Does Activity Affect Residual Limb Skin Temperatures?

Abstract

Background Many lower limb amputees experience thermal discomfort as a result of wearing a prosthesis. The development of new prosthetic technology to address thermal discomfort requires an understanding of how activity (or inactivity) affects residual limb skin temperatures and how skin temperatures are mapped across the skin-prosthesis interface. Questions/purposes We studied skin temperatures inside the socket and suspension system of unilateral transtibial amputees to determine the following: (1) Does residual limb skin temperature change as a function of activity and its cessation? (2) If changes occur, are there regional differences (circumferential or proximal-distal) in temperature? Methods Nine unilateral transtibial amputees provided informed consent to participate in this institutional review board-approved study. Residual limb skin temperatures inside their prosthesis were measured at 16 distributed sites using thermistor sensors and a portable data acquisition system. The 150-minute protocol began with a 60-minute seated rest, continued with a 30-minute treadmill walk at a self-selected speed, and concluded after a second 60-minute seated rest. Data from the last minute of each of the three periods were used for analysis. Results The skin temperature was 31.0°± 1.5°C (mean ± SD) at the end of the initial rest period. After 30 minutes of treadmill walking, skin temperature increased to 34.1°± 1.3°C, an increase of 3.1°C (95% confidence interval [CI], 2.4-3.8; p \ 0.001). After the final 60 minutes of rest, the skin temperature was 33.2°± 1.2°C, 0.9°C lower (95% CI, 0.5-1.2; p \ 0.001) than at the end of treadmill walking but 2.2°C higher (95% CI, 1.4-2.9; p \ 0.001) than the temperature observed at the end of the initial rest period. Skin temperatures were warmest over the tibialis anterior region (p \ 0.006) and decreased from the most proximal to the most distal locations on the residual limb (p = 0.001). Conclusions Walking causes a dramatic increase in skin temperatures inside the prosthesis and subsequent rest of

Residual limb skin temperature and thermal comfort in people with amputation during activity in a cold environment

“…After donning a prosthesis and resting for 15 min, residual limb skin temperatures increased by just under 1°C, with further increases after 10 min of slow walking at room temperature [1]. Klute et al expanded on this research, reporting a similar temperature increase after donning a prosthesis, eventually reaching steady state after 25 min [2]. They reported a continuous increase in skin temperature up to 3.1°C [2.4°C to 3.8°C] after 30 min of walking at 0.7 m/s at room temperature, which was similar to the present study's increase of 2.6°C [1.8°C to 3.5°C] despite ambient temperatures that were at least 20°C colder.…”

“…The residual limb skin temperatures of people with lower-limb amputation increase after merely donning a prosthesis and continue to rise at a rate contingent on activity level [1][2]. These elevated skin temperatures negatively affect quality of life for individuals with amputation, with more than 53 percent reporting discomfort from heat and/or perspiration inside their prosthetic socket in 38 reviewed studies [3].…”

“…Without a prosthesis, the residual limb of a person with amputation is on average 1°C cooler than the contralateral limb [7], suggesting that maintaining lower skin temperatures through improved socket technology may be warranted. A prior study examined residual limb skin temperatures (n = 9) during a 30 min walking session in a moderate ambient room temperature (~20°C) and reported a 3°C increase in skin temperature followed by little cooling (<1°C) after prolonged rest (60 min) [2]. Mathur et al also reported a residual limb skin temperature increase (2°C) during a 10 min walk at 0.6 m/s in a 20°C chamber (n = 1), but temperatures remained constant when the chamber temperature was 10°C [8].…”

The effect of liner design and materials selection on prosthesis interface heat dissipation

“…3,5,7 Prosthesis impermeability means sweat cannot evaporate, and when this hot and sweaty interface is subjected to ambulation forces, skin damage can rapidly occur. 6,[8][9][10][11] Components that aim to minimize or delay heat and sweat discomfort are emerging, 12,13 but more studies are required to comprehensively determine their efficacy. 14, 15 Klute et al 16 suggested that increasing the thermal conductivity of interface components could improve heat transport and suggested that the liner material has a greater effect on skin temperature, in comparison to the socket component as it is thinner.…”

Use of infrared thermography as a tool to monitor skin temperature along the recovery process of an anterior cruciate ligament surgery

“…(Priego et al, 2015;Klute et al, 2014;Badza et al, 2012;Akimov et al, 2009;Bagarone, 1987;BenEliyahu, 1990BenEliyahu, , 1992Bertmaring, 2008;Čoh & Širok, 2007;Ferreira et al, 2008;Garagiola & Giani, 1990Gómez Carmona et al, 2008;Gross et al, 1989;Hildebrandt & Raschner, 2009;Hildebrandt et al, 2010;Katz et al, 2008;Keyl & Lenhart, 1975;Mangine et al, 1987;Pochaczevsky, 1987;Rochcongar & Schmitt, 1979;Roehl et al, 2009;Sillero Quintana, et al, 2010;Tkacova, 2010;Vainer, 2000) have defended its use in sports and health.…”