthesis user. (Radcliffe 1977)
Enhanced alignment techniques to improve the balance and confidence of the trans-femoral prosthesis user may
promote increased mobility and level of function. The aim of this review is to establish current protocols for transfemoral alignment and appropriate balance and confidence outcome measurements.
Methods
A literature review was carried out using searches of key electronic databases. The inclusion criteria are studies
relating to prosthetic alignment, balance, confidence and outcome measures for a lower limb absent population.
Results
The abstracts of 227 articles located in the search were reviewed, 116 were initially excluded due to their
irrelevance and a further 57 articles were excluded after further consideration. The remaining 54 articles are
included in this review. The Results are divided into prosthetic alignment considerations and outcome measures.
These are further sub-divided into biomechanical studies, specific interventions and technical measurements and
the outcome measures are focused on balance and confidence and functional walking tests.
Discussion/Conclusions
From the literature there are a number of tests to assess balance, confidence and stability in the able-bodied
population. With careful consideration these tests may be used for the assessment of a lower limb absent
population. (Miller, Deathe et al. 2003) It is unclear from the literature how prosthetic alignment is undertaken in
day-to-day clinics and therefore if prosthetic users are gaining optimum function and stability from their prosthesis.
Literature suggests a variety of Methods and tools are used to align prostheses and indicates that the principle of
optimal alignment and repeatability may lead to more stable and functional gait.
55
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 2
Room 1.03
Abstract Title: The Effect Of Alignment On The Balance And Confidence Of Trans Femoral Prosthetic Users:
A Literature Review.
Abstract number: 364
Authors: D. Fisher, S. Deans, A. Mcgarry
Presenter: D. Fisher
FREE PAPERS
Monday, Feb 4 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 2
Room 1.03
Abstract Title: What Advantages Do Energy Return Feet Offer The Lower Limb Prosthetic User?
Abstract number: 367
Authors: A. Crimin, E. Harris, A. Mcgarry, S. Solomonidis
Presenter: A. Crimin
There is a variety of energy return feet available on the market place today, and it is commonly believed that the
additional push off force they provide is of considerable benefit to the prosthetic user. However during walking, the
additional power generated around the ankle at toe off may not entirely be a propulsion mechanism. The passive
ability of flexible feet to adjust to the surface/terrain may be the overriding feature of preference, rather than
energy return providing push off. Although prosthetic ankle joints produce significantly less power than the natural
ankle, trans-tibial prostheses users can ambulate surprisingly well. The aim of this study was to analyse the gait
of six trans-tibial prostheses users wearing three different designs of energy return foot while descending a ramp.
The effect these feet have on mechanical work is reported. The ability of the prosthetic user to regulate the body
momentum is influenced by the prosthetic foot used when descending a ramp, which in turn affects work done.
Results suggest that push off force is not a deciding factor on the preferred foot choice of the prosthetic user,
but rather its ability to regulate the ground reaction force and body momentum, therefore stability during double
support. These factors have a direct influence on the energy consumption.
56
Monday, Feb 4 / 14:30 - 15:45
Introduction
To determine if the Genium knee reduces standing and walking effort and increases gait speed and functional
level compared to the C-Leg.
Methods
This interim analysis presents the first 8 subjects’ Results in an ongoing clinical trial of n=20. Subjects were male
(age: 52y[15.1]) with non-dysvascular etiology and utilized C-Leg for >1y. Subjects randomized to either continue
C-Leg use or accommodate with a Genium. C-Leg subjects acclimated 2wks with the newly fitted Trias foot.
Genium subjects acclimated to knee and Trias prior to testing. Following initial testing, subjects crossed-over to
the second condition and re-acclimated prior to retesting.
Outcomes
Functional Level: Amputee Mobility Predictor(AMP).[1] Standing Exertion: Borgs Rating of Perceived Exertion(RPE)
after standing(2min) facing downhill(7deg). Walking Exertion, Gait Speed and Total Heart Beat Index(THBI):
Heart beats were counted and THBI[2] calculated. Effort was rated(Borgs RPE) in a 75m self-selected walking
speed(SSWS) test. Statistical Analyses: Paired t-tests. A priori significance: p<0.05.
Results
AMP scores increased 3.3points (8%; p<0.05) with Genium use and effort required to stand facing downhill
decreased 1.7points (19%; p<0.05). Genium use decreased the 75mSSWS-test duration by 6%(p<0.05). THBI
and RPE also improved (3 and 9% respectively) but were not significant.
Discussion and Conclusion
Mean AMP scores placed the sample at an ambulatory level-3 with C-Leg use compared to the lower end of level-4
with the Genium. Bellmann et als[3] data are confirmed as the 8 subjects, while standing facing downhill, rated
their RPE decreased 19%. This has functional relevance if patients are doing prolonged standing tasks with less
perceived energy consumption. These preliminary findings also showed significantly reduced time to complete a
75mSSWS-test with Genium use.
References
1. Gailey, R.S., et al. Arch Phys Med Rehabil, 2002.
2. Hood, V.L., et al. Arch Phys Med Rehabil, 2002.
3. Bellmann, M., et al. Arch Phys Med Rehabil, 2012.
57
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 2
Room 1.03
Abstract Title: Efficacy Of Genium Versus C-Leg On Functional Level, Standing And Walking Exertion, And
Heart Beats
Abstract number: 203
Authors: J. Highsmith, R. Miro, D. Lura, L. Mengelkoch, J. Kahle, W. Quillen, R. Dubey
Presenter: J. Highsmith
FREE PAPERS
Monday, Feb 4 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 2
Room 1.03
Abstract Title: Clinical Assessment Of Two Common Suspension Systems For Transtibial Amputees
Abstract number: 390
Authors: H. Gholizadeh, N. Abo Osman, A. Eshraghi, S. Ali, E. Yahyavi
Presenter: H. Gholizadeh
Introduction
Proper fitting of the stump inside the socket and appropriate selection of prosthetic suspension have positive
effects on amputees’ satisfaction and could decrease gait deviation, skin problems, and stump atrophy. The main
intention of this study was to evaluate the effects of Seal-In®X5 (suction system) on pistoning within the socket and
patients’ satisfaction and to compare with a common pin and lock transtibial suspension system.
Methods
Ten unilateral transtibial amputees participated in this work and two prostheses (with suction socket and Pin/lock)
were fabricated for each of them. The vertical displacement within the socket in static positions and during the
gait (dynamic) was measured using Vicon motion system. The subjects were also asked to complete a prosthesis
evaluation questionnaire (PEQ) for each suspension systems.
Results
This study showed that the Seal-In could decrease pistoning movement inside the socket compare to the Pin and
lock system. Moreover, during gait and static position a significant difference between the two suspension systems
was found (p<0.05). This type of liner (seal-In) provided less pistoning during the ambulation but the overall
satisfaction with the locking liner was higher
(p<0.05).
Discussion
The suction sockets are commonly prescribed for transtibial amputees to have better suspension compared to
the Pin and lock systems. They are said to decrease displacements inside the prosthetic socket. The current
findings supported our previous studies on the Seal-In liner in terms of pistoning. Nevertheless, satisfaction with
this system was lower possibly due to the relative difficulty of donning and doffing the device.
Conclusion
Therefore, it is possible to conclude that less pistoning may not be the main factor that determines amputees’
overall satisfaction with the prosthesis devices, and that other factors such as easy donning and doffing may also
contribute to comfort and satisfaction with prosthesis.
58
Monday, Feb 4 / 14:30 - 15:45
Organizational leadership has been extensively examined in various practice arenas. The area of leadership in
humanitarian aid organizations has been studied primarily through the westernized cultural lens of functionalist
linear conceptualizations. (Burrell & Morgan, 1979) Because of issues such as colonialism, structural oppression,
and widespread poverty, leadership of aid organizations in much of the developing world often follow interpretive
and less linear development processes. As a result, cross cultural social work at the organizational level must
overcome inherent difficulties particularly in the areas of communication, need assessment and goal setting.
Utilizing two interpretively based theories of leadership development; Organizational Culture (Schein, 2004),
Transformational Leadership (Bass, 1985), evolutionary perspectives of organizational leadership will be explored
from three distinct cultural lenses. In order to address intrinsic paradigmatic considerations, a team of three social
work/development professionals will explore their own cultural assumptions and observations within a specific
practice environment. As part of cross cultural academic exploratory project, a social work pracademician from the
United States will collaborate with a social development practitioner from Western Kenya to explore cultural beliefs,
attitudes and practices of several aid organization directors in Western Kenya. During and after the project, a team
consisting of three social work/ development professionals from different areas of the world; the United States,
Western Kenya, and the Caribbean, will then explore the processes and problems of leadership development
that arose during this project. The collaborative team will examine key differences of perception that may lead to
a deeper understanding of leadership development and discuss these impressions together from a cross cultural
practice perspective. With solid grounding in interpretive theory, the three professionals will explore areas of
miscommunication, conflict or misunderstanding based on their individual cultural expectations or perceptions, and
offer specific insights that will lead to more culturally
humble organizational practice.
59
FREE PAPERS
Session Name and Room: Developing Countries - 1
Room 1.05
Abstract Title: Moving Toward Culturally Sensitive Organization Practice: Three Cross- Cultural Perspectives
Abstract number: 16
Authors: J. Odeyo, J. Osgood
Presenter: J. Odeyo
FREE PAPERS
Monday, Feb 4 / 14:30 - 15:45
Session Name and Room: Developing Countries - 1
Abstract Title: Re-Examining Project Sustainability- Lessons Learned In Haiti
Abstract number: 54
Authors: J. Batzdorff
Presenter: J. Batzdorff, CPO
Room 1.05
'Sustainability' is a term used in many applications and with a variety of implications. When used to describe an
international assistance project in a developing country, it has been used to mean the the project supports and is
supported by local culture and infrastructure, that it empowers local participation if not eventual ownership of the
project, and that it is likely to continue well into the future.
Following the January, 2010 earthquake in Haiti, ProsthetiKa was requested to assist in developing O and P
capacity in the earthquake region of Haiti. Every intention was made to assure that the project was sustainable.
The goal was to create a P and O capacity for the benefit of the Haitians, that would eventually be staffed, run,
and owned by the Haitians. The goal was to provide local capacity, appropriate technology, and to avoid creating
dependency. The project was based on initial information and assumptions based on site visits and Discussions.
A P and O facility was indeed built, Haitians were recruited to work as trainees, side by side with volunteers from
abroad. The project has been, by many measures, a success, but at the same time, the goals were significantly
re-defined based on the realities of the environment, the economy, and the culture.
This paper presents accepted definitions of sustainability. It presents an overview of the ProsthetiKa project in Haiti
and the Results. The paper re-examines sustainability based on these experiences.
60
Monday, Feb 4 / 14:30 - 15:45
The inclusion of PWDs and women is critical in every developmental approach, mainstreaming activities through
the enforcement and practice of twin-track approach. Prosthetics and orthotics training and services are similar
to those in the allied health professions. Prosthetics and Orthotics profession is thought to be a male and nondisabled profession. However, with the need of clinical service and the requirement of more understanding on
disability, women and People with Disabilities (PWDs) are seen to be strong components in the
profession.
The objective is to discuss importance and challenges on inclusion of PWDs in the professional and development
activities in Cambodia and South East Asia.
Methods
The prosthetics and orthotics students at CSPO completed a self-administered questionnaire on learning and
teaching challenges. Out of 36 students, 16 are women and PWDs. In addition, other 15 prosthetists and othotists
from the Cambodia Trust also completed the questionnaires, 8 of those are women and PWD.
Findings:
Challenges encountered in comparison to non-disabled peers:
1. Lack of opportunity for education, employment and training scholarship
2. Minimal social exposures and social value, particularly women with disabilities
3. Low self-confidence & self-esteem due to cultural & community attitude
4. Lack of public awareness on gender issues, disability and disability right
5. Underestimation of women and PWD’s capacity and potential
6. Facility accommodation and disability accessibility
7. Lack of motivation from good role model, support mechanism and concept of self-actualization
Conclusion
The index for disability inclusion through the three dimensions explained by Gahel Weigh (2012) on the
development of inclusive culture, producing inclusive policies structure and evolving inclusive practices should be
endorsed. The need of re-iteration for evidence of disability and gender inclusion is
essential.
61
FREE PAPERS
Session Name and Room: Developing Countries - 1
Room 1.05
Abstract Title: Disability And Gender Inclusion In Prosthetics And Orthotics Profession-Challenges In Asia
And The Pacific Region
Abstract number: 88
Authors: S. Kheng
Presenter: S. Kheng
FREE PAPERS
Monday, Feb 4 / 14:30 - 15:45
Session Name and Room: Developing Countries - 1
Abstract Title: Leveraged Freedom Chair - Indian Trial And Partnerships For Dissemination
Abstract number: 92
Authors: N. Scolnik, A. Winter, M. Bollini, D. Mehta, S. Mehta, M. Mathur, P. Mukul
Presenter: N. Scolnik
Room 1.05
The Leveraged Freedom chair (LFC) is a wheelchair-based mobility aid capable of navigating virtually any terrain
by optimally utilizing upper body power for propulsion through a variable-speed lever drivetrain. The project was
motivated by the 20 million people in developing countries who need a wheelchair, where existing products like
western-style wheelchairs and hand-powered tricycles cannot cope with the rough terrain. A device with the LFC’s
capabilities is desperately needed, as these people must often travel long distances under their own power to
access education, employment and community connections. These users require a device that is maneuverable
within the home and that can also travel long distances on rough roads. The LFC was developed by a team from
the Massachusetts Institute of Technology (MIT) and the design has evolved through four generations based on
quantitative performance data and stakeholder input. The final pre-production field trial was conducted in 2011 in
India with Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS), also known as Jaipur Foot. This collaboration
combined MIT’s engineering background with BMVSS’s 34 years of experience making high-quality, low-cost
mobility aids. Biomechanical data collected during our trial confirmed the advantages of the LFC lever drivetrain,
enabling users to travel 75% faster on tarmac than a conventional wheelchair and off-road like no other mobility
aid available. We are working with a manufacturer in Indore, India called Pinnacle Industries to prepare the LFC
for global distribution. This three-party collaboration represents the intersection of the academic world (MIT), NGO
world (BMVSS) and corporate world (Pinnacle), leveraging the individual strengths of each to bring the LFC to the
users that need it most.
62
Monday, Feb 4 / 14:30 - 15:45
Introduction
Nepal is one of the poorest and least developed countries in the world and has an extreme topography.
Inaccessibility in the country is a large issue for persons with disabilities and puts high demands on the prosthetic
fitting. The aim with the investigation was to explore experiences of the living situation for persons requiring
prosthetic service in accordance to some specific articles from the Convention on the Rights of Persons with
Disabilities which consider health, mobility, work and employment, education and
rehabilitation.
Methods
The investigation was performed through individual interviews using a semi structured interview guide. 16
participants with lower limb amputations were included. For analysis of data latent content analysis was applied.
Results
From the analysis data was divided in to eleven different categories. Those were called; Rehabilitation is
encouraging and provided at a low cost, Prosthesis is essential for mobility but is not adequate for the demands
required in Nepal, Prosthesis increases independence but also limiting, Living without prosthesis in Nepal is
difficult, Accessibility of health care meets the demands but travelling is troublesome, Difficulties of affording
health care, Education improves living situation but is lacking because of poverty, Vocational training improves
independence but is not available for all, Desire for employments but unemployed due to disability, Prosthesis is
essential for working but is not fulfilling requirements, Negative attitudes in society towards persons with disabilities
and Living as a person requiring prosthetics in Nepal is hard.
Conclusion
Healthcare and rehabilitation provided at the study site fulfills the demands from the Convention except regarding
follow-up treatment. In this specific area of Nepal deficits were reported in the fields of mobility, work and
employment and education. The participants requested more advanced prostheses, employment opportunities
and more education. The participants also reported negative attitudes for being a person with disabilities.
63
FREE PAPERS
Session Name and Room: Developing Countries - 1
Room 1.05
Abstract Title: Living As A Person Requiring Prosthetics In Nepal - A Qualitative Investigation In Accordance
With The Convention On The Rights Of Persons With Disabilities
Abstract number: 239
Authors: A. Fransson, B. Andersson
Presenter: A. Fransson
FREE PAPERS
Monday, Feb 4 / 14:30 - 15:45
Session Name and Room: Orthotics: Upper Limb - 1
Room 1.06
Abstract Title: Hand-And-Wrist Exoskeleton Device For The Rehabilitation Of Grasping Function.
Abstract number: 71
Authors: M. Troncossi, M. Mozaffari Foumashi, C. Mazzotti, D. Zannoli, V. Parenti Castelli
Presenter: M. Troncossi
In the field of robot-aided neuro-rehabilitation, the BRAVO project ('Brain computer interfaces for Robotic
enhanced Action in Visuo-motOr tasks') aims at defining a new approach to the development of assistive and
rehabilitative robots for motor-impaired users, in order to perform complex visuomotor tasks. The main novelty
introduced by the BRAVO project is the control of a complete upper-limb exoskeleton system through the active
prediction of intention/action. The system integrates the preliminary information about the movement to carry
out with a prediction of the user's intended action, by interpreting the user's current gaze and brain activation
(measured through an eye-tracking system and Brain-Computer Interfaces, BCIs, respectively) and by suitable
force measurements.
Within this framework the authors designed and manufactured the distal part of the overall exoskeleton, i.e. the
hand-and-wrist system. The hand orthosis has two degrees-of-freedom (DOFs) for (1) the flexion/extension of the
thumb and (2) the flexion/extension of the group composed by the other four fingers. The functions of opening
and closing is controlled by the patient's brain signals detected via a BCI system. The wrist unit has two DOFs
for the actuation of the prono-supination and flexion/extension movements. The device is controlled, as the arm
exoskeleton it is attached to, through a complex scheme involving trajectory planning (based on the patient's
current gaze) and a hybrid position/force control.
At the time of this abstract writing, the hand orthosis prototype underwent bench tests, the manufacturing of the
wrist unit prototype is at its final stage, whereas the two mentioned control systems were tested both with healthy
subjects and neurological patients. A clinical pilot study involving the hand orthosis is foreseen within August
2012, whereas the integration of the whole system (robotic arm-wrist-hand and control systems) and its clinical
application for a significant patients population is due within January 2013.
64
Monday, Feb 4 / 14:30 - 15:45
Introduction
Rheumatoid arthritis (RA) affects over 400,000 people in the UK. The wrist and hand are commonly affected in
the early stages of RA, with most hand deformities occurring during the first year of the disease. Prefabricated
functional wrist-hand orthoses (WHOs) with a volar bar are commonly prescribed to manage the functional deficit
associated with the wrist as a result of rheumatoid changes. Studies have previously investigated the efficacy of
these orthoses, with many reporting on the benefits and limitations of these devices but rarely on compliance. It is
the aim of the present work to report on patients’ perceptions on the use of these WHOs.
Methods
A six month user survey was conducted in the UK to seek and evaluate the opinions of patients with RA who had
been prescribed commercially available prefabricated WHOs. A questionnaire was developed and participants
were invited to both rate and comment on their experience of orthosis provision and of wearing the orthosis.
Results and Discussion
Analysis of the Results demonstrated that patients recognise clear benefits associated with WHO use. However
many users are still dissatisfied with service provision and their orthoses, identifying many limitations to the
functionality of the devices and factors which impact significantly on wear time and overall compliance.
Conclusion
While there are some positive outcomes reported in the literature and recognised benefits from users in wearing
these devices, if patients are to derive optimal benefit from the use of prefabricated WHOs, the factors which
underpin orthotic use must be addressed. If the functionality of wrist-hand orthoses and factors affecting user
compliance are both addressed, there is the potential to achieve additional gains in the outcome measures and
positively impact on quality of life.
65
FREE PAPERS
Session Name and Room: Orthotics: Upper Limb - 1
Room 1.06
Abstract Title: Patients’ Perceptions On The Use Of Prefabricated Wrist-Hand Orthoses In The Management
Of Rheumatoid Arthritis
Abstract number: 401
Authors: K. Ross
Presenter: K. Ross
FREE PAPERS
Monday, Feb 4 / 14:30 - 15:45
Session Name and Room: Orthotics: Upper Limb - 1
Abstract Title: The Effect Of Prefabricated Wrist-Hand Orthoses On Grip Strength
Abstract number: 411
Authors: M. O'Hare, K. Ross
Presenter: M. O'Hare
Room 1.06
Prefabricated wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit and
compromised grip strength as a result of rheumatoid changes. It is thought that an orthosis which improves wrist
extension, reduces synovitis and increases the mechanical advantage of the flexor muscles will improve hand
function. Previous studies report an initial reduction in grip strength with WHO use which may increase following
prolonged use.
Methods
Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on grip strength
was measured using a Jamar dynamometer. Tests were performed with and without WHOs by right-handed,
female subjects, aged 20-50 years over a ten week period. During each test, a wrist goniometer and a forearm
torsiometer were used to measure wrist joint position when maximum grip strength was achieved.
Results and Discussion
The majority of participants achieved maximum grip strength with no orthosis at 30° extension. All the orthoses
reduced initial grip strength but surprisingly the restriction of wrist extension did not appear to contribute in a
significant way to this. Reduction in grip must therefore also be attributable to WHO design characteristics or the
quality of fit.
Conclusion
The authors recognize the need for research into the long term effect of WHOs on grip strength. However if grip
is initially adversely affected, patients may be unlikely to persevere with treatment thereby negating all therapeutic
benefits. In studies investigating patient opinions on WHO use, it was a stable wrist rather than a stronger grip
reported to have facilitated task performance. This may explain why orthoses that interfere with maximum grip
strength can improve functional task performance. Therefore while it is important to measure grip strength, it is
only one factor to be considered when evaluating the efficacy of WHOs.
66
Monday, Feb 4 / 14:30 - 15:45
Wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit associated with the wrist
as a result of rheumatoid changes. The common presentation of the wrist is one of flexion and radial deviation
with ulnar deviation of the fingers. This wrist position Results in altered biomechanics compromising hand function
during activities of daily living (ADL). A paucity of evidence exists which suggests that improvements in ADL with
WHO use are very task specific.
Methods
Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on performing
five ADLs tasks was investigated. The tasks were selected to represent common grip patterns and tests were
performed with and without WHOs by right-handed, females, aged 20-50 years over a ten week period. The time
taken to complete each task was recorded and a wrist goniometer, elbow goniometer and a forearm torsiometer
were used to measure joint motion.
Results and Discussion
Results show that, although orthoses may restrict the motion required to perform a task, participants do not use
the full range of motion which the orthoses permit. The altered wrist position measured may be attributable to a
modified method of performing the task or to a necessary change in grip pattern, resulting in an increased time in
task performance.
Conclusion
The effect of WHO use on ADL is task specific and may initially impede function. This could have an effect on WHO
compliance if there appears to be no immediate benefits. This orthotic effect may be related to restriction of wrist
motion or an inability to achieve the necessary grip patterns due to the designs of the orthoses.
67
FREE PAPERS
Session Name and Room: Orthotics: Upper Limb - 1
Room 1.06
Abstract Title: The Effect Of Prefabricated Wrist-Hand Orthoses On Performing Activities Of Daily Living
Abstract number: 483
Authors: M. O'Hare, K. Ross
Presenter: M. O'Hare
FREE PAPERS
Monday, Feb 4 / 14:30 - 15:45
Session Name and Room: Orthotics: Lower Limb - 2
Room G.06
Abstract Title: Superior Efficacy Of Low-Load Prolonged Stretch Dynamic Orthosis (Ultraflex) In Cerebral
Palsy : Application For Knee Flexion Contractures
Abstract number: 212
Authors: I. Heymann
Presenter: I. Heymann
Introduction
Night time static positioning braces are recommended for treatment of knee flexion contractures in cerebral palsy
but often untolerated and quickly abandoned. The goal is to compare the efficacy and the tolerance of static with
rachet orthoses with Low -Load Prolonged Stretch (LLPS) dynamic orthoses (ULTRAFLEX) in the treatment of the
knee flexion contracture.
Methods
This randomized prospective and monocentric study included children with cerebral palsy, presenting uni or bilateral
knee flexion contracture superior or equal to 10°. Main assessment criterion : the goniometric measurement of
knee extension. Secondary assessment criteria : the measurement of the popliteal angle, the ankle’s dorsi-flexion,
the hamstrings and triceps surae spasticity level, the orthosis's tolerance . Measurements were performed by
the same physiotherapist for consistency. Statistics: test of Student, using adjustment with the method of Tukey
(945;'= 945;/8730;6) Thirty patients with cerebral palsy (age 11.2 years+/-4.2, 14 ambulant; 21 boys) participated
:48 legs were randomized (24 dynamic -24 static KAFO)
Results
Superior efficacy of the dynamic orthosis for the reduction on: -knee flexion contracture at 6 month (9.3° vs 2.8°;
p < 0.001), at 8 month (12.5° vs 3.5 °; p < 0.0001). (for the ambulant as well as for the non-ambulant patients
(p=0.006 and p=0.041)).
-gastrocnemius contracture (p=0.0003)
-gastrocnemius spasticity (p=0.0003)
-hamstrings spasticity (; p=0.0262)
The analysis of the tolerance reveals that 72.5% were good or very good with dynamic vs 31.8% with static
orthoses (p=0.009).
Discussion
The longitudinal follow-up would allow to know if the improvement of the extension of the knee continues beyond
8 months and in which speed .
Conclusion
This first comparative study brings to light the superiority of the dynamic orthosis thanks to the LLPS. This dynamic
orthosis should be in the front line in the conservative treatment of the knee flexum in cerebral palsy.
68
Monday, Feb 4 / 14:30 - 15:45
Introduction
Cerebral palsy (CP) is primarily characterized by central nervous system abnormalities, such as loss of selective
motor control and abnormal muscle tone often lead to secondary deficits, including bony deformities, muscle
contractures, and gait abnormalities. Diplegia is the commonest with an incidence rate of 32%. Dynamic equinus,
as a result of inappropriate activity of spastic plantarflexors, is the commonest deformity for diplegic. The aim of
orthotic management in spastic cerebral palsy is to produce a more normal gait pattern by positioning peripheral
joints in a way that reduces pathological reflex patterns or by blocking pathological movement of the joint.
Methods
The purpose of this review is to summarize the available literature related to the spastic diplegic in the respect
of the different configuration of the Ankle Foot Orthosis (AFO).The literature are searched using the different
keywords.
Results
All orthoses solid AFO, dynamic AFO (DAFO), hinged AFO, posterior leaf spring showed increased stride length,
decreased cadence, controlled plantar flexion during swing phase and increased degree of lower extremity
symmetry compared with no orthoses. One Results show significantly decreased energy cost of walking with the
use of AFOs compare to no orthoses. The DAFOs allowed a significantly larger total ankle range of motion than
the AFOs.
Discussion and Conclusion
Although the studies showed biomechanically controlled ankle motion, but no changes were found in the proximal
joint motions of the trunk, pelvis, hip and knee. W.K. Lam et al Results showed an increase in hip flexion at initial
contact in the DAFO group for which there was no apparent explanation. Future studies are needed that include
a larger sample size of children with spastic CP and moderate to severe amounts of dynamic equinus during
ambulation who receive similar physical therapy for gait training with orthoses. Keywords:- Spastic diplegic CP,
dynamic equines gait
69
FREE PAPERS
Session Name and Room: Orthotics: Lower Limb - 2
Room G.06
Abstract Title: Effectiveness Of Different Configuration Of Ankle Foot Orthoses In Spastic Diplegic Cerebral
Palsy: Literature Review
Abstract number: 241
Authors: H. Trivedi
Presenter: H. Trivedi
FREE PAPERS
Monday, Feb 4 / 14:30 - 15:45
Session Name and Room: Orthotics: Lower Limb - 2
Room G.06
Abstract Title: Gait Efficiency Of Healthy Persons And Polio Survivors While Walking With Carbon FiberReinforced Plastic, Weight-Added Carbon Fiber-Reinforced Plastic And Conventional Knee-Ankle-Foot
Orthoses
Abstract number: 280
Authors: Y. Nakanishi, F. Wada, K. Hachisuka, M. Arai
Presenter: Y. Nakanishi
Introduction
Although a carbon fiber-reinforced plastic knee-ankle-foot orthosis (carbon KAFO) improved gait efficiency, the
main factor that improved their gait efficiency is unclear. The aim of this study was to clarify whether the lighter
weight of a carbon KAFO contributes to improvement of gait efficiency.
Methods
Subjects were 7 healthy persons and 8 polio survivors, for whom both conventional KAFO (1650g) and carbon
KAFO (1050g) were manufactured and adjusted to get a good fit. Walking speed, step length, O2 cost and heart
rate at the most comfortable speed were measured during 3-minute walk on three conditions in random order:
walk with a conventional KAFO (W_CVT), walk with a carbon KAFO with additional 600g weight of leaden plate
(W_WGT), and walk with a carbon KAFO (W_CBN).
Results
In healthy persons, walking speed and step length of W_CBN were significantly greater than those of W_CVT, and
O2 cost of W_CBN was significantly less than that of the two conditions. In polio survivors, O2 cost of W_CBN was
significantly less than that of W_CVT.
Discussion
In healthy persons, the lightweight induces an increase in step length, a slight increase in number of steps, and an
increase in gait speed. This process may reduce O2 cost, and improve gait efficiency. Because the process is not
so distinct in polio survivors as in healthy persons, both the lightweight and structural feature may be related to the
O2 cost reduction in polio survivors during walk with a carbon KAFO. These Results suggest that polio survivors
walk somewhat differently to improve gait efficiency.
Conclusion
A carbon KAFO improved gait efficiency in both healthy persons and polio survivors. The factor of gait efficiency
improvement was the lightweight for healthy persons, while the lightweight and structural feature for polio survivors.
70
Monday, Feb 4 / 14:30 - 15:45
Plantar fasciitis is one of the major causes for foot pain presenting as severe pain in the heel. There are a number
of risk factors, including: high-level activities; increased Body Mass Index; poor foot biomechanics; and limited
range of motion. A conservative management approach is commonly utilised in the treatment of plantar fasciitis.
This study undertook a critical review of the literature to evaluate the evidence for conservative management of
plantar fasciitis with foot orthotics, night splints and stretching. A number of databases were searched, including:
Embase, Medline, Cinahl, Cochrane library, ProQuest, Amed and RECAL legacy. A strict inclusion and exclusion
criteria were applied to achieve a total of 40 studies that were critically reviewed applying SIGN guidelines. The
Results showed that overall there was an effect for each type of conservative management. However, no individual
management technique was deemed better than others.
Quality overall was low, suggesting further work was required to provide stronger evidence. From the findings a pilot
study was designed to assess the dorsiflexion range of motion in plantarfaciitis compared with an asymptomatic
control group. During the assessment the foot was placed in, neutral, supinated and pronated positions and a
constant pressure applied. The study utilised two measurement Methods to assess for reliability. Ethcal approval
was gained. A comparison between measuring using a goniometer with video analysis was done. Statistical
analysis was carried out using SPSS and ANOVA.
The Results support goniometer measures as more reliable than the Silicon Coach, and with a position of knee
extension with the foot in a neutral position. When comparing symptomatic and asymptomatic groups, there was
no significant difference in ROM seen. This study outlines an effective reliable measurement method for assessing
the dorsiflexion ROM in plantar fasciitis using both simple goniometer and Silicon Coach measuring systems.
71
FREE PAPERS
Session Name and Room: Orthotics: Lower Limb - 2
Room G.06
Abstract Title: The Conservative Management Of Plantarfasciitis, A Literature Review And Clinical Trial Of
Assessement Methods For Dorsiflexion Rom
Abstract number: 403
Authors: E. Figgins, J. Halliday
Presenter: A. McGarry
FREE PAPERS
Monday, Feb 4 / 16:15 - 17:30
Session Name and Room: Prosthetics : Lower Limb - 3
Room 1.03
Abstract Title: Implementation Of Combined Advanced Technologies To Assess Multiple And Different
Qualities Of A Hydraulic Prosthetic Foot
Abstract number: 426
Authors: I. Siev-Ner, A. Kristal, A. Gefen, U. Givon, Z. Yizhar, Z. Dvir, H. Sharon, S. Portnoy
Presenter: I. Siev-Ner
Introduction
The mechanism of a prosthetic foot influences the stability, gait symmetry and comfort of transtibial amputees
(TTA). The Echelon® hydraulic prosthetic foot utilizes hydraulic fluid to mimic the way muscle adapts during
stance phase and allows automatic self alignment to compensate for the changes of the surface.
Methods
10 active unilateral traumatic TTA males were examined with their existing stored energy foot, after which it was
replaced to the Hydraulic Foot and after a month they underwent the same exams. The technologies used were:
the CAREN® virtual reality motion analysis system which comprises an electronically-controlled tilting platform,
equipped with two force plates, the CODA Motion Analysis laboratory and an internal stress monitor that utilizes 3
thin and flexible force sensors, placed within the socket.
Results
The Hydraulic foot enabled: Approximately 4º more than the subjects' own prosthetic feet, resulting a decrease
in sagittal knee angle fluctuations in both legs. The COP was more centered. A dorsi- flexion movement through
the swing phase and less hip flexion, as measured during initial contact and swing phase. A greater ankle plantarflexor moment and power was measured while ambulating with the hydraulic foot. Peak internal stresses at the
distal tibial end decreased significantly (p<0.01) while ambulating with the Echelon foot compared to using their
own prosthetic foot
Conclusions
The hydraulic prosthetic foot had an effect on the posture, expressed by both kinetic and kinematic measurements.
It may assist the TTA prosthetic-user while ambulating on uneven terrain and contribute to the stabilization in
standing. It enables a motion at the ankle which Results in less compensation at the hip and knee enabling a
smooth and natural transition from backward to forward acceleration. Internal stresses under the truncated bones
decreased, thereby lowering the risk for internal injury to the soft tissues of the residuum.
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Monday, Feb 4 / 16:15 - 17:30
Room 1.03
Introduction
Lower-limb amputations are a serious adverse consequence of lifestyle related conditions and an increasing
concern amongst increasingly sedentary and aging populations. The health profiles of developed nations are likely
to continue to be impacted by sedentary lifestyle behaviours. This study aimed to investigate the rate of prosthetic
prescription at discharge from inpatient hospital rehabilitation among two cohorts of lower limb amputees.
Method
Clinical outcomes of all lower limb amputees admitted to a tertiary Geriatric Assessment and Rehabilitation Unit
for rehabilitation during 2005 and 2006, as well as 2010 and 2011 were collected. A range of demographic,
clinical and rehabilitation outcome variables were examined using conventional descriptive statistics (median and
interquartile range (IQR), mean and standard deviation (SD) and number and percentage) and conventional tests
of hypothesis (t-test, Mann-Whitney-u).
Results
A total of n=117 and n=102 lower-limb amputation admissions occurred in 2005-06 and 2010-11 respectively.
There was no difference in median (IQR) 40 (22-73) days LOS or mean (SD) 64.8years (14.2) age for patients
admitted in 2005-6 in comparison to patients admitted in 2010-11 (46 (23-79) days LOS, p=0.45; 63.6 years
(12.5) age,p=0.49). Despite similar age and length of stay, a lower percentage of patients were discharged with a
lower limb prosthesis in 2010-11 (n=48, 47.5%) than 2005-06 (n=74, 63.2%). The incidence of a range of lifestyle
associated co-morbidities such as obesity, diabetes and stroke was higher in 2010-11 and will be presented.
Discussion
The lower proportion of patients receiving prosthesis in the more recent cohort may be explained by several factors
that will be discussed. These factors include the impact of stricter prosthesis prescription practice and the effect of
increasing co-morbidities among amputees.
Conclusion
The clinical profile and outcome of inpatient rehabilitation for lower limb amputees are changing to reflect
increasingly sedentary lifestyles and budgetary pressure on health services.
73
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 3
Abstract Title: The Outcomes Of Lower Limb Amputee Rehabilitation Are Changing
Abstract number: 434
Authors: H. Batten, J. Nitz, S. Kuys, P. Varghese, S. Mcphail
Presenter: H. Batten
FREE PAPERS
Monday, Feb 4 / 16:15 - 17:30
Session Name and Room: Prosthetics : Lower Limb - 3
Room 1.03
Abstract Title: The Prosthesis And Weight-Bearing Contributions On Emg Response Latency Subsequent
To Rapid Platform Perturbation In Transtibial Prosthesis Users
Abstract number: 444
Authors: D. Rusaw, K. Hagberg, L. Nolan, N. Ramstrand
Presenter: D. Rusaw
Introduction
An individual’s ability to coordinate physiological responses to postural challenges is integral in preventing
falls. When subjected to sudden movements of the support surface individuals must rapidly coordinate multiple
physiological systems to prevent a fall. Various disease processes contribute to pathological response to
perturbations and have been identified as contributing to falls in various populations (Ting 2007; Allum, Gage,
Frank et al. 2007; Carpenter et al. 2002). Transtibial prosthesis users have altered physiological responses in
rapid movements when to control groups (Aruin, Nicholas et al. 1997; Viton, Mouchnino et al. 2000) but little
is known about their responses to unexpected rapid support surface perturbations. The aim of this study was
to investigate the latency of EMG response in the intact limb and prosthetic limb of individuals with unilateral
transtibial amputation following support surface rotations in the pitch plane (toes-up/toes-down). An additional aim
was to investigate the role of weight-bearing and limb-position on these EMG responses.
Methods
23 transtibial prosthesis users (mean age 48 years [SD 14], height 1.77 m [SD 0.08], and mass 79 kg [SD 14]) were
subjected to a series of rapid, unexpected rotations of the support surface in the pitch plane. Perturbations were
elicited in various weight-bearing and limb-perturbed conditions . The latency of the EMG response for muscles of
the lower-extremity, both intact- and prosthetic-side, were compared to the responses of a matched control group.
Results
The TTA-group had statistically significant delays of response to toes-up rotations in the gastrocnemius muscle
(intact limb), and the biceps femoris muscle (prosthetic limb) compared to the control-group. Significant differences
were also found in limb-position and weight-bearing on the intact side, but not the prosthetic side.
Conclusion
Results suggest being a unilateral transtibial prosthesis user delays muscular response bilaterally to support
surface rotations in some muscles of the lower-extremity.
74
Monday, Feb 4 / 16:15 - 17:30
Introduction
Lower limb contractures are a common complication in amputees,contractures Can impair future mobility.In fact
after the first few days of an amputation,patients are started on an exercise programme ,but some patients might
refuse doing these exercises .The purpose of this study was to investigate the effects of a below knee prosthesis
on the correction of knee flexion contractures.
Methods
This was a case study.a 60 year old man was selected.He suffered from knee flexion contracture but he refused
doing physical therapy exercises so we decided to make a prosthesis for him.at the first session we measured his
knee flexion angle by means of a goniometer which was a clinically easy way to use for the patients .In fact we
made 3 prosthesis for this patient during a 4 months period.We measured the knee angle each time.
Results
Knee flexion angle was measured 60 degrees in the first session by means of a goniometer .it decreased to 15
degrees after 4 months .
Discussion
After an amputation patients should start an exercise program by a physiotherapist but there are some patients
who refuse doing this exercises ,they prefer to walk immediately.We decided to study the real effects of Transtibial
prosthesis in some patients who suffer from flexion knee contractures and are not interested in doing regular
physical exercises.The Results were surprising for us because after 4 months the knee flexion contracture was
just 15 degrees.we are believed that the prosthesis were doing a gradual constant stretching on the knee complex.
Conclusion
This study demonstrated that the Transtibial prosthesis can improve gradually the knee flexion contracture .It is a
good idea to prescribe an early prosthesis for patients who are suffering from knee flexion contracture with physical
therapy exercises simultaneously or specially for some patients who refuse doing physical therapy exercises.
75
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 3
Room 1.03
Abstract Title: The Effects Of Transtibial Prosthesis On Correction Of Knee Flexion Contracture
Abstract number: 454
Authors: F. Kazemi, M. Kamyab
Presenter: F. Kazemi
FREE PAPERS
Monday, Feb 4 / 16:15 - 17:30
Session Name and Room: Prosthetics : Lower Limb - 3
Room 1.03
Abstract Title: Understanding Residual Limb Volume Loss; Utilising A Physical Model (Manikin)
Abstract number: 461
Authors: A. Buis, J. Lizhang, L. Mosler
Presenter: A. Buis
Introduction
For individuals using lower limb prostheses, volume loss of the residual limb can cause discomfort and pain.
Volume loss affects prosthetic fit and how normal and shear stresses are delivered to the weight bearing structure,
the skeleton. Volume change affect suspension and how much the limb is pistoning in the socket during ambulation.
In addition, the amount of volume fluctuation varies greatly among individuals as a function of comorbidities,
prosthesis fit, activity level, etc. It is suggested that vacuum-assisted suspension systems retard limb volume
reduction in part through improving fluid inflow into the residual limb so that it better balances with fluid outflow.
This study investigated if it is it physically possible to manage volume changes in a controlled environment.
Methods
A physical model of a trans-tibial residual limb and matching hard socket was produced. The model was capable
to reduce and gain volume by controlled fluid out- and in-flow respectively. This configuration was placed in
a programmable testing machine and was exposed to various static and dynamic loading conditions the latter
simulating stance and swing phase. Furthermore several sub-atmospheric pressure conditions were introduced
to this configuration.
Results
The following was found within the Manikin: volume loss irrispective of sub-atmospheric pressure. significant
reduced pistoning with vacuum-assisted conditions.
Discussion
Limited evidence exists regarding the management of limb volume, and the evidence available focuses on adults
with transtibial amputation. It is essential to understand what is physically happening under controlled conditions
and this study is a first attempt to do so. Furthermore, the development of a Finite-Element model informed by
empirical and clinical tests created a valuable understanding what is physiological possible and what not.
Conclusions
This study showed that volume loss cannot be avoided however; by applying active-vacuum a considerable stiffer
coupling is created. A clinical-significant-study is recommended.
76
Monday, Feb 4 / 16:15 - 17:30
Introduction
This study investigated whether the Michelangelo® multigrip hand (Otto Bock HealthCare, Duderstadt) offering
three grip modes and seven functional hand positions improves performing activities of daily living (ADL) as
compared to conventional myoelectric hands.
Methods
Within-subject cross-over pilot study. The Orthotics and Prosthetics User Survey - Upper Extremity Functional
Status (OPUS-UEFS) (1) was used as the primary outcome measure. As secondary outcome measure the same
28 ADLs were also rated using the scoring system of the Prosthetic Upper Extremity Functional Index (PUFI) (2)
at baseline for their conventional myoelectric hand as well as after a minimum of 4 weeks of use of the multigrip
hand. Statistical analysis was conducted using the Wilcoxon signed rank test.
Results
15 male transradial amputees with an average age of 40.9±14.8 years gave informed consent to participate.
Mean duration of the multigrip hand use was 11.6±7.5 weeks. OPUS-UEFS: Michelangelo hand use significantly
improved perceived difficulty of performing the 28 ADLs from 90.6±15.0 to 75.5±21.3 (p=.02). In addition, patients
performed significantly more ADLs with “both hands together with the prosthetic hand used actively to grasp” as
compared to the conventional myoelectric hands (means 12.9±6.1 vs. 9.9±5.9 ADLs; p=.046).
Discussion
Limited function of conventional myoelectric hands is an important reason to only passively use or even completely
reject the prosthesis (2). The Results of this pilot study suggest that a multigrip prosthetic hand may improve
prosthetic function and reduce perceived difficulty to perform many ADLs.
References
1. Burger H et al.: Validation of the Orthotics and Prosthetics User Survey Upper Extremity Functional Status
module in people with unilateral upper limb amputation. J Rehabil Med 2008, 40 (5): 393-399
2. Wright FV et al: Evaluation of the validity of the Prosthetic Upper Extremity Functional Index for children. Arch
Phys Med Rehabil 2003, 84 (4): 518-527
77
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 1
Room 1.05
Abstract Title: Functional Differences Between Standard And Multigrip Myoelectric Hands In Performing
Activities Of Daily Living
Abstract number: 27
Authors: A. Kannenberg, B. Zacharias, L. Hermansson, S. Swanson, J. Miguelez, A. Cutti
Presenter: A. Kannenberg
FREE PAPERS
Monday, Feb 4 / 16:15 - 17:30
Session Name and Room: Prosthetics : Upper Limb - 1
Room 1.05
Abstract Title: Learning Curves Of Southampton Hand Assessment Procedure Tasks In Novice Prosthetic
Users
Abstract number: 79
Authors: E. Vasluian, H. Reinders-Messelink, R. Bongers, P. Dijkstra, J. Burgerhof, C. Van Der Sluis
Presenter: E. Vasluian
Introduction
Southampton Hand Assessment Procedure (SHAP) is a standardized procedure of 26 tasks designed to evaluate
the functionality of normal, injured or prosthetic hands. Currently, improvements in functionality assessed by
means of the SHAP can not be distinguished from testing effects (learning). Aim: To evaluate learning curves of
the SHAP tasks in novice prosthetic users.
Methods
In a repeated measurement study, 24 healthy participants (mean age 21.8, 45.8% men) completed eight
measurement sessions during five consecutive days using a prosthetic simulator. The simulator is a myoelectric
prosthesis that can be fixated on a normal hand, and is controlled in the same way as a myoelectric prosthesis.
Participants performed one measurement session on the first and fifth day, and two sessions on the days in
between. Data were analyzed using multilevel analysis.
Results
Participants differed in the time needed to execute the first attempt and the time gained in consecutive attempts.
More difficult tasks (e.g. pick up coins, undo buttons) varied largely and required longer time. Female or participants
who performed with the left hand needed on average more time to perform the tasks, but no difference in learning
curves was seen between male and female participants. Every new day participants were slower in the first
session. SHAP tasks, hand, gender, sessions, interaction of the tasks and sessions, and a “new day effect”
contributed significantly (P<0.01) to the prediction of learning curves. A clear learning effect occurred in all tasks.
Discussion
This study showed a strong learning effect of SHAP in novice prosthetic users. This learning effect will influence
reliability and needs to be taken into account when conducting a reliability study.
Conclusion
SHAP task scores for functionality in prosthetic hands, acquired in one session, should be interpreted with caution.
They may be distorted by the learning effect of the SHAP.
78
Monday, Feb 4 / 16:15 - 17:30
Introduction
Sensible upper limb stumps may be of more functional use than non-sensitive prostheses. As such, sensibility may
be important when giving patients advice whether or not to use prostheses. However, little is known about stump
sensibility, neither in children with upper limb reduction deficiencies (ULRD) nor in adults with acquired upper limb
amputations (AULA).
Aims
To compare stump sensibility in children with ULRD with that of adults with AULA and to compare the sensibility of
stumps with corresponding parts of unaffected arms and hands.
Methods
A cross-sectional study. Subjects: Thirty-one children with ULRD (18 boys, 3 prosthetic users, mean age 14.6
years (sd: 5.8)) and 30 adults with AULA, at least one year after amputation (29 men, 20 prosthetic users, mean
age 51.9 years (sd:13.2)). Level of amputation: from transhumeral to wrist disarticulation. Main study outcomes:
touch pressure measured by Semmes Weinstein monofilaments, stereognosis measured by Shape/Texture
Identification test (STI-test) and kinaesthesia.
Results
Touch pressure in children was better than in adults (p=0.00). Touch pressure of stump circumference in children
was better compared to unaffected hands (p=0,046), stump endpoints (p=0.02) and rudimentary fingers (p=0.00).
In adults, no differences between stumps and unaffected arms/hands were found. Adults not using prostheses had
better sensibility of stump and unaffected arm (p=0.04). STI test. 25 children and 2 adults recognized shapes and
textures with their stump. Kinaesthesia. No differences in shoulders or elbows were found between affected and
non-affected side in children or adults.
Discussion/Conclusions
Touch pressure and shape/texture identification were better in children with ULRD than in adults with AULA.
Sensibility in paediatric stumps was better than in unaffected arms. This excellent stump sensibility may clarify why
children with ULRD, in contrast to adults with AULA, function well without prostheses. The better stump sensibility
of adults not using prostheses needs further exploration.
79
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 1
Room 1.05
Abstract Title: Sensibility Of Upper Limb Stumps In Children And Adults
Abstract number: 102
Authors: C. Van Der Sluis, W. Van Gils, M. Reinkingh, P. Dijkstra, F. Smit-Klaij, R. Bongers, H. ReindersMesselink
Presenter: C. Van Der Sluis
FREE PAPERS
Monday, Feb 4 / 16:15 - 17:30
Session Name and Room: Prosthetics : Upper Limb - 1
Abstract Title: An Improved Approach To Anchoring Surface - Emg Sensor For Tmr Patients
Abstract number: 104
Authors: N. Kumar, J. Van Vliet
Presenter: J. Kalmar
Room 1.05
Fitting of a prosthesis on a patient with shoulder level amputation pose significant challenges. Tracking EMG
signals in patients who have undergone TMR surgery and have hyper-mobile muscle contraction becomes a
significant part of the challenges. This study aims at identifying the problems faced by such a user during operation
of prosthesis and attempting to solve them by developing flexible sEMG sensor anchors. Furthermore, this study
aims as improving the design of the said anchors and modularize the construction for other applications.
A prosthetic system consisting of the Otto Bock Dynamic Arm-TMR, sensor hand speed with rotator unit controlled
by 4/5 surface-EMG (sEMG) sensors was used. The user was retro-fitted with the said anchors in such a way that
it follows the movement of the skin thus tracking the signals. A preliminary lab-based user trial was conducted
which revealed that the concept of anchoring electrodes has a potential to effectively control the prosthesis.
Furthermore, with this design, the prosthetists don’t have to decide on the accurate sensor location at the time of
socket construction. It is adequate to identify the approximate area and then the flexibility of the anchor would
allow the prosthetists to accurately position the sensor.
These aspects of the design seem to help prosthetists avoid errors during socket construction and, the flexibility
in attaching of the anchors seems to help avoiding expensive rebuilding the sockets. It further appears that these
anchors with design modifications could have other applications in UE prosthetics.
The feedback including improvement potential is being incorporated and further tests will be conducted to evaluate
the feasibility of such an approach to TMR users.
80
Monday, Feb 4 / 16:15 - 17:30
Aim
The functional capabilities of prosthetic hands is important to assist clinical decisions. Knowledge of the abilities
of a new generation of devices possessing multi articulated digits, is being built slowly. This project measures
the function of the hands currently on the market. It builds on an earlier study of conventional single axis hands.
Method
Repeated measures of the function are made by a single able bodied subject using a socket fastened over the left
forearm. Each hand is assessed repeatedly. The tool used is the Southampton Hand Assessment Procedure. The
hands under test are the Touch Bionics i Pulse and the RSLSteeper, BeBionic.
Results
The overall scores of both hands is similar (81 for the TB and 72 for the BB). With a similar relationship for the
Tripod (89, 81) and Power (88, 70) and marked lower scores for Tips (59, 39) and Extension (88, 83), while the
Steeper hand had a higher score in the Lateral grip (70, 74).
Discussion
SHAP is designed to give a measure of the function of the hand. It has been demonstrated that the controller
format can have significant impact on the score. For a multi-axis hand this time includes the time to select the
appropriate grip. The selection of grips in this test were based on which formats were available and reliable. The
ability to select an firm two jaw chuck or lateral grip was key to the successful execution of those tasks. This was
different for each of the hands.
Conclusion
While the hands are more complex and attractive than conventional single degree of freedom hands, the current
control formats mean they are not any more functional that the older designs. Critically, this measure is in only one
of the functional domains and other aspects, need to be factored in to any assessment.
81
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 1
Room 1.05
Abstract Title: A Comparative Assessment Of The Functionality Of Multi-Function Prosthetic Hands
Abstract number: 252
Authors: P. J. Kyberd
Presenter: P. J. Kyberd
FREE PAPERS
Monday, Feb 4 / 16:15 - 17:30
Session Name and Room: Orthotics: Lower Limb - 3
Room 1.06
Abstract Title: Clinical Application Of Robotic Orthosis For Patients With Lower Limb Paralysis
Abstract number: 341
Authors: H. Kimura, E. Tanaka, L. Yuge
Presenter: H. Kimura
Introduction
Reacquisition of walking ability can be extremely difficult for patients with lower limb paralysis due to cerebrovascular
disorder and spinal cord injury. We have developed a robotic orthosis to correct the gait posture and support the
walking ability of patients with walking difficulty.
Methods
The robotic orthosis is equipped with joint angle sensors, a biopotential sensor, a floor reaction force sensor and
an ultrasonic sensor, which operates a program to mimic normal human gait. We performed gait analysis in two
patients with hemiplegia before and after use of the robotic orthosis. The patients were a 62-year-old man and a
65-year-old woman, both of whom showed hemiplegia due to cerebral infarction. While both patients were able to
walk without use of an ankle-foot orthosis, gait posture was far from normal.
Results
Using the robotic orthosis, vertical movement of the hip joint improved 7.4% and 19.5%, respectively, and hip
abduction angle during gait improved 25.3% and 14.6%, respectively.
Discussion
Forcing patients with lower limb paralysis to walk passively encourages plasticity of the central nervous system.
Because conventional robotic orthoses only support normal gait, limitations exist to the applicability of orthoses in
patients with abnormal gait or walking difficulty. Our robotic orthosis assists with leg joint force in accordance with
a program for optimal gait, and can thus be used in patients with walking difficulty. Reacquisition of normal walking
through the use of a robotic orthosis can be expected to promote the recovery of brain function.
Conclusion
Our robotic orthosis helps correct gait posture in patients with walking difficulty by forcing them to walk normally.
We believe that this robotic orthosis can help patients with lower limb paralysis by encouraging plasticity of the
central nervous system, leading to independent walking.
82
Monday, Feb 4 / 16:15 - 17:30
Room 1.06
The aim of stroke rehabilitation is to allow the patient to regain an efficient walking ability. Ankle foot orthoses
(AFOs) are nowadays commonly prescribed for this purpose. However, research backed evidence is necessary to
determine the best rehabilitation practice and better understand the interaction between AFO and patient capability
during gait.
The aim of this study was to investigate the effect of polypropylene solid AFOs on gait biomechanics of early stroke
survivors. Three patients, affected by stroke within 2 months from onset, were recruited. 3-D analysis of kinematic
outcomes at the pelvis and lower limb joints was pursued at various times during their rehabilitation for a period up
to six months. Walking kinematics with and without AFO were compared. For one patient, the contribution of the
orthosis to the ankle dorsi/plantarflexion support moment was also quantified, by means of an instrumented AFO.
Influence of the AFO at the ankle, knee and hip was found in all three anatomical planes, with main effects visible
in the sagittal plane. The AFO allowed the patient to contact the ground with the heel and safely swing the leg
forward reducing toe drag and risk of stumbling. The sound leg also gained benefits from AFO use, demonstrating
improved joint kinematics as a result of improved stability in the hemiplegic leg. The AFO contributed to the net
ankle moment by providing assistance to the dorsiflexor muscles during the first half of stance phase.
Although this study was limited to three case studies it provides valuable information with regards to the use of
AFO in stroke rehabilitation and should encourage the conduction of research in this field.
83
FREE PAPERS
Session Name and Room: Orthotics: Lower Limb - 3
Abstract Title: Effect Of Ankle-Foot Orthoses On Gait Biomechanics Of Early Stroke Patients.
Abstract number: 365
Authors: E. Papi, S. Solomonidis, R. Bowers, P. Rowe
Presenter: S. Solomonidis
FREE PAPERS
Monday, Feb 4 / 16:15 - 17:30
Session Name and Room: Orthotics: Lower Limb - 3
Room 1.06
Abstract Title: The Effects Of Foot Orthoses And Knee Orthoses On Gait Pattern And Muscular Activation
Of Patients With Medial Compartment Knee Osteoarthritis.
Abstract number: 372
Authors: C. Lin, L. Chang
Presenter: C. Lin
Introduction
The purpose of this study was to determine the biomechanical mechanisms and effectiveness of foot orthosis (FO)
and knee orthosis (KO) for patients with knee OA by the evidence in joint mechanics, muscle activation pattern and
proprioception of the patients among different orthotic conditions. Methods Fifteen elders with medial compartment
knee OA (7 males and 8 females, age of 67.5¡Ó7.2 years) and fifteen matched controls (3 males and 12 females,
age of 63.3¡Ó3.5 years) were recruited in this research to collect the kinetic, kinematic and surface EMG data to
analyze the biomechanical alterations in different conditions.
Results
The OA group showed significant differences in certain gait parameters in comparison to the control group. They
presented with smaller peak knee flexion angle and knee flexion excursion and had significantly greater values in
lateral co-contraction index than medial side. The proprioception test revealed significant differences between the
KO and shoes-only condition. The peak knee adduction moment decreased 24.4 % in one FO condition and 17.1
% in the KO condition.
Discussion
OA knee caused gait deviations and led to inappropriate knee mechanics. Poor joint proprioception may potentially
reduce joint stability. The orthoses resulted in significant improvements in joint mechanics and re-alignment. And
the higher lateral co-contraction pattern responded to the need to stabilize knee joints. The lateral shift of the
Center of Pressure allowed the Ground Reaction Force to get closer to the knee joint center and minimized
excessive knee adduction moment to improve function.
Conclusion
With the use of lateral wedge foot orthoses or knee orthoses, patients can improve joint mechanical environment
and provide appropriate protection. The Results also support orthotic intervention as non-surgical, low-risk and
less expensive treatments for patients. And the long-term effects of the orthoses await further study to clarify.
84
There is little known about the structure, use and implementation of Clinical Care Pathways (CCP) in the lower
limb orthotic management of ambulatory children with cerebral palsy in the National Health Service (NHS) in the
UK. This is despite the referral, prescription, timing of provision, service delivery method and specifications of an
orthosis all impacting on the functionality and overall success of the intervention.
CCP using Evidence Based Practice (EBP) in other neurological conditions have been shown to improve clinical
outcomes, raise the standard of care, decrease unwanted variation, use resources efficiently, identify research
and development questions and facilitate enhanced communication with patients and also between members of
the multidisciplinary team.
An on-line three-part questionnaire using the Delphi technique was sent to orthotists working in the NHS in the
UK. The Delphi technique is a validated tool that has been widely used in the health industry, to assist with the
development of clinical guidelines and care pathways through group consensus. The technique produces detailed
critical examination and Discussion through a series of structured questionnaires. The questionnaires covered
all aspects of orthotic treatment including the referral process, assessment techniques, prescription of orthoses,
shape capture, fabrication and investigated the implementation of evidence based practice and use of outcome
measures. Additionally, this study examined the current literature relating to orthotic provision, service delivery and
future research recommendations for ambulatory children with CP.
Analysis of the responses revealed the current status of clinical practice in the NHS. The Results also lead to the
development of an orthotist driven CCP for the lower limb orthotic management of children with CP.
85
FREE PAPERS
.Monday, Feb 4 / 16:15 - 17:30
Session Name and Room: Orthotics: Lower Limb - 3
Room 1.06
Abstract Title: Care Pathways In The Lower Limb Orthotic Management Of Children With Cerebral Palsy In
The Nhs
Abstract number: 395
Authors: S. Lalor
Presenter: S. Lalor
FREE PAPERS
Monday, Feb 4 / 16:15 - 17:30
Session Name and Room: Orthotics: Lower Limb - 3
Room 1.06
Abstract Title: Effect Of Carbon-Fiber-Reinforced Plastic Knee-Ankle-Foot Orthosis On Gait: A Gait Analysis
Study On Polio Survivors
Abstract number: 443
Authors: F. Wada, Y. Nakanishi, N. Kato, K. Hachisuka, M. Arai
Presenter: F. Wada
A carbon-fiber-reinforced plastic orthosis (carbon orthosis) is rigid, lightweight and well-fitting compared with a
conventional knee-ankle-foot orthosis (KAFO). We have already reported that compared with the conventional
KAFO, the use of carbon KAFO showed the increase in the walking velocity and the step lengths at the orthotic side,
and no change in the cadence in the normal subject. The purpose of this study is to examine the biomechanical
effect of walking using a carbon KAFO for polio survivors by conducting a 3D motion analysis
Methods
Seven polio survivors ambulated with the aid of three types of experimental KAFOs.: (1) a conventional KAFO, (2)
a carbon-fiber-reinforced plastic KAFO (carbon KAFO), and (3) a carbon-fiber-reinforced plastic KAFO that was
made to weigh equal to the conventional KAFO by attaching weights to it (weighted carbon KAFO). The subjects
walked three times along a 5-m long runway at a self-selected, comfortable speed. The spatiotemporal data were
collected using a 3D motion analyzer.
Result
In comparison with the conventional KAFO, the use of the carbon KAFO during gait resulted in a significant
increase in the walking velocity, the cadence, and the step lengths at the non-orthotic side. The speed of the
weighted carbon KAFO was the same as those of the carbon KAFO.
Discussion
In polio survivors, the spatiotemporal improvements of a carbon KAFO compared with a conventional KAFO were
quite different from normal subjects data.
Conclusion
Our data suggest that a carbon KAFO have been found to improve walking velocity, cadence, and step lengths
at the non-orthotic sides compared with a conventional KAFO in polio survivors. The data of the weighted carbon
KAFO indicated that other factor except the lightweight of orthosis also contributes to these improvements in polio
subjects.
86
Monday, Feb 4 / 16:15 - 17:30
Room G.06
Patients with above knee amputation (AKA) face many challenges to mobility including difficulty with socket fit
and fatigue due to high energy consumption. The aim of the Endo - Exo-Femur Prosthesis (EEFP) is to avoid
problems at the interface between the sleeve of the socket-prosthesis and the soft tissue coat of the femur stump
which often impedes an inconspicuous and harmonic gait. In 1999 we began using a transcutaneous, press-fit
distal femoral intramedullary device whose most distal external aspect serves as a hard point for AKA prosthesis
attachment. The bone guided prosthesis enables an advanced gait via osseoperception and leads to a decreased
oxygen consumption of the patient.
43 patients were implanted between 1999 and 2009. Four of the 43 required removal:one for intramedullary
infection, one due to stem fracture (replaced), and the two for soft tissue infection. The remaining 39 original
prostheses remained. Two pertrochanteric fractures occurred, treated with ORIF. Two bilateral procedures were
performed. Initially, twenty patients had chronic soft tissue irritation requiring debridement. This completely
resolved by changing the connecting components to a highly polished cobalt chrome. All patients reported
increased comfort when compared to socket use. The following additional advantages were observed: improved
mobility and endurance, improved proprioception, decreased time required for prosthetic donning, lack of concern
regarding changing body weight, and the absence of skin irritation. All patients reported an improvement in sense
of position and tactile sensation, leading to an improved gait pattern.
Subjectively, the EEFP represents a significant improvement in terms of comfort. Since the Introduction of highgloss polished surfaces, soft tissue irritation is largely eliminated. Intramedullary infection has been negligible, as
osteointegration seals the medullary cavity within 2-3 weeks. In summary, the EEFP appears to be an attractive
option in transfemoral amputees.
87
FREE PAPERS
Session Name and Room: Rehab Medicine & Surgery - 1
Abstract Title: The Endo-Exo-Prosthesis For Rehabilitation Of Amputees
Abstract number: 32
Authors: D. Juhnke, H. Aschoff
Presenter: D. Juhnke
FREE PAPERS
Monday, Feb 4 / 16:15 - 17:30
Session Name and Room: Rehab Medicine & Surgery - 1
Room G.06
Abstract Title: Opinion Of Certified Prosthetists Orthotists On The International Classification Of
Functioning, Disability And Health (Icf)
Abstract number: 176
Authors: M. Mlakar, H. Burger
Presenter: M. Mlakar
Introduction
ICF was endorsed by World Health Organisation as a common language for health and other professionals. It was
tested at our prosthetics and orthotics outpatient clinics and found to be useful. The main purpose of the present
study was to determine whether medical records with ICF codes are more useful to certified prosthetists and
orthotists (CPO) than medical records with ICD diagnoses only.
Methods
All CPO working in clinical practice in Slovenia were included into study. One was not available at the time of the
study and two did not want to participate. They answered a structured interview.
Results
Fifteen CPOs participated. Seven of them work in the field of orthotics, five in lower limb prosthetics and three
in upper limb prosthetics. Eleven of them are not familiar with the ICF. Approximately 50% of them read medical
records of every patient they work with. Sixty percent (60%) think that medical records are a very important part of
their everyday practical work. One CPO found medical records with ICF codes not useful at all. Seven CPOs found
medical records with ICF codes more useful and seven found them as useful as those without them.
Discussion
In spite ICF has been endorsed ten years ago and we have Slovene translation since 2006, it is still not well known
between CPOs and is not included in the school curriculum. Still most CPOs found its use in medical records as
useful.
Conclusions
The CPOs included in the study found medical records with ICF codes as useful or more useful than those without
them.
88
Monday, Feb 4 / 16:15 - 17:30
Foot deformities followed by stroke such as varus, equinus and hammer toe use to require heavy duty AFO. This
kind of AFO interferes with various kind of ADL which needs barefoot movement. To cope with this problem,
medication, nerve block (using phenol, Botulinum toxin etc.), orthotics and surgical intervention are applying along
with physical therapy. We have changed these nuisance types of orthosis to simple one by MIS .
During the past 11 years since 2002. MIS was carried out on 150 cases which consist of the combination of
certain deformity involved tendons. The targeted tendons were as follow: tenotomy of tibialis posterior (TP);146,
of flexor digitorum longs (FDL);113, of flexor halluces longs (FHL);109, of flexor digitorum brevis (FDB);16, and
the lengthening of gastrocnemius ( by modified Vulpius procedure);102, of tibialis anterior (intra muscular tendon
recession);63.The combination of operated tendons were as follow: 5 tendons: Vulpius+TP+FDL+FHL+TA; 49
cases out of 150, 4 tendons: V+TP+FDL+FHL; 42 cases, 3 tendons: TP+FDL+FHL; 22 cases, 2 tendons: V+TP;
11 cases, one tendon FDB etc.; 22 cases respectively.
Post-operative bed rest is not necessary at all. Neuroleptic anesthesia (NLA) and local one were applied during
these procedure, and perioperative period was uneventful. Soon after, the patients were encouraged to walk
wearing soft casting for a few days postoperatively followed by application of simple, light weighted AFO (such
as UD-AFO-long or UD-AFO- short). Bare foot walking or walking with simple AFO is important particularly in
traditional Japanese life style on tatamifmat. In many cases, satisfactory Results were obtained both in Japanese
and Western life style. Patient's ADL can be improved by combination of MIS and simple orthotics.
89
FREE PAPERS
Session Name and Room: Rehab Medicine & Surgery - 1
Room G.06
Abstract Title: The Results Of Simplified Afo After Minimum Invasive Surgery (Mis) For Spastic Foot
Deformity In Patients With Stroke Hemiplegia
Abstract number: 201
Authors: Y. Konishi, K. Asayama, M. Murakami, H. Kodama, F. Hattori
Presenter: Y. Konishi
FREE PAPERS
Monday, Feb 4 / 16:15 - 17:30
Session Name and Room: Rehab Medicine & Surgery - 1
Room G.06
Abstract Title: Knee Disarticulation In Orthopaedic Patients: Surgical Technique And Experience Over 13
Years
Abstract number: 38
Authors: N. Patel, R. Fernandes, S. Sooriakumaran, D. Ward
Presenter: S. Sooriakumaran
Background and Aims
Knee disarticulation (KD) is traditionally unpopular because of wound complications and prosthetic intolerance,
despite advantages of distal end-bearing, a longer lever arm and lower morbidity. There is now renewed interest
following improved surgical techniques and prosthetic availability but studies in orthopaedic patients are lacking.
We describe the surgical technique and experience of KD at a regional orthopaedic amputation service.
Methods
Consecutive patients undergoing KD by a single surgeon (DAW) between 1997 and 2010 were reviewed. KD
was performed with medial and lateral fasciocutaneous flaps. The patella tendon was sutured to the cruciate
ligaments with a gastrocnemius myoplasty to create a cushioned stump. Patient medical and rehabilitation notes
were examined, and the timed up and go (TUG) and 2 minute walk tests (MWT) functional outcome tests were
measured.
Results
There were 24 patients with a mean age of 52 years (range 10-81): 20 (83.3%) male and 4 (16.7%) female.
Surgical indications were infection in 11 (45.8%), chronic pain in 5 (20.8%), knee contracture in 4 (16.7%), chronic
regional pain syndrome in 3 (12.5%), limb gangrene in 3 (12.5%), ischaemic ulcers in 2 (8.3%) and non-union
in 1 (4.2%) patients. Complications included wound problems in 4 (16.6%) and phantom limb pain in 2 (8.3%).
3 (12.5%) patients required revision surgery – with 1 conversion to a transfemoral amputation. Mean time to the
rehabilitation ward was 10 days(5-34) and time to discharge was 57 days (2-405). Functional outcome test times
improved with time: at 0, 1 and 6 months post-operatively, the mean TUG test was 22.3, 14.2 (p=0.05) and 20.5
seconds; and the 2 MWT was 80.8, 82 and 76.2 seconds respectively.
Discussion
KD remains a useful orthopaedic technique for a select group of patients. Advances in surgical techniques and
prosthetics have led to more acceptable complication rates and good functional outcomes compared to more
conventional amputation levels.
90
Monday, Feb 4 / 16:15 - 17:30
Room G.06
Introduction
Surgery on diabetic feet goes along with a high rate of complications. Because of the raising number of diabetic
patients this means a threat to our health systems.
Methods
In a restrospective study all cases of revision of surgery of Charcot feet in our clinic were included. Type and
number of surgeries, infections need of orthoses and ability to walk pre and after use of a standardized surgery
using a Hoffmann-II-Fiaxteure externe were examined. The hypothese was that due to the polyneuropathy
standard operation procedures represent a high risk of failure and Charcot feet need special surgery algorhythms.
Results
31 patients were included (20 male and 11 female all suffering from polyneuropathy). Most common reason
for revision was failure of material (20 cases) and persisting infection or combination of reasons. After use of
the Hoffmann-Fixateure externe only 6 patients had to be revised, no failure of material was seen. The rate of
infections declined from 21 to 6 cases (p8804;0,05) and the activity class raised from 1,4 (all inside walker) to 2,3
(outside walker, p8804;0,05).
Discussion
In a collective of complications of Charcot´s feet with failed surgery we saw a significant reduction of infections and
a significant improvement of walking in the patients changing to a Hoffmann-II-Fixateure. No failure of material was
seen. Patients with polyneuropathy are hardly able not to step on the operated feet and broken screws and plates
mean a high risk for ulceration and infection, therefore full removal of material seems to be favorable.
Conclusion
Charcot feet represent high risk operations. We propose a standardized treatment and operation management
using a Hoffmann-II-Fixateure, which showed to be a secure and cost-effective treatment option.
91
FREE PAPERS
Session Name and Room: Rehab Medicine & Surgery - 1
Abstract Title: Failed Open Reduction In Charcot´s Arthropathy Of The Foot
Abstract number: 385
Authors: U. Illgner, T. Budny, R. Skowronek, H. Wetz
Presenter: U. Illgner
FREE PAPERS
Tuesday, Feb 5 / 09:00 - 10:15
Session Name and Room: Prosthetics : Lower Limb - 4
Room 1.03
Abstract Title: The Use Of Vibratory Feedback To Improve Postural Stability Of Individuals With Transtibial
Amputation
Abstract number: 455
Authors: D. Rusaw, K. Hagberg, L. Nolan, N. Ramstrand
Presenter: D. Rusaw
Introduction
Accurate sensory feedback from the lower extremities is important in the maintenance of postural stability by
allowing an individual to be updated about the physical environment. Due to an amputation, individuals who
use a prosthesis lack sensory information distal to the amputation level. These individuals have been shown to
have reduced postural stability when compared to controls without an amputation when the stand on a stationary
surface (Buckley, O'Driscoll et al. 2002; Geurts, Mulder et al. 1991) and moving surface (Buckley, O'Driscoll et al.
2002; Vrieling, van Keeken et al. 2008). The use of vibratory feedback about body orientation has been used in
other groups to improve measures of postural stability (Sienko, Balkwill et al. 2008). The aim of this study was to
evaluate the use of a vibratory feedback system, applied only to the prosthetic users’ affected side, on static and
dynamic balance in unilateral transtibial prosthetic users.
Methods
24 transtibial prosthesis users were recruited for the study (mean age 48 years). Three tests were conducted to
evaluate the postural stability of the users: Standing Balance, Limits of Stability, and Rhythmic Weight Shift. These
three tests were evaluated with and without the use of vibratory feedback relaying information about pressure from
under the prosthetic foot.
Results
The use of vibratory feedback increased the mediolateral displacement amplitude of CoP in standing balance and
reduced the response time to rapid voluntary movements of the center of gravity
Conclusions
The performance during the Standing Balance test resulted in increased deviations of the CoP in the mediolateral
direction. Performance during the Limits of Stability test indicated faster reaction times. The Results suggest that
vibratory feedback may benefit the open-loop (feedforward) mechanisms of postural control in unilateral transtibial
prosthesis users.
92
Tuesday, Feb 5 / 09:00 - 10:15
Introduction
Socket fit is the most important characteristic of a prosthesis indicated by amputees (1-3). The consistency of the
final socket fit for an individual amputee is important. The aim of this study was to examine inter- and intra-cast
cross-sectional surface area and circularity consistency of Hands-off and Hands-on casting concepts using MRI.
Methods
Twelve amputee were recruited and the residual limbs were cast four times randomly in a single session, by a
single certified prosthetist, twice for Patellar Tendon Bearing (Hands-on) and twice for ICEROSS pressure casting
(Hands-off) method. After each cast the residual limb was scanned using MRI scanner. Then transverse crosssectional surface area (CSSA) and cross-sectional circularity (CSC) of residual limb in all slices of all volume
images were automatically calculated. The Intra-class correlation coefficient and t-test were used to analyse the
inter and intra cast difference.
Results
Neither Hands-on nor Hands-off intra-cast CSSA and CSC difference was statically significant except for the
Hands-on CSC of the first slice. Besides, there was a statically significant difference between the Hands-on and
Hands-off in CSSA at the far distal region and in CSC in the proximal region. The Hands-on resulted in a larger
intra-cast CSSA mean difference than the Hands-off. The proximal region in the Hands-on casting showed a larger
CSSA intra-cast mean difference and variability and a larger inter-cast variability. At the distal region, a larger interand intra-cast CSC mean difference and variability were noticed.
Discussion
Although not statistically significant, the smaller Hands-off CSSA mean difference and could be due to the uniform
force application around the residual limb and the distal traction of the soft tissue in the Hands-off casting by
the casting. The inter and intra cast CSC inconsistency in the far proximal region could be explained by manual
dexterity in the Hand-on method
93
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 4
Room 1.03
Abstract Title: Transverse Cross Sectional Surface Area And Circularity Consistency For Hands-Off And
Hands-On Casting Of Below Knee Residual Limb Using Mri
Abstract number: 494
Authors: M. Safari, A. Buis, P. Rowe
Presenter: A. Buis
FREE PAPERS
Tuesday, Feb 5 / 09:00 - 10:15
Session Name and Room: Prosthetics : Lower Limb - 4
Abstract Title: Management Of Diurnal Residual Limb Volume Change.
Abstract number: 469
Authors: E. Brannigan, K. Murray, A. Buis
Presenter: E. Brannigan
Room 1.03
Introduction
Diurnal residual limb volume change is a common problem as seen by the number of amputees who have to
change the number of prosthetic socks they use on a daily basis. These volume fluctuations alter the fit of the
prosthetic socket and therefore the pressure distribution on the residual limb. This can cause residual limb soft
tissue damage and gait deviations. The purpose of this project is to explore the causes of diurnal residual limb
volume fluctuations and assess the current solutions.
Methods
Prosthetics and physiological literature was reviewed to ascertain what makes a good socket fit, how volume
fluctuations occur and if they can be prevented. Criteria for an optimum volume management system was
developed and used to assess current Methods of managing diurnal residual limb volume change.
Results
Vacuum suspension systems have an effect on volume fluctuation, the extent of this effect is unknown and it is
unlikely that they prevent it from occurring. Prosthetic socks are inconvenient to use and cannot provide a stiff
coupling when used for large volume decreases. Fluid filled inserts are the most effective solution although further
product development and testing is needed. Air filled inserts are potentially dangerous as they can cause soft
tissue damage and so should be avoided.
Discussion
Very little literature exists on diurnal volume change and studies that have been carried out using out of socket
measurement techniques cannot be relied upon for accuracy. Further research using accurate in-socket
measurement techniques is required in order to fully understand diurnal volume change.
Conclusion
This project highlights areas of further research which, coupled with a knowledge of physiological volume
fluctuation, will enable clinicians to prescribe appropriate volume management tools and contribute to the design
of future intelligent volume management systems.
94
Tuesday, Feb 5 / 09:00 - 10:15
Introduction
Ambulation in small indoor spaces is a continuous process of starting and stopping gait. Transfemoral amputees
(TA) need to adapt for the necessary propulsive and braking forces for initiating and terminating gait. During steady
state walking Microprocessor controlled knees (MPK) perform better on biomechanical variables than conventional
knees (CK), but yielding is minimal. We were interested in the yielding function of a self adapting MPK (Rheo
knee,Ossur) during starting and stopping gait.
Methods
Subjects: 4 Unilateral TA, > 1yr postamputation, K2 to K4. Design: Case control, cross over. Outcomes:
spatiotemporal, kinematic and kinetic parameters during 3 steps after gait initiation and 3 steps prior to gait
termination. Experiment: 5 trials with initiation and 5 trials with termination of gait. Prosthetic foot and knee
alignment were similar in both prosthetic conditions.
Results
There were no differences between the MPK and CK in spatiotemporal, kinematic and kinetic parameters during
the first 3 steps of starting gait. During stopping gait when the prosthetic leg is the final step (before the closing
step), the MPK showed higher stance knee flexion movement (yielding) and a larger stance peak knee flexion
angle than the CK. When the prosthetic leg is the second last step there were no differences in stance between
the two prosthetic knees.
Discussion
The preliminary Results show that during deceleration of gait, just before termination, yielding of the MPK enables
a gradual weight loading on the prosthetic leg. This is in contrast to steady state walking where the yielding function
in both MPK and CK seems minimal1. The additional value of an adaptive MPK during starting gait is questionable,
probably because initiation is predominantly controlled by ankle mechanics.
Conclusion
The adaptable damping forces of a MPK during gait termination may contribute to the ability to maneuver safely
in small indoor spaces.
95
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 4
Room 1.03
Abstract Title: Additional Value Of A Microprocessor Controlled Prosthetic Knee In Starting And Stopping
Gait- Pilot Results
Abstract number: 471
Authors: M. Nederhand, E. Prinsen, H. Rietman
Presenter: M. Nederhand
FREE PAPERS
Tuesday, Feb 5 / 09:00 - 10:15
Session Name and Room: Prosthetics : Lower Limb - 4
Room 1.03
Abstract Title: Adaptation Strategies Of The Lower Extremities Of Patients With A Transtibial Or Transfemoral
Amputation During Walking: A Systematic Review.
Abstract number: 133
Authors: E. Prinsen, M. Nederhand, H. Rietman
Presenter: E. Prinsen
Introduction
During the period of rehabilitation, patients with an amputation learn to compensate for the loss of sensorimotor
function of the amputated body part by gait adaptations in both the intact and amputated leg. This systematic
review aims to describe these strategies in terms of joint power or work.
Methods
Multiple databases were searched until November 2011. Studies were selected that compared: (1) intact and
amputated leg, (2) intact and a referent leg (leg of an able-bodied), or (3) amputated and referent leg.
Results
A total of 13 studies were identified based on the applied inclusion criteria. Trials studied patients with a TT
amputation (n=11), TF amputation (n=1), and both TT and TF amputation (n=1). Results of trials studying TT
amputation showed a reduced amount of performed work on knee level of the amputated leg during stance. On
hip level, the concentric work of the hip extensor during early stance is increased in the amputated and intact legs
when compared to a referent leg. Results of trials studying TF amputation show remarkable similar Results on
hip level when compared to the trials studying TT amputation. In addition, push-off of the intact ankle is increased
when compared to a referent leg.
Discussion
In both TT and TF amputation, adaptations were seen in the amputated and intact leg. The majority of the
adaptation can be attributed to a reduced involvement of the amputated leg in weight acceptance, and the loss of
ankle plantar flexors. In addition, muscle groups were identified that are responsible for the adaptations, primarily
the hip extensor of both the amputated and intact leg.
Conclusion
Based on these adaptations it can be concluded that the amputated and intact leg are asymmetrical in function.
Striving towards gait symmetry based on the idea that symmetry is more functional, seems therefore inappropriate.
96
Tuesday, Feb 5 / 09:00 - 10:15
Introduction
Little is known about the complexity of community mobility and social interaction patterns of people with lower
limb amputations. Currently, multiple questionnaires and structured interviews are used to assess community
ambulation and social integration, although these tools are limited by self and/or proxy report and recall bias.
The aim of the current project is to overcome this knowledge gap by combining proven and validated techniques
of accelerometry with emerging Global Positioning Satellite (GPS) technology to gain accurate and objective
measures of everyday community mobility and social interaction in lower limb amputees.
Methods
Ten individuals with unilateral transfemoral amputations were provided with a commercially available step activity
monitor (Orthocare Innovations ®), and GPS system (I-Blue 747A). The step activity monitors (SAM) was strapped
to the prosthetic limb and GPS was carried in either the purse or wallet of the participants. Participants carried the
devices for a period of three months, following which the data was downloaded from the systems and analyzed
using Geographic Information System (GIS) software and Google Earth.
Results
The combination of GPS and SAM was able to give us extremely accurate information on the patterns of community
mobility and social interaction of individuals using lower limb prosthesis. The outcomes include distance walked;
time spent outdoors, mode of travel used, speed of travel, time spent at community destinations, and physical
activity.
Discussion
Outcomes measures from this study will help the field of prosthetics accurately quantify usability of different
prosthesis, compliance of prosthetic use, and social interaction in individuals with lower limb amputations.
Conclusions
This information will be foundational to understanding how different prosthetic technology and physical interventions
can best promote full inclusion of amputees in the every-day community setting.
97
FREE PAPERS
Session Name and Room: Quality Of Life Issues - 1
Room 1.05
Abstract Title: Quantifying Community Mobility And Social Interaction In Individuals With Lower Limb
Amputations
Abstract number: 55
Authors: A. Jayaraman, G. Mathur, R. Lipschutz, T. Kuiken
Presenter: A. Jayaraman
FREE PAPERS
Tuesday, Feb 5 / 09:00 - 10:15
Session Name and Room: Quality Of Life Issues - 1
Room 1.05
Abstract Title: Quality Of Life Of Women With Disabilities Using Orthotic And Prosthetic Devices In South
India
Abstract number: 96
Authors: K. Göbel, K. Randboll Jensen, L. Magnusson, R. Gosh
Presenter: K. Göbel & K. Jensen
Introduction
Women with disabilities living in developing countries generally suffer from triple discrimination because of their
disability, gender and socio-economic position and are therefore assumed to have a lower Quality of Life (QoL). In
the present study conducted in South India, women with lower-limb disabilities using orthotic or prosthetic devices
were compared to non-disabled women.
Method
119 participants. Socio-demographic data was collected and the WHOQOL-BREF in English and Kannada was
used to measure QoL in four domains: physical, psychological, social relationships and environment.
Results
No statistically significant differences (p > 0.05) were found in the mean scores of the four domains between the
two groups. However, differences related to socio-demographic factors were found: The married test group had
lower scores in the physical, psychological and environmental domains compared to the married control group.
The test group with children had lower scores in the physical domain compared to the control group with children.
Women in rural areas use their assistive devices far less than women living in the city, although no difference in
device satisfaction was found.
Discussion
QoL is not determined to be low when living with a physical disability. Marriage and life with children have a greater
impact on the QoL of women with disabilities. Higher education levels might help to improve their status and enable
full participation in society, underlining the importance of CBR work in this area. Though device satisfaction is quite
high, taking environmental factors and women’s needs into consideration when developing assistive devices might
increase daily use.
Conclusion
Socio-demographic variables play a significant role in determining the QoL - education, income, marriage and
children affect domain scores. Methodological constraints and the small sample size suggest further investigation.
98
Tuesday, Feb 5 / 09:00 - 10:15
Room 1.05
Introduction
Healthcare professionals are increasingly encouraged, expected, or required to document clients’ outcomes using
standardized instruments and protocols. The Patient Reported Outcomes Measurement Information System
(PROMIS) is a suite of reliable, precise, and meaningful self-report instruments designed to assess patients’
health. PROMIS-29 is a 29-item survey designed to evaluate patients in seven health domains: physical function,
anxiety, depression, fatigue, sleep disturbance, social role-participation, and pain interference. PROMIS-29
T-scores are centered on US national norms. Health status of persons with limb loss in these domains is unknown.
Methods
PROMIS-29 was included in a cross-sectional survey of prosthetic users. Respondents were recruited via O&P
clinics, magazine advertisements, list-servs, consumer websites, and social networks. Selection criteria included
18+ years of age, ability to read English, unilateral lower limb amputation, traumatic or dysvascular etiology, and
use of a prosthesis to ambulate. Surveys also included questions pertaining to respondents’ general health,
amputation, prostheses, living environment, activity levels, assistive devices, mobility, balance, concentration, and
demographic characteristics.
Results
The PROMIS-29 instrument was administered to 650 persons with limb loss (mean age=53, SD=14). Participants
reported significantly lower physical function (M=43, SD=9, p<0.01) and fatigue (M=48, SD=10, p<0.01) and more
pain interference (M=55, SD=9, p<0.01) than national norms. Reported anxiety, satisfaction with social roles and
activities, depression, and sleep disturbance were similar to US norms.
Discussion
Persons with lower limb loss report significantly worse physical function, significantly more pain interference, and
significantly less fatigue than the general US population. These findings suggest that reduced capacity for physical
activity and pain associated with limb loss may inhibit regular performance of activities.
Conclusion
Standardized instruments like PROMIS-29 can inform clinical practice through accurate measurement of patients’
symptoms and quality of life indicators. Reference data presented here may serve to facilitate use of PROMIS-29
in clinical practice and limb loss research.
99
FREE PAPERS
Session Name and Room: Quality Of Life Issues - 1
Abstract Title: Health Profiles Of Persons With Lower Limb Loss
Abstract number: 222
Authors: B. Hafner, D. Amtmann, D. Abrahamson, S. Morgan, A. Kajlich, R. Salem
Presenter: B. Hafner
FREE PAPERS
Tuesday, Feb 5 / 09:00 - 10:15
Session Name and Room: Quality Of Life Issues - 1
Room 1.05
Abstract Title: The Use Of Focus Groups To Aid In The Development Of A Mobility Outcome Measure
Abstract number: 75
Authors: D. Abrahamson, S. Morgan, D. Amtmann, R. Gailey, B. Hafner
Presenter: D. Amtmann
Introduction
Restoration of mobility after amputation is an important goal of lower-limb prosthetic care. Focus groups can be
used to enrich our understanding of mobility, allowing users of prostheses to share their lived experiences. The
purpose of this study was to identify conceptual gaps in our understanding of environmental factors that influence
prosthetic mobility as described by the following subdomains: obstacle avoidance, time, distance, ambient
conditions, attentional demands, terrain, and external loads. Results will inform the development of a self-report
item bank for measuring mobility with lower-limb prostheses.
Methods
Four focus groups were conducted across the United States, representing differing environments encountered
by prosthetic users. Purposive sampling was used to recruit lower-limb prosthetic users who were diverse with
respect to level of amputation, age, gender, race/ethnicity, etiology, and time since amputation. Focus groups of
6-12 people lasting 1.5 to 2 hours were facilitated using a semi-structured approach to guide Discussions related
to mobility. Transcripts were collaboratively analyzed by two research prosthetists using a phenomenological
approach.
Results
Participants discussed ways that environment factors impact mobility. Examples included how walking in sand
(terrain), hot temperatures (ambient conditions), and crowds (obstacle avoidance) increased the difficulty of
prosthetic ambulation. Additionally, conversation during walking (attentional demands), walking long distances
(distance), moving quickly (time), and lifting heavy objects (external loads) were noted to challenge prosthetic
users.
Discussion
The proposed subdomains comprehensively described the impact of environment on prosthetic mobility, no new
subdomains were added. Focus group Results enhanced understanding of how environmental factors affect
mobility, providing a meaningful foundation for development of an item bank measuring lower-limb prosthetic
mobility.
Conclusion
Focus groups provided valuable information about environmental conditions encountered by persons with limb
loss and facilitated development of a comprehensive instrument to measure prosthetic mobility.
100
Tuesday, Feb 5 / 09:00 - 10:15
Room 1.05
Introduction
The aim of this study was to examine and compare quality of life scores for three different groups with different
living situations, all with a history of poliomyelitis and explore factors affecting their scores in four different quality
of life domains in India.
Method
91 participants with poliomyelitis from three different settings were included in the study. The groups were recruited
from city, rural area and urban slum. The WHOQOL-Bref questionnaire was used to measure quality of life in four
domains; physical health, psychological health, social relationships and environment.
Results
Significant difference (p<0,05) were found between the groups in three of the domains. In the physical health and
the social relationship domain the group from the city scored significantly higher than the group from the urban
slum. In the environmental domain the group from the city and the group from the rural areas scored significantly
higher than the group from the urban slum. No significant difference was found in the psychological health domain
between any of the three groups.
Discussion
When treating disabled persons, it is important to not only provide a person with an orthotic device, rehabilitation
and inclusion in society is also very important to work with to increase a person’s quality of life.
Conclusion
It was found that the possibility to maintain the orthopedic devices and the opportunity earn an income influenced
the quality of life scores positively. The living environment and rehabilitations services did not influence the scores
in the psychological health domain.
The study was conducted in collaboration between Mobility India and School of health science, Jönköping
University, Sweden.
101
FREE PAPERS
Session Name and Room: Quality Of Life Issues - 1
Abstract Title: Poliomyelitis Patients In South India – A Study Measuring Quality Of Life
Abstract number: 334
Authors: S. Wallén, J. Jonasson, L. Magnusson, R. Ghosh
Presenter: J. Jonasson
FREE PAPERS
Tuesday, Feb 5 / 09:00 - 10:15
Session Name and Room: Paediatrics - 1
Room 1.06
Abstract Title: The Use Of Defo's Shorts In The Treatment Of Abduction Contracture Of The Hipjoint
Abstract number: 7
Authors: A. Suzuki, Y. Matsumoto, M. Takahashi, T. Kitakouji, C. Takeuchi, M. Matthhews
Presenter: A. Suzuki
Introduction
This paper will present and discuss effectiveness of Dynamic Elastomeric Fabric Orthoses(DEFO's )shorts that the
use of Lycra® garments to contracture of the hip joint with arthrogryposis multiplex congenita(AMC). Usually,
the treatment of contracture of the hip joint use rigid hip bracing, but AMC need brace very early so it is very difficult
to wear rigid hip brace made by hard plastic and metal, because it is heavy and hard .From experience obtained
in the treatment of rigid contracture of the hip joint , we tried a new concept of using specifically designed DEFOfs
shorts. This paper will discuss a single case presentation and resultant evidence to provide a basis for Discussion
into the use on DEFO's shorts in non-operative contracture of the hip joint correction.
Method
The DEFO's shorts was designed to provide a adduction and stability of hip joint of a 5 months old girl presenting
with a rigid contracture of the hip joint in 40‹. The shorts designed hip abduction 30‹ to provide force to adduction
,and extended from a waist to legs to provide fixation for the compressive component of the shorts and a basis of
stability for the base of hip joints.
Results
From initial X-rays and photograph, the hip abduction reduced 40‹ to 0 ‹following supply of the shorts.@The angle
remained the same both in and out of the orthoses.@Compliance with the 23 hour wearing regime was 100% with
the shorts.
Discussion and Conclusion
From this paper the DEFO's shorts was effective to rigid contracture of the hip joint with AMC . But the report
similar to this paper was not founded, so this result indicates that a large study is required to further explore these
effects.
102
Tuesday, Feb 5 / 09:00 - 10:15
Upper limb (UL) dysfunction can have an impact on development at all stages of childhood (Ibbotson, 2002).
There is, however, a rejection rate of UL prostheses of up to 50% amongst children (Shida-Tokeshi, et al., 2005).
Research has suggested that children may choose to use a different prosthesis depending on the task (Egermann
et al, 2008), but there is a distinct absence of the views users. Inclusion of end, lay and professional users is crucial
to successful development of medical devices as unless devices are examined in the cultural and social context in
which they are used the effectiveness of the devices will be limited (Ram et al, 2005).
This research explores the views of children, parents and professionals on UL prostheses to contribute towards the
design of prosthetic ULs for children. Stage 1 of this study has been completed. This involved eight children (aged
8 – 15), with experience of using an UL prosthesis, and five parents participating in focus groups and interviews.
Preliminary findings demonstrated that children may choose to use a prosthesis as an aid in activities, to prevent
unwanted attention and to have fun. They may choose not to wear a prosthesis because it is more of a hindrance
than a help or because they are satisfied with who they are. Areas for development identified included appearance,
comfort, weight, movement, ease of use and for assistance with specific activities. These findings were used to
inform the development of new prototype prostheses.
In stage 2 of this study (May 2012) prototype prostheses will be shown to participants in focus groups and
interviews in order to further develop the designs and explore themes in more depth.
Stage 3 of this study (May–Sept 2012) will involve exploring the views of clinicians and gaining their feedback on
prototypes developed.
103
FREE PAPERS
Session Name and Room: Paediatrics - 1
Room 1.06
Abstract Title: Exploring The Views Of Children, Parents And Clinicians To Contribute Towards The
Development Of Upper Limb Prostheses
Abstract number: 42
Authors: T. Sims, M. Donovan-Hall, C. Metcalf
Presenter: T. Sims
FREE PAPERS
Tuesday, Feb 5 / 09:00 - 10:15
Session Name and Room: Paediatrics - 1
Room 1.06
Abstract Title: Gait Pattern In Children With Cp And Leg Length Discrepancy, Effects Of An Extra Sole.
Abstract number: 94
Authors: R. Zügner, I. Stefansdottir, M. Nyström-Eek
Presenter: R. Zugner
Introduction
Cerebral palsy (CP) is the most common cause of motor problems in children. The gait pattern is often different
from normal with slow velocity and increased energy consumption. Factors affecting the gait are muscle tone,
impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy. Asymmetrical gait
pattern is described in normal children with leg length discrepancy. It gives a limp, reduced power at push-off, walk
on tiptoe or to walk with flexed knee. Leg length discrepancy can be treated surgically, with insoles or elevation of
the sole on the short leg. The purpose of this study was to examine if compensation of leg length discrepancy in
the form of insole or sole on the short leg leads to a change in movement pattern during walking in children with
spastic CP.
Methods
Children with spastic CP 7-15 years old and a leg length discrepancy > 1 cm, were included in the study.
Computerized gait analysis with registration of kinematics and kinetics in hip, knee and ankle: barefoot, with shoes
and with an extra sole for the shorter leg.
Results
Differences from normal gait were found at all levels. Preliminary data indicates that with shoes and extra sole
there were more symmetric step length, stance phase, and improved knee extension during stance phase together
with increased power at push off in the ankle.
Conclusions
For a child with CP small differences in leg length can cause an abnormal gait pattern. Clinical experience suggests
that compensation of leg length discrepancy in children with spastic CP can lead to a more normal and symmetric
gait pattern. Insoles or elevation of shoe are simple and cost effective means to improve walking ability in children
with CP.
104
Tuesday, Feb 5 / 09:00 - 10:15
Club Foot is a congenital abnormality of foot with idiopathic etiology. incidence is 1.2 of per 1000 live births. In
club foot ankle in a plantar-flexed and inverted position with the heel, mid-foot and forefoot adducted and inverted
producing a cavus deformity.
Objective
• To find out the ratio of relapse in patients using Dennis brown splint.
• To describe the issues related to non-compliance of the Dennis brown splint.
Materials & Methods
70 patients with corrected club foot using Dennis brown splints for the maintenance of the correction followed by
Ponseti method. parents were interviewed for the issues related to non-compliance to the bracing program and to
check the relapse rate of the deformity. Duration of the study was 12 months followed by the bracing.
Results
It is founded that there is 24% reported with recurrence of deformity during bracing program.
issues of non-compliance consist the following ratio
1. 47%reported with skin problem.
2. 45% reported with residual adduction of the foot part.
3. 30 % reported that their babies withdraw the foot from the shoes.
4. 70% of the families do not have even basic education which also adds to the poor outcomes.
Conclusion
• It is founded that relapse rate is 24% because of the issues related to the non-compliance from which main issue
is skin problem.
• The second other cause is repeated residual adduction.
• Most of the families have very low education so that it was founded very difficult to counsel them.
105
FREE PAPERS
Session Name and Room: Paediatrics - 1
Room 1.06
Abstract Title: Estimation Of Recurrence With Dennis Brown Splint And To Describe The Issues Related To
Non-Compliance In Patients With Club Foot.
Abstract number: 95
Authors: Z. Zahid, I. Zia
Presenter: Z. Zahid
FREE PAPERS
Tuesday, Feb 5 / 09:00 - 10:15
Session Name and Room: Paediatrics - 1
Room 1.06
Abstract Title: Effect Of Custom Molded Rigid Foot Orthosis On The Functional Lumbar Scoliosis In Children
Abstract number: 242
Authors: B. Kim, I. Chang, I. Park, E. Sim
Presenter: B. Kim
Introduction
It is not uncommon for the clinicians to encounter a child with nonstructural spinal malalignment in the lumbar
region accompanied with certain problems in the foot. This type of clinical problems has been taught not to treat
as this is a self limiting benign problem. In Asian countries like Korea shoes are not worn in-house environment
with no protection under the foot when a child has problems in the foot. As this functional problems can progress
into the abnormal structural spinal curves such as scoliosis, lordosis or kyphosis later in their lives clinical practice
guideline is warranted.
Methods
Fifty children with functional scoliosis with hyperpronation of the feet were included in this study. To correct
hyperpronation of the feet custom molded rigid biomechanical foot orthosis (BFO) was fitted and encouraged them
to wear BFO in the shoe while they are not in the bed. Physical examination to measure resting calcaneal stance
position (RCSP) angle and pelvic alignment followed by simple radiographic evaluation of the feet with and without
weight bearing and whole spine in standing were taken before, 2 ,3, and 6 months after fitting BFO. Stretching and
strengthening exercises of the lower extremities and paraspinal muscle were encouraged throughout the study
period. Other fifty children in the same age and gender distribution with similar problems who refused to be fitted
with BFO were encouraged to exercise in the same way and evaluated as a control group. The data was collected
and statistically analyzed.
Results
Statistically significant improvement in spinal alignment in the simple radiographic evaluations were seen in the
group with BFO compared to the control group without BFO.
Discussion and Conclusion
BFO may play an important role in the prevention of the progression of spinal malalignment in children with foot
problems.
106
Tuesday, Feb 5 / 12:00 - 13:15
Introduction
The objective of this study was to determine how foot-ankle roll-over shape was affected by a prosthetic ankle
component that increases sagittal-plane motion. By increasing motion at the ankle during stance phase with the
addition of a compliant prosthetic ankle joint, we hypothesized that the roll-over shape radius of the prosthetic foot
and ankle would be reduced. Similarly, the increased ankle motion was expected to decrease the effective foot
length of the ankle-foot system.
Methods
Subjects with bilateral transtibial amputations were recruited for this study. Subjects signed consent forms that
were approved by Northwestern University’s Institutional Review Board. Quantitative gait data were acquired using
an 8-camera real-time motion capture system and 6 force-plates as subjects walked with and without Endolite
Multiflex Ankle Units along a 10m walkway. For both conditions, subjects used Seattle Lightfoot II feet.
Results
Seventeen subjects completed the study. Ankle motion increased from a mean of 13.0 degrees to 19.4 degrees
while walking with the prosthetic ankle units (p<0.001). The subjects’ roll-over shape radii were significantly less
with the prosthetic ankle units than for the baseline condition (p<0.001), but the effective foot length was not
affected by the prosthetic ankle units (p=0.066).
Discussion
Prosthetists should carefully consider the effects of combining different prosthetic components on overall functional
performance of their patients. When fitting someone with a prosthetic ankle unit, the prosthetist should consider
selecting a prosthetic foot with a slightly stiffer keel in order to provide a more appropriate roll-over shape for the
prosthetic foot-ankle combination. Doing so could improve walking biomechanics and ultimately serve to increase
the efficiency of gait.
Conclusions
The increased ankle motion provided by the Multiflex Ankle Units in this study decreased the radius of the anklefoot roll-over shape. However, the effective foot length was not affected.
107
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 5
Room 1.03
Abstract Title: Effect Of Prosthetic Ankle Units On Roll-Over Shape Characteristics During Walking In
Persons With Bilateral Transtibial Amputations
Abstract number: 83
Authors: S. Gard, P. Su, R. Lipschutz, A. Hansen
Presenter: S. Gard
FREE PAPERS
Tuesday, Feb 5 / 12:00 - 13:15
Session Name and Room: Prosthetics : Lower Limb - 5
Room 1.03
Abstract Title: A Preliminary Evaluation Of A Hydro-Cast Trans-Femoral Prosthetic Socket Design, A Proof
Of Concept
Abstract number: 297
Authors: A. Buis, M. Kamyab, S. Hillman, K. Murray, A. Mcgarry
Presenter: A. Buis
Introduction
This study reports on a research project that has utilised, for the first time, a hydro-casting technique to create a
trans-femoral prosthetic socket. Outcome measurements of the Hydro-Cast (HC) socket were compared with a
prosthesis produced by conventional ischial containment (IC) technique.
Methods
A trans-femoral amputee was provided with two interventions, one copy of the existing prosthesis and
one with a Hydro-Cast socket. Outcome measures included: Dynamic stump/socket interface pressure
distribution(Tekscan™),Femur movement relative to the socket(Ultrasound technology),Full body motion capture
and analysis(Vicon™).
Results
Results indicate that sockets produced by both techniques, generated similar dynamic interface pressures.
The average pressure of the HC system is more uniform during toe-off/ double support compared with that of
the IC system. No marked differences were observed between the two conditions for any upper or lower body
gait parameters or in the temporal and distance parameters.The range of movement of the femur within the HC
prosthetic system was considerably less as compared with the IC system.
Discussion
Adherents of the most widely used design philosophies for trans-femoral sockets have described how their
approaches influence or control the motion of the femur relative to the stump tissues and the socket. Although a
proof of concept study, Results indicate the possibility that the HC socket may offer improved medio-lateral stability
compared to the IC socket as used by the test subject. This is also highlighted by Kahle (2002) who removed
different socket elements systematically in a case study examining trans-femoral socket design.
Conclusions
The Conclusions of this study were significant because it is feasible to produce an acceptable prosthesis with the
HC technique. Additionally, it seems that the fit of this prosthesis is more comfortable than compared with the old
style prosthesis. However, more users should be investigated.
108
Tuesday, Feb 5 / 12:00 - 13:15
Introduction
Gait initiation requires the generation of propulsive forces, which are generated by decoupling the centre of mass
(CoM) and centre of pressure (CoP). The impact of the CoM velocity has to be absorbed after the first step, which
can be difficult when leading with the prosthetic leg. Because microprocessor controlled prosthetic knees, such as
the Rheo Knee, show improved stance stability, these may be beneficial during gait initiation by enabling greater
decoupling.
Methods
Four unilateral transfemoral amputees (> 1 year after amputation; functional level : K2- K4) were included and
measured twice, once with their own mechanically passive prosthesis and once with the Rheo Knee (8 weeks
acclimatization). Measurements were performed using a 6-camera Vicon system and two forceplates. Prosthetic
foot and knee alignment were similar in both prosthetic knee conditions
Results
When starting with the prosthetic leg, one subject showed a larger decoupling of the CoM and CoP when using the
Rheo, resulting in a higher CoM velocity at the end of the first step. In one subject no differences were found and
in two subjects, decoupling was lower. When starting with the intact leg, two subjects showed a larger decoupling
of the CoM and CoP when using the Rheo, resulting in a higher CoM velocity at the end of the first step. In one
subject, no notable differences were found. In one subject the decoupling was slightly lower when using the Rheo.
Discussion
The Results of this preliminary analysis showed no clear differences between both prosthetic knee conditions.
Although microprocessor controlled knees improve stance stability, subjects did not show consistent improvements
in decoupling and CoM velocity when leading with the prosthetic leg.
Conclusion
The Results of this preliminary study indicate that a microprocessor controlled prosthetic knee does not improve
decoupling of the CoP and CoM during GI.
109
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 5
Room 1.03
Abstract Title: Influence Of A Microprocessor Controlled Prosthetic Knee On Biomechanics Of Gait
Initiation, Preliminary Results.
Abstract number: 475
Authors: E. Prinsen, M. Nederhand, H. Rietman
Presenter: E. Prinsen
FREE PAPERS
Tuesday, Feb 5 / 12:00 - 13:15
Session Name and Room: Prosthetics : Lower Limb - 5
Room 1.03
Abstract Title: Effects Of Variable Stiffness Prosthesis On Walking Kinematics During Load Carriage
Abstract number: 488
Authors: A. Auyang, E. Chu, A. Kregling, Q. Chen, K. Collier, J. Shim
Presenter: A. Kregling
Daily activities often involve load carriage during locomotion. Examples of such activities may include light loads
such as carrying groceries or heavy loads like a heavy suitcase. In able-bodied subjects, load carriage at 125% and
150% of body weight does not change ankle or knee kinematics. This is most likely achieved through modulating
joint torques about each of the joints to maintain invariable joint kinematics. In a person with a lower limb transtibial
amputation, the loss of a functional ankle Results in decreases in resources available for the neuromuscular
system to maintain invariable joint kinematics. Prescription of categories and stiffnesses for typical prosthetic
feet are often based on daily activity. Regardless of prescription, these feet are typically mono-stiffness feet.
The purpose of this study is to determine whether a passive variable-stiffness prosthetic foot will allow unilateral
amputees to maintain more invariant joint kinematics as compared to a traditional mono-stiffness foot. Nine
unilateral transtibial amputees were tested in a straight line walking task at self-selected-preferred speeds with
(130% BW) and without additional weight. Subjects were tested in these conditions using a mono-stiffness foot
(Freedom Innovations Sierra) and a passive variable-stiffness foot (Freedom Innovations Thrive). The category/
stiffness (or lowest stiffness for the variable-stiffness foot) of each test foot was based on what the subject’s
prosthetist had prescribed them. The Results showed that while both test feet resulted in similar joint trajectories
throughout the gait cycle, the variable stiffness foot resulted in no change in maximum range of motion while the
mono stiffness foot showed statistically significant increase in maximum range of motion in the loaded condition.
We conclude that a variable stiffness foot, while still not able to provide the range of function of an intact ankle,
does provide additional resources that allow the subjects to perform kinematically similar to able-bodied subjects.
110
Tuesday, Feb 5 / 12:00 - 13:15
Introduction
Contrary to previous scientific belief the foot seems to play a crucial role in the overall optimisation of gait
performance, stability and symmetry. A self-aligning hydraulic ankle has been developed and fitted to over 3000
amputees with an overall positive feedback on overall comfort, performance, increase in both confidence and
stability and energy efficiency.
Methods
Over 3000 fittings have been reviewed in general and a brief survey on selected amputees’ feedback has been
conducted. In this survey the subjects were asked about their previous foot type and experience, the perception
using the self-aligning foot and the impact on their activities of daily living. Additional feedback was provided by the
supervising prosthetist. Beside of the surveys, biomechanical studies with several trials have been carried out both
on transtibial, knee-disarticulated and transfemoral amputees revealing kinematic and kinetic effects.
Results
Especially the brief survey of selected amputees’ feedback proofs the vision of self-aligning ankle-foot prosthesis
as a medical necessity from our point of view. It confirms that the concept enables amputees a more voluntary
control on self-alignment and hence a more natural optimisation of the overall movement performance. This is
believed to be preferable especially when negotiating ramps or standing on inclined terrain as the ankle-foot itself
adapts to the ground so that compensational effects in the knee, hip and upper body can be reduced in comparison
with standard composite feet.
Conclusion
It might be a promising way to develop a range of products based on the adaptive and self-aligning properties
to broaden the range of possible applications within lower limb prosthetics and enable to give the benefit of more
comfort and a smoother roll-over to a broader range of patients.
111
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 5
Room 1.03
Abstract Title: Long-Term Experiences With A Hydraulic Ankle Capable Of Self-Alignment – A Review And
Development Roadmap
Abstract number: 240
Authors: S. Zahedi, N. Stech, D. Moser, G. Harris, J. Mccarthy, A. Mcdougall, J. Ross
Presenter: J. Ross
FREE PAPERS
Tuesday, Feb 5 / 12:00 - 13:15
Session Name and Room: Rehab Medicine & Surgery - 2
Abstract Title: Car Adaptations For Subjects Following Upper Limb Amputation
Abstract number: 81
Authors: H. Burger, Marin, A. Zupan, A. Fidler
Presenter: H. Burger
Room 1.05
Introduction
Amputation - even of a very small part of one finger - Results in decreased pinch and grip force and consequently
in problems with many activities of daily living, including driving. People following upper limb amputation have
more problems with driving and need more adaptations of the car than people following lower limb amputation
(Fernandez et al., Arch Phys Med Rehabil 2000;81:288-91). The aim of our study was to find out which car
adaptations are suggested to people following upper limb amputation.
Methods
Medical documentation of all persons aged 18+ following upper limb amputation performed in the last five years
who visited our outpatient clinic was reviewed.
Results
Thirty-seven persons (27 men), aged 38 years on average, fulfilled the inclusion criteria. All except two were
fitted with prosthesis. Seven were not sent for assessment of driving abilities; the rest were still able to drive,
but they needed from zero up to four car adaptations. The most frequently suggested adaptation was automatic
transmission, followed by moving of the commands from one side of the wheel to the side held by the nonamputated limb, a knob on the wheel, and standard assisted steering. Only three persons were allowed to drive
with the prosthesis.
Discussion
Our findings are similar to those reported by others. Persons following upper limb amputation have problems with
driving and most of them need car adaptations for safe driving. It is important that clinicians working with them are
aware of that and refer them to driving assessment.
Conclusion
People following upper limb amputation need car adaptation for safe driving.
112
Tuesday, Feb 5 / 12:00 - 13:15
Room 1.05
Introduction
In patients with lower limb amputation, mobility and weight bearing activities may be limited. It may cause
generalized and regional osteoporosis. This study was undertaken to determine prevalence and risks factors of
osteoporosis among adult Filipino amputees.
Methodology
Participants (n=19) were interviewed after securing informed consent. Demographic profiles, prosthetic information
and risk factors of osteoporosis were inquired. Participants underwent screening using Sunlight Omnisense®
8000S mobile bone assessment device to determine bone mineral density (BMD). The non-amputated tibia was
used as reference part. Bilateral study was done only among participants with below knee amputation (BKA).
Results
Mean age is 44.5 61617; 14.1 years. Majority were males (74%), unemployed (79%), and married (68%). Ten
participants (53%) have above knee amputation (AKA) followed by 8 BKA (42%) and only one with hip disarticulation
(5%). Mean duration of amputation was 29.7 61617; 31.0 months. Majority (58%) were using prostheses. Majority
were non-smokers (63%) and non-alcoholic drinkers (53%). More than half have non-modifiable risk factors (53%).
Most (95%) were drinkers of caffeine-containing drinks.
Discussion
General prevalence of osteoporosis as determined by presence of osteoporosis in any limb is 63.2% (95% CI:
38.4%; 83.7%). For participants with BKA, prevalence of regional osteoporosis on the residuum is 100.0% (one
sided 97.5% CI: 39.8%; 100.0%). However, this is only based on 4 participants because of machine’s limitation.
Positive osteoporosis screening was commonly observed among elderly participants, male, married, unemployed,
long standing BKA and non-prosthetic users. There may be progression of demineralization on the residuum over
time because of insufficient mechanical weight loading, disuse atrophy and lack of muscular action. Risk factors
identified were cigarette smoking, alcoholic drinking and caffeine intake.
Conclusion
All patients with lower limb amputation may develop osteoporosis because of disuse, altered biomechanics and
risk factors similar to the general population.
113
FREE PAPERS
Session Name and Room: Rehab Medicine & Surgery - 2
Abstract Title: Osteoporosis Among Adult Filipinos With Unilateral Lower Limb Amputation
Abstract number: 227
Authors: J. Montes
Presenter: J. Montes
FREE PAPERS
Tuesday, Feb 5 / 12:00 - 13:15
Session Name and Room: Rehab Medicine & Surgery - 2
Abstract Title: Akan®: An Improvement For The Trans-Femoral Amputee?
Abstract number: 319
Authors: A. Lacraz, G. Carmona, M. Assal
Presenter: A. Lacraz
Room 1.05
Introduction
End-weight-bearing has a number of biomechanical advantages in lower limb amputations while providing more
comfort to the patient. Despite recent progress in prosthetic materials and techniques, end-weight-bearing is not
possible for patients with mid-thigh amputation. The “osteointegration technique” has addressed this issue, but at
a high technical cost. The goal of this research was to develop and evaluate the design and surgical technique of
an implant that consists of a stem and a submuscular cap, offering an end-weight-bearing surface for mid-thigh
amputations.
Material and Method
AKAN® (Above Knee Amputation Nail) is an implant that has a cemented stem of different sizes adapted to the
femoral shaft anatomy. A circular cap, with an angulated neck reproducing the angle between the anatomical and
mechanical axes of the femur, is fixed to the distal end of the stem. The surgical approach includes a long anterior
flap so that the incision will not be on the end-bearing surface, but will be located posteriorly. The myodesis is
performed by securing the muscle attachments through predrilled holes in the cap. Scanographic studies on
cadaveric specimens, as well as finite element studies of the implant were performed.
Results
The scanographic and finite element studies have allowed for validation of the design of the AKAN®. Several trials
on cadaveric specimens have led to the exact step-by-step surgical procedure.
Discussion
This preliminary study, with the utilization of a series of cadaveric specimens, has validated the implant and the
surgical technique.
Conclusion
Based on these favorable Results the project has been submitted to our University Hospital Ethics Committee for
implementation of a clinical trial.
114
Tuesday, Feb 5 / 12:00 - 13:15
Introduction
Ambulation forms an important part of rehabilitation program after lower limb amputations. Diabetes Mellitus and
its complications are commonly associated with amputation. Inspite of this, there is an absence of studies on the
effect of diabetes on the post operative ambulation of an amputee. This study analyses the role of diabetes as an
independent factor affecting post operative ambulation and compares it with non diabetics.
Material and Methods
The present study followed 105 patients; 48 diabetics and 57 non diabetic amputees. Their post operative
ambulatory level was compared by using Pinzur et al ambulation scale. Both groups were age, sex and BMI
matched.
Results
There was a worsening of ambulatory level in 33.3% diabetics as compared to 10.7% in non diabetics
postoperatively. Of the prosthetic users, 78.4% were in non diabetic group and 21.6% were in diabetic group.
17.6% of prosthetic users required additional support, of whom 66.7% were diabetics.
Discussion
Diabetics have a poorer ambulatory level as compared to non diabetics. Further the incidence of prosthesis usage
and its duration is also less in diabetic group. Diabetics have to use additional support more often than non
diabetics
Conclusion
Diabetes Mellitus is an independent factor which has an adverse effect on the functional outcome of a patient after
below knee amputation.
115
FREE PAPERS
Session Name and Room: Rehab Medicine & Surgery - 2
Room 1.05
Abstract Title: Effect Of Diabetes On Postoperative Ambulation Following Below Knee Amputation
Abstract number: 326
Authors: A. Saraf, A. Gupta, J. Prakash, J. Prakash
Presenter: A. Saraf
FREE PAPERS
Tuesday, Feb 5 / 12:00 - 13:15
Session Name and Room: Rehab Medicine & Surgery - 2
Room 1.05
Abstract Title: Roehampton Stump Score - A Method Of Estimating Quality Of Stump For Prosthetic
Rehabilitation
Abstract number: 340
Authors: S. Sooriakumaran, M. Uden, S. Mulroy, T. Collins
Presenter: S. Sooriakumaran
Introduction
It is widely recognised that the quality of amputation surgery has a strong impact on prosthetic rehabilitation
outcome. No validated method of evaluating quality of amputation stump was identified from literature search. We
have developed this method of scoring transtibial and transfemoral stumps. The salient features of the stump that
influence early prosthetic fitting, socket comfort and weightbearing were identified.
Methods
The scoring sheet was completed for all new amputees during their initial assessment. The following ten parameters
were scored: wound healing; stump pain; length of stump; shape of stump; bone end as evaluated using X-ray;
muscle cover; proximal joint range and power; sensation; vascular perfusion; and skin condition. Each parameter
was scored between 0 to10 giving a maximum total score of 100. The date of amputation, Name of surgeon, Name
of hospital and surgical technique were noted.
Results
Since August 2011, 82 stumps have been scored. The study will be completed with 100 stumps and Results will
be analysed fully for the presentation in February 2013. The preliminary analysis has identified inadequate shaping
of bone end and muscle cover. High scores were noted in most of the other parameters.
Discussion
This scoring method offers an objective assessment of quality of stump. The overall high scores indicate a
significant improvement in quality of amputation surgery in recent years. Potential areas of improvement of bone
contouring and muscle attachment were identified.
Conclusions
The plan is to validate Roehampton Stump Score and to encourage colleagues to use it routinely. We believe this
would improve both quality of amputation surgery and prosthetic rehabilitation.
116
Tuesday, Feb 5 / 12:00 - 13:15
Introduction.
The PROPRIO FOOT is the first powered, bionic prosthetic foot that was commercially available.
Methods
LLA using a carbon fibre foot were eligble for study participation. The IRB approved study was a self-controlled
trial. Subjects were measured at baseline on their own prosthesis. Then, changed to a bionic foot for four weeks
and were measured again. Four validated outcome measures, PEQ-MS (primary endpoint), Ramp Assessment
Index (RAI) and Stair Assessment Index (SAI) 2 and 2MWT 6 were used to assess mobility. The Activity Balance
Confidence (ABC) 5 scale, plus a questionnaire on falls developed for the study were used to assess safety.
Results
Eight LLA completed the study, 5 AK and 3 BK amputees. The mean age and weight were 49,4y ± 12y and 92,6kg
±27kg respectively. The PEQ-Mobility score increased from 4,08 at baseline to 4,74 while on the bionic foot. This
increase is significant at the 95% level (p=0,045). For the 2MWT no difference was identfied between the two
feet. The mean scores for the RAI and HAI while walking up and down ramps/stairs, showed trend towards an
improvement across all four conditions when changing to a bionic foot (p>0.05). For the ABC, the mean score
improved from 89,9 to 96,4 after the intervention (P> 0.05). Finally, on average over the past four weeks stumbles
decreased from 9,9 to 5,3 and falls dropped from 3,4 to 1,0 when transferring to the Bionic Foot.
Conclusion
Despite the limitation of the study which is small sample size, Results indicate improvements in mobility and
reduced risk of falling as reported by users, while on the bionic foot –which may relate to the intellegent functions
offered by the bionic foot. In particular, the toe lift in swing and terrain adaptation. To confirm this a larger study
is needed
117
FREE PAPERS
Session Name and Room: Evidence Based Practices - 2
Room 1.06
Abstract Title: Effects On User Mobility And Safety When Changing From A Dynamic Prosthetic Foot To A
Bionic Foot
Abstract number: 497
Authors: A. Ludviksdottir, M. Nicholls, T. Ingvarsson, K. Gunnsteinsson, K. Gruben
Presenter: A. Ludviksdottir
FREE PAPERS
Tuesday, Feb 5 / 12:00 - 13:15
Session Name and Room: Evidence Based Practices - 2
Room 1.06
Abstract Title: Clinical Application Of Self-Report And Performance Based Outcome Measures To Determine
Clinical Effectiveness.
Abstract number: 353
Authors: R. Gailey, V. Agrawal, I. Gaunaurd, A. Finnieston
Presenter: R. Gailey
Introduction
Outcome measures can be used to evaluate clinical progress, establish goals, or simply determine current
functional capabilities of people with limb loss. The purpose of this study was to determine the clinical application
of the Prosthetic Evaluation Questionnaire - mobility Scale (PEQ-MS13), the Locomotor Capabilities Index (LCI),
the Amputee Mobility Predictor (AMP) and 6-minute walk test (6MWT).
Methods
Ten transtibial amputee subjects were assigned to two groups based on cause of limb loss (5 PVD/ 5 traumatic)
for an 8 week trial, receiving a specialized prosthetic training program consisting 4 gait related movement patterns,
2 home exercises and prosthetic foot specific techniques to negotiate sitting, standing, ramps and stairs. The
aforementioned measures were administered at base-line and subsequently every two weeks to determine
differences between training period and the four categories of prosthetic feet.
Results
ANOVA was performed to compare differences between groups and interventions. Of the four outcome measures
only the AMP detected differences with the PVD group demonstrated significant differences between baseline and
training plus all categories of prosthetic feet (p < 0.05) while the traumatic group demonstrated difference between
baseline and the SAFE, Talux and Proprio feet (p < 0.05).
Discussion
After receiving the specialized training the PVD group demonstrated improvement functioning at a higher
classification level and therefore qualifying by government standards for all categories of prosthetic feet. Prosthetic
specific training in conjunction with advanced prosthetic feet such as the Talux and Proprio Foot improved function
in the traumatic group.
Conclusion
Advanced prosthetic foot systems and specialized training can improve functional capabilities as measured by the
performance-based outcome measure the AMP. The ability to maximize prosthetic performance and objectively
demonstrate differences is essential for comparative effectiveness healthcare systems.
118
Tuesday, Feb 5 / 12:00 - 13:15
Introduction
Prosthetic alignment, arranging a custom fitting socket in relationship to the residue limb and an artificial limb
section, is an important part of the prosthetic fitting process, and ultimately of the rehabilitation of transtibial
amputees. Prosthetic alignment is typically performed by prosthetists and is primarily based on subjective
assessments of the patient’s comfort and walking performance. Recently, technologies have become available to
provide objective guidance during the alignment process. The Compas™ system is one such instrument; however,
scarce evidence exists about how effective it is, and how best it can be utilized in the clinic. The aim of this study
was to determine if an instrument-assisted alignment technique would improve patient outcomes when compared
to the conventional subjective alignment technique.
Methods
Both conventional and instrument-assisted prosthetic alignment techniques were evaluated and compared among
8 adult individuals with a unilateral transtibial amputation. Kinetic and kinematic gait parameters were collected
over two sessions using functional walk tests and questionnaires.
Results
Data showed that although there was no significant difference between the two techniques in gait stability and
kinetic patterns, insights were gathered from the biomechanical effects due to change of alignment and from
prosthetists on the clinical usefulness of the Compas™ system.
Discussion
Participants demonstrated similar alignment outcomes having received both alignment techniques. However,
Results suggested biomechanical characteristics of an individual’s gait may be affected by each alignment change.
These can guide improvement of future generations of the Compas™ system, and provide insights to prosthetists
when they perform alignment clinically.
Conclusion
The findings from this research may improve patient care by providing guidelines and insights into the effective
clinical use of instrument-assisted techniques for optimally aligning prosthetic limbs.
119
FREE PAPERS
Session Name and Room: Evidence Based Practices - 2
Room 1.06
Abstract Title: Evaluation Of Dynamic Prosthetic Alignment Techniques For Individuals With Transtibial
Amputation
Abstract number: 361
Authors: J. Andrysek, C. Chen, K. Fairley, W. Heim, R. Clements
Presenter: J. Andrysek
FREE PAPERS
Tuesday, Feb 5 / 12:00 - 13:15
Session Name and Room: Evidence Based Practices - 2
Room 1.06
Abstract Title: Factors Influencing The Reliability Of Different Designs Of Goniometer: A Literature Review
Abstract number: 369
Authors: F. Mohsin, A. Mcgarry, R. Bowers
Presenter: F. Mohsin
Introduction
Different designs of the goniometer are available for clinical measurements of joint range of motion (ROM),
including: universal goniometers, gravity-dependent goniometers and electrical goniometers. Reliability of the
goniometer is essential in clinical practice. Several factors can influence reliability, including: pathology, number
of testers, type of motion, joint characteristics and procedure followed. Hence, it is important to understand how
reliability can change with these factors.
Methods
An electronic and manual literature search was conducted into the reliability of different goniometers. A variety
of search terms were used with no limits or restrictions. Papers sourced were graded according the Scottish
Intercollegiate Guideline Network guidelines.
Results
Normal subjects and patients with variety of pathologies participated in the studies reviewed. The active and
passive motion of lower limb joints was studied. Both intratester and intertester reliability was examined. Several
studies directly compared between the reliability of different goniometric designs.
Discussion
Variation in methodology and measurement procedures across different studies affected the ability to make
comparison between them. The majority of studies concluded that intratester measurements were more reliable
than intertester measurements. Reliability of measurements varied across joints involved, with measurements of
more complex joints proving less reliable than simple joints. In addition, the reliability of the measurements altered
depending on pathology. Moreover, some studies confirmed that measuring active motion was more repeatable
than passive motion. Furthermore, some studies suggested that standardising the method of measurement
increases reliability. Finally, reliability differed between the different goniometric designs and most studies stated
that goniometers should not be used interchangeably.
Conclusion
In Conclusion, clinicians should be cautious when: choosing the appropriate type of goniometer and interpreting
or comparing measurements taken using different designs. Additional studies of appropriate design should be
conducted to provide better understanding of goniometer measurements obtained.
120
Tuesday, Feb 5 / 14:30 - 15:45
Introduction
There is still insufficient experience with pattern recognition (PR) and multi-electrode systems outside of the
laboratory environment. This work shows the strengths and weakness of such systems during the whole fitting
process and during the usage in the habitual environment of the patient.
Methods
A 4 week patient-trial was made with a Michelangelo® hand and an electric wrist (4-DOF) controlled by 8 sEMG
sensors. These were placed circumferentially around the forearm and their signals continuously recorded using
a data-logger. Before commencement of the trial, the training of the PR system was carried out. The patient then
used the system in his normal environment.
Results
The main strength of the system is the faster and more intuitive control. The weakness is that this is only given
if the patterns have small deviations. At home both an expert and laboratory equipment is missing to provide
feedback regarding mismatches. During the first 2 weeks therefore, performance was unsatisfactory. Then a PC
based feedback system was provided at home, allowing the patient to see the classification Results of his patterns
online. By self-training, the Results in the latter 2 weeks improved to full acceptance of the system.
Discussion
Some intuitive movements proved not independent enough or generated to weak EMG to be used. With anatomical
knowledge suitable alternatives can be found and retrained effectively by the patient with use of the feedback
system.
Conclusions
The main benefit of pattern recognition leads to both a significant higher acceptance of the use of prostheses and
an improved rehabilitation result. For this however, it is necessary to support the patient in learning to provide
stable and independent muscle patterns. We showed that early stage training is required, as is a patient feedback
system for pattern deviations, such as a PC software providing real-time visual classification information.
121
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 2
Room 1.01
Abstract Title: Requirements For Effective Use Of Pattern Recognition Controlled Multiple Degrees Of
Freedom (Dof) Transradial Prostheses In The Habitual Environment
Abstract number: 103
Authors: J. Kalmar, J. Van Vliet
Presenter: J. Kalmar
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Prosthetics : Upper Limb - 2
Room 1.01
Abstract Title: Mechanical Testing And Design Refinement Of A Low Cost Multi-Functional Terminal Device
- The Unb Hand
Abstract number: 144
Authors: A. Clawson, A. Wilson, E. Scheme, D. Rogers, P. Kyberd
Presenter: P. Kyberd
There are currently two multifunctional hands that are commercially available to the end user. Although offered,
their high costs can be prohibitive, limiting their adoption. The aim for this project was to create a terminal device
with the dexterity of these products but within the cost typically associated with a single degree of freedom solution.
After identifying the grasp types that are most useful for standard ADL'S, the minimum degrees of active freedom
needed to achieve them was determined. A solution involving three motors, novel transmission systems and
sensory integration was produced to realise this. The package size is equivalent to a 7.25' conventional hand size
to accommodate the maximum number of users. The outer shape and size was initially modelled after the outside
of an existing passive prosthetic glove. Based on preliminary Results, an aluminum endoskeleton was adopted
with the overall shape being formed using plastic components for the non-load bearing surfaces.
The project has evolved through three iterative prototypes with the current gamma solution undergoing extensive
mechanical testing. Use of a load cell in conjunction with real-time data acquisition software enabled the recording
of peak force levels for individual digits and the thumb at multiple degrees of flexion. The force generated by
various grasp patterns, including precision, tripod, power and lateral grasps was also measured. The measurement
protocol also included testing of resistance to being back driven. During all procedures the associated current
draw and position were recorded, from which the speed of closing for each joint was calculated. Long term cyclic
and destructive testing was also performed . Following the long term testing the above tests were repeated and
the Results compared. A Discussion on the techniques used during the development of the UNB Hand, including
manufacturing Methods and mechanical refinements based on testing Results will be presented.
122
Tuesday, Feb 5 / 14:30 - 15:45
Introduction
Myoelectric prosthetic training should start within the first month after amputation for the best Results. To start
training directly after an upper-limb amputation intermanual transfer can be used. Intermanual transfer implies
that motor skills learned at one side of the body, transfer to the other side. This suggests that by practising
the unaffected arm, in the period between amputation and prosthetic fitting, the affected arm will also improve.
Practising the unaffected arm is possible using a prosthetic simulator, a myoelectric prosthesis that can be
attached to a sound arm. Scarce literature in children suggests that intermanual transfer is present from five years
on, and improves further with age.
Aim
The aim was to determine whether intermanual transfer effects could be detected after training with a myoelectric
prosthetic simulator in adults and children.
Methods
Able-bodied right-handed adults (N=48, mean age: 24.6y) and children (N=48, mean age 5.1y) participated in
two separate experiments. The participants were randomly assigned to an experimental or a control group. The
experimental group performed a five-day training program with a simulator. To determine the improvement in skill,
a test was administered before, after, and six days after training. The control group only executed the tests. The
training program was performed with one (‘unaffected’) arm; tests were performed with the other (‘affected’) arm.
Movement times, the time from the beginning until completion of the task, were recorded.
Results
In both experiments, the movement time decreased significantly more (p<.05) in the experimental group compared
to the control group, indicating faster handling of the prosthesis.
Conclusion
Intermanual transfer was present after training with a myoelectric prosthetic simulator in children and adults. These
Results are important as training can start early in rehabilitation after an upper-limb amputation.
This work was supported by Grant 60-62300-98-119 from ZonMW.
123
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 2
Room 1.01
Abstract Title: Intermanual Transfer In Upper-Limb Myoelectric Prosthetic Training In Children And Adults
Using A Prosthetic Simulator
Abstract number: 130
Authors: S. Romkema, R. Bongers, C. Van Der Sluis
Presenter: S. Romkema
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Prosthetics : Upper Limb - 2
Room 1.01
Abstract Title: Influence Of Tasks On The Validity Of The Assessment Of Capacity For Myoelectric Control
(Acmc)
Abstract number: 131
Authors: H. Lindner, A. Eliasson, L. Norling Hermansson
Presenter: H. Lindner
Introduction
The Assessment of Capacity for Myoelectric Control (ACMC) is an observational based instrument that evaluates
the ability to operate a myoelectric prosthetic hand. It is performed during the execution of bimanual tasks chosen
by the clients. Although the ACMC does not assess task performance, it is unknown whether the clients’ ability
measures are influenced by factors such as task complexity. The study aim was therefore to develop standardized
tasks and to examine whether (i) the clients’ ability measures are influenced by the tasks (ii) the tasks function the
same across different client characteristics based on age, sex, prosthetic side and experience.
Method
Six tasks were chosen from ACMC raters’ suggestions and standardized for the ACMC. Myoelectric prosthesis
users (n=58, mean age=20, 31 males) were recruited from the Örebro University Hospital, Sweden. Each user
performed 3 tasks. All task performances were videotaped and rated on the 22 ACMC items according to a 4-point
capability scale.
Many-facets Rasch analysis was used to (i) examine whether the three ability measures of each user were
significantly different from each other, and (ii) to reveal if a particular client characteristics was scored differently
in a particular task.
Result
No significant difference in the ability measures was found in the majority of the sample – only three sporadic
users were significantly different in one or two of their tasks. This implies that the client’s ability measures are not
influenced by the tasks.
No significant difference was found related to prosthetic side and experience. Minor difference was found in sexes
and two age groups (age 7 to 15, over 15) but the differences were too small to be clinically relevant.
Conclusions
This study provides further validity evidence of the ACMC. Research with more challenging tasks is needed to
confirm the findings.
124
Tuesday, Feb 5 / 14:30 - 15:45
Room 1.01
Introduction
Several socket-mounted couplers allow users to interchange terminal devices, including body-powered couplers and
the de-facto standard for myoelectric prostheses: the Otto Bock quick-disconnect coupler. Recent improvements
in myoelectric prostheses are incompatible with the Otto Bock coupler because they can inadvertently unscrew
the terminal device. A new standard interface is required that meets the needs of these powered devices. This
standard coupler will provide a universal interface for both body-powered and myoelectric prostheses.
Methods.
The Rehabilitation Institute of Chicago (RIC), the University of New Brunswick (UNB), and Liberating Technologies,
Inc. (LTI) suggested a list of requirement that the standard should meet after a series of meetings. This draft was
presented during a workshop at the 2011 Myoelectric Controls Symposium. Feedback from over 40 participants—
including prosthetists, engineers, manufacturers, and end-users—was incorporated into the standard, which was
then further refined by a majority of upper-limb manufacturers at the American Orthotics and Prosthetics Annual
meeting.
Results.
RIC, UNB, and LTI have fabricated several prototypes of coupler designs. Because it seems impossible to meet
all of the requirements of the proposed standard, a focus meeting was held at RIC with clinicians and engineers to
assess which requirements in the standard should be prioritized. We have created a coupler that allows different
aspects of the requirements to be met for different users – yet retains the same standardized interface. We believe
this design meets the requirements of all stake-holders.
Discussion.
We will discuss the standard, and the clinician-priority list at ISPO. We will also suggest one or several coupler
designs that meet these requirements.
Conclusions.
It is important to establish a standard universal coupler, allowing devices to remain interchangeable between
manufacturers. We have refined the proposed standard and established a design that we feel can be adopted as
a universal standard.
125
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 2
Abstract Title: Universal Coupler For Upper-Limb Prostheses
Abstract number: 247
Authors: L. Sutton, T. Williams, A. Clawson, A. Thomas, J. Lipsey, J. Sensinger
Presenter: J. Sensinger
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Innovations - 1
Room 1.02
Abstract Title: Self-Management Training For Prosthetic Rehabilitation: A Participative Innovation Study
Abstract number: 87
Authors: S. Van Twillert, K. Postema, J. Geertzen, A. Lettinga
Presenter: S. Van Twillert
Introduction
Patients with a lower limb amputation need to self manage their condition in everyday life just like patients with
chronic conditions such as cardiovascular diseases or COPD. Prosthetic rehabilitation can therefore profit from
successful self-management interventions aimed at empowering patients with chronic conditions. Yet a translation
towards amputation specific issues is therefore needed.
Methods
Generic treatment principles were extracted from self-management interventions in an extensive literature analysis,
providing a general framework for self-management training. Amputation specific issues were gathered by 1)
individual and focusgroup interviews with patients on post-discharge problems and 2)an explorative cohort study
of thirteen patients on functioning after prosthetic rehabilitation. Merging the generic principles with this amputation
specific information led to a self-management training for prosthetic rehabilitation. In co-creation with rehabilitation
professionals and patients the self-management training was refined in clinical practice and tested on feasibility.
Results
Combining several research Methods enabled a translation of promising self-management principles into a selfmanagement training for prosthetic rehabilitation. The training encompasses a psycho-educative and motor
skill training, both based on problem solving principles. In the psycho-educative training several general selfmanagement skills, like problem management, asking for help, finding necessary information and more disease
specific skills like dealing with limb care and problems with prostheses are trained in interactive classes. In the
motor skill training problem solving skills in functioning with a prosthesis in different contexts are trained, to prepare
the patient for the variety in contexts in their home environment.
Discussion
Employing a participative research approach provided a broadly based patient-driven self-management training.
Patients and professionals should more often be seen as collaborative partners in innovation studies. Conclusion
Integrating self-management principles into prosthetic rehabilitation provides professionals with tools to empower
patients in living with the consequences of an amputation.
126
Tuesday, Feb 5 / 14:30 - 15:45
Room 1.02
Introduction
Although many prosthetic ankle-foot systems are commercially available, few if any can adapt to sloped surfaces
on every step of walking. The purpose of this project is to develop an ankle-foot prosthesis that can adapt to
various terrains on every step of walking using only passive mechanical parts—without the need for motors or
batteries. Our design uses two stiffness elements and a method of engaging and disengaging one of the stiffness
elements at specific times in the gait cycle.
Methods
Our development approach includes iterations of design, fabrication, and testing. We use SolidWorks for computeraided drafting and finite element modeling of parts as well as simple static models for part interactions. For
stiffness elements, we use elastomeric materials and carbon fiber foot plates. For the engagement/disengagement
mechanism, we have developed a weight-activated cam clutch system.
Results
We have developed two ankle-foot prototypes. The first prototype had effective stiffness elements, but the
engagement/disengagement mechanism was unable to consistently hold desired ankle torque. The second
prototype had an engagement/disengagement mechanism that consistently held ankle torque in excess of 250
Nm during bench testing, but would not consistently disengage after unloading. Parts for a third prototype are
currently being fabricated to address the problems associated with the first two prototypes.
Discussion
Our group is making progress on the development of a purely passive mechanical ankle-foot system that will adapt
to uneven terrain on every step of walking. Tests from the initial prototypes suggest that the current approach is
feasible. We plan to report on patient testing in our presentation at ISPO.
Conclusions:
Two prototypes of an adaptable ankle-foot system have been developed and bench tested. This system adapts
to uneven terrain on every step of walking. The design is simple and seems feasible as a commercial product.
127
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Session Name and Room: Innovations - 1
Abstract Title: Prosthetic Ankle-Foot System That Adapts To Ramps On Every Step
Abstract number: 161
Authors: A. Hansen, E. Nickel, S. Morin, J. Sensinger
Presenter: A. Hansen
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Innovations - 1
Abstract Title: Pro-Mouse
Abstract number: 533
Authors: Paulas R.
Presenter: Paulas R.
Room 1.02
Introduction
Human hand performs innumerable functions including number of fine movements in our day-to-day activities.
Amputation of upper limb is a great loss and rehabilitation of amputee is a challenging task. Especially, the
rehabilitation of bilateral amputees placed in IT, software, and media and designing industries is a difficult job as
their carrier is confined on a keyboard and mouse.
Method
Pro-mouse is an input device of a computer, substitute to the regular mouse, designed to use with the stump of an
amputee. It has a PCB, with modified scroll wheel and switches with standard components. The outer customized
case is designed to facilitate anterior and posterior tilts in order to elevate the device. The upper body is fitted with
a platform that operates the left and right click-buttons and an adjustable strap to accommodate the stump, which
permits medial and lateral rotation. Anterior tilt enables the scrolling and posterior elevation enables the scroll lock.
Dragging is achieved through left rotation of stump and navigation of the mouse.
Result
Pro-mouse is compatible with most of the operating systems and adaptable with USB or PS/2 port. It can be used
for right/left or below elbow/above elbow or long/short stumps and is fully adjustable for child or adult stump sizes.
Amazingly, upper limb paralyzed patients with minimal pronation and supination function can also easily operate
the device.
Discussion
Patient needs little training to operate the device. Most of the professionals are very well acquainted with the
computer operations and so it was easy for them to achieve accuracy and speed in the operation.
Conclusion
All the functions of a standard mouse are achieved in the Pro-mouse with accuracy after minimal practice, which
enables amputees and upper limb paralyzed to continue their professional career.
128
Tuesday, Feb 5 / 14:30 - 15:45
Introduction
Gel liners constructed from a variety of materials have proven successful in the fitting of individuals with lower
limb amputations for longer than two decades. Prosthetists have also fit gel liners to individuals with upper limb
amputations and have reported moderate success in combination with externally powered, prosthetic fittings.
Methods
At the Rehabilitation Institute of Chicago, we have explored a novel approach to collecting EMG data, using our
internal software system CAPS, from individuals with both lower limb and upper limb amputations using gel liners
with embedded electrodes. Signals have been obtained in both virtual environments and with powered prostheses
using either direct control or Pattern Recognition algorithms.
Results
Early fittings with the liner designs have proven more comfortable and easier to don than traditional designs and
have permitted us to eliminate the need to connect the wire harness and pre-amplifiers separately. The use of gel
liners with embedded electrodes has permitted us to control a virtual avatar, powered upper limb and powered
lower limb prostheses.
Discussion
It has been shown that liners with embedded electrodes can be used to provide information to multiple degree of
freedom prostheses. The next step in this research is to combine the new liner technology with robust, on-board
electronics to control actuated drive units in both upper limb and lower limb prostheses.
Conclusions
Gel liners can be modified in a manner that permits EMG data to be collected without compromising the ease of
prosthesis donning, comfort of the socket or robustness of the wire harness. We believe that this method of EMG
acquisition will be very beneficial to patients and prosthetist; eliminate some of the clinical challenges and reported
drawbacks of liners used in conjunction with myoelectric fittings.
129
FREE PAPERS
Session Name and Room: Innovations - 1
Room 1.02
Abstract Title: A Novel Research And Clinical Approach To Using Gel Liners For Collection Of Surface Emg
Data For Myoelectric Control
Abstract number: 151
Authors: R. Lipschutz, L. Miller, T. Kuiken, B. Lock
Presenter: L. Miller
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 6
Room 1.03
Abstract Title: Influence Of A Microprocessor Controlled Prosthetic Knee On Biomechanics Of Gait
Termination, Preliminary Results
Abstract number: 476
Authors: E. Prinsen, M. Nederhand, H. Rietman
Presenter: E. Prinsen
Introduction
Gait termination (GT) requires the generation of sufficient braking forces. Vrieling et al showed that the peak
braking ground reaction force of the prosthetic leg is decreased. Therefore compensations in the intact leg
(predominantly increased braking force production) are needed to terminate gait. Because microprocessor
controlled knees improve stance stability and yielding they may be beneficial during GT and thereby possibly
reduce reliance on the intact leg.
Methods
Four unilateral transfemoral amputees (> 1 year after amputation; functional level : K2- K4) were included and
measured with their own mechanically passive prosthesis and with the Rheo Knee (8 weeks acclimatization).
Measurements were performed using a 6-camera Vicon system and two forceplates. The braking forces of the
second last step, the last step and the closing step were determined. In addition peak power absorption of the
knee and hip of the intact and prosthetic leg were determined during the different steps. Prosthetic foot and knee
alignment were similar in both prosthetic knee conditions
Results
When the prosthetic leg made the second last step and the final step, no differences in braking forces were found
between both prosthetic knee conditions. Also, there were no differences between the two knee conditions in peak
power absorption of the intact and prosthetic leg.
Discussion
No clear differences were found between both prosthetic knee conditions in the amount of breaking forces or
peak power absorption of the intact and prosthetic leg. This is probably explained by the fact that the ankle is of
particular importance for generating braking forces. Because the prosthetic ankle is passive, production of these
forces is challenged. The role of the knee during GT is probably limited.
Conclusion
The Results of this preliminary study indicate that a microprocessor controlled knee does not reduce reliance on
the intact leg during gait termination.
130
Tuesday, Feb 5 / 14:30 - 15:45
Room 1.03
Background
Amputated bones radiologically often seem partly depleted of mineral. In order to study the bone quality in patients
operated with osseointegrated (OI) prosthesis we made a systematical evaluation of the mineral content by doing
regular dxa-scans before and after surgery.
Materials and Methods
Femoral amputated patients were operated with an OI-prosthesis (Integrum, Sweden) through a two stage (S1
and S2) procedure. At S1 a titanium screw (fixture) is implanted into the bone. Six months later, a rod (abutment)
is inserted into the screw with the other end penetrating through the skin (S2) to be fixed directly into the external
prosthesis allowing direct transmission of walking forces to the bone.
DXA-scan (osteoporosis, femur hip, ortho hip, total body) was performed at admission, 2 weeks, 3 and 6 months
after S1 and 2 weeks, 3, 6 and12 months afterS2.
Results
Four female and six male patients, mean age 48,1 years, have been included.
Four patients have at present finished the rehabilitation period with full weight bearing.
On the amputated side the pre-operative T-score was decreased by 60% (range
56-68) in the proximal femur and 22% (range 16-28) in the ipsilateral pelvis and all but two patients had lumbar
spine T-scores below 0. Three patients have been followed for a year after finishing the rehabilitation and show an
up to 50 % increase in BMD around the fixture together with an increased T-score of the spine.
Conclusion
Although all patients had a high level of physical activity they all showed a decreased BMD in both the amputated
femur and in the ipsilateral pelvis at time of admission. 8 of 10 patients had decreased T- score of their spines.
The osseous loading of the amputated bone due to walking with an osseointegrated prosthesis seems to stimulate
bone quality both locally and universally
131
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 6
Abstract Title: Dxa Evaluation Of Femoral Amputees With Osseointegrated Prosthesis
Abstract number: 495
Authors: P. Jørgensen, K. Petersen, M. Stilling, I. Mikkelsen, K. Søballe
Presenter: P. Jørgensen
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 6
Room 1.03
Abstract Title: Movement Optimisation Approach Of An Integrated Microprocessor Controlled Intelligent
Biomimetic Limb
Abstract number: 213
Authors: N. Stech, D. Moser, A. Sykes, S. Lang, G. Harris, J. Ochoa, J. Mccarthy, J. Ross, S. Zahedi
Presenter: J. Ross
Introduction
The high degree sophistication of human gait is revealed when prosthetic systems have to replace lower limb
functionalities especially after transfemoral amputation. The integrated limb consisting of a microprocessor
controlled hybrid knee joint and a microprocessor controlled self-aligning ankle-foot joint shall provide a step
towards more intuitive and intelligent artificial lower limb movement. It can finely regulate different resistances both
in knee and ankle-foot joint according to the situational requirements.
Methods
A gait study with 5 unilateral amputees was conducted indoors and outdoors. The study examined gait kinematics
and kinetics such as bending moment using internal sensor signals of the integrated limb and external sensor
signals from a force plate, video vector system and/or a load cell. Resistances variations in knee and foot and their
effects on gait were investigated. The data was acquired wireless and post processed in Matlab.
Results
The preliminary Results of the biomechanical analysis showed that changes in resistances of the knee joint
influence the ankle-foot joint and vice versa. Differences in kinetics and kinematics could be correlated with
efficiency and comfort of locomotion in different situational contexts. Especially on uneven ground and inclines
the beneficial effect of a globally microprocessor controlled movement optimisation showed in both self-chosen
velocity and subjective feedback.
Discussion and Conclusion
Using nature as a role model a distributed sensor-actuator system involving both knee and foot-ankle joint is an
intuitive way to improve lower limb prosthetics. The gait study showed that additional support can be provided
when knee and foot-ankle joint communicate with each other to deal with the situational requirements. A first step
towards future high-tech prosthetics has been done. Next steps should comprise refinements of control and a
further integration of an artificial limb that incorporates an intelligent socket to fulfil the vision of a fully integrated
biomimetic leg.
132
Tuesday, Feb 5 / 14:30 - 15:45
Introduction
The Transfemoral Fitting Predictor (TFP) was developed initially in 2003 as an adjunct to assessment for
prosthetic fitting in Dundee. A pilot study on 10 patients suggested that the measure was promising and warranted
further evaluation. The current project was designed to measure the validity and reliability of the revised 9 point
Transfemoral Fitting Predictor.
Aims of Study
To test the validity and reliability of the TFP on a larger and statistically robust sample of patients To develop a
novel, video-base method to assess inter-rater reliability and possible use in tele-health to assist non specialist
centres in assessing prosthetic potential
Results
93 of the possible 125 potential participants approached took part in the paper assessment and 75 of those agreed
to video Internal consistency (Cronbach’s alpha) was very good = 0.92 Step-wise discriminant analysis determined
that tasks 7 and 8 discriminated best between those who eventually received a prosthesis. Construct validity
showed 2 distinct constructs – tasks 1-4 & 6 and 5 - 9 therefore if the order of 5 & 6 was changed the tool could be
split into basic / advanced tasks Inter-rater reliability – p>0.8 indicating high levels of reliability with tasks 2 & 6 the
weakest (bed to WC & back / sit to stand) – all others had a value of p>0.9
Conclusion
The TFP is a simple, valid and reliable measure of prosthetic potential for transfemoral amputees. The measure is
now being used across the UK in many prosthetic centres. Further work would have to be undertaken to determine
whether a specific score could determine prosthetic potential, however at present the tool should be used as an
adjunct to assessment only.
133
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 6
Room 1.03
Abstract Title: Development Of The Transfemoral Fitting Predictor - A Functional Measure To Predict
Prosthetic Potential In Transfemoral Amputees
Abstract number: 9
Authors: L. Whitehead, S. Treweek, E. Condie, A. Mcfadyen
Presenter: L. Whitehead
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 6
Room 1.03
Abstract Title: Energy Expenditure Of Transfemoral Amputees Walking With Different Speeds On Different
Walking Surfaces
Abstract number: 253
Authors: I. Starholm, T. Gjovaag
Presenter: I. Starholm
Introduction
Measurements of oxygen uptake (VO2) at the preferred walking speed (PWS), is frequently used to assess walking
performance of transfemoral amputees (TFA), but previous studies disagree on whether walking on a treadmill
is similar to over ground walking. This study investigates what effect treadmill walking (TMW) and wooden floor
walking (WFW), using the PWS for the two respective walking situations have on the oxygen uptake and walking
economy (Cw) of transfemoral amputees.
Method
The PWS of 8 healthy subjects with transfemoral amputations (mean ± SD age was 37.0±11 yrs.) were determined
on a motorized treadmill (PWSTM) and on wooden floor (PWSWF). VO2 (ml kg-1 min-1) was measured by a
portable analyzer (Metamax 3B, Cortex Biophysik, Germany) during WFW with the PWSWF and PWSTM, and
during TMW with the PWSTM and PWSWF, respectively. Cw was calculated as VO2 ml kg-1 min-1/PWS m min-1.
Results
Results are presented as means ±SD. The PWSWF (1.22±0.2 msec-1) was higher compared to the PWSTM
(0.89 ±0.16) msec-1, p <.0.001. During WFW and TMW with the PWSWF the TFAs’ oxygen uptake was similar
(15.6±3.5 and 15.5±3.8 ml kg-1min-1, respectively). The oxygen uptake during WFW and TMW with the PWSTM
was also similar (12.6±1.5 and 12.4±2.1ml kg-1min-1). The Cw during TMW was similar to Cw during WFW when
using the PWSTM (0.240±0.02 and 0.242±0.03 ml kg-1 m-1, respectively). The Cw during WFW was also similar
to the Cw during TMW when using the PWSWF (0.213±0.04 and 0.213±0.03, respectively).
Discussion
The oxygen uptake is not influenced by the walking surface, but solely on walking speed (physical effort of the
TFA). Since PWSTM is slower than PWSWF this affects calculations of walking economy (Cw) on a treadmill,
negatively.
Conclusion
Cw is not a good measure of walking performance of transfemoral amputees.
134
Tuesday, Feb 5 / 14:30 - 15:45
Introduction
There is a tremendous need for personnel for prosthetic and orthotic services in Africa. The Tanzania Training
Centre for Orthopaedic Technologists has graduated hundreds of students who now work in clinics in different low
income countries in Africa. In association with ISPO’s USAID funded program “Rehabilitation of physically disabled
people in developing countries”, we audited graduate clinical skills and competencies and also determined the
professional development needs of graduates in 3 African countries.
Methods
Following study recruitment by invitation, visits to graduates in their own clinical setting were arranged in Tanzania,
Uganda and Kenya. Each graduate participated in a structured interview with a clinician or educator about lower
limb clinical care at the end of a patient review appointment. The graduate and interviewer then identified at least
3 areas for clinical practice development. At the end of the interview graduates were given a note of feedback and
a personal development plan.
Results
Graduates work in a range of professional environments ranging from unsupervised lone working to rehabilitation
teams. Results of the interviews will be presented, revealing similarities and differences between graduates
working clinically in the different African countries in terms of patient history taking, patient assessment and
prosthetic and orthotic specification and prescription
Discussion
Graduates working in clinical services in Africa are usually expected by the professional community to maintain
and improve their clinical competencies in the years after graduation. This is particularly challenging in African
countries where there are limited resources or existing professional networks.
Conclusions:
We conclude that it is important to identify specific development needs for individual graduates working in low
incomes countries. Detailing a specific development plan can assist the individual clinician to reflect on their
practice. This information can, in turn, be used by employers and sponsors to targets precious resources.
135
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Session Name and Room: Developing Countries - 2
Room 1.05
Abstract Title: Competencies And Development Of Graduates Of An African Regional Training Centre
Working In Low-Income Countries
Abstract number: 248
Authors: S. Sexton, H. Shangali, B. Munissi
Presenter: S. Sexton
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Developing Countries - 2
Room 1.05
Abstract Title: The Revised Shape & Roll Prosthetic Foot For Use In Low-Income Countries - Implementation
In Haiti
Abstract number: 414
Authors: D. Berman, V. Agrawal, R. Gailey, A. Hansen
Presenter: V. Agrawal
Introduction
The roll-over-shape (RoS) concept was previously used to design the Shape&Roll Prosthetic Foot for resource
limited areas. Significant start-up efforts were necessary for the development of this foot, including fabrication of
keel molds and a compression molding device. The purpose of this project was to test a revised version of the
Shape&Roll Prosthetic Foot, which does not require significant start up efforts, to determine its feasibility for use
in Haiti.
Methods
The revised Shape&Roll Prosthetic Foot is fabricated using sawing, sanding, and drilling of solid blocks of
plastic material. A computer program was developed to generate a template of the foot that was appropriate
for a user’s height and weight based on the RoS concept. Instructions on fabricating the foot using the template
were developed for technicians in Haiti. Ten prosthetic foot keels were fabricated out of polypropylene using the
developed methodology and were fit on transtibial and tranfemoral amputees in Haiti.
Results
The total cost of a foot’s keel made using polypropylene was $20, and the fabrication time was 3 hours for
technicians fabricating the foot for the first time. The development process involved printing the 2D template and
using it to fabricate a foot from a block of polypropylene. Initial feedback from subjects using the feet has been
positive with no reported problems.
Discussion
The tools required for fabrication of the revised Shape&Roll Prosthetic Foot are a computer, printer, bandsaw, drillpress and sander. However, templates could be created for a series of heights and weights, removing the need
for the computer and printer. This methodology represents a feasible, sustainable solution for localized production
of foot keels.
Conclusion
The minimal resources needed for the fabrication of this foot make it viable and sustainable option for production
in low-income countries, as proven by its successful implementation in Haiti.
136
Tuesday, Feb 5 / 14:30 - 15:45
A gait analysis laboratory is essential for quantifying gait disorders, as well as for designing and assessing
prosthetic devices. Such facilities are usually equipped with sophisticated devices; such as optoelectronic motion
capture systems and force platforms, which require highly-trained personnel for proper equipment operation and
maintenance.
In 2009, the Simón Bolívar University (USB), Caracas-Venezuela, received equipment suitable to set up a gait
analysis laboratory, as a donation from the International Society of Biomechanics (ISB) in conjunction with its
sponsors (Motion Analysis, AMTI and Delsys). The USB provided space and acquired funding to set-up the
equipment and renovate the environment so that it was suitable as a fully-functional laboratory. In addition, ISB
sponsored a biomechanist to install the equipment and train USB staff in Venezuela. The USB staff continued to
seek ongoing training with assistance from a local orthopedic surgeon. Finally, a clinical gait analysis service was
opened in 2011.
Twenty patients have been successfully treated. Most cases presented spastic hemiplegia or spastic diplegia
secondary to cerebral palsy. The orthopedic surgeon used the gait analysis Results to confirm diagnosis and
to accurately measure gait parameters deemed essential for surgery planning. Unfortunately, the gait analysis
services were temporarily interrupted due to a camera malfunction. However, this issue was resolved in May 2012,
with Motion Analysis repairing the cameras at no cost to USB.
International societies such as ISB, ISPO, and WHO, are dedicated to facilitating access to technologies that can
meet local needs in Economically Developing Countries. However, to guarantee success of these efforts, it is
fundamental that: 1) the required technical and financial support is sustained over time, 2) the laboratory becomes
auto-sustainable, and 3) all individuals involved are highly passionate and committed. Otherwise, all efforts and
investment will be jeopardized in the future.
137
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Session Name and Room: Developing Countries - 2
Room 1.05
Abstract Title: Creating A Gait Analysis Laboratory In Venezuela: A Combination Of Local And International
Efforts
Abstract number: 316
Authors: C. Müller-Karger, R. Torrealba, J. Steele, E. Laurens, B. Amador
Presenter: R. Torrealba
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Developing Countries - 2
Abstract Title: A Low Cost Orthosis Nazh For Developmental Dysplasia Of The Hip (Ddh)
Abstract number: 322
Authors: A. Ali
Presenter: A. Ali
Room 1.05
Introduction
Dislocation of hip or developmental dysplasia (DDH) is an abnormal development of the hip joint. The ball at
the top of the thigh bone called as femoral head is not stable within the socket or acetabulum. The hip joint
ligaments which hold it all together may also be stretched and loose. The usual causes are congenital, maternal
hormone, position of baby in mother's womb and baby cradles. DDH is more common in girls, firstborn children;
breech position babies (bottom-first) and has genetic pre-disposition. DDH can be unilateral or bilateral hip joints.
Symptoms are mild to severe as unequal legs length, less mobility on one side, limping, toe walking or duck
like gait. Splints as Pavlik Harness close and open reduction surgery and osteotomy are common but relatively
expansive solutions.
Methods
A new low cost Orthosis Named as NAZH for DDH is tested among two hundred and ten subjects including
male (88) and female (122) ranging in age from 1.5 yrs to 10 yrs during a period of 4 yrs. Pre and post treatment
radiological images were taken. Necessary measurements of abdomen (for pelvic band) and thighs(for thigh
shells) were taken then device was assembled according to measurements and applied. Limb abduction was
increased by adjustment bars attaching thigh bands and to avoid appliance dragging from thigh, supported by
pelvic belt.
Results
The patient recovery period was six months to two years depending upon infant/child age and severity of disease.
The effectiveness of Orthosis was confirmed by radiological images.
Discussion
The uniqueness of NAZH Orthosis is being its cost effectiveness. This support is twenty times less cost effective,
efficient and less time consuming compare to other DDH orthosis. Majority of patients could afford it.
Conclusion
This new orthosis for treating DDH is a positive improvement towards upgradation of basic health facility.
Key Words: DDH, Hip dislocation, Orthosis.
138
Tuesday, Feb 5 / 14:30 - 15:45
Introduction
Annually between 150.000 - 200.000 children are born with clubfoot deformity of which an estimated 80% occur
in developing countries. The Ponseti method is an effective method of obtaining correction of deformity, thus
preventing disability. Globally it is recognised as the gold standard for clubfoot treatment. The Ponseti method
relies on the use of a Foot Abduction Brace (FAB) to ensure a good result and prevent recurrence. The world-wide
demand for affordable FAB’s is exceeding the supply.
Methods
Data from programs in 20 low-income countries (LIC’s) was collected through the Global Clubfoot Initiative (GCI).
GCI is a collaboration of 'clubfoot treatment organisations' providing information and training resources as well as
collecting data with a focus on LIC’s. Annual (2011) treatment data was collected and calculations made as to
need for FAB’s.
Results
Data from working locations show that availablity of FAB’s is a barrier to completion of treatment programs and that
there is a shortfall in production of FAB’s.
Discussion
Clubfoot treatment programs are being implemented in LIC’s and dramatically increasing the numbers of children
enrolled. FAB manufacture is not keeping up with demand and needs to be scaled up. Appropriate low-cost FAB’s
are not yet commonly produced in orthopaedic workshops in LIC’s. Orthotic technologists need to support the
production of FAB’s and provide quality control. Mass production and outsourcing Methods need to be developed.
Conclusions
There is an unmet need for clubfoot FAB manufacture and delivery in LIC’s. A standardized module for FAB
design and production needs to be be included in the curriculum of Prosthetic and Orthotic training schools. Mass
production and outsourcing could be a logical and workable solution.
139
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Session Name and Room: Developing Countries - 2
Room 1.05
Abstract Title: Cost Effective Clubfoot Braces For Low-Income Countries: Defining The Need.
Abstract number: 458
Authors: M. Steenbeek, R. Owen
Presenter: M. Steenbeek
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Rehab Medicine & Surgery - 3
Room 1.06
Abstract Title: Factors Related To Overuse Syndromes In Subjects Following Upper Limb Amputation
Abstract number: 129
Authors: H. Burger
Presenter: H. Burger
Introduction
The first article on long-term effects of limb amputation was published already in 1978. However, only three other
articles on the same topic have been published since, all using postal questionnaires. Only one of them explored
the influence of prosthesis use on frequency of overuse syndromes. The aim of our study was to find out the
frequency of overuse syndromes in subjects following upper limb amputation, their severity and factors related
to them.
Methods
All subjects who visited our outpatient clinic for upper limb prosthetics in 2011 and had no other injury that may
cause the same symptoms were included into study. We performed a structured interview and clinical examination.
Results
Forty-two subjects (33 men) were assessed. They had been amputated 4-75 years before (40 on average) and
were 61 years old on average at the time of the study. Among them, 52% had shoulder pain, 52% carpal tunnel
syndrome, 33% neck pain and 21% elbow pain. The longer the time since amputation, the more frequent was
shoulder pain on the non-amputated side. Subjects who used their prosthesis more hours per day had neck and
shoulder pain significantly less frequently. Daily use of prosthesis was marginally significantly associated with
carpal tunnel syndrome.
Discussion
Like the previous studies, we found that overuse syndromes are frequent in subjects following upper limb
amputation. Unlike 216;stlie (Arch Phys Med Rehabil 2011;92:1967-73), we found that the use of prosthesis may
be important for decreasing their frequency.
Conclusion
Overuse syndromes are frequent in subjects following upper limb amputation; some are less frequent in subjects
who use their prosthesis more hours daily.
140
Tuesday, Feb 5 / 14:30 - 15:45
Introduction
Branemark method of bone anchored prosthetic rehabilitation was carried out as a Department of Health funded
ethically approved research study. 18 volunteers underwent surgery and rehabilitation according to the Branemark
protocol of Osseointegraion for Prosthetic Rehabilitation for Amputees (OPRA).
Methods
Suitable patients who have been unsuccessful using conventional socket prostheses were selected. Following the
two-stage surgery and gradual loading programme the definitive prosthesis was fitted with a fail-safe mechanism.
Results
The study group was made of 15 males and 3 females all traumatic amputees of age range 21 to 49 years. The
system has been in use for a cumulative period of 125 years. Of the 18 volunteers 11 are heavy users, 4 are light
users and 3 have had the system removed. One light user has died from an unrelated cause. The incidence of
superficial penetration site infection is about 70% and implant related osteomyelitis 33%. The heavy users have
warranted abutment and retention screw replacements.
Discussion
Socket related problems are common especially in active transfemoral amputees with short residual limb. Bone
anchored prosthesis has enabled this active group of amputees to achieve regular functional level of walking.
Conclusions:
The process of two-stage surgery, protracted course of rehabilitation and regular follow up requires careful patient
selection. The successful patients have achieved a high level of prosthetic mobility and overall rehabilitation. A
high incidence of infection and mechanical failure of components of the system remain to be addressed. The use
of high tensile alloy components and upgraded fail-safe mechanism would be expected to reduce the incidence
of mechanical complications.
141
FREE PAPERS
Session Name and Room: Rehab Medicine & Surgery - 3
Room 1.06
Abstract Title: The Roehampton Experience Of Transfemoral Bone Anchored Prosthetic Rehabilitation
Abstract number: 349
Authors: S. Sooriakumaran, M. Uden, J. Sullivan, D. Ward, K. Robinson
Presenter: S. Sooriakumaran
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Rehab Medicine & Surgery - 3
Room 1.06
Abstract Title: Comparison Of Co-Morbidities In A Lower Limb Amputee Population Nine Years Apart.
Abstract number: 380
Authors: N. Ryall
Presenter: N. Ryall
Introduction
The National Rehabilitation Hospital, Dublin, is the national centre for amputee rehabilitation in Ireland.
Rehabilitation is inpatient-based, consultant-led, multidisciplinary, and CARF-accredited. The patient population is
predominantly vascular in aetiology. The aim of this study was to quantify the changes in co-morbidities noted in a
lower limb amputee population nine years apart.
Methods
A chart review was undertaken of all patients who were referred for and attended for primary amputee rehabilitation
in 2002 and in 2011. Demographic data on level of amputation/s, age, co-morbidities and mobility outcome (SIGAM
scale) were gathered. Statistical analysis was undertaken.
Results
115 patients were referred and treated in 2002 compared with 100 in 2011. Patients were on average 64 years in
2002 compared with 66 years in 2011. Total number of co-morbidities rose from 164 in 2001 to 342 in 2011; total
impairments from 106 to176. Obesity occurred in 1% in 2002 compared with 12% in 2011 (p<0.001); cognitive
impairment was documented in 9% in 2002 and 22% in 2011 (p<0.001). Additional musculoskeletal impairments
were found in 20% in 2002 and 45% in 2002 (p<0.001). Results on mobility grades are not yet finalised for all
patients referred in 2011 as some are still completing rehabilitation, but the trend is towards lower mobility levels.
Discussion
There has been a significant increase in major co-morbidities in lower limb amputees over a nine-year period,
reflecting general population trends in obesity and co-morbidities of an aging population. Such co-morbidities act
synergistically to increase impairment level. These markers of increasing clinical complexity significantly impact on
planning, resourcing and delivering prosthetic rehabilitation, as well potentially on prosthetic product development.
Conclusions
A statistically significant trend in increasing amputee patient co-morbid complexity has been found over a nineyear period from 2002-2011.
142
Tuesday, Feb 5 / 14:30 - 15:45
Introduction
The functional Results of Single Event Multilevel Surgery (SEMLS) for Cerebral Palsy are closely dependent
on the quality of post surgical rehabilitation. The aim of the study was to find out the effect of intensity, type and
sequence of postsurgical rehabilitation on the functional outcome of multilevel surgery for cerebral palsy.
Methods
This was a case control study with 20 subjects with mean age of 8±2.89 years were enrolled in the study
group, while 21 subjects with mean age of 9.57±3 years constituted the control group. All the subjects received
same surgical procedures by a single Orthopedic Surgeon, which included Orthopedic Selective Spasticity
Control Surgery and simultaneous restoration of lever arm dysfunctions. The study group received protocol
based, sequenced multidisciplinary rehabilitation for an average of 3 hours per day. The control group received
conventional physiotherapy for an average of 45 minutes per day. The chief outcome measures used in the study
were Manual Ability Classification System (MACS) and Functional Mobility Scale Version 2 (FMS), before the
surgery and at the last follow up after 2 years.
Results & Discussion
There were no significant differences between the two groups before the start of rehabilitation: GMFCS (t-0.91,
p>0.05), FMS (t-0.019, p>0.05), MACS (p>0.05). The Results revealed significant functional improvement among
both the groups after the rehabilitation: GMFCS (study: t-4.29, p<0.001; control: t-2.17, p<0.02), FMS (study:
t-4.29, p<0.001; control: t-3.44, p<0.001), MACS (study: p<0.001; control: p<0.001). While the GMFCS level of
study group had improved significantly compared to the control group after rehabilitation (t-2.88, p<0.001), the
improvements in FMS and MACS were not statistically significant.
Conclusion
The study recommended a structured intensive and sequenced rehabilitation protocol for greater gross motor
functional improvement after SEMLS for cerebral palsy.
143
FREE PAPERS
Session Name and Room: Rehab Medicine & Surgery - 3
Room 1.06
Abstract Title: Effect Of Intensive Rehabilitation On Functional Outcome After Single Event Multilevel
Surgery In Cerebral Palsy
Abstract number: 405
Authors: D. Sharan, A. Sasidharan, M. Kumar
Presenter: D. Sharan
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Rehab Medicine & Surgery - 3
Abstract Title: The Role Of Neural Prostheses In Rehabilitation Of Patients With Disability
Abstract number: 327
Authors: M. Sayyadfar, E. Sarhadi, M. Arazpoor
Presenter: M. Sayyadfar
Room 1.06
Background and aim:
neural prostheses are new generation of prostheses in rehabilitation field in amputee patients. So the awareness
and related surveys is not widely available. The aim of this study was to evaluate the development and application
of neural prostheses and to utilize this prostheses role in disability and rehabilitation domain.
Methods
we used rehabilitation, neural engineering, neural prostheses, and spinal cord injury key words in Science Direct,
ISI web of knowledge, Google scholar, and PubMed data bases and searched related articles in this field. We
screened papers according to inclusion and exclusion criteria and selected them.
Results
the use of neural prostheses has had a significant effect on the improvement of the disabilities living, walking and
standing in patients with spinal cord injury, cerebral palsy and MS.
Conclusion
based on the evidence it seems in the coming years neural prostheses can be a good alternative to classical
rehabilitation devices, using this kind of prostheses in the rehabilitation caused a best improvement in this area,
despite of its great advantages, have limitations that are undeniable. It seems that the high price of neural
prostheses is the most important challenge of using these devices on disabled people.
Keywords: neural engineering, neural prosthesis, rehabilitation, spinal cordinjury, cerebral palsy
144
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Objective
The primary purpose was to get quantitative, empirical knowledge about individual changes in mobility and selfefficacy in a period of six months for older persons who had a transfemoral amputation of vascular reasons and
participated in four weeks of training. The second purpose was to evaluate, through qualitative interviews, whether
and how the participant’s experiences of the training supported or supplemented the quantitative Results. Method
Partially mixed sequential dominant status design. An AB-single Subject Experimentel Design with multiple
nonconcurrent baseline and follow-up was used to get quantitative data, and qualitative interviews were used to
explore the participants´ experiences six months after the treatment. Four persons were included. One person
withdraw. Outcome measure: ABC-scale, 10 meters walk test, 2 minutes test and the L-test. Intervention: The
participants received individual training three times weekly. The training was based on “motor learning based
mobility training principles” with focus on balance- and walking training.
Results
The Results from this study showed improved mobility and self-efficacy after four weeks of training and at the
follow-up. The mean improvement in the follow up period was still better than during the baseline period although
deterioration was seen. The participants reported different experiences, both positive and negative, of the training
period. Mastery experiences and the social support from a therapist were reported to be important. Some of the
participants reported improved function in activities of daily living and reduced anxiety. All the participants reported
that the prosthetic had great influence on performance and not everyone had a desire for a change in mobility.
Conclusion This study indicates that four weeks of individual training has the potential to improve mobility and
self-efficacy for older persons with a transfemoral amputation. The study seems to show that mobility and selfefficacy are complex constructs and many factors might influence these constructs.
145
FREE PAPERS
Session Name and Room: Sports And Physical Activity - 1
Room G.06
Abstract Title: Training For Older People With A Femuramputation. A Study Of Exercise Important For
Mobility And Confidence In Coping
Abstract number: 3
Authors: J. Schack, A. Bergland
Presenter: J. Schack
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Sports And Physical Activity - 1
Room G.06
Abstract Title: Gross Mechanical Efficiency (Ge) And Physical Strain Of The Combined Arm-Leg (Cruiser)
Ergometer In Healthy Subjects
Abstract number: 72
Authors: E. Simmelink, I. Borgesius, R. Dekker, L. Van Der Woude
Presenter: R. Dekker
Introduction
The combined arm-leg Cruiser ergometer is assumed to be a relevant testing and training instrument in the
rehabilitation of patients with a lower limb amputation. Gross mechanical efficiency (GE) and physical strain have
not yet been systematically established in this form of combined arm-leg exercise compared with other common
rehabilitation exercise modes. The purpose of this research is to determine GE and physical strain during steady
state submaximal Cruiser exercise in comparison to cycling ergometry and handcycling under similar conditions
of external power output.
Methods
10 Healthy men (n=10;24±1.8yrs;79±10.5kg) and 12 healthy women (n=12;22.1±2.4;65.8±10.2 kg) enrolled in 4
submaximal steady state exercise tests on respectively a Cruiser ergometer, a bicycle ergometer, a handbike on
a motor driven treadmill and again a Cruiser ergometer. All subjects performed seven 3 min bouts (Power Output
(PO) = 20, 25, 30, 35, 40, 45, 20W) at 50rpm. Oxygen uptake, energy cost, ventilation, breathing frequency, heart
rate and RPE were monitored. GE was determined from PO and energy cost.
Results
GE of the Cruiser (45W; men:13.0±1.3%, woman:15.0±3.1%) was not significantly different from cycling (45W;
men:13.2±1.9%, women:14.6±1.9%), yet both were significantly higher than in handcycling (45W: men:11.2±0.8%,
women:12.2±2.1%; p<0.05). A comparable strain was found between Cruiser and bicycle test, but a significantly
higher strain for handcycling (p<0.05). Apart from RPE, the repeated Cruiser tests did not show significant
differences.
Discussion
In this study in terms of GE there is no significant difference between the bicycle and the Cruiser ergometer at a
submaximal level of power output in healthy young subjects. This makes the Cruiser ergometer a very interesting
device to use in exercise testing and training in patients with a lower limb amputation.
Conclusion
Cruiser exercise at a submaximal level is comparable in GE and physical strain to leg cycling in healthy subjects.
146
Tuesday, Feb 5 / 14:30 - 15:45
Room G.06
Introduction
Physical limitations associated with transfemoral amputation (TFA) are often studied in laboratory settings, but little
is known about how these limitations extend into the free-living environment. Self-report measures are commonly
used to solicit information about participation in life activities. However, surveys alone may be insufficient to
assess specific restrictions experienced by those in this population. The purpose of this study was to objectively
characterize the mobility dimension of participation of persons with TFA using long-term step activity data and to
compare this data to healthy, non-amputees.
Methods
Twelve months of daily step activity were recorded for 17 adults with unilateral TFA. An accelerometer-based
monitor collected step activity data on the prosthetic side. Retrospective analysis was conducted to determine
mean activity levels and to compare activity between subjects of different Medicare Functional Classification
Levels (MFCL).
Results
Subjects averaged 1540 prosthetic steps/day and activity generally increased with MFCL. Activity levels between
MFCL-2 and MFCL-3 subjects were not significantly different, but MFCL-4 subjects were significantly different than
those classified as MFCL-3 (p=0.027) or MFCL-2 (p=0.008).
Discussion
Review of TFA step activity revealed restrictions in excess of the 2108-3063 steps/day described in the literature.
Average daily levels measured in this study were also substantially lower than the 3500-7500 and 3000-4250
single-limb steps reported for healthy younger and older adults, respectively. MFCL-2 and MFCL-3 subjects were
not differentiated as expected, based on their clinical classifications.
Conclusion
Direct measurement of long-term activity complements information derived from self-report instruments to inform
the mobility aspect of participation. However, further investigation into long-term performance of the TFA population
in the free-living environment is needed to better understand the functional deficits and related participation
restrictions experienced by these individuals.
147
FREE PAPERS
Session Name and Room: Sports And Physical Activity - 1
Abstract Title: Long-Term Step Activity In Persons With Transfemoral Amputation
Abstract number: 221
Authors: E. Halsne, M. Waddingham, B. Hafner
Presenter: B. Hafner
FREE PAPERS
Tuesday, Feb 5 / 14:30 - 15:45
Session Name and Room: Sports And Physical Activity - 1
Room G.06
Abstract Title: The Comprehensive High-Level Activity Mobility Predictor (Champ) A Measure Of Higher
Level Prosthetic Performance In Service Members With Traumatic Lower Limb Loss
Abstract number: 351
Authors: R. Gailey, I. Gaunaurd, C. Scoville, M. Raya, A. Linberg, K. Roach, S. Campbell
Presenter: R. Gailey
Introduction
Prior to the development of the Comprehensive High-level Activity Mobility Predictor (CHAMP) there was no
measure of higher level prosthetic performance. The CHAMP was developed to be safely performed by all
unilateral and bilateral lower limb amputees who had achieved a minimum level of prosthetic performance during
rehabilitation. This study examined the construct validity and responsiveness of a new performance-based
assessment instrument called the CHAMP as a measure of high-level mobility in Service Members (SMs) with
traumatic lower limb loss.
Methods
One-hundred eighteen SMs completed the study. Convergent construct validity of the CHAMP was established
using the Six-Minute Walk Test (6MWT) as a measure of overall mobility and physical function.
Results
The known group Methods construct validity examined disparities in high-level mobility capability among SMs with
different levels of lower limb amputation. The CHAMP score demonstrated a strong positive relationship between
6MWT distance (r = 0.80, p < 0.001). Significant differences were found in CHAMP score between SMs with
different levels of lower limb loss. The MDC for the total CHAMP score was 3.74 points.
Discussion
Because the CHAMP measures speed, power and agility in all directions of movement it has the ability to assist
clinicians in determining changes in high-level mobility occur during rehabilitation and has the ability to objectively
measure when and how progress is being made by prosthetic users.
Conclusion
Study findings support the CHAMP as valid and responsive performance-based assessment instrument of highlevel mobility for males with traumatic lower limb loss.
148
Tuesday, Feb 5 / 16:15 - 17:30
Introduction
Congenital deficiency of the leg is very rare. Sometimes, congenital aplasia is treated by surgical modality before
prosthetic intervention is done. Surgical intervention can cause later complications for children amputee which
hampers their future development. This case presents about a happy Sri Lankan’s child after receiving different
prosthetic designs.
Methods
Muditha, a four and half years-old boy was brought to the clinic by his mother with bilateral orthoprosthetic devices.
The mother reported regarding the outcome of previous devices that “Muditha did not to wear them due to poor
suspension and poor aesthetics as well as they were too heavy to wear with sidebar on the right side”. Due to
poor outcome of those prostheses the doctors and surgeons were thinking about making amputation his legs.
After subjective and objective assessment, two different prostheses were prescribed as below knee designs with
supra-condylar suspension to control knee instability medially.
Results
The outcome of the new the prostheses were better than previous ones in terms of cosmestic appearance,
suspension, as well as less restriction with wearing and less weight. The child walks with more balance, less knee
instability as well as walk much faster. By giving new prosthetic designs, the child’s legs were saved from the
amputation which is thought by doctors and surgeons.
Discussion
If the prosthetic outcome is not satisfactory according to patients/caregiver or P&O, alternative device should
be tried by consultation with other P&Os and technicians. External distant resources can be helpful for different
interventions. Doctors or surgeons should not decide to amputate immediately without discussing with other
disciplines or alternative method.
Conclusions
Congenital deficiency of the leg can be treated with different modalities. Various prosthetic designs can be made
to meet individual patients. Surgical should be the last solution where the prosthetic invention is failed.
149
FREE PAPERS
Session Name and Room: Paediatrics - 2
Room 1.06
Abstract Title: Management Of Children With A Congenital Deficiency Of The Leg: N1 Case Study
Abstract number: 69
Authors: O. Teap
Presenter: O. Teap
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Paediatrics - 2
Room 1.01
Abstract Title: A Novel Concept Of Correction Of Ctev By Serial Afo's Using Ponseti Methodology
Abstract number: 286
Authors: M. Choudhary, N. Singh
Presenter: N. Singh
Introduction
CTEV is a common congenital deformity. Conservative treatment by serial manipulation and casting instituted
early in life yields better Results and avoids the need for surgical intervention. The present study aims at using
customized ankle foot orthosis on CTEV foot in varying stages of correction based on ponseti’s principle of
sequential deformity correction and following sequence as abduction, eversion and equinus correction.
Method
Study on five children aged below nine months with supple feet with idiopathic CTEV was done. CTEV scoring
done by Pirani method of scoring. Serial AFO were given and changed at every ten days until the equinus deformity
persisted after which tenotomy was performed and AFO given for three weeks in corrected position. At each of the
visits Pirani scoring was done to assess improvement.
Result
Study follow up awaited.
Discussion
Study follow up awaited.
Conclusion
Study follow up awaited.
150
Tuesday, Feb 5 / 16:15 - 17:30
Introduction
Juvenile hallux valgus (HV) deformity occurs in the developing foot of teenagers and young children. Non-surgical
treatment is always the first option for a patient who has HV deformity. Therefore, a research to evaluate the
biomechanics of HV with different orthoses has been launched.
Methodology
Twenty subjects (sixteen female), mean age of 14yrs (range 12yrs-16yrs), with HVA of 22o (range 16o-25o) and
1-2 IMA of 12 o (range 7o-16o) were recruited. Loading pattern over foot plantar surface was evaluated when
walking with toe spreader (TS), dynamic HV strap (DHVS), & forefoot binder (FFB) for juvenile HV using Tekscan
F-mat sensor.
Results and Discussion
TS or DHVS has been used to adduct the big toe transversely to maintain a better alignment at the first MTPJ.
With orthoses, although the big toe was positioned in a lesser deformed position, the dynamic foot loading pattern
was shown to be no significant change. During the 'before heel-lift period', lower force loading at the 1st MTH was
shown when wearing DHVS. It may suggest DHVS is more effective in 1st MTH region pain relief compare with
TS, especially when symptom appear during 'before heel-lift period'. During the 'after heel-lift period', higher force
loading at the big toe was shown when wearing DHVS. It may suggest DHVS allow the big toe to act with a higher
demand of force after heel-lift. Based on the assumption of better aligned big toe at the 1st MTPJ using orthoses,
the increased force loading at the big toe may suggest an augmented function of the 1st ray structure of the foot
during walking.
Acknowledgment
I would like to thank you for the generous support from the Hong Kong Orthopaedic Association Research Grant
2009
151
FREE PAPERS
Session Name and Room: Paediatrics - 2
Room 1.01
Abstract Title: Biomechanical Analysis Of Plantar Loading Pattern When Walking With Foot Orthoses For
Juvenile Hallux Valgus
Abstract number: 502
Authors: S. Law, W. Chan, S. Au, T. Lui
Presenter: S. Law
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Paediatrics - 2
Room 1.01
Abstract Title: Orthotic Variance In The Conservative Management Of Congenital Talipes Equinovarus
Ctev: A Literature Review.
Abstract number: 265
Authors: E. Figgins, K. Thomson, R. Bowers
Presenter: R. Bowers
Introduction
Congenital Talipes Equinovarus (CTEV) affects 1 in every 1000 births. The aetiology is still unknown although
there are many theories. Methodology: A critical review of the literature was undertaken of the conservative
management of Congenital Talipes Equinovarus. This study evaluated the recent advances, from the year
2000 onwards. Correction of CTEV can be achieved through various Methods such as the Ponseti and French
Functional Methods. Numerous databases were searched and specific boolerian terms used.
Results
Thirty-seven papers were then evaluated and graded according to SIGN guidelines. Evidence examined showed
more favoured Results for the Ponseti method with faster treatment time and improved Results at both short term
and long term follow up. Orthotic management showed varying Results. Most of the papers reviewed used different
orthoses. Some authors found good Results with Dennis Browne boots and bars, while others found good Results
with AFOs or KAFOs.
Discussion
From the critical evaluation of the papers it is clear that there no consensus. No new Conclusions can be drawn
from the literature review on how Congenital Talipes Equinovarus should be managed orthotically following the
Ponseti method.
Conclusions
Rotational control is vital as improved Results were seen when rotation was controlled by the use of either an
abduction bar or by a KAFO. The KAFO extended above the knee and controlled rotation from there. All the papers
highlighted that there were still issues with compliance with regards to orthotic management and this remains an
area which requires further work and investigation.
152
Tuesday, Feb 5 / 16:15 - 17:30
Room 1.01
Paediatric® flat feet are one of the most common conditions seen in orthopaedic practice. Flat feet can alter gait,
by affecting the normal foots biomechanics which can eventually cause indirect damage and lead to pain. This
global issue is a common concern to parents. However its treatment is still debated within clinicians. Although
conservative treatment is known to be the most common approach for idiopathic flat feet, there is no optimal
strategy for it yet.
Objective
To assess current the literature on the conservative treatment of idiopathic flat feet in children.
Methods
Literature was obtained by performing a search of various databases. The inclusion criteria were: children ¡Ü 18
years, normal children without any underlying pathologies other than flat feet, symptomatic and asymptomatic flat
feet, conservative treatments such as physiotherapy, orthotic management and observational treatments. Surgical
management was excluded. The quality of the studies was assessed using the SIGN guidelines.
Results
Thirteen studies were included. The sample size ranged from 8-300. The evidence from one study suggested that
asymptomatic flat feet can be improved using physiotherapy (therapeutic exercises). Besides this, it was evident
that the custom-made and prefabricated orthoses show long term and immediate improvements in asymptomatic
flat feet. In addition, there is also evidence suggesting that asymptomatic flexible flat feet in children slowly improve
with time. For symptomatic flat feet, the evidence from one study reported a reduction in pain intensity after orthotic
use.
Conclusions
The evidence for the conservative treatment of idiopathic paediatric flat feet is very limited. Due to the lack of good
quality studies, it is not possible to make robust Conclusions for both ¨C symptomatic or asymptomatic flat feet. It
was a concern that normal children without flat feet might be treated. Future studies are therefore required which
accurately diagnose flat feet.
153
FREE PAPERS
Session Name and Room: Paediatrics - 2
Abstract Title: A Literature Review On Paediatric Idiopathic Flat Feet
Abstract number: 266
Authors: E. Figgins, M. Caldeira, K. Ross
Presenter: R. Bowers
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Prosthetics : Lower Limb - 7
Room 1.02
Abstract Title: Arm Forces During Assisted Sit-To-Stand And Stand-To-Sit Activities In Unilateral LowerLimb Amputees
Abstract number: 197
Authors: M. Stalin, V. Agrawal, C. O’Toole, R. Gailey , R. Gailey, I. Gaunaurd
Presenter: M. Stalin
Introduction
Sit-to-stand and Stand-to-sit are important activities of daily living and are performed 43-56 times per day by
amputees. Few studies have investigated the biomechanics of these activities in unilateral lower limb amputees.
While the asymmetrical weight distribution between the intact and prosthetic limbs is well established, the role of
arms in supporting body weight during arm-rest assisted rising and sitting has not been investigated.
Methods
10 unilateral Trans-femoral (TFAs), 12 unilateral Trans-tibial Amputees (TTAs) and 12 controls participated in the
study. Subjects performed arm-rest assisted sit-to-stand and stand-to-sit activities on a standard height chair in
response to a verbal command. A custom-built Matscan system was used to collect the vertical Ground Reaction
Forces (GRFs) from the chair and feet at a sampling frequency of 50Hz. Force on arms and feet were determined
at the seat-off and seat-contact event for sit-to-stand and stand-to-sit activities respectively. Symmetry indices (SI)
between the amputated/non-dominant and intact/dominant legs as well as arms on the amputated and intact sides
were calculated.
Results
For sit-to-stand, the SI between the lower limbs were: TFAs8594;36.8%; TTAs8594;71.4%; Controls8594;94.5%;
and between upper limbs were: TFAs8594;83.7%; TTAs8594;92%; Controls8594;95%. For stand-to-sit, the SI
between the lower limbs were: TFAs8594;48.5%; TTAs8594;69.3%; Controls8594;93.4%; and between upper
limbs were: TFAs8594;93%; TTAs8594;89.9%; Controls8594;91.7%.
Discussion
Amputees supported more weight on the arms than the legs during sit-to-stand, compared to the controls. In
amputees, the greater weight on intact leg is concurrent with the greater weight on the arm of the prosthetic side.
During stand-to-sit, there were no differences in arm SIs between amputees and controls.
Conclusion
Amputees with limited arm strength may experience difficulty in performing the sit-to-stand activity. High force on
arms may result in secondary co-morbidities in the upper limb joints. Training techniques to reduce asymmetry in
both lower and upper limbs should be developed.
154
Tuesday, Feb 5 / 16:15 - 17:30
Introduction
The study aimed at evaluating the influence of a hypobaric Iceross Seal-In® X-5 Membrane (HIS) on pistoning and
quality of life compared to the standard suction socket (SSS) in unilateral transtibial amputees (TTA).
Methods
Main inclusion criteria: a) unilateral TTA, b) SSS prosthesis user for at least 18 months, c) a K level 3-4. The
Pistoning test (PT) was used to compare vertical movement of the stump within the socket. We used the
Gholizadeh’s approach (2011). The PTs were carried out when TTAs were wearing their SSS, and after 2, 5 and
7 weeks of HIS use. Prosthesis Evaluation Questionnaire (PEQ) was administered at the beginning and at the
end of the study.
Results
Ten TTAs male (age 44,9±9,5) were recruited. They had been using a SSS continuously for at least 6 h/day. The
PT mean vertical displacement changing from full weight bearing on the prosthetic limb to non-weight bearing was
7.5±4.7mm with SSS, and 4.7±3.1, 4.6±2.9, 3.6±3.1mm with HIS after 2, 5 and 7 weeks of HIS use respectively.
The difference between the SSS and the last HIS PT was statistically significant (p=.016). Adding 30 N to the
prosthesis, the mean vertical displacement increased to 12.4±5.6mm with SSS, and 6.7±4.1, 6.1±3.1, 5.6±3.1mm
with HIS after 2, 5 and 7 weeks of its use, showing a significant reduction in the three evaluations with HIS (p=.025,
p=.010, p=.006 respectively). A significant improvement in the PEQ domains “Appearance”, “Ambulation” and
“Well being” were registered with HIS use.
Discussion
Reliable socket suspension is the key to control over the prosthesis and important for socket comfort. The reduction
of pistoning movements provided by HIS use, seems to be associated with an improvement in the quality of life
as reported by users.
Conclusion
HIS use determined an improvement in prosthesis comfort compared to SSS.
155
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 7
Room 1.02
Abstract Title: Effects Of The Hypobaric Iceross Seal-In® X-5 Membrane On Prosthetic Suspension And
Quality Of Life: Comparison With The Standard Suction Socket System.
Abstract number: 453
Authors: S. Brunelli, A. Delussu, F. Paradisi, R. Pellegrini, D. Zenardi, Á. Lúdvíksdóttir, D. Roberto, M.
Traballesi
Presenter: A. Ludviksdottir
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Prosthetics : Lower Limb - 7
Abstract Title: A Prosthesis Design Platform Centred On Digital Amputee
Abstract number: 277
Authors: C. Rizzi, G. Colombo, G. Facoetti
Presenter: C. Rizzi
Room 1.02
This paper presents a new design platform for lower limb prosthesis centred on the patient’s digital model and
based on a fully computer-aided and knowledge-guided approach. The biomechanical model of the amputee is
created using a biomechanical simulation tool and enriched with amputee’s characteristics (e.g., anthropometric
measures). These represent the key elements that guide the new prosthesis development process. The proposed
design platform provides the technicians with a set of tools to design, configure and test the prosthesis in a
virtual environment. It assists the technicians step by step providing suggestions and rules (e.g., socket shape
manipulation). It comprehends two main environments: the Prosthesis Modeling Lab and the Virtual Testing Lab.
The first permits to generate the 3D assembly of the prosthesis, crucial to virtually study prosthesis set-up and
patient’s walking. It includes the virtual Socket Laboratory to create the 3D socket model through an ad hoc SW
module, Named Socket Modelling Assistant, integrated with FE tools to study the limb-socket interaction and a
commercial 3D CAD system to configure and assembly the prosthesis. Configuration procedure and electronic
sheets have been developed to choose automatically the appropriate components for the amputee and accordingly
size them.
The Virtual Testing Lab permits, once created the amputee's avatar wearing the prosthesis, to set up and
evaluate prosthesis functionality simulating postures and movements. In collaboration with the technical staff of
an orthopaedic laboratory, the platform has been experimented as far as concerns the modelling phase while only
preliminary Results have been obtained for the virtual testing lab.
156
Tuesday, Feb 5 / 16:15 - 17:30
Background
While the C-Leg has Grade-B level evidence supporting its safety efficacy[1] in the transfemoral amputee
population, there are still areas for further improvement. This study’s purpose was to determine if the new Genium
microprocessor knee could improve multi-directional stepping, the limit of stability and patient perception of safety
following accommodation.
Methods
This interim analysis presents Results of the first eight subjects in an ongoing clinical trial of 20 subjects. Subjects
were male (mean[SD] age: 52y[15.1]) with non-dysvascular etiology and utilized a C-Leg for >1y. At enrollment
subjects randomized to either continue C-Leg use or accommodate with a Genium. C-Leg subjects acclimated
2wks with a newly fitted Trias foot. Genium subjects were acclimated to the Trias and Genium prior to testing.
Following initial testing, subjects crossed-over to the second condition and acclimated as previously described
prior to re-testing.
Outcomes
Four Square Step Test(4SST)[2]. Limit of Stability(LOS) Testing as measured on a Biodex-SD suspended force
platform. Prosthesis Evaluation Questionnaire-Addendum(PEQ-A)[3] for mental energy in ambulation, and
stumbles and falls. Statistical Analyses: Paired t-tests at an a priori significance level of p<0.05.
Results
Subjects’ mean 4SST times decreased 2sec (15%; p<0.05) with Genium use and similarly, the overall LOS score
improved by 10% but this difference was not significant. Four of eight directions in the LOS test improved with the
Genium; three of these were on the sound side. For the PEQ-A, 9/14 questions showed an improvement with the
Genium and of these, 2 reached statistical significance.
Conclusion
Subjectively, TFA’s reported an improved safety experience with Genium use which is consistent with objective
stability measures including multi-directional stepping and limits of stability testing.
1. Highsmith, M.J., et al. Prosthet Orthot Int, 2010.
2. Dite, W. and V.A. Temple. Arch Phys Med Rehabil, 2002.
3. Hafner, B.J., et al. Arch Phys Med Rehabil, 2007.
157
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 7
Room 1.02
Abstract Title: An Interim Analysis Of The Effect Of The Genium Knee On Balance And Stability
Abstract number: 202
Authors: J. Highsmith, R. Miro, D. Lura, L. Mengelkoch, J. Kahle, W. Quillen, R. Dubey
Presenter: J. Kahle
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Prosthetics : Lower Limb - 8
Room 1.03
Abstract Title: Investigation Of In Vivo Prosthesis/Residual Limb Stiffness Using A Novel Impact Test
Apparatus
Abstract number: 160
Authors: E. Boutwell, S. Gard
Presenter: S. Gard
Introduction
Shock-absorbing components are often prescribed in transtibial prostheses to cushion the residual limb from
forces transmitted though the prosthesis. However, while subjective data typically indicate increased comfort and
preference for these components, quantitative gait analyses have not been able to demonstrate that altering
prosthetic stiffness substantially changes the overall limb stiffness in vivo. The purpose of this study is to use
a novel technique to provide reliable in vivo estimates of overall limb stiffness as the prosthesis stiffness is
systematically varied.
Methods
Subjects with a unilateral transtibial amputation are positioned on a custom impact testing apparatus with their
prosthetic limb outstretched, elevated a short distance (9cm), and released in a controlled drop during which the
prosthesis contacts a rigidly mounted force platform. This platform measures impact force while a motion-capture
system tracks relative limb displacements, enabling overall limb stiffness to be calculated. Prosthetic stiffness
is modified with a shock-absorbing pylon. The five stiffness conditions include the manufacturer-recommended
stiffness for the subject, and 50%, 75%, 125%, and 150% of this stiffness, administered in randomized order.
Variables of interest include peak impact force and overall limb stiffness, both of which are hypothesized to
decrease in lower prosthetic stiffness conditions.
Results
Data collection for this study is ongoing. Preliminary data indicate that changing the prosthetic stiffness affects
the magnitude of the forces generated during impact. A reduction in the peak impact force of 83.4 N (10.3% body
weight) has been observed between the lowest and highest stiffness conditions.
Discussion
Our data indicate that peak force magnitudes decrease during in vivo impact testing as prosthesis stiffness is
reduced, a result that has not been demonstrated consistently in previous gait analyses This finding may indicate
that subjects modulate overall limb stiffness during gait in response to changes in prosthetic stiffness.
158
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Introduction
The walking school at the Red Cross Hospital (RCH), Sweden, serves the entire Stockholm County Council, as a
specialist center for people with lower limb amputation. Our goal is to enhance the patient´s possibilities to develop
walking abilities with prosthesis. During 2011 we had approximately 200 treated patients and 2600 visits. The aim
of this presentation is to investigate differences in rehabilitation outcome depending on gender, age, cause and
level of amputation.
Methods
A total of 31 patients, (23 men and 8 women, mean age=54, 6 years). Inclusion criteria: Lower limb amputees
that had undergone a rehabilitation program at the RCH, re-visiting the walking school 2010-2011 to get a new
remittance on prosthesis. The rehabilitation outcome has been measured with the Timed up and go test (TUG),
Locomotor Capability Index (LCI) and 4 square step test (4SST).
Result
Men had generally better Results than women (LCI mean 51/47 points, TUG mean 9/11 seconds), although women
had better Results in 4SST (mean 8/9 seconds). Patients of older age had poorer Results then the younger (LCI
mean 44/55). Trauma as amputation cause gave better Results than amputations caused by illness (LCI mean
51/50, TUG mean 8/12, 4SST mean 8/10). Transtibial amputees performed better than transfemoral amputees
(LCI mean 46/52, TUG 14/8 and 4SST 11/8). 97% of the patients are using the prosthesis daily, 84% more than
10 hours/day. 71% are walking without walking aids indoors and outdoors.
Discussion
Men are overrepresented in the subgroup amputation caused by trauma. This subgroup has better Results than
amongst patients with amputations caused by illness and may be one explanation to why men generally have
better Results than women.
Conclusions
These findings indicate that there are differences in rehabilitation outcome amongst lower limb amputees
depending on gender, age, cause and level of amputation.
159
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 8
Room 1.03
Abstract Title: Factors Influencing Rehabilitation Outcome For Lower Limb Amputees At The Red Cross
Hospital, Sweden
Abstract number: 91
Authors: L. Gudmundson, H. Sundgren, M. Skubic-Bergqvist
Presenter: H. Sundgren
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Prosthetics : Lower Limb - 8
Room 1.03
Abstract Title: Prosthetic Use With Transfemoral Osseointegrated Prostheses - Long Term Prospective
Results From The Opra-Study
Abstract number: 108
Authors: K. Hagberg, Ö. Berlin, R. Brånemark
Presenter: K. Hagberg
Introduction
Patients with transfemoral amputation (TFA) can today be treated with bone-anchored prostheses. The
osseointegration treatment includes two surgeries and rehabilitation. The prospective OPRA-study aim to report
outcome on patients with TFA treated in Sweden. It includes 51 patients (55% male, 45% female, mean age 44.2
years, amputation cause 65% trauma, 23% tumor, 12% other) treated with 55 implants (4 treated bilaterally).
Patients were included between year 1999-2007. The aim is to report long term outcome on prosthetic use from
the OPRA-study.
Methods
Patients answered the Questionnaire for individuals with Transfemoral Amputation (Q-TFA) preoperatively
(baseline) and 1, 2, 3, 5, 7 and 10 years postoperatively. The Q-TFA Prosthetic Use score (0-100) is the primary
efficacy variable. A score of 0 means the prosthesis is not used any day/week and 100 means it is used 7 days/
week during >15 hours/day. A Prosthetic Use score of =90 is considered very high.
Results
The baseline Prosthetic Use score was Md 52 (n=51). At baseline 20% did not use a prosthesis at all and 33%
reported a score =90. At 2-years six patients were lost to follow-up: 3 implant removed, 1 deceased, 1 withdrawn
due to other disability, 1 lost to follow-up. At 3-years 1 more implant had been removed and 1 more patient
deceased. The Prosthetic Use score at each follow up was Md 90 (n=45), 90 (n=45), 90 (n=40), 95 (n=34), 100
(n=22) and 95 (n=10) at 1, 2, 3, 5, 7 and 10 years respectively.
Discussion
The study is ongoing and reported Results include data until april 2012. The Prosthetic Use score gives no
information on prosthetic mobility or problems. Such data is also assessed and will be reported in the future.
Conclusions
Patients treated with osseointegrated transfemoral prostheses report high prosthetic use up to 10 years after
treament.
160
Tuesday, Feb 5 / 16:15 - 17:30
Introduction
Patients following an amputation usually try to get back to walking. Different professions are involved in this
process. Several tools are available to monitor the rehab process. But not all tests are practical for every patient
at every stage of the rehab process. In this study the rehab progress was monitored and patients passed different
tests, which were selected according to their current capabilities.
Methods
7 subjects with lower limp amputations were measured in this ongoing study (1 TT; 3 TF; 3 HipEx). Patients
spent min. two weeks near the hospital. In parallel their prosthesis was fitted, different prosthetic components
tested, adjusted and they attend gait education and/or physical therapy. Patients were asked to write a diary,
documenting their perception and activities. The LCI was asked at the beginning and end of the rehab. Depending
on their abilities they performed the 2min-walk-test, level walking, stairs, slopes and outside terrain with video
analysis. Kinematics and kinetics (when walking without aids) was captured via 3D-gait-analysis-system. Static
adjustment was documented with a LASAR posture device.
Results
Available tests can be grouped by min. required patient capabilities. Time distance parameters and left/right
symmetry are indices showing how the user gets familiar to prosthetic walking. A diary illustrates the learning
process from the patient side and is a helpful feedback for the professionals.
Discussion
Measurements at the beginning and end of the treatment are sufficient to document an improvement, but subjects
are often unable to perform the same tests at early and later stage in training.
Conclusions
Performin standardized tests at defined points in the rehab helps to document the process. It’s difficult to detect
effects of single interventions. The outcome is affected by the socket design, prosthetic parts, adjustments as well
as physiological and mental capabilities.
161
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 8
Room 1.03
Abstract Title: Documenting The Rehabilitation Process Of Patients With Lower Limb Prosthesis
Abstract number: 509
Authors: J. Block, D. Heitzmann, S. Wolf
Presenter: D. Heitzmann
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Prosthetics : Lower Limb - 8
Room 1.03
Abstract Title: Malawian Prosthetic And Orthotic Users’ Performance And Satisfaction With Their Lower
Limb Assistive Device
Abstract number: 115
Authors: L. Magnusson, G. Ahlström, N. Ramstrand, E. Fransson
Presenter: L. Magnusson
Introduction
This study aimed to investigate patients’ performance and satisfaction with their lower limb prosthetic or orthotic
device and their satisfaction with prosthetic and orthotic service delivery in Malawi.
Method
Eighty-three patients participated in the study. Questionnaires were used to collect self- reported data.
Result
Ninety per cent of prosthetic and orthotic devices were in use. Patients were quite satisfied with their device (mean
score of 3.9 out of 5) and very satisfied with the service provided (mean score of 4.4 out of 5). The majority of
patients were able to move around the home (80%), rise from a chair (77%), walk on uneven ground (59%) and
travel by bus or car (56%). Patients had difficulties or could not walk at all on; stairs (60%) and hills (79%),Thirtynine percent reported pain when using the assistive device. Forty-eight percent of the devices were in use but
needed repairs and 10 % were never used or completely broken. Access to repairs and servicing were rated by
patients as most important, followed by durability of the device and follow up services. Lack of finances to pay for
transport was a common barrier to accessing the prosthetic and orthotic centre.
Discussion
Prosthetic and orthotic devices can be further improved in order to accommodate for ambulation on uneven
surfaces, hills and stairs, as well as increasing patients’ ability to walk long distances with reduced pain.
Conclusion
Patients were satisfied with the device and service received and the majority of prosthetic and orthotic patients
in this study reported increased mobility when using their assistive devices. However, patients reported pain
associated with use of the device and difficulties were experienced when walking in hills and on stairs. Costs
associated with transport to the prosthetic and orthotic facility prevented them from receiving follow-up and repair
services.
162
Tuesday, Feb 5 / 16:15 - 17:30
Room 1.05
Introduction
Humans control their body by integrating sensory inputs to create knowledge of the body’s disposition. When a
person is using a prosthetic limb, some of these modalities may be absent, but many more are hard to integrate
into the control of their prosthesis. An example is the ability to maintain the hand orientation while the body position
changes as the person gets up from a chair or reaches forward. This is simple with an intact arm, but when there
is a loss above the elbow, the ability to correct the change in angle of the forearm as the arm reaches forward, is
challenging. If additional sensors are added to the arm then this task can be devolved to the electronic controller.
Method
The second generation ToMPAW arm, contains microcontrollers that can take integrate additional inputs from
accelerometers in the arm. While this idea was put forward in the 1980s, it is only with the advances in electronics,
that these ideas can be pursued. The hand, elbow and wrist are controlled sequentially, switched from the shoulder
harness. When the hand instructed to hold an object, the rest of the arm is informed and the orientation of the wrist
and forearm be maintained relative to gravity. If the user switches control to the elbow or wrist they can override
the position and change it.
Results
The arm has been prepared for the single subject who was a long term user of the and advanced arm. The velocity
of the correction motions has been reduced so that the arm does not over react to small changes in attitude, but
steady co-ordinated movements can be corrected for, until the wrist or elbow reaches their range limits.
Conclusion
Microprocessor controllers and cheap sensor technology can be combined to give prosthetic arms more autonomy.
163
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 3
Abstract Title: The Use Of Multiple Sensors In The Control Of Prosthetic Arms
Abstract number: 110
Authors: P. Kyberd, A. Poulton
Presenter: P. Kyberd
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Prosthetics : Upper Limb - 3
Room 1.05
Abstract Title: Searching For Optimal Channel Configuration And Number In Multichannel Myoelectric
Prosthesis Control
Abstract number: 138
Authors: D. Boere, H. Witteveen, H. Hermens, J. Rietman
Presenter: D. Boere
Introduction
A higher number of intuitively controllable functions in myoelectric forearm prostheses might be obtained using
pattern recognition and multichannel configuration. However, it is unknown what configuration is optimal. We
tested dependency of channel configuration and number on the performance of an eight-motion classifier.
Methods
EMG signals of 8 wrist and hand motions from 10 able-bodied subjects were collected using a grid of 4x10
monopolar electrodes. Three approaches were applied: 1) forming channel-subsets (varying length of 1 to
12) by selecting channel pairs corresponding to six specific muscle regions; 2) a sequential forward selection
algorithm, which starts with an empty subset and successively adds the channel that yields maximum increase
of the classification performance, until performance does not improve anymore; 3) selection of circumferential
arrays, using all (10) and every other channel (5) in a circumference of the grid as channel-subsets. Using RMS
over 150ms-signals of each selected electrode, nearest neighbor classifiers were trained and tested. Classifier
performances were calculated for both average reference (AR) and bipolar (BP) derivation for all approaches.
Results
For the muscle-specific configuration, optimal result was obtained with 5 BP-channels: 97.6% accuracy. For the
selection algorithm, optimal result was obtained with 6 AR-channels: 97.5%. The circumferential selection of 10
AR-channels gave 98.2% and 5 BP-channels 96.17%.
Discussion
Increasing channel number up to 4 improved performances substantially for all configuration approaches. After
that, performances increased minimally. Although a BP 5-channel muscle-specific configuration seems to be the
optimal number and configuration, it requires 10 electrodes on the forearm. In this respect, an AR 10-channel
circumference configuration might also be optimal.
Conclusion
For this set of contractions, no substantial differences in classifier performance were found for the different
approaches and derivations when using 5 or 6 channels. The circumferential array is the most practical way of
positioning electrodes.
164
Tuesday, Feb 5 / 16:15 - 17:30
Introduction
Body-powered devices use one of two types of prehensors. Voluntary opening (VO) prehensors require the user
to pull on the cable to open the device but can then relax, allowing the rubber bands on the device to provide the
grasp force. This method is easy to use but limits the grasp force to that of the rubber bands. Voluntary closing
(VC) devices require the user to pull on the cable to close the device in a grasp, thus giving the user more pinch
force and control. However, VC prehensors typically require continued user-generated force to maintain the grasp.
This study had two goals: First, to compare the objective function of VO and VC devices across a range of grasp
patterns and activities of daily living. Second, to analyze if a new type of device that could switch between the VO
and VC modes would improve function.
Methods
Three able-bodied subjects wearing a bypass transradial prosthesis performed the Southampton Hand Assessment
Protocol (SHAP) using a Hosmer 555 VO device and an APRL VC device.
Results
The average index of functionality was 43.3 for the VO device, 36.7 forthe VC device, and 51 if the best device for
each task was used.
Discussion
All three subjects performed more quickly with the VO device for certain tasks (light and heavy extension grip tasks
and screwdriver task), whereas they performed more quickly with the VC device for others (e.g. heavy lateral grip,
coin moving). This is consistent with the questionnaire responses. We will present data at ISPO on 25 able-bodied
subjects and many transradial amputees.
Conclusion
The most efficient way to complete all of the tasks in a SHAP test would be to use a device that could switch
between VO for some of the tasks and VC for others.
165
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 3
Room 1.05
Abstract Title: Functional Comparison Of Voluntary Opening And Voluntary Closing Body-Powered
Prostheses
Abstract number: 249
Authors: J. Sensinger, S. Cohick
Presenter: J. Sensinger
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Prosthetics : Upper Limb - 3
Room 1.05
Abstract Title: Type Of Feedback While Learning To Control Force With A Myoelectric Prosthesis.
Abstract number: 143
Authors: R. Bongers, H. Bouwsema, C. Van Der Sluis
Presenter: R. Bongers
Introduction
The feedback a therapist can provide to enhance learning the use of a myoelectric prosthesis is an important
aspect in the development of a training program. The aim of this study is to examine a new virtual task to train grip
force control with the prosthetic hand, while two types of feedback are tested for their contribution to the learning.
Methods
Able-bodied participants (N=32) were randomly assigned to two groups. Group 1 received feedback in the form
of knowledge of Results (KR), group 2 received feedback in the form of knowledge of performance (KP) during
training. Participants trained force control in 5 sessions in a two-week period, receiving KR or KP feedback after
every trial. The training consisted of a virtual game, in which participants were instructed to shoot a ball, placed in a
slingshot, into a target, all displayed on a computer screen. Release angle and velocity of the ball were determined
by the participants using a handle, equipped with force sensors. To test the performance in force control of the
prosthetic hand, the grip force was assessed in a set of force control tasks during a pretest, a posttest and a
retention test.
Results
Preliminary analysis of the tests showed that participants who received KR feedback were better able to control
grip force compared to participants who received KP feedback. The performance of the KP group deteriorated in
the retention test. Future effort will involve further analyses of performance in the test phases as well as during
the training.
Discussion/Conclusion
To enhance the learning of grip force control in a prosthetic hand, participants might benefit more from feedback
given in the form of knowledge of Results than that of knowledge of performance. This implies that occupational
therapist should provide this type of feedback during training.
166
Introduction
Patient outcomes studies in upper limb prosthetics are traditionally limited, and as technology develops in the field
of upper limb prosthetics the options available to Prosthetists and patients are constantly increasing. It is important
to ensure these technological advancements are translated into improved outcomes and functional benefit to the
upper limb patient.
Method
The Patient Care Pathway is an online tool designed to collect information before and after a patient is fitted
with a prosthesis. This tool is being used internationally in clinics fitting i-limb ultra prosthetic hands. This tool not
only collects validated outcome measures of the Disabilities of the Arm, Shoulder and Hand (DASH) and Trinity
Amputation and Prosthesis Experience Scales (TAPES) but also documents a client-centered approach to the
prosthetic rehabilitation experience and achievement of personal and functional goals.
Results
The Results of over 50 patients fitted with i-limb ultra hand prosthesis, completing the Patient Care Pathway forms,
prior to fitting and at regular intervals post-fitting during 2012, will be presented. The TAPES provides a measure
for each of the areas of psychosocial adjustment, activity restriction and satisfaction with their prosthesis; the
DASH study provides a disability score for the patient. The patients’ duration of wear of the prosthesis, activities of
use, and the impact of functional therapy training on patient outcomes will also be presented.
Discussion
As patients and Prosthetists seek information on the effectiveness and application of advanced prosthetic hand
technologies, this data will provide a greater understanding of patient usage of upper limb prostheses assisting
clinicians in patient selection and appropriate prosthesis prescription.
Conclusion
The Patient Care Pathway enables the clinician to gather a broad collection of patient outcome data, thus providing
insight into the functional and quality of life benefits of advanced prosthetic upper limb technology.
167
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Prosthetics : Upper Limb - 3
Room 1.05
Abstract Title: Measuring Physical And Psychosocial Outcomes Of Patients Using Multi-Articulating Hand
Prostheses
Abstract number: 430
Authors: A. Goodwin, D. Atkins
Presenter: A. Goodwin
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Pedorthics - Footwear - 1
Abstract Title: Effectiveness Of Insoles In Preventive Treatment Of Diabetic Patients
Abstract number: 10
Authors: U. Tang, R. Zügner, R. Tranberg
Presenter: U. Tang
Room 1.06
Introduction
Insoles and shoes are frequently prescribed to people with diabetes to prevent occurrence of foot ulcers. Use of
insoles and stable shoes decreases the plantar peak pressure (PPP) in regions of interests (ROI). These regions
are defined as metatarsal phalangeal joint 1-2 and heel. The aim of this study was to compare three different types
of insoles with respect to pressure distribution. Main outcomes were plantar pressure and incidents of ulcers in
the first 12-month period.
Method
114 patients with diabetes: 62 males and 52 females; type I/II n=31/83; mean (SD) duration of 12.3 (11.2) years;
age 58 (15.5), BMI: 28 (4.7); neuropathy in 39% of the people. Patients were recruited from Dep. of Prosthetics
and Orthotics at Sahlgrenska University Hospital, Gothenburg. Patients were randomized in three groups: group
1) prefabricated insoles, group 2-3) custom made insoles of EVA 35 and 55 shore respectively. Inclusion criteria:
diabetes, > 18 years; ability to walk independently. Examination takes place at baseline and subsequently
every 6 months until 24 months is reached. The test includes: in shoe pressure measurement with F-ScanTM ;
questionnaires; and foot examination.
Result
Pressure measurement at baseline shows mean PPP values less than 282 Kpa for all types of insoles in ROI. After
twelve months mean PPP was below 272 Kpa. Twelve months use of the insoles gives following values in heel
region: prefabricated insole 240 (SD 74); EVA 35sh 187 (68) and EVA 55sh 171 (73). A significant difference was
seen in heel region between prefabricated insoles and insoles of EVA 35sh and 55sh (p=0,001). Only one case
was reported with ulcers during the first twelve months.
Discussion and Conclusion
All three types of insoles show acceptable Results regarding distribution of pressure with a low incident of ulcers.
168
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Introduction
In diabetic subjects, reulcerations following first ray amputations are particularly frequent. The natural history
of first ray amputation is characterized by a reulceration and consequent reamputation rate. Treatment usually
includes an in-shoe intervention designed to reduce plantar pressure by using insoles and a variety of off-theshelf products. Our aim was to investigate the effects of a suggested total contact insole on the plantar pressure
reduction in patients with partial first ray amputations.
Methods
Twenty subjects (mean age 60year, mean body mass index 27 kg/m2) with diabetes mellitus and partially
amputated first ray of one foot. Plantar pressure data were recorded using Matscan Tekscan systems (ver. 6.34,
Boston USA) while standing and taking a step for three conditions (shoe, shoe + total contact insole, and shoe +
flat insole). For each condition tested, plantar pressures were determined at the five metatarsal areas, mid foot
area and medial heel and lateral heel areas.
Results
Twenty patients completed the study over one year The mean age of the participants was 60 years, mean Body
mass index was 27kg/m2. Pressures diminished significantly (P<0.05) in tested areas using the total contact
insole while standing and walking However while using the Flat insole, significant pressure changes were only
seen while walking, during standing pressures diminished significantly at M1, MF, MH and LH areas (P<0.05). A
highly significant change in pressures (decrease) with the total contact insoles during walking in all areas except
for the M1 area (P<0.001) as compared to that of Flat insole. Discussion We designed the insole to adequately
conform to the irregularities of the foot. The total contact insole was more effective in diminishing pressures than
the regular flat insole.
Conclusion
The conforming total contact insole showed a promising significant reduction in plantar pressures indicating a very
useful design of such orthoses.
169
FREE PAPERS
Session Name and Room: Pedorthics - Footwear - 1
Room 1.06
Abstract Title: The Role A Total Contact Insole In Diminishing Foot Pressures Following First Ray
Amputation In Diabetics
Abstract number: 175
Authors: R. El-Hilaly, O. El-Shazly, A. Amer
Presenter: R. El-Hilaly
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Pedorthics - Footwear - 1
Room 1.06
Abstract Title: A Proximally Placed Rocker Bar And External Ankle Moments During Walking And SlowSpeed Running
Abstract number: 98
Authors: K. Postema, S. Sobhani, E. Vd Heuvel, J. Zwerver, J. Hijmans, R. Dekker
Presenter: K. Postema
Introduction
Achilles Tendinopathy is a common overuse injury in runners. In daily practice a proximally placed rocker at the
shoe is prescribed regularly, to reduce tension on the Achilles Tendon. The Masai Barefoot Technique shoe in fact
is provided with a proximally placed rocker bar. It produces a small decrease of the external ankle dorsal flexion
moment during the third rocker while walking (Nigg et al, 2006). However, no information is available on the effects
of a proximally placed rocker bar on the ankle moments during slow-speed running.
Methods
Sixteen healthy recreational runners were tested in the Motion Lab Rehabilitation of the University Medical Center
Groningen, using a VICON motion capture system and a force plate (AMTI).
Intervention
one pair of running shoes with and one without a proximally placed rocker bar with sole stiffening. The subjects
walked at comfortable speed and ran slowly (approximately 7 km/h). Seven trials in both situations were measured
with a maximum speed variability of 5%.
Results
With a rocker bar the maximum external dorsal flexion moment decreased during walking and slow running in all
subjects, with an average of 15 and 11% respectively. Also the moment over time (Nms) and the power (W/kg)
decreased in both situations.
Discussion
It was striking that in every subject the maximum external dorsal flexion moment decreased. A decrease of the
external moment goes hand in hand with the same decrease of the internal ankle moment. The internal moment
arm stays approximately the same during the motion trajectory of the ankle during the third rocker. This means
that the force of the Calf Muscles decreases 15 and 11% respectively, during walking and slow-speed running.
Conclusion
A proximally placed rocker bar causes a decrease of tension on the Achilles
Tendon during walking and slow-speed running.
170
Tuesday, Feb 5 / 16:15 - 17:30
A study of the quantitative merits of a wholly digital approach over traditional methods in the production of a pair of
custom orthotic insoles. Many laboratories are aware of digital technology that can be utilised in the consultation,
prescribing, design and manufacture of custom orthotic insoles but there is little quantitative evidence of the
improvements that can be obtained when adopting a total or partial digital process. This study offers clarity and
thus enables laboratories to make more informed decisions on digital investment.
Methods
Selections of typical laboratories were consulted that had previously been using traditional data capture, design
and manufacturing processes and have now converted to a digital process. In order to obtain comparable
results laboratories creating similar style orthotics that are now using similar types of CAD/CAM technology were
consulted.
Results
The level of improvements varied but for a typical laboratory the average costs per pair reduced by 400%, returns
for adjustments reduced by 800%, and the return on their investment was within 2 years but as little as 8 months.
For the practitioner the data capture process was on average reduced to just one minute and lead times cut from
over a week to a little as 48 hours.
Conclusions
It is clearly evident that adopting a digital process from initial consultation through to delivery has significant
quantitative improvements for both the practitioner and laboratory as well as a better experience for the patient.
The key to improvements is the quality and application of the CAD/CAM tools that enable the 3D capture of the
patient’s foot, completion of a digital prescription, instant transmission to the lab, and rapid design of the orthotic
and then an efficient use of milling machines and materials to create the orthotic before it is sent back to the
practitioner.
171
FREE PAPERS
Session name and Room: Pedorthics – Footwear - 1 Room 1.06
Abstract Title: Traditional vs. Digital In The Design And Manufacture Of Custom Orthotic Insoles
Abstract number: 481
Authors: D. Swatton, C. Lawrie
Presenter: D. Swatton
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Education - 1
Abstract Title: Smart Materials Inspiring Innovation In P & O Field
Abstract number: 23
Authors: S. Rout, A. Sinha
Presenter: S. Rout
Room G.06
'Playing God' is actually the highest expression of human nature. Our machines will become much more like us,
and we will become much more like our machines. In the era of artificial intelligence some materials immerge
with the ability to sense, stimulate, process and actuate a response. These are lifeless but still act different from
other conventional materials when placed in specific environments. These materials are so called smart materials.
The field of Prosthetics & Orthotics developed from the era of iron and wood to an ultra modern era of light and
ultra light composites. The evolvement of smart materials adds more reasons to the development of this field in
the material aspect. There are different smart materials like Shape memory alloys, Magnetic Rheological Fluid,
Piezoceramics whose properties can be sensibly utilized in Prosthetics and Orthotics Arena. In this paper I have
highlighted some of the Smart materials, their features and uses in rehabilitation field.I believe that the information
about these advance materials will definitely help the young P & O professionals and students to utilize these
materials in different R & D projects in future.
172
Tuesday, Feb 5 / 16:15 - 17:30
Introduction
It has been established that Degree of Prosthetics and Orthotics program should address topics on developments
in biomedical and rehabilitation engineering, which undeniably have led to improved diagnosis, new intervention
and more reliable outcome evaluation.
Methods
Courses employed, apart from the curricular which has significant engineering components were i) Biomechanics
of Prosthetics and Orthotics, ii) Biomechatronics, iii) Invention assignment in Prosthetics and Orthotics Clinical
Practice.
Results
In Biomechanics of Prosthetics and Orthotics, each student undertake 3D motion analysis of a prosthesis user and
an orthosis user under different walking conditions. Study design development and data analysis were conducted
to make comparisons between the different gait characteristics set by each student pair under the supervision of
the lecturer. Students were able to apply 3D biomechanics software skills to quantify patients’ gait performance and
supplement their future clinical prescription and assessment. In Biomechatronics course students were exposed to
the principles of Rehabilitation Engineering technology and the latest integrated engineering application in the field
of Prosthetics and Orthotics. As a group assignment they designed a prototype of smart prosthetic leg, which was
conducted using a cooperative approach where each group member was responsible for one design component.
The invention design assignment as part of their Clinical Practice required each individual students to make use
of their clinical experience and propose a better solution, technically, for a selected problem they encountered
during the course.
Discussion and Conclusion
These exercises links their clinical assessment skills with the technical skills of motion analysis to justify gait
assessment, and trained them to work integratively in a group to produce an optimal solution based on research
and product development. As Prosthetics and Orthotics students with adequate engineering background and
skills, they were also able to critically analyze their clinical practice experience with an ingenious eye for design.
173
FREE PAPERS
Session Name and Room: Education - 1
Room G.06
Abstract Title: Embedding Engineering Skills Into Prosthetics And Orthotics Degree Education: Examples
Of Approaches Implemented And Outcomes
Abstract number: 41
Authors: N. Hamzaid
Presenter: N. Hamzaid
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Education - 1
Abstract Title: Training Of Orthopaedic Technologists In Francophone Africa: A Challenge
Abstract number: 59
Authors: K. Aklotsoe, A. Kpandressi
Presenter: K. Aklotsoe
Room G.06
Introduction
P&O appears to be new business in most developing countries, including those of Francophone Africa. The
training of health technical professionals is a concern of governments only when it is about doctors, nurses ... and
not for orthopaedic technologists (OT). Our aim is to show the needs (numbers) of OT in Francophone Africa to
mobilize governments to invest more in the training of OT.
Methods
We identified the population of Francophone and Lusophone Africa. We identified the OT of those regions, trained
at ENAM-L and elsewhere. We also identified the necessary number of OT for quality cares in a given population
according to the standards of WHO.
Results
Population: 259.5 millions
Number of trained OT at ENAM from 1976 to 2011: 212 (7.56%)
Number of trained OT elsewhere: 10 (0.44%)
Required number of OT Cat. I and II: 2803
Difference: 2,581 (92%)
Discussion
The number of OT trained until now is only 8%.This number is inadequate and can not address the issue of access
to P&O cares for the Physically Disabled. The training of the remaining 92% was and remains a challenge. It would
not be an impossible mission because it is a continental challenge. The solution is to raise the admission capacity
of ENAM in order to get more students and reinforce its teaching staff.
Conclusion
The situation of the orthopaedic services should call out to all. The lack or inadequacy of qualified OT contributes to
poor quality cares. OT training should be the prerogatives of academic and normative institutions, and be included
in the priorities of states.
174
Tuesday, Feb 5 / 16:15 - 17:30
Room G.06
What is APOS?
APOS is a group of training institutes and their supporters in Asia which including core members from Prosthetic
and Orthotic Schools in Cambodia, Thailand, Vietnam, Sri Lanka, and Pakistan. The alliance consists of board,
task officers, and repository officer, and the members in those committees are representatives from each core
member school. The cooperation was initiated in 2003 with the development of staff exchange, annual meeting
and the sharing resources with the financial support from The Nippon Foundation.
Why APOS?
The alliance is established for ensuring the quality of care and education of prosthetic and orthotic professionals
for the benefits of patients in the region by conducting a series of activities that helps to strengthen and deepen
the professionals in the region.
APOS Activities
a. Staff exchange
APOS fosters staff exchanges among its members and supporters with all level of staff in the professions, so that
staff can share their experiences, learn from other schools, and improve cooperation and communication.
b. Mentoring
It is a capacity building program within the school with the help from expert for specific topic to assist the
development of skills and promote the quality of prosthetic and orthotic services and education that finally provide
good care to patients.
c. Web-base resource sharing
APOS has its repository site that is taken care by a repository group to upload all useful information into database
that can be accessed by all members at each school as a resource sharing and learning from each other for
ensuring best practice of professionals.
Conclusion
The alliance is a good model for capacity building in the region that can help to provide a better care to patients by
improve the quality of education at the school.
175
FREE PAPERS
Session Name and Room: Education - 1
Abstract Title: Alliance Of Prosthetics And Orthotics Schools-Asia (Apos)
Abstract number: 70
Authors: T. Heang
Presenter: T. Heang
FREE PAPERS
Tuesday, Feb 5 / 16:15 - 17:30
Session Name and Room: Education - 1
Room G.06
Abstract Title: Four Different Trial Knee Disarticulation Prosthesis For Teaching Prosthetists And Physicians
Abstract number: 244
Authors: B. Kim, I. Chang, S. Bok, J. Huh, K. Cho
Presenter: B. Kim
Introduction
Recent advances in the prosthetic components have provided the amputees, prosthetists and prescribing
physicians with great opportunity to select knee joints or foot and ankle assembly from too many possibilities in the
market. Biomechanical data may give some answers to this question however, it is still unclear to the professionals
how amputee would function with the newly developed items on the market. Experimental prostheses were
designed for the professional in this field to experience the differences in the functions of the parts of the knee
disarticulation prosthesis.
Methods
For the able bodied to try on 4 different right knee disarticulation prostheses were assembled with the different
combination of knee joints and foot and ankle, and finished with the adjustable carbon fiber socket with posterior
opening to accept the able bodied right leg with the knee bent around 90 degrees. Ten healthy male professionals
participated in this study. After initial gait training comfortable walking speed was evaluated followed by the
computerized 3 dimensional gait analysis with 4 different prostheses. A questionnaire was collected to evaluate
the learning effect of these trials. Data were collected and statistically analyzed.
Results
Walking with these trial prostheses was found to be a good learning tool for the professionals to understand the
real function of the different parts of the prosthesis with different combination of the knee and foot and ankle. These
experiences helped them to understand function of the parts better with the Results of the biomechanical data from
3-D motion analysis.
Discussion and Conclusion
These 4 trial knee disarticulation prostheses have been wonderful teaching tool to students of all levels including
physicians and prosthetists for better understanding of the functions of the different knee and foot and ankle
components.
176
Wednesday, Feb 6 / 09:00 - 10:15
Room 1.06
Introduction
One of the most common problems in patients with Cerebral palsy is the deterioration of the musculoskeletal
system, especially the legs and feet, manifested in tip toe walking. As conservative treatment there are orthopaedic
shoes, splints, physiotherapy and in more severe cases injections of Botulinumtoxin in combination with serial
casting to avoid operation. Fulltime-Bracing with orthopaedic devices is one of the more recent options. Aim of the
study was to proof the functional outcome orthopaedic dynamic orthotics.
Patients/Materials/Methods
A total of 10 children with CP, hemi- or diplegic, were included. All patients were free ambulating, tip-toe-walking
before the first examination and treatment. GMFCS classification ranged from I-II. Patients were adjusted with
dynamic ankle foot orthosis including the ring shaped foot support developed by Baise/ Pohlig. 3D-Gait-Analysis
has been done to discriminate differences before treatment and after 3 months. No orthosis was worn during the
analysis.
Results
All patients changed their initial contact from toe to heel. Ankle joint ROM improved significantly. Improvements in
the knee-joint in sagittal plane like the reduction of hyperextension in mid stance, better max. knee flexion timing
and increased maximal knee-flexion in swing. Maximum of ankle moment was increased. Maximal ankle-power
increased significant.
Discussion/Conclusions
This study shows the positive effect of bracing with night-and-day splints for 23 hours. A long wearing time of the
splints, nearly 24h per day for 3 months in combination with the design of the orthosis are the key features. The
ankle joint pattern towards to improve to normal. The slightly reduced walking speed, slightly increased ankle
power at push off and a better foot progression angle indicates a better functional outcome. The question is how
long can this improvement be maintained? 23h bracing with splints showed significant improvements concerning
gait parameters and can be recommended as a treatment option.
177
FREE PAPERS
Session Name and Room: Orthotics: Lower Limb - 4
Abstract Title: Outcome Of 23H Bracing For Tip-Toe-Walking Children With Cerebral Palsy
Abstract number: 452
Authors: C. Grasl, A. Kranzl, R. Csepan
Presenter: C. Grasl, MSc
FREE PAPERS
Wednesday, Feb 6 / 09:00 - 10:15
Session Name and Room: Orthotics: Lower Limb - 4
Abstract Title: Mechanical Properties Of A Spring-Hinged Floor Reaction Orthosis
Abstract number: 470
Authors: Y. Kerkum, M. Brehm, A. Buizer, J. Van Den Noort, J. Harlaar
Presenter: Y. Kerkum
Room 1.06
Introduction
Floor Reaction Orthoses (FROs) are commonly prescribed in children with cerebral palsy (CP) walking with
excessive knee flexion. FROs are stiff, and aim to counteract excessive knee flexion in midstance, by shifting the
Ground Reaction Force forward. However, an FRO also impedes plantar flexion in preswing, thereby obstructing
push-off power. Spring-like FROs might create push-off power by storing and releasing energy. Literature shows
that energy cost of walking with an ankle-foot orthosis in adults can be minimized by optimizing it’s stiffness.
Recently, a new type of hinge with adjustable springs was designed, which can be integrated into an FRO.
Biomechanical optimization of the stiffness requires quantification of the hinge’s mechanical properties. This study
aims to quantify the mechanical properties of this hinge build within an FRO.
Methods
One FRO with an integrated Neuro Swing® ankle joint (Fior & Gentz) was constructed and mechanical properties
of five springs were measured with BRUCE (Bregman et al., 2009). Each spring was fully compressed and released
three times, while hinge angles and exerted net moments were continuously measured. The spring’s range of
motion (ROM)[º], stiffness[Nm/º], threshold[Nm], and hysteresis[%] (loss of energy calculated as percentage of
stored energy) were averaged.
Results
Stiffness ranged from 0.01Nm/deg to 1.61Nm/deg. Hysteresis (14.0%-28.5%) decreased with increasing stiffness,
while threshold (1.4Nm-20.6Nm) was higher for stiffer springs. ROM varied between 6.2º and 13.9º.
Discussion
Although hysteresis is present, resulting in loss of energy that potentially could be used for push-off, FROs with
integrated springs might still be beneficial, since conventional FROs can’t store energy at all. However, it remains
unknown whether these springs are sufficiently stiff to counteract excessive knee flexion in gait in CP. This is
subject of further research.
Conclusion
The Neuro Swing ankle joint are potentially effective in optimizing FROs in children with CP.
178
Wednesday, Feb 6 / 09:00 - 10:15
Introduction
Statistics reveal that approximately 2.5 million people have been diagnosed with MS worldwide. This research
aimed to review all available literature on the use of Ankle-Foot Orthoses (AFO) and Functional Electrical
Stimulation (FES) for the treatment of gait difficulties in MS.
Methods
An extensive systematic search was carried out using the electronic databases Embase, Medline, CSA Illumina,
DyNamed, The Cochrane Library, Science Direct, ISI Web of Knowledge and The Knowledge Network. Of the
full texts sourced only 14 experimental papers were considered appropriate for critical appraisal in this literature
review.
Keywords
Multiple Sclerosis, MS, Ankle-Foot Orthosis, AFO, Ortho*, Splint, Brace, FES, Functional Electrical Stimulation,
Rehabilitation, Function, Gait
Results
The most reported outcomes were walking speed and energy expenditure. Six of the nine FES trials reported a
statistically significant increase in walking speed while one reported a non-significant decrease. Of the four AFO
trials, three reported an increase in walking speed, although only one was statistically significant, and one trial
showed a decrease. Psychological Cost Index (PCI) was commonly utilised as an indication of energy expenditure.
Two of the four AFO trials reported a decrease in PCI compared to four of the nine FES, (three significant). Only
the direct comparison trial and two of the five AFO trials, reported on stance phase kinematics, with the others
focusing on swing phase related outcomes. The variation in outcome measures makes comparison between AFO
and FES challenging.
Conclusions:
This literature review highlights several limitations in the current evidence base, particularly a lack of baseline
information regarding participants and interventions being investigated. Few studies adequately report the
biomechanical effects of FES and AFO. The majority of the reviewed studies are of a low level of evidence.
Considerably more research is required of an elevated standard to strengthen evidence to inform future clinical
practice.
179
FREE PAPERS
Session Name and Room: Orthotics: Lower Limb - 4
Room 1.06
Abstract Title: A Systematic Literature Review Comparing Ankle-Foot Orthoses And Functional Electrical
Stimulation In The Treatment Of Patients With Multiple Sclerosis.
Abstract number: 472
Authors: E. Davidson, R. Bowers
Presenter: E. Davidson
FREE PAPERS
Wednesday, Feb 6 / 09:00 - 10:15
Session Name and Room: Orthotics: Lower Limb - 4
Abstract Title: Walker Braces Improve Gait Compared To Traditional Walking Casts
Abstract number: 339
Authors: M. Nicholls, T. Ingvarsson
Presenter: A. Ludviksdottir
Room 1.06
Introduction
Walker braces are promoted as offering a more natural gait or ease of ambulation compared to traditional casts.
One benefit of this is to improve patient mobility. This study investigated whether walker braces improved gait
compared to traditional casts.
Methods
Ten healthy subjects with no recent history of lower limb injury gave informed consent and were recruited. The
subjects´ symmetry of gait was measured using an instrumented treadmill. Symmetry was estimated by calculating
the difference in single stance time, as a percentage of the gait cycle, between the left and right leg, with zero
indicating perfect symmetry. Measurements were taken at self-selected speed for eight conditions: no brace,
below the knee fibre glass walking cast and three types of walker braces (Rebound, Equalizer and Aircast).
Analysis of covariance was performed on the data using self-selected speed as a covariant.
Results
Gait symmetry with no brace was better than all other conditions (-0.46%, p<0.05). Gait symmetry while wearing
the Rebound (3.17%) or the Equalizer (3.31%) was better than while wearing the fibreglass cast (6.53%, p<0.05).
Symmetry with the Aircast (4.41%), was not different to fibreglass cast.
Discussion and Conclusion
The Results show that gait symmetry is worse when wearing a brace or a walking cast compared to not wearing a
brace or walking cast. However, some braces allow for greater gait symmetry than a walking cast. This suggests
that walker braces may improve gait by improving gait symmetry in comparison to a walking cast. The differences
seen between braces could reflect the different sole designs and hence new sole designs may improve gait further.
The strength of these Results is limited by the fact that all subjects were healthy. Nevertheless, for patients who are
allowed to weight bear, these braces may offer an advantage over walking casts by improving mobility.
180
Wednesday, Feb 6 / 09:00 - 10:15
Introduction
The process of growing can cause deformities of the plantar aspect in children. Talipes planovalgus is one of
the deformities that afflict children. The plantar aspect deforms as the child grows, and if the condition remains
unimproved when the child reaches puberty, it can cause foot pain, fatigability, abnormal gait, and other problems.
Subjects and Methods
Our medical department provides lifestyle guidance and orthotic treatment using shoe inserts to talipes planovalgus
patients. In this study we evaluated the effectiveness of orthotic treatment for 102 patients between January 2004
and December 2008 using arch supports, metatarsal pads, and shoe inserts with medial wedges. Evaluations
were made of subjective symptoms, objective findings (Carter and Wilkinson criteria for joint laxity, plantar aspect,
x-ray), and other aspects.
Results
Of the symptoms of talipes planovalgus, the improvement rate for abnormal gait and fall risk was high. Objective
findings showed the following Results. The incidence of the longitudinal arch during weight bearing improved from
2.94% at first examination to 57.8% at final examination, and the incidence of the transversal arch during weight
bearing improved from 2.0% at first examination to 22.5% at final examination.
Discussion and Conclusion
Opinions are divided on orthotic treatment of flat feet in children. However, the Results of this study show that it is
effective in providing lifestyle benefits by improving abnormal gait and fall risk. In addition, early correction of the
alignment of the lower extremities during childhood, a period when the bones have great plasticity, is important to
childrenĀfs growth. In other words, we believe that orthotic treatment using shoe inserts for talipes planovalgus in
children is one effective method.
181
FREE PAPERS
Session Name and Room: Orthotics: Lower Limb - 4
Room 1.06
Abstract Title: Orthotic Treatment Using Shoe Inserts For Talipes Planovalgus In Children
Abstract number: 302
Authors: T. Asami, K. Kodama, N. Akiyama, N. Yamanouchi, K. Yamamoto, Y. Nanri, S. Tokuda, Y. Arizono
Presenter: T. Asami
FREE PAPERS
Wednesday, Feb 6 / 09:00 - 10:15
Session Name and Room: Prosthetics : Lower Limb - 9
Room 1.03
Abstract Title: Spinal Motion During Walking In Persons With Transfemoral Amputation With And Without
Low Back Pain
Abstract number: 150
Authors: S. Fatone, R. Stine, A. Rodriguez, S. Gard
Presenter: S. Gard
Introduction
Gait abnormalities may contribute to the high incidence of low back pain (LBP) in persons with transfemoral
amputation (TFA), but few studies have explored spinal motion during walking. We investigated spinal motion
during walking in persons with unilateral TFA with and without LBP.
Methods
Persons with unilateral TFA were tested in the motion analysis laboratory while walking at their comfortable selfselected speed. Reflective markers were placed on the body using a modified Helen Hayes configuration and on
the back using a regional spine model. Two tailed t-tests were used to compare data between groups (alpha =
0.05).
Results
Data were collected from 7 persons with LBP and 8 without. The groups did not differ in body mass index, time
since amputation, residual limb length, hip flexion contracture, socket comfort score, walking speed, or step width.
The group with LBP had a longer intact limb step length and the group without LBP had a longer amputated limb
step length. Lower body kinematics (e.g. vaulting, hip hiking) were typical of persons with unilateral TFA. Both
groups had anterior pelvic tilt that peaked in terminal stance and rapidly rotated posteriorly at prosthetic toe off,
with greater variability in this pattern of motion in the LBP group. We observed a coupling of motion between the
pelvis, lumbar and thoracic spines with the majority of motion occurring as the prosthesis transitioned from stance
to swing. The two groups had similar patterns of motion at the pelvis and thoracic spine, but opposing motions in
the lumbar spine in the latter half of stance with the LBP group demonstrating out of phase motion.
Discussion/Conclusion
Pelvic and spinal motion patterns are different among individuals with TFA depending on whether they have LBP
or not. Further research is required to identify the underlying sources of these differences.
182
Wednesday, Feb 6 / 09:00 - 10:15
Room 1.03
Introduction
Current hydraulic and microprocessor controlled prosthetic knee joints for trans-femoral amputees (TFA) enable
the user to flex the prosthetic knee throughout weight bearing of the prosthetic limb. TFA are able to use this
functionality while alternate walking down stairs or descending inclines. However, clinical practice shows that not
all TFA use this so called “stance phase flexion” on slopes, especially on inclines with a moderate angle.
Methods
Five male TFA (48.6y±12.9y/99.5kg± 20.3kg/1.77m±0.06m) were fitted with a microprocessor controlled prosthetic
knee (Rheo Knee II TM) and a common prosthetic foot (Variflex EVO TM / all parts Ossur, Reykjavik, Iceland).
TFA underwent a conventional clinical gait analysis while walking down slopes of 2.5°, 5° and 7.5°. TFA walked
at self selected speed and with their preferred strategy. For reference purpose, eleven healthy subjects (NORM/3
female;8 male/29.6y± 4.6y/74.4kg±13.8kg/180.7cm±7.8cm) finished the same protocol.
Results
Prosthetic knee kinematics show that the five TFA have adopted two different strategies for walking down the
slopes of 5° and 7.5°: 1) to bend the prosthetic knee in stance 2) to keep the prosthetic knee in stance extended.
On the shallow 2.5° slope none of the TFA tends to bend the prosthetic knee in stance.
Discussion & Conclusions
For the shallow 2.5° slope none of the TFA uses stance phase flexion of the prosthetic knee. However, for steep
slopes this strategy seems to be favorable, possibly for a better control of gait speed. Noticeably, all TFA slow
down when they switch from strategy 2 to 1. However, not all users change their strategy. This might be due to
individual
References
Further, the length of the incline, technical properties of the knee and the alignment of the prosthesis may influence
this choice of strategy.
183
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 9
Abstract Title: Gait Strategies Of Transfemoral Amputees Walking Downhill
Abstract number: 109
Authors: D. Heitzmann, M. Alimusaj, J. Block, T. Dreher, F. Braatz, S. Wolf
Presenter: D. Heitzmann
FREE PAPERS
Wednesday, Feb 6 / 09:00 - 10:15
Session Name and Room: Prosthetics : Lower Limb - 9
Room 1.03
Abstract Title: Experiences Of Providing Prosthetic And Orthotic Services In Sierra Leone - The Local
Staff’s Perspective
Abstract number: 114
Authors: L. Magnusson, G. Ahlström
Presenter: L. Magnusson
Introduction
In Sierra Leone, West Africa, there are many people with disabilities in need of rehabilitation services after a long
civil war. The aim of this qualitative study was to explore the experiences of prosthetic and orthotic service delivery
in Sierra Leone from the local staff’s perspective.
Method
Fifteen prosthetic and orthotic technicians representing all the rehabilitation centres providing prosthetic and
orthotic services in Sierra Leone were interviewed. The interviews were transcribed and subjected to latent content
analysis.
Results
One main theme emerged: Sense of inability to deliver high-quality prosthetic and orthotic services. This main
theme was generated from eight sub-themes: Desire for professional development; Appraisals of work satisfaction
and norms; Patients neglected by family; Limited access to the prosthetic and orthotic services available; Problems
with materials and machines; Low public awareness concerning disabilities; Marginalisation in society and Low
priority by the government.
Discussion
There is a need for educating more prosthetic and orthotic staff to a category I or II level in Sierra Leone. To
increase access to prosthetic and orthotic services there is a need to focus on making materials available for the
fabrication of prosthetic and orthotic devices and to facilitate transport for patients to reach the services.
Conclusions
The findings illustrated traditional beliefs about the causes of disability and that the public’s attitudes need to
change in order to include and assign value to people with disabilities. Support from international organizations
was considered necessary as well as educating more prosthetic and orthotic staff to a higher level.
Magnusson L, Gerd Ahlström G. Experiences of Providing Prosthetic and Orthotic Services in Sierra Leone — the
Local Staff’s Perspective. Disability and Rehabilitation. Accepted for publication February 2012
184
Wednesday, Feb 6 / 09:00 - 10:15
Introduction
As user-centered development (UCD) involves users for an understanding, objective assessment and utilization
of their needs, it represents a promising approach to develop improved user-friendly prostheses. Hence, human
factors have to be identified and integrated into development.
Methods
To identify relevant factors and assess the amputees’ requirements, a literature review , questionnaire Results
and interviews are considered. Further, models of the identified factors’ impacts on the development and Quality
Function Deployment (QFD) for the translation from the human understanding to technical design are prepared
for evaluation with amputees. The important body scheme integration (BSI) is examined in experiments with
unharmed subjects exploring a Rubber Leg Illusion similarly to the Rubber Hand Illusion.
Results
Besides BSI, satisfaction and feeling of security (FOS) show to be important factors for UCD. Satisfaction is linked
to quality of life (QoL) and time of daily use and influenced by appearance, usability and functional properties of
prosthetic components. FOS seems to be an issue of the overall system leading to reliability and balance during
use. BSI also affects QoL and might lead to more user-friendly prostheses. Technical functions (enabling) contrary
to characteristics from the user’s view (predisposing) seem to be perceived as different properties. The first ones
are utilized: Functional units are identified and assessed. Models and QFD are used for their evaluation and
translation to technical development. The technical functionality is reviewed and extended based on a comparison
of functional and psychological aspects of the units and the overall concept.
Discussion
The elaborated approach should enable to involve users during the whole development process. Yet, it is not
validated with a sufficient number of users.
Conclusions
Substantiating this approach with sufficient data is necessary – e.g., a comparative analysis to solve conflicting
goals. It is promising for the development of future user-friendly prostheses.
185
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 9
Room 1.03
Abstract Title: A Methodological Approach To Integrate Psychological Factors To Lower Limb Prosthetic
Functional Design
Abstract number: 105
Authors: P. Beckerle, O. Christ, M. Windrich, S. Rinderknecht, J. Vogt, J. Wojtusch
Presenter: J. Wojtusch
FREE PAPERS
Wednesday, Feb 6 / 09:00 - 10:15
Session Name and Room: Prosthetics : Lower Limb - 9
Room 1.03
Abstract Title: Secondary Posterior Keel In Carbon Fiber Prosthesis Changes The Foot-Ground Kinetic
Interactions During Walking
Abstract number: 484
Authors: A. Kregling, A. Auyang, E. Chu, Q. Chen, K. Collier, J. Shim
Presenter: A. Kregling
Introduction
Shock absorption is seen as the phase of gait when the swinging foot rapidly decelerates through the heel rocker
(heel contact through foot flat). For amputees, their prosthetic ankle-foot-units’ heel emulates this heel rocker, which
contributes to load acceptance. Carbon-fiber prosthetic ankle-foot-units are often distinguished by their physical
design, mechanical behavior, and functionality. A carbon fiber design engineered with a secondary posterior keel
(z-shaped heel) was developed as a walking foot to improve gait by increasing shock absorption. However, the
biomechanical responses of this type of prosthesis have not been thoroughly evaluated. The purpose of this study
was to investigate the kinetic interactions between the new prosthesis with a secondary posterior keel and the
ground during walking.
Methods
Eight healthy unilateral transtibial amputee subjects (7 males; 1 female) wearing two different prostheses, single
posterior keel (Freedom Innovations Sierra) and secondary posterior keels (Freedom Innovations Renegade),
during two walking conditions (unloaded and loaded with 30% BW) at a self-selected-speed. The vertical ground
reaction forces were recorded and analyzed for evidence of shock absorption. Results The prosthesis with the
secondary posterior keel showed the lowest initial peak force and smallest rate of force development. It also
showed a longer stance phase, thereby keeping a similar impulse to the single keel foot and allowing for a lower
rate of force production. These findings became more pronounced in the loaded condition.
Discussion
Amputees that wish to participate in multiple activities without pain from shock on their residual limb would benefit
from a shock absorbing component since higher peak and rate of force have been reported to be associated with
elevated gait injuries.
Conclusions
The prosthesis with the secondary posterior keel (Freedom Innovations Renegade) may play a role in reducing
long-term injuries while providing vertical shock absorption during regular walking and during increased loads.
186
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Room 1.05
The first P&O school in Japan started in 1982. the P&O Act was established by The Ministry of Health, Labor
and Welfare(MHLW) in 1987, and the profession became established with a nationally recognized medical care
qualification. As of 2012, there are 9 schools around Japan. Kobe College of Medical Welfare (KMW) made
initial meeting with ISPO in Nov. 2009. This meeting set an agreed pathway for the four year program in P&O to
move to an initial consultation in Mar. 2010 and then move to a formal ISPO Cat. I Evaluation in Mar. 2012. The
initial consultant report said Overall the current four year program in P&O at KMW is well positioned in most of
the necessary aspects and elements that are required to attain official ISPO Cat.1 status. but on other hand, it
indicated The offsite clinical experience needs to be examined further to enhance and standardize the process.
The MHLW requires 180 hours of clinical training, but this does not provide students with sufficient clinical skills
right before graduation. In Japan, students basically complete their studies at school, take the national exam, and
then receive their license. The system which recognizes specialist medical professions through clinical experience
in the certification system using intern education or each specialist associations is firmly entrenched in Japan.
KMW with ISPO Japan proposed Japanese model of ISPO Cat.1 Individual Accreditation Examination including
15 month internship to guarantee the quality of post-graduation clinical experience. The proposed post-graduate
internship period and competency exam will help facilitate the development of a high standard of competency for
those graduates who chose to enter this process. It is a very positive development for ISPO and ISPO Japan to
have this process be included as a required element for those wishing to attain Cat.1 status.
187
FREE PAPERS
Session Name and Room: Education - 2
Abstract Title: Ispo Cat 1 Pathway For A P&O Program In Japan
Abstract number: 315
Authors: M. Uchida
Presenter: M. Uchida
FREE PAPERS
Wednesday, Feb 6 / 09:00 - 10:15
Session Name and Room: Education - 2
Room 1.05
Abstract Title: Strengthening Prosthetics And Orthotics School Research Strategy: Case Study
Abstract number: 317
Authors: M. Samala, S. Srithumboon
Presenter: M. Samala
Abstract
This article presents case studies of prosthetic and orthotics programs that have created enduring research efforts.
Introduction
Sirindhorn School of Prosthetics and Orthotics had officially established on September 4, 2002 .The school aimed
to produce well qualifies Prosthetists and Orthotists in Bachelor degree level in the Name of Bachelor of Science
in Prosthetic and Orthotic. In March 2009, school was recognized ISPO standard Category I.
Research project is a significant component of undergraduate students at Sirindhorn School of prosthetics and
Orthotics, Mahidol University. The research project provides the student a study basis for acquisition of in-depth
knowledge in particular areas of Prosthetics and Orthotics through conducting basic research in their area of
interest.
To achieve the aim related to recent and future condition as mentioned, Sirindhorn School of Prosthetics and
Orthotics (SSPO) necessary to strengthening in an appropriate and right academic work in order to create
framework for producing student research with academic standard quality leading to social development.
Methodology
Policy Mixed Research Methodology was used .Content analyses were used to analyze Results of by institutional
survey and stakeholders interview. The population consisted of all staff in SSPO and experts in prosthetic and
orthotics filed.
Result and Discussion
To begin creating an infrastructure for school research and to create research collaboration within and outside
institute. In order to maintain the quality of research and assist the student, SSPO provides strategic support in
terms of funding, facilities and supporting documents.
Conclusion
Sirindhorn School of Prosthetics and Orthotics contributes to students of success by providing this opportunity to
undergraduates. The well organized facility supports are a key ingredient in the SSPO undergraduate research.
188
Wednesday, Feb 6 / 09:00 - 10:15
Room 1.05
Introduction
PIPOS provide opportunity to its undergraduate students of semester VII and VIII (14-18 students) for clinical
placement at centers that provide P&O services in different areas of Khyber Pakhtoon khwa and Azad Jammu
Kashmir. The Aim is to expose the undergraduates to P&O practice in clinical environment under careful supervision
Learning Objective
• Enhancement of professional development of the students under clinical supervision
• To provide knowledge and understanding of patient protocol of the centers
• Get experience of patient care and good communication with both patients, their families and rehabilitation
team
• To have experience to work effectively as part of an interdisciplinary team in rural and urban areas Centers:
Seven PRSP centers and 02 ICRC administrated centers offer the clinical placement to students of PIPOS, where
they have to work under the mentoring of P&O with 4-5 years of experience and supervision of expatriates.
Students’ Submission
• Log books
• Report
• Problem based learning
PIPOS faculty Role
Senior faculty members from PIPOS visit these centers as per planning to assess the skills and progress of
the students. They attend the Power Point Presentations made by students; check the log books and guide the
students in report writing.
Outcomes
At the end of clinical placement the students should be able to work independently while providing quality
rehabilitation services. Since 2009 three clinical placements were held successfully.
Challenges
• Female students face challenges while working in remote area of country
• It is quite challenging for students to in areas that are away from their institute.
• Students deal with variety of cases with multiple problems.
Conclusion
Up till now clinical placement is successfully accomplished. Students got good skills in clinical and technical areas.
However, there are certain challenges that needs to be addressed for betterment of placement.
189
FREE PAPERS
Session Name and Room: Education - 2
Abstract Title: Pipos Academic Clinical Placement For Semester Vii And Viii Students
Abstract number: 442
Authors: U. Jabeen
Presenter: U. Jabeen
FREE PAPERS
Wednesday, Feb 6 / 09:00 - 10:15
Session Name and Room: Education - 2
Room 1.05
Abstract Title: The Conceptual Foundations Of Modern Educational Standard Of Training Prosthetics
Specialists
Abstract number: 446
Authors: E. Shataeva, L. Tomasevic
Presenter: E. Shataeva
Introduction.
A significant change in modern prosthetic-orthopedical activity became the transition from system of help to
service delivery. Market relations are actively included into systems of social help everywhere. Demographic
situation in developed countries leads to expansion of the market. Big part of these services is paid by state and
private insurance foundations.
Methods
Analyze of improvement of prosthetic-orthopedical activity during last 10 years from the position of system analyze
allow to see its basical tendencies, perspectives and problems.
Results
Rapid development of mechatronics, computer technologies largely expanded technical possibilities of this activity.
At the market appeared completely new products and services. Existence of market relation in this sphere, from
one hand, stimulates the improvement of quality of products and services, on another, their price. Working within
these relations, service provider is interested to receive more profit and more costumers. The achievement of
social result in the form of optimal prosthetic–orthopedical help for the reasonable price is not the main goal of the
service provider. Moreover, part of offered of the market prosthetic-orthopedical services can have a character
of aggressively advertised “need”, which has nothing to do with real Results. Problems of equity in the provision
of prosthetic-orthopedical services to different categories of patients in such market situation are not considered.
Discussion
Implementation of standards for prosthetic-orthopedical services doesn’t resolve problems of their optimization
fully. Only specialist (interdisciplinary group) for every concrete situation can determine and provide the optimal
amount of rehabilitation services, including prosthetic-orthopedical ones. Therefore, exactly these specialists
should be responsible for decision regarded patient. This responsibility, first of all, has bioethical component.
Conclusions
Modern educational standards of training prosthetic specialists should greatly enhance bioethical part of
educational programs of all special disciplines. Bioethical principles should become the foundation of training of
rehabilitation and health care specialists.
190
Wednesday, Feb 6 / 09:00 - 10:15
Introduction
Students attending training programmes represent from diverse groups in terms of age, culture, experience
in rehabilitation field and level of preparedness as learners. The greatest challenge that trainers face today is
improving the level of student satisfaction with the curriculum and learning environment. Students have specific
learning style
References
One characterization of learning style is to define the learners preferred mode of leaning in terms of sensory
modality by which they prefer to take new information. Trainers need to understand the learning strategies of
students in order to facilitate their learning.
Methods
The VARK questionnaire developed by Neil Fleming was used to identify the learning style of Prosthetics, Orthotics
& Rehabilitation Therapy Students. A total of 39 students (13 female and 26 male) completed the questionnaire.
The validated VARK questionnaire consists of 16 items which identify four different learning styles: visual, auditory,
reading/writing and kinesthetic. Descriptive statistics were used to identify the learning styles of students.
Results
Data indicated that 31.2% of students preferred learning by single sensory modality and 68.8% preferred multiple
learning styles. Among 39 participants, 6.4% were (visual), 8% (auditory), 7.7% (reading/writing) and 9.1%
(kinesthetic) learners.
Discussion
We found that many students preferred to learn by more than one mode of information presentation. Trainers can
develop their pedagogical strategies if they know the preferred modes of learning of their students. This allows
them to change from their own preferred mode of teaching towards the learning
References of students which may help to develop their knowledge, skills and attitudes and that may enable them
to become a competent student.
Conclusion
The Results of the study would help trainers to be aware of differences and broaden their teaching strategies as
per students learning
References and create a learning environment which is more productive and enjoyable.
191
FREE PAPERS
Session Name and Room: Education - 2
Room 1.05
Abstract Title: Assessing Learning-Style PReferences Of Rehabilitation Professional Students Attending
Mobility India Training Institute In Bangalore, India.
Abstract number: 462
Authors: M.R. Ghosh, R. Kumar
Presenter: V. Masilamani
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Prosthetics : Upper Limb - 4
Room 1.01
Abstract Title: Changes In Movement Characteristics While Learning To Use A Myoelectric Prosthetic
Simulator
Abstract number: 142
Authors: R. Bongers, H. Bouwsema, C. Van Der Sluis
Presenter: R. Bongers
Introduction
Training increases the functional use of upper limb prostheses. However, the way training should be set up has
received little attention in scientific literature. To develop an evidence-based training program, one first has to know
how people learn to use their prosthesis.
Aim
To examine changes in behaviour while practicing with an upper limb myoelectric prosthesis and to study how the
neuromotor system learns to incorporate the characteristics of the prosthetic device.
Methods
Able-bodied participants were assigned to an experimental condition (N = 31) or a control condition (N = 31).
Participants in the experimental condition, randomly assigned to one of four groups, practiced with a myoelectric
simulator for five sessions in a two-week period. Group 1 practiced direct grasping, Group 2 practiced indirect
grasping, Group 3 practiced fixating, and Group 4 practiced a combination of all three tasks. The Southampton
Hand Assessment Procedure (SHAP) was assessed in a pretest, posttest, and two retention tests. Participants
in the control condition performed SHAP two times, two weeks apart with no practice in between. Compressible
objects were used in the grasping tasks. Time scores, changes in end-point kinematics, joint angles and force
control were examined.
Results
The experimental group improved more on SHAP than the control group (p = .00). Global positioning was learned
relatively quickly as improvement leveled off after three days of practice, whereas learning to control grip force
required more time. Object rigidity affected coordination of grasp as the more compressible objects required longer
grasping times and lower hand closing velocities.
Discussion/Conclusion
The neuromotor system learned to adapt to the prosthesis for gross movement patterns rather quickly, while fine
motor control aspects seems more difficult. A training program should therefore spend more time on learning fine
control aspects than on gross movements with the prosthetic hand during rehabilitation.
192
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Introduction
In children with upper limb reduction deficiency (ULRD) scoliosis has been reported but the development of
these spinal deviations over time is unclear. Furthermore, little is known about the development of other upper
body structures and potential physical complaints in this population. Also, the influence of prosthesis use on the
development of body structures or complaints is unknown.
Aim
To describe upper body structures of persons with unilateral ULRD and the development of these structures over
time, to examine the presence of physical complaints in this population, and to study the effect of prosthetic use
on body structures and physical complaints.
Method
A prospective cohort study with a follow-up period of 24 years was conducted. Twenty-eight persons (age 8-18
years at inclusion) with ULRD and 62 matched controls underwent measurements of upper-arm, trunk and spine
and answered study-specific questionnaires at baseline and follow-up. In addition, at follow-up the Brief Pain
Inventory and the Quick Disability of Arm, Shoulder and Hand questionnaires were answered.
Results
Within-subject differences in structures of the arm and trunk were shown in patients but not in controls both at
baseline and follow-up. Spinal deviations were greater in patients compared to controls. No structural scoliosis was
found. Self-reported disability was higher in patients compared to controls. Differences in back pain and effects of
prosthesis use could not be detected.
Discussion
The structural within-person difference between body-halves may explain the findings of spinal deviations. The
rates of physical complaints were remarkably low, compared to other studies. This might be due to differences
between persons with ULRD and acquired upper limb amputations, level of deficiency, prosthetic use or age.
Conclusions:
Persons with ULRD have consistent differences in upper body structures over time. Deviations of the spine,
probably of functional origin, do not proceed to clinically relevant scoliosis.
193
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 4
Room 1.01
Abstract Title: Body Structures And Physical Complaints In Upper Limb Reduction Deficiency: A 24 Year
Follow Up Study
Abstract number: 251
Authors: S. Postema, C. Van Der Sluis, K. Waldenlöv, L. Norling Hermansson
Presenter: S. Postema
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Prosthetics : Upper Limb - 4
Room 1.01
Abstract Title: Force Perception During Ipsilateral Scapular Cutaneous Anchor System Versus Figure Of 9
Shoulder Harness Operation
Abstract number: 262
Authors: M. Hichert, D. Plettenburg, G. Smit
Presenter: M. Hichert
Introduction
For years the disadvantages of shoulder harnesses are known: discomfort, skin irritations, pain, numbness
and nerve damage, as well as a poor cosmetic value. In 2007 Debra Latour presented her Ipsilateral Scapular
Cutaneous Anchor System as an alternative for the conventional shoulder harness. Compared to the conventional
shoulder harness the shoulder protraction of the sound side as a control action is deactivated. A promising solution,
but does this anchor system also provide sufficient feedback to the user while operating the prosthesis?
Methods
A prosthesis simulator was fitted to 10 subjects without arm defect. The first series of experiments was conducted
with the anchor system and for the second series a Figure of nine harness was used. A force sensor placed on the
control cable measured the cable activation forces the subjects created. The measured force was fed to a laptop
running a LABVIEW programme. The subject was requested to reproduce a given force and hold it as constant
as possible for 10 seconds. Visual feedback was enabled every second repetition. The constant error between
created force and reference force as well as the standard deviation of the created force were calculated.
Results
No significant differences were found for the constant error whereas the standard deviation of operating forces
seems to be significant lower during the operation with the anchor system compared to the harness.
Discussion
Even if no differences were found in terms of constant errors, subjects seem to be able to hold a given force at
a more constant level with the anchor system. Less deviation in operating forces means better control on the
terminal device.
Conclusions
In terms of force feedback the anchor system seems to be the preferred system.
194
Wednesday, Feb 6 / 14:30 - 15:45
Room 1.01
Recent studies show that visual attention behaviour changes as individuals get more comfortable, skilled or
confident with their activities, or when they are less distracted. Differences in visual attention are noticeable
when analysing activities where individuals display different levels of skill. Novices usually display longer fixations
than experts. This study investigates the visual attention patterns of prosthesis users while they perform the
Southampton Hand Assessment Procedure. Eye metrics are acquired using an eye tracking device placed on
the subject’s head, which is capable of recording both the scene and the eye movements of the participant and
combining them in a manner that allows visual attention to be measured.
Three prosthesis users and an able bodied individual were tested in an experiment which involved picking up four
coins from different locations on a table and placing them in a container. The task was chosen due to its relative
difficulty and amplitude of hand and eye movement necessary for accomplishment. Compared to other SHAP
tasks, this specific activity required repetitive movement of the hand, fine grasping ability and a consistent and
thorough eye movement over the field of view.
Longer fixations were observed in the case of prosthesis users, mostly at the hand or the surroundings of the
grasping area. On average, prosthesis users spent more than one second per fixation (1.27s 963;=1.04s; 1.65s
963;=1.36s; 1.82s 963;=1.77s) as opposed to the healthy individual (0.37s 963;=0.08s). Maximum fixations ranged
between 3.26s and 5.03s for the prosthesis users, while the able bodied fixated at most for 0.46s.
Results are consistent with previous visual attention studies and suggest that employing visual attention analysis
to prosthetics is viable. Underlining longer fixations in the case of prosthesis users, which was expected, is a sign
that new means of understanding prosthesis use may be possible using eye metrics.
195
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 4
Abstract Title: Assessment Of Prosthesis Use By Visual Attention Analysis
Abstract number: 275
Authors: F. Popa, P. Kyberd, A. Hussaini
Presenter: A. Hussaini
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Prosthetics : Upper Limb - 4
Abstract Title: Acceptance Of Powered Prosthesis In Upper Limb Congenital Deficiency
Abstract number: 357
Authors: R. Munjal, G. Vankateshwara
Presenter: R. Munjal
Room 1.01
Introduction
The aim was to know the acceptance and possible reasons for rejection of the powered prosthesis in congenital
upper limb deficiency patients with particular emphasis on the sidedness, level of deficiency and gender of the
patient over a decade of follow up. The convention is to provide the prosthesis as baby starts object manipulation.
There is limited literature available about the ideal age for providing cosmetic or functional prosthesis, rejection
rates and outcomes
Method
59 patients with congenital upper limb deficiency over the past 15 years were considered for the study. The
inclusion criteria were congenital deficiency, upper limb pathology and regular follow ups until 5 years post
prosthetic usage. The information regarding the demographics, level of deficiency, current prosthesis, and current
activity level with or without the prosthesis was collected.
Results
A total of 32 (54%) males & 27 (46%) females were considered. There was left upper limb deficiency in 38 (64%)
and right upper limb deficiency in 21 (36%). The transradial deficiency was the commonest with 37 (62.7%)
cases, followed by wrist, hand and longitudinal deficiencies. About 12 were wearing cosmetic prosthesis and rest
were provided with powered prosthesis. Prosthesis was provided in 47 (~80%) and prosthesis was subsequently
abandoned in 9 (~15%) cases. There is significant correlation noted between sidedness and abandonment in that
all the 9 cases who abandoned use were powered prosthesis & had left upper limb deficiency (Pearson chi-square
p-value 0.015) of which 6 cases were at transradial level.
Conclusions
85% continue to use the prosthesis. Intensity of use varies with early school age to senior school age. There is a
dominance of patients with localisation to left upper limb deficiency who abandon the prosthesis over a period of
time which needs further evaluation. Surprisingly, none of the cosmetic prosthesis use was abandoned.
196
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Deformational plagiocephaly (DP) is an asymmetrical flattening of the skull in infancy due to prolonged external
force in one area. The recent increase in infants presenting with deformational plagiocephaly has seen more
interest in the subject. The deformity can be corrected by cranial orthosis or by active repositioning. This literature
review aims to compare Methods of shape capture, determine the more successful method of intervention and
also explore the relationship between DP and developmental delay.
Literature published between 2006 and 2011 was sourced using seven databases. Twenty-nine publications met
the inclusion criteria. All studies were appraised by the Scottish Intercollegiate Guidelines Network. Methodological
quality was varied. Three systematic literature reviews and two randomised controlled trials were included.
Currently, head shape can be quantified by either anthropometric measurement by hand or through three
dimensional imaging (3D) or photogrammetry. It is argued that 3D imaging may be a more accurate and repeatable
method as there is no need to determine exact anatomical landmarks by hand. However, measurements by hand
will remain a simple and in-expensive method of measurement. There is evidence that both orthotic treatment
and active repositioning are successful; however when treated orthotically, the head shape asymmetry is seen
to reduce at a faster rate. Research shows that there is a relationship between DP and developmental delay,
particularly in the gross motor skills.
Further work is required to determine a standard measurement method and thus a standard severity scale which
can be used by all clinicians to determine the mode of treatment required. The relationship between DP and
developmental delay has not yet been fully established and in some cases it is thought that it is the delay in
development which causes the infant to develop the head shape deformity.
197
FREE PAPERS
Session Name and Room: Paediatrics - 3
Room 1.02
Abstract Title: The Orthotic Management Of Deformational Plagiocephaly: A Review Of The Current
Literature
Abstract number: 356
Authors: R. Kakaiya, A. Mcgarry
Presenter: R. Kakaiya
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Paediatrics - 3
Room 1.02
Abstract Title: Outcome Of Single Event Multilevel Lever Arm Restoration And Anti Spasticity Surgery For
Cerebral Palsy
Abstract number: 408
Authors: A. Sasidharan, D. Sharan, R. Ranganathan, R. Alva, M. Manikandan
Presenter: D. Sharan
Introduction
In Cerebral Palsy (CP), lever arm dysfunction and spasticity of non-antigravity or the body propelling muscles are
the major factors which restrict gait and motor function. The aims of the study to find out the functional outcome of
single event multiple lever arm restoration and anti-spasticity surgery (SEMLARASS).
Methods
The study design was pre-post experimental design. 314 children with different types of cerebral palsies
participated in this study. Mean age of the participants was 9.7±4.8 years. Distributions of children were spastic
diplegia (58%), spastic quadriplegia (35%) and spastic-athetoid quadriplegia (7%). The surgical procedures
were performed by a single Orthopedic Surgeon which included Intramuscular Release and Controlled Tendon
Lengthening using the principles of Orthopedic Selective Spasticity Control Surgery and simultaneous restoration
of lever arm dysfunctions and was followed protocol based, sequenced multidisciplinary rehabilitation for an
average of 6 months. Outcome measures such as Functional Mobility Scale (FMS), Manual Ability Classification
System (MACS), Pediatric Quality of Life (PQOL) were used to measure the functional status of the children
following post operative rehabilitation.
Results & Discussion
The Results showed a significant improvement after a 1 year post -surgical rehabilitation. Correlation studies
showed median value of FMS of 3 before surgery and 5 after surgery. Before surgery the median value of Gross
Motor Functional Classification System (GMFCS) was level 4 and after surgery it was level 2. Before surgery the
mean value of PQOL was 39.64± 17.49; after surgery the mean value was 23.11 ±14.02. Before surgery median
value of MACS was 3 and after surgery it was 1.
Conclusion
A well-planned and executed SEMLARASS, followed by intensive protocol based, sequenced multidisciplinary
rehabilitation provides the person with CP an excellent functional improvement.
198
Wednesday, Feb 6 / 14:30 - 15:45
Gait abnormalities are present at a very early age in children with CP. Proper orthotic management is crucial part
of multidisciplinary rehabilitation. Aim: To describe prevalence of different gait types according to the Modified
Amsterdam Gait Classification (MAGC) in the youngest walkers with bilateral spastic CP. To deliver proper
orthoses according to gait deviation.
Methods and Subjects
We analysed gait using 2D video recording in 75 children (150 legs) with spastic diplegia younger than 3 years
GMFCS level II-IV selected for spasticity treatment with Botulinum Toxin. Gait type was described using the
MAGC:
Mid Stance abnormalities:
Type 1 - normal.
Type 2 - Knee (hyper)extension without heel rise (HR)
Type 3 - Knee (hyper)extension with HR
Type 4 - Knee flexion with HR
Type 5 - Knee flexion without HR
Swing phase abnormalities:
Type A - dropfoot in midswing
Type B - stiff knee (initial swing knee flexion < 60 degrees, or delayed)
Type C - limited knee extension in terminal swing
Type D - adduction (+ - endorotation) of the hip in terminal swing
Results and Discussion
In the study group gait type 2 was represented by 17 legs (11,3%), type 3 in 90 legs (60%) and type 4 in 43 legs
(28,6%). Type 1 and 5 were not observed at all. Swing phase abnormalities A, B, C and D were observed in 107
(71%), 22 (14,6%), 143 (95%) and 92 (61%) legs respectively. Orthoses for gait improvement were prescribed and
manufactured for all participants. Posterior Leaf Spring AFO (PLS) for combination of types 2 and A; PLS or PLS
reinforced with carbon fiber for 2 or 3 and B, or B, C; AFO for type 4 regarding swing abnormalities. Supination,
medial arch support or leather shoes were added according to feet abnormalities in weight bearing.
199
FREE PAPERS
Session Name and Room: Paediatrics - 3
Room 1.02
Abstract Title: Distribution Of Gait Abnormalities In Very Young Children With Bilateral Spastic Cp
According To The Modified Amsterdam Gait Classification. Implication For Orthotic Management.
Abstract number: 493
Authors: M. Bonikowski, A. Czernuszenko, M. PawOwski, J. GSior
Presenter: M. Bonikowski
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 10
Room 1.03
Abstract Title: A Bionic Foot - Compliance Control Supports A Broad Range Of Adls In Real Time
Abstract number: 57
Authors: P. Kampas, A. Harms, J. Van Vliet
Presenter: P. Kampas
Introduction
Prosthetic feet have to fit a range of activities of daily life (ADLs). These include walking with different speeds,
on inclines and using different shoes. However, mechanical designs of prosthetic feet have to be laid out to fit
particular shoes and walking speeds. Current mechatronic designs adjust to changing conditions, but they typically
adapt only gradually with time. The goal of the project was to design a foot with real time compliance control during
each individual step.
Methods
A microprocessor controlled, hydraulic foot with a series elastic element and a multiaxial kinematic was used. The
sensors include a distinguished inertial sensing system. The design was tested by patients with various amputation
levels and different body weights by executing activities of daily life in a gait lab.
Results
The prosthetic foot adapts its compliance in real-time throughout the gait cycle. It supports different walking speeds,
changing to different inclinations, walking on stairs, stepping on obstacles and shoes of different heel heights.
Discussion
For mechanical feet a trade-off has to be made when selecting the stiffness of the foot, i.e. different stiffnesses
would be desirable depending on the walking speed. The plantarflexion has to be set to fit a specific heel height
for level walking and standing. Introducing a variable series hydraulic element gives the possibility to adjust the
foot’s compliance throughout the gait cycle. The hydraulic element introduces dissipation which is in contradiction
to the paradigm of maximal energy return. However this anticipated disadvantage does not report in the patients’
feedback.
Conclusions
A microprocessor compliance controlled, hydraulic foot can give improved support to a broader range of activities
of daily life when compared to mechanical designs. By using distinguished sensorics it is possible to react in real
time to the situation during each individual step.
200
Wednesday, Feb 6 / 14:30 - 15:45
Introduction
Polio outbreaks and violence during the Sierra Leonean civil war resulted in an increased number of patients in
need or orthotics and prosthetics. The aim of this study was to investigate patients’ performance and satisfaction
with their lower-limb prosthetic or orthotic device and their satisfaction with service delivery in Sierra Leone.
In addition, the project aimed to compare groups of patients regarding gender, type and level of devices and
demographics. Method Questionnaires were used to collect self-reported data from 139 lower-limb prosthetic and
orthotic patients in Sierra Leone.
Result
Eighty-six per cent of the devices were in use by patients. However about half of these devices needed repair. A
third of the patients experienced pain or wounds related to their device. Patients had the ability to move around in
their home and rise from a chair even though many experienced difficulties in doing so. Difficulties were reported
while walking on uneven ground or up and down hills. Only a few patients could not walk on stairs or get into a
car or bus even though the majority experienced difficulties while performing these activities. Patients were quite
satisfied with their assistive device (mean score 3.7 out of 5) and the service provided(mean score 3.7 out of 5).
About half of the patients could not access rehabilitation services or pay for costs related to receiving or repairing a
device. In relation to both performance and service delivery, women had poorer Results than men; orthotic patients
poorer Results than prosthetic patients; and patients using above knee devices had poorer Results than patents
using below knee devices.
Conclusion
Overall, patients were satisfied with their assistive devices and with the services provided. Patients had difficulties
accessing follow up services and repairs and this was considered to be an important issue requiring attention.
201
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 10
Room 1.03
Abstract Title: Performance And Satisfaction With Assistive Devices Among Amputees And Polio Patients
In Sierra Leone
Abstract number: 116
Authors: L. Magnusson, N. Ramstrand, E. Fransson, G. Ahlström
Presenter: L. Magnusson
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 10
Abstract Title: Functional Significance Of A Biomimetic Hydraulic Ankle/Foot System
Abstract number: 113
Authors: E. Iversen, H. Sears, B. Mac Williams
Presenter: E. Iversen
Room 1.03
Introduction
The Motion Foot is a new foot/ankle system that offers near-normal ankle range of motion via a hydraulic ankle
(ROM = 50 deg), paired with an energy-storing foot plate. This system has been developed to offer above-knee
and below-knee prosthesis wearer: 1) shock absorption at heel-strike, 2) smooth adjustable resistance to roll-over
in mid-stance, 3) higher toe clearance during swing phase and 4) stability standing and walking on inclines.
Methods
Instrumented gait lab analysis has been performed with trans-tibial and trans-femoral wearers of the new Motion
Foot. (The gait lab utilized a 10 camera Vicom MX and four AMTI force plates.) Furthermore, the Compas System
that measures sagittal and transverse moments in the pylon was used to compare moments on the remnant limb
when using the Motion Foot compared to the moments with previous prosthetic foot while walking up slopes, down
slopes and on level ground.
Results
Wearers of the Motion Foot have reported improved comfort and stability and much less concentration and effort
while walking on declines with the new foot/ankle system. Gait lab Results and moments measured with the
Compas system both show reduced proximal limb loading and joint power especially on declines. Furthermore,
gait symmetry was improved.
Discussion
The benefits of a near-normal range of ankle plantar/dorsi flexion are verified for wearers of the Motion Foot, from
both high ratings in comfort and stability (compared with their earlier feet) and also from gait analysis data which
indicates greater stability, lower proximal joint power and shock absorption, especially on slopes - the higher the
slope, the greater difference between this foot and others.
Conclusion
A foot/ankle prosthesis that offers anthropomorphic range of motion with hydraulic damping can improve comfort,
stability, reduce proximal joint loadings at heel strike and improve gait symmetry.
202
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Introduction
In this paper a systematic and methodical approach for the development of an active knee prosthesis system is
presented. The presented procedure starts with the definition of the boundary conditions and ends with a graphical
description of the important parameters for the power train in powered knee prostheses. An example of a active
powered knee prosthesis will be shown.
Methods
Basis for dimensioning active supporting systems for humans is always data that are collected for one certain
application. For dimensioning an active artificial limb, data taken from gait analysis have to be used. For the
following dimensioning of the drive system it is important to structure and document all relevant boundary
conditions. The presented model describes a development process of a active powered knee prosthesis.
Results
An active powered knee prosthesis using an EC-Motor with a gearbox-combination is developed using a systematic
and methodical approach during the development procedure. The active knee prosthesis is able to support the
gait of a transfemoral amputee in an active way. Possible torque output of this knee prosthesis is about 60 Nm at
the knee axis.
Discussion
The most important process step in the model is the accurate transfer of medical requirements into technical
parameters. Core of the suggested procedure is the definition of a generally admitted coordinate system in which
the technical parameters of the biomechanical systems are described in a mathematical form. The model also
contains the consideration of the mechanical properties of the prostheses or orthotics system.
Conclusions
In this paper a general approach for the development of an active driven prostheses or orthoses system is
discussed. A model for the development process is presented and an example is given. With the presented model
the design of drive systems for a biomechanical motion-system, a active powered knee prosthesis, is realized.
203
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 10
Room 1.03
Abstract Title: A Systematic And Methodical Approach For The Development Of Powered Knee Prostheses
Abstract number: 145
Authors: B. Budaker
Presenter: B. Budaker
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 10
Room 1.03
Abstract Title: The Development Of A Knee Joint Nal-Knee, And Evaluation Of A Gait Test About Using It
Abstract number: 289
Authors: M. Ninomiya, M. Gotoh
Presenter: M. Ninomiya
We have developed the knee joint Named “NAL-Knee” (Natural Automatic Lock Knee) for use in trans-femoral
prostheses, enabling users to ascend and descend stairs. This knee joint is 24 cm in length, and it weighs 1080g.
It has a new link (referred to as a “bouncer”) under the hydraulic cylinder of the knee joint.
When ascending stairs with the load on the toe, the knee is stopped from bending at an arbitrary angle, and when
descending with the load on the heel, the knee performs a yielding function. This knee does not require socket or
foot replacement, and does not require batteries.
We tested ascending and descending stairs, and the flat-ground gait test. Compared to the conventional method of
descending one step at a time, the NAL-Knee was better for descending stairs, in terms of both oxygen uptake and
speed. In other words, we proved that the yielding function was effective for all three subjects. When ascending
stairs, a trans-femoral amputee with good athletic ability could climb faster and easier when using NAL-Knee, as
compared to the conventional step-by-step method.
Another advantage of NAL-Knee is, that the motion of the knee joint on either side when changing walking speed
on level ground is almost the same (the difference in the maximum knee flexion angle on either side is small). This
may be because the use of a large hydraulic cylinder decreases resistance to the flow of oil, which appears to
allow smoother bending of the knee in the swing phase, so that it becomes almost symmetrical with the able side.
Running also appeared to be facilitated by the cushion action of the link and the moderate oil pressure resistance.
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Contrasts are common in developing countries, where on one hand most medical devices are available but costly
for most of the population, and on the other there is high-tech in some R+D centers, which could be used to create
high quality products with more competitive prices. This paper is aimed as a bridge between these two realities
in Venezuela.
A survey was applied to 17 transfemoral amputees in order to establish the specifications of a mechanical knee
prosthesis. Then, the conceptual design was defined and the device was further developed, using a solving
platform which runs a genetic algorithm that proposes dimensions to each of the parameters of the mechanism.
A rapid prototyping model was built to verify the mechanism's kinematics and later, two metallic prototypes were
manufactured and tested on patients.
For the population polled in the survey, the most important design parameter was the stability, for which the most
suitable mechanism is a polycentric one. Every mechanism proposed by the genetic algorithm was simulated in
the solving platform, especially comparing the location of the instantaneous center of rotation (ICR) with respect
to the ground reaction force (GRF) line during the stance phase of gait cycle. Once stability was guaranteed,
the two prototypes manufactured were adapted to patients who wore them during three months, three-times a
week, without claiming any discomfort. The performance of the prosthesis was assessed qualitatively through
the patients' opinion, and quantitatively by observing the behavior of the ICR with respect to the GRF during the
stance phase. This prosthesis represents a simple functional product available for low cost, but designed through
an elaborated procedure that led to optimum dimensions. The prosthesis here introduced represents an example
of the capabilities found in developing countries when technology is aimed to assist their own requirements in
prosthetic field.
205
FREE PAPERS
Session Name and Room: Developing Countries - 3
Room 1.05
Abstract Title: Aiming Technology In Developing Countries To Obtain High Quality Prostheses At Low Cost
Abstract number: 228
Authors: R. Torrealba, B. Amador, C. Müller-Karger
Presenter: R. Torrealba
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Developing Countries - 3
Room 1.05
Abstract Title: Living With A Physical Disability In Malawi: A Prosthetic And Orthotic Patient Perspective
Abstract number: 496
Authors: E. Berg Lissel, E. Fredriksson, L. Magnusson
Presenter: E. Berg Lissel
Introduction
Malawi is located in south-east Africa, 53% of the population live below the poverty line. Few studies have
specifically investigated the situation for people with physical disabilities in Malawi. The aim of this study was to
explore the opinions and feelings of how it is to live with a physical disability in Malawi from a prosthetic and orthotic
patient perspective.
Methods
A qualitative study using individual semi-structure interviews for data collection was performed with 16 patients,
men and women with physical disabilities receiving services from the prosthetic and orthotic centre in Lilongwe,
Malawi. Data were analysed using content analysis.
Results
Six categories emerged from the data. People with physical disabilities felt independent and wanted to take care
of themselves. They experienced mainly positive attitudes and encouragement from others. They had a positive
view of life, but the disability affected their life situation. Contact with other people with physical disabilities was
requested for support and experience-sharing. The major concern was work and the financial situation. Ability to
work was important to meet basic needs and for the feeling of independence. Negative attitudes were a result of
poor knowledge.
Discussion
The study showed a clear need of creating work opportunities specifically for people with physical disabilities, since
having a job was found important for many reasons. Support programs profiled to help and strengthen people with
physical disabilities in Malawi would be beneficial for them to access the labour market. Spreading knowledge and
information about physical disabilities and orthopedic devices is a key issue to create a better understanding and
to change people´s attitudes.
Conclusions
Work was important for the feeling of freedom, independence and for the self-image. Negative attitudes were
uncommon, but when seen they were a result of poor knowledge about causes of disability and the situation for
these people.
206
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Introduction
On January 12, 2010, the earthquake struck the poorest country in the western hemisphere, Haiti, resulting in more
than 200,000 deaths. A large number of survivors sustained significant injuries resulting in approximately 2-5,000
amputations. The purpose of this study was to assess the effect of the employment and recreational activity of
lower-limb amputees (n=55) two years after January 2010 catastrophe.
Methods
Seventy- three patient-records of amputees were reviewed from Hospital Bernard Mevs/Project Medishare
hospital’s archive; interviews were completed with 55 patients (28 TFA, 25 TTA, 1 TMTA, and 1 BTTA). Data was
extracted from patients’ records and in-person and phone interviews were conducted to complete missing data
and to confirm recorded data in the medical records. The ICF Activity and Participation Survey was used to assess
functioning; and employment and recreational activity statuses were acquired through additional direct questions
to participants.
Results
The self-report outcome measure found that 81% ranked themselves as having a high level of functional capability
with 83% indicating average or above average self-esteem. However, 53% had lost their jobs and/or learning
opportunity and 34% quit participating in recreational activities after earthquake related amputation. Reasons for
loss of job or educational opportunities, included: discrimination, intolerance, lost support from family or friends and
lack of funding to secure employment opportunities.
Discussion and Conclusion
Despite significant employment / lost learning opportunities and change in recreational activity status, post
earthquake Haitian with limb loss report high level of function and have high self-esteem. Providing job opportunities,
proper support and guidance would very likely result in a highly-productive amputee community in Haiti.
207
FREE PAPERS
Session Name and Room: Developing Countries - 3
Room 1.05
Abstract Title: Assessment Of Functional Capability And Self-Esteem Of Haiti Earthquake Victims With
Lower-Limb Loss
Abstract number: 355
Authors: H. Alhamzah, R. Gailey, J. Kornfeld, J. Miller
Presenter: R. Gailey
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Developing Countries - 3
Room 1.05
Abstract Title: The Hispaniola Island Prosthetic And Orthotic Education Program (Hipoe) – An Overview
Abstract number: 388
Authors: D. Lawrence, G. Grisetti
Presenter: D. Lawrence, MSPT, ATC
Introduction
For over 10 years Physicians for Peace and the Walking Free project have worked in the Dominican Republic and
Haiti to establish, enhance and advance prosthetic and orthotic rehabilitation providing programs to a variety of
rehabilitation professionals. During this time, education for prosthetic and orthotic technicians was clinically based
because of the absence of formal educational institutions in either country for training or certification. Over time
Physicians for Peace determined that clinically based education, though helpful, would not produce a long-term
sustainable P&O system in either county. Distance learning was viewed as a viable alternative and a program was
implemented to address the need on a permanent basis.
Methods
An international collaborative partnership between entities with a common goal to provide the knowledge base,
administrative structure, organizational skills and resources was developed to produce a successful outcome
with a distance learning program. The stakeholders included NGOs, in country rehabilitation centers, institutions
of higher learning, and governmental agencies. Twelve trainees were selected from partner institutions and
the training began in 2011 although plans for post earthquake Haiti changed. Participants have completed two
modules of the University of Don Bosco distance education program from El Salvador.
Results
Of those trainees who took the exam, 75% (n8) passed module one and 90% (n8)passed module two.
Discussion
The pass rate suggests that the majority of trainees are meeting established standards.
Conclusion
The success of the program continues to depend on support provided by the stakeholders at all levels including
week long curriculum support missions scheduled near the end of each module as well as the provision of a
mentor who spends at least 2 weeks in-county in the middle of each module. Interim and final evaluation will be
performed to determine the impact of this distance learning program.
208
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Introduction
Clubfoot is a congenital deformity affecting nearly 200,000 children born each year worldwide, with 80% of these
in low income countries. Increasingly, the Ponseti method is being taught and utilised in these settings to prevent
severe disability caused by untreated clubfoot.
Methods
Following Introduction of national programmes for clubfoot using a standardised approach to capacity building
and service provision programme managers in 20 low income countries were surveyed in order to collect data on
clubfoot cases treated and training activities in 2009. The survey will be repeated for data from 2011 in order to
compare performance over 2 years and to gain qualitative data on barriers and factors for success in implementing
national programmes for clubfoot.
Results
More than 6,000 babies were enrolled for treatment in sample year 2009. Introduction of programmes resulted
in rapidly increased awareness and in children identified and treated. In one integrated programme involving 12
countries, 112 clubfoot clinics were established, 634 personnel trained and 7705 babies treated over 2 years.
These data will be compared with outcomes for the same 20 countries for 2011.
Discussion
The Ponseti method has been found to be effective in correcting the clubfoot deformity, with good long-term
functional outcomes. Addressing the need for treatment in low income countries will require an approach
incorporating public health principles, early intervention and building capacity through training and coordinated
national or regional programmes.
Conclusions
Country-wide programmes for the treatment of babies with congenital clubfoot can be successfully implemented
when appropriate health systems administration is followed. The methodology was found to be applicable across
continents and cultures. Standardisation of methodology facilitates integration into national plans and allows
potential for global programming.
209
FREE PAPERS
Session Name and Room: Developing Countries - 3
Room 1.05
Abstract Title: Implementing National Programmes For Clubfoot In 20 Low Income Countries: Progress
Over 2 Years
Abstract number: 468
Authors: M. Steenbeek, R. Owen
Presenter: M. Steenbeek
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 11
Room 1.06
Abstract Title: Clinical Experiences With Temporary Socket And Modular Socket System In Patients With
Lower Limb Amputation
Abstract number: 147
Authors: H. Hashimoto, S. Hirabayashi, K. Hasada
Presenter: H. Hashimoto
An initial lower limb prosthesis during rehabilitation period has to be fitted and delivered to achieve early discharge
from hospital , while stump volume and shape are fluctuating. It also has to be considered the way to evaluate the
stump for determining the socket design. Therefore, we have adopted a procedure using temporary cast socket
prior to modular socket system.
Firstly, general condition is assessed to determine the patient is suitable for fitting prosthesis or not. Once general
condition has assessed, one week trial of Iceross liner will be given. When a Iceross liner is usable, a temporary
TSB cast socket is made with a Icross liner and Icecast at hospital. The TSB cast socket will be assembled with
ideal prosthetic components, and then physiotherapist can start standing and gait training immediately. When the
socket loosens, it could be renewed at the hospital. The final evaluation will be conducted during the training period
whether a TSB socket is suitable or not. When TSB is usable, the modular socket system is applied and complete
prosthesis will be delivered before discharge.
With this procedure 23 cases are fully succeeded. There was no failure when utilizing the modular socket system֕
because of ill- fitting. A cast socket enables the amputee to start the training process early because it is easy to
be renewed when edema is minimized or the stump shape is changed. It is also cost-effective and useful for
evaluating Iceross liner with TSB socket. Complete prosthesis with modular socket system will be produced within
3-4 hours which includes casting and fabrication, so it is considered to be useful for early discharge. It is efficient
to use both temporary cast socket and modular socket system for a first lower limb prosthesis during rehabilitation
period.
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Introduction
In vacuum suspension sockets, loss of elevated vacuum pressure is often a result of non-conformation of
the socket material to changes in residual limb shape and volume. Reduced vacuum suspension may lead to
increased relative movements (i.e. pistoning) of the residual limb within the socket. Fabrication of the socket from
a flexible material provides a direct solution; however, to be of practical use, minimum socket rigidity for stable
load transfer between the residual limb and prosthesis must be maintained. To maximize socket flexibility, we use
a fenestrated rigid socket (i.e. frame) embedded within a laminated polyurethane flexible material. We present
Results of a finite element (FE) analysis evaluating the effect of different frame designs on residual limb/socket
interface stress distributions.
Methods
Equipment: Creaform 3-D digitizer, Novel pliance system, Instron mechanical testing system Procedure: A FE
model of a transfemoral sub-ischial prosthetic socket is developed and validated. The model assembly was
simplified to the following components: (1) Rigid frame, (2) Flexible polyurethane layer, (3) Silicone liner and (4)
Residual limb. A FE analysis was then performed in Abaqus FEA (Dassault Systemes).
Results
Qualitative Results from the FE analysis showed a non-uniform stress distribution that was different for each
socket. Preliminary Results indicate regions of high normal stresses around the proximal brim and regions of low
normal stress values along the lateral wall of the socket. On-going work is focused on quantitative assessment of
the effect of different frame geometries of various thicknesses on the stress distribution.
Discussion
The sockets differed only in locations and extent of cut-outs within their rigid frames. Cut-outs in transfemoral
sockets have been used to provide release areas that accommodate displaced tissues. The Results suggest this
approach is useful to optimize flexible sockets capable of conforming to changing residual limbs, while achieving
biomechanical load requirements.
211
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 11
Room 1.06
Abstract Title: Stress Analysis Of Different Rigid Frame Designs Within A Flexible Transfemoral Prosthetic
Socket
Abstract number: 165
Authors: O. Komolafe, R. Caldwell, K. Tucker, A. Hansen, W. Chen, C. Sun, S. Fatone
Presenter: S. Fatone
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 11
Room 1.06
Abstract Title: Assessing Gait Adaptability Longitudinally In Rehabilitation After A Transtibial Amputation.
Abstract number: 156
Authors: K. Schenkeveld, M. Kerste, H. Wiggerts, O. Bosboom, T. Janssen, M. Roerdink
Presenter: K. Schenkeveld
Introduction
An important goal of the rehabilitation after a transtibial amputation is to increase walking ability. An important
aspect of walking ability related to fall risk in community walkers is the capacity to adjust gait to environmental
circumstances, such as avoiding obstacles and targeting safe foot placement locations. However, research on the
course of walking ability and specifically gait adaptability during the rehabilitation program is scarce. The aim of the
present study is to assess gait adaptability longitudinally in rehabilitation by exploiting an innovative instrumented
treadmill (C-Mill, ForceLink) with visual context (e.g., stepping targets, obstacles) projected on the belt’s surface.
Methods
Longitudinal descriptive study. Six patients with a recent transtibial amputation, who were in primary amputee
rehabilitation, were included in the study. They performed obstacle avoidance and visually-guided stepping tasks
on the treadmill and overground three times with intervals of six weeks. Outcome measures include walking
velocity, obstacle-crossing success rates and crossing strategies.
Results
Soon after participants received the prosthesis, they were able to perform the C-Mill gait adaptability tasks.
Preferred walking speed increased and most patients showed improvements in obstacle avoidance and visuallyguided stepping tasks. The number of strategies to avoid obstacles increased over time. Patients required less
stabilizing walking aids in daily life as gait adaptability improved over time.
Discussion
The C-Mill can be used to evaluate walking ability in terms of gait adaptability during rehabilitation in prosthetic
patients, who become community-walkers. It is important to assess gait adaptability in this group for several
reasons: 1) to evaluate progress in the rehabilitation process, 2) to facilitate goal setting during the rehabilitation
process, 3) to guide prosthesis fitting and 4) to assess their fall risk.
Conclusion
With rehabilitation, patients with a recent transtibial amputation increase their preferred walking speed, improve
gait adaptability performance and develop multiple obstacle-crossing strategies.
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Aim
The purpose of this study was to investigate that the effect of quadratus lumborum contraction muscle in
asymmetrical loading on energy expenditure and stride parameter of unilateral transtibial amputee. Thirty
transtibial amputees subjects selected for measure the energy expenditure and stride parameter.
Methods
The PCI measurement is the simple method to measure the energy cost. It is calculated by measuring the heart
rate. Heart rate is calculated from pulse oximeter (CMS-50D ver.1.2) by placing on index figure. The energy
expenditure measured through the difference in resting heart rate and walking heart rate with load carrying on
ipsilateral and contra lateral side of prosthesis on shoulder divide by walking speed. Stride parameters were
measured on the 10 meter paper walkway with 10% of body weight (BW) asymmetrical loading condition on the
shoulder. The following gait characteristic stride parameters for each participant on the 10 meter walkway paper:
- stride length, walking velocity.
Result
The energy expenditure showed significant difference in right side amputee with two different loading conditions.
Stride length and velocity were showed significant difference in the left amputee.
Conclusion
Concluded that right side Quadratus Lumborum muscle contraction reduces energy expenditure by helping in right
side hip elevation of right side transtibial amputee.
213
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 11
Room 1.06
Abstract Title: The Role Of Quadratus Lumborum Muscle In Asymmetrical Loading Condition In Unilateral
Transtibial Amputee
Abstract number: 199
Authors: A. Vimal, S. Sharma, D. Joshi, R. Kumar
Presenter: A. Vimal & S. Sharma
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 11
Abstract Title: Moisture Management Within A Prosthetic Socket
Abstract number: 217
Authors: J. Mccarthy, J. Ross, A. Mcdougall, L. Ritchie, A. Ward, S. Zahedi
Presenter: J. McCarthy
Room 1.06
Introduction
Maintaining an intimate fit between the skin and prosthetic socket is a key factor to ensure the comfort and
control of prosthetic devices. Relative movement (pistoning) causes abrasions, lack of control and extra energy
expenditure leading to pain fatigue etc. Liners are usually made from visco-elastic materials such as polyurethane,
silicone, or mineral gels which damp peak pressures increasing comfort. However, these liners do not “breathe”,
they create an air tight seal between the residuum and the liner. The effects of amputation level and energy
expenditure will be discussed.
Method
A blind trial was carried out using trial liners, one of which incorporated sweat management. A questionnaire was
completed after wearing each liner and the Results recorded.
Results
Results were recorded after using each of two trial liners. There was an improvement in most cases when
perforated liners were employed.
Discussion
Amputees expend more energy during gait than the able bodied yet have less ability to cool due to loss of surface
area. Experiments have shown that perforating a liner can have advantageous effects on moisture management
including some unexpected advantages.
Conclusion
Perforating liners can have advantageous effects.
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Room G.06
Introduction
Fitting a thoracolumbosacral orthosis for patients after trauma or surgery requires a great deal of effort and
expertise by an experienced orthotist. The current method of fabricating a custom TLSO begins with casting the
torso of the patient which is often done while the patient is lying in a trauma unit. Obtaining a cast in this manner
is challenging for the orthotist to maintain spinal stability while moving the patient into supine and prone positions
increasing the risk of injury and discomfort. In this study, we used Computed Tomography scans of a patient’s
torso, to create a custom TLSO. The aim of the study was to compare the anthropomorphic measurements using
the three-dimensional (3D) reconstruction of a torso surface model from CT scan to the traditional hand molding
method for fabrication of TLSO.
Method
Subjects: sixteen male subjects with pre-existing CT scans were evaluated in whom conventional TLSO fitting
was performed. Procedure: Patients received CT scans utilizing “Trauma Chest Abdomen Pelvis” protocol. A 3D
image in STL format was created from CT and custom mold was exported to TracerCAD. Virtual Comparison:
Circumference, anterior-posterior (A-P), medial-lateral (M-L) Intervals are measured and compared for the two
models generated for each subject. Data analysis: Pearson correlations and Bland-Altman tests were used to
assess the relationship and agreement between the CT and conventional TLSO.
Results
Sixteen male subjects mean age 53.31 and mean body mass index 27.91 kg/m2 were evaluated. Correlations
were high with an average correlation .72 (.71 - .93).
Discussion and Conclusion
We found that 3D model measurements from CT scan and from plaster models were strongly related. This study
provides preliminary support for the use of the CT method given its relation to conventional method.
215
FREE PAPERS
Session Name and Room: Orthotics : Spinal - 1
Abstract Title: Use of 3D Volume Rendered Ct Scans In The Design and Fabrication of Tlso
Abstract number: 99
Authors: P. Ammanath, E. Wizuer, G. Shah, S. Murphy, G. Graziano
Presenter: P. Ammanath
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Orthotics : Spinal - 1
Room G.06
Abstract Title: The Effect Of Spinal Bracing On Sitting Function In Children With Scoliosis And
Neuromuscular Impairment
Abstract number: 111
Authors: A. Blomkvist, K. Olsson, M. Eek
Presenter: A. Blomkvist
Introduction
Treatment with modified custom-molded Boston brace is common in children with scoliosis and neuromuscular
impairment in the western region of Sweden. The purpose of this study was to describe how sitting function is
affected by the brace.
Methods
A retrospective review of medical records from children fitted with scoliosis braces during 2003-10 at the Regional
Rehabilitation Centre. An objective analysis of sitting on a bench was made using a pressure mapping system.
Results
122 children were included; mean age 10.4 years (1.7-17.7). The most frequent diagnoses were cerebral palsy
(CP)(n = 38) and myelomeningocele (MMC) (n = 19). Thirty-two children were independent walkers and 66
children could sit without support. Cobb angle was between 19° and 126°. The pressure mapping showed that
symmetry was improved in 46/90 children while two deteriorated. Stability improved in 31/49 children and eight had
decreased stability. Changes in sitting were also described in words, with improvement noted in 77 children and
deterioration in five. These changes were categorised as: Stability, Posture, Ability to sit, Head Control, Activity,
and Muscle tone.
Discussion
The brace reduced the need for support in sitting. A more upright sitting position with improved head control
increased the possibilities of participation. Sitting analysis with pressure mapping can identify the need for
adaptations of the chair and corrections of the brace. The motivation of children and families to use the brace and
the understanding of adaptations can be increased.
Conclusion
This study shows that a brace has a positive impact on sitting function. The greatest effect was seen in children
who could not sit without support, those with severe scoliosis and non-walkers. Children with CP seemed to gain
more than children with MMC.
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Load carriage is common in school-age children for transferring books and personal belongings. It is conventionally
believed that abnormal external loading is one of the possible factors that may exacerbate spinal deformity. Thus,
children are usually recommended to carry the load symmetrically over the shoulders. However, as asymmetric
and side-shift exercises have been demonstrated to be effective therapeutic exercises for scoliosis management,
we propose the use of properly controlled asymmetric load for postural correction and muscle conditioning in
adolescents with idiopathic scoliosis (AIS). In our preliminary study of six subjects with AIS (Cobb’s angle between
10° and 21°), cross-chest single strap shoulder bags of different weights (2.5, 5, 7.5, 10 and 12.5% of subject’s
bodyweight) were applied to either shoulder of the subject in normal upright stance. Spine curvature, expressed
in term of spinuous process angle (SPA), was assessed by manual palpation of spinuous processes and
measured by photogrammetric method. SPA of the affected spinal region under different asymmetric load carriage
configurations were compared to that of the unloaded situation. A preferable asymmetric loading configuration
with minimum SPA was identified for each subject. The spinal curvature under the preferred loading configuration
for each subject was further measured and confirmed by an ultrasound system. It was observed that scoliotic
deformity could consistently be reduced by an asymmetric load positioned opposite to the apex of the major
curve. Preliminary Results showed that an appropriate asymmetric loading configuration could help to reduce
the lateral deformity of patients with mild scoliosis. Further investigations of the prolonged effects of asymmetric
load carriage on spinal curvature, posture and back muscle activity in patients with AIS under dynamic situation
are warranted.
217
FREE PAPERS
Session Name and Room: Orthotics : Spinal - 1
Room G.06
Abstract Title: The Application Of Asymmetric Loading For Spine Curvature Correction In Subjects With
Adolescent Idiopathic Scoliosis
Abstract number: 126
Authors: H. Cheng, Z. Huang, J. Cheung, Y. Zheng, D. Chow
Presenter: H. Cheng
FREE PAPERS
Wednesday, Feb 6 / 14:30 - 15:45
Session Name and Room: Orthotics : Spinal - 1
Room G.06
Abstract Title: A Case Study Of Biomechanical Effect Of Spinal Orthosis On Scoliotic Spine Versus Time
Domain
Abstract number: 288
Authors: M. Li, K. Cheung, K. Wong, K. Luk, M. Wong
Presenter: M. Li
Introduction
The biomechanical effect of spinal orthosis on a scoliotic spine may not response immediately because of the low
stiffness and viscoelastic properties of the soft tissues surrounding the spine. This study aims to apply 3D clinical
ultrasound (3D CUS) method to monitor the curvature changes of a scoliotic spine at and after donning/ doffing
of spinal orthosis.
Methods
A female subject with adolescent idiopathic scoliosis and under orthotic treatment for a year was invited. She had
right thoracic (50? and left lumbar (30? curves. It was a two-day study protocol. The first day was to check the
doffing effect, while the second day focused on the donning effect. Before the ultrasound scanning, the subject was
instructed to wear her orthosis 23 hours/day with prescribed strap tightness. On the first day, 3D CUS was used
to monitor the spinal curvature changes from in-orthosis stage to immediate off-orthosis, 15-minute, 30-minute,
60-minute, 90-minute and 120-minute off-orthosis. Afterwards the orthosis was kept in the clinic. On the second
day, 3D CUS was applied to monitor the spinal curvature changes from 24-hour off-orthosis stage to immediate
in-orthosis, 15-minute, 30-minute, 60-minute and 90-minute in-orthosis.
Results
According to the Cobb’s angle estimated from US images, the immediate in-orthosis and off-orthosis effects were
not obvious. By monitoring the curvature changes, both thoracic and lumbar curves increased > 5?at and after
90-minute off-orthosis, while both curves decreased > 5?at 60-minute in-orthosis.
Conclusions:
This pilot study demonstrated the low stiffness and viscoelastic properties of the spine and time lag on the
response of orthotic treatment. The best correction happened 60 minutes after bracing and the correction could
not be maintained at and after 90 minutes off bracing. A further study with more subject number has been initiated
in order to find out a solid Conclusion.
218
Wednesday, Feb 6 / 14:30 - 15:45
Introduction
A module size of Boston brace (Allard support UK ltd.) is selected from matching a patient's body size in each
four specified points. If an order does not match prefabricated standard modules (PSM) of 30 patterns, a custommade module (CMM) is applied. In our cases, 43% of all order belongs to a CMM. The applied condition of a PSM
satisfies whether each of the measured size falls in the error range of +/- 2cm (waist) and +/- 4cm (chest, hip, ASIS
(anterior superior illiac spine)) .We tried to find integral four-measurement combinations for Japanese scoliosis
patients by using a statistical clustering method.
Methods
K-means clustering was applied on measurement data in 663 patients with CMM from Sep. 2004 to Oct 2011.
The data consists of each circumference (chest, waist and hip) and distance between left and right ASIS. The first
step is to divide measurement data groups into 8 classes by k-means method. The second step is to divide into 10
classes (C1-C10) by k-means method applying for classes except for lower 3 classes as outliers.
Results
The top three center value of the cluster which belongs a lot of samples were as follows: [Chest-Waist-HipASIS(cm):C1:69-64-82-25, C2:64-61-75-24, C3:62-54-80-24]. 49% of all of CMM belongs to the C1-C3.
Discussion
In our investigation, the size combination of the most used in PSM is [S1:66-57-80-22]. Although the C1, C2 and
C3 size combination exists near the S1, one size in the each combination does not fall in an allowable range. When
simulated what percentage matches each C1-C10 center value of cluster, 42% of the CMM applied was covered.
Conclusions:
We proposed method to find four size combinations simultaneously related to matching of Boston brace with
k-means clustering and showed the validity of our proposed method in CMM applied cases.
219
FREE PAPERS
Session Name and Room: Orthotics : Spinal - 1
Room G.06
Abstract Title: A Study Of Size Classification Using K-Means Clustering Applying To The Boston Brace In
Japan
Abstract number: 419
Authors: B. Masuhara, K. Kato, A. Sakamoto, T. Sakamoto
Presenter: B. Masuhara
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Seating & Wheelchair - 1
Abstract Title: Design And Development Of A Wheelchair Having An Integral Transfer Board.
Abstract number: 283
Authors: V. Agrawal, S. Winkler, J. Sanford
Presenter: V. Agrawal
Room 1.01
Introduction
People with bilateral or higher level amputations typically use a wheelchair for indoor mobility and transfer-boards
for transferring to/from the wheelchair. Users who lack adequate strength, balance and coordination are at risk of
experiencing a fall while using portable, standard transfer-boards (STB). The purpose of this study was to design
and develop a wheelchair with an integral transfer-board (SafeSlideBoard-SSB) and to compare the SSB with
STB.
Methods
A new prototype of the transfer wheelchair was developed in collaboration with a manufacturer to meet all
performance specifications of a mass produced product. Finite element analyses (FEA) and fatigue testing were
done with the SSB model and prototype, respectively. Comparison between STB and SSB was then performed
by 11 wheelchair users and 9 therapists, in terms of independence, safety and difficulty during a toilet and a tub
transfer.
Results
Modifications were made to the SSB design following FEA and the prototype successfully passed mechanical
testing without safety concerns. There were no significant differences between the two transfer devices in either
test group for independence, safety and difficulty. When toilet and bench transfers were aggregated, “Safety” was
found to be significantly higher for SSB than STB.
Discussion
The small sample size made achieving significant differences between SSB and STB difficult. Trends, however,
demonstrated more positive outcomes with the SSB compared to the STB. Open-ended responses about the
design and usability of SSB suggest that having a transfer board fixed to the wheelchair is not only safer and more
secure, but also more convenient and easier to use.
Conclusion
Observational and self report data from both older wheelchair users and therapists demonstrate that the attached
transfer device is not only highly feasible, but has the potential to have large effects on the independence, safety
and ease of transfer for older users.
220
Wednesday, Feb 6 / 16:15 - 17:30
Room 1.01
Introduction
Disasters result in death and injury. A significant number of people injured will need to use a wheelchair
permanently or temporarily. Disabled people who lose their wheelchair are also vulnerable; they are unable
to access emergency services such as food, shelter and medical aid. In an emergency response, wheelchairs
are usually slow to arrive and rarely meet international standards. They are not designed for the challenging
environments typical of emergencies, cannot be adapted to fit the user and often cause secondary complications.
Method
The lack of appropriate wheelchairs for emergency situations hinders inclusion of disabled people in a humanitarian
response. Motivation and Handicap International have collaborated to develop a wheelchair specifically for this
purpose; easily transportable, quick to assemble and low-cost. The wheelchair is also adjustable, durable, and
designed for rough terrain. This product is a starting point for effective rehabilitation, helping ensure that appropriate
and long term wheelchair provision is planned at the onset of a humanitarian response.
Results
The emergency wheelchair design has been prototyped and tested to ISO7176-8, and is currently undergoing
trials. The Results of these trials will be fed back into the design. A support package to ensure it is delivered safely
and effectively has also been developed and will undergo trials later this year.
Discussion
This product complements existing activities in the field and will enable a shift in international practice. Wheelchair
services are under-represented aftermath of a disaster, yet the P&O sector is well placed to integrate appropriate
wheelchair provision into its existing activities.
Conclusions
An emergency wheelchair delivered promptly in crisis situations can reduce overflow in health services; enable
follow-up and facilitate mobility in successive displacement. It can also help avoid isolation; allowing disabled
people to participate in relief activities; relieving the burden on families and contributing towards psychological
recovery.
221
FREE PAPERS
Session Name and Room: Seating & Wheelchair - 1
Abstract Title: The Rapid Provision Of Appropriate Wheelchairs In Emergency Situations
Abstract number: 329
Authors: D. Constantine, S. Sheldon
Presenter: D. Constantine MBE
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Seating & Wheelchair - 1
Abstract Title: A Project On Prefabricated Special Chair
Abstract number: 149
Authors: M. Kumari, S. Raju, R. Hussain, S. Govindasamy
Presenter: M. Kumari
Room 1.01
Introduction
Many children with disabilities, primary Cerebral Palsy require special chair. It is observed that special chair
improve child’s siting posture, engage in self-care, play activity and have a meaningful impact on child and the
family. Fabrication of special chair is often tedious, requires skills and takes time. The need of hours is to find
solution for the above challenges.
Objectives
To design ‘off the shelf product’. A prefabricated special chair with adjustable features, cost effective, is reducing
the delivery time.
Method
Randomized sample selection technique was used to collect data of 200 children with cerebral palsy, delayed
milestone and spina bifida having poor seating balance with or without head and neck control. Individual
measurements were taken in relation to segmental classification of height, width, depth and body circumference.
Mean and standard deviation at baseline were derived from measurement for each part required to assemble the
chair.
Results
Parts for eight different sizes of prefabricated special chair have been developed. Sizes are 1(A, B), 2 (A, B), 3 (A,
B) and 4 (A, B). The size varies in height and depth. Each size has two seat widths A and B ranging from 20-38
cms. Range of difference for A and B is 4 cms. Back rest (50 to 65 cm), seat depth (20 to 40 cm), foot rest position
(16 to 37 cm), and length of foot plate (15 to 24 cm).
Discussion
Prefabricated parts of eight sizes along with adjustable features enable us to reduce the delivery time considerably.
In 2010, 44 special chairs were fabricated and delivered whereas in 2011, 203 prefabricated special chairs were
fitted.
Conclusion
Adjustable features allow modifying the same chair as the child grows, reducing the cost required for replacing to
new piece. Introducing the prefabricated special chair significantly increased the overall fitment rate.
222
Wednesday, Feb 6 / 16:15 - 17:30
Room 1.01
Introduction
A person with leg disability may have to use a wheelchair for his/her entire life. In a conventional wheelchair, the
user spends most of the time seated in one position. Providing the ability to stand can help alleviate physical
issues such as sore body, building of pressure points, and lowered blood circulation due to lack of movements. In
addition, it can improve the quality of life for the wheelchair user by enabling eye-level interaction with other people
and access to objects at elevated heights. In this work, a mechanical wheelchair with an adjustable frame that can
elevate the user to a standing position has been designed for household use.
Methodology
This development of the wheelchair was carried out in a sequential manner starting from understanding the
user's needs, synthesizing kinematic mechanisms, evaluating various design options and selecting a design
for further analysis and prototyping. Kinematic synthesis was carried out to determine suitable link lengths for
the mechanism.The design was modeled using CAD and Finite Element Analysis was carried out to determine
suitable cross-sections for the links for the material chosen. A wooden prototype was initially made to evaluate the
proof-of-concept. Springs are used in the wheelchair to balance the weight of the person and reduce the effort of
the user in getting to the standing position. Based on the experience with the wooden prototype, a metal prototype
made of Aluminum has been built.
Results
Able-bodied users weighing about 65 kg have tried the prototype with good success. By operating the hand levers,
the user is able to lift himself up to a standing position and come back down to the seated position. The design
exhibits good stability for the user in both the seated and standing positions. Improvements are being made to the
design to incorporate additional safety features in the next prototype before having actual wheelchair users test the
design. The design has been demonstrated at national level competitions and has won several awards. A patent
application has been filed and commercialization of the design is being explored.
Conclusion
A mechanical user-operable standing wheelchair has been designed in this work. The goals of a costeffective,
simple, easy-to-operate design have been met.
223
FREE PAPERS
Session Name and Room: Seating & Wheelchair - 1
Abstract Title: Design Of A Standing Wheelchair
Abstract number: 538
Authors: H. Chaudhary, S. Veer, S. Srinivasan
Presenter: S. Veer
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Orthotics : Spinal - 2
Room 1.02
Abstract Title: The Effectiveness Of Milwaukee Brace On Thoracic Hyperkyphosis In Patient Referred To
The Iranian Red Crescent Society
Abstract number: 422
Authors: M. Khanali, Z. Hedayati Roshan, S. Hasanpour, M. Seif, A. Daryabor
Presenter: M. Marashian
Introduction
Hyper kyphosis is a common spinal deformity which means an increase in the normal kyphosis angle in the sagittal
plane.Its frequency assumes to be 15.3% in western countries and 13.2%[3] in Iran in those attending high school.
If the deformity angle is more than 40 degrees orthotic intervention may be recommended.Thus new Methods for
conservative treatment of hyperkyphosis have been suggested during the last several decades,Milwaukee brace
has remained as the gold standard for managing this disorder. The aim of the study was to analysis the effect
of Milwaukee brace on patient with hyperkyphosis referred to the Red Crescent society between 2009 and 2011
during seven months.
Methods
304 Patients who referred to the Rehabilitation Center of Iranian Red Crescent Society between years 2009 and
2011, and were managed using Milwaukee brace, were recruited to participate in this retrospective longitudinal
study (210 female and 94 male) among which 119 subjects have been referred because of hyperkyphosis. The
cobb angles were extracted out of the x-rays to the third and seventh month of using the Milwaukee brace. These
angles were statistically analyzed using the statistic package SPSS version19. After assuming normal distribution
of the data, paired sample t-test was employed to compare the means.
Results
The amount of hyperkyphosis between the primary angle (mean=59.57) and the secondary one after 3 and 7
months (means= 44.54 and 43.54 respectively) were compared and a significant difference was revealed (p-value=
0.007). The incidence of hyperkyphosis in this study was 38% in girls and 55% in boys.
Conclusion
This study demonstrates that hyperkyphosis prevalence in boys is more than girls. The Milwaukee brace reduced
the kyphosis angles in both genders equally.
224
Wednesday, Feb 6 / 16:15 - 17:30
Introduction
Severe osteoporosis could cause vertebral compression fracture and hyper-kyphotic deformity. Thoraco-lumbosacral-orthosis (TLSO) is generally applied in controlling such deformity. However, limitations such as restricted
respiration, poor compliance and trunk muscle atrophy were found. A wireless posture monitoring system (WPMS)
has been developed for posture training through audio-biofeedback mechanism. This study aims to compare
clinical effectiveness of these two captioned interventions (TLSO and WPMS) for the patients with osteoporotic
vertebral fracture (OVF).
Method
Female patients (with age > 55 & OVF) were recruited for the four-week posture training programme. They were
divided into a test group (8 subjects were applied with WPMS for 3 hours/day) and control group (11 patients were
applied with TLSO for 3 hours/day). The assessment parameters included kyphotic angle (electronic-inclinometer),
pain assessment (Roland-Morris Disability Questionnaire, RDQ) and health related quality of life (HRQOL, through
Short Form -36).
Results
The average kyphosis angle of the test group had a significant decrease of 4.6¡ã (¡À2.5¡ã) at the 4th week (p <
0.05) while the reduction of the kyphosis angle in the control group is not significant (p > 0.05). The average RDQ
scores for the test group were 21.3¡À0.3 (1st week) and 19¡À1 (4th week) while the control group were 21.5¡À1.5
(1st week) and 20.5¡À0.5 (4th week). No significant difference in HRQOL between the two groups.
Discussion and Conclusion
Obvious spine extension occurred in the thoraco-lumbar region of the test group. In this ongoing study, X-rays will
also be used to compare the clinical Results. A long-term assessment and posture information will be collected for
further comparison of effectiveness of TLSO and WPMS.
225
FREE PAPERS
Session Name and Room: Orthotics : Spinal - 2
Room 1.02
Abstract Title: The Clinical Investigation Of Wireless Posture Monitoring System In Treating Patients With
Osteoporotic Vertebral Fracture
Abstract number: 440
Authors: L. Wang, A. Wong, M. Wong
Presenter: L. Wang
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Orthotics : Spinal - 2
Room 1.02
Abstract Title: Development Of A New Cervico Thoracic Orthoses Its Design & Pilot Evaluation
Abstract number: 480
Authors: T. Hanajima, B. Masuhara, A. Sakamoto, T. Sakamoto
Presenter: T. Hanajima
Introduction
In a spine position, patients wearing a conventional CTO (c-CTO) often complain of pain caused by a pressure
created by a posterior support surface which often fails to conform to the shape of the head. In order to decrease
the pain due to the pressure, a new CTO (n-CTO) is developed with a new posterior support surface to create
better pressure distribution. This study aims to compare the posterior support surfaces of c-CTO and n-CTO. The
n-CTO-posterior shell has two layers with an outer-shell made of hard plastic and an inner-shell made of an elastic
one. The inner-shell has a mesh shape which conforms to the shape of the head, and it hangs like a hammock
within the outer-shell and fixed to the outer shell by the four pins.
Method
The subjects were three healthy volunteers. Range of height and weight of subjects were 169-171cm and 6181.6kg. A sensor sheet was used to measure the pressure of the contact area between the head and the CTOs
in the spine position. Measurement was performed three times alternatively while wearing c-CTO and n-CTO.
We compared contact area and mean pressure of c-CTO and n-CTO. Coefficient of Variance (COV) was used to
statistically compare two sets of data. (COV=standard deviation/mean) A COV value is lower when a degree of
pressure distribution is higher.
Result
Compared to c-CTO, Contact area of n-CTO increased to 18%, Mean pressure of n-CTO reduced to 30% and
COV of n-CTO was 0.18point lower.
Discussion
As a result n-CTO increased the contact area, hence reduced mean pressure also COV value was lower. Therefore
the n-CTO suggests its effectiveness in pressure distribution compared to the c-CTO.
Conclusion
The new design of n-CTO-posterior shell was successful in reducing the mean pressure with better pressure
distribution than c-CTO in this study.
226
Wednesday, Feb 6 / 16:15 - 17:30
Objectives
The aim of this presentation is to present the safety and performance of ReWalk in enabling people with paraplegia
due to spinal cord injury to carry out routine ambulatory functions.
Our Results
We currently have data on 16 subjects. After training, all subjects were able to independently transfer and walk,
without human assistance while using the ReWalk, for at least 100 m continuously, for a period of at least 5 to 10
mins continuously and with velocities ranging from 0.1 to 0.55 m/sec (mean, 0.35 m/sec).
Some subjects reported improvements in pain, bowel and bladder function, and spasticity during the trial. All
subjects had strong positive comments regarding the emotional/psychosocial benefits of the use of ReWalk.
Conclusions:
ReWalk holds considerable potential as a safe ambulatory powered orthosis for motor-complete thoracic-level
spinal cord injury patients. Most subjects achieved a level of walking proficiency close to that needed for limited
community ambulation. Further development and application of this rehabilitation tool to other diagnoses are
expected in the future.
227
FREE PAPERS
Session Name and Room: Orthotics : Spinal - 2
Room 1.02
Abstract Title: The Rewalk Powered Exoskeleton: A Powered Orthosis To Restore Ambulatory Function To
Individuals With Thoracic-Level Motor-Complete Spinal Cord Injury
Abstract number: 539
Authors: A. Esquenazi
Presenter: A. Esquenazi
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Prosthetics : Lower Limb - 12
Room 1.03
Abstract Title: A Biomechanical Model For The Estimation Of Dynamic Interactions At The Transfemoral
Socket Interface
Abstract number: 136
Authors: J. Wojtusch, P. Beckerle, O. Von Stryk
Presenter: J. Wojtusch
Introduction
For the analysis of the human gait with prosthesis and the design of prosthetic devices, the knowledge of
fundamental dynamic interactions at the user-prosthesis interface is required. A direct measurement of these
interactions, including forces, torques, and powers, is complex and necessitates additional sensors in the
prosthesis.
Methods
In this work, a biomechanical model for the estimation of dynamic interactions at the transfermoral interface in
sagittal plane is presented. By applying an inverse dynamic simulation, the normal force, torque and power at
the interface are computed for different gait scenarios and lengths of the residual limb. The biomechanical model
consists of multi-body system dynamics models of the legs and the trunk. The sound leg is modeled by three rigid
bodies for thigh, shank, and foot as well as three rotatory joints representing the hip, knee, and ankle joint. The
model of the leg with prosthesis is obtained by partitioning the rigid body of the thigh into a residual and a prothetic
limb and linking both partitions by virtual joints representing the transfemoral interface. The parameters of the
residual limb are identified by fitting the inertial specifications to a detailed geometric model of the human thigh.
Results
The simulation Results provide essential information for gait analysis and prosthesis design.
Discussion
The power characteristics allow to evaluate the effort that has to be expended by the prosthesis user, while the
torque characteristics show the influence of different prosthesis lengths on the loads of the residual limb. The
normal force characteristics describe the impact of force peaks introduced by ground reactions and are a measure
for the pressure distribution at the prosthesis stem.
Conclusions
The presented biomachnical model is a first approach towards a comprehensive simulation environment for the
human gait with prosthesis and will be further enhanced in accuracy and applicability.
228
Wednesday, Feb 6 / 16:15 - 17:30
Introduction
The healthy limb has an amazing capability to adapt to the changing requirements of walking such as walking on
varied inclined ground and at different walking speeds. An advanced microprocessor controlled ankle foot system
has been developed that has the capability to alter and adjust how the foot interacts with the ground by controlling
the amount of energy that is stored and released elastically by the foot in the stance phase of the gait cycle. This
study aimed to develop a deeper understanding of how changing ankle foot properties automatically for different
walking environment may influence biomechanical parameters at the ankle.
Methods
Gait trials and measurements were conducted both outdoors on various walking inclines and speeds. For each
walking scenario/task the ankle foot properties were altered in each case to determine how the ankle foot kinetics
would change if a microprocessor or control foot system would adapt the ankle kinetics and kinematics.
Results
The Results of the study highlighted distinct differences in ankle bending moment data which could be correlated
to changes in ankle motion, walking speed and the walking task undertaken. The largest differences in the kinetic
ankle moment data were shown in the first 40-50% of the stance phase. Overall the Results showed that adaptation
to the viscoelastic response of the foot could produce marked changes in both ankle motion and kinetics that were
independent of the walking activity being carried out.
Conclusions
The Conclusion from this study supports the view that future ankle-foot systems should ideally have the capability
to adjust to better optimize the gait tasks being undertaken. The consequences of pathological kinetics at the ankle
we believe contribute greatly to the energetic of locomotion and the degree to which amputees have to adapt and
compensate their gait.
229
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 12
Room 1.03
Abstract Title: Analysis Of Ankle Biomechanics With An Advanced Microprocessor Controlled Ankle-Foot
Prosthesis
Abstract number: 215
Authors: J. Mccarthy, N. Stech, A. Sykes, D. Moser, J. Ross, A. Mcdougall, S. Zahedi
Presenter: J. McCarthy
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Prosthetics : Lower Limb - 12
Room 1.03
Abstract Title: Service And Cost Of Transfemoral Osseointegrated Prostheses Compared To
Socket-Suspended Prostheses
Abstract number: 379
Authors: E. Häggström, K. Hagberg
Presenter: E. Häggström
Introduction
Transfemoral amputation (TFA) prostheses can be fitted directly to the skeleton using an osseointegrated implant
(without socket). Treated patients have reported improvements in quality of life but no study has investigated
prosthetic maintenance costs. The aim of this paper is to investigate differences of prosthetic service and costs of
osseointegrated prostheses (OI-prostheses) as compared to socket-suspended prostheses (S-prostheses) among
patients with unilateral TFA.
Methods
All prosthetic costs and number of visits were noted during ~10 years and taken from one non-profit prosthetic
workshop. The study included 36 patients with S-prostheses (83% male, mean age 51.3 years, cause 75% trauma,
19% tumour, 6% other) and 20 patients with OI-prostheses (55% male, mean age 56.6 years, cause 65% trauma,
25% tumour, 10% other). The mean cost of a new prosthesis, including material and working-hours, was compared
in a sub-group.
Results
There was statistically significantly fewer workshop-visits with OI-prostheses compared to S-prostheses (3.1 vs
7.2 visits/year, p<0.0001). The mean total annual cost of new prostheses, services, repairs and adjustments was
14% lower for OI-prostheses than S-prostheses (€3,149 and 3,672 respectively, p=0.632). The OI-group had to
larger degree been supplied with more expensive knee-components. The distribution of cost of labour and cost of
material was 7 and 93% for new OI-prostheses and 30 and 70% for new S-prostheses.
Discussion
The main finding was not the small difference in costs between the two kinds of prostheses but the significant
difference in number of visits for service. The osseointegration treatment includes other costs (e.g. surgery,
implant, hospitalisation) which also needs to be investigated further.
Conclusions:
Despite fewer visits for prosthetic service with OI-prostheses the overall prosthetic costs for OI-prostheses were
comparable to S-prostheses. This study suggests this is due to higher costs of material used with OI-prostheses
such as more expensive knee-components.
230
Wednesday, Feb 6 / 16:15 - 17:30
Introduction
The extent to which prosthetic alignment influences the gait mechanics of persons with transfemoral amputation
is poorly understood, particularly during mechanically-demanding tasks when knee-joint stability and voluntary
control are exceedingly important. In this study, we sought to characterize the association between prosthetic
alignment and the neuromechanical control options of transfemoral amputees during gait tasks that were designed
to uniquely challenge stance-phase stability and controllability of the prosthetic knee joint.
Methods
Twelve subjects with transfemoral amputation (age 46+/-15 years; mass 88+/-14 kg; height 176+/-7 cm) were
fitted with an Otto Bock 3R95 knee (single-axis, no stance-phase control), rigid pylon, and Otto Bock 1D35
foot for testing. Gait was assessed (kinematics, kinetics, EMG) for different combinations of walking surface
(level; 5-degree incline; 5-degree decline) and alignment (BASE: bench alignment; ANT: 1 or 2 cm anterior knee
translation; POST: 2 cm posterior knee translation).
Results
As expected, external knee extension moments increased for POST (p<0.001) and decreased for ANT (p=0.04)
compared to BASE for all walking surfaces. Regarding ANT, internal hip extension moments increased at
contralateral toe off for level walking (p=0.05) and even more so for declined walking. Subjects also exhibited
persistent trunk flexion throughout stance phase (p=0.01) compared to BASE. Despite the expectation that POST
would increase the hip flexion moment required to initiate knee flexion for swing phase, no significant changes
were observed.
Discussion
For all walking surfaces, anterior knee alignment significantly altered the stability of the prosthetic knee joint, as
evidenced by a prominent shift in external knee extension moment during most of stance phase. Consequently,
subjects increased both their internal hip extension moment and trunk flexion to prevent inadvertent knee buckling
during early stance phase. To understand the underlying control mechanisms associated with this response, future
work will focus on characterizing the corresponding activity of residual-limb musculature.
231
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 12
Room 1.03
Abstract Title: Does A Mechanically-Demanding Task Exaggerate The Effect Of Prosthetic Alignment For
Persons With Transfemoral Amputation?
Abstract number: 226
Authors: S. Koehler, R. Lipschutz, R. Stine, S. Gard
Presenter: S. Koehler
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Prosthetics : Lower Limb - 12
Room 1.03
Abstract Title: Biomechanical Analysis Of A New Prosthetic Suspension System For Lower Limb Amputees
Abstract number: 287
Authors: A. Eshraghi, N. Abu Osman, M. Karimi, H. Gholizadeh, S. Ali, W. Wan Abas
Presenter: A. Eshraghi
Introduction
Suspension in lower limb prostheses is achieved through liners and attachments that link them to the rest of the
prosthetic components. The purpose of this study was to perform biomechanical analysis on a newly-designed
magnetic prosthetic suspension system, and to compare that with two other existing systems of locking and sealin suspension. Our hypothesis was that the new suspension system will cause less pistoning than the locking
suspension system, but higher than the seal-in suspension. We also conjured that the new system will solve the
so-called problem of milking of the locking liners.
Methods
A new prosthetic suspension system was designed and tested mechanically. The system was incorporated into
lower limb prosthetic limbs for lower limb amputees. Each subject was provided with three prostheses fabricated
with three different suspension systems including our new system. The biomechanical analyses were accomplished
by the evaluation of liner-socket interface pressures and pistoning during walking and stair negotiation.
Results
The statistical analysis showed significant difference in pistoning values among the three studied systems. The
pistoning values for the new suspension system were significantly lower than the locking liner during one gait
cycle (P < 0.05). Mean peak pressure values (kPa) were also significantly different between the three systems in
different regions of the residual limb.
Discussion
The Results of the study supported our hypotheses in terms of pistoning and interface pressure. There was
evidence that locking liners cause milking phenomenon at the residual limb which will lead to pain, discoloration
and skin problems in amputees.
Conclusions:
Clinical evaluation of a new prosthetic suspension system revealed that it could successfully retain prosthesis on
the residual limb with an acceptable amount of pistoning. It may also solve the so-called problem of milking of the
locking liners.
232
Wednesday, Feb 6 / 16:15 - 17:30
Introduction
Body powered arm prostheses require too high operating forces. Prosthetic use is found tiresome or even painful.
The required operating forces need to be lowered. The ideal prosthesis should be powered by cable operation
forces and displacements which can be invariably perceived by the user and do not lead to pain or fatigue. Earlier
research showed good perception in a force range between 20 and 30 N at fixed cable displacement. The question
remains: With which cable force and displacement should a prosthesis be operated when also taking into account
cable displacements?
Method
A prosthesis simulator was fitted to 30 subjects without arm defect. Instead of a prehensor an interchangeable
spring was placed at the end of the control cable. The cable forces were measured with a force sensor located
close to the shoulder harness. Cable displacement was calculated though the known spring constant and the
measured cable forces close to the spring. Cable force and displacement were fed back to a laptop running a
LABVIEW programme. The subject was requested to reproduce a given force and hold it constant for 2 seconds.
Visual feedback was enabled every second repetition. Nine different combinations of forces and displacements
were measured.
Results
The smallest replication error (reproduced minus reference force) was found between 24 and 33 N. For every
spring an inverse relationship between cable displacement and replication error was found.
Discussion & Conclusion
The smaller the replication error the better the perception. Since in this experiment the smallest replication error
(and therefore the preferred force level for prosthesis control) was found for cable forces between 24 and 33 N, the
finding of the prior research seems to be confirmed. Perception of cable displacement seems to be dependent on
spring constants and is better at larger spring deformations.
233
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 5
Room 1.05
Abstract Title: Arm Prosthesis Control: Perception Of Cable Activation Forces And Displacements
Abstract number: 263
Authors: M. Hichert, M. Valk, D. Plettenburg, G. Smit
Presenter: M. Hichert
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Prosthetics : Upper Limb - 5
Room 1.05
Abstract Title: Compensatory Motions Observed When Performing Bimanual Activities Of Daily Living
Abstract number: 274
Authors: A. Zinck, P. Kyberd, A. Hussaini
Presenter: A. Hussaini
Patients who undergo an amputation of the upper limb experience a reduction in range of motion and several
degrees of freedom. Though the number of upper limb amputations is relatively small when compared to patients
with lower limb loss, the dexterity and the ability to interact with one’s environment is severely compromised. Even
the most advanced upper limb prostheses available today are nowhere near replicating the function of the natural
upper limb. Componentry used in fingers, wrists and elbow joints of prosthetic devices do not offer sufficient
range of motion and a patient is forced to compensate by twisting their trunk, lifting their shoulders and positioning
themselves in unnatural stances that put them at risk of developing repetitive strain injuries.
The aim of this study was to analyze the compensatory motion of 4 patients with transradial amputation and
compare these against a reference of 20 able-bodied subjects, as they perform a set of controlled exercises. The
movement of the wrist was paid particular importance.
Movement data was captured with the use of the Vicon 512 motion capture system and relative changes in joint
angles were calculated and analyzed. It was observed that there were identifiable compensatory motions during
certain tasks for the prosthesis users. Synergies in head and trunk motion, as well as compensatory movement
in the non-dominant (i.e. prosthetic) arm of patients were observed for activities related to eating, slicing bread,
and stirring tasks. Increases in motion and angles were usually distributed over a number of joint which lessened
the occurrence of larger compensations at any one joint. It was concluded that prosthesis users do perform
compensatory movements to accommodate for their limb loss and that the wrist plays an important role in effective
positioning of a hand or other terminal device when performing certain activities of daily living.
234
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Introduction
Pattern recognition (PR) has been described as a method of controlling more prosthetic arm movements than
those that are possible with current commercial myoelectric devices. Work has shown that PR can also be used
for transradial amputees to control a physical device with seven degrees-of-freedom.
Methods
One individual has been fit with a socket and liner with six electrodes. An embedded controller was developed that
could be programmed with either pattern recognition or two-site direct control. For PR control, EMG from all six
electrodes was input into an LDA classifier running in real-time. For direct control (DC), two sites (over the flexors
and extensors) were used as input. The subject switched between the degrees of freedom and used only the
two signals for control. The two Methods were applied to a multifunction hand-wrist system with wrist pronation/
supination, wrist flexion/extension, and two grasps (three-jaw chuck and key). The subject was trained and took
the device home for a one month trial using each control.
Results
Data (ACMC, SHAP, Jebsen-Taylor, Box-and-Blocks, Clothespin test and a custom survey) were collected using
both two-site and PR control. Usage statistics were recorded as well as subjective feedback. Comparison of
pre-home trial data (ACMC not yet completed) for one user shows PR out-performed in all tests, except Box-andBlocks. It is expected that data from 5 additional users will be collected for presentation.
Discussion
The subject was able to complete all testing tasks using the additional DOFs of the multifunction system. PR
removed the need to switch between motors; the additional degrees of freedom could therefore be accessed more
easily. The subject preferred PR control over the DC method.
Conclusions
Future work will expand upon our initial home trial experiments, further examining the evaluation of PR and DC
multi-function hand-wrist system home trials.
235
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 5
Room 1.05
Abstract Title: A Comparison Of Direct Control And Pattern Recognition Control Of A Seven
Degree-Of-Freedom Hand Wrist System.
Abstract number: 346
Authors: L. Miller, K. Stubblefield, S. Finucane, R. Lipschutz, T. Kuiken
Presenter: L. Miller
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Prosthetics : Upper Limb - 5
Room 1.05
Abstract Title: Rehabilitation And Outcome Of Osseointegrated Amputation Prostheses On Upper Limbs
Abstract number: 398
Authors: K. Caine-Winterberger, S. Jönsson, R. Brånemark
Presenter: K. Caine-Winterberger
Objective
The aim was to describe the osseointegration procedure for surgery, prosthetics and rehabilitation. A titanium
fixture was implanted for first time in a thumb amputation in Sweden in 1990. The same procedure was performed at
transradial amputation in 1992 and at transhumeral level in 1994. The treatment involves two surgical procedures,
where a titanium fixture is operated into the skeleton and after six months a skin penetrating abutment is connected
to the fixture, to enable a prosthetic attachment. Rehabilitation starts shortly after surgery following a strict protocol.
The patient can be supplied with a cosmetic prosthesis after eight weeks and a myoelectric prosthesis after three
months.
Material and Methods
Patients selected to the treatment, were highly motivated, difficult to fit with conventional prosthesis, with
adequate bone quality and no contra-indicated illness. They were operated with titanium fixtures and supplied with
osseointegrated prostheses.
Results
From 1990 to April 2010, totally 37 upper limb amputees were fitted with osseointegrated prostheses. Of these 10
were thumb amputees, 1 partial hand, 10 transradial- and 16 transhumeral amputees. Thirty-one were males and
6 were females. Cause of amputation was trauma in 32 cases, three with congenital deformities and 2 cases with
tumour. Twenty-four were amputated on the right side and 13 on the left. Today 7 patients are non-users due to
either deep infection, loosening of the implant or overload accident of the implant. Patients indicate that overall
function and quality of life were improved since osseointegration, range of motion has increased and prosthetic
use has improved.
Conclusion
Osseointegration improves the prosthetic situation for the individual due to the stable fixation, freedom of motion
and functionality.
References
Jönsson S, Caine-Winterberger K, Brånemark R. Osseointegration amputation prostheses on the upper limbs:
Methods, prosthetics and rehabilitation. Prosth. Orthot. Int 35(2), p 190-200, 2011.
236
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Room 1.05
Introduction
The main function of upper limb is to set
1. Reach
2. Manipulation
3. Prehension activities
Therefore reaching activities are driven by proximal joints like elbow and shoulder. Hence no reaching, manipulation
and prehension activities are possible in case of shoulder disarticulation amputee. The development of simple
functional shoulder disarticulation prosthesis with shoulder cap and modified harness and peroneal operated lever
for shoulder, elbow and terminal device is quite amazing.
Methods
The multi lever mechanism, forming an amplifying unit which is responsible for functional oscillation of arm and
forearm with driving of terminal device.
Results
Control cable system and chest strap is attached as per general principle, peroneal strap terminated with dog hook
through a cable and attached with posterior lever of shoulder joint. By scapular elevation, the posterior lever pulled
downward resulting arm flexion. Cable attached to control attachment strap displaced resulting in forearm flexion
and sound side shoulder flexion will be sources to operate the elbow lock and unlock for operation of terminal
device.
Discussion
The design consists of shoulder cap. The shoulder joint and its extension lever joined with arm unit below the
shoulder joint and it is extended posteriorly, connected with peroneal strap through a cable. The lower end of the
arm, upright is attached with elbow joint as per requirement. The prosthesis is suspended with basic shoulder
harness and dual control cable system and modified figure ‘9’ harness is attached to cable of the elbow lock
and unlock. This shoulder disarticulation prosthesis is operated through body power sources on the principle of
shoulder driven tenodesis orthosis.
Conclusion
This is a versatile simple endoskeletal design shoulder driven functional prosthesis, it restores more comfort and
function and provides more freedom of movement which brings jubilant smile on the face.
237
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 5 Abstract Title: An Indigenious Design Of Shoulder Disarticulation Prosthesis.
Abstract number: 237
Authors: N. Ojha, S. Sahu
Presenter: N. Ojha
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Technology - 1
Room 1.06
Abstract Title: Assessing The Prosthetics Needs Of Farmers And Ranchers In The U.S.A.: Interview Results
Abstract number: 256
Authors: K. Waldera, C. Heckathorne, M. Parker, S. Fatone
Presenter: S. Fatone
Introduction
Farming and ranching in the United States remains a hazardous occupation with the fourth highest level of fatalities
and with 11% of nonfatal agricultural injuries resulting in an amputation. Although the majority of amputations
involve fingers and toes, farmers with major limb amputations (at least the complete loss of a hand or foot) find
that contemporary prostheses are not meeting their occupational needs. A descriptive qualitative study was
undertaken from an engineering perspective to elucidate how prostheses are a help or hindrance in the work of
farming and ranching.
Method
Farmers with a major upper- or lower-limb amputation were interviewed. Data was gathered on current and
past prosthesis use, failures of prosthetic components, and ability to complete farm tasks using a prosthesis.
Additionally, interviews were conducted of prosthetists who serve farmers and ranchers to identify specific devices
and practices utilized with this population.
Results
Analysis of interviews with 40 farmers and 26 prosthetists identified specific themes related to prostheses. These
themes included durability/utility, environment, adaptation, cost, and education. It was also found that farmers
and ranchers with amputations often modified their prostheses, their farm equipment, and their daily and seasonal
routines to continue farming or ranching.
Discussion
All farmers with lower-limb amputations (transtibial and transfemoral) and all farmers with upper-limb amputations
distal to the elbow used prostheses. All farmers experienced device failures at a higher rate of incidence than the
general population of prosthesis users even when they were provided with components considered to be “heavy
duty”. Farmers and ranchers prefer prostheses that are mechanically simple, maintainable locally, and easy to
clean of farm and ranch contaminants.
Conclusions:
Design improvements are needed to achieve prosthetic systems for farmers and ranchers that are more durable,
more affordable, and better adapted to the rigors of the farm and ranch environments.
238
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Room 1.06
Introduction
While Charcot arthropathy (DNOAP) of the foot is well known and represent a threat to modern health systems due
to the fast rising number of diabetic patients, the DNOAP of the hand and the knee is nearly unknown. Only single
case reports are published, systematical studies are missing.
Methods
All patient´s reports suffering of DNOAP who were treated between 1998-2010 in our clinic were included
and systematically searched for DNOAP of the hand and the knee. Then clinical examination, x-rays, and a
standardized questionnaire were done.
Results
5 Patients were included (all female, 4x diabetes type I, 1x diabetes type II, all suffering from polyneuropathy, 4
patients younger than 35y). All patients had multiple complications of the diabetes, 2 died under the age of 30.
We saw 3x DNAOP of the hand, 3x DNOAP of the knee (one patient hand and knee). All patients complained
about paraesthesia, loss of strength and instability without trauma over months. Finding diagnose took years in all
patients. Immobilization improved the clinic similar to the treatment of DNOAP of the foot.
Discussion
There is DNAOP of hand and knee as well, probably with a high number of undiagnosed patients. The course is
similar to the foot and the same treatment standards showed to be effective. Type I diabetes seems to be a risk
factor.
Conclusion
Diabetic patients showing atypical symptoms of the hand and knee should be examined for DNAOP and treated
in the same way as the foot.
Key words
Charcot arthropathy, hand, knee, Diabetes type I, polyneuropathy
239
FREE PAPERS
Session Name and Room: Technology - 1
Abstract Title: Charcot Arhtropathy Of Hand And Knee
Abstract number: 386
Authors: U. Illgner, C. Droste, H. Wetz
Presenter: U. Illgner
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Technology - 1
Room 1.06
Abstract Title: A Pilot Study Investigating The Intra And Inter-Rater Reliability Of Siliconcoach Within The
Field Of Gait Analysis
Abstract number: 473
Authors: E. Davidson, R. Bowers
Presenter: E. Davidson
Introduction
Siliconcoach P&O Clinical Movement Data is a mobile two-dimensional video analysis system designed for the
Prosthetics and Orthotics clinical environment. This pilot study investigated Intra-Rater and Inter-Rater reliability
of the P&O Clinical Movement Data for measuring kinematics during gait analysis.
Methods
Sixteen staff and senior students from the National Centre for Prosthetics and Orthotics and the Bioengineering
Department, University of Strathclyde, measured ankle, knee and hip angles at Initial Contact, Mid Stance and
Terminal Stance on three analysis sessions at one week intervals. To investigate whether predefined anatomical
markers improved reliability of measurements, two videos of the same volunteer were provided, one with markers.
To assess Inter-Rater reliability three participants measured knee flexion at initial contact on videos of 15 different
subjects using predefined anatomical markers. Significance level was set at p<0.05, with reliability ICC 0.7 – 0.9.
Results
Intra-rater reliability at the hip with markers throughout gait is excellent for Initial Contact and Mid Stance (ICC=
0.999), and for Terminal Stance (ICC=1.000). Confidence Intervals for all three were very narrow (CI = 0.998-1.000
and 0.999-1.000) and were highly statistically significant (p<0.001). Without markers, Intra-rater reliability at the
hip whilst still statistically significant (p<0.01), was less reliable (ICC < 0.7). Reliable Results were recorded at all
joints in terminal stance with markers, but not without. Measurement of knee angle at initial contact proved reliable
when inter-rater reliability was assessed (ICC = 0.867), with a fairly narrow confidence interval (CI = 0.710-0.949)
(P<0.05).
Discussion
Results may have been adversely affected by the need to exclude measurements that were not taken according
to the protocol in this relatively small sample.
Conclusions:
Using predefined anatomical markers increases reliability. Results indicate that Intra-rater reliability of Siliconcoach
software varies across the gait cycle and was best in terminal stance. Inter-rater reliability was high.
240
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The Prosthetics and Orthotics work properly when they are well designed and above all when they fit properly with
the anatomic part of the body in interaction. Nowadays, many digital technologies are used to better understand
the static and dynamic information which are then used to design and manufacture P&O items. Although the digital
technologies are spread and used in the diagnostic context along with the biomechanical analysis, the Results are
not properly integrated with the manual and traditional approaches used to manufacture prosthetics ad orthotics.
The manual approach is justified by an economic point of view since it is cheaper compared to industrial and
automated processes, applied here for individual production. The current manufacturing Methods make the P&O
device not adequately accurate and they do not include most of the static and dynamic information acquired through
diagnostic technologies and morphology scan of the body part. Additive technologies could represent a valid
alternative methodology, able to involve the conceptualization of a virtual object which can be properly modified
and directly manufactured thanks to the digital data flow. However, the availability of the virtual model and contour
inputs, such as static and dynamic data, are not sufficient to justify the use of additive technologies, but functional
requirements must be verified for technological feasibility. The consistency of Fused Deposition Modeling was
investigated with an attempt to replace the traditional manufacturing processes of personalized orthotics, in details
feet orthosis, through a Direct Digital Manufacturing approach. An investigation of technological opportunities was
performed through a characterization of materials (physical and chemical tests) and technological process in terms
of tolerances and functional validation of final product, tested by human patients in defined scenarios. At the end,
different additive strategies have been performed in order to individualize the best manufacturing strategy.
241
FREE PAPERS
Session Name and Room: Technology - 1
Room 1.06
Abstract Title: A Potential Design & Manufacturing Alternative At The Service Of Individual And Functional
Orthotics Production
Abstract number: 510
Authors: M. Cavallaro, A. Armillotta
Presenter: M. Cavallaro
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Technology - 1
Room 1.06
Abstract Title: Description Of A System For Wear Time Measurement For Orthopedic Devices Based On
Radio Frequency Identification (Rfid) Technology
Abstract number: 535
Authors:
Presenter: M. Roller
When it comes to treatment provided by orthopedic devices, the conversation often centers on the term
'compliance'. Almost any and all papers that discuss the use of orthopedic devices in terms of correcting, growthguiding or mitigating measures emphasize the importance of patient compliance. This is not surprising since, in
fact, especially there where there is only a small window of treatment time, for example, in the case of helmet
therapy for skull asymmetry (Plagiocephaly), it is necessary to make use of this.A statement known in the field of
scoliosis treatment, Namely 'Only a scoliosis orthosis that is actually worn will end up being effective', has become
somewhat of a truism, but it certainly is on track when putting a finger on the problems of treatment per orthosis.
The goal was to develop the most accurate and practical time monitoring system for everyday clinical and scientific
activity possible. The result is a documentation system that consists of a reading device, software and a small
micro-sensor. The micro-sensor is built into the orthopedic device and stores the temperature in the device every
15 min, every 24 hours. The maximum lifespan of the micro-sensor after the wireless activation is at least 18
months. With the aid of RFID technology, the memory of the micro-sensor is transmitted and read in a wireless
manner. The analyzed data is displayed graphically on the computer monitor and it allows a comparison of the
actual wear time with the recommended wear time specifications. The gestation period monitoring system has
been made clinical use of for one year now. Reports on the initial experience with regard to the suitability for daily
use of the system as well as patient acceptance are currently being submitted.
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Room G.06
Introduction
People with disabilities require access to quality physical rehabilitation services to improve their functional
capacities and autonomy in order to actively participate in all aspects of life. Before the invasion of Afghanistan in
1979 by the USSR there was only limited provision of P&O services. In 1980s P&O services started in the refugee
camps in Pakistan and in Afghanistan through different International organizations and NGOs. These organizations
started to train Afghans as physiotherapists and P&O technicians to meet the demand from individuals requiring
physical rehabilitation. Now International committee of Red Cross (ICRC), Swedish committee for Afghanistan
(SCA), Handicap International (HI) and Kabul Orthopaedic Organization (KOO) have been implementing projects
to extend the reach of quality physical rehabilitation in Afghanistan for several years. This includes access to
prosthetics, orthotics, physiotherapy, corrective surgery across the country. Beside prosthetic/orthotic services at
the centres, Swedish|committee for Afghanistan (SCA) and Handicap International (HI) are also providing CBR
services using Community Based Rehabilitation workers (CBRWs).
Method
The Methods used in this study were desk research, standardized questionnaires, focus group Discussions
(FGDs), and field observations.
Results
Sixteen Orthopaedic Workshops are currently functional throughout the country. Out of sixteen Orthopaedic
Workshops only two are managed by government. According to Central Statistical Organisation (CSO), the current
population of Afghanistan is 29.021 million. It is estimated that 2 % – 3% , (563,000 – 844,500) are people are with
disabilities. Of the wider group of people with disabilities, 1.5% (495,000) are people with physical disabilities who
need some kind of orthopaedic device or mobility aid.
NDSA – 2.7% , UNDP/UNOPS – 3%, WHO estimates 0.5% of a population could need an orthopaedic device.
The current production of prosthetics orthotics and mobility devices in the country is 21,7373 excluding repairs.
This indicates only about 4.39% population in need of orthopaedic devices including mobility devices are presently
able to receive a device where 95.6 % are deprived of it.
Conclusion
There is a serious need to reduce this shortfall as much as possible by all stakeholders and service providers in
the country in an effective and coordinated manner to expend the services.
243
FREE PAPERS
Session Name and Room: Developing Countries - 4
Abstract Title: Prosthetics And Orthotics Services In Afghanistan
Abstract number: 490
Authors: M. Zia
Presenter: M. Zia
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Developing Countries - 4
Room G.06
Abstract Title: A Strategy To Implement The Locally Maintainable Limbs Polycentric Knee In The Developing
World On A Large Scale
Abstract number: 500
Authors: R. Gonzalez
Presenter: R. Gonzalez
Introduction
The LIMBS Knee is a 4-bar polycentric knee specifically designed for implementation in the developing world. The
initial strategy for the LIMBS Knee was to fabricate and maintain the knee at the local clinic level using a jig based
fabrication model. This strategy has proven successful in several clinics around the world and has produced very
high quality locally repairable, polycentric knees.
Methods
To promote uptake of the LIMBS Knee on a large scale, we have enhanced our initial jig based clinic fabrication
strategy with a jig based mass production line in Bangladesh, partnering with a third party that is ISO 9001 and
ISO 13485 certified. The jig based mass production model has allowed for higher quality control than was possible
at the clinic level for both our raw materials and finished product.
Results
The assembly line in Bangladesh is currently producing approximately 1000 knees per year. Scaling plans are in
place as orders increase. All knees are now made from batch tested raw materials, and produced by an ISO 13485
(medical device quality) certified company.
Discussion
The LIMBS Knee is a low-cost, polycentric knee unit which passes ISO 10328 testing requirements and is field
maintainable. The knee has been implemented in 30 clinics in 14 different countries. In order to facilitate the
implementation the LIMBS Knee on a much larger scale, LIMBS has established a jig based mass production
fabrication facility to supplement our already successful jig based clinic fabrication model.
Conclusions
The addition of our refined mass produced LIMBS knee to supplement our clinic fabricated knees will not only allow
us to provide our current clinics with another source of high quality low cost LIMBS Knees, but it will also allow us
to implement the LIMBS Knee on a much larger scale throughout the developing world.
244
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Purpose
To explore the Prosthetic and Orthotic (P&O) service and barriers to receiving P&O care in Malawi. Suggestions
were provided to improve the P&O service.
Methods
18 patient receiving services at the P&O centre in Lilongwe, Malawi, participated in semi-structured interviews. A
qualitative content analysis was applied to analyzing the data.
Findings:
Patients were satisfied with receiving P&O services and a P&O device but there was uncertainty about payment
of treatment. The main barriers experienced to receiving P&O care were lack of awareness about available P&O
services, long travel distance and finance of transportation to P&O centres. Suggestions to reduce barriers were
for instances increased number of P&O centres and more highly educated P&O’s.
Conclusion
Elimination of the experienced barriers is needed to enable persons with physical disabilities access to P&O care
which Results in increased mobility and chance to make their own living. The level of P&O care is sufficient at
present; it is only needed on a greater scale.
Based on author´s bachelor thesis in Prosthetics & Orthotics. Supervisor: Lina Magnusson, Certified Prosthetist
and Orthotist, Master’s degree in Prosthetics and Orthotics, Master’s degree in International Health.
245
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Session Name and Room: Developing Countries - 4
Room G.06
Abstract Title: Exploring The Prosthetic And Orthotic Service And Barriers For Receiving The Service In
Malawi, Based On Interviews With Patients.
Abstract number: 524
Authors: G. Omarsdottir
Presenter: G. Omarsdottir
FREE PAPERS
Wednesday, Feb 6 / 16:15 - 17:30
Session Name and Room: Developing Countries - 4
Room G.06
Abstract Title: A Descriptive Review Of Lower Limb Amputation Cases In Benazir Bhutto Hospital
Rawalpindi, Pakistan, Of Last Five Years
Abstract number: 511
Authors: S. Muhammad, M. Ali
Presenter: S. Muhammad
This is five year retrospective study (January 2007 to December 2011) on amputees of lower limb seen in Benazir
Bhutto Hospital Rawalpindi. Yearly occurrence of amputation cases are noted with leading cause and level of
amputation, in respect to their age and sex.
Material and Methods
During the last five year (January 2007 to December 2011) retrospective study was done 401 cases were founded
in surgery data record registers in orthopedic, main and causality operation theaters of Benazir Bhutto Hospital
and entered on designed Performa. 401 patients (Amputees) were Included in our study, out of which of which 303
(75.6%) were male and 98 (24.4%) were female.
Results
Out of total 401 patients with lower limb amputations, .Our retrospective study concluded that PVD/Diabetes is
a leading cause of amputation. Which is (316 or 78.8%), trauma (44 or 11%), infection (30 or 7.5%), cancer (11
or 2.7%) has least value. Our Results of level of amputation shows that the below knee amputations has highest
percentage (183 or 45.6%) and partial foot has lowest percentage. descending order of the level of the amputation
is(below knee, ray, Above knee, through knee, Syme then partial foot) . The right side lower limb amputations
(280 or 69.8%) are more common them left side. The age group 41-60 shown the highest ratio (182 or 45%), age
61-80 (92 or 22.9%), age 21-40 (81 or 20.0%), age 01-20 (42 or 10.5%) and least in age group 81-100 (4 or 1.0%)
Yearly analysis of the amputations of the lower limb shows that more in the year 2011 (93 or 23.9%), year 2009(91
or 22.7%), year 2008(85or 21.2%) year 2010 (78 or 19.5%) and least in the year 2007 (51 or 12.7%) while the
percentage of re amputation is very less (6%).
246
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Two programs of assistance for developing countries have been administered by ISPO and funded by the US
Agency for International Development (USAID). A theme of the programs has been the awarding of scholarship
funds to persons from developing countries. In the last ten years, over 220 scholarship awards resulting in ISPO
Category I or ISPO Category II certification were made. We were interested in determining the impact of developing
these professionals in their home countries.
Seven training institutions continued to participate in the scholarship award scheme over a ten year period with the
institutions themselves based in low income countries (Cambodia, Tanzania and Togo) or lower middle income
countries (India, El Salvador, Pakistan and Vietnam) according to the World Bank Country Data.
A study of graduates from one or two countries suggested by each of the seven participating institution academic
heads was undertaken. Investigators led a structured interview with study participants. The study was conducted
in the workplace, a Named prosthetic/orthotic clinic of each participant. Participants were ISPO certified graduates
who are 1, 2 or 3 year post-graduation and who have a scope of practice in lower limb prosthetics and/or lower
limb orthotics patient management. Exploratory data analysis was used to determine common areas of strength and areas for development in lower
limb prosthetic/orthotic practice in terms of patient history taking, patient assessment and prosthetic and orthotic
specification and prescription. The Results helped us to map out the development of services and highlighted
areas for the professional development needs of personnel. The impact of training personnel for prosthetic and
orthotic services can be measured in terms of access to services for persons with disabilities. It is important to
map the development of personnel and the services they offer within the context of the specific country situations.
247
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Session Name and Room: Developing Countries - 4
Room G.06
Abstract Title: The Impact Of Training Personnel For Prosthetic And Orthotic Services In Developing
Countries: An Overview
Abstract number: 522
Authors: S. Sexton, D. Blocka, J. Fisk, R. Horvath, M. Stills, B. Krausse, M. Thorpe
Presenter: S. Sexton
FREE PAPERS
Thursday, Feb 7 / 09:00 - 10:15
Session Name and Room: Prosthetics : Lower Limb - 13
Room 1.03
Abstract Title: Weight Distribution Symmetry During Sit-To-Stand And Stand-To-Sit Activities In
Transfemoral Amputees
Abstract number: 424
Authors: V. Agrawal, M. Stalin, C. O'Toole, R. Gailey, I. Gaunaurd, R. Gailey Iii
Presenter: V. Agrawal
Introduction
To determine weight distribution symmetry between lower limbs in unilateral transfemoral amputees (TFAs) and
non-amputee controls during the various events of sit-to-stand and stand-to-sit activities.
Methods
Ten TFAs and 12 controls performed 3-5 sit-to-stand and stand-to-sit trials using a standard height chair and
test shoes. Vertical ground reaction forces (GRFs) from the chair and both feet were collected at 50 Hz using
a Matscan system, as subjects performed the activities upon a verbal command. The sit-to-stand activity was
divided into 5 events: Pre-Ascent; Ascent Initiation; Seat-Off; Deceleration and Standing. The 5 events of standto-sit activity were: Descent Initiation; Deceleration; Seat-Contact; Stabilization and Sitting. Symmetry indices (SI)
between GRFs on amputated/non-dominant and intact/dominant sides were calculated for each event.
Results
In TFAs, maximum asymmetry was present at the Seat-off (SI=36.8%) and Seat-Contact (SI=48%). events.
The Deceleration event, which followed Seat-Off and preceded Seat-Contact events, also showed significant
asymmetry in load distribution between limbs (SI=35.6% and 56.8% respectively). While sitting, weight was
symmetrically distributed between the 2 sides (SI=95%) and during standing the intact leg supported greater body
weight (SI=70%). Controls exhibited high symmetry for both activities.
Discussion
During the course of both activities, TFAs transferred weight over to the intact limb to complete the physically
demanding events of Seat-off and Seat-Contact. Sudden increase in intact limb forces could place higher stresses
on the joints and may contribute to secondary conditions, as these activities are repeated multiple times per day.
Non-amputees did not exhibit 100% symmetry between limbs and had a tendency to load the dominant limb more
than the non-dominant limb.
Conclusion
TFAs are able to successfully execute sit-to-stand and stand-to-sit activities by using the intact limb to compensate
for deficits of the prosthetic limb. Clinicians could discuss various strategies to reduce limb loading asymmetry
while rising and sitting down.
248
Thursday, Feb 7 / 09:00 - 10:15
Room 1.03
Introduction
An individual’s ability to carry a weighted backpack is an important mobility consideration for many people. Most
biomechanical studies examined changes in able-bodied gait when carrying a load; however, research is lacking
on backpack loads and amputee gait.
Methods
Four males with unilateral transtibial amputations walked on level ground at a self-selected pace, with and without
a 24.5kg weighted backpack. A ten-camera Vicon Motion Analysis system collected DoF marker set data. Visual
3D was used to generate 3D joint and trunk kinematics.
Results
At the prosthetic ankle, dorsiflexion before pushoff was consistently greater for the weighted condition. Prosthetic
ankle dorsiflexion velocity was also greater with backpack use. Ankle plantarflexion angle during weight acceptance
was greater on the intact side for weighted walking, but the plantar flexion angle at pushoff was lower. On the
prosthetic side, knee angle during swing was consistently greater for the unweighted condition, but knee angle
on the intact side was greater for backpack trials. Hip flexion angular velocity at foot strike was greater for the
backpack trials, on both prosthetic and intact sides. The hip was also more adducted at pushoff for the weighted
condition. Trunk angle decreased when wearing a backpack load.
Discussion and Conclusion
Differences were found for transtibial prosthesis users when walking with and without a weighted backpack.
Changes at the prosthetic ankle were consistent with increased device deformation under load, with prosthetic
components successfully handling these forces. Trunk motion was minimized with backpack use, likely minimizing
centre of gravity movement away from the base of support. In contradiction to the literature on able-bodied
backpack users, no consistent increase in hip extension was found during weight acceptance and foot off. Further
investigations could provide a basis for workplace backpack load carriage by transtibial prosthesis users.
249
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 13
Abstract Title: Transtibial Prosthetic Gait With Backpack Loads
Abstract number: 243
Authors: E. Lemaire, S. Doyle, M. Besemann, N. Dudek
Presenter: E. Lemaire
FREE PAPERS
Thursday, Feb 7 / 09:00 - 10:15
Session Name and Room: Prosthetics : Lower Limb - 13
Room 1.03
Abstract Title: The Influence Of Polyurethane Cosmeses On The Mechanical Performance Of Transfemoral
Prostheses
Abstract number: 271
Authors: N. Cairns, K. Murray, S. Solomonidis
Presenter: N. Cairns
Transfemoral prostheses are often covered with a flexible Polyurethane foam cosmesis to provide an aesthetic
finish and protect the mechanical components. Despite its flexibility, the cosmesis is known to influence joint
movement and alter amputee gait particularly in the swing phase. In fact amputees can be advised to keep the
limb in full flexion for a period of time when the limb is first issued in order to stretch the cosmesis and reduce its
impact on joint movement. Over time the cosmesis ruptures, typically in the knee area, due to repeated material
flexure during gait. Although the cosmesis limitations are evident in clinical practice, the information is largely
anecdotal; the impact of the polyurethane cosmesis on the function of the prosthesis has not been addressed in
the scientific literature. The aim of this study was to determine if thecosmesis affects the mechanical performance
of the prosthesis and consequently alters amputee gait.
Three transfemoral amputees were voluntarily recruited for the study conducted in the Strathclyde University
Bioengineering Unitgait laboratory, using a VICON motion analysis system. Temporal gait parameters and joint
angles were recorded as the subjects walked at a self-selected speed along a 12 metre level surface under
two test conditions: without wearing a cosmesis and wearing a newly fitted cosmesis. Surface markers were
attached to the prosthesis at standardised landmarks to allow kinematic and kinetic analysis. Differences were
measured in the swing phase gait parameters with and without a cosmesis. This is likely to reduce over time as
the cosmesis stretches. Consequently, ongoing swing phase adjustments may be required to accommodate for
the cosmesis effect on the mechanical performance of the prosthesis. The findings pose the question: how do we
design cosmeses that do not influence the performance of advanced prosthetic components optimally set up for
each amputee?
250
Thursday, Feb 7 / 09:00 - 10:15
Introduction
Saggital and frontal plane motions of foot and ankle are vital to the successful execution of sit-to-stand and standto-sit activities. Unilateral transtibial amputees (TTAs) have a tendency to preferentially load the intact lime more
than the prosthetic limb during these movements. The purpose of this study was to determine the influence of four
prosthetic feet – which allow varying degrees of dorsiflexion/plantarflexion – on weight distribution symmetry of
TTAs during sit-to-stand and stand-to-sit activities.
Methods
Eleven TTAs performed 3-5 arm-rest assisted sit-stand trials on a custom built chair with adjustable height and
adjustable arm-rest position. Order of the four test feet - SACH, SAFE, Talux, Proprio – was randomized and
subjects received training during a 10-14 day accommodation period with each foot. Vertical ground reaction force
data were collected from the chair and feet at 50 Hz with a Matscan system. Subjects performed the activities with
test shoes upon hearing a verbal command. Symmetry in weight distribution between the intact and prosthetic
limbs was determined at the Seat-Off and Seat-Contact events.
Results
Symmetry Indices (SI) were not significantly different between feet for any activity. During sit-to-stand, Proprio had
the highest symmetry (92.6%) of all test feet. For stand-to-sit, all feet had similar SIs.
Discussion
The active ankle dorsiflexion of the Proprio foot during sit-to-stand may have promoted greater weight acceptance
by the prosthetic limb. The lack of significant differences between feet may be related to the absence of inversioneversion motion in all test feet. During stand-to-sit, subjects appeared to have a rapid and controlled descent to
the seat, resulting in similar SIs for all feet.
Conclusion
Sit-to-stand and stand-to-sit activities were not significantly influenced by the ankle motion of test feet. Combination
of inversion-eversion, along with dorsiflexion-plantarflexion may result in greater inter-limb weight distribution
symmetry for unilateral transtibial amputees.
251
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 13
Room 1.03
Abstract Title: Influence Of Ankle Motion In Reducing Sit-To-Stand And Stand-To-Sit Asymmetry Of
Unilateral Transtibial Amputees
Abstract number: 423
Authors: V. Agrawal, R. Gailey, C. O'Toole, I. Gaunaurd, A. Finnieston
Presenter: V. Agrawal
FREE PAPERS
Thursday, Feb 7 / 09:00 - 10:15
Session Name and Room: Rehab Medicine & Surgery - 4
Room 1.05
Abstract Title: Ambulation And Its Support In Patients With Fibrodysplasia Ossificans Progressiva
Abstract number: 400
Authors: N. Haga, Y. Nakahara, N. Ogata
Presenter: N. Haga
Introduction
Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder characterized by progressive ectopic
ossification in soft tissues, leading to multiple joint contractures and spinal deformities. Though ability for ambulation
gradually decreases with age, ambulation and its support have not been investigated in detail.
Methods
Questionnaires were sent to 28 Japanese patients. For patients who have ever visited the authors institution,
support for ambulation was investigated.
Results
Twenty-three patients reported their ambulatory status. At age 12, 17 out of 18 walked independently and one
used wheelchair. Among seven patients aged 30 or over, two walked independently, two used crutches and/or
orthoses, two used wheelchair, and one used a stretcher. Among the eight patients visiting our institution, two
patients aged 34 and 39 used powered wheelchair, but could walk for a short distance with specially modified
crutches. One patient experienced head injury and humeral fracture falling down on the floor. Among the other
six aged <20, only one patient used wheelchair. Three patients aged 12 to 16 could walk independently without
crutches or orthoses in spite of major joint contractures and/or rigid spinal deformities, though one patient needed
shoe modification at age 20.
Discussion
Decreased capacity for ambulation with age leads to decreased ADL and QOL in FOP, but articles regarding
ambulation and its support are scarce. Levy, in 2005, described the benefits of custom-made shoes, canes, and
powered wheelchairs. In the present study, most patients aged <20 could walk independently, and two patients
aged >30 used powered wheelchairs. Because accidental falls may lead to severe trauma, meticulous estimation
of standing balance and walking posture is necessary to promote easier locomotion and prevent falls.
Conclusion
Ambulatory status worsens with age in FOP patients. Support for ambulation to promote easier locomotion and
prevent falls is mandatory.
252
Thursday, Feb 7 / 09:00 - 10:15
Room 1.05
FREE PAPERS
Session Name and Room: Rehab Medicine & Surgery - 4
Abstract Title: Functional Outcome Of A New Surgical Approach In Severe Cerebral Palsy
(Gmfcs Iv And V)
Abstract number: 406
Authors: D. Sharan, A. Sasidharan, R. Ranganathan
Presenter: D. Sharan
Introduction
Cerebral Palsy children with gross motor classification system (GMFCS) levels of IV and V are non-ambulatory
and at a greater risk of complications. Prevention of these complications required to make the patients ambulant
with or without assistive devices.
Methods
In this study 170 children with GMFCS V&IV were participated. Mean age of the participants was 9.68±4.77.
The surgical procedures were performed by a single Orthopedic Surgeon which included Intramuscular Release
and Controlled Tendon Lengthening using the principles of Orthopedic Selective Spasticity Control Surgery
and simultaneous restoration of lever arm dysfunctions and was followed by protocol based, sequenced
multidisciplinary rehabilitation for average of 6 months. The outcome measures such as component of GMFM-88,
Functional Mobility Scale (FMS), Physicians Rating Scale (PRS), Manual Ability Classification System (MACS)
were used to compare the functional status of the child which followed by the rehabilitation.
Results & DISSCUSSION:
The Results showed a significant improvement in all GMFM-88 components and the values were Lying and Rolling
(A); GMFM V: t-9.77 (P<0.001), GMFM IV t-8.56 (P<0.001), Sitting (B); GMFM V: t-20.01 (P<0.001), GMFM IV:
t-12.61 (P<0.001), Crawling and Kneeling (C); GMFM V: t-22.26 (P<0.001), GMFM IV: t-21.01(P<0.001); Standing
(D); GMFM V: t-20.01 (P<0.001), GMFM IV: t-22.64 (P<0.001),Walking, Running and Jumping (E); GMFM V:
t-12.71 (P<0.001), GMFM IV t-15.65 (P<0.001), and total GMFM-88; GMFM V t-31.55 (P<0.001), GMFM IV:
t-32.86 (P<0.001), respectively. The result of Pre-Post PRS evaluation showed a significant improvement for both
sides (Right: t-8.60, (P<0.001); Left: t-9.21, (P<0.001). The improvement in the MACS (Right: t-4.05 (P<0.001);
Left: t-5.74 (P<0.001) and FMS (t-5.46 (P<0.001) were also significant among both GMFCS IV and V.
Conclusion
A well-planned and executed SEMLARASS, followed by intensive rehabilitation, in the context of a multi-disciplinary
team, provides the person with GMFCS levels IV and V a significant functional improvement.
253
FREE PAPERS
Thursday, Feb 7 / 09:00 - 10:15
Session Name and Room: Rehab Medicine & Surgery - 4
Abstract Title: Recurrence In The Treatment Of Charcot Foot Arthropathy
Abstract number: 432
Authors: G. Osterhoff, T. Boeni, M. Berli
Presenter: M. Berli
Room 1.05
Introduction
The Charcot arthropathy (CA) of the foot is a chronic destructive process affecting the osseous foot’s arc in
patients with sensitive neuropathy. Immobilization and total contact casting (TCC) are the treatments of choice,
yet, evidence-based suggestions for the very heterogeneous affected population are missing. Purpose of the
present study was to evaluate patient specific risk factors in the treatment of CA.
Methods
Patients with CA and a minimum follow-up of three months after definite shoe wear or orthotic treatment between
01/2005 and 01/2012 were enrolled and analyzed retrospectively. Demographic and clinical characteristics at time
of diagnosis, treatment paths and duration, recurrence rates and complications were documented.
Results
Forty-three patients (mean age 59±10 years; female 13, male 30; 48 osteoarthropathic feet) were included. Mean
follow-up after definitive treatment was 48 months (range 3 – 155 months). Recurrence of osteoarthropathic activity
occurred in 11 patients with 12 feet (25 %) after a mean 69±41 months follow-up. These patients had shorter initial
immobilization (3±4 months; p=.049). Patients that did not adhere to the suggested treatment schedule had a
higher chance for recurrence (OR 24, CI 5 – 127; p<.001).
Discussion
This is one of the largest series of CA patients focussing on the recurrence of the disease after an extensive
treatment with off-loading until complete disappearance of the symptoms was established. Main factors for
recurrence were a too short immobilization period or non-compliance of the patient.
Conclusion
The mainstay in the treatment of Charcot arthropathy is early diagnosis and immediate, long-lasting off-loading.
Recurrence of osteoarthropathic activity is possible even after several years. Good patient management with a
close doctor-patient relationship may be the key to avoid these.
254
Thursday, Feb 7 / 09:00 - 10:15
The aim of the study is to identify a relationship between post amputation outcome (i.e. limb fitted, non-limb fitted
and died) with pre amputation key characteristics i.e. aetiology, demographics, co-morbidities, pre admission
mobility and level of amputation using a National database of amputees in Scotland from 2007-2009.
Method
Rehabilitation data is collected on every person undergoing a major lower limb amputation in Scotland. The
database is called SPARG (Scottish Physiotherapy Amputee Rehabilitation Group). The data is inputted in
Scotland and quality checked by a data management group. Quantitative statistical analysis was performed with
Minitab 15. The Population cohort excluded those undergoing amputation for trauma, tumour or orthopaedic
aetiologies, focussing on Peripheral arterial disease patients with or without diabetes. Levels of amputation other
than trans-femoral or trans- tibial were also excluded as more likely performed for non dysvascular reasons.
Results
The population based cohort of 1739 amputees in Scotland showed 41% of amputees went on to limb fit with
prosthesis, 15.9% died during rehabilitation and 38.6% did not limb fit. Of those who limb fitted 73% were males
with a mean age of 66.5 years. Of the limb fitted patients 53.4% were diabetics as opposed to 46.6% PAD with
no diabetes. The more distal levels of amputation were fitted, 71% trans- tibial, as opposed to 16% Trans femoral
amputees. Bilateral amputees accounted for 12% of the cohort limb fitted.
Conclusion
Dysvascular amputations occur more commonly in men with a 1:1 ratio of those with or without diabetes. Men more
frequently proceed to limb fitting with more distal amputations being limb fitted. There is no significant difference in
the co-morbidity index of those who limb fit to those who do not. Those who died during the rehab process were
older by approximately 6 years.
255
FREE PAPERS
Session Name and Room: Rehab Medicine & Surgery - 4
Room 1.05
Abstract Title: Is There A Difference In The Characteristics Of An Amputee Population When Divided Into
Outcome?
Abstract number: 420
Authors: F. Smith, L. Paul
Presenter: F. Smith
FREE PAPERS
Thursday, Feb 7 / 09:00 - 10:15
Session Name and Room: Innovations - 2
Abstract Title: Locking Single-Axis Prosthetic Ankle For Stability During Standing
Abstract number: 162
Authors: A. Hansen, J. Dawson, G. Lahr, N. Smith, M. Sass, D. Castle, S. Morin, E. Nickel
Presenter: A. Hansen
Room 1.06
Introduction
Ankle-foot systems of able-bodied persons create effective rocker shapes that are curved during walking (radius
~ 1/3 of leg length), but that are flat during standing and swaying (radius ~ 2 times leg length). The purpose of this
project was to develop a single-axis prosthetic ankle that could lock for standing and unlock for walking, providing
biomimetic rocker shapes for these tasks.
Methods
A group of mechanical engineering students from the University of Minnesota worked with engineers and
technicians at the Minneapolis VA Health Care System to design and fabricate a working prototype of a locking
single-axis prosthetic ankle. The prototype was tested under “pseudoprostheses” for walking (ankle unlocked)
and standing/swaying (ankle locked) in a motion analysis laboratory with 8 Qualisys cameras and a Bertec
instrumented treadmill to verify function.
Results
The final design used a sliding mechanism to limit motion of the ankle in standing mode and allow a range of
motion in walking mode. A Firgelli linear actuator was used to move the slider between the “locked” and “unlocked”
states. This actuator was controlled wirelessly using a key fob. The final design fit within a College Park cosmetic
foot shell. The best-fit radii of the locking ankle-foot prototype in walking and standing modes were 1/2 leg length
and 3/2 leg length respectively.
Discussion
Use of a locking single-axis ankle-foot prosthesis could provide enhanced stability for lower limb amputees with
balance deficiencies, particularly those with above-knee and/or bilateral amputations. The system we developed
could be improved by microprocessor control of the modes and by providing locking over a range of ankle angles.
Conclusions:
A locking single-axis prosthetic ankle was developed and tested. Results show significantly different effective
shapes for standing and walking modes. Future work is needed to assess the benefits of this device for prosthesis
users.
256
Thursday, Feb 7 / 09:00 - 10:15
Introduction
This paper presents the preliminary experience of a ”plaster-less” orthotic fabrication technique based on the
dilatancy principle investigated by WJ Mead in 1940s. This project is funded by the National Institute on Disability
and Rehabilitation Research (NIDRR) of U.S. Department of Education to develop an improved system for capturing
the impression of a body part in order to efficiently fabricate custom orthoses for individuals with disability.
Methods
This development project involves: design of casting systems; laboratory testing on plaster models; clinical
evaluation on consented able-bodied subjects and individuals with disability; review of data; demonstration for
feedback, and, knowledge translation.
Results
The initial trials on original plaster replicas of lower limbs for creating positive plaster models showed dilatancybased casting consistently yielded key dimensional measurements within 0-2mm of traditional circumferential
plaster-based wraps. An acceptable impression (negative polystyrene mold) can be formed easily and rapidly
using the dilatancy orthotic casting system and a specially designed casting frame. Conversion of the formed
negative polystyrene mold into a positive sand model requires a few special steps because of the complexity
of the anatomy around the ankle joint. However, the dilatancy-based casting system not only captures shapes
accurately, it also allows changes of hindfoot and forefoot position of the positive model.
Discussion
To date, the dilatancy-based casting system with a casting frame appeared to be a very promising technology for
fabricating ankle-foot orthoses.
Conclusion
Like the previous prosthetic dilatancy casting system (Wu et al, 2009), it is expected that the orthotic dilatancy
casting system could result in significant reductions in time, cost and waste materials produced as compared with
conventional means. As an alternative to both plaster-based and CAD-CAM-based approaches, we believe that
dilatancy-based orthotic fabrication will be attractive within both resource-limited and healthcare-cost-containment
environments worldwide.
257
FREE PAPERS
Session Name and Room: Innovations - 2
Room 1.06
Abstract Title: Development Of A Low-Cost Dilatancy-Based Casting System For Fabrication Of Ankle-Foot
Orthoses: A Preliminary Report
Abstract number: 308
Authors: Y. Wu, C. Robinson, H. Casanova, J. Michael, S. Gard
Presenter: Y. Wu
FREE PAPERS
Thursday, Feb 7 / 09:00 - 10:15
Session Name and Room: Innovations - 2
Abstract Title: Osseointegration In Transfemoral Amputees. The Gothenburg Experience.
Abstract number: 439
Authors: Ö. Berlin, P. Bergh, B. Gunterberg, K. Hagberg, B. Rydevik, R. Brånemark
Presenter: Ö. Berlin
Room 1.06
Introduction
Transfemoral amputations due to trauma or tumor surgery often cause problems with conventional socket
prostheses. In 1999 we initiated the prospective OPRA study (Osseointegrated Prosthesis for Rehabilitation of
Amputees) using standardized surgery, equipment and rehabilitation program.
Methods
The surgery consists of a two-stage procedure. First a titanium screw (fixture) is inserted into the remaining
skeleton (S1 operation). Six months later a second implant (abutment) is inserted into the first, allowing it to
penetrate the skin (S2 operation). Gradual increase of loading and activity are initiated over a 6-month period.
Results
The OPRA study includes 51 patients with 55 implants (1999 – 2010). Follow up is 2 years. Four implants have
been removed due to loosening (3) or infection (1). One patient was lost to follow-up, two were excluded. The
implant survival was 92 % (48/52). The patients had an average of one superficial infection every two years.,
successfully treated conservatively in all cases. There were 6 deep infections in 4 patients. All but one were
successfully treated by conservative means. Four patients had 9 mechanichal complications (bent or fractured
implant parts) and 3 skeletal fractures occurred. Prosthetic use, prosthetic functions and global quality of life were
all significantly improved (p<0.001) and prosthetic problems were reduced (p<0.001).
Discussion
The implementation of a standardized OI surgical technique and the graded rehabilitation protocol is of importance
for the promising Results. The benefits are related to the removal of the socket as attachment of the prosthesis to
the stump. The amputee no longer has skin ulcers, pain when loading, and problems with stump volume changes.
Normal sitting comfort and normal hip range of motion can be expected.
Conclusion
All these changes lead to a significantly improved quality of life for the individual with a transfemoral amputation.
Most complications can be handled appropriately.
258
Thursday, Feb 7 / 09:00 - 10:15
Introduction
Technological advancements in lower limb prostheses have resulted in actuated motors in both knees and ankles.
Currently, these components use “state-based” control via information measured from various electro-mechanical
sensors attached to the prosthesis. It is proposed that the additional information from the user’s EMG to the
intrinsic controller will enable the intent of the user to signal transitions between “states”.
Methods
To extract useful control information, it is imperative that consistent and high-quality EMG data be collected from
the patients. Different approaches are presented to maintain consistent electrode placements on individuals with
transfemoral and transtibial amputations during 1) static, non- weight bearing conditions, and 2) during dynamic
weight-bearing activities.
Results
After several iterations of the electrode/skin interface, the EMG being collected has proven effective in both
conditions. Performance measures: Classification Accuracy, Completion Time and Completion Rate have been
obtained for individuals with transfemoral and transtibial amputations in order to determine their ability to control
prostheses with 2 or 4 degrees of freedom.
Discussion
Our Results show that a variety of Methods, similar to those used in upper limb fittings, may be used to collect
high quality EMG data during static non-weight bearing conditions. These outcomes are presented in a real-time
environment utilizing both active prostheses and virtual environments. EMG data collection during dynamic weightbearing activities is more challenging. The type, size, shape, and placement of electrodes must be carefully
chosen to maintain contact with the individual without comprising comfort when weight bearing through the socket.
Conclusions
Based on our preliminary work, we feel that it is plausible to obtain and use EMG from individuals with lower limb
amputations to control powered prostheses. Results of data collection and classification will be presented as we
attempt to define parameters for “state-changes” within the control of powered knees and ankles.
259
FREE PAPERS
Session Name and Room: Innovations - 2
Room 1.06
Abstract Title: Utilizing Emg From Individuals With Lower Limb Amputations To Control Powered Prostheses
Abstract number: 152
Authors: R. Lipschutz, L. Miller, T. Kuiken, H. Daley, A. Simon, S. Finucane, L. Hargrove
Presenter: L. Miller
FREE PAPERS
Thursday, Feb 7 / 12:00 - 13:15
Session Name and Room: Prosthetics : Lower Limb - 14
Room 1.03
Abstract Title: Improved Energy Management – A Combination Of Energy Efficient Structures And
Optimised Dynamic Alignment.
Abstract number: 219
Authors: J. Mccarthy, G. Harris, J. Ross, A. Ward, S. Zahedi
Presenter: J. McCarthy
Summary
Trials have been carried out on a new prosthetic foot which combines the energy management elements of a
dynamic foot system with the improved alignment capabilities of a biomimetic ankle.
Introduction
Overall performance of a Prosthetic foot requires not only efficient energy return, but also an optimised alignment
especially over uneven terrain and across a range of walking speeds. A new design of foot has been produced
which combines highly efficient heel, toe and axial springs with a damped hydraulic ankle motion to simulate a
simple spring and dashpot model of a natural foot and ankle. A series of tests, trials and clinical evaluations have
been carried out to fine tune and balance the performance of the overall system.
Methods
A series of gait experiments using a force platform and load cell have been carried out to compare the performance
of the new foot to an existing bio-mimetic design. The effect of the various functional elements during different
phases and styles of gait was analysed. Test simulations were used to show how various movements can be
optimised to give a harmonised system. User response was also recorded.
Results / Discussion
Kinematic data has been compared for simple dynamic feet, biomimetic feet and the new design which shows
the benefits of the new system. An optimised range of movement has been identified based on energy distribution
during stance and direct user feedback.
Conclusion
Improved prosthetic foot function requires not only efficient energy management but also an optimised alignment
for a given walking or standing situation. It is important that the elements in the system are balanced so that the
amputee can enjoy a smooth, controlled gait over a range of walking speeds and terrains.
260
Thursday, Feb 7 / 12:00 - 13:15
Introduction
Functional activities of ramp and stair negotiation place different biomechanical demands on prosthetic feet than
level walking. The purpose of this study was to investigate the design features of prosthetic feet that result in
greater work symmetry during ramp and stair gait.
Methods
A custom-built 24-foot long wooden ramp was used for incline/decline walking, while stair ascent/descent was
done on an 11-step staircase. Eleven unilateral transtibial amputees tested four feet – SACH, SAFE, Talux and
Proprio. There was a 10-14 day accommodation period with each foot. Subjects were instructed to not use handrails on ramps and to use them only for support on stairs. Vertical ground reaction forces were collected at 50Hz
using F-scan insole sensors and symmetry in external work (SEW) between the intact and amputated limbs was
calculated for each test session.
Results
For decline walking, the Talux foot had 100% work symmetry between limbs; which was significantly greater than
the SACH/SAFE feet. During incline walking, SEW values were not significantly different between feet. While
descending stairs, all feet had low SEW values, with no significant differences between feet. For stair ascent, the
Proprio foot resulted in a significantly higher symmetry than SACH/SAFE feet.
Discussion
‘J’ shaped ankle and heel-to-toe foot plate design of Talux foot promoted greater symmetry during decline walking.
Absence of active power generation by prosthetic feet likely resulted in similar SEW values between feet during
incline walking. During stair ascent, swing phase dorsiflexion of Proprio foot facilitated forward center-of-mass
progression resulting in higher symmetry. While descending stairs, subjects rolled-over the edge of steps with all
test feet.
Conclusion
Gait symmetry during functional activities can be influenced by the prosthetic foot design. Features such as “J”
shaped ankle, heel-to-toe foot plate and active dorsiflexion appear to be beneficial during descending ramps and
ascending stairs.
261
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 14
Room 1.03
Abstract Title: Comparing Prosthetic Feet On Ramps And Stairs Using The Symmetry In External Work
Meassure
Abstract number: 416
Authors: V. Agrawal, R. Gailey, C. O'Toole, I. Gaunaurd, A. Finnieston, R. Tolchin
Presenter: V. Agrawal
FREE PAPERS
Thursday, Feb 7 / 12:00 - 13:15
Session Name and Room: Prosthetics : Lower Limb - 14
Room 1.03
Abstract Title: The Effect Of Dermo And Seal-In X5 Liner On Transtibial Amputees’ Satisfaction And
Perceived Problems
Abstract number: 293
Authors: S. Ali, N. Abu Osman, H. Gholizadeh, A. Eshraghi, L. Abdul Latif, P. Varadan, N. Abd Razak
Presenter: S. Ali
Introduction
Prosthetic liners have a significant effect on amputee’s satisfaction and comfort. Prosthetic liners are available in
different materials to provide a contented interface by adding a soft cushion between the stump and the socket.
Dermo liner and Seal-In X5 liner are two new interface systems and their effect on patient satisfaction and
perceived problem is unclear. The aim of this study was to investigate the effect of these two liners on patient
satisfaction and perceived problems.
Methods
Ten unilateral transtibial amputees have participated in this study. Two prostheses were fabricated for each
amputee, one with Dermo liner and the other one with Seal-In X5 liner. Amputees use the prostheses for four
weeks. After four weeks of using the prostheses, each subject filled in a Prosthetic Evaluation Questionnaire
(PEQ) regarding the satisfaction and problems faced with the two liners.
Results
Significant difference were found between the two liners regarding satisfaction and problems (p<0.05). In five out
of nine questions significant difference were recorded regarding satisfaction with Dermo liner compared to the
Seal-In X5 liner. Suspension score was significantly higher (p<0.05) for the Seal-In X5 liner compared to Dermo
liner. Subject faced significantly higher problems with the Seal-In X5 liner compared to Dermo liner.
Discussion
The subjects were more satisfied and had fewer problems with Dermo liner. It seems that Dermo liner provides
more comfortable interface fitting in the socket comparing to the Seal-In X5 liner. However, further studies are
needed with a large subject population to study which system give more comfort and the least problems for
patients.
Conclusion
There is a good reason to believe that the Dermo liner provide more comfortable interface between the stump
and liner compared to Seal-In X5 liner. Therefore Dermo liner can be the best interface for transtibial amputees’.
262
Thursday, Feb 7 / 12:00 - 13:15
Room 1.03
Introduction
Questions about mobility were administered to a large sample of individuals with unilateral lower-limb amputations
as part of development of the Prosthetic Limb Users Survey-Mobility (PLUS-M). This study investigated the
presence of distinct latent classes of prosthetic limb users based on responses to a subset of candidate mobility
items. Latent class analysis of cross-sectional data was used to empirically identify groups of individuals with
similar patterns of association in symptoms.
Methods
Lower limb prosthetic users over 18 years of age with amputation from trauma or dysvascular causes responded to
a survey of mobility, health symptoms, and quality of life indicators. Latent classes were derived from participants’
responses to a subset of mobility items selected for their correspondence to US Medicare Functional Classification
Levels (MFCL). Model fit criteria (BIC, entropy) and class interpretability guided class selection.
Results
Respondents (n=616) completed 23 mobility items. A four-class solution was selected based on statistical
considerations and interpretability of classes. Class 1 (n=111, 17.8%) reported best mobility, least problems
with physical and social functioning, and highest employment level (72%). Class 2 (n=197, 31.6%) reported
some difficulties with mobility and physical function; nearly half (47.2%) were employed. Class 3 (n=207, 33.1%)
reported moderate difficulties with mobility, physical and social function, and higher unemployment (75.4%). Class
4 (n=101, 16.2%) reported low mobility, low physical and social function, and high anxiety, depression, fatigue, and
sleep disturbance. Most Class 4 respondents were unemployed (91.1%). Class 1 and 2 had higher proportions of
people with below knee amputations and amputations due to trauma.
Discussion
Prosthetic users with higher mobility report better functioning on all aspects of physical and psychosocial function.
Better mobility and overall function appears associated with higher employment levels.
Conclusion
Future studies should compare these empirically-derived classes to existing classifications of mobility.
263
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 14
Abstract Title: Empirical Support For Distinct Mobility Groups Of Prosthetic Users
Abstract number: 299
Authors: D. Amtmann, R. Askew, D. Abrahamson, S. Morgan, B. Hafner
Presenter: D. Amtmann
FREE PAPERS
Thursday, Feb 7 / 12:00 - 13:15
Session Name and Room: Prosthetics : Lower Limb - 14
Room 1.03
Abstract Title: Development Of Mechanically Controlled Prosthetic Knee Unit For Stair Ascent
Abstract number: 337
Authors: K. Inoue, R. Harada, T. Wada, S. Tachiwana
Presenter: K. Inoue
Introduction
Stair ascent is a demanding activity for transfemoral amputees because of the restricted prosthetic knee joint
function. To improve prosthetic knees, development of not only motorized and microprocessor-controlled knee
units but also mechanically controlled ones is required. This paper therefore proposes a transfemoral prosthetic
knee joint unit with a novel mechanism for stair ascent.
Methods
The proposed knee joint (link knee joint: LKJ) unit was designed to convert external force into knee flexion lock and
knee extension motion. This unit has a nearly zero-friction knee joint; it also contains a linear joint that is supported
by springs and is shortened by external forces such as ground reaction force. Depending on the magnitude of the
external force that causes displacement of the linear joint, the link mechanism of the LKJ unit limits the maximum
knee flexion angle. This maximum angle is determined by displacement of the linear joint. The LKJ unit also
generates knee extension motion when the external force increases. These functions work in joint angles ranging
from 90° to 150°.
Results and Discussion
In stair ascent experiments performed using a simulated prosthetic leg, the LKJ unit facilitated stair ascent in a
step-over-step manner without assistive devices—an impossible feat with existing mechanically controlled knee
units. The knee joint angle was nearly 130° at the beginning of the stance phase of the prosthetic leg. This angle
increased at a nearly constant rate to 180° through the stance phase. These Results suggest that after the knee
joint angle became 150°, knee extension occurred because of inertia of the thigh and upper body.
Conclusions
The proposed knee joint unit mechanically restricts the maximum knee flexion angle and generates knee extension
motion depending on the external force, without requiring external power. It facilitates stair ascent in a step-overstep manner without assistive devices.
264
Thursday, Feb 7 / 12:00 - 13:15
Introduction
Immobilisation following ankle fracture is essential whether treated conservatively or surgically. However there is
evidence to suggest that early weight bearing applied during the immobilisation period may improve outcomes.
The purpose of this study was to investigate whether there is a difference in pressure distribution over the sole
between functional ankle braces and a cast.
Methods
The study was an IRB approved, prospective, randomised controlled study. Ten healthy subjects with no recent
history of lower limb injury gave informed consent and were recruited. Pressure distribution under the sole was
measured while walking on an instrumented treadmill at self selected speed. This was done for five conditions:
normal shoe, fibreglass cast with walking sole and three types of functional ankle braces (Rebound®, Equalizer
Air Walker® and XP Walker™). Average pressure under the hind, mid and forefoot was measured. An analysis of
variance was performed on the data.
Results
The Rebound showed significantly less pressure under the forefoot and hindfoot (30.8N/m^2, 21.7N/m^2
respectively) compared to the fibreglass cast (forefoot,62.3N/m^2; hindfoot 50.6 N/m^2), the Equalizer (forefoot,
60.8N/m^2; hindfoot 41.3N/m^2) and the XP Walker (forefoot, 79.5N/m^2; hindfoot, 52.2 N/m^2). Intraclass
correlation coefficients (ICC) were 0.63 and 0.6 respectively for the forefoot and hindfoot indicating the reliability
of the measures. While significant differences were seen for average midfoot pressures, an ICC of 0.02 indicates
poor reliability.
Conclusion
Differences in average pressure on the forefoot and hind foot were seen between the conditions with the Rebound
brace showing the least amount of pressure on both the forefoot and the hindfoot. To our knowledge this type of
data has not previously been published. This reduced pressure could indicate that it would be more comfortable to
walk in the Rebound brace and thus weight bearing exercise could take place earlier
265
FREE PAPERS
Session Name and Room: Orthotics: Lower Limb - 5
Room 1.05
Abstract Title: A Comparison Of Fibreglass Casting And Functional Ankle Brace For Ankle Fractures
Abstract number: 342
Authors: M. Nicholls, T. Ingvarsson, A. Ludviksdottir
Presenter: G. Omarsdottir
FREE PAPERS
Thursday, Feb 7 / 12:00 - 13:15
Session Name and Room: Orthotics: Lower Limb - 5
Room 1.05
Abstract Title: Comparison Of Anterior And Posterior Afo In Foot Drop Patients Using Metabolic And Gait
Analysis
Abstract number: 532
Authors: H. Uppal, G. Handa, U. Singh, S. Wadhwa, S. Yadav, R. Pandey
Presenter: H. Uppal
Introduction and aim
Anterior AFO is a fairly recent approach but research studies are scarce. The metabolic analysis and energy
efficiency aspects of Anterior AFOs are a potential topic of research. Aim is to compare the effect of anterior and
posterior AFO in foot drop patients on metabolic and gait parameters.
Purpose
A pilot study was done to investigate and compare the changes in terms of rate of oxygen consumption (metabolic
equivalent), VO2, VCO2, VO2/Kg body weight, VCO2/Kg body weight, and various gait parameters in foot drop
patients with the use of anterior and posterior AFOs.
Materials
20 unilateral foot drop patients who could walk independently or with a cane. Patients with LMN paralysis or those
having spasticity score of <2 as per the Modified Ashworth Scale were incorporated in the study. Methods Ethical
clearance was obtained. Cross over study in which metabolic and gait analysis of the patients was carried out while
wearing anterior and posterior AFOs independently. The study also incorporated a questionnaire about patient’s
preference.
Results
Anterior AFO is more energy efficient than posterior in metabolic analysis however there is no significant difference
between the two in gait analysis except in terms of double support time. Anterior AFO was preferred by 60% as
compared to posterior by 40%. Further 90%, 55% and 70% patients preferred anterior AFO over posterior in terms
of cosmesis, donning and doffing and ADL respectively.
Conclusion
The prescriptions for foot drop orthoses should also consider anterior AFOs wherever suitable and as per the
patient’s preference.
266
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The use of stance control orthotic knee joints are becoming increasingly popular as unlike locked knee-ankle-foot
orthoses, these joints allow the limb to swing freely in swing phase while providing stance phase stability, thus
aiming to promote a more physiological and energy efficient gait. It is of paramount importance that all aspects
of this technology is monitored and evaluated as the demand for evidence based practice and cost effective
rehabilitation increases.
A robust and thorough literature review was conducted to retrieve all articles which evaluated the use of stance
control orthotic knee joints. All relevant databases were searched, including The Knowledge Network, ProQuest,
Web of Knowledge, RECAL Legacy, PubMed and Engineering Village. Papers were selected for review if they
addressed the use and effectiveness of commercially available stance control orthotic knee joints and included
participant(s) trialling the SCKAFO. A total of 11 publications were reviewed and the following questions were
developed and answered according to the best available evidence:
1. The effect SCKAFO (stance control knee-ankle-foot orthoses) systems have on kinetic and kinematic gait
parameters
2. The effect SCKAFO systems have on the temporal and spatial parameters of gait
3. The effect SCKAFO systems have on the cardiopulmonary and metabolic cost of walking.
4. The effect SCKAFO systems have on muscle power/generation
5. Patient’s perceptions/ compliance of SCKAFO systems
Although current research is limited and lacks in methodological quality the evidence available does, on a whole,
indicate a positive benefit in the use of SCKAFOs. This is with respect to increased knee flexion during swing
phase resulting in sufficient ground clearance, decreased compensatory movements to facilitate swing phase
clearance and improved temporal and spatial gait parameters. With the right methodological approach, the benefits
of using a SCKAFO system can be evidenced and the research more effectively converted into clinical practice.
267
FREE PAPERS
Session Name and Room: Orthotics: Lower Limb - 5
Room 1.05
Abstract Title: Use Of Stance Control Knee - Ankle - Foot Orthoses: A Review Of The Literature.
Abstract number: 397
Authors: P. Mcgeachan, K. Ross
Presenter: P. McGeachan
FREE PAPERS
Thursday, Feb 7 / 12:00 - 13:15
Session Name and Room: Orthotics: Lower Limb - 5
Abstract Title: Orthotic Corrections Of Infantile Tibia Vara
Abstract number: 34
Authors: S. Alsancak, S. Guner, H. Kinik
Presenter: S. Alsancak
Room 1.05
Several Methods have been described for orthotics treatments on infantil tibia vara. The aim of the study is to
compare the effect of different type of orthoses and correction Methods on decreasing the curve in children
with severe genu varum. Three different type of Knee-Ankle-Foot Orthoses (KAFOs) were applied in 35 lower
extremities of 22 pediatric patients aged 19-38 months. The same design was applied to the orthosis in the
corrective forces on the femur, while different designs were applied in the corrective forces on the tibia. The
orthoses applied to 20 patients were evaluated for the differences among them and the effects of the orthoses on
the treatment process. In addition, the Methods used in the treatment, the problems encountered, production of
different type of orthoses, convenience of application of the orthoses, and the dimension of patient satisfaction are
discussed in this paper.
The mean duration of treatment of the patients until completion of treatment was 25.3 ± 9.7 weeks with a minimum
of 9 weeks and maximum of 41 weeks. No statistically significant correlation was found between the duration
of orthoses in these with succesfully outcome and percentile height and percentile weight of the patients. When
the relevance between the type of orthoses and duration of treatment was analyzed, significant differences were
found between Type I and Type II, and Type I and Type III (p<0.05), while no difference was found in the duration
of treatment between Type II and Type III. We found that bracing is an effective form of treatment for infantile tibia
vara up though age 38 months. We conclude that full-time using and use of as a-5 force on the KAFOs which
forces full lenght of the limb.
268
Thursday, Feb 7 / 12:00 - 13:15
Room 1.06
Introduction
Prosthetics research studies are mainly focused either on new prosthetic designs or studying the impact of these
designs on the function and wellness of individuals with amputations. The field of prosthetics presents a growing
area of research and thus it is important research studies conducted in this area are well designed and executed.
The randomized clinical trial (RCT) is the gold standard of research designs, providing the best evidence of effect.
However, RCTs are costly and time-consuming and usually require a large population. Issues of underpowered
studies, sample size, and recruitment goals often plague prosthetics research. In this abstract, we will summarize
strategies that prosthetics researchers may consider for study designs in which small samples sizes are expected.
Methods
Design parameters that can be utilized include randomization of subjects, subjects acting as their own internal
controls or using a cross-over design. Standardizing prosthesis use; example all participants are within one year
post-fitting or between 2-5 years of fitting. When newly designed prosthesis are introduced a standard acclimation
period needs to be utilized across compared prosthesis. If study involves prosthesis knee research, care should
be taken to standardize other components foot and socket. Subjects should be grouped based on quantitative
measures instead of their K-levels. Validated clinical outcome measures along with quality of life measures and
quantitative measures of prosthesis usability and compliance should be included. Results Clear study objectives
without trying to find the answers to all questions at one go, Results in a good design. Adding quantitative outcomes
will help achieve good Results with small samples.
Discussion
Given the small sample sizes in prosthetic studies, it is important that studies are carefully planned and executed.
Conclusion
Researchers and funding sources will value small n studies and encourage this area of research if well-designed
studies are regularly published.
269
FREE PAPERS
Session Name and Room: Evidence Based Practices - 3
Abstract Title: Design Of Research Studies In Prosthetics
Abstract number: 60
Authors: R. Lipschultz, A. Jayaraman, T. Kuiken
Presenter: A. Jayaraman
FREE PAPERS
Thursday, Feb 7 / 12:00 - 13:15
Session Name and Room: Evidence Based Practices - 3
Abstract Title: Intensive Training Camp For Children With A Myoelectric Prosthetic Hand
Abstract number: 456
Authors: L. Hermansson, H. Lindner, L. Sjöberg
Presenter: L. Hermansson
Room 1.06
Since 1978, the Limb Deficiency and Arm Prosthetic Centre (LDAPC) at Örebro University Hospital in Sweden
offers a 5-day training camp for paediatric myoelectric prosthesis users1. The aim of the camp is to support the
establishment of a regular prosthesis wearing pattern, increase capacity for control of the device, and establish
prosthesis use in everyday tasks. Every year in August paediatric myoelectric hand users and their parents are
invited to attend this intensive training. The camp consists of around 8 hours of scheduled training each day,
both in everyday tasks and outdoor play activities. A structured programme with training of fine motor skills in
the mornings and gross motor skills later in the days is prepared by the occupational therapists. The aim was to
evaluate the effectiveness of this training procedure on children’s ability to operate the myoelectric hand.
During 8-13 August, 2010, 11 children (aged 6-9, 6 boys) with unilateral below-elbow deficiency participated in the
camp. The Assessment of Capacity for Myoelectric Control (ACMC)2 was used to evaluate the effectiveness of
intensive training on ability to operate the hand. Every child performed an ACMC activity on the first and the last
day of the camp (packing suitcase). Their performances were videotaped and scored by an ACMC rater that did
not take part in training of the participants at the camp. An ability score for each child was calibrated by Winsteps
program.
The average ability scores changed from 2.45 logits to 5.04 logits. Most of the children (n=8) had a big change in
the ACMC items that measure timing in grasping and releasing objects. The Conclusion is that the training camp
is effective in improving the children’s ability to operate a myoelectric hand. The long-term effects on wearing time,
skill and bimanual performance from intensive training camps need further studies.
270
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Introduction
Continuous Quality Improvement (CQI) seeks to improve healthcare outcomes by monitoring healthcare outcomes,
maintaining a customer focus, and understanding processes of care. CQI requires the use of performance
indicators that specify key desired outcomes and al-lows comparisons across facilities or over time within a facility.
This presentation describes a quality improvement consultation project that we provided to five Midwest O&P
facilities after they collected outcomes data using the Orthotics & Prosthetics User Survey (OPUS).
Methods
Five ABC-accredited facilities participated. Eligibility criteria included referral for a lower limb prosthesis, age 18+,
and ability to read and answer questions at a sixth grade level. OPUSs measure functional status, quality of life,
satisfaction with services and satisfaction with devices. The facilities agreed to administer OPUS at the initial
visit, device delivery, and 2-months later. Facilities received a report showing descriptive statistics. De-identified
comparative data were shared with each facility so that they could evaluate their patient outcomes in comparison
with the other four facilities.
Results
Facilities encountered various challenges in collecting data routinely. The facility that tied staff performance
reviews to data collection had the highest proportion of cases with com-pleted forms. Leadership commitment to
CQI was associated with consistent data collection and receptivity to consultation feedback.
Discussion
This study demonstrates the feasibility of routine outcomes data collection when staff receives incentives to report
data and leadership demonstrates a commitment to CQI prin-ciples. The prototype outcomes report is a valuable
means of monitoring organization perfor-mance over time and across facilities. Assessment of satisfaction is also
important for maintaining facility accreditation with ABC.
Conclusions
CQI is enhanced by the use of a reliable and valid outcomes instrument such as OPUS. Data management and
reporting services are critical to providing outcomes information to staff in a timely manner.
271
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Session Name and Room: Evidence Based Practices - 3
Room 1.06
Abstract Title: Improving The Quality Of Prosthetic And Orthotic Services With Process And Outcome
Information
Abstract number: 260
Authors: A. Heinemann, L. Ehrlich-Jones, L. Connelly, S. Fatone
Presenter: A. Heinemann
FREE PAPERS
Thursday, Feb 7 / 12:00 - 13:15
Session Name and Room: Evidence Based Practices - 3
Abstract Title: Mobility India Gait Training Approach For Unilateral Lower Limb Amputee.
Abstract number: 324
Authors: S. Moulic, R. Hussain, D. Khataniar
Presenter: S. Moulic
Room 1.06
Introduction
The purpose of the data investigates the effect of Mobility India’s (MI’s) new approach to gait retraining for unilateral
lower limb amputees. The new approach considers amputee’s pre-amputation functional ability and mobility,
established through the Amputee Mobility Predictor with prosthesis (AMPPRO) and Locomotor Capabilities Index-5
(LCI). Its expected this approach will better address individual needs and allow more efficient rehabilitation.
Method
Efficiency of gait rehabilitation process was measured by recording the number of training sessions taken to
achieve set functional tasks. 26 Service users were divided into 2 groups, a conventional and new group.
Conventional group received MI’s old retraining approach which is not individualized but all amputees completed
a set check list of tasks in a specified order. The new group approach involves the use of the AMPPRO and LCI.
Both groups received 2 hours of training daily, totaling a maximum of 45 sessions. A comparison was made
between the numbers of sessions taken to achieve independence in set tasks for each group. If an individual was
unable to achieve a set task, 45 sessions were attributed to that individual.
Results
In the conventional group, the mean number of sessions taken to achieve independent gait outside the parallel
bars was 9.90, the 10m walk was 30.90, stair climbing was 17.81 and descent to floor was 41.27. In the new group,
the mean number of sessions taken to achieve the same functional tasks was 13.73, 15.4, 15.53 and 27.
Discussion
This data collection indicates the new approach may have resulted in faster mean times for these Service User’s
to achieve independence in 3 out of 4 pre-set functional tasks. It is postulated these measures assist in guiding
appropriate, individualized rehabilitation for amputees.
Conclusion
This data collection highlights the importance of individualized gait retraining post unilateral amputation with
prosthesis.
272
Thursday, Feb 7 / 14:30 - 15:45
Introduction
Processing and pattern recognition of bioelectric signals have been at the core of prosthetic control research for
decades. Although most studies agree on reporting the accuracy of predicting movements, there is a significant
amount of study-dependent variables that hinder high-resolution inter-study comparisons. As an effort to provide
a common research platform for evaluation and development, BioPatRec has been released as open source.
Methods
BioPatRec is a modular platform implemented in MATLAB that allows a seamless integration of a variety of
algorithms in the fields of signal processing; feature selection and extraction; pattern recognition; and, real-time
control. It includes all the required functions for myoelectric control; from data acquisition to real-time evaluations,
including a virtual reality environment. Moreover, BioPatRec functionalities are easily available through graphical
user interfaces.
Results
Over 20 non-amputees and amputees have tested BioPatRec reporting offline accuracies over 90%, and
successful real-time control of a virtual hand and multifunctional prosthetic devices. All the required instructions
for use and development are provided in the online project hosting platform (http://code.google.com/p/biopatrec/),
which includes issue tracking and an extensive “wiki”. This transparent implementation has shown to facilitate
utilization, but more importantly, collaboration. Currently, BioPatRec is used for 3 other research groups in different
countries.
Discussion
The modular design of BioPatRec allows researchers from different fields to seamlessly benchmark their
algorithms by applying them in prosthetic control. For example, a pure artificial intelligence researcher can easily
add a pattern recognition algorithm without necessarily knowing how to obtain and process bioelectric signals, or
how to produce and evaluate physically meaningful outputs.
Conclusions
BioPatRec is a new tool for the development of algorithms applied in prosthetic control. It is available as open
source, to facilitate international collaboration and will hopefully accelerate the development of better algorithms
which can improve the patient’s quality of life.
273
FREE PAPERS
Session Name and Room: Prosthetics : Upper Limb - 6
Room 1.01
Abstract Title: Biopatrec: A Modular Research Platform For Prosthetic Control Algorithms Based On
Bioelectric Pattern Recognition
Abstract number: 460
Authors: M. Ortiz-Catalan, R. Brånemark
Presenter: M. Ortiz Catalan
FREE PAPERS
Thursday, Feb 7 / 14:30 - 15:45
Session Name and Room: Prosthetics : Upper Limb - 6
Room 1.01
Abstract Title: Hand Opening And Grasping Force Feedback Through Vibrotactile Stimulation For Users Of
Myoelectric Forearm Prostheses
Abstract number: 465
Authors: H. Witteveen, H. Rietman, P. Veltink
Presenter: J. Rietman
Introduction
The number of myoelectric forearm prostheses not being used by their owners remains quite high, amongst
others caused by the lack of sensory information about hand opening and grasping force. In this study vibrotactile
stimulation on the stump providing this information is investigated.
Methods
An array of 8 small vibrotactile stimulators was placed on the stump of 10 amputees and forearm of 10 healthy
subjects, providing feedback about the hand opening of a virtual hand. Feedback about grasping force and object
slip was provided via a linear relation between the force or slip and the vibration amplitude of one stimulator. The
subjects’ task was to control a virtual hand, grasping and holding virtual objects of different sizes and weights,
by scrolling a mouse wheel. The task performance was described by the time taken to grasp and hold the object
and the deviations from the correct hand opening and force level. The orientation of the array (transversal or
longitudinal) and the type of feedback (force or slip) were varied.
Results
Compared to the non-feedback situations, the addition of both hand opening and force feedback significantly
increases the performance in grasping tasks, but at the cost of a longer task duration. Equal performances were
found for both array orientations and both types of feedback.
Discussion
The use of a transversal oriented array is preferred for amputees, because this can be applied easily in the
prosthesis. Slip feedback is preferred over force feedback, because performance Results are comparable, but no
in advance information about the weight or roughness of an object is required. However, this method should be
validated with real sensors and myoelectric control.
Conclusions
Vibrotactile feedback about hand opening and force has the potential to increase the performance in grasping
tasks, but should be validated on myoelectric controlled forearm prostheses.
274
Thursday, Feb 7 / 14:30 - 15:45
Room 1.01
Introduction
This presentation will focus on the formulation and implementation of comprehensive prosthetic rehabilitation
treatment plans for patients who sustain traumatic high level upper limb loss. Secondary to the traumatic nature of
the loss, co-morbidities compromising range of motion, mobility, spatial awareness, and cognitive awareness must
be considered. Patients with complex presentations benefit from a comprehensive team approach to rehabilitation.
Methods
The foundation for this approach begins with healthcare professionals working in partnership with the patient.
Highly experienced teams mobilize quickly to manage these difficult cases in a timely and cost effective manner.
This approach combined with the utilization of innovative technologies, materials and creative prosthetic options
are critical.
The process begins with the prosthetic rehabilitation evaluation and collaboration with the medical team. The team
incorporates patient goals into a prosthetic care plan. The team implements an expedited fitting protocol leveraging
technology and materials to create an innovative prosthesis design combined with aggressive therapeutic training
to meet individual patient needs.
Results
The well planned expedited fitting protocol will yield a functional prosthesis within 24-48 hours. Intensive prosthetic
therapy training will occur simultaneous to the expedited fitting process. The expedited fitting creates a diagnostic
prosthesis to evaluate the interface design’s performance in functional use during therapeutic training.
Discussion
Clinical expertise in selection of appropriate technology, including innovative socket interface designs, integrated
advanced materials, sophisticated components and terminal devices to maximize function for improved outcomes
is essential. Simultaneous training with therapists knowledgeable in the operation of this technology provides the
foundation for patient success.
Conclusions
It is beneficial to enlist input from prosthetic rehabilitation resources with extensive experience in treating high level
upper limb loss patients. Clinicians with advanced skills in treatment of this population can best facilitate patients
in overcoming some of the unique challenges they and their healthcare providers face.
275
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Session Name and Room: Prosthetics : Upper Limb - 6
Abstract Title: Improving Outcomes For High Level Upper Limb Amputees
Abstract number: 120
Authors: J. Miguelez, D. Conyers, T. Ryan, R. Dodson
Presenter: J. Miguelez
FREE PAPERS
Thursday, Feb 7 / 14:30 - 15:45
Session Name and Room: Prosthetics : Upper Limb - 5
Abstract Title: Design For Function: The Electric Terminal Device (Etd) – A 10-Year Review
Abstract number: 291
Authors: H. Sears, E. Iversen
Presenter: H. Sears
Room 1.05
Introduction
The ETD is a unique example of hybridization of body-powered features with electric components, i.e., hook
fingers with a water-resistant motorized drive. After a 10-year clinical history, lessons gained from the ETD are
found in both case studies and survey data documenting wearers’ functional ratings and their specific usage.
Methods
The five case studies illustrate activities performed by bilateral and unilateral wearers: ADLs, kitchen tasks, farming,
welding, and nursing tasks requiring frequent water immersion. Survey Method Over the ten-year experience a
subgroup of 17 wearers were surveyed. The ETD is compared to wearer’s earlier TDs in functional areas, as well
as documenting the extent of usage.
Results
Hook gripping demonstrates fine-tip prehension, flat surfaces with high surface area, large diameter cylindrical
objects, slender tips reaching into pockets, and passive functions, e.g., pushing and hook-and-pull type tasks.
Electric Drive vs. Body-Power comparison shows differences in pinch force, effort, and comfort. Usage data shows
hours of usage per day (average 12 hr), usage of the ETD compared to other devices (average 82%), importance
level of the ETD (12/17 answer “very important), and self-rating of level of activity (12/17 answered “heavy-duty
usage”). Performance data assesses speed, appearance, grasp abilities, ease of use, and overall ratings (the
average rating equates to “much better”)
Discussion & Conclusions
Rugged work and hobby activities create functional needs beyond capabilities of hand-type TDs. Interchangeability
of the ETD with Hands greatly broadens utility. Stereotypes of hand vs. hook wearers are unreliable - male/female,
rural/urban, blue-collar/white-collar, unilateral/bilateral characterizations do not predict usage of a hook-type
prosthesis. Aesthetics of a work-type TD remain a great opportunity. Future design innovations could broaden
the population using electric hook-type TDs, improving size constraints and strength, as well as aesthetic appeal.
276
Thursday, Feb 7 / 14:30 - 15:45
Introduction
Although myoelectric prostheses have been clinically implemented since the 1960’s, they are still far from the
functionality of their biological counterpart. It is a widely known fact that the lack and instability of physiologically
appropriate control signals are the bottleneck of the field. Implantable neuromuscular interfaces could provide
enough and long-term stable signals, however, the permanent communication with implanted devices is a major
constraint that has hindered this solution for decades. In order to overcome this problem, we have developed a
permanent bidirectional interface into the human body, the Osseointegrated Human-Machine Gateway (OHMG).
Methods
The OHMG is an enhancement of the OPRA Implant System which has been used to treat over 200 patients.
Its modular design allows customization of the neuromuscular interfaces according to the patient’s anatomy and
prosthetic needs. It comprises epimysial and cuff electrodes combinations which account for up to 12 contacts.
The recording features of the cuff electrodes have been optimized in a frog sciatic nerve model. Furthermore,
analog electronics and a control system based in pattern recognition have been developed (BioPatRec).
Results
16 non-amputees and 5 amputees, with and without OPRA, have shown successful real-time control of
multifunctional prostheses using BioPatRec. A new semi-discrete tripolar configuration was found to increase
the signal to noise ratio in neural recordings, but more importantly, it provides additional channels for neural
information.
Discussion
Preliminary preclinical results show that the OHMG has the potential to allow permanent access to implanted
electrodes, and once validated, it will potentially open new possibilities for more advanced and natural prosthetic
control.
Conclusions
Long-term clinical studies are required to prove the benefits of implantable interfaces in prosthetic control. The
early clinical results from the OHMG study will be reported.
277
FREE PAPERS
Session name and Room: Prosthetics : Upper Limb – 6
Room 1.01
Abstract Title: The Osseointegrated Human-Machine Gateway: A Permanent Bidirectional Interface for the
Natural Control of Artificial Limbs
Abstract number: 445
Authors: M. Ortiz-Catalan, R. Brånemark
Presenter: M. Ortiz-Catalan
FREE PAPERS
Thursday, Feb 7 / 14:30 - 15:45
Session Name and Room: Sports And Physical Activity - 2
Abstract Title: Relative Activity Variations In Persons With Transfemoral Amputation
Abstract number: 220
Authors: M. Waddingham, E. Halsne, B. Hafner
Presenter: B. Hafner
Room 1.02
Introduction
Evidence describing the long-term mobility patterns of persons with transfemoral amputation (TFA) is limited.
While it is acknowledged that TFA imposes considerable physical impairments, little empirical information is
available to convey how these deficits may manifest in the free-living environment. The purpose of this study is to
quantify the relative variation in step activity in persons with TFA over annual, seasonal, and monthly periods. A
secondary objective was to compare variations in activity observed in persons with TFA to healthy, non-amputees
described in the literature.
Methods
A retrospective analysis of twelve months of daily step activity data was conducted. Subjects’ step activity was
recorded with an accelerometer-based step monitor and averaged over annual, seasonal, and monthly periods.
Relative variations in step activity over each period were quantified with coefficient of variation (CoV).
Results
Data from 17 subjects with TFA were examined for patterns of activity. Activity was generally observed to increase
and decrease with warmer and colder months. Relative variation in step count observed over annual, seasonal,
and monthly periods ranged widely within the sample. Annual variation in activity for the TFA sample (CoV= 0.65)
was greater than that reported in healthy, non-amputees (CoV= 0.34). Seasonal and monthly variations were also
significantly different between those with TFA and non-amputees (p=0.000 and p=0.001, respectively).
Discussion
Variations in day-to-day activity among persons with TFA may be elevated as a result of activity-related discomfort
or fatigue. Prospective research and studies incorporating subjective feedback may provide additional insight
into the health conditions and personal factors (e.g., motivations and opportunities) that influence activity in this
population.
Conclusion
Additional efforts to characterize TFA mobility, particularly in the free-living environment, are needed to better
understand the functional consequences of lower limb amputation and, subsequently, the efficacy of clinical
interventions intended to address them.
278
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Introduction
Disabled children in northern Uganda experience extreme discrimination, social exclusion and severe risks to their
health and well-being. They are routinely barred from attending mainstream schools and excluded from community
activities with no access to any sports activities. Many are hidden away inside the home, leaving them extremely
isolated, and a significant number of parents have reported pressure from family members to drown a child born
with a disability to avoid disgracing the family.
Methods
Motivation, and our partners the Kids League and the Gulu Disabled Persons Union, set up a programme in 2011
to address these problems by using sport to empower children and change attitudes. The project established an
inclusive sports league for 300 disabled children and built the capacity of a team of coaches and peer mentors to
organise inclusive sports training and competitions and to lead training for children in disability rights, self-advocacy
and preventative health. The programmes’s goals were to improve the children’s confidence, develop their selfadvocacy skills and improve their social inclusion. These three outcomes were measured through surveys, focus
groups and regular assessments by the peer mentors.
Results, Discussion and Conclusions
The Results of the research found that participation in sport improved the children’s confidence and inclusion in the
community, but that significant gains in self-advocacy (for example, lobbying their parents to send them to school)
were only achieved through assistance from their peer mentors. Based on these Results, we would recommend
that future disability-focused sport for development projects are linked to a tangible support mechanism—for
example, peer mentors attached to the local disabled people’s organisation, which can provide practical training
and support with real-life challenges faced by each child. In this way, the increased confidence and reduced stigma
achieved through sports participation is channelled into a specific positive outcome.
279
FREE PAPERS
Session Name and Room: Sports And Physical Activity - 2
Room 1.02
Abstract Title: Using Sports And Peer Mentoring To Improve Outcomes For Disabled Children In Northern
Uganda
Abstract number: 343
Authors: J. Browning
Presenter: B. Humphrey
FREE PAPERS
Thursday, Feb 7 / 14:30 - 15:45
Session Name and Room: Sports And Physical Activity - 2
Abstract Title: The Advent Of Sprint Prosthesis In Kenya
Abstract number: 344
Authors: P. Ongubo, R. Ewoi
Presenter: P. Ongubo
Room 1.02
Introduction
The area of Sports Medicine in Prosthetic sciences has not been exploited in Kenya. Being a renowned home
of athletics, Kenya has never produced a leg amputee athlete for track events. The exploits of the famous South
African “blade runner” Oscar Pistorius has given us an impetus to introduce this concept in Kenya. This is in
tandem with rehabilitation goals of not only promoting mobility, but enhances quality of life of amputees through
sports.
Methods
A hands on approach was adopted and literature review for comparison was undertaken. An inaugural athlete
who is a below knee amputee was identified and fitted with customized blade prosthesis. The Milan City Marathon
provided an opportunity to showcase the athlete’s capability and functional outcomes were measured.
Results
Provisional Results saw the amputee run 2km to validate its efficiency. The athlete has since specialized in short
sprint races. It is expected that by the Congress time we shall have had a sufficient number of athletes to validate
the Results following a national campaign to be rolled out soon.
Discussions
Following the impressive outcome, the Kenyan Paralympics Society(KPS) has welcome this new product and
a national appeal is currently underway to help raise awareness and support amputees to be fitted with sprint
prostheses to help them participate in track events. Our aim is to contribute to the needs of the KPS whose aim is
to participate in upcoming amputee track events.
Conclusions
Sports prostheses are vital in changing lives of many people with amputations. This inaugural case has been an eye
opener for amputees to take part in athletics with much hope and inspiration. It is our expectation that if exploited
fully; shall impact positively to the lives of amputees and others with physical disabilities, thus empowering them
to participate actively in nation building.
280
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Background
The United Kingdom (UK) will host the Paralympics in 2012 and Commonwealth Games in 2014 showcasing
the talents of elite athletes and aiming to inspire the population to become involved. However, low levels of
physical activity are prevalent: only 40% of men and 28% of women meet the minimum UK physical activity
recommendations(1). The population of people with limb absence is no exception.
Objectives
To examine the current literature to determine if people with amputation are participating in physical activity and
sport; whether post-amputation activity levels match pre-amputation levels; and if there are motivations and
barriers to participation.
Methods
A prosthetic and physical activity for health research team systematically searched for all peer reviewed and gray
literature in seven bibliographic databases and the Cochrane Library.
Results
Following rigorous elimination, 12 articles were finally included in the review and critically appraised. Four themes
were identified: components; rehabilitation outcomes; body image; and motivations and barriers to participation.
Conclusions:
People with limb absence are not participating in physical activity conducive to health benefits, and only a minority
participate in exercise and sports. Participation following amputation does not mirror that of pre-amputation levels,
and more barriers than motivations exist to adopting or maintaining a physically active lifestyle.
Clinical Relevance
This literature review aims to inform those involved in rehabilitation and ongoing care of those with limb absence
about what motivates or precludes their participation in physical activity, exercise and sport. Such knowledge could
be applied to improving health and wellbeing in the amputee population.
Reference (1): NHS The Information Centre. Health Survey for England 2006: CVD
and risk factors adults, obesity and risk factors children. 2006. [published 31
January 2008]. Available from http://www.ic.nhs.uk/
281
FREE PAPERS
Session Name and Room: Sports And Physical Activity - 2
Room 1.02
Abstract Title: Motivations & Barriers To Prosthesis Users Participation In Physical Activity, Exercise &
Sport: A 2011 Review Of The Literature
Abstract number: 5
Authors: S. Deans, D. Burns, A. Mcgarry, K. Murray, N. Mutrie
Presenter: A. McGarry
FREE PAPERS
Thursday, Feb 7 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 15
Room 1.03
Abstract Title: The Development Of The Plus-M, A New Measure Of Mobility For Prosthetic Limb Users
Abstract number: 300
Authors: D. Amtmann, D. Abrahamson, S. Morgan, R. Salem, R. Askew, R. Gailey, B. Hafner
Presenter: D. Amtmann
Introduction
Standardized outcome measures can be used to document clients’ health outcomes and facilitate treatment
of those requiring prosthetic and orthotic services. The Prosthetic Limb Users Survey-Mobility (PLUS-M) was
developed using modern psychometric Methods to be a brief, precise and flexible measure of mobility for persons
with lower limb amputation.
Methods
A candidate item bank was developed from existing instruments, input from clinical and scientific experts, and
feedback from prosthetic limb users. Items were administered to a large sample of unilateral amputees. Data
were used to develop scoring using Item Response Theory (IRT). Five-level response options range from “with no
difficulty” to “cannot do.” Unidimensionality was assessed by confirmatory factor analysis (CFA). Item fit to IRT was
assessed using standard statistical criteria.
Results
105 candidate items were administered to over 1000 prosthetic limb users with traumatic or dysvacular amputation
etiologies. CFA Results supported unidimensionality. Items were calibrated using a two-parameter gradedresponse IRT model. Items with poor discrimination and those with less than optimal fit were dropped from
the bank. The item and test characteristic curves documented that the PLUS-M score is reliable and precise
across different levels of mobility (from low to high mobility). The calibrated item bank can be administered by
Computerized Adaptive Testing (CAT). A subset of 8 items was selected for a PLUS-M Short Form to minimize
respondent burden. PLUS-M score is a t-score with a mean of 50 and standard deviation of 10.
Discussion
Results support validity and reliability of the PLUS-M. IRT calibration allows for PLUS-M to be administered by
paper or by CAT on phones, tablets, or computers.
Conclusion
The PLUS-M is a psychometrically sound, brief, and precise measure of mobility for prosthetic limb users. The full
instrument and short form are freely available and ready for use in clinical care and research.
282
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Room 1.03
Transfemoral amputees with prosthesis walk more slowly than the normal population. They prefer a self-selected
walking speeds (SSWS).This is evident both in adult and paediatric cases. It is believed that this is due to a
prolonged prosthetic swing phase. When prosthetic shank is considered, the available variables are the total mass
of the shank and the distribution of that mass within the system. Different modeling Methods predict conflicting
Results. Various types of physical theories and mathematics equations have been applied .Two mathematical
models are being discussed to know the cause of slow cadence and how far the mass of the shank is responsible
for delayed swing.
Two theories are:
PENDULUM THEORY and DIFFERENTAIL EQUATION method
Conclusion
The duration of prosthetic swing decrease is identified as time required for the shank to traverse the arc from peak
knee flexion to terminal extension. If the Variables are kept constant except the distribution of shank mass ‘m’ or
length r, then the swing time will decrease as the location of c.m. from knee center increases. Keeping length ‘r is
constant but varied overall mass, then increase mass will correlate with decreased swing time
The result of two modeling theory contradicts each other. Pendulum based theory predicts that decreased value
of r should less the time period of shank & the calculus based theory don’t agree with it. Again Pendulum theory
holds that periods will be constant regardless of the value of ‘m’ & the calculus based model predicts that increase
in ‘m’ Results decreased swing periods. Therefore both theories hold good for better ambulation of transfemoral
amputees with prosthesis if marginal adjustments to the values are considered , then it should affect the swing
phase as much as 50%.
283
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 15
Abstract Title: Mathematical Analysis Of Prosthetic Shank
Abstract number: 312
Authors: M. Dash, A. Patra
Presenter: M. Dash
FREE PAPERS
Thursday, Feb 7 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 15
Abstract Title: Microprocessor-Controlled Prosthetic Knees – A Review Of The Literature
Abstract number: 314
Authors: T. Quake, A. Mcgarry
Presenter: T. Quake
Room 1.03
Introduction
Microprocessor-controlled prosthetic knees (MPCKs) help better replicate normal knee function, providing transfemoral amputees (TFAs) benefits compared to non-microprocessor knees. MPCKs are not widely prescribed
due to issues such as high cost and a poor knowledge base. A literature review on MPCKs was performed to:
1) assess the justifications for their prescription, 2) compare different MPCKs and 3) assess the effect of (2) on
prescription criteria.
Methods
A literature search was performed. 6 categories were deemed pertinent to TFA rehabilitation: gait biomechanics,
energy expenditure, functional activities, safety, cost-effectiveness and quality of life (QoL). Studies were grouped
into one or more of these categories based on the issues addressed. SIGN50 guidelines were used to grade
studies and form recommendations.
Results
47 studies were reviewed. 5 studies made inter-MPCK comparisons. 5 MPCKs were studied – the C-leg, Intelligent
Prosthesis, Rheo Knee, Adaptive Knee and Power Knee. Most studies were performed on otherwise healthy,
unilateral TFAs. 2 case studies investigated bilateral TFAs.
Discussion
MPCKs improve gait efficiency and energy expenditure but do little to reduce sound side overuse. All studies
investigating mobility, stair/slope ambulation, functional level or safety-related measures noted statistically and
clinically significant improvements. All 3 economic studies found the C-leg cost-effective from healthcare and
social viewpoints. MPCKs significantly improved QoL for most TFAs. MPCKs benefit K2-4 unilateral TFAs. K2
TFAs, who are not normally considered MPCK candidates, may suffer underprescription. Both case studies on
bilaterals showed little benefit in improving energy expenditure, safety and QoL. A lack of inter-MPCK studies and
the inconsistency of Results makes it difficult to assess inter-MPCK performance.
Conclusion
MPCKs provide functional benefits for unilateral TFAs and appear to be cost-effective, justifying their prescription.
Clinicians should consider prescribing them more often. More research on different TFA subpopulations and interMPCK comparisons are needed.
284
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Room 1.03
Various materials such as thermoplastic plastics or fiber reinforced composites(FRPs) of glass or carbon fibers
have been used widely as socket materials for limb prostheses. Each materials have pros and cons. For examples,
carbon or glass fiber as widely used socket materials are good in physical property and socket performance.
However they may cause skin irritation and/or respiratory trouble to prosthetic workers, since the harmful debris
chops of fibers tend to be made during grinding process in fabricating sockets. In this study, we attempted to make
prosthetic sockets using woven fabrics of a new thermoplastic material, which can reduce skin irritation in contact,
with still offering the good mechanical property and durability of sockets. The thermoplastic woven fabrics made
from polyvinylalcohol(PVA) as a new socket material have been developed and successfully applied to fabricate
the prosthetic sockets for lower limb. The surface treatment for PVA fibers could be conducted effectively to
acquire improved adhesion and impregnation of fiber and matrix. The cured matrix of the composites maintains the
good strength for the socket. Comparing PVA fiber with carbon fiber, it shows competent value as socket material
in tensile strength. The PVA fibers can be impregnated with more resin of about 20% in weight than carbon fiber.
The composite thus shows similar values in the flexure strength test.
To investigate the shape and size of debris particles of PVA fibers, the particles produced during grinding were
collected and observed with optical microscopy. The PVA fiber chops do not separate from the matrix resin, and
their scattering in the air can be reduced effectively. We could conclude that the sockets fabricated using PVA fiber
and epoxy resin enable to give less harmful environment of fabrication as well as good mechanical properties and
durability in limb prosthetic performance.
285
FREE PAPERS
Session Name and Room: Prosthetics : Lower Limb - 15
Abstract Title: New Thermoplastic Woven Fabrics As The Material Of Prosthetic Sockets
Abstract number: 336
Authors: S. Lee, G. Cha, J. Song, M. Mun
Presenter: S. Lee
FREE PAPERS
Thursday, Feb 7 / 14:30 - 15:45
Session Name and Room: Prosthetics : Lower Limb - 15
Room 1.03
Abstract Title: An International Questionnaire On The Delivery Of Lower-Limb Prosthetic Treatment
Abstract number: 362
Authors: J. Andrysek, D. Wyss, W. Cleghorn
Presenter: J. Andrysek
A crucial component of prosthetic rehabilitation research that is often neglected in purely product-oriented
research is a preliminary needs assessment of the problem. A survey was developed to gain an understanding of
the unique issues and demands relating to the delivery of lower-limb prosthetic services and technologies within
individual regions of the world, and also on a global perspective. The survey was anonymous, self-administered
and distributed online through the networks of various healthcare professionals targeting practitioners working in
any level of lower-limb prosthetic rehabilitation. Data collected included respondent demographics and information
about the types of services and technologies provided under the following categories i) feet, ii) knees, iii) sockets
and suspension, iv) alignment, and v) materials and
Methods
Complete responses were obtained from 199 prosthetic clinicians and technicians working in 64 different countries.
The average per capita expenditure on healthcare for each country was used as an indicator to investigate the
different groups of respondents.
The Results show that the average country health spending is often significantly different between the levels of
use of certain prosthetic technologies and procedures. The average healthcare spending was most often lower
for the respondents identifying problems in the delivery of their prosthetic services and technologies. Examples
of these include: the use of polycentric knees or energy-storing feet, achieving adequate knee flexion, foot
durability, ease of alignment adjustments, and socket liner selection. Moreover, a qualitative analysis of openended responses identified general priority areas of concern for each of the sections of lower-limb prosthetics
investigated. Developing countries with lower spending on healthcare have different demands and priorities for
lower-limb prosthetic rehabilitation. The Results of this study may be used by future researchers to direct their
efforts to deliver the most effective prosthetic devices and treatments to people with lower-limb amputations living
around the world.
286
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Introduction
The incidence of hip dislocation in Cerebral Palsy (CP) varies from 6% - 70%. Despite increased surveillance,
chronic hip dislocations are not uncommon. Deformation of femoral head makes surgical reconstruction impossible.
The purpose of this study is to investigate the effect of proximal femoral resection (PFR) on the quality of life (QOL)
in patients with CP.
Methods
Consecutive patients between 2007 and 2011 were included in the study. Patient demographics, GMFCS score,
range of movement (ROM) of hips, and complications were documented. X-rays were reviewed for type of
heterotrophic ossification (HO). The QOL was assessed pre and post operative using CP caregiver Questionnaire
(Version 5.0).
Results
16 patients with 19 hips underwent PFR for painful hip dislocations. M:F 10: 6. All patients belonged to GMFCS
V. Mean age at the time of surgery was 21 years. The average follow-up time was 3 years. 1 post-operative
Hematoma needed evacuation. HO was seen in 14 hips (Type I – 9, type II – 4 and type III - 1). Hip ROM
improved in all cases. One patient (1 hip) refused to participate in the study. All other patients except one showed
significant improvement in positioning, transfers, mobility, comfort, emotions and social interaction. Care givers felt
an improvement in general health. The perceived QOL improved from very poor/poor to good/very good.
Discussion
Neglected and painful hip dislocation causes significant limitation of daily activities, leading to confinement in bed.
This affects the general health. PFR improves hip ROM. Complications are low. HO occurred in 73% of patients,
however did not affect ROM of hip and QOL. Comfortable positioning, painless transfers and ability to be mobile
on wheel chair improve QOL in these patients.
Conclusions
Proximal femoral resection is an excellent one-off operation that significantly improves the QOL. HO did not affect
the QOL.
287
FREE PAPERS
Session Name and Room: Quality Of Life Issues - 2
Room 1.05
Abstract Title: Resection Of Proximal Femur Improves Quality Of Life In Cerebral Palsy Patients With
Painful Hip Dislocations
Abstract number: 358
Authors: C. Dussa, H. Lengnick, L. Doederlein
Presenter: C. Dussa
FREE PAPERS
Thursday, Feb 7 / 14:30 - 15:45
Session Name and Room: Quality Of Life Issues - 2
Room 1.05
Abstract Title: Quality Of Life Measures Differ Between Female And Male Young Adults With Lower Limb
Reduction Defects
Abstract number: 450
Authors: T. Kaastad, I. Holm
Presenter: T. Kaastad
Introduction
Lower limb reduction defects can be treated with fitting of prosthesis, but can also be corrected through callotasis
surgery with elongation to obtain gait function. The aim of our study was to evaluate general health in young adults
with lower limb reduction defects to see if there were differences related to choice of treatment modality.
Methods
Thirty-four former patients (13 female, 21 male) between ages 18 and 35 with below knee defects, were invited
to a follow up study of health-related quality of life evaluated with EuroQol (EQ-5D) and Short Form 36 (SF-36).
Seventeen were lengthened in tibia and/or femur, while 17 used prosthesis.
Results
There were no differences in age, height, weight, level of education, marital status, or self-esteem. The EQ5D general health value was median 70 in both groups, and there were no differences in the eight scales of
SF-36. Female patients had lower physical functioning and emotional role limitations scores compared to the
general population, while male patients had lower scores for physical functioning, bodily pain, and general health
perception.
Discussion
Our study groups were relatively small, and the diversity within groups considerable, but the demographic data
suggest they are comparable. The SF-36 has different scores for women and men in the general population. Since
the Results in our groups were similar, we chose to combine them and compare all female and all male patients
with the general population.
Conclusions
There are no major differences in general health issues between young adults with lower limb reduction defects
who have been through lengthening procedures and those who walk with a prosthesis. The whole group has lower
physical functioning scores compared to the general population, while only female patients have reduced scores
for emotional role limitations, and only men for bodily pain and general health perception.
288
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Introduction
The impact of prosthetics and orthotics services in enhancing the Quality of Life (QOL) of people with disabilities
are not known much, especially in the developing world. Towards this, a study was carried out to evaluate the
Impact of prosthetics and orthotics services on the Quality of Life (QOL) of people with disabilities in India. The
major aim of the study was to evaluate thoughts and feelings of the person who received a prosthesis or orthosis
and not evaluating the actual device which was prescribed and fitted.
Methodology
Mobility India runs a Community-Based Rehabilitation (CBR) programme in Anekal Taluk of Bengaluru Rural
District of Karnataka, India. Among their beneficiaries, 60 subjects (n=60) who were requiring an orthosis or
prostheses were selected for the study. CBR workers were trained to carry interview based on WHOQOL-Bref tool
(a set of 26 questionnaire to measure Quality of Life). Subjects were interviewed twice with the same questionnaire:
first time before orthotics/prosthetics intervention (pre-test) and then one month after the fitment (post-test).
Results
Among the subjects (n=60), 43 were male (72%) and 17 female, 46 had orthosis (77%) and 14 had prosthesis.
The mean age for male was 37 and for female 28. Among 60 subjects, 43 were first time user of orthosis/prosthesis
(72%). From the comparative study of the pretest and posttest data, it was evident that a higher mean score was
achieved after orthotics/prosthetics intervention in relation to individual’s quality of life and in all the four domains
of WHO-QOL: Physical, Psychological, Social and Environmental.
Conclusion
From the study, it was evident that people with disabilities living in rural areas faces significant barriers to access
orthotics and prosthetics services. People with disabilities can have a better Quality of Life (QOL) with an orthosis
or prosthesis, which leads to empowerment, inclusion and participation.
289
FREE PAPERS
Session Name and Room: Quality Of Life Issues - 2
Room 1.05
Abstract Title: Impact Of Prosthetics And Orthotics Services On The Quality Of Life (Qol) Of People With
Disabilities In India.
Abstract number: 499
Authors: C. Khasnabis, K. Murray, S. Deans
Presenter: C. Khasnabis
FREE PAPERS
Thursday, Feb 7 / 14:30 - 15:45
Session Name and Room: Quality Of Life Issues - 2
Room 1.05
Abstract Title: Skin Problems Of The Stump In Lower Limb Amputees; Influence On Functioning In Daily
Life
Abstract number: 429
Authors: H. Meulenbelt, J. Geertzen, M. Jonkman, P. Dijkstra
Presenter: H. Meulenbelt
Aim of this study was to analyze influence on functioning in daily life of stump skin problems in lower limb
amputees, since data on this topic is scarce. A cross-sectional study was performed by means of a questionnaire.
It assessed influence of skin problems of the stump on functioning in daily life by 9 items. Item scores were added
to calculate a sum score (scoring range 0-27). 2039 potential participants were invited to participate, resulting in
805 completed questionnaires. 507 participants reported a present skin problem. Negative influence of a skin
problem was reported on household, prosthesis use, social functioning, and performing sports. Mean sum score
was 5.5 (SD=4.1). It correlated significantly with number of complaints (r= .483, p=.01). In linear regression analysis
gender (â=-.15) and number of skin complaints (â= .25) explained 23% of the variance. This study establishes the
influence of skin problems on functioning in daily life.
290
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Introduction
Limb defects seen in childhood are mainly congenital. Reported birth prevalences of congenital limb defects (CLD)
vary largely between countries: from 10.4 in France to 4.8 in Italy during 1979-1987. There is little information on
the birth prevalence of CLD in the Netherlands. Smoking, alcohol, chronic diseases, obesity, not taking folic acid
supplements are controversial possible risk factors affecting limb development.
Aim
To describe the epidemiology of CLD in the northern Netherlands and identify potential risk factors.
Methods.
In a population-based epidemiological study we investigated the prevalence of CLD for the period 1981-2010.
Additionally, in a case-control study we searched for possible risk factors associated with CLD like maternal
smoking, alcohol consumption, chronic diseases, maternal weight, folic acid supplementation before and
during pregnancy, maternal age, education level, and fertility problems. Data on cases with CLD in the northern
Netherlands were collected by EUROCAT. Logistic regression was used to analyze risk factors.
Results.
The birth prevalence of all limb defects for the period 1981-2010 was 21.3 per 10,000 births. There was an
overall decrease in isolated limb defects (not part of a genetic condition, p=0.023) during 1992-2010, specifically
in syndactyly (p<0.01). Of 1061 children with CLD, 54.9% were males, 51.1% had isolated defects, 14.8% had
multiple congenital defects, and 34.1% had a recognized syndrome. The upper/lower limb ratio was 2:1, and the
left/right side ratio was 1.2:1. Commonly associated anomalies were of cardiovascular and musculoskeletal origin
(20.2% and 14.7%, respectively). We did not find a significant association with the risk factors we studied.
Conclusions.
The birth prevalence of limb defects and of syndactyly in particular, has dropped in time in the northern
Netherlands. We found no association of CLD with smoking, alcohol consumption, obesity or multivitamin/folic
acid supplementation, but more studies with larger sample sizes may highlight possible relationships.
291
FREE PAPERS
Session Name and Room: General - 1
Room 1.06
Abstract Title: Birth Prevalence And Possible Risk Factors For Congenital Limb Defects In The Northern
Netherlands
Abstract number: 89
Authors: E. Vasluian, C. Van Der Sluis, H. Reinders-Messelink, A. Van Essen, P. Dijkstra, H. De Walle
Presenter: E. Vasluian
FREE PAPERS
Thursday, Feb 7 / 14:30 - 15:45
Session Name and Room: General - 1
Room 1.06
Abstract Title: Work-Related Musculoskeletal Disorders In The Prosthetics And Orthotics Profession
Abstract number: 125
Authors: S. Anderson, J. Oakman
Presenter: S. Anderson
Introduction
Work-related musculoskeletal disorders (WMSDs) are the largest group of work injury claims both in terms of cost
and numbers of compensation claims both in Australia and worldwide. Progress in reducing the numbers of claims
has been limited with little reduction in injury numbers evident in the previous decade. WMSDs occur across in all
areas of employment, however, certain sectors experience greater prevalence. Workers in the health sector are at
high risk of developing WMSDs, due to the nature of the work undertaken. Experienced health professionals are in
high demand and as such injuries due to WMSDs are problematic, with significant cost to the individual, employer
and the community.
WMSDs are multifactorial in nature with a complex aetiology of interacting physical and psychosocial factors.
Management strategies for WMSDs tend to be focused on single hazards, primarily physical hazard and risk
factors, without appropriately addressing the complex nature of WMSD aetiology.
Aim
The overall aim of this study is to determine the prevalence of WMSDs in the Prosthetics and Orthotics (P&O)
profession and identify what are the key hazards and risk factors in relation to WMSDs.
Method
Focus group interviews of practicing Prosthetics and Orthotic clinicians were conducted. Structured open-ended
questions were utilized to provide direction for the focus group.
Results
Qualitative data analysis, including thematic analysis, of the focus groups has been undertaken to determine key
hazards in P&O. The Results of this analysis will be presented in this paper.
292
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Background
Patients with Charcot arthropathy present a high risk of ulcers with secondary bone infections or sepsis. Infections
with Pseudomonas aeruginosa represent a severe threat to the patients. Clinical studies are missing.
Hypothesis
Infections with P. aeruginosa cause a longer stay in hospital and more operations than infections with other
bacteria.
Methods
All patients who underwent surgery of Charcot arthropathy of the feet between 1996-2006 (n=205) in our clinic
were included. Residence time in hospital and number of surgeries in patients with infections due to methicillin
resistant Staphylococcus aureus (MRSA) vs. P. aeruginosa were compared to infections with other bacteria. All
patients were scanned for MRSA and were isolated when tested positive and treated according to a defined
algorithm.
Results
79 intra-operative samples exhibited bacterial growth: 12 cases of MRSA, 14 cases of P. aeruginosa and 53 other
bacteria. Patients with deep infections due to P. aeruginosa stayed significantly longer in hospital (52d vs. 35d,
p<0.041) and needed significantly more surgery (1.71 vs. 1.28 surgeries, (p<0.027). There was no significant
difference between patients with MRSA infections to those without MRSA or P. aeruginosa.
Discussion
Infections with P. aeruginosa caused significantly more operations and a longer stay in hospital. Rapid debridement
is the basic treatment.
Conclusion
A specific algorithm for isolation, surgical and antibiotic treatment for P. aeruginosa infections is proposed as a
similar algorithm for MRSA showed to be successful.
Key words: P. aeruginosa; MRSA; Diabetic foot; Foot infection; Anbtiotics
293
FREE PAPERS
Session Name and Room: General - 1
Room 1.06
Abstract Title: Infections In Charcot´s Arthropathy Of The Foot Due To Pseudomonas Aeroginosa The Underestimated Threat
Abstract number: 383
Authors: U. Illgner, A. Uekoetter, H. Wetz, S. Runge
Presenter: U. Illgner
FREE PAPERS
Thursday, Feb 7 / 14:30 - 15:45
Session Name and Room: General - 1
Room 1.06
Abstract Title: Infections With Pseudomonas Aeruginosa In Charcot´s Arthropathy Of The Foot –
The Underestimated Threat
Abstract number: 384
Authors: U. Illgner, A. Uekoetter, S. Runge, H. Wetz
Presenter: U. Illgner
Background
Patients with Charcot arthropathy present a high risk of ulcers with secondary bone infections or sepsis. Infections
with Pseudomonas aeruginosa represent a severe threat to the patients. Clinical studies are missing.
Hypothesis
Infections with P. aeruginosa cause a longer stay in hospital and more operations than infections with other
bacteria.
Methods
All patients who underwent surgery of Charcot arthropathy of the feet between 1996-2006 (n=205) in our clinic
were included. Residence time in hospital and number of surgeries in patients with infections due to methicillin
resistant Staphylococcus aureus (MRSA) vs. P. aeruginosa were compared to infections with other bacteria. All
patients were scanned for MRSA and were isolated when tested positive and treated according to a defined
algorithm.
Results
79 intra-operative samples exhibited bacterial growth: 12 cases of MRSA, 14 cases of P. aeruginosa and 53 other
bacteria. Patients with deep infections due to P. aeruginosa stayed significantly longer in hospital (52d vs. 35d,
p<0.041) and needed significantly more surgery (1.71 vs. 1.28 surgeries, (p<0.027). There was no significant
difference between patients with MRSA infections to those without MRSA or P. aeruginosa.
Conclusion
Infections with P. aeruginosa caused significantly more operations and a longer stay in hospital. Rapid debridement
is the basic treatment. A specific algorithm for isolation, surgical and antibiotic treatment for P. aeruginosa infections
is proposed as a similar algorithm for MRSA showed to be successful.
Key words: P. aeruginosa; MRSA; Diabetic foot; Foot infection; Anbtiotics
294
Thursday, Feb 7 / 14:30 - 15:45
Room 1.06
Our cross sectional study (prevalence survey) has been conducted on School children among 6-10 years (class
one to class fifth) in six schools of the Rawalpindi/Islamabad. Our study determined the prevalence of the flat
foot (age, gender, side involvement, and type). Our study included 712 children, male (512) and female (202).A
specially designed Performa (subjective, objective history) is filled after doing physical examination and special
tests for flat foot. The statistical analysis concluded that that the prevalence of flat foot in school children among
6 to 10 years (from class 1 to 5) is 14.8% (106) and more common in male child then female child and bilateral
(76.4%) involvement of the flat foot is more than unilateral (23.4%). The study showed that prevalence of flexible
flat foot is ten times more than rigid flat foot having a ratio of 9:1 .all rigid flat foot cases are symptomatic and
flexible flat foot cases are asymptomatic (showing no symptoms).the prevalence of flat foot is more in children’s
who are physically inactive .while physically active children have a very well developed medial longitudinal arch.
It is our Conclusion that people/child who are living in different countries but having similar condition like
environment, social, economical, life style. They have equal chance of developing flat foot or they have same % of
the prevalence of the flat foot. Our study concluded that physical activity is directly proportional to the development
of the medial longitudinal arch.
295
FREE PAPERS
Session Name and Room: General - 1
Abstract Title: Prevalence Of Flat Feet Among School Children Between 6-10 Years
Abstract number: 513
Authors: M. Ali, S. Muhammad
Presenter: M. Ali
FREE PAPERS
Thursday, Feb 7 / 14:30 - 15:45
Session Name and Room: Rehab Medicine & Surgery - 5
Room G.06
Abstract Title: Conversion Of Hip Disarticulation Into Above Knee Amputation And Prosthetic Management
Abstract number: 486
Authors: B. Dhar
Presenter: B. Dhar
Osteo Sarcoma such as Ewing’s is common bone affliction with very common occurrence in early years.
Management often Results in amputation at the proximal joint .For patients with Sarcoma of proximal femur ,
amputation is always carried out at the hip leading to hip disarticulation. Such amputations are hard to rehabilitate
due to difficult prosthetic fitting and increased energy consumption. The novel surgical procedure converts a hip
disarticulation surgery into an above knee amputation wherein a viable residual limb and functional hip joint is
created. Modified and step wise Prosthetic fitting then helps patient ambulate as Above knee amputee with much
improved outcome and acceptance.
Patient Report:
• Six Amputations performed till date at KFSH&RC between age 16 and 23 in King Faisal Hospital. Two
patients ambulatory for more than six months .One patient dead due to metastasis . Three patients in process
of prosthetic fitting.
Steps of amputation Procedure:
The known basic principles of transfemoral amputation in skin incision and soft tissue dissection was followed.
Femur is completely removed while the soft tissue is preserved. A Prosthetic implant was installed with 4 to 6 inch
long stem. The muscles were sutured to the implant and the closure of skin was performed usual way. Rehab was
immediately started with muscle strengthening exercises and volume management by shrinker socks.
Results
All the patients healed normal. Prosthetic management was initiated in 6 weeks’ time .All patients walked with
prosthesis without any pain . All the patients were fitted with ischial containment sockets and endoskeletal
prosthesis. Prosthetic gait was like any above knee amputee.
Conclusion
Conversion of Hip Disarticulation into above knee amputation goes long way in energy saving and better gait.
Acceptance of prosthetic fitting is higher and the ambulation is much improved due to presence of Hip Joint.
296
Thursday, Feb 7 / 14:30 - 15:45
Loss of the upper limb can severely limit the function of the amputee. Rehabilitation of bilateral cases is very
challenging. Prosthetics do offer a fair amount of independence, however, the amputee remains as dependent
without the use of these devices. The Krukenberg procedure offers independence without use of prosthetic
devices. Our centre has a vast cumulative experience of around 500 such procedures over the last 50 years.
The Krukenberg procedure, which was first carried out by German Army surgeon H Krukenberg (1917) on British
Prisoners of War (POW) during 1st World War, converts non-functional below elbow stump into a highly functional
and sensate organ. Absolute indication for this procedure is loss of both the hands especially if there is loss of
vision as well. It is done by separating radius and ulna, and converting them into two prong / fork like sensate
fingers that are capable of performing most of the functions of hand. Pronator teres, which pronates the hand,
does the apposition of the radius and ulnar prongs to hold an object, while supinators open them. This procedure
helps converting a helpless person into a totally independent and useful member of the society. Krukenberg
offers a sensate prehension and also allows a functional or cosmetic prosthesis. Though usually advised for
blind bilateral amputees, such as due to bomb blasts, in our experience the procedure offers good outcome for
unilateral, sighted patients too. Suitable patients may be reluctant due to the cosmetic issues, however appropriate
peer and specialist counselling may help. The author is a prosthetic surgeon in the Indian Armed Forces, working
at the largest organised limb centre in India. He will elaborate on the surgical technique, and advantages and
limitations of the procedure.
297
FREE PAPERS
Session Name and Room: Rehab Medicine & Surgery - 5
Room G.06
Abstract Title: Krukenberg Procedure - Revival Of A Independence For Upper Limb Amputees.
Abstract number: 518
Authors: S. Chittoor
Presenter: S. Chittoor
FREE PAPERS
Thursday, Feb 7 / 14:30 - 15:45
Session Name and Room: Rehab Medicine & Surgery - 5
Room G.06
Abstract Title: Geriatric Rehabilitation Of Lower Limb Amputees; A Dutch Multicenter Cohort Study
Abstract number: 531
Authors: M. Spruit- Van Eijk, H. Van Der Linde, B. Buijck, A. Geurts, S. Zuidema, R. Koopmans
Presenter: M. Spruit- Van Eijk
Purpose
The aim of this study was to determine factors independently associated with successful rehabilitation and
prosthetic use of patients with lower limb amputation in skilled nursing facilities (SNFs).
Methods
All patients admitted to one of the 11 participating SNFs were eligible. Multidisciplinary teams collected the
data. Successful rehabilitation was defined as discharge to an independent living situation within 1 year after
admission. Functional status at discharge, as measured with the Barthel index (BI), was a secondary outcome.
Finally, a prediction model for prosthetic use was made. Multivariate regression analyses were used to assess the
independent contribution of each determinant to the outcome measures.
Results
Mean age was 75 years. Sixty-five percent rehabilitated successfully. Multivariate analyses showed that presence
of diabetes mellitus (DM) (OR 23.87, CI 2.26–252.47) and premorbid BI (OR 1.37, CI 1.10-1.70) were the most
important determinants of successful rehabilitation, whereas 78% of the variance of discharge BI was explained
by premorbid BI, BI on admission, and 1-leg balance. Of the thirty-eight patients that were eligible for fitting a
prosthesis at the end of rehabilitation, 50% were indeed fitted prosthesis and able to functionally use it. Being able
to ambulate independently, and having a transtibial amputation (rather than a higher level of amputation), without
phantom pain determined prosthetic use (R2=56%).
Conclusion
The presence of DM and high premorbid BI were associated with discharge to an independent living situation
within 1 year after admission. Premorbid BI, admission BI, and 1-leg balance were independently associated to
discharge BI. Elderly patients referred to an SNF for prosthetic training have a high probability of using a prosthesis
when having an independent ambulation after transtibial amputation, without phantom pain. These patients should
be considered for prosthetic training.
298
Thursday, Feb 7 / 14:30 - 15:45
Room G.06
Introduction
Osseointegrated prostheses have been used on transhumeral amputees for the last fifteen years. This is the first
radiological report on the first 18 patients.
Methods
18 patients received 20 implants. Average age at implantation was 42 (19-69) and female/male ratio was 2/16.
The cause of amputation was either trauma (16) or tumor (2). Their x-rays were qualitatively evaluated by one
observer. An anteroposterior and a lateral view of the implant were examined for structural changes such as near
bone resorption and cancellization at bone/thread interface, cortical thinning, distal bone resorption and proximal
trabecular buttressing.
Results
Of the 18 patients treated, 2 had implant failures. 2 implants failed in the same patient and one implant failed in
another patient and was revised. Of the remaining 17 implants (in 17 patients) 2 are followed elsewhere and one is
lost to follow up. 13/14 patients are using their upper limb prosthesis. Near bone resorption was observed in 7/20
implants (35%) mainly at the distal third of the fixture. Cancellization also occurred in 7/20 implants but was more
common at the middle third of the fixture. Cortical thinning appeared in 5/20 implants (25%) mainly at the distal
third. Distal bone resorption was less common (3/20 implants, 15%) and limited without exposing the fixture. The
most common radiological change was proximal buttressing (10/20 implants, 50%).
Discussion
This study reports on up to 15 years radiological follow up on transhumeral amputees with osseointegrated
prostheses. Late implant loosening has not been observed clinically or radiologically. On the other hand 3 implants
loosened early within two years without any signs of bone resorption on the x-rays indicating the difficulty to
correlate between clinic and radiology regarding early loosening.
Conclusion
The study supports that bone anchored protsheses in upper arm amputees work satisfactory with few implant
failures.
299
FREE PAPERS
Session Name and Room: Rehab Medicine & Surgery - 5
Abstract Title: Bone Anchored Prostheses In Upper Arm Amputees: Radiologic Outcomes.
Abstract number: 178
Authors: G. Tsikandylakis, R. Brånemark, Ö. Berlin
Presenter: R. Brånemark
300
FREE PAPERS
FREE PAPERS
POSTERS
301
POSTERS
Mon, Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Tue, Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Posters 1 - Developing Countries / Exhibition Hall
Presenter Name
Page No.
Rwandan’S Vision Toward Moving Beyond Disability
D. Ngendahayo
308
Overview Of Physical Rehabilitation In Africa, Methodology
Components, Population: First Results 2010-2011
I. Urseau
309
Prosthetics And Orthotics Service And The Poverty In Cambodia.
S. To
310
The Challenge Of The Relevance,Quality And Sustainability Of
Prosthetic Service In Thailand,The Best Practice.
V.
Rujiwetpongstorn
311
Challenges For Prosthetics And Orthotics: In Rural India.
J. Yadav
312
Organization Of Rehabilitation Medicine After A Disaster – Haiti 2010
I. Siev-Ner
313
Indian Technology Transfered To Arched Enemy And Followed Up By V. Qurashi
European Standards
314
Orthotic Lower Innovations In Polio Rehabilitation
Paulas. R
315
R & D Practices In Prosthetics And Orthotics: A Clinical Review
P. Singh
316
Implementation Of The Un Convention On The Rights Of Persons
With Disabilities In Jordan
R. Alkhattab
317
Importance And Significance Of Iso 10328 Certification In Prosthetic
Hi-Tech Modular Component Manufacturing
S. Bhowmik
318
An Upgrade Programme From Ispo Category Ii Level To A Bachelor
Degree In Prosthetics And Orthotics: Sirindhorn School Of Prosthetics
And Orthotics (Sspo), Mahidol University, Thailand
S. Kaewtip
319
Posters 1 - Education / Exhibition Hall
Developing And Supporting Clinical Activities With An Indian Prosthetics K. Murray
And Orthotics Charity As Part Of An Undergraduate Curriculum
320
Technology Assisted Evaluation To Improve Outcomes Of A
Technician Training Program In The Dominican Republic
321
G. Grisetti
Posters 1 - Evidence Based Practices / Exhibition Hall
Test-Retest Reliability Of The Orthotics And Prosthetics Users´ Survey L. Hermansson
322
Earth Quake 2005 And Icrc Physical Rehabilitation Activities In
Kashmir (Pakistan)
J. Ali
323
Kinetics Of Prosthesis For Congenital Hemimelia With Multiple
Anomalies
S. Maharana
324
Title: A Case Study :Functional Prosthetic Rehabilitation Of A Varied
Bilateral Lower Limbs Amputee.
R. Ewoi
325
Patient Satisfaction Audit First Of Its Kind Carried Out In Pakistan
V. Qurashi
326
A Unique Twenty Year Folllow Up Study Of Four Limbs Amputee
N. Doshi
327
Cross Sectional Survey Of The Scope And Effectiveness Of The Pre
Amputation Consultation
R. Munjal
328
The Conservative Management Of Soft Tissue Contractures- A
Literature Review And Supporting Case Studies
R. Bowers
329
302
Mon, Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Tue, Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Presenter Name
Page No.
P&O Body'S Role And Responsibilities; The Japanese Academy Of
Prosthetists And Orthotists
K. Sakai
330
Numerical Analysis Of Prosthetics And Orthotics Manufacturing And
Fitting In Turkey According To Social Security Administration Of
Turkey
S. Alsancak
331
The Prosthetic Orthotic Component Clearinghouse: A 5 Year Review
R. Kistenberg
332
Changes In The Incidence Of Diabetes-Related Lower Extremity
Amputation: A Long-Term Observational Survey In Geneva,
Switzerland
C. Gorki
333
New Approach And Guideline For The Rehabilitation Of Limb Deficient T. Datta
Child
334
Robot-Assisted Habilitation For Children With Cerebral Palsy
T. Dukendjieva
335
Device For Patient With Bilateral Hip Disarticulation And Unilateral
Elbow Disarticulation
J. Carvalho
336
The Effect Of A Spinal Orthosis On Posture And Cardio-Respiratory
Functions In Progressive Myopathic Scoliosis: A Case Report
R. Mohanty
337
The Two Folds Flexible Seat Corset For Children With Cerebral Palsy
K. Aklotsoe
338
Short Term Effect Of Conventional Tlso On Balance & Gait In
Individuals With Osteoporosis Of Spine.
S. Pal
339
Lumbo-Sacral Orthosis And Magnetic L.S.O With Adjustable
Turnbuckle: A Comparative Study
K. Balram
340
Management Of Back Pain For Handloom Weaver With Pneumatic
Spinal Orthosis.
Chandrakala. Th
341
Design Of Spinal Orthosis For Management Of Scoliosis.
N. Ojha
342
Effectiveness Of Hand Soft Splinting In Rheumatoid Arthritis: A
Perspective On Human Occupational Behavior.
K. Hara
343
The Effect Of Prefabricated Wrist-Hand Orthoses On Wrist Motion
K. Ross
344
The Efficacy Of Modified Design Of Simple Wrist Extensor Splint On
The Carpal Tunnel Syndrome: A Pilot Study
S. Sengiad
345
POSTERS
Posters 1 - General / Exhibition Hall
Posters 1 - Innovations / Exhibition Hall
Posters 1 - Orthotics : Spinal / Exhibition Hall
Posters 1 - Orthotics : Upper Limb / Exhibition Hall
303
POSTERS
Mon, Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Tue, Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Posters 1 - Orthotics: Lower Limb / Exhibition Hall
Presenter Name
Modern Custom Orthotic Solutions For The Lower Limb With Case
Studies
V. Schmidt
Page No.
346
Bringing Alignment Fixture Into Use To Make Orthotic Calipers For
S. Bhowmik
Masses In Welfare Camps/Projects, Which Enables To Have Optimum
Alighmnet, Resulting Increase Rate Of Acceptibility
347
Gait Pattern And Mobility In Patients With Diabetic A Two-Year Follow
Up Study
R. Zugner
348
Development Of A Study Design For The Use Of Cpm Night Splints
On Spastic Calf Muscles
W. Sepin
349
A Comparison Of Foot Insole Material In Planter Pressure Relief
A. Mishra
350
Meta-Analysis Of Contracture Reduction: Knee To Toe
S. Curran
351
Adjustable Orthotic Prescription Tool
J. Hijmans
352
Case Study - Effect Of An Ankle-Foot Orthosis And Functional
Electrical Stimulation On Gait Kinematics In Multiple Sclerosis.
E. Davidson
353
Reducing Friction And Shear: A Pedorthic Perspective
D. Janisse
354
Quantitative Analysis Of Effect Of Lateral Wedging Insole In Medial
Compartment Knee Osteoarthritis On Foot Pressure And Radiological
Parameters
S. Yadav
355
The Clinical Application Of Stance Control Knee Ankle Foot Orthoses
For Individuals With Neuromuscular Disease.
J. Campbell
356
Development Of A Curb-Climbing Aid For Powered Wheelchair
G. Kim
357
Jaipur Limb Technology Revisited By European Standards
V. Qurashi
358
Use Of Radio Wave And Optical Control For Quality Assessment Of
Orthopedical Products
E. Shataeva
359
Posters 1 - Technology / Exhibition Hall
Wed, Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Thu, Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Posters 2 - Paediatrics / Exhibition Hall
Musculoskeletal Disorders In Caregivers Of Children With Cerebral
Palsy Following A Multilevel Surgery
D. Sharan
360
Virtual Reality Based Therapy For Post- Operative Rehabilitation Of
Children With Cerebral Palsy
D. Sharan
361
Orthoses To Prevent Hip Dysplasia And Foot Deformities In Cerebral
Palsy
F. Landauer
362
304
I. Siev-Ner
363
Comparison Of 3D Gait And Balance Effects From An Adjustable
Dynamic Response Versus Fixed Ankle Foot Orthosis In A Child With
Hemiplegic Cerebral Palsy
M. DeHarde
364
Sfa Brace- Mobility India Initiative In Treatment Option For Club Feet
In India
S. Oinam
365
Effect Of A Ypsylon (Carbon Reinforced) Ankle-Foot Orthosis On Gait
In Children With Spastic Cerebral Palsy.
M. Bonikowski
366
Improving Manufacturing Excellence Of Prosthetic Socket Design
Using Reverse Engineering (Re) –A Case Study
R. Pandey
367
The effect of floor quality on postural control in patients with diabetic
neuropathy
M. Mehdikhani
368
Spatio-Temporal Characteristics Of Locomotion Of Transfemoral
Amputees Fitted With Bone-Anchored Prosthesis
L. Frossard
369
Hip Joint Stabilization Vs. Propulsion And Resistance In Individuals
With Transfemoral Amputation
L. Frossard
370
Rehabilitation At The Red Cross Hospital, Sweden. Intervention And
Outcome For Lower Limb Amputees.
H. Sundgren
371
Tf Seal-In Liner Use In Interims:Effect On Rehab Time, Outcome And
Continued Use.
A. Cox
372
The Need For Only 1 Tt Interim Prosthesis/Socket When Appropriate
Oedema Control And Management Is Applied.
A. Cox
373
The Impact Of Transfemoral Amputation On The Cognitive Load
Associated With Walking
B. Hafner
374
Preliminary Study Of Quantification Of Shape And Elasticity Of A
Residual Limb Of A Transfemoral Amputee
T. Nakamura
375
Characterization Of Mechanical And Electrical Vacuum Pumps For
Use In Vacuum-Assisted Suspension
S. Koehler
376
The Role Of Prosthetic Feet In Promoting Gait Symmetry Of Unilateral
Transtibial Amputees
V. Agrawal
377
Lateral Trunk Flexion During Bilateral Transtibial Amputee Gait
Y. Wu
378
Dynamic Stability Of Individuals With Transfemoral Amputations
Walking With Varying Prosthetic Knee Alignment.
Y. Wu
379
Biomechanical Gait Evaluation Of The Cr-Sach Prosthetic Foot
A. Lacraz
380
Cr-Equipements™ Sach Foot Versus Otto Bock™ Sach Foot A
Prospective Double Blind Study Assessing Patient’S Satisfaction
A. Lacraz
381
New Ankle Device Adjusting The Angle And Height Of Heel Of
Prosthesis
J. Song
382
Biomechanical Evaluation Of Microprocessor Controlled Prosthetic
Knee Mechanisms
A. Crimin
383
POSTERS
Congenital Limb Deficiencies – Epidemiology And Management
Posters 2 - Prosthetics : Lower Limb / Exhibition Hall
305
POSTERS
Wed, Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Thu, Feb 7 (14:00 - 14:30, 15:45 - 16:15)
A Movement Analysis Application To Analyze Energy Recovery In
The Prosthetic Feet
C. Frigo
384
Effects Of Different Knee Joint Of Trans-Femoral Amputee Elevating
Stairs.
Y. Nagakura
385
Clinical Experience With An Early Walking Aid With A Free-Moveable
Prosthetic Knee Joint In Transfemoral Amputees
J. Hijmans
386
Custom Removable Immediate Post Operative Prosthesis : A Cost
Effective Way
A. Nanda
387
Using The Timed Up And Go To Objectively Evaluate Variable
Cadence Ability In Transfemoral Prosthetic Users
D. Amtmann
388
Sensor For Artificial Feedback In Lower Limb Exoprostheses
G. Tschupp
389
Posters 2 - Prosthetics : Upper Limb / Exhibition Hall
Presenter Name
Five Year Experience Fitting Partial Hand Prostheses Using Powered
Fingers
J. Uellendahl
390
Body-Powered Functional Partial Hand Prostheses Using The
M-Finger System
J. Uellendahl
391
A Completely Body Powered Active Prosthetic Mechanical Finger- A
New Concept
H. Babariya
392
Interlimb Transfer Of Unimanual Grasping Movement In Upper Limb
Amputees (A Pilot Study)
L. Frossard
393
Promas-6: A Modular Upper Limb Prosthesis For Shoulder
Disarticulated Patients.
M. Troncossi
394
Development Of A Lightweight, Low-Cost, Myoelectric Prosthesis
J. Sensinger
395
Voluntary-Opening / Voluntary-Closing Body-Powered Terminal
Device Provides Cosmesis And Function
J. Sensinger
396
Correlation Analysis Between Skin Density And Semg For Sensory
Feedback In Hand Prostheses
Y. Chang
397
Nanocomposites For Polycentric Knee Joint Used For The Above
Knee Prosthesis
Arun. S
398
Effects On Pressure Distributions At The Socket Interface In
Transhumeral Amputee During Elbow Flexion And Extension
Movements.
N. Abd Razak
399
Rehabilitation Of The Multiple Limb Amputee
M. Jacobs
400
Psychosocial Issuesrelated To Non Compliance Of Upper Limb
Prosthese In Adolescent Transradial Amputees
N. Akhtar
401
306
Page No.
Wed, Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Thu, Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Presenter Name
Page No.
Land Mine Survivors And Their Physical Rehabilitation In Pakistan
Administrated Kashmir.
Z. Mirza
402
Patient Satisfaction In Acute Amputee Rehabilitation
K. Primett
403
The Use Of Cognitive Interviews To Evaluate Item Content In A
Prosthetic Mobility Outcome Measure
D. Amtmann
404
Ortho-Prosthesis In Phocomelia
P. Sidhu
405
Quality Of Life And Functionality After Lower Limb Amputations:
Comparison Between Unilateral Versus Bilateral Amputee Patients
K. Yazicioglu
406
Comparison Of Quality Of Life And Functionity In Patients With
Traumatic Unilateral Below Knee Amputation And Salvage Surgery
K. Yazicioglu
407
Psychosocial Experiences With A Prosthesis: Perspectives From The
User
P. Gallagher
408
Complications During Post-Surgical Rehabilitation Following Single
Event Multilevel Surgery In Cerebral Palsy.
D. Sharan
409
Bone Anchored Transhumeral Prosthesis - A Case Study
S. Sooriakumaran
410
Use Of Lokomat In Spinal Cord Injuy (Sci)
D. Van Kuppevelt
411
Lower Limb Amputations: Surgical Techniques In Light Of Prosthetic
Considerations
S. Chittoor
412
Upper Limb Amputations - Surgical Techniques In Light Of Prosthetic
Considerations
S. Chittoor
413
E. Iversen
414
A. McGarry
415
POSTERS
Posters 2 - Quality Of Life Issues / Exhibition Hall
Posters 2 - Rehab Medicine & Surgery / Exhibition Hall
Posters 2 - Seating & WC / Exhibition Hall
Design Of The Whirlwind Rough Rider Wheelchair
Posters 2 - Sports And Physical Activity / Exhibition Hall
An International Comparison Of Sporting Prosthetic Users At The
London 2012 Paralympic Games
307
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Developing Countries, Poster Board 1
Abstract Number: 78
Abstract Title: Rwanda’s Vision Toward Moving Beyond Disability
Authors: D. Ngendahayo
Presenter: D. Ngendahayo
Introduction
Rwanda is a country located in central Africa. Its population is about 11 millions. Rwanda was abandoned by
international community in 1994, during the Genocide period and about 1 million of Tutsis and moderate Hutus
were killed and others left with different disabilities. For now, the country has a political stability and many policies
are put in place to deal with consequences of the Genocide whereby the physical disabilities are concerned. To
optimize the service rendered to people with disabilities, that number is still not enough and Hence:
• Recruitment of the additional staff
• Formation of ISPO Rwanda
• P&O department was approved to start.
Appeal to Ispo International
We would like to invite ISPO assist in the following areas.
• Consultation visit for the school this year.
• Give a keynote address or scientific paper during our nation member society annual congress,
• support and guide ISPO Rwanda in Promoting clinically relevant research and evidence based practice in the
field of Prosthetics and Orthotics.
• We intend to apply for the ISPO Short courses
Outcome From The Above Activities
• Strengthening the newly formed National society.
• Future accreditation of the school for P/O
• Boosting our professional status through holding the short courses since the entire national will benefit and be
sensitized at the same time
• Ability to address the need in terms of service delivery, advocating for best practices to governments and
non-governmental organizations and advising on key relevant issues.
Conclusion
We ISPO Rwanda and the school are still young and currently facing some problems, but with collaborating
partners we will overcome these hurdles. As the entire nation is rebuilding, we in P/O must not be left behind.
308
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
POSTERS
Exhibition Hall: Posters 1 - Developing Countries, Poster Board 2
Abstract Number: 80
Abstract Title: Overview Of Physical Rehabilitation In Africa, Methodology Components, Population:
First Results 2010-2011
Authors: I. Urseau
Presenter: I. Urseau
The collaboration between the African Federation of Orthopaedic Technologists (FATO), World Health Organization,
Handicap International and the International Committee of the Red Cross has enabled the development of a
questionnaire resulting in a survey to determine the social, health, legal, geographical factors that promote the
development of a strategy for physical rehabilitation in African countries.
The questionnaire aimed to provide an inventory of the situation throughout Africa. It consists of three parts:
Country Context, Rehabilitation Sector, Appendices providing background details. The survey was disseminated
to all country members of FATO. Each country formed a multi-disciplinary National Committee of stakeholders to
conduct the investigation. The survey was analyzed using Sphinx Plus2 software.
The return rate was 73%, 29 country members of FATO responded. The organization of the National Committees
has led to local Discussions, leading in some cases to an awareness vis-à-vis the question of rehabilitation in
the country. The questionnaire helps understand the characteristics of the different countries and to link these
characteristics to the functioning of health systems and/or related social rehabilitation.
The heterogeneity among National Committees led to answers of different quality. The statistical analysis was
presented at different sessions of the FATO Congress 2011, in order to illustrate different points, stimulate
Discussion and highlight the interest to develop a strategy in the field of rehabilitation. An analysis of open-ended
questions was performed of enablers, barriers to access to care, and existing data on the number of people with
disabilities.
A more analytical approach to develop relationships between groups of countries and the functioning of the
rehabilitation sector is still ongoing. This process will provide accurate information to assist governments in
decision-making and will be completed at the FATO Congress 2013.
309
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Developing Countries, Poster Board 3
Abstract Number: 128
Abstract Title: Prosthetics And Orthotics Service And The Poverty In Cambodia
Authors: S. To
Presenter: S. To
To Sichoeun Cambodia has gone through a period of warfare and a genocide regime which has left behind
many consequences. As such, a high number of persons with disabilities as well as poverty still remain as one of
main challenges for the development in Cambodia. Despite rapid economic development over the recent years,
Cambodia remains one of the 59 countries listed within the least developed countries report (UN, 2010). The
National Census indicates that 1.4% of total Cambodian population had disabilities; most of them are the poorest
amongst the poor in Cambodia (National Census, 2008). Therefore, the provision with quality of prosthetics and
Orthotics to persons with disability should be considered with respect to the reality of Cambodia. Due to the
poverty, Cambodian people with disability and as well as the Cambodia government and other donor are unable
to afford a high price component and material to run prosthetics and orthotics service. Thus, the provision of
prosthetic and orthotics service adapting to polypropylene technology for low income country is chosen. With the
production cost of each device about USD 200 together with well-trained professional and the national standard in
place, the provision of the service for person with disabilities are widely accepted in term of quality that suit to the
environment and the livelihood of Cambodian people with disability . In the Conclusion, the provision of prosthetics
and orthotics service is dependent on a real circumstance. The environment and the livelihood of the service user
should be considered. A developing country like Cambodia is illustrated as an example. The success stories in
Cambodia are to be presented to prove the statement.
310
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Therdchai Jivacate, MD., Boonyu Tipaya,Tippaporn Yesuwan, MBA., ML Buddhibongsa Devakula, MD.,
Vajara Rujiwetpongstorn, MD.
The Prosthese Foundation of H.R.H. the Princess Mother was established in 1992 as a non-profit organization,with
the clear vision and Objectives to support the poor amputees with the appropriate prosthetic legs regardless of
nationality and religion. The prosthetic services have been done regularly both in Foundation's main workshop
and mobile clinics,by using high quality local materials and cost-effective green technology appropriate to the
environment of Thailand. Thirty satellite workshops in the distric hospitals,distributed around the country to ensure
adequate and sustainable service to the remote rural areas.The satellite workshops are run by the technicians
who suffered leg ampution in theirs communities,trained by the Foundation.The Prostheses Foundation
of H.R.H.the Princess Mother,Thailand believes this is the state-of-the-art prosthetic service at the most
economical,affordable,high quality and sustainable,appropriate to the developing countries. ( The key successes
will be presented.)
311
POSTERS
Exhibition Hall: Posters 1 - Developing Countries, Poster Board 4
Abstract Number: 170
Abstract Title: The Challenge Of The Relevance,Quality And Sustainability Of Prosthetic Service In
Thailand,The Best Practice.
Authors: V. Rujiwetpongstorn
Presenter: V. Rujiwetpongstorn
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Developing Countries, Poster Board 5
Abstract Number: 331
Abstract Title: Challenges For Prosthetics And Orthotics In Rural India.
Authors: J. Yadav, K. Balram
Presenter: J. Yadav
Introduction
India is land of agriculture. 60% of working population in country is involved in agriculture sector. There is lot to
be done in prosthetics and orthotics, so that a farmer should be able perform to his/her A.D.L and can improve
his/her quality of life.
Objectives
Our approach is to depict the real scenario of prosthetics and orthotics in developing country like India and
suggest various changes in prosthesis and orthotic designs.
Methods
1.) Various changes in Prosthesis for a farmer.
2.) Adaptation in prosthesis for a rural woman.
3.) Low cost energy return prosthetic foot.
4.) Squatting prosthesis.
5.) Adaptation in stubbies.
6.) Use of plywood/bamboo for making splints. Etc.
7.) Suggestions of various low cost materials that can be used for prosthetics and orthotics.
Conclusion
Although many multinational companies have emerged in country, but at grass root level their effect cannot
be seen. Government, companies and N.G.O.s have ample scope in rural areas for development of prosthetics
and orthotics.
312
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POSTERS
Exhibition Hall: Posters 1 - Developing Countries, Poster Board 6
Abstract Number: 427
Abstract Title: Organization Of Rehabilitation Medicine After A Disaster – Haiti 2010
Authors: I. Siev-Ner, A. Kristal, D. Abadi
Presenter: I. Siev-Ner
On January 12th 2010, Haiti was struck by a major earthquake. An estimated 230,000 people were killed with
an additional 300,000 injured – the majority suffering from severe limb injuries. Initial treatment was delivered by
a multitude of teams which arrived from all over the world. The treatment was delivered in facilities ranging from
clinics through field hospitals to more advanced medical facilities, but all were done in a setting of mass injury –
damage control approach. This catastrophic event left in its aftermath thousands of people with either amputations
(estimated number – 4,000), or severe sequelae of fractures and soft tissue injuries – all of which requires further
treatment and prolonged rehabilitation in order to return to a reasonable level of function.
Realizing these needs as well as their urgency, we organized a comprehensive team which was sent to Haiti in order
to assess the needs and plan a long term rehabilitation mission. The field of rehabilitation was underdeveloped
in Haiti before the earthquake. The disparity between the needs and service availability was obviously increased
hundred fold following the calamity. This applies to all aspects of rehabilitation including personnel, facilities and
equipment.
At the end of April 2010, we established a joint Haitian - Israeli Rehabilitation Center in Haiti in the General
University Hospital in Port-au-Prince. The center is based on rotating Israeli multidisciplinary teams. The goal of
the center is to concomitantly treat the patients, as well as training of local personnel at all levels. We regard this as
a long term project with the aim of eventually handing it over to full Haitian operation. The presentation will address
international collaboration, cultural aspects, the lack of involvement of the international rehabilitation organizations
and practical facts of operating a rehabilitation project in the third world.
313
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Developing Countries, Poster Board 7
Abstract Number: 435
Abstract Title: Indian Technology Transfered To Arch Enemy And Followed Up with European Standards
Authors: V. Qurashi
Presenter: V. Qurashi
Two neighbouring countries have fought three wars in the last 62 years since independence,relations start to
thaw following the massive earthquake 2005 and resulting in several amputees,as a gesture of god will Indian
technicians and technology was offered to Pakistan,in the first instance around 300 limbs were manufactured,
even Pakistani amputee soilders who once had fought with Indian counterparts,started walking,a initiative well
appreciated by peace lovers of two countries,and well quoted in AMAN KE ASHA, since than relations started
thawing,and who knows these two nuclear states,will bury the hachet and work for the betterment of their people.
Since than about 3000 prosthetic limbs are made in Pakistan using the same technology,and the Jaipur limb has
gone vigrous trial and testing, lasting for 16 months here in England,by a reputable firm who works for the ministry
of defence,the outcome of test is quite encouriging and at par with european standard and ISO 2008.
314
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
POSTERS
Exhibition Hall: Posters 1 - Developing Countries, Poster Board 8
Abstract Number: 485
Abstract Title: Orthotic Lower Innovations In Polio Rehabilitation
Authors: Paulus. R
Presenter: Paulus. R
Introduction
India being one of the major players in orthotic rehabilitation for polio affected victims has number of conventional
designs of orthosis in practice. Most of them have its own practical disadvantages, considering the customs and
rituals of the country, which in turn limits the lifestyle of the user. Based on these requirements 'modular orthosis'
is designed with various innovations.
Methods
Modular orthosis is fabricated from the custom moulded shells made of polypropylene/ HDPE/ fibre reinforced
lamination over the positive mould taken from the negative plaster cast of the limb. Suitable joints are properly fixed
in place of knee joints and ankle joints to connect the thigh, calf and foot shell. The foot shell with outer sole permits
bare-foot walking for different occasions. The full device is given enough padding and a smooth brim for comfort.
Various design modifications and material changes were applied at different levels on different age groups of more
than six hundred users for the past twenty years, which resulted in the consolidation of 'Modular Orthosis'.
Results
The orthosis is modular in its design, easy to wear and remove as it is beltless and self suspending, light in weight,
sleek and better in aesthetic appearance, usable without any footwear where it is required, and ensures comfort
and convenience by eliminating uneven pressure to the user.
Discussion
The individual custom fabrication is a lengthy process and the inner liner material creates fungal problems and
sweating to few users, due to more coverage area of the skin with synthetic foam, which has to be controlled by
using cotton stockings.
Conclusion
All the users, especially the working women and younger generation fitted with modular orthosis are fully satisfied
and testify the effect of its design and its performance for a better lifestyle.
315
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Developing Countries, Poster Board 8 A
Abstract Number: 370
Abstract Title: R & D Practices In Prosthetics And Orthotics: A Clinical Review
Authors: P. Singh, A. Sinha, R. Kumar
Presenter: P. Singh
Introduction
Prosthetic and orthotic practice is an empirical field. Present advances have come primarily from practical
experience and clinical experiments rather than from theory. A science of prosthetics and orthotics could be
developed from the present knowledge base that would provide a theoretical framework allowing the field to
advance in an accelerated, more orderly fashion. Although the field is currently in a relatively high state of clinical
development, most advances in recent decades have been technical. The prosthetic and orthotics profession is
at an exciting stage in its development. To function at this level of responsibility and accountability prosthetist and
orthotist need to be able to draw on research that has been evaluated critically to inform their evidence based
practice. This emphasis on research for the educational preparation of the prosthetics and orthotics is so they can
‘use research evidence to design, improve and implement effective prosthetics and orthotics practice’ and thus to,
importantly, improve patient outcomes. Prosthetist and Orthotist engage in on-going research and development
in an effort to improve their patients’ lives. Many patients have special needs, demands and that is where R&D
experience becomes essential in the field of prosthesis and Orthoses.
Conclusion
This paper focuses on the need and importance of research methodology and development and its process in the
field of prosthetics and orthotics and enhances the transfer of knowledge from research to clinical practice and the
result in the provision of improved patient services and care, that will increase the credibility and parity of the P&O
profession within the health care realm.
316
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
A Mirror of Reality – A Tool for Change
The process of preparing This Study to the Convention on the Rights of Persons with Disabilities and its publication
and circulation; part of the national effort exerted by the various sectors of civil and official in the direction of
strengthening the rights of persons with disabilities are guided by the principles of the Convention and provisions of
the detailed. The methodology totalitarian variety used in the preparation of this report; which relied on extrapolation
of legislation, policies to touch the reflection and measure the impact of all this on a practical reality for people with
disabilities through the practice learned of case studies and consultation meetings. This Survey of a rich source of
knowledge and analysis of reality in the arena of disability from different perspectives and diverse, a post-effective
tool for advocacy and lobbying organizations of persons with disabilities, and a guide to the executive bodies
to develop their performance and fulfilment of obligations imposed by the Convention in its Article IV et seq. of
texts. It is also the first and the only tool to monitor the legislative and practical reality of the rights of persons with
disabilities to guidance, reform and change, and not ambushed monitor errors and omissions. The coalition that
worked on the preparation of this report for more than two years and faced challenges that narrows the place
for detailed description, putting humbly in the hands of all concerned, including nongovernmental organizations,
national institutions, executive bodies, decision-making, international bodies and the International Committee of
the Convention; inorder to find out the reality of the situation and the requirements of reform and evaluation;
through joint work and exchange experiences, knowledge and communication between the parties, all at the
forefront of people with disabilities and their organizations.
317
POSTERS
Exhibition Hall: Posters 1 - Education, Poster Board 9
Abstract Number: 20
Abstract Title: Implementation Of The Un Convention On The Rights Of Persons With Disabilities In Jordan
Authors: R. Alkhattab, M. Al-Azzih, M. Al-Nahhas, S. Al-Majali, M. Hamam, R. Zetawi
Presenter: R. Alkhattab
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Education, Poster Board 10
Abstract Number: 90
Abstract Title: Importance And Significance Of Iso 10328 Certification In Prosthetic Hi-Tech Modular
Component Manufacturing
Authors: N. Ghorai, S. Bhowmik
Presenter: S. Bhowmik
What is ISO Standard – International Organization for Standardization For any product or services, when it is to
be optimized, a team of experts from various segments meets and decides, utmost acceptance criteria from user
point of view. It ensures standards desirable characteristics of products. The national delegations of experts of a
committee meet to discuss debate and argue until they reach consensus on a draft agreement.
Who and how ISO standards are developed
• ISO standards are developed by technical committees, (subcommittees or project committees) comprising
experts from the industrial, technical and business sectors which have asked for the standards. Why Standard
matters
• When products and services meet our expectations, we tend to take this for granted and be unaware of the
role of standards.
• When products, systems, machinery and devices work well and safely, it is often because they meet standards.
• When standards are absent, we soon notice. ISO 10328:2006- Prosthetics -- Structural testing of lower-limb
prostheses -- Requirements and test Methods It specifies procedures for static and cyclic strength tests on
lower-limb prostheses where, with one exception, compound loadings are produced by the application of
a single test force. The compound loads in the test sample relate to the peak values of the components of
loading which normally occur at different instants during the stance phase of walking.
The tests comprise of: 61607; Principal static and cyclic tests for all components. 61607;
A separate static test in torsion for all components. 61607;
A separate static ultimate strength test in maximum knee flexion on knee joints and associated parts for all knee
units or knee-shin-assemblies and adjacent components that normally provide the flexion stop on a complete
prosthesis.
318
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The Sirindhorn School of Prosthetics and Orthotics (SSPO), was established in 2002 in collaboration with the
Sirindhorn National Medical Rehabilitation Center and the Department of Rehabilitation Medicine of the Faculty of
Medicine Siriraj Hospital, Mahidol University, with partial support from the Nippon Foundation. The school offers an
internationally-recognized Bachelor degree in Prosthetics and Orthotics (B.PO), both domestic and international
program. Since 2009, the program has been recognized by the International Society for Prosthetics and Orthotics
(ISPO) as a Category I program. The major duties of SSPO are to provide education, PO service and research at
an international level.
The current situation is that most of the regional PO schools are qualified as Category II by ISPO. Slowly but
surely, the number of qualified Category II professional in greater Asia is increasing including the proportion
of persons with disabilities. With the increase in Category II professional, there is an urgent need for Category
I professionals who are able to supervise them, take the profession to the next level, and become instructors.
Therefore there is a considerable interest among those graduates and their employers to upgrade their education
to the Category I level without spending four years to take the entire program.
As the only currently accredited school in Southeast Asia at the Category I level, and already having experience
with international students, it would seem natural for SSPO to assist in this endeavor. SSPO has done comparative
research and developed a proposed curriculum for these potential students. SSPO, with the support from the
Nippon Foundation, has established a 2-year upgrade programme from ISPO Category II level to a Bachelor
Degree in Prosthetics and Orthotics and is now ready to launch this program from June, 2012.
319
POSTERS
Exhibition Hall: Posters 1 - Education, Poster Board 11
Abstract Number: 135
Abstract Title: An Upgrade Programme From Ispo Category Ii Level To A Bachelor Degree In Prosthetics
And Orthotics: Sirindhorn School Of Prosthetics And Orthotics (Sspo), Mahidol University, Thailand
Authors: S. Kaewtip, S. Seng-Iad, S. Sukthomya, N. Opartkiattikul
Presenter: S. Kaewtip
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Education, Poster Board 12
Abstract Number: 259
Abstract Title: Developing And Supporting Clinical Activities With An Indian Prosthetics And Orthotics
Charity As Part Of An Undergraduate Curriculum
Authors: K. Murray, A. Mcgarry
Presenter: K. Murray
The National Centre for prosthetics and orthotics at the University of Strathclyde, Glasgow has been involved in
international student field trips for over 20 years. Normally 3rd/4th year students fund raise over the preceding
year to finance travel and accommodation costs to allow a group to travel to overseas clinics and/or conferences.
Generally students will only visit clinics and observe clinical techniques. It has been recognised within the National
Centre that a more sustainable and collaborative approach needs to be taken with student field trips. Consequently
the National Centre is developing a collaborative relationship with the Indian charity ‘Mukti’ based in Chennai. The
objective of this collaboration is to provide students with the opportunity to immerse themselves in the local culture
and at the same time contribute their clinical skills to assist in the provision of Prosthetic/Orthotic services to the
local community.
The staff of the National Centre hope to gain insight into working in a developing part of the world and at the
same time provide advice to the charity on Methods of improving their services. Mukti means Freedom and the
charities slogan is ‘Freedom from crutches’. The charity provides prostheses and orthoses for people with mobility
problems as a result amputation or polio and who would otherwise be left without care and unable to provide for
their families.
This paper will report on progress being made 1 year on from initial contact with the charity. The process of
fundraising and student application to become involved with the project will be presented. By the time of the
conference two members of staff along with 4 students will have spent a total 2 weeks working in Chennai.
320
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Introduction
To address the lack of trained prosthetic technicians globally, organizations have provided education programs
which include visits by certified prosthetists to host countries. Feedback from experts is critical to learning;
however, resources may limit the frequency and duration of visits, therefore limiting the feedback from experts on
fabrication techniques. This research aims to determine the effectiveness of using video calling (e.g. Skype) to
improve learning and fabrication abilities of trainees in the Dominican Republic.
Methods
Certified prosthetists will provide on site evaluation of limbs fabricated by trainees without immediately providing
any feedback. Following this on site evaluation a video call between the trainee and a second expert prosthetist
in North America (United States or Canada) will occur. During the video call the online expert will evaluate the
prosthesis and provide immediate feedback to the student. Following the video call, the trainee will make any
recommended modifications. The onsite expert will then reevaluate the prosthesis providing feedback to the
student of any further modifications. The evaluations of the prostheses by the experts will be documented by the
researchers using an evaluation form and recorded via a voice recorder.
Results
On-site and video call evaluations will be compared through correlation of the static and dynamic evaluation
criteria, including: proportion, alignment, function and appearance. The comments by the certified prosthetists will
also be analyzed qualitatively in order to determine what characteristics of a prosthetic device can and cannot be
accurately assessed using video calling.
Discussion
Certified prosthetists provide expert feedback to trainee prosthetists. This research evaluates whether accurate
feedback about static and dynamic factors of prosthesis can be provided over video calling.
Conclusion
Video call evaluations could make an important contribution to the education of prosthetic technicians by increasing
the frequency of feedback between onsite visits
321
POSTERS
Exhibition Hall: Posters 1 - Education, Poster Board 13
Abstract Number: 387
Abstract Title: Technology Assisted Evaluation To Improve Outcomes Of A Technician Training Program
In The Dominican Republic
Authors: G. Grisetti, D. Russell
Presenter: G. Grisetti
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Evidence Based Practices, Poster Board 14
Abstract Number: 238
Abstract Title: Test-Retest Reliability Of The Orthotics And Prosthetics Users´ Survey
Authors: G. Jarl, M. Holmefur, L. Hermansson
Presenter: L. Hermansson
Introduction
The Orthotics and prosthetics users’ survey (OPUS) consists of five modules for self-report: Lower extremity
functional status (LEFS), Upper extremity functional status (UEFS), Client satisfaction with device (CSD), Client
satisfaction with services (CSS), and, Health-related quality of life (HRQoL), each giving a measure on a 0–100
unit scale. In previous studies, OPUS was translated into Swedish and validated with Swedish clients. The study
aim was to investigate the test-retest reliability and calculate the smallest detectable difference (SDD) for OPUS
with Swedish users of different prosthetic and orthotic devices.
Methods
Ninety-six outpatients at the Department of prosthetics and orthotics, Örebro County Council, Sweden, completed
OPUS on two occasions separated by a two-week interval, giving 18–67 valid answers per module. Intraclass
correlation coefficient (ICC; version 1,1), common person linking plots, Bland-Altman plots and paired t-tests were
used to investigate the reliability. The SDD was calculated for a 95% confidence level.
Results and Discussion
The ICC was satisfactory for LEFS, UEFS, CSD and HRQoL (0.82–0.96) but was weaker for CSS (0.62). This
pattern was confirmed by the common person linking plots and Bland-Altman plots. The t-tests did not reveal any
systematic differences between the response occasions, and the weaker reliability for CSS was not associated
with any single item. The SDD was 7.4 units for HRQoL, between 12.1 and 15.0 units for LEFS, UEFS and CSD,
and was 24.6 units for CSS.
Conclusion
The test-retest reliability was satisfactory for four out of five OPUS modules. The lower reliability of CSS needs
further study. On all modules but HRQoL, relatively large changes are needed to achieve statistical significance
when assessing individuals.
322
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POSTERS
Exhibition Hall: Posters 1 - Evidence Based Practices, Poster Board 15
Abstract Number: 12
Abstract Title: Earth Quake 2005 And Icrc Physical Rehabilitation Activities In Kashmir (Pakistan)
Authors: J. Ali
Presenter: J. Ali
Kashmir(Pakistan) total population 3, 963,000, literacy rate 65%, According to1998 census 2.49 % 98676 PWDs
in Kashmir, 19% of PWDs18748 are physically disables, and according to computerize ID card total 8,874 adults
physical disabled are registered, Before earthquake2005, there was no center in Kashmir to provide physical
rehabilitation services to physical disables they were traveling to Fauji Foundation Artificial limb center (FF. ALC)
Rawal Pindi, ICRC were already planning to establish a physical rehabilitation in Muzaffarabad (Kashmir), the
center’s construction were supposed to start in the beginning of 2006
October 8 2005 morning Kashmir and northern parts of Pakistan heavily damaged by an earthquake magnitude
7.6 on rector scale, 73 338 died, 128 309 reported injured, Rescue and Relief work started by national and
international organization, Injured were rushed to different hospitals inside and out side the country, 741 were
detected got spinal injuries 61.54% female and 38.46% male, 713 were reported got major& minor amputations
51.33% female 48.66% male
ICRC started out reach program with FF ALC’s collaboration and patients required P&O services were transported,
accommodated and treated in ALC Rawal Pindi, Until May 2007 ICRC registered 411 patients and delivered
orthopaedic devices, June 2007 the ICRC Muzaffarabad physical Rehabilitation Center (MPRC) started
functioning, Until Feb 2012 MPRC registered 4336 patients and 21524 Services (prosthesis, orthosis, physiothery,
wheel chairs and walking Aids) has been given to physically handicapped Patients, ICRC socio-economically
integrated 755 physically disabled through grants,
Future Plan Out reach program and establish satellite centers Establish links with all professionals related to physical
rehabilitation Advocate and support Disability and physical rehabilitation. Challenges Limited professionally trained
human resources Limited financial resources
Conclusion
Physical Disability and its management is Question Mark for developing Countries available resources and always
needs Global support from different national and international organizations
323
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Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Evidence Based Practices, Poster Board 16
Abstract Number: 106
Abstract Title: Kinetics Of Prosthesis For Congenital Hemimelia With Multiple Anomalies
Authors: S. Maharana, A. Nanda
Presenter: S. Maharana
Introduction
An appropriate Kinetic mechanism for multiple locomotor disability like a boy of age 7 yrs. Right side congenital
hemimelia, trans-pelvic loss left side, short leg length with unstable hip joint and ill formed internally rotated
pseudo-knee joint just below the hip joint and absence of upper limb through elbow is some time mere complex
than the existing design. A successful kinetic mechanism development for such specialize conditions depends on
gross analytical study of forces, spatial arrangement of existing joint and available quantum of force and its applied
execution.
Methods
Multiple anomalies with differentiated force execution and low intensity controlled value refer to think about a
coordinated integration programme for successful prosthetic option. Hence we are deviated from the normal surge
mechanism and treated it as “one of a kind”.
Results
The whole system is synthesized under the analysis of Craig-scott principle and critical factors for successful
function. The Patient is capable to walk with appropriate trunk balance and very good rejoice. The critical load is
also reduced by equal and opposite hip and knee joint. Contra lateral side is stabilized by A.F.O. adjoin with single
axis joint at trocanteric level.
Discussion
It is assumed that loss of lower limb with function deficient in the present limb requires the use of motion constraint
knee mechanics for requiring stability. The ample clinical evidence also shows locking knee mechanics are seldom
necessary so, here a recipocating hip knee joints was used under active function of ground reaction force (GRF).
The resultant hip and knee extension moments are resisted by elastic hyperextension bias.
Conclusion
Despite the present physical and psychological challenges for such high level prosthetic rehabilitation is
materialized through appropriate design of component, base r5eceptable and appropriate gait training.
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Introduction
Patients with bilateral lower limb amputations face a complex process of physical and emotional recovery. To the
Prosthetists they pose unique challenges of restoring functional mobility. Though regaining mobility and learning
to walk on prostheses are usually the ultimate goals,It may seem that their most practical option is to accept using
a wheelchair for mobility and using crutches and a swing-through gait. A host of factors are magnified and are to
be seriously considered for clinical decision making.
Methods
A hands-on practical approach was adopted. Mrs. B A is a bilateral amputee; Left Hip Disarticulation (HD) and
Right Trans Femoral (TF) amputee following a devastating crash by 3 train wagons. 2 months later she was
referred to us for Prosthetic rehabilitation. It took 1 week to finalize the fabrication and interim gait training. A
3-month follow up date was scheduled to review her functional status and a measurable outcome was gauged. A
year later a final follow up was done to validate the outcomes.
Results
Functional outcome was gauged utilizing the SF-36 Form, evaluative and descriptive approaches. 1. Independence
in most Activities of Daily Living( ADLs); Back to office work and can handle light domestic chores. 2. Independent
crutch gait (3-point crutch gait) 4. Reduced donning and doffing time 5. Good compliance and enhanced
psychosocial boost
Discussion
This varied amputation levels combination called for careful attention to the details of socket fit, prostheses
alignment and component selection to interact effectively following sound biomechanical principles in order to
optimize her ambulation potential.
Conclusion
The clinical measures taken have made us maximize on the ambulatory potential of this client. Results depict a
trend towards self reliance from the client and sense of satisfaction from the Prosthetists. Evidently, functional
prosthetic rehabilitation contributes to the realization of quality of life of an amputee.
325
POSTERS
Exhibition Hall: Posters 1 - Evidence Based Practices, Poster Board 17
Abstract Number: 325
Abstract Title: A Case Study: Functional Prosthetic Rehabilitation Of A Varied Bilateral Lower Limbs
Amputee.
Authors: R. Ewoi, D. Fleming
Presenter: R. Ewoi
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Evidence Based Practices, Poster Board 18
Abstract Number: 163
Abstract Title: Patient Satisfaction Audit - First Of Its Kind Carried Out In Pakistan
Authors: V. Qurashi
Presenter: V. Qurashi
Lower limb prosthesis,were not available to general population in Pakistan until 2005 earthquake,with the transfer
of technology from jaipur[india]till date we have provided over 2800 lower limb prosthetsis to the effecties we
carried out the very first follow up patient satisfaction audit on 800 patients ,and the Results were tabulated by
independent teams,with no inteference from the author Results were very promising,for the reason,these patients
were provided free of charge prosthesis,a repair and alteration workshop was availabe, and a`named contact
technician was the point of contact,patient satisfaction level both for transtibial andtransfemoral amputees was
slightly better than international standards,bilateral amputees did not do well as expected,but overall Results were
quite encouraging.
326
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POSTERS
Exhibition Hall: Posters 1 - Evidence Based Practices, Poster Board 19
Abstract Number: 528
Abstract Title: A Unique Twenty Year Folllow Up Study Of Four Limbs Amputee
Authors: N. Doshi, M. Doshi
Presenter: N. Doshi
20 Years Follow Up Study of 4 Limb Amputee
Mahesh Deshpande was a 4 limb amputee ie bilateral shoulder disart and bilateral below knee amputee due
to electrical burns .The paper was presented in the year 1992 in Chicago. As time moved on the patient has
completed his 12th std exams and has completed his graduation in arts .long follow up with Mahesh is quite
encouraging to understand so many factors like usefulness of prosthetic devices, self created practice and how to
solve the socio economic issue. Today Mahesh is working as a teacher and giving education to the other children,
.his courage to fight with life is unbelievable.
327
POSTERS
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Evidence Based Practices, Poster Board 20
Abstract Number: 359
Abstract Title: Cross Sectional Survey Of The Scope And Effectiveness Of The Pre Amputation Consultation
Authors: R. Munjal, R. Saad
Presenter: R. Munjal
Introduction
Pre amputation consultation is a relatively common process in the UK for patients who are either border line cases
due to their underlying pathology or are unable to make a decision with regard to reconstructive surgery or where
risks of such surgery are very high. The specific aims of the study were to identify If patients were informed of the
rehabilitation process and what to expect post amputation and impact on their future life.
Methods
Data was collected from 45 patient notes between the periods Jan 2008 - Feb 2010. Patient questionnaire was
designed specifically to capture desired information and sent to 40 patients. 23 patients returned the completed
questionnaire.
Results
78 % of the patients were males. 31% of the patients had severe chronic pain as the reason for pre amputation
consultation. 24% had chronic osteomyelitis. All the patients saw both doctor and nurse but only 38 % saw the
Prosthetists. Pre amputation consultation was both useful and effective as 51% underwent amputation after their
consultation. In contrast, 49% of patients decided not to undergo amputation after consultation.
Discussion
About 94% of patients indicated that they understood the purpose of consultation and the explanations given
and 88% reported that they were able to make an informed decision. 66% reported that the complications of
amputation were explained. 69% of patients were unsure of what life would entail post amputation and only 50%
of patients acknowledged being given information of the rehabilitation process including timescales. 75% reported
that their concerns were addressed in the consultation.
Conclusion
The prosthetic rehabilitation team should be collectively present.
Patients often have difficulty in remembering. Written information may be better.
All patients where their there is a doubt about the need or outcome of amputation should be referred for preamputation consultation.
328
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Contractures are a reduction in joint mobility, which are a common complication. They can affect a person’s quality
of life, severely limiting independence. Many forms of contracture management exist to limit onset, progression,
or correct contractures. Orthoses, physiotherapy and serial casting are amongst the conservative management
options, but there remains dispute over their effectiveness. A literature review was undertaken to look at the
evidence supporting conservative management of soft tissue contractures; predominately orthotic treatment, and
including physiotherapy and serial casting. The literature was searched on various online sources and critically
reviewed using the SIGN grading. Joint mobility was an outcome measure essential for inclusion in this review.
Exclusions included; contractures due to burns, Dupuytren’s or ischaemia, surgeries to release the contracture,
serial casting for CTEV, or an amputation directly below the contracted joint.
The Results highlighted thirty-two relevant studies. Twenty-four studies on orthotic treatment; four used
physiotherapy only, and four combined physiotherapy and serial casting. There was low level evidence to support
both for the use of orthotic treatment for corrective contracture management of the shoulder and elbow and
orthoses providing static, progressive stretch. There was also little evidence supporting the use of physiotherapy
for contracture management; serial casting initially increased ROM of a contracted joint, but these Results
were transient and not maintained long-term. There is a lack of robust evidence on the use of orthoses and/or
physiotherapy in corrective contracture management within the literature. However this is not reflected in clinical
practice. This is difficult due to the low number with comparable contractures, and the ethical considerations
regarding a control group.
To conclude some successful case studies on both upper and lower limb orthotic devices will suggest the need
for more, reliable research in the future to support this practice with an evidence base.
329
POSTERS
Exhibition Hall: Posters 1 - Evidence Based Practices, Poster Board 21
Abstract Number: 264
Abstract Title: The Conservative Management Of Soft Tissue Contractures- A Literature Review And
Supporting Case Studies
Authors: E. Figgins, I. Hamlet, R. Bowers
Presenter: R. Bowers
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - General, Poster Board 22
Abstract Number: 233
Abstract Title: P&O Body's Role And Responsibilities; The Japanese Academy Of Prosthetists And
Orthotists
Authors: K. Sakai, A. Kuriyama, T. Komine
Presenter: K. Sakai
As discussed in one of the sessions taken place in the 13th ISPO world congress, P&O professional bodies
in each country have played an important role to build up professional capacity of their members, Prosthetists
and Orthotists. The Japanese Academy of Prosthetists and Orthotists (JAPO) was founded in May 1993, as a
professional organization consisted by national licensed Prosthetists and Orthotists. The mission of JAPO is to
contribute to the welfare of handicapped, and towards medical and healthcare development. In addition, its aim is
to fulfill our social responsibility by promoting scientific and educational attainments in the discipline of prosthetics
and orthotics.
JAPO currently gathers more than 2,600 members including students those who are learning P&O at colleges
and/or universities. In order to implement missions given, the Academy sets up and run its several committees.
As one of the important roles of the Academy, to provide members continuing education required for continuous
P&O professional developments, Editorial Committee and Educational Committee and Lifelong Committee work
together and/or individually in this aspect. Specifically, the Academy publishes journals five times per year, and
holds a scientific meeting and several technical seminars in each year.
In addition to that, International Committee has just started a foundation to support financially members those
who have will to contribute to developing countries through providing P&O technical assistance. In 2009, the
Academy did a survey to grasp current situation of members by questionnaire. The questionnaire consisted of
twenty five questions including years of working experience, annual income, average of working hours, number of
attendances to seminars and/or trainings and so on. As a result, there were some interesting Results to know what
the actual situation surrounding Prosthetists and Orthotists in the county was (Detail of the survey will be shown
in the poster presentation).
330
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
In Turkey, prostheses and orthoses have been manufactured early nineteenth century. The aim of this study is to
analyse prosthetics and orthotics, which have been manufactured in Turkey over the last five years and create the
infrastructure for scientific studies on this issue and to determine resource consumption.
In the last five years with applied prosthetics and orthotics manufacturing were analysed based on the data
achieved from Social Security Administration of Turkey. According to the Administration 26236 prostheses and
orthoses were manufactured during the last five years. 19381 of them were orthoses and 6755 were prostheses.
9588 lower limb orthoses, 8214 spinal orthoses, and 1579 upper limb orthoses, constitutes orthotics manufacturing
and fitting. 6062 lower limb prostheses and 693 upper limb prostheses constitute all prosthetic manufacturing and
fitting.
According to the Results, KAFOs are the most widely applied in the lower extremity orthotics. KAFOs constitute
74% of lower limb orthotics, 37% of orthotics and 27% of all prosthetic-orthotic applications. In addition to that, the
most widely applied lower limb prostheses are modular TT prostheses. Modular TT prostheses constitute 63% of
lower limb orthotic applications, 57% of prosthetic applications and 15% of prosthetic-orthotic applications.
As Conclusion the numbers of KAFOs and modular TT prostheses are 10969 which is nearly 40% of 26236
prosthetic-orthotic applications.
331
POSTERS
Exhibition Hall: Posters 1 - General, Poster Board 23
Abstract Number: 35
Abstract Title: Numerical Analysis Of Prosthetics And Orthotics Manufacturing And Fitting In Turkey
According To Social Security Administration Of Turkey
Authors: S. Alsancak, H. Altinkaynak, S. Guner
Presenter: S. Alsancak
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - General, Poster Board 24
Abstract Number: 82
Abstract Title: The Prosthetic Orthotic Component Clearinghouse: A 5 Year Review
Authors: R. Kistenberg
Presenter: R. Kistenberg
The Prosthetic Orthotic Component Clearinghouse (POCC) was established in the United States in 2007 as a
means to recycle prosthetic & orthotic goods, to provide tax benefits for donors, and to support research and
education related to prosthetics and orthotics by providing components and supplies. This presentation will cover
POCC's history, processes, successes and challenges. It will also clarify the mechanism by which individuals and
organizations can request components. Over the last five years, almost 2 tons of P&O goods has been removed
from the waste stream and sent to recipients.
332
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Introduction
Almost all major lower extremity amputations (LEA) in Geneva are performed at a single institution. This unique
setting permits assessment of a number of public health and patient-related parameters, specifically the change
in incidence of LEA over time. Material and Method This retrospective survey included all LEA, defined as any
level of amputation proximal to the foot, performed between 1 January 1990 and 31 December 2010. Patients with
diabetes who underwent a LEA, have been prospectively collected since 1990. Demographic data were obtained
from the Cantonal Office of the Population. The prevalence of diabetes in the local population was based on
specific official data.
Results
404 non-traumatic LEA were performed in 308 diabetic patients (69.5% men). The mean age at amputation was
69.7±11.6 years. 212 patients were considered “geriatric,” defined as older than 65 years. The mean age of
women (72.9± 12.4 years) was significantly higher than men (68.5±11 years) (p=0.0024). The mean incidence of
LEA was 10.75/10,000 diabetic inhabitants/year. The relative risk of amputation decreased 62% for women, and
the age increased 2-fold for those of geriatric age. The incidence of LEA significantly (p<0.001) decreased by 32%
between 2001-2010 as compared to 1990 to 2000, and by 21% in the geriatric diabetic population. Similarly, there
was an 11% decrease in the rate of re-amputation, as well as an older age at the time of amputation in the diabetic
population (68.6±12 vs. 71.6±10.9; p=0.014).
Discussion
The decrease in incidence of amputation, as well as the older age at the time of the intervention in the diabetic
population reflects the successful implementation of prevention efforts.
Conclusion
Despite an increasing incidence of diabetes and as well an aging population, efforts centered on primary and
secondary preventions have decreased the incidence of LEA over the last decade.
333
POSTERS
Exhibition Hall: Posters 1 - General, Poster Board 25
Abstract Number: 459
Abstract Title: Changes In The Incidence Of Diabetes-Related Lower Extremity Amputation: A Long-Term
Observational Survey In Geneva, Switzerland
Authors: G. Carmona, A. Lacraz, P. Hoffmeyer, M. Assal
Presenter: C. Gorki
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Innovations, Poster Board 26
Abstract Number: 64
Abstract Title: New Approach And Guideline For The Rehabilitation Of Limb Deficient Child
Authors: T. Datta
Presenter: T. Datta
The birth of a child with congenital anomalies is a traumatic event for the parents as well as the community. Limited
research available that identify that appropriate Rehabilitation program and explore all developmental sectors. Our
experience is to treat well number of such children in our centre with different experience in rehabilitation, social
life and functional ability. We measure the activities and participation and collect the comprehensive information
based on environmental barriers, participation, emotional, ADL and developmental reflex which are delayed in
limb deficient child.
The WHO disability assessment schedule (WHODAS II) is standardized measure the individual 12 item is used
to category mild, medium, moderate and severe We identified ten different category of limb deficient child and
under this method we observed significant outcome in access to rehabilitation. We prepared a multifunctional
ADL supportive seat to develop reflex and coordination. and established facts that such children due to absence
of limbs they do not come across the stages of development as like kicking of limbs, moving of upper limbs, side
lying, prone lying, sitting etc. which causes fitting of a limb, assistive device or orthosis to the congenital limb
deficient child
The rehabilitation plan is always person centered, goal oriented and realistic. This device facilitates assistance to
people with wide range of impairment and enabling them to maintain and maximize their function within their home
and community. This especially multifunctional device with prosthesis and orthosis improve an individual level of
independent and skill.
We found a significant improvement and fulfillment of our goal that is to make the mother and the child independent.
This is our holistic approach to rehabilitation for the limb deficient child and coordinate more research with objective
measurement tools of psycho-social variables is needed to validate clinical experience
334
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POSTERS
Exhibition Hall: Posters 1 - Innovations, Poster Board 28
Abstract Number: 192
Abstract Title: Robot-Assisted Habilitation For Children With Cerebral Palsy
Authors: E. Dukendjiev, T. Dukendjieva
Presenter: T. Dukendjieva
Introduction
Man undergoes four stages of locomotion floating (in mother s womb), after birth crawling on ones stomach, going
on hands and knees and, finally, bipedal walking.The subject of the research is creation and application of robots
that implement the stages of locomotion in automatic mode.
Method
Provide habilitation in the patients with paediatric cerebral palsy with the help of evolutionary and locomotor robots.
Results
For bionic simulation of crawling and moving on hands and knees an evolutionary robot was created. The robot
represents a rectangular frame on adjustable wheeled props supplied with brakes and the platform hanging on
straps, on which the child lies down on the stomach. Under the frame a platform is installed that rotates around
the longitudinal axis. Under the platform there is an assembly of cascade quasi-Maltese crosses with the rollers
suspended on the left and right arms; with the cables running around rollers and ending with orthotic braces for
supporting the patient¡¦s limbs and head. Locomotor robot for bipedal walking consists of the reciprocal orthotic
system put on the whole body, which is fastened to the assembly stand to keep the patient in vertical position and
is supplied with the active horizontal mechanism and an treadmill.
Discussion
For robots application a habilitation schedule is made up according to the authors¡¦ method. Five sessions per day
are required; duration of each session is 1.5 hours. Thanks to evolutionary locomotor robots the operator no longer
needs to apply physical efforts in the process of habilitation.
Conclusion
Creation of evolutionary and locomotor robots allowed for the first time to perform habilitation and rehabilitation
procedures at home.
335
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Innovations, Poster Board 29
Abstract Number: 278
Abstract Title: Device For Patient With Bilateral Hip Disarticulation And Unilateral Elbow Disarticulation
Authors: J. Carvalho, G. Juliani, B. Livani
Presenter: J. Carvalho
Introduction
This paper describes the construction of a modified gait device indicated for patient with congenital malformation
of the bilateral hip disarticulation and unilateral elbow disarticulation.
Methods
A 33-year-old male patient with congenital abnormalities of the lower limbs (hip disarticulation) and left upper
limb (elbow disExhibition Hall) showed great interest in and motivation to use a mobility device that could replace
skateboarding in some situations. A carbon pelvic basket fiber was fixed between the hip joints of the RGO
Parawalker. Regarding the left upper limb, a silicon liner socket with pin connection was set to the rod in an
aluminum stick, allowing contact with the ground. The structure of the RGO Parawalker was chosen because it
has great vertical stability and you can easily go in and out the apparatus.
Results
With only one week of training, the patient has maaged to complete the gait using lateral tilt movements with the
aid of a Canadian cane upper right and the left prosthesis adapted. The patient use a ordinary chair in order to get
in and out of the carbon pelvic basket.
Discussion
The possibility of 'standing up', a long-time desire of the malformed with congenital bilateral hip disarticulation who
always locomoted in skateboards, should be considered, even though its use is mainly therapeutic and at home
Conclusion
The RGO Parawalker with specific adaptations with the fitting of the upper limb with a rod to ground support
enabled the patient to carry out running with high security and low effort, increasing self-esteem of the user.
336
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Background
Historically, the orthotic treatment in progressive myopathic scoliosis has not been as effective as expected. The
purpose of this study was to investigate the effect of a spinal orthosis on scoliotic curve correction, alignment of
altered posture and cardio-respiratory functions.
Case Description and Methods
An 11-year-old girl diagnosed with myopathy was fitted with a custom molded thoracolumbo-sacral orthosis to
enhance the sitting ability. The cardio-respiratory tests were performed by a COSMED K4 b² metabolic analyzer.
The A-P radiograms were analyzed for measuring Cobb angle and Ferguson angle. A plumb line test was used to
assess the postural improvements.
Findings and Outcomes
No significant difference was observed for variables such as O2 consumption level, PaO2, tidal volume, heart rate
and energy expenditure/min. The improved posture was evident by shifting of the plumb line 18 mm towards the
mid line with the use of orthosis. Very minor improvements in both angles were observed with the use of the brace.
Conclusion
The brace treatment cannot be expected to have a lasting corrective effect although it can be used as a sitting
support and for maintaining posture
Clinical relevance
This study provides an objective prescription of thoraco-lumbo-sacral orthosis as a sitting support and for improving
posture in progressive myopathic scoliosis if suitably designed and properly fitted.
Keywords
Cardio-respiratory functions, metabolic, myopathy, posture, scoliosis
337
POSTERS
Exhibition Hall: Posters 1 - Orthotics : Spinal, Poster Board 30
Abstract Number: 28
Abstract Title: The Effect Of A Spinal Orthosis On Posture And Cardio-Respiratory Functions In Progressive
Myopathic Scoliosis: A Case Report
Authors: R. Mohanty, A. Tripathi, P. Lenka, A. Equebal, R. Kumar
Presenter: R. Mohanty
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Orthotics : Spinal, Poster Board 31
Abstract Number: 19
Abstract Title: The Two Folds Flexible Seat Corset For Children With Cerebral Palsy
Authors: K. Aklotsoe, A. Kpandressi, K. Kadja, T. Koutcho, A. Adama
Presenter: K. Aklotsoe
Abstract
The two folds flexible seat corset (T2FSC) was initiated to allow extension and flexion in children with Cerebral
Palsy (CP) who reject the monoshell. The resistivity of the PP blade on the weight of the patient should be
proportionate to allow above mentioned movements. Tests on the PP blades at the University of Lome have led
us to choose 5 mm thick blades.
Introduction
The conventional monoshell seat corset does not allow extension and flexion of trunk. Children with PC and
especially the spastic (75%) are subject to extension movement. The T2FSC solves that problem. Materials and
Methods
The study, carried out at ENAM-Lomé (Togo) involved two male children (the first, X, 3¬6 months, 8 kg and the
second Y 38 months, 10 kg). The manufacturing steps are the same as those of a conventional seat corset, with
the exception that the PP shell has been divided into two folds at the lumbar level. After tests performed on PP
blades at the University of Lomé, we have choosen a blade of 5 x 40 x 250 mm according to the weights of the
children.
Materials
plaster bandages, plaster powder, Polyprpylen, Alvéolux.
Results
The T2FSC was accepted by these patients who were able to perform extension and flexion of their trunks due
to the flexibility of the posterior PP blade. The angle of maximum extension was estimated to 10° and 30° and
therefore patients of 8 and 10 kg have respectively developed an horizontal strength of 14,10 and 57,73 N. The
T2FSC was estimated at € 180.
Conclusion
The T2FSC is a solution for the children who reject the conventional rigid seat corset. The result obtained after a
year of positioning of the T2FSC was satisfactory to all.
338
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Osteoporosis is the most common of the metabolic bone disease described as osteopenia meaning “too little
bone'. Osteoporosis is associated with decreased strength and deficits of gait and balance, all together resulting in
an increased risk of falls and subsequent aggravation of fracture risk. Previous Studies have evaluated the efficacy
of specific device for Orthotic management of spinal problems due to osteoporosis. The effect of conventional
Thoraco Lumbar Sacral Orthosis (TLSO) on balance and gait is still a matter of controversy due to little evidence.
Thus, the purpose of this study was to determine the Effect of conventional TLSO on Balance and gait in Individuals
with Osteoporotic spine.
Design Pre test-Post test experimental design was used in this study
Sampling Technique: Non probability convenient sampling
Variables: Dependent variables : Balance and Gait .
Independent variables: conventional TLSO
Result
The comparison of mean difference between pre and post balance and gait score of subjects on POMA (T) without
orthosis was 15.5 ± 3.7 showing that patients were in high risk of fall. Post balance and gait score with conventional
TLSO after one week, was recorded 22.2 ± 2.107. The result shows that there is significant difference between pre
and post intervention. (t- value = 18.48, p- value = 0.00). Thus, it indicates that conventional TLSO is effective in
improving balance and gait in short term use.
Conclusion
The experimental hypothesis that conventional TLSO improve balance and gait in individual with osteoporotic
spine is supported by this study. Conventional TLSO shows significant improvement on balance and gait outcome
scale and thus it can be concluded that conventional TLSO is a good prescription for osteoporotic spine patients
who are under risk of fall due to impaired balance. Key Words:- Osteoporosis, Balance, Gait, and Conventional
TLSO
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POSTERS
Exhibition Hall: Posters 1 - Orthotics : Spinal, Poster Board 32
Abstract Number: 179
Abstract Title: Short Term Effect Of Conventional Tlso On Balance & Gait In Individuals With Osteoporosis
Of Spine.
Authors: S. Pal, R. Sharma, A. Sinha
Presenter: S. Pal
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Orthotics : Spinal, Poster Board 33
Abstract Number: 378
Abstract Title: Lumbo-Sacral Orthosis And Magnetic LSO With Adjustable Turnbuckle: A Comparative
Study
Authors: K. Balram, G. Khare
Presenter: K. Balram
Introduction
Back pain and fractures is common problem now a days. A lumbo sacral orthosis (LSO) is usually indicated for
back pain . A modified LSO with adjustable turnbuckle mechanism gives better segmental stability & distraction
Objectives
My appproch is to design a modify lumbo sacral orthosis and compare it with conventional LSO
Methods
LSO has been modified with 2 parallel bars (uprights) and magnets are embedded in jacket to improve blood
circulation in spinal area
Results
Magnetic LSO with adjustable turnbuckle
fracture. and magnet provide pain relief
340
provides segmental distraction which helps in quick healing of
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
POSTERS
Exhibition Hall: Posters 1 - Orthotics : Spinal, Poster Board 34
Abstract Number: 523
Abstract Title: Management Of Back Pain For Handloom Weaver With Pneumatic Spinal Orthosis.
Authors: Chandrakala Th
Presenter: Chandrakala Th
Introduction
Manipur is a small state at the easternmost corner of India surrounded by green hills, inhabited by multi-ethnic
communities. Womenfolk of the state are hardworking, apart from household works she helps in family economy
also. Small industries like handloom weaving, sericulture etc are traditional work for women in addition to
agricultural activities. Even now these are earning means for many. Back pain is one of the common complaints
of hndloom weavers.
Method
Modified pneumatic spinal orthosis is applied during weaving and the feedbck is recorded.
Result
Patient feel more comfortable with the orthosis. Time taken is less at per production.
Discussion
The findings suggest the orthosis is effective in long term use also. The goal of the study is to improve weaving
effectiveness and good production flow.
Conclusion
It is a low cost. The study can continue and the design may turnout as an useful and effective device for handloom
weaver.
341
POSTERS
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Orthotics : Spinal, Poster Board 35
Abstract Number: 132
Abstract Title: Design Of Spinal Orthosis For Management Of Scoliosis.
Authors: N. Ojha
Presenter: N. Ojha
Introduction
The design of under arm moulded TLSO with lateral opening on concave side, incorporates a turn buckle
mechanism, to achieve correction of scoliotic spine at flexible stage of primary curvature on concave side. The
brace is splitted horizontally from concave side towards the convexicity of the curvature at its apex level. It also
includes a locking mechanism along with the turn buckle which locks the brace after donning to act as two separate
sections. Thus the superior and inferior hinge at convex side of the curvature makes the whole system to work
efficiently by intermittent rotation of adjustment nut for graduated production of distraction forces.
Methods
llizarov principle of force distraction is applied with simple adjustable device and lateral opening provides corrective
variable to prevent curvature of spine.
Results
The dynamic variable force quantum is strategically correcting scoliotic curve with minimum effort.
Discussion
Variable distraction force contributed from lateral turn buckle mechanism is undoubtly reduces the curves intensity
and gradually it imparts the maximum correction with appreciable reduction of critical load. However such under
arm brace provides lateral opening rather than posterior or anterior opening Methods.
Conclusion
This indigenous design of under arm orthosis is light weight, washable, easy for donning and doffing, cosmetically
well accepted, provides dynamic force to correct scoliosis and the magnitude of force is adjustable and it remains
constant to maintain the correction of scoliosis.
342
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Individuals with Rheumatoid Arthritis (RA) generally prefer hand splints made of soft materials such as cloths,
leathers or sponge rubbers rather than rigid one. Although soft materials are inadequate mechanically to prevent
deformity, its effect has been reported by many case studies.
The objective of this paper is to discuss the effectiveness of hand soft type splinting in RA using the theory of human
occupational behavior as affordance and emergence. According to affordance theory (j.j.Gibson), perception of
the environment inevitably leads to some course of action. Affordances, or clues in the environment that indicate
possibilities for action, are perceived in a direct immediate way with no sensory processing.
The term”emergence” was defined here as “the arising of novel and coherent structures, patterns and properties
during the process of self-organization in complex systems “ (Goldstein 1999). Two RA patients who preferred soft
splinting rather than rigid one were interviewed and observed.
Results indicated that the soft and light types of splints were preferred and their respective condition and individual
occupational behavior were improved or continued. The purposes of splinting were preventing and/or remedy the
deformity.
The theory of affordance and emergence was able to explain this effect. Though the soft splinting informed the
patients by dynamic touch, they kept the hands to prevent heavy load to incorrect direction. Then the patients
were doing protective joint motion at activity of daily living. They felt relaxation from muscle strain and pain relief
by splinting. The Results supported that the patients with RA develop individual activity with the splint. The soft
splints afford many occupational activities and member of rehabilitation team could advance these conditions
called by emergence.
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POSTERS
Exhibition Hall: Posters 1 - Orthotics : Upper Limb, Poster Board 36
Abstract Number: 391
Abstract Title: Effectiveness Of Hand Soft Splinting In Rheumatoid Arthritis: A Perspective On Human
Occupational Behavior.
Authors: K. Hara
Presenter: K. Hara
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Orthotics : Upper Limb, Poster Board 37
Abstract Number: 402
Abstract Title: The Effect Of Prefabricated Wrist-Hand Orthoses On Wrist Motion
Authors: K. Ross, M. O'Hare, E. Henderson
Presenter: K. Ross
Introduction
Prefabricated wrist-hand orthoses (WHOs) with a volar bar are commonly prescribed to manage the functional
deficit of the wrist as a result of rheumatoid changes. Studies have previously investigated the efficacy of these
orthoses, with a number of these authors reporting that the wrist was positioned in extension by the WHO. However
the literature does not report on whether this wrist position was maintained by the orthosis during the period of
investigation. It is the aim of the present work to investigate and underpin the shortcomings of several different
WHO designs.
Methods
Using normal subjects, and thus in the absence of pain as a limiting factor to wrist motion, ten WHOs were
investigated over a ten week period using a robust and repeatable testing protocol. A maximum active range of
wrist motion test with and without WHOs was performed by right-handed, female subjects, aged from 20-50 years.
A wrist goniometer and forearm torsiometer were used to measure motion.
Results and Discussion
The Results challenge the assumptions in the literature that these orthoses hold the wrist in a defined position. These
orthoses clearly enable wrist motion to occur, albeit with varying degrees of motion restriction. This enablement of
motion means that in many cases the functional deficit of the patient is not being optimally addressed and that use
of these orthoses is often discontinued. This lack of functionality may be attributable to both the functional design
characteristics of the orthoses and quality of fit.
Conclusion
This work raises questions regarding the design of these orthoses which has essentially remained unchanged for
several decades. Variations in the efficacy between the orthoses tested in reducing wrist motion suggest there is
potential to develop enhanced WHO designs to facilitate motion restriction.
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
This pilot study aimed to develop the simple design of the wrist hand orthosis to improve the severity of the carpal
tunnel syndrome patient. The sample is the patient with mild to moderate CTS. The comparison of the result of
the treatment was done before and 4 weeks after using the prefabricated device (controlling device) and modified
design of simple wrist extensor splint (experimental device) . The outcome measure is Thai version of Boston
Carpal Tunnel Questionnaire (BSTQ) composed of symptom severity scores (SSS) and functional severity scores
(FSS).
The average SSS of controlling and experimental group in 1st and 2nd data collection were 26.6 177;8.7, 21.1
177;4.4, 20.8 177;5.9 and 18.0 177;4.0, respectively, refereed that the severity of the CTS symptom in controlling
and experimental group were in moderate and mild level, correspondingly. Additionally, the SSS of controlling
group was higher than the experimental group. When comparing the SSS of 1st and 2nd data collection, the
SSS in both groups were reduced. FSS of controlling and experimental group in 1st and 2nd data collection were
17.1 177;2.5, 11.8 177;1.4, 13.3 177;4.1 and 9.6 177;1.2, respectively, which means the functional status of the
patient in controlling and experimental group were defined as moderate difficulty and little difficulty during the 1st
data collection and after using the splint for 4 weeks. The functional status of both group were defined as little
difficulty that mean the FSS was reduced in both group after using the splint for 2 weeks so the functional status
was improved.
Therefore by keeping the wrist in a neutral position diminishes intra carpal tunnel pressure. Results demonstrated
that the modified design of simple wrist extensor splintprovided more efficient in relieving symptoms including a
better patient’s compliance in term of average hours for using the splint in each day.
345
POSTERS
Exhibition Hall: Posters 1 - Orthotics : Upper Limb, Poster Board 38
Abstract Number: 463
Abstract Title: The Efficacy Of Modified Design Of Simple Wrist Extensor Splint On The Carpal Tunnel
Syndrome: A Pilot Study
Authors: S. Deechareon, S. Sengiad, G. Srisawadi, A. Ignas Mella
Presenter: S. Sengiad
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Orthotics: Lower Limb, Poster Board 39
Abstract Number: 50
Abstract Title: Modern Custom Orthotic Solutions For The Lower Limb With Case Studies
Authors: V. Schmidt
Presenter: V. Schmidt
This posterr will be about orthotic solutions for the lower limb with an emphasis on KAFO designs and the correct
component selection. After an overview of biomechanical aspects there will be different fitting aspects presented.
The use of different components from easy solutions, carbon springs to complex systems like Stance Control
Orthoses are subject of this paper.
The benefit for the attendees will be that they can take home recommendations on how to improve the quality of
their fittings of orthotics of the lower limb in practise. This topic is especially suitable because it will include many
technical details that can be used for the daily practice management. There will be a well maintained mixture of
clinical and technical solutions. Certain clinical indications and their matching type of device are strongly linked
together. Regarding fabrication the use of modern materials like carbon/prepreg will be shown. The different
material characteristics are important to know and the correct use of them is essential when it comes to modern
orthotic fittings.
As an example the fabrication of a KAFO in lamination technique will be explained in more details. This will make
the paper interesting for technicians and clinicians as well. The comparison of traditional fittings with steel/leather
to these modern materials is displayed with patient cases. Pros and cons will be discussed. A decision tree for the
selection of different components is also part of the fitting process. The different joint combinations and types will
be explained and new technology for KAFO users will be shown with videos. For validation of the fitting Results
the use of LASAR Posture and video analysis Dartfish is included.
346
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
The acceptance rate for using Orthotic Calipers made in welfare Projects/Camps in developing countries increases
from 32% to 94% by using PTO* developed dynamic Alignment Fixture. By spending merely approx of 93% more
than the prevailing expenditure of welfare camps, which is still lower by 60 % compared to private establishments
the output of usage goes to 100%.
(A) Making of Orthotic Calipers - Adoption and practicing most suitable technology to cater masses (Community
based rehabilitation – CAMP) in developing Countries.
i) Increasing acceptance rate to 95% by spending 1/6 lesser than the Private Establishment.
ii) Orthotist/Technician friendly technology
iii) Beneficiaries/victims are delighted as lesser indirect cost to the individual.
(B) Main cause for usage of Orthotic Caliper– Lower Limb weakness (Motor and sensory involvement)
iv) Polio Myelities (Weakness of Lower Limb)
v) Hemi or Para pelagic patients
(C) Features of Calipers as per Victim Category (Broadly depends upon Income)
vi) Higher Income group victims (2 to 5 %) go for advance mechanism using Carbon fiber fully molded using
Titanium Auto Knee- lock mechanism with leather suspension system.
vii) Good volume of victims (12 to 17 %) prefers to have External Caliper (using MS plated joints using leather
shoes and getting made on moulds and measurement taken on paper – profiles (No plaster cast and mould
are brought into use).
viii)Very large Volume of victims (80 to 85 %) go for subsidized or free supply of caliper, especially made in
Welfare camps.
* Proactive Technical Orthopaedics, Pune, India
347
POSTERS
Exhibition Hall: Posters 1 - Orthotics: Lower Limb, Poster Board 40
Abstract Number: 77
Abstract Title: Bringing Alignment Fixture Into Use To Make Orthotic Calipers For Masses In Welfare Camps/
Projects, Enabling Optimum Alignment and Increased Acceptibility
Authors: S. Bhowmik, A. Tezan
Presenter: S. Bhowmik
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Orthotics: Lower Limb, Poster Board 41
Abstract Number: 93
Abstract Title: Gait Pattern And Mobility In Patients With Diabetic A Two-Year Follow Up Study
Authors: R. Zugner, U. Tang, R. Tranberg
Presenter: R. Zugner
Introduction
Affected joint range of motion (ROM) and stiffness of tendon and muscles is seen as a consequence of peripheral
angiopathy and neuropathy. Altered gait and neuropathy will increase the risk of ulcers and amputations. The aim
of this study was to present Results from initial- and 12-month evaluation with focus on gait, mobility and functional
tests in a cohort of diabetic patients. Method 114 (62/52) diabetic patients, mean age of 58 years (20-88) with a
BMI of 28 (17-42), referred to Dept of Prosthetics & Orthotics were asked to participate in the study. They were
supplied with shoes and insoles, were independently walkers and had no ulcers at start of study. Type 1 and 2
(31/83) diabetes were accepted. The mean duration of diabetic was 12 years (0-52). All patients were examined
at the beginning and then periodically every six month until 24 month was reached. ROM was analyzed in hip-,
knee- and ankle joints. Neuropathy was evaluated superficial- and deep sensory test together with mono-filament
and vibration sensibility. Walking habits was evaluated with a questioner and a five-minute walking test.
Result
Functional measurement of the hip and knee showed impact on joints in 5-10% at 0 (n=114) and 12 month
(n=80). At the same time dorsiflexion showed mean values of 25° (10-50) and 27° (10-45) respectively. The
superficial and deep sensibility was affected 6-12% and mono-filament in 20-25% at both occasions. The vibrationtest showed a decrease of sensitivity in 37% and 33% respectively. Evaluation of 5 minute walking test showed at
the first occasion, a mean distance of 377m (160-610) and 385m (80-548) at 12 month.
Conclusion
The investigated diabetic population was affected in several ways central and distal Exhibition Hall. The ankle joint
(ROM) and walking distance had a wide distribution from poor to excellent. 30-40% had neuropathy.
348
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Introduction
Passive stretching, splinting, casting and the use of continuous-passive-motion (CPM) devices are the most
common treatments to prevent spastic-associated complications such as muscle shortening and contracture. The
use of a night splint in combination with a continuous passive movement (CPM) unit for patients with spastic CP
has not been discussed widely. A prototype of an ankle-foot orthosis (AFO) with a CPM unit was built and tested
as part of a master course study. To prove the principle of treatment with the CPM night splint in a further clinical
study, a study design was developed.
Methods
A research of the existing literature in the concerning areas was performed. Furthermore it was investigated
which technical properties a CPM night splint should have to achieve an improvement of the disease pattern.
Clinical assessments were chosen to proof the principle. Finally a single case pilot study on feasibility and patient’s
acceptance was performed.
Results
A study design and the necessary protocols to test the improvement on joint mobility, spasticity of the calf muscle
and the gait pattern was developed. The single-case-study (40 days) showed that the CPM night-splint was used
on 26 days (65%); on 15 days the CPM night splint was used more than 6 hrs/day (37,5%). No adverse effects
were recorded.
Discussion
The prototype demonstrated technical stability and safety but CPM-Unit and AFO had to be customized several
times. Poor compliance was the major factor for limiting everyday use. Therefore no clinical relevant differences
in joint mobility could be registered.
Conclusion
The combination of a CPM unit with an AFO for night splinting might be a new medical-technical approach for
treating CP patients with spastic foot drop. With the utilisation of the study design the effectiveness of the treatment
of muscle shortages with a CPM orthosis could be researched more closely.
349
POSTERS
Exhibition Hall: Posters 1 - Orthotics: Lower Limb, Poster Board 42
Abstract Number: 193
Abstract Title: Development Of A Study Design For The Use Of Cpm Night Splints On Spastic Calf Muscles
Authors: W. Sepin, K. Fheodoroff, W. Strobl
Presenter: W. Sepin
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Orthotics: Lower Limb, Poster Board 43
Abstract Number: 307
Abstract Title: A Comparison Of Foot Insole Material In Planter Pressure Relief
Authors: A. Mishra, R. Kumar
Presenter: A. Mishra
Insoles have been widely accepted as a front-line defence to cushion the foot, decrease foot Pressures and reduce
tissue destruction associated with repetitive high pressures in the insensate foot. Planter pressure were studied
with the use of both insoles Silicone gel and MCR (Micro cellular Rubber) on 5 old age subjects. Experimental
research- Pre-test – Post-test design was followed.
The aim of the study is to check the efficiency of both these commonly prescribed insoles on the basis of their
effect on forefoot pressure, midfoot pressure, rearfoot pressure and overall foot pressure. A pair t-test analysis was
used to compare the difference between Silicone gel insole and MCR insole in terms of pressure reduction. The
mean age of the population taken is 62.2 years.
By comparing the both the insoles, the Results shown that there will be significant difference between Silicone gel
insole and MCR insole in forefoot and midfoot pressure reduction. These findings of the study suggest that the use
of silicone gel insole is significantly more beneficial than MCR insole in terms of overall planter pressure reduction.
Key words: Planter pressure, MCR insole, Silicone gel insole.
350
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
POSTERS
Exhibition Hall: Posters 1 - Orthotics: Lower Limb, Poster Board 44
Abstract Number: 368
Abstract Title: Meta-Analysis Of Contracture Reduction: Knee To Toe
Authors: S. Curran, F. Willis, J. Furia, R. Shanmugam
Presenter: S. Curran
Introduction
Joint contractures are relatively common disorders that can result in significant long term morbidity. Initial treatment
is non-operative and often entails the use of mechanical modalities such as dynamic and static splints. Dynamic
splinting (DS) employs the protocol of prolonged durations of passive stretching at end-range(s) of motion.
Although widely utilized, there is a paucity of data that supports the use of such measures. The purpose of this
review was to evaluate the safety and efficacy of DS for the treatment of joint contracture.
Methods
Reviews of Pubmed, Science Direct, Medline, AMED, and EMBASE websites were conducted to identify the
term ‘contracture reduction’ in manuscripts published from January 2002 to January 2012. Publications selected
for inclusion were controlled trials, cohort, or case series studies employing prolonged, passive stretching for
contracture reduction of the lower extremities. Over 350 abstracts were screened, and eight studies (487 patients)
met the inclusion criteria for this analysis. The primary outcome measure was change in active range of motion
(AROM) and weighted variables included Duration, Size (N in each study), and Hours in DS treatment.
Results
Outcome measures of these eight studies examined change in maximal, active range of motion (AROM) as a
common, dependent variable. Also noted was a greater difference and improvement from prolonged passive
stretching versus short durations of stretching. There was also consistency between studies of prolonged passive
stretching in patients with outcome in change of AROM. (N=226, Ä AROM =23.5°, SD=7.6).
Discussion
Prolonged, passive stretching showed uniform, consistent efficacy through 385 patients in eight studies. This
systematic analysis confirms that DS with prolonged, passive stretching should be utilized as a primary intervention
for contracture reduction of any peripheral joint.
Conclusion
Prolonged passive Stretching should be utilized in the initial standard of care of contracture reduction of the lower
extremities.
351
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Orthotics: Lower Limb, Poster Board 45
Abstract Number: 396
Abstract Title: Adjustable Orthotic Prescription Tool
Authors: J. Hijmans, L. Frortington, K. Postema, B. Verkerke
Presenter: J. Hijmans
Introduction
An ankle foot orthosis (AFO) is frequently prescribed for a range of neuro-musculo-skeletal conditions including
cerebral palsy. AFOs are designed to manipulate the ground reaction force and the position of the foot and ankle.
A poorly fitting or poorly functioning AFO can result in negative consequences including pain and increased
energy consumption. Prescription of the correct features and function is fundamental in avoiding these negative
consequences.To test how one may respond to certain characteristics in an AFO, gait analysis is performed.
Temporary components (e.g. walking cast to mimic a fixed ankle) are used during gait analysis to represent
components of the potential AFO. However, a cast is limited to one fixed ankle angle and only heel/toe rises can
be added. The limitations of AFO prescription based on gait analysis with limited temporary components means
important details of the design must be estimated. Our aim was to develop an adjustable tool to improve AFO
prescription.
Methods
Working with a team from clinical, research and engineering backgrounds a list of required and ideal design
elements were developed. Following a standardized development process, different solutions to mimic any
function of any AFO were developed. The most suitable solution was chosen and further developed.
Result
The ADjustable Orthosis Prescription Tool (ADOPT) allows for alteration of the ankle angle and foot floor angle.
Moreover, movements in the sagittal plane can be assisted or resisted.
Discussion
The effect of ADOPT in clinical practice is yet to be determined.
Conclusion
The ADOPT can be used in gait analysis to assist prescription of an AFO. It can be adjusted to the dimensions
of the subject, ankle angle can be fixed or moving (freely, assisted or resisted) with or without plantar and/or
dorsiflexion stops, foot floor angle can be changed, and roll-off shapes can be applied.
352
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Introduction
This study compared the effects of a custom-made tuned Ankle-Foot Orthosis (AFO) and Functional Electrical
Stimulation (FES) on gait kinematics of a patient with Multiple Sclerosis.
Methods
The subject was a 59 year old female with Secondary Progressive Multiple Sclerosis, diagnosed 22 years
previously, who had used FES for approximately 3 years. Assessment was conducted at baseline to identify
crucial information required for prescription of a custom AFO. Full knee and hip extension was possible in the
affected leg, and full range ankle dorsiflexion with knee flexed (Soleus length). Limited dorsiflexion to 90„a with
knee extended indicated Gastrocnemius shortening. Gait Analysis was performed with FES, AFO and shoes only
using Siliconcoach P&O Clinical Movement Data System.
Results
Both interventions positively impacted on gait kinematics compared to shoes only. Ankle dorsiflexion at initial
contact was similarly improved with both interventions, as was mid stance knee extension. In terminal stance, a
crucial stage of the gait cycle(1), kinematics was only improved with the AFO which prevented excessive tibial
inclination and improved knee and hip extension. Walking speed was similarly improved with both AFO and FES
compared to shoes only, however the Borg Scale of perceived effort showed that walking with AFO was easier
than both FES and shoes only at review.
Discussion
This case study illustrates the ability of an AFO to realign the limb in terminal stance to a more optimal position
for gait. The only other study comparing AFO and FES in this patient group reported on swing phase and early
stance kinematics(2).
Conclusion
While improvements in walking speed and ankle dorsiflexion can be seen with both AFO and FES, knee alignment
in stance was only improved with the custom AFO.
353
POSTERS
Exhibition Hall: Posters 1 - Orthotics: Lower Limb, Poster Board 46
Abstract Number: 474
Abstract Title: Case Study - Effect Of An Ankle-Foot Orthosis And Functional Electrical Stimulation On Gait
Kinematics In Multiple Sclerosis.
Authors: E. Davidson, R. Bowers
Presenter: E. Davidson
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Orthotics: Lower Limb, Poster Board 47
Abstract Number: 508
Abstract Title: Reducing Friction And Shear: A Pedorthic Perspective
Authors: D. Janisse
Presenter: D. Janisse
Reddened painful skin, abrasions, blisters and ulcerations are common problems observed on a daily basis
by orthopedists, nurses, pedorthists and orthotists. When these prob;ems occur within footwear, orthoses, or
prosthetic devices the cause is repetitive loading - a combination of peak load magnitude and number of loading
cycles sufficient to produce significant skin trauma. These loads contain both normal (perpendicular to the skin
surface) components and friction (parallel to the skin surface) components.
Historically, most instances of skin trauma have been attributed directly to excess peak pressure loads and
have been addressed with 'offloading'. Techniques to reduce pressure can often lead to some improvement, but
addressing only peak plantar pressures can lead to inadequate solutions and missed opportunities to achieve the
highest levels of pain-free, functional and safe skin protection.
Research has established that the friction component of repetitive loading is the major governing factor in the
number of load cycles a given area of skin can tolerate before the onset of pain and acute trauma. To increase
comfortable, pain-free function and protect the foot, the magnitude of friction load peaks applied each loading
cycle must be reduced. This can be accomplished by reducing peak normal (pressure) load magnitudes and/or
reducing the coefficient of friction (CoF) operating between the skin and support surface in the affected area. In
this presentation we will review many available products that reduce friction and shear.
As mentioned above, the problem areas can be very specific so the focus will be on products and techniques for
relieving friction in particular areas of the shoe and/or foot orthosis. Case studies will include pathologies such
as diabetes, arthritis and trauma. We will see how reducing CoF can and does protect tissue from ulceration and
decreases callusing and foot pain.
354
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Introduction
Osteoarthritis Knee is a highly prevalent chronic clinical condition that limits mobility and causes disability in
seniors. Due to its consequent effects on functional limitation and quality of life, there is a growing need for
scientific tools to study the mechanisms of OA. Purpose: Laterally wedged insoles inside the shoes are advocated
as a simple, inexpensive, self-administered intervention for knee osteoarthritis, there is currently limited evidence
to support their use. Aim of this study is to assess the effect of lateral wedging quantitatively. Material: Zebris Gait
Analysis System for foot pressure analysis. Plain Radiograph bilateral Knee joints in standing position to evaluate
the joint space and angles.
Methods
Study Design: Prospective Interventional Pre Post Study. Sample Size: 40 Case Selection: Patients of either sex
between 35-75 year age attending PMR OPD with Grade 1-3 osteoarthritis on Kellgren and Lawrence System
affecting medial compartment of knee are included after informed consent. Plain radiograph bilateral knee joint
standing and foot pressure force plate analysis is done at baseline besides routine diagnostic investigations. ¼
inches lateral wedge is given in footwears of the patient. Reassessment after wedging is done with Radiographs
of the knee and foot pressure analysis wearing wedged shoes.
Results and Conclusion
This is a preliminary report for 40 patients who completed the study. Changes indicating improvement in joint
space are observed in post wedging radiographs. Foot pressure peaks also show change in distribution. Complete
statistical analysis is yet to be done to ascertain the significance of observed changes in parameters.
355
POSTERS
Exhibition Hall: Posters 1 - Orthotics: Lower Limb, Poster Board 48
Abstract Number: 525
Abstract Title: Quantitative Analysis Of Effect Of Lateral Wedging Insole In Medial Compartment Knee
Osteoarthritis On Foot Pressure And Radiological Parameters
Authors: S. Saxena, S. Yadav, S. Wadhwa, G. Handa, U. Singh
Presenter: S. Yadav
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Orthotics: Lower Limb, Poster Board 49
Abstract Number: 121
Abstract Title: The Clinical Application Of Stance Control Knee Ankle Foot Orthoses For Individuals With
Neuromuscular Disease.
Authors: J. Campbell, M. Lofiego, M. Sibila
Presenter: J. Campbell
Patients with lower extremity weakness, caused by neuromuscular disease, often present with a complex and
varied set of problems that may benefit from orthotic intervention. This presentation will focus on individuals with
lower motor neuron pathologies and will specifically address the clinical application of Stance Control Knee Ankle
Foot Orthoses (SC KAFO) in 50 individual patients with a primary diagnosis of poliomyelitis or myelomeningocele.
Originally designed specifically for patients with quadriceps weakness, this family of orthotic joints allows the
orthotic knee joint to lock at a point approximating initial contact (the beginning of first rocker) and unlock at a
point approximating heel off (the beginning of third rocker). This arrangement permits the patient with lower limb
paralysis to more closely mimic normal gait than ever before.
Through a series of structured case presentations the authors will contend that an increased understanding of the
biomechanical deficit (inability to stabilize the pelvis, accept body weight and preserve progression) that is being
replaced in individuals with poliomyelitis and myelomeningocele will lead to increased utilization. As a result many
individuals, who may currently be viewed as unsuitable candidates for this technology, have realized benefit.
Relating specifically to the myelomeningocele group the presentation will examine the use of stance control
KAFOs in patients with a lumbar neuro-segmental level of paralysis.
For individuals with these complex deficits every aspect of the evaluation process must be carefully performed.
Accurate individual selection, assessment and physical therapy training protocols have been developed and will be
presented. The patient’s ability to be trained to use this technology, as well as their cognitive ability to understand
and apply it must be assessed. Direct involvement of the physical therapist during assessment is critical, the
implementation of a structured physical therapy program after fitting helps achieve an optimal outcome and will
be discussed.
356
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Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
POSTERS
Exhibition Hall: Posters 1 - Technology, Poster Board 50
Abstract Number: 66
Abstract Title: Development Of A Curb-Climbing Aid For Powered Wheelchair
Authors: G. Kim, S. Jung, J. Ryu, M. Mun
Presenter: G. Kim
Introduction
Disabled persons with Paraplegia who cannot walk independently and the elderly with degenerative disorders can
use the powered wheelchair in order to move. Upon movement of the powered wheelchair, the wheelchair may
come across a sidewalk or a driving way. Since the curb of 150 mm or higher is built on a sidewalk and a driving
way for pedestrian safety, wheelchairs cannot run cross over a sidewalk on the road where a ramp is not installed.
In this study, we would like to develop the curb climbing aid device to climb up and down a curb of 150 mm or less
which will limit the movement of users of powered wheelchair in a stationary state.
Methods
A pair of links, linear actuator (LINAK Co. LA28, 3500 N max, Denmark) and urethane wheels (120 mm)was used
as a mechanism to get over the curb. Wheel installed on link is rotating and climbing up to a maximum of 200 mm
which is the vertical distance from the initial position upon operating the actuator. The operating device installed
on the wheelchair to get over the curb can tilt the wheelchair forward or backward.
Results
The driving torque of the driving wheel showed the maximal value of 200 Nm at the time of approximately 4
seconds. It was shown that the maximal torque of approximately 900 N was applied on front actuator of the curb
climbing aid device at the time of 1.8 seconds.
Conclusion
The developed curb climbing aid device was installed on a powered wheelchair and was able to climb a curb of
150 mm up and down smoothly. Results of the simulation confirmed that it made the torque necessary to get over
the curb.
357
POSTERS
Feb 4 (14:00 - 14:30, 15:45 - 16:15)
Feb 5 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Exhibition Hall: Posters 1 - Technology, Poster Board 51
Abstract Number: 164
Abstract Title: Jaipur Limb Technology Revisited By European Standards
Authors: V. Qurashi
Presenter: V. Qurashi
Although Jaipur limb and foot are in production for underdeveloped world for the last fifty years,and has crossed
the mark of one million prosthesis supplied world wide,our experience here in england and pakistan is fairly new
and just over five years,although this paticular prosthesis is not used in in the european continent we subjected
this limb to rigrous test and endurance in england,by a reputable company SATRA based in Northampton.
Satra ia a leading authority on international legislation and testing,and technical aspects of wide range of
consumer products including foot wear,leather goods apparel, toys,personal and protective equipment,many of its
test Methods become industry standards and its production efficiency and accrediation system are unrivaled our
prosthesis underwent seventeen months of inspection
The executive summary is based on BS EN ISO 10328.....Prosthesis-structural testing of lower limb prosthesis,feet
were tested under both static and cyclic loads, the unversal furnitue tester was used for all loads child leg with
stood static loads upto 3098 N and 1,000,000 cycles of load from 460 N to 1610 N . Aduldt leg withstood static
loads upto 3098N. Having carried out static load tests based on Methods outlined in BS EN ISO 10328;2006 Ii is
our considered opinion that the prosthesis submittd for assessment performed to a level above that which would
be e xpected from these products considering the simplicity and economy of their construction.Therefore we belive
them to be more than fit for purpose or the intended application.
358
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Introduction
Among thermoplastic polymers in orthopedic special place has the polyethylene (high, medium, low pressure).
Internal defects in products from polymeric materials (air cavity, excessive porosity) which arise during the process
of their production reduce physical-mechanical properties of the constructions. So their timely identification with
the use of non-destructive views of control is important for products operating under load.
Methods
Basis of modern Methods of nondestructive quality control of products, indication of above mentioned defects, is
physical penetration of some physical field into tested detail (construction) without its deformation of analyze of
following response. For work with orthopedical products can be used radio waves and optical types of control. Both
Methods are based on the use of electromagnetic radiation, which makes them non-contact and rapid. Results.
During product inspection, one of the factors reducing sensitivity and accuracy of control is the state of the surface
under radiator. Offered system of compensation, which has three types of abnormal areas (different effects on the
reflectance and transmission): areas with higher, lower optical density, than by the surface area, and area with
small optical density because of scattering factor (roughness, porosity).
Discussion
In many cases technology of production doesn’t allow machining of the surface, and on it can be found areas with
different optical properties because of different porosity, density and so on. And even after mechanical machining
product can have on the surface abnormal areas which don’t affect working conditions and are not defects, but
change the intensity of the radiation wave, which passes through these areas. As a result, is possible contrast
reduction of detection of internal defects or even false indication of these areas as internal defects.
Conclusion
Theoretically and experimentally is proved the principal possibility of radio wave and optical quality control of
orthopedical products made of polymer insulators.
359
POSTERS
Exhibition Hall: Posters 1 - Technology, Poster Board 52
Abstract Number: 451
Abstract Title: Use Of Radio Wave And Optical Control For Quality Assessment Of Orthopedical Products
Authors: E. Shataeva, V. Klopov, G. Skok
Presenter: E. Shataeva
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Paediatrics, Poster Board 1
Abstract Number: 407
Abstract Title: Musculoskeletal Disorders In Caregivers Of Children With Cerebral Palsy Following A
Multilevel Surgery
Authors: A. Sasidharan, D. Sharan, R. Ranganathan, M. Manikandan
Presenter: D. Sharan
Introduction
Persons with cerebral palsy often need assistance for activities of daily living which exposes their caregivers to
different risk factors for developing musculoskeletal disorders. This study was designed to identify the prevalence
and risk factors of musculoskeletal disorders among the caregivers of children with cerebral palsy.
Methods
A case control study where the study group comprised of 257 caregivers of children with CP who underwent
multilevel surgery. The control group comprised of 117 caregivers of ambulatory children with other orthopaedic
problems such as clubfoot or spina bifida. The study was conducted in a tertiary or referral rehabilitation hospital over
a period of 3 years. The study utilised a closed ended self-administered questionnaire, which included questions
regarding demographic factors such as age, gender, BMI, level of independence of the child, cooperativeness of
the child, the level of sleep disturbance and mental stress measured by visual analog scale (VAS). The level of
physical exertion during lifting/carrying child and fatigue were measured using Borg CR-10 scale, and the Modified
Caregiver Strain Index (CSI).
Results
The common musculoskeletal disorders identified were Myofascial Pain Syndrome (27.6%), Fibromyalgia
Syndrome (24.5%) and Thoracic Outlet Syndrome (23%) among the study group. Prevalence of musculoskeletal
discomfort at shoulder, elbow, upper back, lower back and ankle were significantly higher among the study group
as compared to control group.
Discussion
Study further revealed that the sleeplessness (p<0.001) and level of fatigue (p<0.001) were significantly higher
among the study group than the control group. Statistical comparison of CSI between two groups showed that both
the groups were similarly (t-1.13 p>0.05) exposed to caregiver strain.
Conclusion
The Results indicated a significant prevalence of pain, discomfort and back pain among the caregiver of sever
disability, higher BMI, non-ambulatory phase of rehabilitation children with CP.
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Introduction
Virtual reality is the use of interactive replication created with computer hardware and software to impart users with
opportunities to engage in environments that appear to feel similar to real world objects and events. The use of
virtual reality based training (VRBT) for rehabilitation of cerebral palsy is not common. To find out the efficacy of
Virtual Reality Based Therapy (VRBT) in Post- Operative Rehabilitation of Children with Cerebral Palsy .
Methods
This is a retrospective cohort study in which 29 subjects participated (study group – 14 and control group – 15).
Nintendo Wii sports and Wii fit were used for VRBT. The study group received VRBT along the conventional
rehabilitation modalities, whereas, control group received only conventional rehabilitation modalities. The subjects
of the study group were assigned to play the games (VRBT) in every three alternate days in a week. The outcome
measures used were Manual Ability Classification System (MACS) for upper limb function, Pediatric Balance
Score (PBS) for balance, level of participation, motivation, cooperation and satisfaction of the child. Both the
measures were collected before the treatment and after completing the treatment (after three weeks).
Results & Discussion
The balance and manual ability were significantly improved in both the groups (Balance: study: t-2.28, p<0.05;
control: t-3.5, p<0.01; Manual ability: study: t-5.58, p<0.001; control: t-7.06, p<0.001). Level of participation,
motivation, cooperation and satisfaction of the child were also reported to be significantly higher among the study
group as compared with control group.
Conclusion
Results of this study showed that improvement in balance of postoperative children with cerebral palsy was
possible through the use of VR-based therapy in the form of Wii-Fit. VRBT is an effective method in Post- Operative
Rehabilitation of Children with Cerebral Palsy.
361
POSTERS
Exhibition Hall: Posters 2 - Paediatrics, Poster Board 2
Abstract Number: 409
Abstract Title: Virtual Reality Based Therapy For Post- Operative Rehabilitation Of Children With Cerebral
Palsy
Authors: A. Sasidharan, D. Sharan, R. Ranganathan, M. Manikandan
Presenter: D. Sharan
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Paediatrics, Poster Board 3
Abstract Number: 417
Abstract Title: Orthoses To Prevent Hip Dysplasia And Foot Deformities In Cerebral Palsy
Authors: F. Landauer
Presenter: F. Landauer
Introduction
Cerebral palsy (CP) is continuously changing its effect on control and movement function.
Methods
Treatment of congenital hip dysplasia according to R. Graf and clubfoot according to Ponseti are compared with
cerebral palsy.
Results
Hip geometry: Normal hip geometry developes in the first year of life. The risk of hip dysplasia in cerebral palsy
is a well known problem. Following the example of Prof. R. Graf successful orthotic treatment can be reached
only in the very early stage of age. This highlights the crucial factor of time. An early treatment with little power
but plenty of time could prevent many cases of hip dysplasia and hip disExhibition Halls. Foot deformity: Foot
deformity is a much more complex problem. In CP equinus, clubfoot or calcaneus valgus become dominant.
Orthoses can be used to correct deformity according to Ponseti technique and influence function of the foot.
Correction can be expected only in the first year of life by early and long-term orthotic treatment. This is depending
on the calcification of the bone in the following years of life. In almost all textbooks recommendations concerning
orthoses are focused on diagnoses as hip dysplasia or clubfoot etc.. This is definitely too late. We have to find new
criteria for the indication of orthoses. But orthoses can do much more than prevent deformity. They compensate
deformities, improve musculosceletal function and support the independence of the patients as a central issue in
the treatment of CP.
Discussion
Orthoses are not an independent therapy. It is a supportive part in the overall concept of the basic physical therapy,
medical and surgical treatment.
Conclusion
With these considerations currently orthoses are indexed too late, and therefore the begin of orthotic treatment has
to be started in the first year of life.
362
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Feb 7 (14:00 - 14:30, 15:45 - 16:15)
POSTERS
Exhibition Hall: Posters 2 - Paediatrics, Poster Board 4
Abstract Number: 62
Abstract Title: Congenital Limb Deficiencies – Epidemiology And Management
Authors: I. Siev-Ner, D. Guthman, A. Daich, A. Kristal, S. Levy
Presenter: I. Siev-Ner
Introduction
Congenital Limb Deficiencies (CLD) is a challenge in rehabilitation. Despite the Introduction of screening ultra
sound in pregnancy, certain populations refuse an abortion even if a severe fetal defect is diagnosed. We present
112 cases followed in our special clinic for CLD. In the last decade (1998 – 2008) we received 40 new cases, for
an unknown reason 10 (25%) were born in 2004 and 7 (17.5%) in 2002.
Methods
Retrospective study. Recording of patients files.
Results
11 (9.8%) out of the 112 individuals have a PFFD (Proximal Femoral Focal Deficiency). Of the remaining 101
individuals: 77 individuals (76.2%) had a single limb deficiency, 3 (2.9%) – 2 limb deficiency, 4 (3.9%) – 3 limb
deficiency and 6 (5.9%) – 4 limb deficiency, at different levels. Site: 39 (38.6%) - left upper limb, 19 (18.8%) – right
upper limb, 8 (7.9%) – each lower limb.
Discussion
The treatment was personally tailored to each individual. For the PFFD patients the treatments included:
orthoprostheses with and w/o an arthrodesis of the 'hip/knee' joint and partial foot amputations. The amputations
were carried out for a better prosthetic fitting, A 'Van Ness' operation was also performed. For the other CLD,
most of them use prostheses. Most of the upper limb deficiency (ULD) patients use a cosmetic prostheses, some
of them a functional one. All the lower limb deficiency (LLD) patients use prostheses or an orthoprostheses and
ambulate.
Conclusion
The peaks in new CLD patients in certain years raise the question about environmental factor being responsible
for the developmental absence.
363
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Paediatrics, Poster Board 5
Abstract Number: 521
Abstract Title: Comparison Of 3D Gait And Balance Effects From An Adjustable Dynamic Response Versus
Fixed Ankle Foot Orthosis In A Child With Hemiplegic Cerebral Palsy
Authors: M. Deharde, L. Curatalo, K. Alter, D. Damiano
Presenter: M. Deharde
Objective
To objectively evaluate performance of the ADR ankle orthosis during gait and balance tasks compared to barefoot,
shoe inserts, and locked brace conditions.
Methods
A 12 year old boy with right spastic hemiplegia participated in this pilot investigation. He was given a customdesigned ADR ankle orthosis for daytime use. 3D kinematic, kinetic and EMG analyses and the Limits of Stability
Test on the Neurocom were performed after he had worn the brace for several weeks.
Results
His fast gait speed improved by 0.2-0.3 m/sec in all brace conditions compared to barefoot. Both the locked and
ADR braces improved sagittal plane kinematics by improving toe clearance and foot positioning for contact but
the ankle curve was notably “flatter” in the locked brace. By allowing more dorsiflexion in stance, the ADR brace
allowed better tibial progression, leading to greater knee and hip extension at mid-stance. Increased dorsiflexion
in swing further reduced compensatory ipsilateral hip flexion and contralateral hip abduction-circumduction. The
first of two ankle peak moments in stance was markedly reduced with the ADR orthosis. However, the second
peak did not increase as desired. Since plantarflexion resistance was set fairly high, no motion occurred at selfselected speed with slight motion at fast speed. Tibialis anterior EMG magnitude decreased during swing in the
ADR brace, suggesting that assistance was more than was required. Instrumented balance parameters of reaction
time, movement extent and velocity were best in the ADR compared to other conditions.
Conclusion
The ADR showed improvements over the traditional brace, consistent with design goals. Some adjustable
parameters were optimized supporting the concept of “actively” assisting eccentric muscle actions. This
promising approach warrants greater study, development and implementation. Quantitative techniques may prove
increasingly valuable to optimize dynamic bracing strategies, especially for more subtle or invisible effects (such
as in-phase muscle activation).
364
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Feb 7 (14:00 - 14:30, 15:45 - 16:15)
POSTERS
Exhibition Hall: Posters 2 - Paediatrics, Poster Board 6
Abstract Number: 491
Abstract Title: Sfa Brace - Mobility India Initiative In Treatment Option For Club Feet In India
Authors: S. Oinam, R. Kumar
Presenter: S. Oinam
Introduction
As per Indian census (2011) more than 1.2crore children are affected with club feet in India. There is a definite
need for appropriate, low cost brace to manage club feet. The advent of SFA Brace has been a welcome option
in the India context. The move initiated by CURE International and other NGOs is slowly bringing in the needed
change. The SFAB project was started in the year 2009.
Methods
“CURE International” with support from CBM has taken the initiative to work on the management of the club foot.
Mobility India (MI) partnering with CURE International has set up the SFAB fabrication unit with local resources
with the procedural guidelines from Mr. Michael Steenbeek, the designer of the brace. MI has trained local shoe
makers in fabrication of the braces with locally available materials. The in house fabrication set up produces SFA
brace from size 6cms to 20cms and has produced 4000 braces since 2009.
Results
Demand for SFA brace is on a rise in India. The design has been widely accepted in India with positive Results
with feedback from doctors, therapists and orthotic practitioners.
Discussion
In India, with a population of 1.5billion people and an estimated 2500 children born each year with clubfoot.
The method proved to be highly accepted by doctors and almost all families, with excellent functional Results.
Application of the foot abduction brace did not result in pathological changes of femoral anteversion or tibial
torsion.
Conclusion
SFA brace could be considered to be an acceptable approach for club foot management. There is a definite need
for more centers around the country and region to start fabrication of the braces and human resources trained.
Proper information sharing and distribution system could ensure better access and patient care.
365
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Paediatrics, Poster Board 7
Abstract Number: 514
Abstract Title: Effect Of A Ypsylon (Carbon Reinforced) Ankle-Foot Orthosis On Gait In Children With
Spastic Cerebral Palsy.
Authors: M. Bonikowski, A. Czernuszenko, K. Krasowicz
Presenter: M. Bonikowski
Gait abnormalities are often present in children with CP. Proper orthotic management is a part of multidisciplinary
approach. Ypsylon dynamic ankle-foot orthoses (Y-AFOs) are made with thermoplastic material reinforced with
up side down Y shaped carbon fiber on posterior side of 1/3 distal part of shank. Y-AFOs are flexible enough to
substitute hinged AFOs, conserve energy in stance and release it in early swing.
Aim
The purpose of this study was to determine the effect Y-AFOs on gait.
Methods
We studied the effect of Y-AFOs on gait in 20 children: 10 with bilateral and 10 with unilateral CP, GMFCS level
II-III. We analyzed gait using 2D video recording and sagittal plane kinematics from 3D gait analysis. Walking
with the Y-AFO was compared with walking barefoot. Patients presented following gait deviations in stance: Type
2 - Knee (hyper)extension without heel rise (HR), Type 3 - Knee (hyper)extension with HR or Type 4 - Knee flexion
with HR according to the Modified Amsterdam Gait Classification (MAGC). During Swing we observed: Type A drop foot in midswing, Type B - stiff knee, Type C - limited knee extension in terminal swing, Type D - adduction of
the hip in terminal swing, according to MAGC.
Results
With Y-AFO stance phase was normalized in all patients. We also observed better clearance and in majority
of patients improvement of knee flexion in early swing and knee extension in terminal swing. In some children
dramatic improvement of trunk and upper extremities motion were achieved. All patients and/or caregivers referred
improvement of walking performance and orthotic compliance.
Discussion
The Y-AFO had the advantage of less restriction on ankle movement during stance, power absorption and
generating improved knee movement in swing. Children use them for a whole day even for sport activities such
as soccer or running.
366
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Feb 7 (14:00 - 14:30, 15:45 - 16:15)
The paper introduces some important aspects of an innovative methodology to improve the manufacturing
excellence of the prosthetic socket design and manufacture using RE methodology. There has been drastic change
in the development of prosthetic socket fabrication replacing the old conventional casting method using plaster of
paris by the digital modelling and socket generation. The aspect of manufacturing excellence has been studied
at every stage where the design has been altered till the last stage of fabrication. There is an industrial need for
enhancement of manufacturing excellence in the prosthetic design and manufacture in small scale industries.
The socket is considered an element of major importance in the makeup of prosthesis. Each socket is a tailor made
device designed to fit unique geometry of the patient’s residual limbs The paper identifies the shortcomings of the
conventional method of preparation of sockets done in the usual small scale industries and the replacement of it
by the new technology of CAD/CAM and Reverse Engineering.
The work started by identifying the small scale industries which were involved in the fabrication of the prosthetic
sockets and a survey was made from the manufacturers and the users/ patients. Then the problems associated
with the fabrication were sorted out and also the problems of the wearer were also noted. The study served a s
a pilot to develop a methodology for a large number of manufacturing solutions using Reverse manufacturing to
attain manufacturing excellence
367
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 8
Abstract Number: 8
Abstract Title: Improving Manufacturing Excellence Of Prosthetic Socket Design Using Reverse Engineering
(Re) –A Case Study
Authors: R. Pandey
Presenter: R. Pandey
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics: Lower Limb, Poster Board 8A
Abstract Number: 86
Abstract Title: The Effect Of Floor Quality On Postural Control In Patients With Diabetic Neuropathy
Authors: M. Mehdikhani, N. Abu Osman, P. Sin Lee, N. Mortaza, D. Tze Yang
Presenter: M. Mehdikhani
Introduction
Diabetes is the most common disease in the current century. This disease causes various disabilities. Neuropathy
is the most common complication in diabetics. Previous studies have shown that diabetic neuropathic people are
more unstable than diabetic non-neuropathic people. So the risk of fall increases in these patients.
Objective
The goal of this study was to evaluate the stability of patients standing on three different types of floor quality.
Method
15 subjects with diabetic neuropathy have been experimented standing on three different floors in quiet stance,
erect position, with 5-7 external rotation of lower extremities to increase conformable and stability. The distance
between feet was equal to shoulder width. Stability was calculated by the Biodex Balance System with a 20 Hz
sampling rate in the bipedic stance (BLS) and unipedic stance (ULS) for 30 s.
368
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Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Background
The conventional method of attachment of prosthesis involves on a socket. A new method relying on
osseointegrated fixation is emerging. It has significant prosthetic benefits. Only a few studies demonstrated the
biomechanical benefits.
Purpose
The specific objective of this study was to present the key temporal and spatial gait characteristics for unilateral
amputation. The ultimate aim of this study was to characterise the functional outcome of the individual with
transfemoral lower limb amputation fitted with osseointegrated fixation, which can be assess through temporal
and spatial gait characteristics.
Methods
This study evaluated eleven participants who have transfemoral amputation fitted with an osseointegrated fixation
(OPRA). Two females and nine males fitted with an osseointegrated fixation were asked to perform seven trial of
straight walking. Speed walking, cadence, duration of gait cycle, support and swing phases, length of stride and
step, were extracted from displacements of foot markers using a 3D motion analysis system recording at 200 Hz.
Results
The speed of walking and the cadence were 0.84±0.13m/s and 47.19± 3.9steps/min, respectively. The duration
of the gait cycle was 1.29±0.11s. The support and swing phases were 0.77±0.07s and 0.52±0.07s corresponding
to 59.85±2.86% and 40.15±2.86%, respectively. The step length for the prosthetic side was 0.67±0.08m and
0.62±0.10m for the sound leg.
Conclusion
The Results demonstrate that the amputees fitted with an osseointegrated fixation showed a highly functional level
compared to normative data presented in previous studies focusing on amputees fitted with a socket and ablebodied. This study also confirms that the prosthetic benefits will translate into an increased functional outcome.
369
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 9
Abstract Number: 112
Abstract Title: Spatio-Temporal Characteristics Of Locomotion Of Transfemoral Amputees Fitted With
Bone-Anchored Prosthesis
Authors: V. Pinard, L. Frossard
Presenter: L. Frossard
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 10
Abstract Number: 392
Abstract Title: Hip Joint Stabilization Vs. Propulsion And Resistance In Individuals With Transfemoral
Amputation
Authors: R. Dumas, L. Cheze, L. Frossard
Presenter: L. Frossard
Joint moments and joint powers are widely used to determine the effects of rehabilitation programs and prosthetic
components (e.g., alignments). A complementary analysis of the 3D angle between joint moment and joint angular
velocity has been proposed to assess whether the joints are predominantly driven or stabilized.
Joint power is a dot product. 3D angle < 60° means a propulsion configuration (more than 50% of the moment
contribute to positive power). 3D angle > 120° means a resistance configuration (more than 50% of the moment
contribute to negative power). Within this range, the joint is in a stabilization configuration (less than 50% of the
moment contribute to power). This joint power is maximized at 0° and 180° and cancelled at 90°.
Previous studies demonstrated that hip joints of able-bodied adults are stabilized (3D angle about 90°) during
almost all the stance phase and not fully driven at pre-swing (3D angle far from 0°). In able-bodied children, the hip
joints are in a propulsion configuration during almost all the stance but neither fully driven at pre-swing.
The present study analyses this 3D angle at the hip joint of individuals with transfemoral amputation (TFA). The
joint moments are computed from a multi-axial transducer mounted above the prosthetic knee in order to manage
the absorption at the foot and resistance at the knee. The Results show that, in contrast with able-bodied adults,
TFA demonstrate less stabilization during the stance phase and a clear propulsion configuration (3D angle near
0°) at pre-swing.
This analysis of the 3D angle between the joint moment and the joint angular velocity provides complementary
insights into the gait strategies of TFA that can be used to support evidence-based rehabilitation and fitting of
prosthetic components.
370
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Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Introduction
The walking school at the Red Cross Hospital (RCH), Sweden, serves the entire Stockholm County Council, as
a specialist center for people with lower limb amputation (LLA). Our main objective is to improve patients walking
abilities with prosthesis and increase their level of independence. Approximately 200 patients made 2600 visits
during 2011. This is a review of the rehabilitation intervention and outcome.
Methods
194 patients with a LLA, visiting the RCH walking school during 2011 (134 men/ 60 women, age ranging from 6-94
years). Information about gender, amputation level, age and cause of amputation was collected. The rehabilitation
was evaluated with the physiotherapist’s judgment about how the patients manage to stand up, walk indoors and
outdoors. Four alternatives were given: with help, with supervision, independent with- or without walking aids.
Result
122 men and 48 women managed to stand up, 113 men/50 women managed to walk indoors and 91 men/39
women managed to walk outdoors independently, with or without walking aids. The group of amputations
performed in Stockholm 2011 and the group of new patients visiting the RCH 2011 were compared.The gender
difference is considerable as the first group consisted of 52% men/48% women compared to 69% men/31%.
Discussion
The positive outcome along with the gap between performed amputations and visits at the RCH raises the
apprehension that many amputees possibly benefitting from prosthesis never reach the RCH. Every LLA patient
should be given a fair chance of prosthetic fitting and rehabilitation. Do men participate in rehabilitation at a higher
extent than women in general and if so, why?
Conclusion
These findings indicate that the majority of the patients reach a high level of independence; men more than
women. There are differences in the group of amputations performed and the group visiting the RCH.
371
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 11
Abstract Number: 107
Abstract Title: Rehabilitation At The Red Cross Hospital, Sweden. Intervention And Outcome For Lower
Limb Amputees.
Authors: L. Gudmundson, H. Sundgren, M. Skubic- Bergqvist
Presenter: H. Sundgren
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 12
Abstract Number: 189
Abstract Title: Tf Seal-In Liner Use In Interims:Effect On Rehab Time, Outcome And Continued Use.
Authors: A. Cox
Presenter: A. Cox
Introduction
discuss the use of TF seal-in liners in interim prosthetics and their effect on rehab length of stay, functional
outcome level and retention of prosthetic use.
Methods
Review of cases using TF seal-in liners in the last 4-5 yrs compared to traditional suspension Methods prior to that.
Results
Patients had a shorter Rehab stay, higher functional level and increased independance at discharge and %100
prosthetic use retention rate.
Discussion
Increased Prosthetic use and activity level, it's affect on general health and wellbeing, maintaining independance,
staying at home, less comorbidities, less hospitalisation, improved quality of life, improved psychological factors
and less home modifications will be discussed.
372
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Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Introduction
Gooed oedema control in the new TT amputee and waiting untill stump size stabilises, Results in %99 of these
amputees only requiring 1 socket/interim prosthesis which often lasts for 3-6 months.
Method: Review of clinical practice at Bendigo Health and how oedema is controlled and interim prostheses
managed.
Results
Case studies of numbers of amputees and number of interims/sockets required by each and how long they were
able to keep that 1st interim prosthesis. Includes some cases where ealier fitting was desirable and how those
prosthese/sockets had to be replaced.
Discussion
Discussion of cost effectiveness of this method, effect on patient outcome, minimal delay in rehab as not waiting
for new sockets, free up prosthetist time, less fitting issues etc
373
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 13
Abstract Number: 190
Abstract Title: The Need For Only 1 Tt Interim Prosthesis/Socket When Appropriate Oedema Control And
Management Is Applied.
Authors: A. Cox, K. O'Connor
Presenter: A. Cox
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 14
Abstract Number: 166
Abstract Title: The Impact Of Transfemoral Amputation On The Cognitive Load Associated With Walking
Authors: S. Morgan, V. Kelly, B. Hafner
Presenter: B. Hafner
Introduction
The incidence of limb loss throughout the world is rapidly increasing. People with lower-limb loss often report
a need to concentrate on walking tasks that may not challenge non-amputees. The effects of lower-limb loss
on the cognitive load associated with walking are not well understood, but they likely increase with proximal
amputation levels, task complexities, and demanding environmental conditions. Cognitive loads cannot be directly
measured, but they may be inferred by comparing walking performance in dual-task (walking while performing
a cognitive task) relative to single-task (walking only) conditions. The purpose of this research is to quantify the
effects of increased cognitive load on walking across different surfaces in persons with transfemoral amputation
(TFA) compared to controls.
Methods
Participants with TFA and age/gender-matched controls walked at self-selected speeds over firm and foam
surfaces under single- and dual-task conditions. Cognitive task performance was measured relative to a singletask (sitting) condition. Gait speed and stride-to-stride variability were assessed for walking tasks. Response
latency and accuracy were assessed for the cognitive task.
Results
Results to date indicate that participants with TFA walk slower and with more variability in dual-task (relative to
single-task) conditions on foam surfaces compared to controls.
Discussion
Concurrent cognitive tasks have greater effects on walking (particularly when walking across a complex surface)
in persons with TFA compared to controls. This suggests that people with TFA may use more cognitive resources
to control walking than do persons without amputation.
Conclusion
Dual-task Methods can be used to quantify the effects of cognitive load on walking in persons with TFA. The
degree to which a cognitive task interferes with walking in people with TFA may increase with complex walking
tasks or environmental conditions. Advances in prosthetic technology and rehabilitation strategies may ameliorate
the negative impact of amputation on dual-task performance.
374
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Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Introduction
Various approaches have been conducted to evaluate trans-femoral prosthetic socket fitting. However there is still
no quantified method. The purpose of this research is to quantitatively describe the prosthetic socket fitting. In this
preliminary study, shape and elasticity of the residual limb tissue were chosen as dominant factors.
Methods
A male unilateral trans-femoral amputee was tested. Two types of suction (IRC and QL) sockets were applied
and investigated. Measurements were achieved in conditions of doffing and donning the prosthesis as follows.
16 measurement points positioned on 5cm and 15cm distal from the ischial tuberosity were transversely aligned
around the sockets. The corresponding measurement points were transferred to the residual limb by marking
through the small holes drilled in the each point of the socket. Three dimensional coordinate data of the residual
limb and the sockets were collected with the 3D digitizer (FUSION, FARO). Elasticity of the residual limb was
measured with the stiffness gauge (OE-220, Ito Co.). Both data in each socket were measured through the holes
on the socket.
Results and Discussion
3D data showed the features of the shape variation conformed to the concept of socket design. Elastic moduli of
the residual limb within the sockets got significantly higher (53.0-174[kPa]) than without the sockets. The rate of
the sockets radius change had a certain similarity to the elastic moduli changes. Nevertheless it was observed
that the elasticity distribution was clearly different compared to two types of the socket. IRC had higher value on
mediolateral direction than anteriolateral direction, whereas QL had the completely opposite. Therefore these data
conformed to features of each socket design and showed that the socket shape influenced to both shape and
elasticity of the residual limb.
Conclusion
This study might provide one of Methods for quantitative description of the prosthetic socket fitting.
375
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 15
Abstract Number: 225
Abstract Title: Preliminary Study Of Quantification Of Shape And Elasticity Of A Residual Limb Of A
Transfemoral Amputee
Authors: T. Nakamura, T. Maruyama, T. Takashima, H. Fujimoto
Presenter: T. Nakamura
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 16
Abstract Number: 158
Abstract Title: Characterization Of Mechanical And Electrical Vacuum Pumps For Use In Vacuum-Assisted
Suspension
Authors: S. Fatone, S. Wood, R. Caldwell, O. Komolafe, W. Chen, C. Sun, A. Hansen
Presenter: S. Koehler
Introduction
Vacuum-assisted suspension is becoming a popular system for use in lower-limb prostheses. However, the
performance of current prosthetic vacuum pumps has not been studied. In this study, prosthetic vacuum pumps,
both mechanical and electrical, were tested and compared to gain insight into their overall performance and
efficiency.
Methods
We compared 2 electrical (Otto Bock Harmony® epulse and Ohio WillowWood LimbLogic® VS) and 3 mechanical
pumps (Otto Bock Harmony® P3, P2, and HD). Sealed canisters simulated estimated volumes of a range of
socket/liner interfaces (37.5, 68.6, 99.3, 133.1, 198.9 cm3). A lever activated fixture was used to actuate the
mechanical pumps. Each canister was evacuated to ~17 inHg at least 5 times with each pump. Vacuum pressure
and time were recorded during evacuations using a digital gauge. Electrical pumps were also tested repeatedly on
the 99.3 cm3 canister to complete battery depletion. All P3 functional rings (f0 to f4) were tested, while the P2 and
HD pumps were set for a 55 kg patient (equivalent to the P3 f0 ring). Average power was calculated by multiplying
the achieved vacuum pressure by the canister volume and dividing by the time taken to achieve that pressure.
Results
The LimbLogic® was 47% more powerful on average than the e-pulse. There was a large difference in number
of evacuations to complete battery depletion between electrical pumps (e-pulse < 180 trials; LimbLogic® > 225
trials). Additionally, time to evacuation for the epulse increased by 7.5% over the course of battery depletion, while
the LimbLogic® demonstrated no change. The P3 was the most “powerful” of the mechanical pumps.
Discussion & Conclusion
While this study provides some insight into pump performance it may not be directly indicative of in-vivo performance
given other prosthetic and human subject variables that may affect development and maintenance of vacuum.
376
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Introduction
Biomechanics of transtibial amputee (TTA) gait are influenced by variables including the prosthetic foot, socket
design, suspension system, gait training and accommodation period with the foot. The purpose of this study was
to determine the influence of the prosthetic feet on the symmetry of external work (SEW) during unilateral TTA gait;
by controlling the other confounding variables.
Methods
Eleven unilateral TTAs who were healthy and had no known medical conditions in the intact limb participated
in the study. Each subject tested four prosthetic feet – SACH, SAFE, Talux and Proprio – using a study socket
with total surface bearing design and suction suspension with a sleeve. The test feet were randomized and there
was a 10-14 day accommodation period with each foot. Each subject also received upto 4 hours of standardized
prosthetic training aimed to maximize use of test feet. Vertical Ground Reaction Forces (GRFs) were collected
as subject walked on a 30-meter walkway at a self-selected speed. SEW between the intact and prosthetic limbs
were calculated for each test session.
Results
Negative work symmetry was highest for the Talux foot (94.4%) and was significantly greater than SACH and
SAFE feet. SEW values for Proprio foot were intermediate between Talux and SACH/SAFE feet. Positive work
symmetry was not significantly different between feet.
Discussion
“J” shaped ankle and heel-to-toe foot plate design of the Talux foot helped reduce the negative work done by the
intact limb and increased SEW values. The solid ankle design and shorter keels of SACH/SAFE feet contributed
to greater asymmetry. As prosthetic feet are unable to generate power like muscles, positive work symmetry was
not different between feet.
Conclusion
The combination of gait training and prosthetic foot designs, such as “J” shaped ankle and heel-to-toe footplates,
may contribute to a symmetrical gait pattern in unilateral TTAs.
377
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 17
Abstract Number: 421
Abstract Title: The Role Of Prosthetic Feet In Promoting Gait Symmetry Of Unilateral Transtibial Amputees
Authors: V. Agrawal, R. Gailey, C. O'Toole, I. Gaunaurd, A. Finnieston, R. Tolchin
Presenter: V. Agrawal
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 18
Abstract Number: 198
Abstract Title: Lateral Trunk Flexion During Bilateral Transtibial Amputee Gait
Authors: M. Major, R. Stine, S. Gard
Presenter: Y. Wu
Introduction
Relative to able-bodied individuals, bilateral transtibial amputees (BTAs) walk with reduced self-selected speeds,
increased step width (StW), and hip-hiking, which may contribute to their increased metabolic cost. The unique
upper body dynamics of BTAs (i.e., exaggerated lateral trunk flexion range-of-motion (LtROM)), which may
contribute to this increased metabolic cost, have not previously been quantified. The purpose of this study was to
quantify LtROM of BTAs and determine the relationship of these motions to StW.
Methods
A retrospective analysis was conducted on ten BTA participants whom performed overground walking trials at
normal, fast, and slow self-selected speeds while wearing two prosthetic configurations: PC-A) Seattle LightfootII and rigid pylon, and PC-B) Seattle Lightfoot-II with Endolite Multiflex Ankle and Ottobock Torsion adaptors.
Following two weeks of acclimation to each configuration, kinematic data were collected via optical motion capture
to estimate LtROM and StW. Data for thirteen age/speed-matched able-bodied controls walking at self-selected
speeds provided baseline comparison. Between-condition and between-group differences were statistically
analyzed using a repeated-measures and one-way ANOVA, respectively (alpha=0.05).
Results
At similar speeds, BTAs walked with greater StW (18.6±3.7cm (PC-A) and 16.5±3.1cm (PC-B) versus 12.2±2.7cm;
p<0.001) and LtROM (11±5deg (PC-A) and 12±6deg (PC-B) versus 4±1deg; p<0.001) than controls. Increasing
walking speed decreased StW (p=0.018), but did not affect LtROM for both configurations. PC-B reduced StW for
all walking conditions (p=0.004), but did not affect LtROM.
Discussion
Relative to controls, BTAs displayed greater StW and LtROM while walking that is characteristic of abducted gait.
Although StW decreased with walking speed and prosthesis alteration, LtROM remained invariant.
Conclusion
BTAs walk with greater StW and LtROM compared to able-bodied individuals. This exaggerated LtROM is not
affected by decreases in StW, which may suggest that this motion is not solely used to shift the body center of
mass laterally over the stance limb.
378
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Introduction
Optimal prosthetic knee alignment is critical for transfemoral amputees (TFAs) to reduce mechanical work at the
hip joint and ensure safe mobility. With knee translational misalignment in the posterior and anterior direction, TFAs
would have to increase the effort required to initiate knee bending in late stance or prevent knee collapse during
weight bearing, respectively. Such misalignments could reduce dynamic stability during walking. The purpose of
this study was to quantify the relative level of gait instability produced by knee translational misalignment. Relative
dynamic stability was quantified by estimating the maximum Lyapunov exponent (MLyE), a measure of kinematic
repeatability, of pelvic motion during steady-state walking.
Methods
Four subjects with unilateral transfemoral amputation walked on a treadmill at a self-selected speed under three
prosthetic alignment conditions: BA) bench alignment, AA) 2cm anterior knee translation from bench, and PA) 2cm
posterior knee translation from bench. All subjects were fitted with an Ottobock 3R95 prosthetic knee and knee
translation was achieved using a custom-built adaptor. Pelvic kinematic trajectories (collected via optical motion
capture) from 10 strides following 2 minutes of walking were used to calculate the MLyE of the three conditions.
Results
MLyE increased considerably in all four subjects for each misalignment condition relative to BA (median values of
2.20 (AA) and 2.93 (PA) versus 1.46 (BA)), indicating reduced stability.
Discussion
MLyE analysis of pelvic motion suggests that dynamic stability of TFAs during steady-state walking decreased
with knee translational misalignment. The quantitative changes in MLyE can be used to interpret changes in the
sensitivity to external perturbations and hence upright gait stability.
Conclusion
Prosthetic knee translational misalignment reduced dynamic stability of TFAs during steady-state walking. MLyE
analysis of pelvic motion appears to be a useful method for quantifying relative dynamic stability of TFAs during
steady-state walking and may have implications for fall-risk.
379
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 19
Abstract Number: 229
Abstract Title: Dynamic Stability Of Individuals With Transfemoral Amputations: Walking With Varying
Prosthetic Knee Alignment.
Authors: P. Gottipati, M. Major, S. Gard
Presenter: Y. Wu
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 20
Abstract Number: 318
Abstract Title: Biomechanical Gait Evaluation Of The Cr-Sach Prosthetic Foot
Authors: K. Turcot, Y. Sagawa, A. Lacraz, J. Lenoir, M. Assal, S. Armand
Presenter: A. Lacraz
Introduction
Individuals who undergo a lower limb amputation should benefit of a well fitted prosthesis to improve their
locomotion and societal reintegration. The International Committee of the Red Cross (ICRC) has developed a new
version of their prosthesis foot in 2010 which is currently distributed worldwide: CR Equipements SACH Foot (CRSACH). This prosthetic foot has already shown a good lifespan in developing countries [1], however no study has
yet evaluated its biomechanical properties during locomotion. The aim of this study is to compare the CR-SACH
foot to the well-recognized Solid Ankle Cushion Heel (SACH) foot made by Otto Bock™.
Methods
A doubled-blind study was conducted to compare biomechanical properties during locomotion of both feet (CRSACH versus SACH). Fifteen unilateral transtibial amputees were included in this study. A 3D motion analysis
system and two force plates were used to capture body motion and ground reaction forces during gait at a selfselected speed and at 1.2 m/s. Relevant spatio-temporal, kinematics and kinetics parameters [2] have been used
to compare feet in a randomized order using non-parametric Wilcoxon Matched Pairs Tests.
Results
Using the CR-SACH foot, amputees increased significantly the ankle range of motion in the sagittal plane (SACH:
7° vs. CR-SACH: 12°), the maximal plantar flexion angle during the terminal stance phase (SACH: 10° vs. CRSACH: 13°) and the ankle power (SACH: 0.31W/kg vs. CR-SACH: 0.45W/kg). No significant difference was found
for knee, hip and pelvis parameters.
Discussion
The CR-SACH foot provides more flexibility and restitution of energy in the sagittal plane than the SACH foot.
Conclusion
This study suggests CR-SACH foot presented better biomechanical performances than the SACH foot.
Reference
[1] P. Gauthier P., ISPO 2010 [2] Y. Sagawa, Jr., et al., Gait Posture,(33);511-26;2011.
380
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Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Introduction
The International Committee of the Red Cross (ICRC) has designed a Solid Ankle Cushion Heel (SACH) foot
produced at low cost by CR-EQUIPEMENTS™. This foot is available worldwide in all orthopedic centers supported
by the ICRC. The objective of this study is to compare patient satisfaction with the CR-EQUIPEMENTS™ SACH
foot with that made by Otto BOCK™, the latter considered by many as the “golden foot.”
Materials and Methods
Cross over and double blind trial including patients with a traumatic trans-tibial amputation, autonomous in
ambulation for more than two years and without co-morbidities affecting gait and balance. Each patient was
equipped with one foot and then the other, without knowledge of the specific type. Each foot was worn for 7 days.
A validated satisfaction questionnaire (SAT-PRO) [1] was completed at 3 stages, first at the time of inclusion
into the study and then again after using each foot. In addition, we developed a 7-item questionnaire specifically
addressing the prosthetic foot itself.
Results
There were 15 patients, 12 men and 3 women with a mean age of 46.9±12.5 years (range, 26.9-73.4 years),
who met the criteria of the study and completed the entire trial. The SAT-PRO questionnaire showed slightly
better satisfaction for the CR-EQUIPEMENTS™ foot (80%; p=0.0025) compared to the Otto BOCK™ foot (78%;
p=0.019); however this difference was not statistically significant (p=0.54). The foot-oriented questionnaire
revealed a difference in favor of the CR-EQUIPEMENTS™ foot, but this was not statistically significant (p=0.06).
Discussion
This study demonstrated that the CR-EQUIPEMENTS™ foot provided comparable satisfaction to the Otto
BOCK™.
Conclusion
This is the first study that addresses patient’s satisfaction using the CR-EQUIPEMENTS™ foot. It is an important
ethical issue in the context of humanitarian aid provided by the ICRC. Reference [1] Bilodeau S et al., Can J Occup
Ther. 1999 Feb;66(1):23-32.
381
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 21
Abstract Number: 320
Abstract Title: Cr-Equipments™ Sach Foot Versus Otto Bock™ Sach Foot A Prospective Double Blind
Study Assessing Patient’s Satisfaction
Authors: A. Lacraz, K. Turcot, Y. Sagawa, J. Lenoir, G. Carmona, M. Assal
Presenter: A. Lacraz
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 22
Abstract Number: 335
Abstract Title: New Ankle Device Adjusting The Angle And Height Of Heel Of Prosthesis
Authors: J. Song, H. Kim, S. Lee, M. Mun
Presenter: J. Song
In many countries including Korea and Asian countries, people have a sedentary lifestyle while they usually indoors
take off shoes. Due to heel height of shoe when taking off shoes, amputees using lower limb prosthesis experience
difference in ankle angle and height between the intact and the affected legs. Elderly or feeble amputees may be
exposed to greater risk of falling, when it appears to become more difficult to maintain gait balance and usual gait.
In this study, a new ankle device capable of adjusting the angle and height of heel in a wide range of angle was
designed and effectively applied to prosthetic usage. By using convertible mechanical and hydraulic cylinder, the
angle variation of the device covers up to as much as 26o, and it operates by clicking touch button once. Even
female amputees wearing high heals can gain control of changing the angle in a very simple way.
382
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 23
Abstract Number: 348
Abstract Title: Biomechanical Evaluation Of Microprocessor Controlled Prosthetic Knee Mechanisms
Authors: A. Crimin, A. Mcgarry, S. Solomonidis
Presenter: A. Crimin
The advent of prosthetic knee mechanisms using embedded systems was seen in the 1990s with the commercial
release of the Blatchfords swing phase microprocessor controlled intelligent prosthesis (IP). Microprocessor
controlled prostheses (MCP) now incorporate inputs which are used to exert control over both swing and stance
phase, utilising peripheral electromagnetic or hydraulic devices connected to the microcontroller to alter the knee
resistance. Unlike conventional mechanical knee designs, the inputs to microcontroller give the MCP artificial
proprioception or feedback control. This is achieved using strain gauges and angular velocity sensors enabling
the prosthetic system to work in unison with the user. Further development of MCP technology by leading
manufacturers has resulted in a premium range of prostheses being commercially available. Positive subjective
feedback from user trials suggest increased confidence and reduced voluntary control.
The principal objective of this pilot study is to objectively determine why the MCP user reports improved stability
and control during gait, relative to prostheses regulated mechanically, such as the Otto Bock 3R80 knee. A series
of gait lab procedures analysing the functionality of MPCs during level walking, stairs and ramp ambulation,
relative to the 3R80 knee will be assessed. The analysis will primarily concentrate on both swing and stance
phase kinematics and kinetics of six lower limb users. Early intra subject statistical analysis indicates that the MCP
knee enables the prosthetics user to regulate external body forces with less compromise and increased control.
However, Results also point to future MCP developments, such as the need for improved response during stair
ambulation. Results from the study indicate that the MCP knee enhanced the control and comfort of the active
prosthetic user compared to the mechanical knee.
383
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 24
Abstract Number: 375
Abstract Title: A Movement Analysis Application To Analyze Energy Recovery In The Prosthetic Feet
Authors: C. Frigo, E. Pavan, P. Cecini, D. Bonacini
Presenter: C. Frigo
A method has been developed to compute the amount of energy stored and restituted during walking by prosthetic
feet. This approach can be used to compare different foot designs and the effect of different covering materials
and shoes. A movement analysis system (Smart-E, BTS, Italy) with 8 TV cameras working at 60 Hz, and one force
platform (Kistler 9286, Switzerland) were used to collect kinematic and kinetic data. Retroreflective markers were
positioned over relevant bone prominences. At the amputated limb, markers were attached to the prosthetic pylon
just above the deformable foot leaves. The ground reaction force (GRF), that was measured during the foot-ground
contact, was transferred to a reduction point at the basis of the pylon, and the ground reaction moment (GRM)
was computed in relation to this same reduction point. The translational and rotational velocities of the pylon were
computed and multiplied by GRF and GRM respectively, so that the power flow between ground and pylon was
quantified. Then, by time integration, the energy exchange was computed.
Two subjects with transtibial and one with transfemural amputation were analyzed. They wear their own prosthesis
that was equipped with a newly designed multi-leaf foot (Roadrunnerfoot, Italy). Trials were performed barefoot
and with covers of different materials: polyurethane, silicone and EVA.
Results have shown that energy wasted by the barefoot was about 5 J and did not increase significantly with
covers (t-Student test, p<0.05) except for covers in polyurethane, for which the energy dissipated was about 8 J.
The flow of energy was also obtained all along the stride cycle, so that the absorption- restitution mechanism could
be analyzed with reference to relevant phases of the stride, like heel-strike, load acceptance, mid-stance, push-off.
This can help improving the design of the structural components of the foot and their mechanical characteristics.
384
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 25
Abstract Number: 376
Abstract Title: Effects Of Different Knee Joint Of Trans-Femoral Amputee Elevating Stairs.
Authors: Y. Nagakura, S. Matsubara, M. Ninomiya
Presenter: Y. Nagakura
Introduction
Advanced power knee make contribution to trans-femoral amputee’s activities of daily living (ADL) such as
ascending stairs. However, it is said that patients should be educated to stop using power knee when they are
not necessary for ascending low stairs. The purpose of this study was to examine the influence of motion and
cardiorespiratory effect on elevating stairs using Natural Automatic Lock Knee (NAL) which was new type of
yielding knee (YK).
Methods
Subjects were 3 males, who had trans-femoral amputees. And, selected joints were NAL and YK which used
usually in ADL. Motions of ascending stairs were recorded using by 10cm settings on the force platforms. And,
subjects were requested take prosthesis side first stride toward. Additionally, subjects were requested ascending
99 stairs the ways of step by step and alternate up stair. Heart rate (HR), oxygen uptake (VO2), respiratory rate
(RR) and minute ventilation (VE) were measured during at that trial.
Results
Anterior-posterior ground reaction forces impulse of NAL were greater than that of YK. Positive work of ankle joint
of NAL was greater than that of YK. On the other hand, negative work of ankle joint of NAL was smaller than that of
YK. Positive and negative knee joint work of NAL was smaller than that of YK. Positive and negative hip joint work
of NAL was greater than that of YK. HR, VO2, RR and VE of alternate up stair Methods were greater than that of
step by step Methods. Also, these were greater than that YK in alternate up stair Methods.
Discussion
Because of the positive hip joint work contributed to ascending stairs, positive hip joint work was considered as
key work for ascending stairs. Also, because of the VO2 was increased, muscle activities of prosthesis side were
required for ascending stairs.
385
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 26
Abstract Number: 146
Abstract Title: Clinical Experience With An Early Walking Aid With A Free-Moveable Prosthetic Knee Joint
In Transfemoral Amputees
Authors: A. Vrieling, J. Hijmans, C. Rommers, H. Zijlstra
Presenter: J. Hijmans
Introduction
In the current early walking aids transfemoral amputees walk with a stiff knee. We developed a new early walking
aid for transfemoral amputees that allows knee flexion, the Beatrixoord Training Prosthesis (BTP). The prosthetic
knee unit in the BTP can be used as a free-moveable or locked knee. By using the free-moveable BTP transfemoral
amputees are able to train the ability to walk with knee flexion in the early rehabilitation period.
Methods
In this pilot study patients with a recent transfemoral amputation used the BTP in early rehabilitation. Usability,
safety, comfort and functionality were evaluated by questionnaires and gait speed, knee flexion and ground
reaction forces were measured in a gait laboratory.
Results
We included 4 patients. The fitting of the BTP was not optimal for all patients since only one socket size was
available. No falling incidents occurred. Skin problems, wounds or pain were not reported. All patients preferred
the BTP over the other early walking aid (airboot). The K-level prognosis was K2 for all patients prior to the training
with the BTP, after training K3 for 1 patient and K2 for 3 patients. All patients did use knee flexion while walking
with the BTP. Gait speed and vertical ground reaction force were slightly higher when walking with the stiff knee,
most likely since patients felt more safe.
Discussion
Patients were very satisfied on walking with the BTP. Walking with the BTP was safe and comfortable. The knee
flexion ability of the BTP was used. Further research is needed to examine the influence of training with the BTP
on the learning process of amputee gait and the quality and length of the rehabilitation.
Conclusion
The Beatrixoord Training Prosthesis which allows knee flexion is a valuable extension of the current early walking
aids for transfemoral amputees.
386
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 27
Abstract Number: 119
Abstract Title: Custom Removable Immediate Post Operative Prosthesis : A Cost Effective Way
Authors: A. Nanda, S. Panda, P. Sahu
Presenter: A. Nanda
Have we ever thought, in developing nations, how to bring up a cost effective immediate post operative prosthesis
(IPOP)? The main aim of this paper is to highlight a cost effective, advantageous and methodological implementing
procedure of an IPOP for a transtibial amputee, so that rehabilitation as a whole becomes easy and time saving.
The term Custom removable signifies an open IPOP system that can be easily accessible by prosthetists to make
adjustments for accommodating the volume changes and limb shaping, by physical therapist for strengthening and
range of motion exercises & by surgeons for wound inspection. The result is faster healing and a greater chance
for successful rehabilitation.
For this design, we used a standard endo-skeletal trans-tibial kit with a modified POP socket attachment plug.
Alignment is always necessary hence; a built-in alignment coupling was incorporated. There were POP bandages
for the rigid removal Dressing (RRD) and a superimposed synthetic cast acting as the ‘socket’ with all the structural
components attached to it, which was later cut to change the RRD whenever necessary. The suspension is by a
waist belt and concentric circumferential elastic Velcro enclosures through out the split socket.
After following each step vividly to its minute details we got a fully matured stump with no or less edema and not a
single sign of infection in just 15 days after surgery. The patient was ready for a definitive fitment in the 23rd day.
The CRIPOP if done correctly can open up a new field which is often neglected due to the cost factor in developing
nations; this is the most cost effective method.
The CR-IPOP has proven to be an effective adaptation to the original IPOP concept. All lead to a more cohesive
clinical team approach with a better understanding of the challenges of postoperative management.
387
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 27 A
Abstract Number: 123
Abstract Title: Using The Timed Up And Go To Objectively Evaluate Variable Cadence Ability In Transfemoral
Prosthetic Users
Authors: D. Abrahamson, D. Amtmann, B. Hafner
Presenter: D. Amtmann
Introduction
Assessing cadence variability is an important aspect of care for persons with transfemoral amputation. The ability
to vary cadence informs prosthetic knee selection and may be used to determine component eligibility. Strategies
to assess variable cadence may include client self-report or informal clinical observation. Presently, there is no
“gold standard” for objectively measuring variable cadence among prosthetic users in clinical settings. Therefore,
the purpose of this study was to examine if the “Timed Up and Go” (TUG) may be sensitive to measuring cadence
changes made by transfemoral prosthetic users. The TUG is a performance measure where participants are timed
as they rise from a chair, walk three meters to a line, and return to a seated position in the chair.
Method
Persons with unilateral, transfemoral amputation (n=8), who used hydraulic knee units, and were classified as
unlimited community ambulators performed the TUG under two conditions. First participants were instructed
to complete the TUG “at your normal and comfortable pace” (TUGcomfortable) and then “as fast as you can
safely walk” (TUGfast). A paired-samples t-test ( 945;=0.05) was used to compare participants’ TUGfast and
TUGcomfortable times.
Results
Significant differences between TUGfast (M=9.42, SD=1.37) and TUGcomfortable (M=11.59, SD=1.40) times
were identified; t(7)= -6.74, p =<.001. These Results suggest that the TUG, when performed at comfortable and
fast speeds, may be sensitive to changes in walking speed of transfemoral prosthetic users who walk with variable
cadence.
Discussion
A difference between TUGcomfortable to TUGfast times may serve as an objective indicator of the transfemoral
prosthetic users’ ability to ambulate with varied cadence.
Conclusion
The TUG is a simple outcome measure that has clinical utility when evaluating the transfemoral prosthetic user.
Its use at both fast and comfortable speeds is recommended for the evaluation of variable cadence ability in the
transfemoral prosthetic user.
388
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Lower Limb, Poster Board 27 B
Abstract Number: 482
Abstract Title: Sensor For Artificial Feedback In Lower Limb Exoprostheses
Authors: G. Tschupp, H. Vallery, P. Favre, R. Riener, T. Schanze, A. Pagel
Presenter: G. Tschupp
The functionality of leg prostheses has been increasing steadily during the past years. However, amputees still
have to deal with decreased sensory information. One promising approach is, therefore, to feed back the anteriorposterior centre of pressure (CoP) underneath the prosthetic foot using, e.g. electrotactile stimulation.
To calculate CoP-position, two forces and one torque need to be measured. As conventional prostheses do
not provide this information, a 3-DOF modular sensor was developed that can easily be integrated into in the
prosthetic shank. The sensor has to support body weights of up to 100 kg whereas its weight should not influence
gait dynamics. Thus a lightweight aluminum bending beam design with high mechanical load capacity has been
chosen. Additionally, the device has to measure forces with a sufficient accuracy. This is accomplished using strain
gauges being wired into three Wheatstone bridges.
For evaluation a Zwick static materials testing machine (Z145670; Zwick/Roell, Ulm, Germany) was used. To
confirm preceding FEM calculations, a static stress test according to ISO 10328 was carried out. The sensor
resisted the prescribed load with marginal deformation (35 µm). The resulting mass of the sensor is 210 g. The
accuracy of the whole measurement range is 34 N for the axial force, 5 N for the anterior-posterior force and 16
Nm for the torque. Gaussian error propagation reveals that despite measurement errors CoP-position can be
estimated with an accuracy of 10 % during 95 % of the stance phase.
As the sensor passes the stress test it is safe to be tested with patients. Its low weight does not influence gait
dynamics. The sensor precision outperforms the accuracy at the electrotactile interface. The developed sensor
fulfills, therefore, the requirements on mechanical load, weight and accuracy. It has already been successfully
tested in a clinical case study with three patients.
389
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Upper Limb, Poster Board 28
Abstract Number: 44
Abstract Title: Five Year Experience Fitting Partial Hand Prostheses Using Powered Fingers
Authors: J. Uellendahl
Presenter: J. Uellendahl
Introduction
Prosthetic management of partial hand amputation poses many challenges to prosthetists and other treating
professionals. With the commercial Introduction of individually powered fingers exciting possibilities for fitting
externally powered finger prostheses that can replicate various hand postures is now feasible.
Methods
Partial hand amputations have been challenging to fit with externally powered devices due to the limited space
available for prosthetic mechanisms. Presently there are 2 powered finger systems commercially available, iLimb
Digits (formerly ProDigits) by TouchBionics and Vincent Systems Powered Fingers. The author has considerable
experience fitting both system and both will be described in this presentation.
Results
Since 2008 the author has experience fitting over 50 partial hand prostheses using powered fingers. These
amputees can use powered finger prostheses well to improve their functional abilities. Both unilateral and bilateral
fittings have been accomplished for individuals with traumatic as well as congenital absences.
Discussion
Prosthetic Methods for optimizing hand function and appearance are being developed. With improvements in
technology it is necessary to consider how surgery can be used to optimize function and appearance of the hand
when fitted with a functional prosthesis. Partnering with surgeons and hand therapists is necessary to arrive at the
optimal outcome.
Conclusion
Powered finger prostheses have allowed individuals with partial hand absence to regain some of the dynamic and
conformable grasp functions they lost. With the many hand postures possible with individually powered fingers
comes the task of controlling these motions. In recent years much progress has been made in development of
real-time pattern recognition that can allow direct access to various grasp patterns. In this regard IMES also offer
interesting possibilities. Whatever control method is employed it should provide consistent and reliable control and
with experience use should become subconscious.
390
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Upper Limb, Poster Board 29
Abstract Number: 45
Abstract Title: Body-Powered Functional Partial Hand Prostheses Using The M-Finger System
Authors: J. Uellendahl, M. Mikosz
Presenter: J. Uellendahl
Introduction
Innovations in technology for partial hand patients have been limited until recently. Over the past few years the
prosthetic industry has seen a considerable improvement in advancing this area of technology. Partial hand
amputees now have more options than ever before, which allows for improved function and independence in
ADL's.
Methods
The M-Fingers were designed specifically for partial hand patients and can accommodate full or partial finger
amputations. M-Fingers use a cable actuated wrist driven design to flex the fingers. A multi-positional M-Thumb
that allows for manual positioning in rotation and flexion and extension is used when the thumb is amputated.
Partial M-Fingers use MCP flexion to drive PIP flexion. A custom carbon fiber frame imbedded in silicone is
fabricated to go over the patients remaining digits, which allows for independent finger motion for the partial finger
amputee. The control cables are attached on the dorsum of the hand via a silicone hand piece.
Results
The full M-Fingers will accommodate partial hand level amputees at the metacarpal-phalangeal to trans-metacarpal
levels. Two requirements for a successful outcome are adequate strength and leverage from the remaining limb.
Appropriate candidates have shown good functional grasp capabilities using the M-Finger systems. Partial
M-Fingers provide a functional extension of the remnant finger and have shown improved performance in grasping
large objects and precision grasp.
Discussion
Grip force is low due to the mechanical design, however due to the conformable grasp prehension is adequate in
many cases. Proper rehabilitation is essential in maximizing the user’s potential and overall functional outcome.
Pre-Prosthetic therapy includes maximizing wrist strength, range of motion and limb desensitization.
Conclusion
The M-Finger system has been demonstrated to allow restoration of some of the functional grasp lost by partial
hand amputees.
391
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Upper Limb, Poster Board 30
Abstract Number: 48
Abstract Title: A Completely Body Powered Active Prosthetic Mechanical Finger- A New Concept
Authors: H. Babariya
Presenter: H. Babariya
Introduction
To improve and restore the functions to the optimal level is the basic goal of any kind of hand prosthetics. Most
widely used silicone fingers fail to accurately mimic the characteristics exhibited by the human finger. A completely
body powered active prosthetic mechanical finger with a new concept is the perfect solution for partial/ full finger
amputee providing individual movements of all the fingers.
Method
In this mech. Finger, a central pulley connecting the PIP & DIP joints, provides simultaneous movements of these
joints. Another central pulley connects the wire configuration suspension and middle phalanx. So when the patient
flexes the MP joint, this central pulley is going to be stretched and flexes the PIP joint which indirectly flexes the
DIP joint simultaneously; providing complete flexion.
Results
This mechanical finger is a totally body powered, providing movements of the PIP & DIP joints with MP joint
simultaneously by the residual or adjacent finger as per the amputation level. It also provides a powerful grasp
with a natural bending pattern.
Discussion
In this new concept of the prosthetic mechanical finger, there are no side lever arms which are used as a lever for
the movements in older design available in the market. Instead it incorporates a central lever system and that why
it’s very easy to make a silicone cover with this mech. Finger.
Conclusion
With a new concept, this type of mechanical finger is the most effective management for partial/ full finger
amputee. It accommodates all kind of object shapes with a powerful grasp and natural bending pattern and most
cosmetically acceptable as compare to any else.
392
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
We have previously shown in healthy adults asymmetrical interlimb transfer of grasp orientation favouring
dominant hemisphere. In the present study, we investigate interlimb transfer process of force and grasp orientation
parameters in uperlimb amputees during rehabilitation phases.
Five adult men participate in a grasping task during which force and grasp orientation parameters are recorded
during two separated rehabilitation phases. The Results showed that, following wearing the prosthetic arm
between both rehabilitation phases, there are symmetrical transfer of force from dominant to non-dominant arm
and vis versa, however, asymmetrical transfer was found in grasp orientation transfer favouring only the dominant
arm/hemisphere.
These data showed dissociation between force and grasp orientation transfers and suggest that task parameters
can determine the nature of inter-hemispherical communications during interlimb transfer in amputees.
393
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Upper Limb, Poster Board 31
Abstract Number: 63
Abstract Title: Interlimb Transfer Of Unimanual Grasping Movement In Upper Limb Amputees (A Pilot Study)
Authors: N. Allami, L. Frossard, V. Frak
Presenter: L. Frossard
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Upper Limb, Poster Board 32
Abstract Number: 216
Abstract Title: Promas-6: A Modular Upper Limb Prosthesis For Shoulder Disarticulated Patients.
Authors: M. Troncossi, E. Gruppioni, M. Chiossi, C. Mazzotti, V. Parenti Castelli
Presenter: M. Troncossi
An upper limb prosthesis for amputees with high-level disarticulations is proposed as the result of a longstanding
collaboration between the INAIL Prosthesis Centre and the University of Bologna. The main novelty with respect
to commercial solutions is the presence of a powered shoulder articulation composed of three independent
mechanisms that, from the distal end, are: a 'humeral rotator' (J3) for the humeral intra-extra rotation, a 'flexor
mechanism' (J2) for the flexion/extension of the upper arm around a horizontal axis (for an upright posture of
the wearer), and an 'azimuth mechanism' (J1) that allows one to rotate the J2 axis around a vertical axis for the
selection of the elevation plane of the arm.
The current prototypes are the second generation for each mechanism and present improvements both from the
wearability (lightness, human size and appearance…) and functionality viewpoints with respect to the previously
proposed versions (and would be the core of the presentation at ISPO2013 along with the Results of experimental
tests). The INAIL elbow joint, a commercial prono-supination unit of the wrist, and different commercial solutions
for the terminal device complete the prosthetic system, which, as a whole, weights 3.3 kg and allows the patients
to manipulate 0.75 kg objects. The modularity of the system was conceived in order to fit amputees with different
requirements and characteristics with prosthetic solutions obtained from the same versatile technological basis.
The most significant combinations for the shoulder mechanisms, listed in a descending order of functional features
and increasing order of wearability characteristics, are: J1-J2-J3, J2-J3, J1-J2-Jp (Jp is a passive humeral rotator),
J2-Jp, J2, J3 (this solution being particularly interesting also for trans-humeral amputees). The current efforts of
the activity are focused on the definition of control strategies suitable to effectively control a prosthetic limb with
up to six actuated joints.
394
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Upper Limb, Poster Board 33
Abstract Number: 140
Abstract Title: Development Of A Lightweight, Low-Cost, Myoelectric Prosthesis
Authors: J. Sensinger, J. Lipsey, L. Sutton, A. Thomas
Presenter: J. Sensinger
Introduction
Most existing myoelectric prostheses are designed for the 50th percentile male. That means they are too large
and too heavy for 73% of people. The largest reason persons in the US reject the use of a prosthesis is the
uncomfortable weight of the device. We need small, lightweight, cosmetic devices that are inexpensive and still
strong and fast enough to be comparable to existing devices.
Methods
The Rehabilitation Institute of Chicago is advancing enabling technologies such as stronger lightweight motors
and transmissions. These new technologies have allowed us to develop a modular, low-cost, powerful upper-limb
prosthesis that is as small and as lightweight as a 25th percentile female arm. Such a design can be fit to 87% of
adults and more than half of adolescents.
Results
We have developed a modular, lightweight prosthesis that includes a 330g elbow, modular wrist flexion and wrist
rotation, and a hand that has powered thumb movement and wrap-around grasp. The entire design fits inside
a 25th percentile female shell, and is controlled by an advanced but inexpensive controller capable of patternrecognition, which provides intuitive control of the prosthesis.
Discussion
We will discuss the enabling technologies that allowed us to achieve these goals, our overall design, initial
responses from prosthetists and subjects, and our future direction as we make the prosthesis even lighter and
stronger before we launch a clinical trial.
Conclusion
We have developed a lightweight, inexpensive, myoelectric prosthesis that is small enough and affordable enough
to be used by a large portion of people across the world that are currently unable to use myoelectric devices.
395
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Upper Limb, Poster Board 34
Abstract Number: 141
Abstract Title: Voluntary-Opening / Voluntary-Closing Body-Powered Terminal Device Provides Cosmesis
And Function
Authors: J. Sensinger, S. Cohick, L. Sutton
Presenter: J. Sensinger
Introduction
There are two general types of body-powered prehensors. With voluntary-opening (VO) prehensors the user
pulls on their cable to open the device but can then relax and allow the prehensor to grasp an object using the
force supplied by rubber bands. VO devices are easy to use but the rubber bands provide a weak grasp force.
Voluntary-closing (VC) prehensors require the user to pull on the cable to close the device. They enable the user
to apply a large pinch force—as large as the user can generate, but are more difficult to use because continual
user-generated force is required to maintain any pinch force; if the user relaxes then they will drop any object they
are holding unless a locking mechanism is used.
Methods
We have developed an innovative, simple switching system that allows the user to easily switch between VO and
VC modes using a basic linkage. Thus the most useful features of VO and VC devices can be combined in a single
VO/VC device; one that is easy to operate in the VO mode for light duty, but that can provide high pinch force, in
the VC mode, when needed.
Results
Our VO/VC prehensor has a low weight of 130g—similar to the lightest adult split-hook (#5XA, 113g), and is the
same size as the Sierra 2-Load VO Hook. Our VO/VC prehensor provides a relatively linear gear ratio, has 100%
efficiency, and does not break under the largest forces a user can exert.
Discussion
VO/VC devices may allow prosthetic hands to become more functional in the near future, and are particularly well
suited for a developing world context, where both cosmesis and function are often required.
Conclusion
We have developed a simple, inexpensive VO/VC body-powered terminal device that combines the best of VO
and VC devices.
396
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Determining stimulus intensity is very important when using a sensory feedback system for people using electrical
hand prostheses. Vibrotactile sensory perception of the same stimulus level differs between people and is
influenced by physiological characteristics of the human skin, such as soft-tissue thickness, skin temperature,
gender, age, stimulation duration, body fat, and presence of glabrous or non-glabrous skin.
The study aimed to evaluate differences in surface electromyography (sEMG) signals according to skin density
during vibratory stimulation. This study involved 17 healthy participants. The mean age was 36.06 ¡¾ 9.48 years;
mean height, 1.65 ¡¾ 0.10 m; and mean weight, 63.38 ¡¾ 13.44 kg.
Before the experiment, we measured physiological characteristics such as vibration threshold and skin hardness
and thickness in the center of the 40% proximal part of the medial side of the right forearm. We measured sEMG
signals at the elbow at a point where a coin-type vibration sensor had been attached; the distance between the
sEMG electrode and vibration sensor was 1 cm. The vibration stimulus intensity was 10 levels at 37~285 Hz, and
both stimulus time and interval were 3 seconds. The sEMG signal increased with increase in vibration frequency;
the mean range was 2.1~7.3 ¥ìm. The skin density was greater and the vibration threshold was more sensitive
in women than in men (p < 0.05). The skin density was negatively correlated with the sEMG signal (r = -0.689).
However, skin thickness and threshold were not correlated with the sEMG signal. The skin density was higher in
cases where the sEMG signal was low.
Thus, vibrotactile sensory perception is influenced by skin hardness, and skin characteristics should be considered
when deciding the force level to be used for the sensory feedback system for people using electrical hand
prostheses.
397
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Upper Limb, Poster Board 35
Abstract Number: 211
Abstract Title: Correlation Analysis Between Skin Density And Semg For Sensory Feedback In Hand
Prostheses
Authors: Y. Chang, S. Kim, G. Kim, S. Kim, M. Mun
Presenter: Y. Chang
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Upper Limb, Poster Board 36
Abstract Number: 272
Abstract Title: Nanocomposites For Polycentric Knee Joint Used For The Above Knee Prosthesis
Authors: Arun. S, Daniel. V.M, G. Joshi, Kanagarj. S
Presenter: Arun. S
Human lower limbs have a highly articulated and very complex structure which is able to generate sophisticated
and versatile functional joint movements. The Above Knee (AK) amputation is a surgical interference that severs
the thigh segment between the knee and hip joints. Due to inherent limitations of the existing prosthesis in different
aspects such as terrains, weight and cost, an attempt is made to find the best possible design for the AK prosthesis
with a focus on Knee joint for low income group of the North-Eastern people of India.
The morphological analysis and AIDA techniques were followed to explore all possible solutions to determine
the best design of the different aspects to the people of the North-Eastern India. Where, polycentric knee joint
design is found to be superior to other types. The CAD design of a polycentric knee joint with required functional
considerations was drawn and the stress analysis of the knee joint made of high density polyethylene (HDPE) with
different concentration of multi walled carbon nanotubes (MWCNTs) was done.
It is observed that the nanocomposites were found to be a suitable material for the application of polycentric Knee
joint. An experimental study is also being carried out in order to confirm the above findings. It is concluded from the
above studies that polycentric knee joint made of HDPE/MWCNTs nanocomposite is suitable for the above knee
prosthesis with overall cost reduction of 44%.
398
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
F-Socket sensors have been used to measure dynamic socket interface pressure during the elbow flexion and
extension movements of transhumeral amputee. The objective is to investigate the discomforting effects to the
user when most pressure incurred at the socket interface. The printed circuit with a thickness of 0.18 mm is fitted
between the socket and the surface of the amputation level. Only one F-Socket sensor is needed to cover the
entire socket surface attached to the amputation level.
The average of 10 trials made on prosthetic users in elbow flexion and extension movements were recorded. The
pressure gradient shows that the circumference of the socket interface gives the most pressure distributions to the
amputees compared to the pressure gradient at the bottom of the socket interface. The improvement of socket
interface makes the amputees more comfortable in using the prosthetic hands.
399
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Upper Limb, Poster Board 37
Abstract Number: 323
Abstract Title: Effects On Pressure Distributions At The Socket Interface In Transhumeral Amputee During
Elbow Flexion And Extension Movements.
Authors: N. Abd Razak, N. Abu Osman, W. Wan Abas
Presenter: N. Abd Razak
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Prosthetics : Upper Limb, Poster Board 38
Abstract Number: 139
Abstract Title: Rehabilitation Of The Multiple Limb Amputee
Authors: M. Jacobs
Presenter: M. Jacobs
Aims and Objectives: This poster aims to provide an overview of the complex rehabilitation process of multiple limb
amputees who have attended Queen Mary’s Hospital, Roehampton. The patients referred to are all quadruple limb
amputees of varying levels. This poster is based on a case study initially presented to the College of Occupational
Therapists Specialist Section in Trauma and Orthopaedics (COTSSTO), study day in December 2012 but has
been amended for ISPO. The poster aims to address the need to prioritise and remain client centred when working
with patients of this level of complexity and highlights the need for a multidisciplinary, goal centred approach. The
poster references the use of the Canadian Occupational Performance Measure which can be used both as a client
centred goal setting tool and as an outcome measure.
Techniques or methods used: This poster highlights some of the commonly identified rehabilitation goals of these
patients, the prosthetic and non-prosthetic rehabilitation process, some simple and more complex solutions and
examples of their progress to date. The main focus will be upper limb rehabilitation and participation in activities
of daily living using a combination of compensatory strategies, prostheses, adaptive aids and bespoke devices.
Summary of the results: Some of the patients’ included in the poster are still undergoing rehabilitation however I
aim to demonstrate some of the achievements made to date by the patients and the team. Some examples include
driving a car, independent feeding, writing, walking, food preparation and participation in community outings.
Conclusions: This poster aims to highlight the importance of a goal orientated approach when working with the
multiple limb amputee. In addition the team (including the patient) need to acknowledge that this is a process of
trial and error and that we do not always get it right the first time. Therefore we need to remain flexible and creative
in order to find acceptable solutions to various difficulties whilst acknowledging that we do not have all the answers.
Finally it is concluded that this in-patient treatment at Queen Mary’s is the only the initial stage in a long process
of rehabilitation.
400
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Material and Methods
This study was muti-centered throughout Pakistan held in June, 2009. It included 72 patients (n=72) with ages
ranging from 11 to 17(14.25 ± 2.16) years. Male and female participants were at ratio 2:1 respectively. Right
hand amputees were two thirds of the total sample. The major cause of amputation was trauma (83.33%) and the
balance (16.67%) as congenital. The prosthetic non compliance was assessed by a self designed questionnaire;
based on literature review and approved by the ethical committee of Psychology department. Seven variables
i-e Body image, Depression, Anxiety, Social isolation, Sexual adjustments, Smoking or alcohol consumption
and Suicidal thoughts were analyzed according to patients’ responses. Pearsons’r was used to find relationship
between non compliance and psychosocial issues.
Results
It was noted that most of the patient’ compliance was less than 25%, just a few have shown compliance greater
than 30%. Finally Persons’r of mode of psychosocial issues compared to the use of prostheses wear was recorded
(0.81029). The value of persons’r clearly indicated that there was a decrease in prostheses wear with an increase
in psychosocial issues and as a result it supported our hypothesis.
Discussion
Because of small number of the UL adolescent amputees many studies concerted mainly on physical factors while
giving slight concern to psychosocial factors. In UL prosthetic technological achievements regarding materials and
Methods have been attained to recommend patients the opportunity of regaining greatly of the tasks vanished
because of amputation but the prospective of these technological advancements can only be successful by a
complete understanding of psychosocial intricacies relating to these amputees. While reviewing the prosthetics
rehabilitation during 1993 to 2001, there is not even a single article which measured the psychosocial aspects in
relation to UL amputees and prosthetic use. The majority of published articles were based closely on quantitative
style, thus mostly paid no attention to a qualitative methodology to offer chance for amputees to influence their
views and thoughts.
Conclusion
Amputees currently not wearing prostheses would reconsider using prostheses if psychosocial factors associated
with adolescent rejection are meticulously recorded to deal with the particular differences of rehabilitation
methodology.
401
POSTERS
Exhibition Hall: Posters 2 - Prosthetics : Upper Limb, Poster Board 38 A
Abstract Number: 534
Abstract Title: Psychosocial Issues Related To Non Compliance Of Upper Limb Prosthese In Adolescent
Transradial Amputees
Authors: N. Akhtar
Presenter: N. Akhtar
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Quality Of Life Issues, Poster Board 39
Abstract Number: 15
Abstract Title: Land Mine Survivors And Their Physical Rehabilitation In Pakistan Administrated Kashmir.
Authors: Z. Mirza
Presenter: Z. Mirza
Introduction
The number of land mine survivors is more in border areas and refugee camps of Pakistan administrated Kashmir
(PaK). The survivors do not have enough opportunities for physical rehabilitation because of less physical
rehabilitation centres in the region and being far from the centres. Every 9 of 10 casualties are civilian because
land mines travel from LOC to near by villages through land sliding, snow sliding and earthquake etc.
Methods
Not enough data is available in Pakistan or PaK regarding land mine survivors. Literature has been reviewed and
average number of survivors came to Physical Rehabilitation Centres of PaK have been taken as a reference to
evaluate the number of land mine survivors present in the region, rehabilitation services available to them and
efforts made to aware them of land mines.
Results
Out of all 3.5 % disables of the region 0.25 % are refuggee land mine survivors and 0.8 % are permanent resident
survivors from border areas. Most of the patients are from Muzaffarabad and Bagh district mostly male of age
40-60. Above 70 % of survivors are male of more then 40 years in age which shows that the active people are
affected more.
Discussion
Most of the survivors got amputated in the time period of 1992-2003 because in 1992 it was flood in Kashmir which
can be a cause of moving land mines from border to populated area and also in this time period the tension was
more on border.
Conclusion
Mine blast is one of the main causes of amputation in the region. People get in contact with mine while working in
their fields or grazing their animals. Not enough opportunities are available for survivors for physical rehabilitation
and not enough work is done to make them aware of mines.
402
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
POSTERS
Exhibition Hall: Posters 2 - Quality Of Life Issues, Poster Board 40
Abstract Number: 51
Abstract Title: Patient Satisfaction In Acute Amputee Rehabilitation
Authors: K. Primett
Presenter: K. Primett
Introduction
Evidence suggests that more satisfied patients continue using health services; have improved compliance;
maintain better relationship with care providers and recommend services to others. This study aims to evaluate
and analyse current Methods of obtaining patient satisfaction and explore strategies to implement future quality
improvement initiatives in line with current government Objectives.
Methods
Feedback from 39 primary amputee inpatients was obtained using a bespoke patient satisfaction questionnaire
(PSQ). The PSQ was designed by a specialist steering group consisting of physiotherapists, occupational
therapist, psychologist, and clinical nurse specialists. The PSQ combined 21, positively phrased, open and closed
questions relating to rehabilitation, discharge, ward experience, and information received. Following a pilot study,
the finalised PSQ’s were distributed and collected before discharge. Reponses from 2010 and 2011 were collated
and analysed.
Results
39/84 (46%) primary amputees returned completed questionnaires. Non returns were attributed to patient death
(n= 3/51, 2010; n=4/33, 2011), refusal (n = 6/51, 2010; n= 3/33, 2011) and discharge pre PSQ dissemination (n =
20/51, 2010; n= 9/33, 2011). In 2010 and 2011 38% of the total responses were recorded as ‘Strongly Agree’. In
2010 only 7.14% responded ‘Strongly Disagree’ compared with 5% in 2011. Positive feedback was obtained from
questions relating to nursing care, physiotherapy input and goal setting. Negative feedback was related to pre
operative information and counselling accessibility.
Discussion
Consistently positive feedback was received from the majority of responses obtained. However, strategies
to improved questionnaire validity, reliability, reduce bias and increase response rates can be identified. In
accordance with government initiatives future development strategies will focus on converting the PSQ to Patient
Experience Questionnaire (PEQ).
Conclusion
With an increased proportion of provider income being related to patient experience collation of accurate patient
experience data is essential to maintaining a high quality efficient service and attracting future commissioning.
403
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Quality Of Life Issues, Poster Board 41
Abstract Number: 167
Abstract Title: The Use Of Cognitive Interviews To Evaluate Item Content In A Prosthetic Mobility Outcome
Measure
Authors: S. Morgan, D. Abrahamson, R. Gailey, D. Amtmann, B. Hafner
Presenter: D. Amtmann
Introduction
Patient-reported outcomes (PROs) help clinicians and researchers understand how health conditions impact
patients’ lives. When developing PRO questionnaires, it is critical to examine the cognitive processes that
participants use to respond to each item to ensure that the responses provide meaningful information. Cognitive
interviews may be used to assess these processes and to examine if questions are perceived similarly across
participants. The primary aim of this study was to inform the development of an item bank to measure mobility in
persons with lower-limb amputation through use of cognitive interviews with prosthetic users.
Methods
Thirty-seven cognitive interviews were conducted with 31 participants who have lower-limb amputation(s) and
use prostheses. Each participant responded to up to 30 items from the Prosthetic Limb Users Survey - Mobility
(PLUS-M) candidate item set. Subsets were selected to include items of varying content and difficulty. Each
candidate item was reviewed by a minimum of five participants who differed in self-reported mobility, literacy, level
of amputation, and time since amputation. Items were revised based on participant feedback. Any items that were
substantially revised were re-evaluated through additional cognitive interviews.
Results
Feedback from cognitive interviews identified areas for item improvement with respect to clarity, content, and
reading level. Participant responses to follow-up questions informed modification of 112 out of a total 153 questions
that did not function as intended. These items were revised (42%) or deleted (31%).
Discussion
Cognitive interviews were used to assess the content validity of a candidate item set, identify problematic items,
and revise and/or eliminate those items. This process reduced potential response error associated with confusing
questions and considerably enhanced the quality of the items in the final item bank.
Conclusion
Cognitive interviews were an essential step in the development of a candidate item bank for measuring mobility.
404
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
POSTERS
Exhibition Hall: Posters 2 - Quality Of Life Issues, Poster Board 42
Abstract Number: 345
Abstract Title: Ortho-Prosthesis In Phocomelia
Authors: P. Sidhu
Presenter: P. Sidhu
Introduction
The emergence of Thalidomide related limb deficiencies acted as a spur to the development of new prosthetic
limb technologies in 1960s (N. Bent 2007). Ortho-Prosthesis is a synthetic alternative for missing or deformed
limbs. With the development high-tech components for upper or lower-limb prostheses, we, as clinicians, have
been finding more constructive and functional uses for congenital phocomelic and digital appendages. In previous
years their potential value often was not appreciated. They were considered useless, and the digits or deformed
limbs often were surgically removed for cosmesis or for reasons of prosthetic fit. Their possible growth and function
were not considered.
Methods
Cases were referred to the Rehabilitation Centre, for clinical assessment of their multiple malformation complex and
informed consent was obtained followed by a thorough check and identification of the patient’s existing limbs. After
fitment, an evaluation questionnaire was developed in conjunction with the Clinical Governance at Rehabilitation
Centre, related to elicit general back ground. Two sections were based upon Likert Scales (Oppenhiem 1992).
Results
From these Results it was clear that no patients reported problems with cosmetic appearance & functionality of the
ortho-prosthesis. 75% scored for effectiveness, more than 70% for appearance of appliances & more than 80%
for comfort level.
Discussion
Prosthetic restoration for lower limbs can be considered when the upper limbs are present (Richard A. Sullivan).
Conclusion
The major decision making arises where more complicated limb deficiencies exist. Each of these patients must
be considered independently. Function must always be given more importance over cosmesis. In the very young
child, every effort should be made to preserve all epiphyses for future growth and to save any available major joint;
each decision must be made with consideration of the other limbs and rest body. 405
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Quality Of Life Issues, Poster Board 43
Abstract Number: 332
Abstract Title: Quality Of Life And Functionality After Lower Limb Amputations: Comparison Between
Unilateral Versus Bilateral Amputee Patients
Authors: S. Akarsu, L. Tekin, I. Safaz, S. Göktepe, K. Yazicioglu, K. Tan
Presenter: K. Yazicioglu
Study Design: Cross-sectional study.
Background
it is difficult for the lower limb amputee patients to get adopted to their new lifestyles. Objective: To compare the life
quality and functionality of patients with bilateral vs unilateral lower extremity amputations.
Methods
Fifteen bilateral and 15 unilateral lower extremity amputee patients were enrolled. Demographics, cause and level
of amputations, frequency and duration of prosthesis use were evaluated. SF-36, Satisfaction with Prosthesis
Questionnaire (SAT-PRO), Amputee Body Image Scale (ABIS), Houghton Scale (HS), 6 minutes walking test
(6MWT), and 10 metres walking test (10 MWT) were performed.
Results
Physical function, physical and emotional role scores of SF-36 were significantly lower in the bilateral amputee
group in comparison with the unilateral group. SAT-PRO and ABIS total scores were similar between the groups.
There was a positive correlation between the frequency of prosthetic use and SF-36 subgroups (except pain).
Unilateral amputee group had significantly better scores than bilateral amputee group in terms of HS, 6MWT and
10 MWT.
Conclusion
In the light of our Results, we imply that physical capacity of bilateral lower extremity amputee patients is lower
than the unilateral amputee patients, that satisfaction with prosthesis and body image are not related with the
amputation level and that the life quality and satisfaction with prostheses are increased in parallel with the use of
prostheses. Key words: Lower extremity amputation, quality of life, prosthesis satisfaction, body image
406
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
The aim of this study was to compare the functionality during daily activities and quality of life of patients with
transtibial amputation vs. salvage surgery after severe lower limb trauma.
Ten patients with unilateral below knee amputation and nine patients with salvage surgery after severe lower
limb trauma were enrolled. Functional Ambulation Scale (FAS), Visual Analogue Scale (VAS), Short Form 36 (SF36) Energy Expenditure Index (EEI), 6-Minute Walking Test (6MWT) and 10-Meter Walking Test (10MWT) were
used for the evaluation of subjects. Patients in the salvage group were also evaluated radiologically with Graves’
radiological assessment method and Freiburg ankle scoring system. All patients were classi 64257;ed as grade
5 according to FAS.
All SF-36 subgroup values were higher in the amputation group whereas only those of general health and vitality
reached statistical signi 64257;cance (p50.05). The visual analogue scale (VAS) has been used to assess the e
64259;cacy of pain management. Mean VAS scores were found to be statistically higher in the salvage group
(p50.005). Reoperation rates were one in 10 amputee and six in nine salvage patients. Mean Freiburg ankle
scores of the patients in the salvage group were 55.33+15.51 which was consistent with moderate functionality.
According to Graves’ radiological assessment; four patients had grade 3 degeneration, four had grade 2 and
one had grade 1 degeneration in the ankle joints. Mean EEI values, 6-MWT and 10-MWT Results were not signi
64257;cantly di 64256;erent between the groups (p values40.05).
Although amputation still remains as the last resort both for patients and the physicians, our Results demonstrated
that reoperation rates, quality of life (general health and vitality) and pain scores were better in amputee patients.
407
POSTERS
Exhibition Hall: Posters 2 - Quality Of Life Issues, Poster Board 44
Abstract Number: 333
Abstract Title: Comparison Of Quality Of Life And Functionity In Patients With Traumatic Unilateral Below
Knee Amputation And Salvage Surgery
Authors: L. Tekin, I. Safaz, S. Goktepe, K. Yazicioglu, K. Tan
Presenter: K. Yazicioglu
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Quality Of Life Issues, Poster Board 45
Abstract Number: 505
Abstract Title: Psychosocial Experiences With A Prosthesis: Perspectives From The User
Authors: P. Jefferies, P. Gallagher, M. Maclachlan, M. Philbin
Presenter: P. Gallagher
Prosthetic technology has developed significantly in recent years, enabling increasingly dynamic function and
improved realism of the artificial limb. However, relatively little is known about the experiences of individuals with
amputations that make use of these modern prostheses. In addition, there is a growing focus in the research
literature concerning prosthesis outcomes and the importance of defining ‘success’.
This research is seeking to understand how prosthesis users adjust to, live with and make the most of the artificial
limbs that have become available in recent years. A qualitative approach was undertaken, employing a Grounded
Theory design in order to explore the main concerns of prosthesis users from their perspective, to identify patterns
in the data, and to account for variability in these patterns. This study focuses on the data emerging from fifteen
in-depth interviews with participants that have been using a prosthesis for a minimum of three months. Data from
relevant internet sites have also been incorporated into the study.
Emerging themes include: (1) Adjusting to the new prosthesis: Points of Discussion will include discovering issues
in initial usage, managing discomfort, and seeking sources of relevant information. (2) The importance of the
client-prosthetist relationship. This will include a Discussion of the subtleties involved in the complex relationship
between the user and the professional, and management of necessary physical adjustments. (3) Managing first
impressions: This pertains to the social situation where individuals are required to reveal the prosthesis to others,
including the extent of control of the situation enabled by the prosthesis, coping styles employed by the individual,
and the impact of the design choice on behaviour.
This research highlights the benefits and challenges of living with prostheses. More specifically it provides an
interesting context within which to explore how people integrate or interact with technology which will inform
rehabilitation efforts.
408
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Introduction
The functional Results of Single Event Multilevel Surgery (SEMLS) for Cerebral Palsy (CP) are closely dependent
on the quality of post-surgical rehabilitation. This study was conducted to find out the prevalence and types of
complications encountered during rehabilitation following SEMLS.
Methods
463 subjects diagnosed with CP participated in this prevalence study. The distribution of patients were Spastic
Diplegia (59%), Spastic Quadriplegia (33%), Spastic Athetoid Quadriplegia (6%) and Spastic Hemiplegia (4%).
The present study analysed the complications during post-surgical rehabilitation following SEMLS during a period
of 12 years (2000-2012). The mean age at the time of surgery was 8±4 years. All 463 children underwent SEMLS
followed by a post- operative plaster immobilization period which varied between 2 weeks (upper limbs) to 6-10
weeks (lower limbs) and was followed by physical therapy for at least 6 months.
Results
The complications were Myofascial Pain Syndrome (32.60%), Prolonged Articular Stiffness beyond 4 weeks
(24.23%), Patellofemoral Pain Syndrome ( 8.13%), Osteopenia (7.88%), Meralgia Paresthetica (5.69%), Pressure
Ulcers (4.10%), Hypertrophic Scar (3.94%), Low Energy Fractures (4.06%), Superficial Pin Tract Infection (2.56%),
Wound Dehiscence (1.92%), Patellar Tendinitis (1.71% ), Myositis Ossificans (1.51%), Complex Regional Pain
Syndrome (1.07%), Rickets (0.6%), Osteomyelitis (0.43%), Transient Common Peroneal Nerve Palsy (0.43%),
Transient Axillary Nerve Palsy (0.43%), Skin Hypersensitivity (0.21%), and IT Band Friction Syndrome (0.21%).
There was a significant association between the anatomical distribution of abnormality and osteopenia ( 967;2 –
8.01, p<0.05).
Discussion
A preoperative GMFCS level IV and V was associated with a higher prevalence of complications like Osteopenia,
Low Energy Fractures and Myositis Ossificans. However, none of the complications were life threatening,
permanent or affecting the long term outcome of surgery.
Conclusion
To minimise the rate of complications we recommend a structured rehabilitation protocol carried out by an
experienced multidisciplinary medical team.
409
POSTERS
Exhibition Hall: Posters 2 - Rehab Medicine & Surgery, Poster Board 46
Abstract Number: 404
Abstract Title: Complications During Post-Surgical Rehabilitation Following Single Event Multilevel Surgery
In Cerebral Palsy.
Authors: D. Sharan, A. Sasidharan, R. Ranganathan
Presenter: D. Sharan
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Rehab Medicine & Surgery, Poster Board 47
Abstract Number: 373
Abstract Title: Bone Anchored Transhumeral Prosthesis - A Case Study
Authors: S. Sooriakumaran
Presenter: S. Sooriakumaran
Introduction
Limited tolerance of conventional socket and suspension are known to compromise rehabilitation outcome in
transhumeral amputation. Bone anchored prosthesis was used to achieve better tolerance and functional outcome
in a patient with traumatic amputation of his dominant arm.
Method
A 56 years old mechanic underwent transhumeral amputation following an unsalvageable injury in 2003. His
residual limb was of optimal length and power. He was initially fitted with a working prosthesis. He found the socket
limiting abduction. Limited improvement was achieved with Iceross self-suspension. The prosthesis was fitted with
hand-operated elbow and spilt hook and cosmetic hand. Due to continued frustration with harness and socket he
underwent assessment and was found suitable for bone anchored prosthesis. In 2004 application for funding was
approved. He had the stage I surgery in March 2005 and stage II in August 2005. He was initially fitted with short
training prosthesis based on modified Swedish protocol.
Results
The definitive prosthesis has been fitted with Otto Bock dynamic powered elbow and Greiffer. Mr SE has achieved
full time use and appreciated freedom of shoulder ROM. He has had 4 episodes of superficial sepsis at the
abutment site treated successfully. Mr SE has achieved full time successful prosthetic use for personal care, ADL,
driving and work with no significant complications.
Discussion
Functional prosthetic outcome in transhumeral level amputation is known to be poor. Often patients abandon
prostheses due to the discomfort with socket and find the suspension quite cumbersome to tolerate. Bone
anchorage of prosthesis using the technique of osseointegration has now become an established method to
overcome socket related problems.
Conclusion
In selected patients bone anchored prosthesis offers a viable means of prosthetic attachment and suspension.
410
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
POSTERS
Exhibition Hall: Posters 2 - Rehab Medicine & Surgery, Poster Board 48
Abstract Number: 504
Abstract Title: Use Of Lokomat In Spinal Cord Injuy (Sci)
Authors: D. Van Kuppevelt, I. Van Nes, H. Rijken
Presenter: D. Van Kuppevelt
Body Weight Supported Training (BWST) has an increasing interest in the field of rehabilitation medicine.. Gait
training in SCI: Besides the neurological level and the ASIA impairment scale classification, other factors are
important for the possibility to walk There is a difference starting training early after onset of injury or starting late.
Training Principles: BWST is an individual training which allows the patient to experience locomotion and exercise
with it on his own level of possibilities. The patient is always exercising on the border of his own possibilities. There
is a difference of BWST over ground and BWST (treadmill)T. The last one is possible with and without robotics.
BWSTT: In a former studies we concluded that BWSTT is an additional tool in gait training in people with incomplete
spinal cord injury. However experience in BWSTT and insight from the physical therapist with respect to relearning
of gait, in combination with an adequate training equipment, are required to achieve maximum effect. The Results
of BWSTT in SCI show some evidence for improved gait, balance, speed and endurance, changes in central
nervous system and improved cardiovascular fitness. Individual studies claim more success than systematic
reviews shows. Robotics / Lokomat: Goal of rehabilitation robotic devices should be to facilitate therapists in
performing activities and exercises that give the best change of recovery. There are several advantages of robotic
rehabilitation over traditional therapy. To achieve maximum Results, BWSTT or robotic gait training should be
given in combination with conventional gait training.
Results
To achieve maximum functional Results, BWSTT or robotic gait training should always be combined with
conventional gait training. To get insight of de development of the individual, measurement of walking performance
should be made. These measurements can be helpful in case of motivation for training or acceptation problems
of the functional level.
411
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Rehab Medicine & Surgery, Poster Board 49
Abstract Number: 516
Abstract Title: Lower Limb Amputations: Surgical Techniques In Light Of Prosthetic Considerations
Authors: S. Chittoor
Presenter: S. Chittoor
While some kind of prosthesis can be fitted to any stump, perfect prosthetic outcome requires a perfect stump. An
ideal stump is the one in which the disease has been removed, the wound heals well and the stump is compatible
for prosthetic fitting. While most surgeons are able to achieve the first two criteria, some do falter when it comes to
producing a residuum that allows the best prosthetic fitting and functional outcome.
This is primarily due to poor understanding of the prosthetic principles. Important considerations are the length,
shape, skin and tissue handling, bone section, myoplasty and myodesis, handling the neurovascular structures,
post-operative and pre-prosthetic care, and avoiding and managing complications. The ideal length should provide
adequate leverage while allowing fitment of the most-suited prosthetic components. e.g., fitment of higher activity
components is possible only with endoskeletal design; that is not possible with a very long transtibial amputation.
The shape should be cylindrical, not conical as most often followed. Of the various skin flaps, a skew flap or a
well performed posterior flap are most suitable. Good handling of muscles ensures maintenance of their bulk and
retains control of the stump. Post-op care is very vital in determining the psychological and functional outcome.
The author is a prosthetic surgeon in the Indian Armed Forces, working at the largest organised limb centre
in India. He will elaborate on the above mentioned considerations along with guidelines for specific levels of
amputations (Mainly ankle and knee disartic, and Transtibial and Transfemoral amputations). The presentation
may be split into general principles and level-specific presentations to allow for a more elaborate Discussion.
412
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
POSTERS
Exhibition Hall: Posters 2 - Rehab Medicine & Surgery, Poster Board 50
Abstract Number: 517
Abstract Title: Upper Limb Amputations - Surgical Techniques In Light Of Prosthetic Considerations
Authors: S. Chittoor
Presenter: S. Chittoor
'Hand is the most individual and personal part of the human being' - Sandra L. Hubbard Winkler, PhD. The human
hand is a milestone in evolution being an organ with the most sophisticated structure, controls, versatile functions
and uses. Its loss naturally imposes a severe restriction on the amputee. This loss is compounded by the fact that
no single prosthesis can restore even a fraction of the immense features of the hand. Fortunately such losses are
seen less often as compared to the lower limbs.
However when the amputation is inevitable it is important for the surgeon to keep in mind the prosthetic options
available and the maximal feasible functional abilities with such prostheses. Also as upper-limb amputations are
less frequently seen, many surgeons may have little or no experience in managing potential amputations. Important
considerations are the length, shape, skin and tissue handling, bone section, myoplasty and myodesis, handling
the neurovascular structures, post-operative and pre-prosthetic care, and avoiding and managing complications.
The author is a prosthetic surgeon in the Indian Armed Forces, working at the largest organised limb centre
in India. He will elaborate on the above mentioned considerations along with guidelines for specific levels of
amputations. The presentation may be split into general principles and level-specific presentations to allow for a
more elaborate Discussion.
413
POSTERS
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Exhibition Hall: Posters 2 - Seating & WC, Poster Board 51
Abstract Number: 122
Abstract Title: Design Of The Whirlwind Rough Rider Wheelchair
Authors: E. Iversen, R. Hotchkiss
Presenter: E. Iversen
This paper discusses and documents some of the important design decisions and tradeoffs made by Whirlwind
International director Ralf Hotchkiss and his numerous collaborators over the last 35 years in designing the Rough
Rider Wheelchair (RR).
No wheelchair can meet the needs of all individuals. With the RR, Ralf and Whirlwind have sought to meet the
needs of the largest group of individuals in less-resourced areas. These individuals need a dependable, locally
repairable, manual wheelchair for use indoors and out, on both smooth and uneven terrain. Furthermore, many
need a chair that can be folded for easy transport. The RR is not for individuals who need a wheelchair only
indoors on smooth surfaces, those who need highly specialized seating, those who use a wheelchair primarily on
very rough terrain, or those who travel very long distances (whose needs are better served by chairs powered by
hand pedals or levers). However, with minor modifications the RR can be made appropriate for those with some
specialized seating needs.
Anyone who has been involved in design knows that the process is quite often a series of very difficult tradeoffs. It is
hard to prioritize all of the design decisions that have gone into the RR. However, one of the most important design
considerations is cost. The needs of disabled individuals in less-resource countries far exceed the resources,
which currently often come from donations.
Furthermore, there isn’t a wheelchair rider in the world who wouldn’t want a wheelchair that is as light as possible.
The problem is, the weight of a wheelchair trades off directly with cost, strength, durability, adjustability, portability,
and reparability. This paper will discuss these issues and other issues and why the RR's features and specifications
have been chosen.
414
Feb 6 (14:00 - 14:30, 15:45 - 16:15, 17:30 - 18:00)
Feb 7 (14:00 - 14:30, 15:45 - 16:15)
Prosthetic users are among the highest profile athletes competing at the Paralympic Games. Despite this there
is a lack of evidence relating to the most appropriate provision Methods of sports prostheses. Competitors from
different countries access a range of sports by a variety of means. Athletes are funded differently and use a
plethora of prosthetic components and socket designs. If competitors are not competing on the same terms,
arguably some may be disadvantaged during competitive events.
The aim of this research was to conduct a survey to facilitate data collection of sporting prosthetic demographics
and provision to allow comparison within and between competing nations. The survey provides a useful indication of
competitor numbers in each classification of event across all sports and examine current trends across recruitment
into specific disciplines with prosthesis user classes. The study provides a unique opportunity to benchmark
current sports prostheses provision for international athletes, including the design and performance specifications.
Results will be used to develop hypotheses for studies at future sporting events. An abstract and inclusion criteria
has been included for potential participants via the ‘London Paralympic Games online-research website’ with
links to the online questionnaire. All athletes with limb absence are included in the survey regardless of whether
the prosthesis is used in the sporting event or not. The survey will be accessible via electronic software one
month prior to and two weeks after the Games and available in 8 different languages. The survey aims to answer
questions in four broad themes: Demographics; Prosthetic design Pathway to competitive sport Motivations and
barriers to competition
Ethical approval has been obtained. Results will reflect international variations in the funding pathways available
to athletes for sports prosthesis provision, whether there is an integrated approach for national teams, or if barriers
exist in some areas.
415
POSTERS
Exhibition Hall: Posters 2 - Sports And Physical Activity, Poster Board 52
Abstract Number: 347
Abstract Title: An International Comparison Of Sporting Prosthetic Users At The London 2012 Paralympic
Games
Authors: A. Mcgarry, A. Mcfadyen, K. Murray, J. Head
Presenter: A. McGarry
416
POSTERS
POSTERS
INSTRUCTIONAL COURSES
417
INSTRUCTIONAL COURSE
Mon, Feb 4 / 12:00 - 13.15
Education / Room G.02 & G.03
Chair
ICS Code 3 - Advancing O&P Education in Emerging Economies
exemplified by Latin America
Dan Blocka
Page No.
421
Prosthetics : Upper Limb / Room 1.01 & 1.02
ICS Code 7 - Evaluation of interventions for individuals with upper limb Liselotte
amputation or reduction deficiency present at birth – implementation of Hermansson
outcome measures in clinical practice
422
Mon, Feb 4 / 14:30 - 15.45
Education / Room G.04 & G.05
ICS Code 28 - Essential Physiotherapy – what all Prosthetists should
know
Carolyn Hirons
423
Venu Kavarthapu
424
Jose Miguel
Gomez
425
Siegmar
Blumentritt
426
Karl-Heinz Schott
427
Sun Hae Jang
428
Y.C. Law
429
Rehab Medicine & Surgery / Room 1.01 & 1.02
ICS Code 60 How to prevent amputation in severe diabetic foot
deformities?
Mon, Feb 4 / 16:15 - 17.30
Orthotics : Spinal / Room 1.01 & 1.02
ICS Code 58 - Alignment, balance and stability: The Key for Orthotic
Treatment of Spine Deformities
Prosthetics : Lower Limb / Hall-3
ICS Code 14 - Prosthetic alignment: Biomechanical basics and clinical
approach for lower limb prostheses
Tuesday, Feb 5 / 9:00-10:15
Pedorthics - Footwear / Room 1.01 & 1.02
ICS Code 56 - Pedorthic Footcare Orthopaedic Shoe Technique
International
Tuesday, Feb 5 / 14:30-15:45
Orthotics : Spinal / Room G.02 & G.03
ICS Code 39 - A key biomechanical corrective principle based on the
specific goals and techniques used in a Gillette custom molded TLSO
for idiopathic scoliosis
Orthotics: Lower Limb / Hall-3
ICS Code 11 - Biomechanics of medial compartment knee
osteoarthritis: Implications for orthotic treatment
418
Tuesday, Feb 5 / 16:15-17:30
Chair
Page No.
ICS Code 57 - Biomechanical aspect of idiopathic scoliosis and
Orthotic management
Tarit Kumar Datta
430
Kenton Kaufman
431
C.H. Emmelot
432
Orthotics: Lower Limb / Room G.02 & G.03
ICS Code 34 - Stance Control Orthotics
Rehab Medicine & Surgery / Hall-3
ICS Code 2 - The postoperative management after transtibial
amputation
Wednesday, Feb 6 / 09:00-10:15
Education / Room G.04 & G.05
ICS Code 38 - ISPO Accredited Distance Learning Blended Prosthetic
and Orthotic Education E-Learning - A Solution for the World"
Christian Schlierf
433
A.C.H. Geurts
434
Rehab Medicine & Surgery / Hall-3
ICS Code 12 - Neuroprosthesis for drop foot in upper motor neuron
syndrome
Wednesday, Feb 6 / 14:30-15:45
Rehab Medicine & Surgery / Hall-3
ICS Code 27- Reduced walking distance: does AFO treatment
benefit? Practical application of clinical energy cost and fitness
assessments in children with cerebral palsy
Jules Becher
435
Wednesday, Feb 6 / 16:15-17:30
Orthotics: Lower Limb / Room G.04 & G.05
ICS Code 55 - Orthotics for Clubfoot
Alaric Aroojis
436
Saffran Moeller
437
Maria Grazia
Benedetti
438
Sarah A. Curran
439
Ashok Johari
440
O. B. Idusuyi
441
Prosthetics : Lower Limb / Hall-3
ICS Code 13 - Microprocessor knees, How to maximize functional
ability
Rehab Medicine & Surgery / Room G.02 & G.03
ICS Code 32 - Rehabilitative and prosthetic approach to patients with
amputation for lower limb musculoskeletal tumors
Thursday, Feb 7 / 9:00 - 10:15
Education / Hall-3
ICS Code 54 - How to Write an Article
Paediatrics / Room G.02 & G.03
ICS Code 44 - Advanced Dynamic Orthotic Management for the Child
with Cerebral Palsy
Rehab Medicine & Surgery / Room G.06
ICS 61 - Treatment Options for Charcot Arthropathy (Standby)
419
INSTRUCTIONAL COURSE
Orthotics : Spinal / Room G.04 & G.05
INSTRUCTIONAL COURSE
Thursday, Feb 7 / 12:00 - 13:15
Education / Room G.02 & G.03
Chair
Page No.
ICS Code 26 - Developing Prosthetic and Orthotic Case Studies Using
Applied Biomechanics in Less Resourced Settings for Demonstrating
Clinical Outcomes
Gordon Ruder
442
Stefania Fatone
443
ICS Code 50 - Advances in Functional Rehabilitation of Cerebral Palsy Deepak Sharan
444
Prosthetics : Lower Limb / Room 1.01 & 1.02
ICS Code 15 - Subischial Sockets with Vacuum Assisted Suspension
for Persons with Transfemoral Amputation
Rehab Medicine & Surgery / Hall-3
Thursday, Feb 7 / 14:30 - 15:45
Developing Countries / Room G.02 & G.03
ICS Code 30 - Jaipur Limb Technology
M.K. Mathur
445
T. Ingvarsson
446
Andreas Samson
447
Orthotics: Lower Limb / Hall-3
ICS Code 48 - Osteoarthritis creates a heavy disease burden
Prosthetics : Lower Limb / Room G.04 & G.05
ICS Code 1 - Biomechanical and functional principles of transfemoral
socket designs
420
Monday, Feb 4, 12:00-13:15
Chair: Dan Blocka
Presenters: Berit Hamer, Carlos Zelaya, German Antonio Mendieta, Wilson Zampini
Objective
Provide best practice experiences for advancing O&P programmes in emerging economies
Course content
o The need to include modern differentiated fitting concepts and technologies in O&P programmes
o Challenges in health care with regards to assistive devices in Latin America: differentiated fitting vs.
reimbursement situation
o The Otto Bock approach of a Public Private Partnership to support O&P education in LA
o Example Don Bosco University, El Salvador: Curriculum development and train the trainer approaches
o Example SENA, Columbia: Approaches to create sustainability in an O&P programme
o Experiences and lessons learned in providing training support for O&P programmes in emerging markets
Benefits to Attendees
The Attendees learn which aspects have to be considered in advancing O&P programmes according to International
standards and learn to know experiences and best practices which can be transferred to other schools in emerging
economies
Intended Level of Audience
Directors of O&P study programmes and education institutions, O&P decision makers in health care, O&P teachers
Currently we are observing a gap in the level of O&P programmes in emerging economies compared to developed
economies. Modern differentiated fitting standards and technologies are often not part of the curricula – partly
due to the health care and reimbursement situation partly due to lacking professional infrastructures, resources
and knowledge. The Instructional course should help to raise the awareness of decision makers and education
providers in O&P for the need to advance the level of O&P programmes and demonstrate concrete approaches.
421
INSTRUCTIONAL COURSE
Congress Topic: Education
Session Title: ICS Code 3 - Advancing O&P Education in Emerging Economies exemplified by Latin America
Room: G.02 & G.03
INSTRUCTIONAL COURSE
Monday, Feb 4, 12:00-13:15
Congress Topic: Prosthetics : Upper Limb
Session Title: ICS Code 7 - Evaluation Of Interventions For Individuals With Upper Limb Amputation Or
Reduction Deficiency Present At Birth – Implementation Of Outcome Measures In Clinical Practice
Room: 1.01 & 1.02
Chair: Liselotte Hermansson
Presenters: Anita Stockselius, Christina Ragnöe, Helen Lindner, Liselotte Hermansson
Objective
To guide practitioners how to choose and use outcome measures in every day practice and in research.
Course content
A structured method based on the International Classification of Functioning, Disability and Health (ICF) [1]to use
outcome measures in both adult and children’s clinic will be presented. Different methods validated to evaluate
the consequences of upper limb amputation or reduction deficiency will be demonstrated. Oral presentations and
videos will be used. Cases will be used to initiate discussions among the attendees.
Benefits to Attendees
Hands on advice how to select a suitable method for different purposes will be provided. Participants will get
introduction to methods that are readily available for use and also information about other methods that need
further training before they can be used.
Intended Level of Audience
The course is intended for beginning practitioner and experienced clinician about to specialize in upper limb
prosthetics.
Improvements of surgical techniques and prosthetic devices offer increased possibilities for rehabilitation of
individuals with upper limb deficiency or amputation. In order to justify the increased costs this brings, health care
professionals need evidence to support their choice of intervention. Furthermore, professionals need structured
methods to evaluate the need for the individual interventions that are required. Same as in other rehabilitation
areas [2], the use of structured outcome measures in rehabilitation of people with upper limb amputation is still
not common in everyday practice. We believe that this can be changed when practitioners learn some of these
new methods.
Hence, there are two reasons for using validated outcome measures in rehabilitation. The first, most obvious to
clinicians, is to guide the choice of intervention. What is the patients’ need? Is it, for example, a simple assistive
device to help in performing a specific task, or, is there a need for an advanced prosthetic hand to use for everyday
tasks? How do we make the best choice? The second reason, which is subject to clinical research, is to measure
the outcome to support the evidence for the specific intervention. Both reasons have their justifications.
This Instructional Course will build upon the results from our review of outcome measures in upper limb prosthetics,
and linking of items from upper limb outcome measures to the ICF by giving hands on examples and guidance for
practitioners how to use this knowledge.
422
Monday, Feb 4, 14:30-15:45
Chair: Mrs Carolyn Hirons
Presenters: Carolyn Hirons, Laura Burgess
Objective:
To teach prosthetists about basic movement control and posture and its impact on alignment and component
function at fitting stage. To teach basic techniques for movement training in order to maximise prosthetic fitting
and performance.
Course content
Basic theory of how we move. Outline of normal posture. Secondary anatomical faults common to prosthetic limb
wearers and their impact on the prosthesis. The influence of posture on alignment and alignment on posture, and
the resultant influence on user function with a prosthesis.
Benefits to Attendees
Improved understanding of the prosthetic influence on the wearer.
Intended Level of Audience
All levels of prosthetists
The multi-disciplinary approach to rehabilitation following amputation is well known. Although clinicians endeavour
to do this, it is not always possible under one roof. When physiotherapy starts during prosthetic provision,
exercises to control posture and movement often create a need to change prosthetic alignment, requiring repeat
appointments and delay. Having insight to the physiotherapy role and a basic overlap in skills facilitates an
improved outcome in prosthetic rehabilitation, in a timely manner.
By being able to assess and correct basic patient posture at prosthetic fitting stage, the alignment can be optimised,
reducing the number of appointments with the prosthetist once physiotherapy training commences.
ISPO world congress is the ideal stage for this instructional course due to the multi-disciplinary nature of the
delegates. For newly qualified prosthetists, this instructional course will help them to look above the prosthesis
and understand the impact it has on the skeletal frame, and thus on how someone moves and functions. For the
more experienced prosthetist, who has a wealth of understanding of componentry, it will revise how prosthetic
functions can be enhanced by user posture control. For prosthetists in the developing world, this will provide
invaluable skills, where physiotherapy input in prosthetic provision may be scarce or limited.
423
INSTRUCTIONAL COURSE
Congress Topic: Education
Session Title: ICS Code 28 - Essential Physiotherapy – What All Prosthetists Should Know
Room: G.04 & G.05
INSTRUCTIONAL COURSE
Monday, Feb 4, 14:30-15:45
Congress Topic: Rehab Medicine & Surgery
Session Title: ICS Code 60 - How To Prevent Amputation In Severe Diabetic Foot Deformities?
Room: 1.01 & 1.02
Chair: Dr B.D. Athani
Presenters: Dr B.D. Athani, Shyam Kalavalapalli, Srinivas Seshabhattaru, Pinjala Ramakrishna
Venu Kavarthapu, Deepak Chawla
Objective
To raise awareness on the magnitude of the problem. To outline the treatment principles, with particular emphasis
on modern surgical orthotic treatment
Course content
The current status of amputation risk in diabetic foot deformities. The modern surgical approach. The modern
orthotic treatment.
Benefits to Attendees
Provides comprehensive update on how to prevent amputation in severe diabetic foot deformities
Intended Level of Audience
Orthopaeidic surgeons, orthotic and prosthetic providers and professionals, general practitioners, diabetologists,
rheumatologists.
Diabetes is prevalent in all age groups, with an estimation of 150 million people affected worldwide in 2000. This is
expected to increase to 366 millions in 2030. Diabetic foot ulcers and deformities are a significant problem in this
population and this requires a dedicated multidisciplinary approach. ??The risk of amputation in severe diabetic
foot deformities with ulcerations is extremely high. This requires a multidisciplinary approach in which the orthotic
treatment is of paramount. The has been major advances in limb salvage orthopaedic surgery in severe diabetic
foot deformities and this session will aim to give an update on these advances, and the modern approaches to
orthotic treatment in this area.
424
Monday, Feb 4, 16:15-17:30
Chair: Jose Miguel Gomez
Presenters: Jose Miguel Gomez, Amit V Bhanti
Objective
Change the biomechanical plan from treating x-rays and cobb angle to treating the patient as an entire structure,
starting with alignment, balance and stability. It is important to highlight the value a conservative treatment as first
option for spinal deformities to prevent unnecessary spine fusions.
Course content
History and Overview
Historically, scoliosis bracing has relied upon 3-point force systems and specific pads, such as lumbar and
trochanteric pads. In contrast, the CAD-CAM system utilizes moment loading. Rather than applying corrective
forces through isolated pads, with CAD-CAM, a large surface area is manipulated to provide an unbending
moment. This allows for greater correction with improved comfort and compliance.
Preliminary adjustments are made at that time. Follow-up adjustments are performed as the patient acclimates to
their new shape. Once maximum wearing time has been achieved in brace x-rays are taken to assess the efficacy
of the orthosis in curve correction and the overall balance and stability. As part of the clinical evaluation, over
25 anthropometric measurements are taken that include lengths, MLs, APs and circumferences as well as the
geometry in all 3 planes. Accuracy is required to ensure optimal function of the corrective modifications that are
created in the next phase.
Photo Documentation
Optimal use of a CAD-CAM based system requires multiple inputs. Each treatment plan begins with a careful
evaluation of the patient's deformity and in the coronal, sagittal and transverse planes documented by digital
photography. Then multiple patient measurements and careful assessment of each patient's flexibility in each
biomechanical plane are photographically recorded. Additionally, visual observation of the patient's compensation
is reassessed during the evaluation and compared against the x-rays. The orthosis is then designed, fabricated
and fitted.
Patient Assessment Protocol
The extent to which corrective modifications are applied to the template are dependent upon the assessed flexibility
of the patient. A final component to the patient assessment is careful observations of the patient's overall balance.
This is done in both the sagittal and coronal plane and can be performed with the assistance of a laser level.
Case presentation: Sagittal and 3-Dimensional deformities
Benefits to Attendees
They will be able to see the case from a different perspective by a precise protocol where measurements, digital
pictures, flexibility and correctability factors are used.
Intended Level of Audience
Multidisciplinary team for spine treatment.
425
INSTRUCTIONAL COURSE
Congress Topic: Orthotics Spinal
Session Title: ICS Code 58 - Alignment, Balance And Stability: The Key For Orthotic Treatment Of Spine
Deformities
Room: 1.01 & 1.02
INSTRUCTIONAL COURSE
Monday, Feb 4, 16:15-17:30
Congress Topic: Prosthetics : Lower Limb
Session Title: ICS Code 14 - Prosthetic Alignment: Biomechanical Basics And Clinical Approach For Lower
Limb Prostheses
Room: Hall-3
Chair: Prof. Dr. Siegmar Blumentritt
Presenters: Malte Bellmann, Siegmar Blumentritt
Objective
Imparting biomechanical knowledge/backgrounds, deriving of alignment guidelines and practical proceeding in
fitting different amputation levels – from foot amputation to hemipelvectomy
Course content
At first we will shortly inform about the history of prosthetic alignment and important results of various studies.
Then present biomechanical aspects (Blumentritt) and the concrete practical procedure for prosthetic alignment
that has been repeatedly proved by the speakers will be demonstrated (Bellmann). As biomechanics as well as
the practical procedure are very different for the individual amputation levels both contents will be explained for
each amputation level
(1.Alignment of lower limb prostheses: Biomechanics and guidelines (Blumentritt)
2.Alignment of lower limb prostheses: How to do in clinical practise (Bellmann)).
Benefits to Attendees
Learn about current biomechanical knowledge for prosthetic alignment in TT, TF and HD amputees, learn
Objective biomechanically based alignment guidelines and how to apply that knowledge in everyday clinical
practise
Intended Level of Audience
Students and prosthetists of different experience level, interested rehabilitation physicians
The alignment of the prosthesis has a considerable influence on the fitting quality of lower limb amputees. In
current clinical practice, optimization of prosthetic alignment is a timeconsuming, subjective process requiring
many years of experience combined with feedback from the amputee for the best result. However, it is inevitable
that this subjective method results in a wide variation in definitive alignments. In the course, current biomechanical
knowledge on prosthetic alignment for the different amputation levels will be imparted. Biomechanically based
alignment guidelines will be derived and their practical use at the patient explained. Thus the course will provide
the theoretical background in combination with practical instructions for individual prosthetic alignment according
to modern biomechanical principles of fitting practise.
426
Tuesday, Feb 5, 09:00-10:15
Chair: Karl-Heinz Schott
Presenters: Dennis Janisse, Karl-Heinz Schott, Dominik Stumpf
Summary
Pedorthic foot care and orthopaedic footwear services are practiced in one form or another around the world and
have become increasingly important to maintain an aging population and ensure those with diabetes stay on
their own feet. The scope of practice is often misunderstood and varies from country to country. This workshop
introduces you to the international professional association IVO, highlights systems of education, training, scope
of practice and service provisions in Germany, the USA and Australia including a short introduction to other IVO
member countries. The 3 speakers are from 3 different continents showing the scope of the field as it presents
itself globally. The speakers will present on the latest Pedorthic treatment and education modalities but also show
a span of training and treatment suitable for different countries and budgets.
Discussion
IVO Internationaler Verband Orthopaedieschuhtechniker / International Association Orthopaedic Shoe Technique
and Pedorthists. The IVO is the international non profit association representing national non profit pedorthic and
orthopaedic footwear/care professional organisations from 15 countries totalling approximately 4200 members.
The IVO is the patron of an international congress event which is held every 3 years in various countries across
the globe.
The state of Pedorthics in the USA, Germany, Australia, Japan and other countries will be surveyed.
427
INSTRUCTIONAL COURSE
Congress Topic: Pedorthics - Footwear
Session Title: ICS Code 56 - Pedorthic Footcare Orthopaedic Shoe Technique International
Room: 1.01 & 1.02
INSTRUCTIONAL COURSE
Tuesday, Feb 5, 14:30-15:45
Congress Topic: Orthotics : Spinal
Session Title: ICS Code 39 - A Key Biomechanical Corrective Principle Based On The Specific Goals And
Techniques Used In A Gillette Custom Molded Tlso For Idiopathic Scoliosis
Room: G.02 & G.03
Chair: Sun Hae Jang
Presenters: Janet Cortes, Sun Hae Jang, Tenner Guillaume
Objective
To review clinical guidelines for diagnosis, treatment, and management of idiopathic scoliosis (IS), identify the
current biomechanical goals of the orthotic treatment for IS with a Gillette thoracolumbosacral orthosis (TLSO,
provide detailed techniques for the entire process that the Gillette spine orthotists take, and explain a new key
biomechanical principle in re-aligning the three dimensional deformity of IS with a orthosis
Course content
Part 1 - Idiopathic Scoliosis: Diagnosis and Management : Overview of IS, Classification, Natural history and
prognosis,Clinical evaluation guidelines for diagnosis ,Treatment protocols
Part 2 - The biomechanical goals and techniques used in the orthotic treatment of adolescent idiopathic scoliosis
(AIS) with a Gillette custom molded TLSO; Why is "achieving a balanced and aligned spine and trunk in all 3
planes in the orthosis" Gillette's primary goal in treating AIS?; How do Gillettte spine orthotists achieve their
biomechanical goal? Techniques for Radiograph and Patient evaluation, Casting, Cast modification and fitting
Part 3 - A new biomechanical corrective principle in treating IS with an orthosis; How is an optimal orthotic
outcome measured? What is a key biomechanical corrective principle aside from the three point pressure
correction theory? Passive and active components, De-rotational forces and a lateral translational force, lateroposterior trunk migration to the concave side of the curve
C.What is the optimal design of an orthosis?
Part 4 - General discussion
Benefits to Attendees
On completion of the course, the participant is expected to be able to increase understanding about the current
practice of the orthotic treatment for IS from the view point of orthotists, gain knowledge of the underlying
biomechanical goal and specific techniques used in the entire process of a Gillette TLSO , develop knowledge of a
new biomechanical corrective principle in treating IS with an orthosis, and adapt this knowledge to the participant's
own practice for better orthotic treatment of IS.
Intended Level of Audience
Advanced Level Course: This course is intended for orthotists, orthopedic surgeons, clinicians who treat children
with IS. Open to all who are interested.
428
Tuesday, Feb 5, 14:30-15:45
Chair: Mr. Y.C. Law
Presenters: Nobuhiro Kito, Sam YC Law
Osteoarthritis (OA) of the knee is one of the most common symptomatic sites of OA. OA knee causes substantial
pain and disability, significant impact to quality of life, disturbing sleeping quality to patients, and social impact to
patients and their family.
Orthotic treatment is one of the most common recommended non-pharmacological treatments in guidelines for
management of knee osteoarthritis. Many patients present clinically with unicompartmental OA knee, usually
medial is more common than lateral. Although application of knee bracing was shown to be effective in treating
patients with OA knee, foot orthoses or insoles would seem to be more comfortable, economical and easier to use,
especially for the elderly in developing countries.
Objective
To enhance knowledge on biomechanical characteristics of medial compartment knee osteoarthritis and update
latest evidence on clinical effectiveness of its orthotic treatment
Course content
i) Introduction: Prevalence, Symptoms, Health risk, and Classification of knee osteoarthritis;
ii) Characteristics of OA knee in anatomical, kinetic, kinematic, and kinesiologic aspects;
iii) Biomechanical factors related to disease progression;
iv) Recommended orthotic treatment for knee osteoarthritis in published guidelines; and
v) Review on latest functional and clnical evidence on effectiveness of foot orthoses, valgus-force producing
orthoses, knee braces and shoes for medial compartment OA knee.
Benefits to Attendees
In-depth knowledge on biomechanical characteristics of pathological osteoarthritic knee would allow attendees to
understand more about pathomechanics of symptoms. Systematic review on evidence of current orthotic options
would backup attendees to select the most appropriate and effective orthotic treatment for patients with medial
compartment osteoarthritic knee. Characteristics of medial compartment OA knee mentioned in this instructional
course would allow audience to understand functional deficits for this knee pathology. Biomechanical knowledge
could guide orthotist to make right treatment decision and footwear recommendations. A summary of evidencebased effectiveness of orthotic treatment for medial compartment OA knee would be discussed in this instructional
course to backup beginner orthotists on the potential benefits and risks of different treatment options in order to
ensure quality and patient safety.
Intended Level of Audience
This is a course for beginner practitioner who has interest to provide an effective orthotic treatment for medial
compartment knee osteoarthritis. Basic knowledge on biomechanics would be a plus to understand the contents
of this course.
429
INSTRUCTIONAL COURSE
Congress Topic: Orthotics: Lower Limb
Session Title: ICS Code 11 - Biomechanics Of Medial Compartment Knee Osteoarthritis: Implications For
Orthotic Treatment
Room: Hall-3
INSTRUCTIONAL COURSE
Tuesday, Feb 5, 16:15-17:30
Congress Topic: Orthotics : Spinal
Session Title: ICS Code 57 - Biomechanical Aspect Of Idiopathic Scoliosis And Orthotic Management
Room: G.04 & G.05
Chair: Tarit Kumar Datta
Presenters: Arif Raihan, Tarit Kumar Datta, Hema Trivedi, Sant Prakash Gautam
Objective
An extensive yet incomplete understanding of the natural history of idiopathic scoliosis (IS) means uncertainty
remains associated with selection of treatment. A new therapeutic approach is based upon the etiology and
pathogenesis of IS. This instructional course focus on overview of IS with clinical Biomechanics and the various
latest technique
Course content
Clinical Biomechanics of orthotic treatment of IS will cover introduction of definitions, Cobb angle, Riser sign,
postural evaluation and force applications. The concept of latest technique under which this course will highlight
clinical evaluation, postural geometry and radiological evaluation with etiopathogenic concept. This course will
present a 3-D definition of spine in a static and dynamic condition. The course will analyze the scoliosis geometry
and the latest technique of the effect of dynamic force creates a new movement strategy which has significant
effect progressive curve reduction with neuro muscular integration. This course will also cover and focus on clinical
evaluation of body level orientation and a relation with shoulder, rotation of thorax and pelvis in horizontal plane
Benefits to Attendees
The attendee will get an opportunity for interaction with others and gather knowledge from a very experienced
expert and after return can implement it in the work place
Intended Level of Audience
Academicians, practitioners, clinicians, students and researchers.
Over time the current practices used are not much helpful for an effective approach in terms of reduction of
idiopathic scoliosis. Formal education in many developing countries is not followed and the course curricula are
not updated.This instructional course can be a gateway to learn and know the effective treatment and orthotic
management of IS.This course will focus on localized features of X-Ray with vertebral tilt, rotation, cobb angle
which is not covered in regular course and it will be a chance for the professionals, faculties to gathered knowledge
and what is happening around the world.
The goal of using an orthosis in the treatment of IS is to stop curve progression and minimize negative cosmetic
consequences is a major part of the instructional course the following latest orhosis and practical experiences will
be discuss and presented
1. Trunk/ TL Orthosis: The latest safe, intelligent, effective next generation reclining brace/orthosis will be present
with the experience on Indian patients.
2. Flexible spinal orthosis: In this section we will discuss the Cobb angle measurement with radiological
evaluation which covers the rotational aspect measuring technique.We will present how this flexible orthosis
control the three dimensionalDeformities of spine.
We will discuss how this controls the postural disorganization, and unsynchronized particular movement pattern
of the body.
430
Tuesday, Feb 5, 16:15-17:30
Room: G.02 & G.03
Chair: Kenton Kaufman
Presenters: Kenton Kaufman, James Campbell, Karyn Ross
Objective
Provide a knowledge base for informed orthotic prescription based upon biomechanical principles, orthosis
capabilities, and patient functional deficits.
Course content
This course will provide a foundation of biomechanical principles and specific examples for effective use of SCOs.
The course will also provide a summary of current research on SCOs and areas that require future development
efforts.
Benefits to Attendees
Attendees will gain knowledge about the technical features SCO designs along with an understanding of the
biomechanical deficits that can be replaced.
Intended Level of Audience: Advanced
Lower limb orthosis design has been advanced by the introduction of knee mechanisms that provide stance phase
control and swing phase freedom, referred to as a stance control orthosis (SCO). The intent is to allow a more
normal, energy efficient gait. This technology is relative new and many practitioners have only limited experience.
An instructional course will make it possible for more practitioners to gain the knowledge needed to introduce this
technology into their clinical practice.
431
INSTRUCTIONAL COURSE
Congress Topic: Orthotics: Lower Limb
Session Title: ICS Code 34 - Stance Control Orthotics
INSTRUCTIONAL COURSE
Tuesday, Feb 5, 16:15-17:30
Congress Topic: Rehab Medicine & Surgery
Session Title: ICS Code 2 - The Postoperative Management After Transtibial Amputation
Room: Hall-3
Chair: C.H. Emmelot
Presenters: Anton Johannesson, Kees Emmelot, Saffran Möller
Objective
To give insight in modern approach of early care after a transtibial amputation, the clinical choices which can be
made with respect to possibilities depending on local situations, seen from a functional point of view
Course content
1. medical issues shortly after amputation: Emmelot
2. theoretical background soft/elastic vs rigid dressing; Emmelot
3. postoperative dressing (which includes wound dressing): Johannesson
4. compression therapy: Carlsson
5. early training: Carlsson
6. early/interim prosthesis: Johanneson and Emmelot
Benefits to Attendees
To get an overview about the minimum level of care to amputees in the postoperative stage; merits and
desadvantages of different approaches; newer developments
Intended Level of Audience
Working in the field of amputation and prosthetics at level of secundary care, especially starting professionals
(therapists, residents, CPO) and those with experience who need refreshing.
The presenters give an overview in best clinical practice about postoperative care seen from a functional point
of view and as evidence based as possible. It is practical and gives answers to workers in the field. Explanations
are given to found the choices which can be made in clinical decision making. Controversies are avoided and
attendees can make their own choices based on what can be heared and seen. It gives starting professionals the
cues they can use in their daily practice.
432
Wednesday, Feb 6, 09:00-10:15
Chair: Christian Schlierf
Presenters: Christian Schlierf, Mehmed Latifagic, William C. Neumann, Eldar Husanovic
Introduction
The combined population of Africa, Asia and Latin America was approximately 6 billion in 2010. Thus, the
estimated number of people in need of P&O services according to WHO is 30 million, meaning that the number
of personnel needed to provide services in P&O would therefore be 180,000. According to the “ISPO and WHO
Guidelines for Training Personnel in Developing Countries for P&O Services, 2005”, over 75% of developing
countries currently have no P&O training programs at all and there are only 24 schools of varying levels and
standards training only 400 personnel per year for all developing countries. This clearly shows that the existing
training programs are totally inadequate and insufficient in comparison to the urgent need. The building of a viable
orthotic-prosthetic service with a sustainable basis requires associated skills building, combining a strong medical
academic foundation blended with hands-on training and direct supervised patient contact for local professionals
in order to insure standards of contemporary competency on a comparative level. Over the past decade a small
group of organisations and institutions such as La Trobe University (Australia), Polytech University (Hong Kong),
Don Bosco University (El Salvador), Human Study e.V. (Germany) and others, started to deliver distance learning
education according to ISPO Category II standards, which have potential to be provided to more regions and
countries in the world that do not have formal educational facilities.
Objective
Provide participants an overview about state of the art e-learning possibilities in Prosthetic and Orthotic sciences.
Differentiations between Complete Formal Education, Upgrading Education and Continued Education demonstrate
the huge e-learning possibilities, capable to address various needs and demands for P&O education in different
context. The Instructional Course should illustrate the different methodologies and learning tools that have been
developed for andragogical as well as for classic pedagogical purposes. Online and Offline simulations of the
various e-learning tools shall facilitate a better understanding of the individual delivery methods and e-learning
potential in general.
Intended Audience
Individuals that are interested in, or actively provide education in Prosthetics and Orthotics; as well as teachers,
clinical instructors, lecturers, etc. in the professional field who have an interest and/or experiences in distance
learning education/e-learning designed for Prosthetic and Orthotic sciences.
Conclusion
P&O education and e-learning experts who actively deliver and/or develop P&O Distance Learning Education
contribute to the Instructional Course. Not only a comprehensive update on the state-of-the-art e-learning methods
and current delivery models will be shared and discussed with the participants of this Instructional Course, a broad
overview about existing e-programs and the future developments will be elaborated as well.
433
INSTRUCTIONAL COURSE
Congress Topic: Education
Session Title: ICS Code 38 - Ispo Accredited Distance Learning Blended Prosthetic And Orthotic Education
E-Learning - A Solution For The World
Room: G.04 & G.05
INSTRUCTIONAL COURSE
Wednesday, Feb 6, 09:00-10:15
Congress Topic: Rehab Medicine & Surgery
Session Title: ICS Code 12 - Neuroprosthesis For Drop Foot In Upper Motor Neuron Syndrome
Room: Hall-3
Chair: Prof. Dr. A.C.H. Geurts
Presenters: A.C.H. Geurts, J.J. Den Boer, Esther Bruecker
Objective
To provide insight in theoretical and practical background and scientific evidence to use neuroprostheses for drop
foot in patients with to upper motor neuron lesion.
Course content
- An introduction in peroneal functional electrical stimulation; Evidence, State of the art
- An introduction in peroneal functional electrical stimulation; (theoretical background)
- An introduction in peroneal functional electrical stimulation; Practical use.
(Pros and Cons of different external and implantable devices, L300 from Bioness, The Pace of Odstock, the Walkaid of Innovative Neurotronics and the Actigait and Neurostep of Ottobock.)
Benefits to Attendees
The participants of the course are able to adequately select patients and treat drop foot due to an upper motor
neuron lesion with an external neuroprosthesis; they are also able to refer appropriate patients for implantable
devices.
Intended Level of Audience: physiotherapists, CPOs, and physicians in rehabilitation medicine experienced in
neurorehabilitation, but with limited knowledge of neuroprostheses for drop foot
Patients with a drop foot due to an upper motor neuron lesion are usually provided with an ankle foot orthosis
(AFO). Due to recent developments, advanced surface-based neuroprotheses and implantable systems are a
growing alternative for an AFO. Compared to AFOs the advantage of peroneal functional electrical stimulation
(FES) is that (i) there is an active stimulation of the muscles that dorsiflex and evert the ankle joint, (ii) ankle
mobility is left free which permits residual plantar flexion (push-off) as well as balance correcting movements in
stance, and (iii) by modulation of spinal reflexes and muscle tone there may be more knee and hip flexion during
swing.
There is now convincing evidence for beneficial effects of FES as a neuroprosthesis for people with stroke related
drop foot compared to walking without an orthosis (Kottink, 2004). There is also evidence for improvement of
functional abilities due to long term use of FES (Robbins, 2006; Stein 2010). Studies comparing FES to AFO
showed that patients judged FES superior regarding the effort and stability of walking, quality of the gait pattern,
walking distance, comfort and appearance of the device (Swigchem, 2010). In addition FES appears to be superior
to an AFO with regard to obstacle avoidance ability and self-perceived gait skills (Swigchem et al, 2011).
The improved technology and growing evidence for FES make it of great interest for health care practitioners to
be provided with ‘state of the art’ knowledge and practical skills concerning FES for drop foot in patients with an
upper motor neuron lesion.
434
Wednesday, Feb 6, 14:30-15:45
Chair: Prof. Jules Becher
Presenters: Annet Dallmeijer, Jules Becher
Objective
To provide health professionals with a basic understanding of clinical exercise testing principles to assess energy
cost of energy cost of walking and fitness and its clinical applications in orthotic treatment with Ankle Foot Orthosis
in children with mobility limitations with Cerebral Palsy and illustration of the use of the results for advise for
treatment.
Course content
Assessment of energy cost and fitness is becoming increasingly important in the treatment of mobility limitations
in children with Cerebral Palsy. Common complaints in this group like reduced walking distance and early fatigue
during daily life activities can both be associated either with increased energy cost or reduced fitness levels.
One goal of treatment with Ankle Foot Orthosis (AFO) in these children is to reduce energy cost in walking by
improving the efficiency of gait. Appropriate assessments of these outcomes are therefore essential for applying
adequate treatment strategies. This course provides a basic background in exercise physiology that is required
to understand and interpret test results. Evidence based test protocols and safety procedures are presented.
Indications for exercise testing in clinical context, including patient needs and treatment goal will be presented in
a clinical context. Several clinical cases with AFO treatment, energy cost and fitness assessments are presented
as clinical example and will be discussed with the audience. The opportunities and limitations to improve clinical
practice are discussed.
Benefits to Attendees
Attendees will understand basic clinical exercise physiological principles needed for interpreting energy cost and
fitness data, learn the exercise testing protocols and the indications for exercise testing and be able to translate
test results of energy cost and fitness testing to clinical rehabilitation treatment
Intended Level of Audience: Experienced clinician
One of the indications to use Ankle Foot Orthosis in children with Cerebral Palsy is to improve efficiency of gait
(1) . Reduced walking distance or early fatigue during walking could be related to increased energy cost, reduced
efficiency of gait. On the other hand, increased energy cost could lead to reduced levels of physical activity, and
so to reduced level of fitness (2). So, in children complaints about with early fatigue in walking or reduced walking
distance, analysis of the energy cost during walking and analysis of anaerobic and aerobic fitness level can help to
analyse the cause of these limitations. The clinical benefits of the use of Ankle Foot Orthosis to improve efficiency
of walking is still a matter of debate (3;4). Analyzing the cause of reduced walking distance or early fatigue in
walking by measurement of energy cost and physical fitness is a tool to improve rehabilitation programs in these
children. Understanding these measurements, and be able to interpretate the results of tests of energy cost and
physical fitness will support clinical practice and treatment of these children.
435
INSTRUCTIONAL COURSE
Congress Topic: Rehab Medicine & Surgery
Session Title: ICS Code 27 - Reduced Walking Distance: Does Afo Treatment Benefit? Practical Application
Of Clinical Energy Cost And Fitness Assessments In Children With Cerebral Palsy
Room: Hall-3
INSTRUCTIONAL COURSE
Wednesday, Feb 6, 16:15-17:30
Congress Topic: Orthotics: Lower Limb
Session Title: ICS Code 55 - Orthotics For Clubfoot
Room: G.04 & G.05
Chair: Dr. Alaric Aroojis
Presenters: DK Taneja, Alaric Aroojis, Michiel Steenbeek, Mukesh Doshi, Norgrove Penny, Pankaj Sinha,
MK Jain
Objective
The course is designed to provide an update on different orthotics used for maintenance of clubfoot correction.
Course content
Clubfoot is one of the commonest congenital orthopaedic anomalies in a child. The Ponseti method, which
emphasizes on gentle manipulation and serial casting, is the current gold-standard for correction of clubfoot in
infancy & early childhood. Post-correction maintenance in a foot abduction brace is an integral part of the Ponseti
method, to prevent relapses. The course will focus on evidence in literature to support the use of foot abduction
brace and to introduce the various prototypes available in the market. Special emphasis will be placed on newer
designs and emerging technologies in fabricating an ideal foot abduction brace. Participants will learn how to
design and fit a foot abduction brace. Various pitfalls in prescription of clubfoot braces will also be discussed.
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What is the evidence to support use of foot abduction brace after successful correction of clubfoot deformity?
Various types of foot abduction braces available commercially
Use of CAD-CAM technology and rapid prototyping to design a customized foot abduction brace
Does an articulated foot abduction brace improve compliance?
Methods of ensuring compliance with brace wear (Does a dedicated clubfoot programme and parent education
improve compliance? / use of sensors to document compliance)
- Is there is role of AFO for clubfoot bracing?
- Manufacturing details of an ideal foot abduction brace
Intended Level of Audience
Orthotists, Orthopaedic surgeons, Physical therapists, Physiatrists
436
Wednesday, Feb 6, 16:15-17:30
Chair: Saffran Moeller
Presenters: Robert Gailey, Saffran Moeller
Objective
To introduce clinicians to a comprehensive and practical system of care designed to prepare and train transfemoral
amputee in the proper use of commonly available Microprocessor Knees Systems.
Course content
The instructors will discuss the clinical biomechanics and application of commonly prescribed microprocessor
knee systems with regards to prosthetic gait training, exercise and evaluation with transfemoral amputees across
multiple levels of functional capabilities. Concrete gait training exercises for Amputees using Microprocessor
Knees.
Benefits to Attendees
Attendee will be introduced to the biomechanical principles related to all microprocessor knee systems to enable
clinicians to evaluate and train transfemoral amputees to sit, stand, walk on level ground, negotiate ramps, and
stair. In addition, specific exercise designed for a variety of functional levels will be demonstrated offering attendees
new treatment strategies that are appropriate for any clinic.
Intended Level of Audience
Practitioners from all disciplines novice to expert will find interest in this presentation.
As prosthetic knee systems with microprocessor controls continue to improve, with features such as increased
stance control and greater cadence variance, prosthetic gait training enabling amputees to take full advantage of
these enhancements becomes critical. Advanced gait training methods can promote a more natural gait pattern
with reduced effort to initiate prosthetic knee flexion. If knee movement is fluid, maintaining proper posture
within the pelvis and trunk is easier to sustain. Exercises designed to increase hip strength in the closed chain
environment of the socket can intensify the speed and power of muscular contractions for improved single limb
stance control. Functional activities such as sitting, turning, fast walking as well as negotiating ramps and stairs
can also be improved with some relatively simple training strategies.
This presentation will discuss the biomechanics of gait and functional activities, identify specific training techniques
that will enhance performance and illustrate clinically friendly assessment techniques that will enable transfemoral
amputees of any functional capacity to maximize their potential with the use of microprocessors knee systems.
Additionally, the treatment approaches introduced are designed to help clinicians differentiate between gait
deviations that are prosthetic in nature versus those originating from physical limitation secondary to lack of
physical training.
This multimedia presentation will include PowerPoint slides, video and live demonstration by a variety of clinicians
who have worked with microprocessor knees with a variety of patients since their introduction. All training and
evaluative techniques discussed will be suitable for any clinic worldwide.
437
INSTRUCTIONAL COURSE
Congress Topic: Prosthetics : Lower Limb
Session Title: ICS Code 13 - Microprocessor Knees, How To Maximize Functional Ability
Room: Hall-3
INSTRUCTIONAL COURSE
Wednesday, Feb 6, 16:15-17:30
Congress Topic: Rehab Medicine & Surgery
Session Title: ICS Code 32 - Rehabilitative And Prosthetic Approach To Patients With Amputation For
Lower Limb Musculoskeletal Tumors
Room: G.02 & G.03
Chair: Maria Grazia Benedetti
Presenters: Alessandro Zati, Miranda Rossi, Tommaso Nervegna, Maria Grazia Benedetti
Objective
This course aims to enable all those involved in the rehabilitation process of amputees for neoplastic disease of
the musculoskeletal system to acquire more skills in the use of prosthetic rehabilitation. This is an ever-changing
field and the course offers and update view from one of the most important hospitals involved in the orthopaedic
and rehabilitative treatment of musculoskeletal tumors.
Course content
Criteria for evaluating the patient in the immediate postoperative period taking into account the extent of the tumor,
the surgical demolition, and the possible presence of metastases.
Assessment of comorbidity and influence of chemotherapy in the physical performance of the patient.
Assessment of distribution of residual muscles and their assessment.
Choice of the prosthesis according to the level of amputation (inter-ileo, above knee, below knee, disarticulation,
foot), and assessment of the patient, his needs, age, socio-environmental situation and the possible comorbidity.
Recognition and treatment of intercurrent problems related to the rehabilitation program (underlying disease, use
of the prosthesis, psychological aspects).
Benefits to Attendees
To receive information about major issues in the rehabilitation of oncological amputees and discuss the presented
approach with personal experience.
Intended Level of Audience
All students, beginning practitioners, experienced clinicians about to specialize or clinicians already specialized
Continuous innovation in drug protocols and targeted radiotherapy for tumors of the musculoskeletal system
has profoundly improved the prognosis and quality of life of patients with musculoskeletal tumors. As a result,
increased attention to the needs and expectations of functional, social and work of the patient is required,
especially considering that this disease affects people mostly at a young age with very high functional demands.
Thus, rehabilitation is no longer only devoted to the selection of the appropriate prosthesis, but has to consider
patients in a global perspective of their individual project, assessing the real impact of the prosthesis on the level
of disability, participation and quality of life during daily life. A very early walking training with the prosthesis and
a tailored rehabilitation program for retraining effort, in view of the chemotherapy they undergo, and in the context
of an oncological disease, is crucial for these patients in order to obtain the best possible recovery of the skills
necessary for returning to a satisfying quality of life.
438
Thursday, Feb 7, 09:00-10:15
Room: Hall-3
Chair: Sarah A. Curran
Presenters: Aaron Leung, Samuel Phillips, D.H Plettenburg, E. Lemaire, Sarah A.Curran
Objective
Maximise chances for authors of having their work accepted for publication.
Course content: guidelines and advice which authors should follow
Benefits to Attendees
Intended Level of Audience: This instructional course lecture is predominantly aimed at authors who are nonEnglish speakers and/or are new, inexperienced authors.
Whether you are an academic or clinician, the process of writing and publishing an article can take time, effort and
skill. Although there is no definitive guide to writing an article, there are guidelines and advice which authors should
follow in order to maximise their chances of having their work accepted for publication. This instructional course
lecture is predominantly aimed at authors who are non-English speakers and/or are new, inexperienced authors.
The lecture will be divided into three sections and with specific reference to the requirements of the journal of
Prosthetics and Orthotics International, the first section of the lecture will provide an overview of what publication
means and discuss the role of the peer review process. Misleading assumptions and common mistakes made by
authors are also discussed.
The second section will state what is involved in writing an article for submission, which includes writing an abstract,
clinical relevance statement, and an example from the category of 'original research reports' and 'technical note'
will be used to illustrate key points during the preparation process of an article.
The last section will be reserved for questions and answers that the audience may ask the Editorial Team of
Prosthetics and Orthotics International.
439
INSTRUCTIONAL COURSE
Congress Topic: Education
Session Title: ICS Code 54 - How To Write An Article
INSTRUCTIONAL COURSE
Thursday, Feb 7, 09:00-10:15
Congress Topic: Paediatrics
Session Title: ICS Code 44 - Advanced Dynamic Orthotic Management For The Child With Cerebral Palsy
Room: G.02 & G.03
Chair: Dr. Ashok Johari
Presenters: Ashok Johari, Pankaj Sinha, Asha Chitnis, Mark DeHarde
Objective
To introduce participants to an advanced approach to treating the child with Cerebral Palsy (CP) through the use
of adjustable dynamic orthotic management in combination with existing comprehensive treatment plans including
surgery, BTX, casting and therapy.
Course content
We will present the use of innovative adjustable dynamic orthoses to complement the comprehensive management
of the child with Cerebral Palsy. We will provide detailed information on how clinicians can use adjustable
components and preferred design concepts (proper foot alignment and posting) to create unique orthoses to
improve ankle motion and muscle recruitment, optimize walking ability and improve dynamic balance and walking
endurance. Three scenarios for the use of adjustable dynamic orthoses will be discussed: 1) to increase ROM, 2)
to allow increased ankle motion during activities, 3) to help patients increase balance, strength and endurance, and
ultimately reduce their need for more restrictive static orthoses. We will discuss how adjustable dynamic orthoses
complement other treatments (pre surgical conservative treatment, post surgical recovery, BTX, casting therapy),
Case studies will illustrate the potential benefits of an adjustable dynamic orthoses program used with proper foot
correction, alignment and posting as needed versus prior more restrictive ankle motion designs with less rigorous
foot alignment covering comparison cases from childhood through adolescence.
Benefits to Attendees
Learning Objective 1: Differentiate between the different designs, capabilities and potential uses of various types of
adjustable dynamic orthoses with proper foot alignment and posting as needed versus older more restrictive ankle
motion designs with less rigorous foot alignment.
Learning Objective 2: Demonstrate an understanding of how to develop and adapt an individualized management
program for patients that includes the use of adjustable dynamic orthoses.
Learning Objective 3: Learn to identify patients that could benefit from an adjustable dynamic orthosis program.
Learning Objective 4: Understand how adjustable dynamic orthoses can be used to enhance the benefits of other
treatments (surgery and pharmacological interventions, casting and therapy).
Questions to Students for Course Feedback
1) How do measurements of R1 and R2 relate to dynamic orthotic management? 2) How can day and night time
adjustable dynamic orthoses be used in a comprehensive team approach to improve outcomes in children with
cerebral palsy? 3) How does resisted PF and DF ankle motion, rigorous foot alignment and posting as needed for
soft tissue limitations (muscle length and strength) positively influence gait biomechanics?
Intended Level of Audience
This course is relevant to all clinicians treating children with Cerebral Palsy
440
Room: G.06
Chair: O. B. Idusuyi
Presenters: O. B. Idusuyi, Amit V Bhanti
Objective
Discuss the etiology, pathophysiology, incidence/prevalence, and typical clinical presentation of Charcot foot,
including common symptoms and physical examination findings. Identify laboratory, imaging, and diagnostic
studies, tests, and procedures helpful in confirming the diagnosis of Charcot foot and in guiding management
decisions. Describe management options for Charcot foot, including nonsurgical and surgical treatment, and
identify the general considerations, indications, contraindications, and complications of surgical management
Course content
The course will cover: Clinical Presentation, Surgical repair, Pre-operative assessment, Exostectomy, Fixation
options and Reconstructive surgery
Conclusion
Charcot arthropathy is a disabling disease for the patient and a challenging problem for the treating physician.
Although close management is the preferred method, surgical reconstruction is valuable for those patients with
severe unstable deformities with stability in 80-90% of patients. Guidelines of surgery include correct timing,
adequate fixation, and a long post-operation nonweightbearing period. Ideally, the prompt identification of patients
in the early stages of neuroarthropathy would enhance treatment outcomes and reduce patient morbidity. The goal
of surgery is to render the patient able to wear shoes and braces to prevent amputation.
Benefits to Attendees
The course will benefit Orthotist and/or prosthetist,specialized nurses, podiatrists, other medical personnel
involved in the treatment or management of neuropathic -osteoarthropathic foot secondary to diabetes, leprosy,
syringomyelia etc. Will increase the knowledge and provide practical applications on the diagnosis and treatment
of the Charcot foot. Will provide a forum for clinicians with experience in the treatment of diabetic foot to discuss
in depth different treatments modalities of the Neuropathic Foot. Will enable a coordinated approach to a
multidisciplinary treatment of charcot utilizing evidence based medicine and current literature
Intended Level of Audience
Orthotists, surgeons, specialized nurses, podiatrists, primary care doctor or any Health care profesional who
desire a greater understanding of how to diagnose and manage the charcot foot.
441
INSTRUCTIONAL COURSE
Thursday, Feb 7, 09:00-10:15 (Standby)
Congress Topic: Rehab Medicine & Surgery
Session Title: ICS Code 61 - Treatment Options For Charcot Arthropathy
INSTRUCTIONAL COURSE
Thursday, Feb 7, 12:00-13:15
Congress Topic: Education
Session Title: ICS Code 26 - Developing Prosthetic And Orthotic Case Studies Using Applied Biomechanics
In Less Resourced Settings For Demonstrating Clinical Outcomes
Room: G.02 & G.03
Chair: Gordon Ruder
Presenters: Chathuranga Munasinghe, Dan Blocka, Gordon Ruder, Sirirat Seng-iad, Thyda Ros
Objective
To increase capacity in teaching, recording and demonstrating applied biomechanics in the clinic and classroom
setting.
Course content
This symposium would provide an introduction to a recent Alliance of Prosthetic Orthotic Schools (APOS) of
Asia short course where faculty of APOS affiliated programs from Sri Lanka, Cambodia, Thailand and the UK
participated in 4 day short course to review and advance their knowledge of applied biomechanics. In this
symposium the Chairperson will provide an introduction to the session. The aim is to increase capacity within
the schools to employ applied biomechanics using patient volunteers to demonstrate a practical approach to the
clinical and technical skills needed to develop case studies. With a focus was on measuring gait perimeters to
illustrate the effectiveness of orthotic/prosthetic interventions.
Faculty from the participating schools will each present a case study that demonstrates the techniques developed
during the course. Followed by a summary of the key technical aspects required to effectively capture relevant
case studies.
Benefits to Attendees
Attendees would be exposed to the basic skills required to develop case studies with a focus on measuring
gait perimeters to illustrate the effectiveness of orthotic/prosthetic interventions in settings where full-scale gait
laboratories are not available or practical.
Intended Level of Audience
This symposium would be appropriate for faculty or clinical personnel, particularly those involved in allied health
education. Participants in the original course were from both Category I and II level training and both identified the
course provided a valuable learning experience.
In addition, any clinician who aims to improve their ability to identify, evaluate, document and explain their clinical
findings would benefit from exposure to the skills and knowledge in this symposium.
Improving practitioners and educators ability to identify, record and demonstrate key biomechanical aspects
is of importance in developing clinically relevant case studies and in justifying treatment plans implemented.
Unfortunately, full-scale gait laboratories are rarely available in clinical settings and less resourced teaching
environments. It's also apparent, that many tools that are regularly available are normally underutilized.
This symposium would be appropriate due to its practical approach and simple techniques, facilitating practitioners
to identify relevant case studies and then facilitate the documentation of their findings for use in education or
clinical practice settings
442
Thursday, Feb 7, 12:00-13:15
Chair: Stefania Fatone
Presenters: Stefania Fatone
Objective
To provide attendees with a description of a newly developed approach to management of persons with
transfemoral amputation using a subischial socket with vacuum assisted suspension.
Course content
(1) Introduction to subischial sockets with vacuum assisted suspension
(2) Overview of patient selection, casting, model rectification and socket fitting
(3) Preliminary results of functional analyses
(4) Q&A with attendees
Benefits to Attendees
Attendees will gain knowledge of an additional prosthetic option for the management of persons with transfemoral
amputation.
Intended Level of Audience
Prosthetists with experience in the management of persons with transfemoral amputation.
Current transfemoral prosthetic socket designs encase the hip joint and portions of the pelvis, limiting range of
motion at the hip and compromising comfort. Subischial socket design does not impinge on the pelvis when the
hip is moved because it has intentionally lower trimlines than typical transfemoral sockets.The socket we have
developed is flexible, allowing muscles to move comfortably within the socket as they contract during activity and
to improve comfort during sitting. The socket is held securely to the leg by suction from a vacuum pump, which
makes for a firmer connection between the residual limb and prosthesis. Increased comfort, hip range of motion,
and connectivity between the residual limb and prosthesis provides better functional performance for individuals
with transfemoral amputations. Modeling of the socket, quantification of the rectification process and evaluation
of function using motion analysis and pressure measurement provides insights into the potential benefits of this
socket for persons with transfemoral amputation.
443
INSTRUCTIONAL COURSE
Congress Topic: Prosthetics : Lower Limb
Session Title: ICS Code 15 - Subischial Sockets With Vacuum Assisted Suspension For Persons With
Transfemoral Amputation
Room: 1.01 & 1.02
INSTRUCTIONAL COURSE
Thursday, Feb 7, 12:00-13:15
Congress Topic: Rehab Medicine & Surgery
Session Title: ICS Code 50 - Advances In Functional Rehabilitation Of Cerebral Palsy
Room: Hall-3
Chair: Dr. Deepak Sharan
Presenters: Deepak Sharan, Soikat Ghosh Moulic
Objective
This instructional course will cover an overview of recent developments in surgical, rehabilitation and orthotic
management of CP.
Course content
Session DurationTopic
1
10 min An overview of currently available treatment options
2
20 min Recent advances in surgical management of CP: Principles, Techniques and Postoperative Rehabilitation Protocol
3
20 min Recent advances in rehabilitation of CP: Body Weight Supported Treadmill Training, Virtual Reality Based Therapy, Hippotherapy, Therapeutic Swimming, EMG Biofeedback, Whole Body Vibration Therapy, etc.
4
25 min Recent advances in orthotic management of CP
Benefits to Attendees
The attendees will be exposed to an overview of recent developments in treatment strategies related to surgery,
rehabilitation and orthotic management of CP, with an emphasis on evidence based practice and practical tips to
achieve better functional outcomes with CP.
Intended Level of Audience
Orthopaedic Surgeons, Neurologists, Neurosurgeons, Physiatrists, Paediatricians, Orthotists, Physical and
Occupational Therapists and other rehabilitation professionals involved in the management of CP.
CP is one of commonest causes of disabilities in all age groups across the world. The treatment of CP has evolved
to focus on measurable functional improvement and not on measurements of tone, reflexes, and other academic
parameters. In recent years, many traditional and popular rehabilitation approaches have given way to newer and
innovative concepts and modalities. This course will update attendees in recent developments in the management
of CP that they can incorporate into their clinical practice.
444
Thursday, Feb 7, 14:30-15:45
Room: G.02 & G.03
Chair: Dr. M. K. Mathur
Presenters: M. K. Mathur, Pooja Mukul, Tarun Kulshreshtha
Course content
Evolution of the technology
Design features
Fabrication process
Benefits to Attendees
Exposure to alternate technology
Intended Level of Audience
Prosthetists,students
Jaipur limb technology is currently one of the largest used systems of prosthetics.It is a very distinctive technology.
Over 400,000 amputees have been fitted using this technology by its parent body “ Bhagwan Mahaveer Viklang
Sahayata Samiti ” since 1975.
it has reached the amputees in more than 30 countries in the world, which include Afganistan, Iraq , Pakistan, Sri
Lanka , Sudan ,Senegal, Sierra Leone , Somalia , Rwanda , Vietnam , Zimbabwe , Kenya , Indonesia , Cambodia
, Nigeria , Zambia , Panama , Honduras , Fiji , Bangladesh, Columbia ,Malawi , Philippines, Lebanon etc.
With the alarming rise in the amputee population worldwide, this technology is very relevant on account of its
rapid fabrication – materials ,material form ,processes , functional performance, durability , affordability & ease of
technology transfer. The technology is dynamic & undergoing constant developement.the polycentric knee being
the latest addition. Prosthetists from around the globe should become familiar with this system of prosthetics.
445
INSTRUCTIONAL COURSE
Congress Topic: Developing Countries
Session Title: ICS Code 30 - Jaipur Limb Technology
INSTRUCTIONAL COURSE
Thursday, Feb 7, 14:30-15:45
Congress Topic: Orthotics: Lower Limb
Session Title: ICS Code 48 - Osteoarthritis Creates A Heavy Disease Burden
Room: Hall-3
Chair: T Ingvarsson
Presenters: Thorvaldur Ingvarsson, Stefan Lohmander
Osteoarthritis (OA) is the most common form of arthritis. Its high prevalence, especially in the elderly, and frequency
of OA related physical disability make OA one of the leading cause of disability , especially with respect to weight
bearing functional tasks. OA is listed among the top 10 conditions representing a global disease burden, according
to the World Health Organization, with the knee being one of the most frequently affected joint .
Knee OA increases in prevalence with advancing age. More than 10% of persons older than 65 years have
symptomatic knee OA. The number of people older than 65 years is expected to roughly double in the next 25
years which will challenge the providers of musculoskeletal care and demand for surgery will increase accordingly.
Risk for knee OA includes a variety of endogenous and exogenous factors such as obesity, occupational bending
or squatting, lifting, knee injury and previous knee surgery such as meniscectomy. Misalignment has also been
associated with the progression of radiographic joint space loss and loss of function. In its most severe form
knee OA is a wasting disease that causes pain, stiffness and disability. As there are no known cures for OA, the
treatment is aimed at symptoms by use of pain killers, NSAIDs, physiotherapy, weight loss and braces. There is
an increased demand for correction of misalignment, both surgical with osteotomies and nonsurgical with braces
and even insoles, where the load on the symptomatic compartment of the knee is reduced by changing alignment
in the knee.
When there is no other treatment alternative such as in severe knee OA, uni- or bi compartmental joint replacement
is often the only choice which yields good results by increasing function and decreasing pain. Many patients with
knee OA want to be active and are interested in maintaining sports activities and some are motivated to delay joint
replacement surgery and are therefore seeking alternative treatment for their knee OA.
446
Thursday, Feb 7, 14:30-15:45
Chair: Andreas Samson
Presenters: A. Samson, M.Bellmann
Objective
The presented contents shall enable the technician to perform transfemoral fittings in amore differentiated way in
accordance with the individual indication. Focus will be on the functional principles and the adequate selection of
materials.
Course content
1. History and development overview of transfemoral socket designs (A. Samson) The first documented prosthetic
fittings will be presented as well as the ideas and principles that laid the foundation for developing socket shapes
from ancient times until the present. Special emphasis will be given to the change processes of shaping and
to the use of "new" materials whereas the clear interaction between shape development and material use and
attachment techniques will be explained.
2. Biomechanical differences between transfemoral socket designs (M. Bellmann) At first basic differences
of functional principles of transfemoral sockets are described. In addition, biomechanical advantages and
disadvantages of various systems and the resultant indication criteria for the practical fitting are presented.
Based on scientifically proven data it will be explained in depth, how the practically discussed differences of force
transmission may be quantified to allow more detailed indications for certain socket technologies.
Benefits to Attendees
The acquired knowledge shall enable the technician to fit patients with transfemoral amputation according to the
individual indication based on sound current findings.
Intended Level of Audience
Students and prosthetists as well as clinicians with different experience levels
From our experience we have learnt that worldwide basic standards in prosthetic fitting have not been sustainably
established yet, therefore the proposed topic seems to be a valuable contribution to the ISPO Congress within
the scope of an Instructional Course. The prosthetic socket as interface between humans and technology is of
fundamental importance and crucial for the fitting quality.
447
INSTRUCTIONAL COURSE
Congress Topic: Prosthetics : Lower Limb
Session Title: ICS Code 1- Biomechanical And Functional Principles Of Transfemoral Socket Designs
Room: G.04 & G.05
448
INSTRUCTIONAL COURSE
INSTRUCTIONAL COURSE
SYMPOSIA
449
SYMPOSIA
Mon, Feb 4 / 12:00 - 13.15
Rehab Medicine & Surgery / Hall-3
Chair
Page No.
ICS Code 18- Psychological and Social Issues in Amputation
Pamela Gallagher
452
Laurent Frossard
453
Rickard Brånemark
454
Dick H. Plettenburg
455
Mukesh Doshi
456
J.S. (Hans)
Rietman
457
M S Wong
458
Stefania Fatone
459
Friedbert Kohler
460
Sisary Kheng
461
Prof. Klaas
Postema
462
Laurent Frossard
463
Peter Vee Sin Lee
464
Technology / G.04 & G.05
ICS Code 6- Direct measurement of loading for evidence-based
practice
Mon, Feb 4 / 14:30 - 15.45
Rehab Medicine & Surgery / Hall-3
ICS Code 19- Bone-anchored prostheses – considerations regarding
prosthetic supply, rehabilitation and efficacy data
Technology / G.02 & G.03
ICS Code 17- Body powered prostheses: they are old school, right?
Mon, Feb 4 / 16:15 - 17.30
General / G.02&G.03
ICS Code 41- Experiences in disaster management & rehabilitation
Technology / G.04 & G.05
ICS Code 23- Use of robotics in upper limb stroke rehabilitation
Tuesday, Feb 5 / 9:00 - 10:15
Orthotics : Spinal / G.04 & G.05
ICS Code 49- Orthotic Management of Adolescent Idiopathic Scoliosis
Orthotics: Lower Limb / G.02 & G.03
ICS Code 24- From Stable Standing to “Rock’n’Roll” Walking
Prosthetics : Lower Limb / Hall-3
ICS Code 35- ICF Core Set for amputees
Tuesday, Feb 5 / 12:00 - 13:15
Developing Countries / 1.01 & 1.02
ICS Code 46- Capacity building and technologies transfer between
North and South programmes in physical rehabilitation-a model of
professional exchanges
Pedorthics - Footwear / G.02 & G.03
ICS Code 59 - An Update of research in footwear
Prosthetics : Lower Limb / Hall-3
ICS Code 5- Osseointegration and biomechanics: future solutions
Technology / G.04 & G.05
ICS Code 25- What do stump-socket interface pressures tells us?
450
Tuesday, Feb 5 / 14:30 - 15:45
Chair
ICS Code 20- National Quality Registries of Amputation, Prostheses
and Outcome after Lower Limb Amputation
Anders Stenström
Page No.
465
SYMPOSIA
Prosthetics : Lower Limb / G.04 & G.05
Wednesday, Feb 6 / 09:00 - 10:15
Prosthetics : Upper Limb / G.02 & G.03
ICS Code 52- Advances in Upper Limb Prosthetics
Peter J Kyberd
466
Edward Lemaire
467
Technology / 1.01 & 1.02
ICS Code 29- Robotic Exoskeletons and Orthotics
Wednesday, Feb 6 / 14:30 - 15:45
Orthotics: Lower Limb / G.04 & G.05
ICS Code 22- Can Orthoses Enhance Postural Stability? Implications
for Fall Prevention
Sam Y.C.Law
468
Rob Horvath
469
Jaap Harlaar
470
Marco Cavallaro
471
Seating & Wheelchair / G.02 & G.03
ICS Code 53- Wheelchair Consensus Conference, Guidelines and
Training Packages
Thursday, Feb 7 / 9:00 - 10:15
Orthotics: Lower Limb / G.04 & G.05
ICS Code 36- AFO biomechanics
Technology / 1.01 & 1.02
ICS Code 33- Manufacturing Technologies: the digital approach to
design and production of Prostheses and Orthoses
Thursday, Feb 7 / 12:00 - 13:15
Developing Countries / G.04 & G.05
ICS Code 43- Haiti 2010 Earthquake: Lessons Learned after 3 years
Al Ingersoll
472
451
SYMPOSIA
Monday, Feb 4, 12:00-13:15
Congress Topic: Rehab Medicine & Surgery
Session Title: ICS Code 18 - Psychological And Social Issues In Amputation
Room: Hall-3
Chair: Dr Pamela Gallagher PhD
Presenters: Allen Heinemann, D. Desmond, P. Gallagher, Maggie Donanvan-Hall
Responses to limb loss are varied and complex, and are influenced by a range of personal, clinical, social, physical
and environmental factors. No single professional group can address all of the multifaceted care needs that patients
and their families present; comprehensive, effective, patient-centered rehabilitation after amputation requires an
interdisciplinary team approach in partnership with the patient. While the medical and physical consequences of
amputation serve as the centerpiece in acute care and are commonly at the forefront of prosthetic rehabilitation,
working within the limits of their professional competencies, team members, including the patient and their family,
increasingly share responsibility for attending to psychosocial health across the continuum of care.
The proposed symposium aims to highlight critical psychological and social issues in amputation and prosthetic
rehabilitation, and to describe new, evidenced based developments in psychological interventions designed to
address these issues. The topic is suitable for a symposium as it covers issues of large and broad appeal and
interest to the ISPO membership and is suitable for an oral presentation format.
452
Monday, Feb 4, 12:00-13:15
Congress Topic: Technology
Session Title: ICS Code 6 - Direct Measurement Of Loading For Evidence-Based Practice
Room: G.04 & G.05
The demand for an evidence-based clinical practice involving lower limb amputees is increasing. Some of the
critical care decisions are related to the loading applied on the residuum. This loading is, indeed, the results of the
interface between the patient and the prosthesis that is determinant for comfort and functional outcome.
This loading can be assessed using inverse dynamics equations. Typically, this method requires a gait laboratory
fitted with tridimensional motion analysis system and force-plates. It is mainly suited for the analysis only few steps
of walking while being expensive and labour intensive.
However, recent scientific and industrial developments demonstrated that discrete and light portable sensors
can be placed within the prosthesis to measure accurately the loading during an unlimited number of steps and
activities of daily living. Several studies indicated that method based on direct measurements might provide more
realistic results. Furthermore, it is a user-friendly method more accessible to clinicians, such as prosthetists.
Therefore, all together, this method is creating additional opportunities for clinicians to obtain relevant data for
evidence-based choice of components, fitting, alignment, and rehabilitation, for example.
The purpose of this symposium will be to give an overview of these opportunities. The three main aims will be:
• To present some of the equipments used for direct measurements,
• To propose ways to analyse some key data sets,
• To give some practical example of data sets for transtibial and transfemoral amputees.
453
SYMPOSIA
Chair: Laurent Frossard
Presenters: Eva Haggstrom, Laurent Frossard, Edward S. Neumann, David Boone, George Papaioannou,
Goeran Fiedler
SYMPOSIA
Monday, Feb 4, 14:30-15:45
Congress Topic: Rehab Medicine & Surgery
Session Title: ICS Code 19 - Bone-anchored prostheses – considerations regarding prosthetic supply,
rehabilitation and efficacy data
Room: Hall-3
Chair: Rickard Brånemark
Presenters: Dora-Lisa Juhnke, Munjed Al Muderis, Eva Häggström, Kerstin Hagberg, Rickard Brånemark
The symposia will give a brief presentation of the prosthetic supply and the rehabilitation programs for two different
treatment solutions for bone-anchorage of artificial limbs - the Swedish OPRA-system and the German ILP-system
(former named ESKA).
The main aim is to discuss experiences and problems considering the prosthetic supply and the rehabilitation and
to discuss measurements for efficacy data.
454
Monday, Feb 4, 14:30-15:45
Congress Topic: Technology
Session Title: ICS Code 17 - Body powered prostheses: they are old school, right?
Room: G.02 & G.03
SYMPOSIA
Chair: Dick H. Plettenburg
Presenters: Dick H. Plettenburg, Gerwin Smit, Mona Hichert
From current scientific literature, from popular media, as well as from industry activities, one might easily conclude
that body powered prostheses are old fashioned and will soon be extinct. In this symposium we will argue that body
powered prostheses can and must be revived as they offer unique advantages for the prosthetic user.
First, the symposium will investigate the pro’s and con’s of body powered prostheses from a theoretical point of
view.
Secondly, the current state of the art in body powered prostheses is highlighted, from where conclusions can
be drawn towards what is needed to really express the benefits of this type of prostheses, both from a user
perspective and of a research perspective.
Thirdly, future perspectives and some first steps into it will be illustrated.
455
Monday, Feb 4, 16:15-17:30
SYMPOSIA
Congress Topic: General
Session Title: ICS Code 41 - Experiences In Disaster Management & Rehabilitation
Room: G.02 & G.03
Chair: Mukesh Doshi
Presenters: Liladhar Gada, M. M. Prabhakar, Mukesh Doshi, Veerendra Shandilya
The last decade has seen various kinds of disasters like Earthquake, Tsunami, manmade disasters like bomb
blasts, war and terrorist attacks in various countries. Rehabilitation remains a challenge from day one to long term
with various issues and how to solve them.
This symposium shares the experience of various people from India who have travelled around the world supporting
rehabilitation management with a long term policies. Rehabilitation management gives an important role to orthotic
devices initially, and in the longer term to both prosthetic and orthotic devices.
This symposium also gives an idea of the challenges in making orthotic and prosthetic devices when nothing is
available. Early mobilization of patients with orthotic and prosthetic devices simplifies rehabilitation management.
456
Monday, Feb 4, 16:15-17:30
Congress Topic: Technology
Session Title: ICS Code 23 - Use Of Robotics In Upper Limb Stroke Rehabilitation
Room: G.04 & G.05
SYMPOSIA
Chair: Prof. Dr. J.S. (Hans) Rietman
Presenters: Gerdienke Prange, Jaap Buurke, Johan S. Rietman
Stroke is one of the main causes of disability in Europe and North America. Due to hemorrhagic or ischemic
damage to brain tissue, motor planning and the integration of sensorimotor information are degraded. This results
in a disturbed generation of muscle activity, which may present as weakness, co-contraction and disturbed timing
Coordination between muscles can also be impaired, leading to less selective movements. In clinical practice,
stereotypical patterns of involuntary coupling of movements (i.e. synergies) are often observed. Movements are
restrained within either a flexion synergy (shoulder abduction, shoulder external rotation, elbow flexion and forearm
supination) or an extension synergy (shoulder adduction, shoulder internal rotation, elbow extension and forearm
pronation), or a combination of both. In a majority of stroke patients, these limitations account for a reduced ability
to use the arm. At most 20% of all patients regain complete arm function after 6 months.
Recent development in robot-mediated rehabilitation has revealed the great potential of robotic devices for
delivering repetitive training, thus facilitating a high intensity and a large number of repetitive training during subacute and chronic phases of stroke rehabilitation. Motivation can be increased through combination with virtual
reality game environment. While there is growing evidence that such technologies are beneficial to patient’s
recovery of functional and motor outcome, the uptake of these technologies has been slow.
In this symposium the more fundamental issues of robotic therapy as well aspects of clinical implementation will
be addressed.
457
Tuesday, Feb 5, 09:00-10:15
SYMPOSIA
Congress Topic: Orthotics : Spinal
Session Title: ICS Code 49 - Orthotic Management Of Adolescent Idiopathic Scoliosis
Room: G.04 & G.05
Chair: M S Wong
Presenters: Andreas Donauer, Edmond Lou, M S Wong
Scoliosis is a three-dimensional spinal deformity usually with lateral curvature of the spine and vertebral rotation.
Most cases are with unknown cause and found in adolescence, therefore, it is termed as adolescent idiopathic
scoliosis (AIS). For severe cases, surgeries will be considered but for moderate AIS, the conventional treatment
method is to apply rigid spinal orthoses to patients during their puberty to mechanically support the spine and
prevent further deterioration. The outcome of orthotic treatment for AIS is generally considered being associated
with the patient’s compliance. The more often the patients wear their spinal orthoses to the prescribed tightness
as well as to the prescribed length of time each day, the better the treatment outcome is expected.
However, the current orthotic techniques seem non-scientific although there are some evidences to demonstrate
the spinal orthosis being effective. There is lack of technical information such as “How tight should patients wear
the orthoses? How long should they wear the orthoses? How good their compliance really is at home and at
school? Whether all these factors are really important and necessary and related to the clinical efficacy?”
This symposium will share clinical experiences and scientific evidences in order to better understand the science
behind the phenomenon that orthoses appear effective and go further for evidence-based practice.
458
Tuesday, Feb 5, 09:00-10:15
Congress Topic: Orthotics: Lower Limb
Session Title: ICS Code 24 - From Stable Standing to “Rock’n’Roll” Walking
Room: G.02 & G.03
SYMPOSIA
Chair: Stefania Fatone
Presenters: Andrew Hansen, Elaine Owen, Stefania Fatone
This symposium will bridge the fields of lower limb orthotic and prosthetic practice. It will focus on designs for
ankle-foot othosis footwear combinations and lower limb prostheses. It has direct relevance to current clinical
practice and future research. It will apply to adults and children. The theme will be linkage, across orthotics and
prosthetics, of the following:
- Segment kinematics, especially of foot, shank and thigh, during a normal gait cycle.
- The influence of distal foot and shank alignment on more proximal thigh, pelvis and trunk alignment.
- The rockers of gait.
- The alignment of ankle-foot orthoses and prostheses.
- The influence of the shank kinematics of normal gait on the design of rollover shapes of prostheses and the
design of heels and soles of footwear used with ankle-foot orthoses.
- The influence of the length, and stiffness, of heel and toe levers.
- The varying prosthetic rollover shapes and ankle-foot orthosis footwear designs required for stable standing,
first steps, stepping and walking.
The research work of the presenters, as well as other established evidence, will be presented and used to
demonstrate these links.
459
Tuesday, Feb 5, 09:00-10:15
SYMPOSIA
Congress Topic: Prosthetics : Lower Limb
Session Title: ICS Code 35 - ICF Core Set For Amputees
Room: Hall-3
Chair: Dr Friedbert Kohler
Presenters: Helena Burger, Friedbert Kohler, Jim Xu
The International Classification for Functioning, Disability and Health (ICF) is a WHO endorsed classification to be
used widely in all areas related to disability. Considerable work has been done to develop tools which have broad
ownership and which enable the ICF to be used in day to day clinical practice. One such toll is the development of
an ICF Core Set for paersons following a lower limb amputation.
The purpose of this seminar is to provide the current state of the development of this Core Set to the audience.
460
Tuesday, Feb 5, 12:00-13:15
Chair: Ms. Sisary Kheng
Presenters: Joanna Cole-Hamilton, Line Helen Torsdatter, Harold Shangali, Rune Nilsen, Teap Odom
With current demands of well-rounded professionals in clinical services including interdisciplinary approaches to
comprehensive rehabilitation services, the essence of high quality education for prosthetists and orthotists should
be emphasized. In addition, post-graduation support is seen to be critical to provide adequate support mechanism
for young professionals.
The Fredskorpset-Esther programme develops an opportunity for capacity building and technologies transfer
between modern physical rehabilitation settings-Norway to less privilege societies such as Cambodia, Tanzania
and Malawi. Furthermore, South-South collaboration has assisted the partners in the South (Cambodia, Norway
and Malawi) to learn from one another’s experience in delivering best possible quality prosthetic and orthotic
education, physical rehabilitation and mentoring for young prosthetists/orthotists in challenging environment.
The incorporation of Telemedicine in either clinical practice or training in prosthetics and orthotics is seen to be
a way forward to encourage a life-long learning concept and practice. The implications and impacts from this
programme are significant and the application of this model could be reduplicated in any part of the world with
interest in either clinical practice advancement and/or educational quality enhancement.
This project is gathering information about services and student knowledge through our monitoring system and
reporting on the indicators in our objectives. This knowledge and information is readily available for anyone who
contacts the project or any of ours project partners. The increased of quality of P/O education at the regional
schools are spreaded information and knowledge to many countries. The programme is effective and serving as
a mechanism to build the local capacity and less resourced settings with better skills and critical analyses where it
will enhance the global quality practice and education.
461
SYMPOSIA
Congress Topic: Developing Countries
Session Title: ICS Code 46 - Capacity Building And Technologies Transfer Between North And South
Programmes In Physical Rehabilitation - A Model Of Professional Exchanges
Room: 1.01 & 1.02
Tuesday, Feb 5, 12:00-13:15
SYMPOSIA
Congress Topic: Pedorthics - Footwear
Session Title: ICS Code 59 - An Update Of Research In Footwear
Room: G.02 & G.03
Chair: Prof. Klaas Postema
Presenters: Andrew Hansen, Klaas Postema, Jaap Buurke, Ulla Tang
The symposium deals with some recent, important results of research in footwear. All speakers will include clear
clinical messages as results of their studies.
1. The heelless runnershoe presents the results of the development of a new runnershoe. It gives the advantages
and disadvantages of this soletype.
2. Usability of orthopaedic footwear. A qualitative research was performed on the reasons for patients to wear
or not to wear their orthopaedic shoes. It gives some clues on important aspects we have to take into account
when prescribing orthopaedic footwear.
3. Effects of rocker shoe radius on ankle movement, roll-over shape, and O2 cost. The effect of different shoe
models, roll-ovder shapes and rocker radius on the ankle movement was examined. This has direct clinical
implications. Also the effects on O2 will be presented.
4. Diafos; prevention for ulcers by insoles / influence of adherence. 85 patients with DM got orthopaedic footwear.
Randomly the insoles were optimized based on insole footpressure. The effects on the incidence of foot ulcers
are discussed. Very important proofed to be the adherence, which was measured by special sensors in the
shoes.
5. The D-Foot process, development of a protocol for assessment of the diabetic foot. In Sweden a special tool
is developed for assessment of the riscs in diabetic feet. Development, first results and use of the instrument
will be presented.
462
Tuesday, Feb 5, 12:00-13:15
Congress Topic: Prosthetics : Lower Limb
Session Title: ICS Code 5 - Osseointegration And Biomechanics: Future Solutions
Room: Hall-3
SYMPOSIA
Chair: Laurent Frossard
Presenters: Annette Pantal, Pawel Tomaszewski, Eva Haggstrom, Laurent Frossard, Sofie Vertriest
A number of limb amputees worldwide have experienced the benefits of an osseointegrated fixation to attach their
prosthesis. It is anticipated that this trend is going to increase to become one of the primary surgical treatment and
method of attachment. Indeed, the number of amputees fitted with a fixation has consistently increased over the
last decade. The range of commercial fixations and subsequent rehabilitation programs available to the community
of amputees is growing. Furthermore, the design principles for the fixations as well as the know-how and guidelines
to conduct a safe rehabilitation are both regularly refined at the light of scientific research.
However, some significant issues remain to be solved to make this option safely available to all amputees. Some
of these issues are associated with the length of the rehabilitation due to the necessity of progressive increase
loading until full weight bearing. Others are related to the osseointegration process it-self and the reduction of
infections.
Typically, the ways to alleviate these issues have been presented in symposium focusing on osseointegration with
a strong emphasis on the surgical, fitting and rehabilitation aspects. However, these issues are strongly connected
with the applied and fundamental biomechanics aspects. Therefore, there is a need for a symposium focusing
solely on these aspects, more particularly those susceptible to provide new insight.
The purpose of this symposium will be to give an overview of some of the current cutting edge research topics such
as osseointegration and EMG, vibration, electrical field, osseoperception.
463
Tuesday, Feb 5, 12:00-13:15
SYMPOSIA
Congress Topic: Technology
Session Title: ICS Code 25 - What Do Stump-Socket Interface Pressures Tells Us?
Room: G.04 & G.05
Chair: Dr. Peter Vee Sin Lee
Presenters: Arjan Buis, Tony McGarry, Peter Lee
Lower limb amputee’s stump / socket interface pressures have been considered as one of the most viable
parameters to quantitatively evaluate prosthetic socket fit. This is supported by the number pressure measurement
and finite element modeling investigations over the years, attempting to measure and predict stump / socket
interface pressures respectively. We may deduce that such knowledge will lead to the best possible socket fit for
the amputee.
However, a good prosthetic socket fit today is still highly dependent on the skill of the prosthetist, his/her knowledge
and experience. He/she must create a socket that will encourage muscles usage, relieve pressure at pressure
intolerant areas, distribute pressure around the stump to tolerant areas and maintain suspension of the prosthesis
throughout the gait cycle. Therefore, the question we are raising is what do stump/socket interface pressure tells
us?
In this symposium, we will provide a historical perspective and the challenges in measuring stump/socket interface
pressure, review the advances in socket fitting methodologies motivated by knowledge of stump/socket interface
pressure, and discuss the key obstacles preventing stump/socket interface pressure measurement routine clinical
practices.
464
Tuesday, Feb 5, 14:30-15:45
Chair: Anders Stenström
Presenters: Alan Thurston, Anders Stenström, Bengt Söderberg, Fiona Smith, Gert-Uno Larsson
A national quality register contains individualised data concerning patient problems, medical interventions, and
outcomes after treatment. During the last decades a wide range of national quality registries have been developed
for different health-care areas to constitute overall knowledge system for continuous learning, quality improvement
and management of healthcare services. To our knowledge a few registries have also been developed specifically
for the group of patients with lower-limb amputations.
This symposium will present such registers and discuss their strengths and weaknesses as well as give an
overview of the results.
465
SYMPOSIA
Congress Topic: Prosthetics : Lower Limb
Session Title: ICS Code 20 - National Quality Registries Of Amputation, Prostheses And Outcome After
Lower Limb Amputation
Room: G.04 & G.05
Wednesday, Feb 6, 09:00-10:15
SYMPOSIA
Congress Topic: Prosthetics : Upper Limb
Session Title: ICS Code 52 - Advances In Upper Limb Prosthetics
Room: G.02 & G.03
Chair: Professor Peter J Kyberd
Presenters: Laura Miller, Ali Hussaini
The advances in the mechanical designs of prosthetic hands has begun to produce real changes in the options
available to the industry. With new designs, the need for more effective control for these devices has become
more pressing. One possibility is to build intelligence into the prosthesis, so that the co-ordination of the muscles
developed for natural motion can be used by the operator with little additional training. This is Pattern Recognition
(PR) of the muscle signals, the computer selects the patterns in the muscle activity and controls the axis of the
arm directly.
While this has been a popular research idea for decades, it is only in recent years that this has been possible
to consider this in a clinical environment, several groups are now beginning to apply the idea in the field. While
the ideas behind the technology are complex, it is possible to make the application as simple and straightforward
as other aspects of modern high technology. PR can be used with users with Targeted Muscle Reinnervation
surgery, but it can also be used with persons with conventional losses and absences. One surprising result of
PR is that while it aimed at processing signals from multiple channels, the same technology makes simpler two
channel control easier to fit and use.
This symposium will explain the current state of the art of clinical Pattern Recognition control. The speakers will
discuss the prosthetic considerations for electrode placement. They will outline the training of users and the
Occupational Therapy needed.
466
Wednesday, Feb 6, 09:00-10:15
Congress Topic: Technology
Session Title: ICS Code 29 - Robotic Exoskeletons And Orthotics
Room: 1.01 & 1.02
SYMPOSIA
Chair: Edward Lemaire
Presenters: Ed Lemaire, Yuichiro Honda
Powered orthotic systems, or robotic exoskeletons, are emerging as viable options for people with lower extremity
mobility deficits. These devices provide joint moments and forces to enable activities that cannot be achieved
with traditional energy storing orthotic devices. Various approaches have been explored; including, self-stabilizing
walking frames, partial body weight assist devices, and wearable powered assist.
This symposium will present the state-of-the-art in powered orthotic/exoskeleton devices and discuss the future
for these technologies in clinical care.
467
SYMPOSIA
Wednesday, Feb 6, 14:30-15:45
Congress Topic: Seating & Wheelchair
Session Title: ICS Code 53 - Wheelchair Consensus Conference, Guidelines And Training Packages
Room: G.02 & G.03
Chair: Rob Horvath
Presenters: Aaron Leung, Chapal Khasnabis, David Constantine, Ritu Ghosh
The wheelchair is one of the most commonly used assistive devices for enhancing personal mobility, which
is a precondition for enjoying human rights and living in dignity and assists people with disabilities to become
more productive members of their communities. For many people, an appropriate, well designed and well fitted
wheelchair can be the first step towards inclusion and participation in society.
The United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities, the Convention
on the Rights of Persons with Disabilities and World Health Assembly resolution WHA58.23, which deals with
disability including prevention, management and rehabilitation, all emphasize the importance of wheelchairs and
other assistive devices. To ensure that people with disabilities can access an appropriate wheelchair, especially in
less resourced parts of the world, WHO developed the Guidelines on the provision of manual wheelchairs in less
resourced settings based on the recommendations from the Wheelchair Consensus Conference, in partnership
with the United States Agency for International Development (USAID) and the International Society for Prosthetics
and Orthotics (ISPO).
However, providing an appropriate wheelchair to every user will remain a distant dream unless and until, we have
properly trained human resources especially the rehabilitation professional on wheelchair service provision. In
spite of the fact, wheelchair is one of the most common assistive devices which empowers the users and facilitates
their inclusion and participation, there are not enough information or study-hours in existing rehabilitation courses
across the world. In order develop a good wheelchair delivery system based on the Wheelchair guidelines, WHO
in partnership has developed Wheelchair Service Training Package - Basic and Intermediate Level.
The proposed symposium will help to achieve the ultimate aim of the Wheelchair Service Training Package, which
are:
i. increase the number of wheelchair users who receive a wheelchair which meets their needs, facilitates their
empowerment, inclusion and participation;
ii. increase the number of wheelchair users who receive training in the use and maintenance of wheelchairs and
how to stay healthy in a wheelchair;
iii. increase the number of personnel trained in basic-level wheelchair service delivery;
iv. improve the competencies of wheelchair service providers and therefore the quality of wheelchair service
delivery;
v. include wheelchair service training in regular paramedical/rehabilitation training programmes; and
vi. achieve greater integration of wheelchair service delivery into rehabilitation services.
468
Wednesday, Feb 6, 14:30-15:45
Congress Topic: Orthotics: Lower Limb
Session Title: ICS Code 22 - Can Orthoses Enhance Postural Stability? Implications For Fall Prevention
Room: G.04 & G.05
SYMPOSIA
Chair: Mr. Sam Y.C.Law
Presenters: Junji Katsuhira, Klaas Postema, Sam YC Law, Simon FT Tang
Postural stability and balance may be affected in many spinal or lower-limb disorders. Injuries resulting from a fall
incidence, e.g. hip fracture, can cause profound impact on quality-of-life of patient and increase burden to their
family and caregiver. Moreover, it would cause significant economical impact to the healthcare system of our aging
society.
Orthoses are commonly prescribed for patient complaint of pain and deformities. However, orthotic prescription
for fall prevention is rare in the current practice. Although hip protectors are commonly prescribed for hip fracture
prevention, however, cost-effectiveness is limited by patient compliance. For community-dwelling elderly,
assessment of fall risk, identification of fall risk factors, and implementation of interventions are common strategies
for fall prevention.
To become an intervention for fall prevention, evidence-based effectiveness of orthoses on postural stability
enhancement for different pathologies should be fully understood. Simple but reliable assessment should be
provided to orthotists for assessing the pathology of instability as well as the degree of improvement with orthoses.
With support of clinical researches, application of orthoses could be a cost-effective measure for fall prevention
of patients in the future. Therefore, effectiveness of functional enhancement on postural stability using orthoses
should be discussed in the 14th world congress of the ISPO.
In this symposium, current evidence on orthotic function for postural stability enhancement for elderly, stroke, knee
osteoarthritis, and elderly with hallux valgus would be reported. Simple but reliable assessment for assessing the
pathology and monitoring the effectiveness would be discussed.
469
Thursday, Feb 7, 09:00-10:15
SYMPOSIA
Congress Topic: Orthotics: Lower Limb
Session Title: ICS Code 36 - AFO Biomechanics
Room: G.04 & G.05
Chair: Jaap Harlaar
Presenters: Jaap Harlaar, Elaine Owen, V. de Groot, S. Yamamoto
There is an increasing awareness that a specific patient-orthosis match is the key to optimal functioning of the
patient. For Ankle Foot Orthoses (= AFO, in fact the AFO -Shoe combination) providing this match requires: a) that
the AFO is characterized in mechanical parameters, and b) a biomechanical analysis of the walking pattern of the
patient to characterize specific deficiencies.
Recent studies taking this approach have focused on the biomechanical evaluation of the patient orthosis match.
Those studies informed about the working mechanisms of AFO’s i.e. how walking performance is promoted by
the interaction of the mechanics of the AFO and the walking patterns of the patient. This has resulted in treatment
algorithms on AFO selection and tuning of AFO shoes combinations in patients.
In this symposium state of the art knowledge on biomechanics of AFO are summarized, and consequences for
clinical practice and future research are discussed.
470
Thursday, Feb 7, 09:00-10:15
Chair: Marco Cavallaro
Presenters: Marco Cavallaro, Carlo Frigo, Maria Grazia Benedetti
Prosthetics and orthotics (P&O) are extremely customized devices. They work properly when they are well
designed and above all when they fit properly with the anatomic part of the body in interaction. Nowadays many
digital technologies are used to better understand the static and dynamic information which are then used to design
and manufacture P&O items. Although the digital technologies are spread and used in the diagnostic context along
with the biomechanical analysis, the results are not properly integrated with the manual and traditional approaches
used to manufacture prosthetics and orthotics.
The manual approach is justified by an economic point of view since it is cheaper compared to industrial and
automated processes, applied here for individual production. The current manufacturing methods make the P&O
device not adequately accurate and they do not include most of the static and dynamic information acquired
through diagnostic technologies and morphology scan of the body part. Moreover, the outcome of designed
equipments depends strictly on the P&O technician experience, which is connected to an individual person who
is not well formed about engineering topics. Advanced systems could enable orthotic and prosthetic devices
providing a better fit and a shorter manufacturing time over more traditional solutions.
This scientific symposium could review the additional benefits realized from using these innovative options and
also examines the technology involved in the systems. Further, real world case studies will be shared to illustrate
the advantages.
471
SYMPOSIA
Congress Topic: Technology
Session Title: ICS Code 33 - Manufacturing Technologies: The Digital Approach To Design And Production
Of Prostheses And Orthoses
Room: 1.01 & 1.02
Thursday, Feb 7, 12:00-13:15
SYMPOSIA
Congress Topic: Developing Countries
Session Title: ICS Code 43 - Haiti 2010 Earthquake: Lessons Learned After 3 Years
Room: G.04 & G.05
Chair: Al Ingersoll
Presenters: Al Ingersoll, Karl-Heinz Trebbin, Mary Kwasniewski, Claude Tardif
Haiti’s January 12, 2010 Earthquake Lesson’s Learned: Multiple Discipline Review of disaster, response,
development and current situation. One of the largest humanitarian responses in recorded history encompassed
many aspects of the physical medicine and rehabilitation community and to learn from must be evaluated and
critiqued.
This symposium brings together leaders from all levels of the response for presentations, panel discussion and
audience participation hosted by the only pre-earthquake full time functioning organization.
472
SYMPOSIA
EXHIBITOR’S WORKSHOPS
473
Monday February 4, 2013 / Room G.01
Time
Company
Speaker
Title
12:00 - 12:35 DIERS International
GmbH
Narasimman
Swaminathan
Rasterstereography - A tool in clinical decision
making
12:40 - 13:15 Medi
Wiebe Heidema
Discussion on phantom limb pain in lower
extremity
14:30 - 15:05 Wagner
Polymertechnik
GmbH
Youssef Salam
SALARM liner, socketless solution for upper
extremity
15:10 - 15:45 DARCO (Europe)
GmbH
Raphael Boehm
Orthopedic Footwear and the Diabetic Foot. A
challenge - not only but also in India
16:15 - 17:30 Touch Bionics
Colin Egan
I-Limb Ultra
Tuesday, February 5, 2013 / Room G.01
Time
Company
Speaker
09:00 -10:15
Otto Bock
HealthCare GmbH
Martin Pusch
Lean development of prosthetic components –
challenges, tools and solving strategies
Title
12:00 - 13:15 Össur
Dr. Thorvaldur
Ingvarsson, M.D.,
Ph.D.
The OA Epidemic – An overview of prevalence
and causes of Knee Osteoartritis and treatment
options, with specific focus on the Unloader One
knee brace as a clinically proven, non-invasive
treatment option for Unicompartmental Knee OA.
14:30 - 15:45 Rodin 4D
Luc Boronat
Mickael
Guimberteau
Improve your work and patient care with
CADCAM
16:15 - 17:30 medi
Wiebe Heidema
medi Panthera CF, Evolution in Dynamics
Spinomed: New options for treatment of
osteoporotic vertebral fractures
Gonarthrosis treatment with functional OAbraces
474
Wednesday, February 6, 2013 / Room G.01
Time
Company
Speaker
09:00 -10:15
Vorum
Michelle Wymer
Title
CANFIT: Transforming P&O Practices using
CAD/CAM solutions
12:00 - 13:15 Freedom Innovations Leroy Oddie, C.P.
Freedom Innovations - Advanced Lower Limb
Prosthetics
14:30 - 15:45 Össur
Knut Lechler,
CPO-D
Outcome Focused Solutions for Low Active
Users
16:15 - 17:30 DIERS International
GmbH
Dipl. Ing. Helmut
Diers
New standard in functional analysis of the
musculoskeletal system
Thursday, February 7, 2013 / Room G.01
Time
Company
Speaker
Title
09:00 -10:15
Tekscan
Prof. Nachi
Chockalingam
Usefulness of Pressure mapping in the
Prescription of Prosthetics and Orthotics
12:00 - 13:15 Fillauer
Harold Sears/
Edwin Iversen
Upper Extremity: Advances for Elbow, Wrist and
Terminal Devices
14:30 - 15:45 Fillauer
Michael Fillauer
Lower Extremity: Foot Advances in Performance
and Comfort
475
Index of Presenters
A
Blumentritt, S. 426
Abdul Razak, N. 399
Boere, D. 164
Agrawal, V. 136, 220, 248, 251, 377
Bongers, R. 166, 192
Akhtar, N. 401
Bonikowski, M. 199, 366
Aklotsoe, K. 174, 338
Boone, D. 453
Ali, A. 138
Bowers, R. 152, 153, 329
Ali, J. 323
Brånemark, R. 299, 454
Ali, M. 295
Brannigan, E. 94
Ali, S. 262
Bruecker, E. 434
Alkhattab, R. 317
Budaker, B. 203
Alsancak, S. 268, 331
Buis, A. 76, 93, 108, 464
Ammanath, P. 215
Burger, H. 112, 140, 460
Amtmann, D. 100, 263, 282, 388
Burgess, L. 423
Anderson, S. 292
Buurke, J. 457, 462
Andrysek, J. 54, 119, 286
C
Aroojis, A. 436
Caine-Winterberger, K. 236
Arun, S. 398
Cairns, N. 250
Asami, T. 181
Campbell, J. 356, 431
Athani, B. D. 424
Carvalho, J. 336
B
Cavallaro, M. 241, 471
Babariya, H. 392
Chandrakala, T. 341
Balram, K. 340
Chang, Y. 397
Batten, H. 73
Chawla, D. 424
Batzdorff, J. 60
Cheng, H. 217
Becher, J. 435
Chitnis, A. 440
Bellmann, M. 40, 426, 447
Chittoor, S. 297, 412, 413
Benedetti, M. G. 438, 471
Cole, M. 51
Berg Lissel, E. 206
Cole-Hamilton, J. 461
Berli, M. 254
Constantine, D. 221, 468
Berlin, Ö. 258
Cortes, J. 428
Bhanti, A. V. 425, 441
Cox, A. 372, 373
Bhowmik, S. 318, 347
Crimin, A. 56, 383
Blocka, D. 442
Curran, S. 351
Blomkvist, A. 216
Curran, S. A. 439
476
D
G
Dallmejer, A. 435
Gada, L. 456
Dash, M. 283
Gailey, R. 52, 118, 148, 207
Datta, T. 334
Gallagher, P. 408, 452
Datta, T. K. 430
Gard, S. 107, 158, 182
Davidson, E. 179, 240, 353
Gautam, S. 50, 430
de-Groot, V. 470
Geurts, A. C.H. 434
DeHarde, M. 364, 440
Gholizadeh, H. 58
Dekker, R. 146
Ghosh, R. 468
Den Boer, J. 434
Göbel, K. M C. 98
Desmond, D. 452
Gomez, J. M. 425
Dhar, B. 296
Gonzalez, R. 244
Donanvan-Hall, M. 452
Goodwin, A. 167
Donauer, A. 458
Gorki, C. 333
Doshi, M. 436, 456
Grasl, C. 177
Doshi, N. 327
Grisetti, G. 321
Dukendjieva, T. 335
Guillaume, T. 428
Dussa, C. 287
H
E
Hafner, B. 49, 99, 147, 278
El-Hilaly, R. 169
Haga, N. 252
Emmelot, K. 432
Hagberg, K. 160, 454
Eshraghi, A. 224, 232
Haggstrom, E. 230, 453, 454, 463
Esquenazi, A. 227
Hamer, B. 421
Ewoi, R. 325
Hamzaid, N. 173
F
Hanajima, T. 226
Fatone, S. 43, 211, 238, 443
Fiedler, G. 453
Fisher, D. 55
Fransson, A. 63
Frigo, C. 384, 471
Frossard, L. 369, 370, 393, 453
Hansen, A. 127, 256, 459, 462
Hara, K. 343
Harlaar, J. 470
Hasanovic, E. 433
Hashimoto, H. 210
Heang, T. 175
Heinemann, A. 271, 452
Heitzmann, D. 161, 183
Hermansson, L. 270, 322, 422, 422
477
Heymann, I. 68
Kampas, P. 200
Hichert, M. 194, 233, 455
Kannenberg, A. 45, 77
Highsmith, J. 57
Katsuhira, J. 469
Hijmans, J. 352, 386
Kaufman, K. 41, 431
Hirons, C. 423
Kavarthapu, V. 424
Honda, Yuichiro 467
Kazemi, F. 75
Humphrey, B. 279
Kerkum, Y. 178
Hussaini, A. 195, 234, 466
Khasnabis, C. 289, 468
I
Kheng, S. 61
Idusuyi, O. B. 441
Kim, B. 106, 176
Illgner, U. 91, 239, 293, 294
Kim, G. 357
Ingersoll, A. 472
Kimura, H. 82
Ingvarsson, T. 446
Kistenberg, R. 332
Inoue, K. 264
Kito, N. 429
Iversen, E. 202, 414
Koehler, S. 231, 376
J
Kohler, F. 460, 460
Jabeen, U. 189
Jacobs, M. 400
Jain, M. K. 436, 436
Jang, S. H. 428, 428
Janisse, D. 354, 427
Jayaraman, A. 42, 97, 269
Konishi, Y. 89
Kregling, A. 110, 186
Kulshreshtha, T. 445
Kumari, M. 222
Kwasniewski, M. 472
Kyberd, P. 81, 122, 163
Jensen, K. R. 98
L
Johannesson, A. 432
Lacraz, A. 114, 380, 381
Johari, A. 440
Lalor, S. 85
Jonasson, J. 101
Landauer, F. 362
Jørgensen, P. 131
Larsson, G. 465
Juhnke, D. 87, 454
Latifagic, M. 433
K
Law, S. 151
Kaastad, T. 288
Kaewtip, S. 319
Kahle, J. 157
Kakaiya, R. 197
Kalavalapalli, S. 424
Kalmar, J. 80, 121
478
Law, S. Y. C. 429, 469
Lawrence, D. 208
Lee, P. V. S. 464
Lee, S. 285
Lemaire, E. 249, 439, 466
Leung, A. 439, 468
Li, M. 218
Lin, C. 84
Lindner, H. 124, 422, 422
N
Nagakura, Y. 385
Lohmander, S. 446
Nakamura, T. 375
Lou, E. 458
Nakanishi, Y. 70
Ludviksdottir, A. 117, 155, 180
Nanda, A. 387
M
Nederhand, M. 95
Magnusson, L. 162, 184, 201
Nervegna, T. 438
Maharana, S. 324
Neumann, E. S. 453
Masilamani, V. 191
Neumann, W. C. 433
Masuhara, B. 219
Ngendahayo, D. 308
Mathur, M. K. 445
Nikamp, C. 47
McCarthy, J. 214, 229, 260
Nilsen, R. 461
McGarry, A. 71, 281, 415
Ninomiya, M. 204
McGarry, T. 464
O
McGeachan, P. 267
Odeyo, J. 59
Mehdikhani, M. 368
Odom, T. 461
Mendieta, G. A. 421
O'Hare, M. 66, 67
Meulenbelt, H. 290
Oinam, S. 365
Miguelez, J. 275
Ojha, N. 237, 342
Miller, L. 129, 235, 259, 466
Omarsdottir, G. 245, 265
Mirza, Z. 402
Ongubo, P. 280
Mishra, A. 350
Ortiz Catalan, M. 273, 277
Mlakar, M. 88
Ostler, C. 53
Mohanty, R. 337
Owen, E. 459, 470
Mohsin, F. 120
P
Möller, S. 432
Montes, J. 113
Moulic, S. 272, 444
Muderis, M. A. 454
Muhammad, S. 246
Mukul, P. 445
Munasinghe, C. 442
Munjal, R. 196, 328
Murray, K. 320
Pal, S. 339
Pandey, R. 367
Pantal, A. 463
Papaioannou, G. 453
Paulas, R. 128, 315
Penny, N. 436
Phillips, S. 439
Plettenburg, D. H. 439, 455, 455
Postema, K. 170, 462, 469
Postema, S. 193
479
Prabhakar, M. M. 456
Schlierf, C. 433
Prange, G. 457
Schmalz, T. 46
Primett, K. 403
Schmidt, V. 346
Prinsen, E. 96, 109, 130
Schott, K. 427
Q
Scolnik, N. 62
Quake, T. 284
Sears, H. 276
Qurashi, V. 314, 326, 358
Sengiad, S. 345, 442
R
Sensinger, J. 125, 165, 395, 396
Ragnö, C. 422
Raihan, A. 430
Ramakrishna, P. 424
Richards, J. 44
Rietman, J. 274, 457
Rizzi, C. 157
Roffman, C. 39
Roller, M. 242
Romkema, S. 123
Ros, T. 442
Ross, J. 111, 132
Ross, K. 65, 344, 431
Rossi, M. 438
Rout, S. 172
Ruder, G. 442
Rujiwetpongstorn, V. 311
Rusaw, D. 74, 92
Ryall, N. 142
S
Sepin, W. 349
Seshabhattaru, S. 424
Sexton, S. 135, 247
Shandilya, V. 456
Shangali, H. 461
Sharan, D. 143, 198, 253, 360, 409, 444
Sharma, S. 213
Shataeva, E. 190, 359
Sidhu, P. 405
Siev-Ner, I. 72, 313, 363
Sims, T. 103
Singh, N. 150
Singh, P. 316
Sinha, P. 436, 440
Smit, G. 455
Smith, F. 255, 465
Söderberg, B. 465
Solomonidis, S. 83
Song, J. 382
Sooriakumaran, S. 90, 116, 141, 410
Sakai, K. 330
Spruit- Van Eijk, M. 298
Samala, M. 188
Stalin, M. 154
Samson, A. 447
Starholm, I. 134
Saraf, A. 115
Steenbeek, M. 139, 209, 436
Sayyadfar, M. 144
Stenström, A. 465
Schack, J. 145
Stockselius, A. 422
Schenkeveld, K. 212
Stumpf, D. 427
480
Sundgren, H. 159, 371
Suzuki, A. 102
Swatton, D. 171
T
W
Wada, F. 86
Wang, L. 225
Whitehead, L. 133
Taneja, D. K. 436
Wojtusch, J. 185, 228
Tang, S. F. T. 469
Wong, M. S. 458
Tang, U. 168, 462
Wu, Y. 257, 378, 379
Tardif, C. 472
X
Teap, O. 149
Thurston, A. 465
To, S. 310
Tomaszewski, P. 463
Torrealba, R. 137, 205
Torsdatter, L. H. 461
Trebbin, K. H. 472
Xu, J. 460, 460
Y
Yadav, J. 312
Yadav, S. 355
Yamamoto, S. 470
Yazicioglu, K. 406, 407
Trivedi, H. 69, 430
Z
Troncossi, M. 64, 394
Zahid, Z. 105
Tschupp, G. 389
Zampini, W. 421
U
Zati, A. 438
Uchida, M. 187
Uellendahl, J. 390, 391
Uppal, H. 266
Urseau, I. 309
Zelaya, C. 421
Zia, M. 243
Zissimopoulos, A. 48
Zugner, R. 104, 348
V
Van Der Sluis, C. 79
Van Kuppevelt, D. 411
Van Twillert, S. 126
Vasluian, E. 78, 291
Veer, S. 223
Verstriest, S. 463
Vimal, A. 213
481
482
483
484
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