Residual limb shear strain during gait is correlated with patient reported outcomes for persons with transfemoral amputation

Gale, Tom; Yang, Shumeng; McGough, Richard L.; Fiedler, Goeran; Anderst, William

doi:10.1016/j.jbiomech.2021.110826

Cited by 2 publications

(3 citation statements)

References 22 publications

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“…Given an effect size of 1.75 and an α of .05 for a paired t test, a sample size of 21 will be powered at >99% to detect differences between EV on and off. For skin strain, Gale et al [30] found a maximum shear strain of approximately 0.08. Assuming a shear strain of 0.08 with a moderate effect size of 0.75 (α=.05), a sample size of 21 will be required to achieve 90% power to detect differences between EV on and off.…”

Section: Power Analysismentioning

confidence: 99%

“…Motion between the bone and the skin (skin deformation) and motion between the skin and the inner surface of the liner will be examined simultaneously with bone movement in the prosthetic socket. Motion between these interfaces can be directly associated with discomfort while wearing a prosthesis [3,30]. In addition, motion between the socket and both the skin and inner surface of the liner will be examined for a complete understanding of the motion between the limb and the prosthesis.…”

Section: Quantification Of Skin and Liner Deformationmentioning

confidence: 99%

“…Other techniques, such as magnetic resonance imaging and CT, can be used to evaluate in vivo strains, but they are also limited by static protocols, low resolution, motion artifacts, and shape distortion [29]. Gale et al [30] used DSX to measure residual limb skin strain and strain rate for individuals with transfemoral limb loss during gait and found that shear strain increased from proximal to distal regions of the residual limb. The proposed investigation will use time-efficient and highly accurate analytical techniques to measure in-socket residual limb skin strain for individuals with transtibial limb loss during dynamic activities.…”

Section: Introductionmentioning

confidence: 99%

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Quantifying Bone and Skin Movement in the Residual Limb-Socket Interface of Individuals With Transtibial Limb Loss Using Dynamic Stereo X-Ray: Protocol for a Lower Limb Loss Cadaver and Clinical Study

Maikos,

Chomack,

Herlihy

et al. 2024

JMIR Res Protoc

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Background Relative motion between the residual limb and socket in individuals with transtibial limb loss can lead to substantial consequences that limit mobility. Although assessments of the relative motion between the residual limb and socket have been performed, there remains a substantial gap in understanding the complex mechanics of the residual limb-socket interface during dynamic activities that limits the ability to improve socket design. However, dynamic stereo x-ray (DSX) is an advanced imaging technology that can quantify 3D bone movement and skin deformation inside a socket during dynamic activities. Objective This study aims to develop analytical tools using DSX to quantify the dynamic, in vivo kinematics between the residual limb and socket and the mechanism of residual tissue deformation. Methods A lower limb cadaver study will first be performed to optimize the placement of an array of radiopaque beads and markers on the socket, liner, and skin to simultaneously assess dynamic tibial movement and residual tissue and liner deformation. Five cadaver limbs will be used in an iterative process to develop an optimal marker setup. Stance phase gait will be simulated during each session to induce bone movement and skin and liner deformation. The number, shape, size, and placement of each marker will be evaluated after each session to refine the marker set. Once an optimal marker setup is identified, 21 participants with transtibial limb loss will be fitted with a socket capable of being suspended via both elevated vacuum and traditional suction. Participants will undergo a 4-week acclimation period and then be tested in the DSX system to track tibial, skin, and liner motion under both suspension techniques during 3 activities: treadmill walking at a self-selected speed, at a walking speed 10% faster, and during a step-down movement. The performance of the 2 suspension techniques will be evaluated by quantifying the 3D bone movement of the residual tibia with respect to the socket and quantifying liner and skin deformation at the socket-residuum interface. Results This study was funded in October 2021. Cadaver testing began in January 2023. Enrollment began in February 2024. Data collection is expected to conclude in December 2025. The initial dissemination of results is expected in November 2026. Conclusions The successful completion of this study will help develop analytical methods for the accurate assessment of residual limb-socket motion. The results will significantly advance the understanding of the complex biomechanical interactions between the residual limb and the socket, which can aid in evidence-based clinical practice and socket prescription guidelines. This critical foundational information can aid in the development of future socket technology that has the potential to reduce secondary comorbidities that result from complications of poor prosthesis load transmission. International Registered Report Identifier (IRRID) DERR1-10.2196/57329

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Section: Power Analysismentioning

confidence: 99%

Section: Quantification Of Skin and Liner Deformationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quantifying Bone and Skin Movement in the Residual Limb-Socket Interface of Individuals With Transtibial Limb Loss Using Dynamic Stereo X-Ray: Protocol for a Lower Limb Loss Cadaver and Clinical Study

Maikos,

Chomack,

Herlihy

et al. 2024

JMIR Res Protoc

View full text Add to dashboard Cite

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Quantifying Bone and Skin Movement in the Residual Limb-Socket Interface of Individuals With Transtibial Limb Loss Using Dynamic Stereo X-Ray: Protocol for a Lower Limb Loss Cadaver and Clinical Study (Preprint)

Maikos,

Chomack,

Herlihy

et al. 2024

Preprint

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BACKGROUND Relative motion between the residual limb and socket in individuals with transtibial limb loss can lead to substantial consequences that limit mobility. Although assessments of the relative motion between the residual limb and socket have been performed, there remains a substantial gap in understanding the complex mechanics of the residual limb-socket interface during dynamic activities that limits the ability to improve socket design. However, dynamic stereo x-ray (DSX) is an advanced imaging technology that can quantify 3D bone movement and skin deformation inside a socket during dynamic activities. OBJECTIVE This study aims to develop analytical tools using DSX to quantify the dynamic, in vivo kinematics between the residual limb and socket and the mechanism of residual tissue deformation. METHODS A lower limb cadaver study will first be performed to optimize the placement of an array of radiopaque beads and markers on the socket, liner, and skin to simultaneously assess dynamic tibial movement and residual tissue and liner deformation. Five cadaver limbs will be used in an iterative process to develop an optimal marker setup. Stance phase gait will be simulated during each session to induce bone movement and skin and liner deformation. The number, shape, size, and placement of each marker will be evaluated after each session to refine the marker set. Once an optimal marker setup is identified, 21 participants with transtibial limb loss will be fitted with a socket capable of being suspended via both elevated vacuum and traditional suction. Participants will undergo a 4-week acclimation period and then be tested in the DSX system to track tibial, skin, and liner motion under both suspension techniques during 3 activities: treadmill walking at a self-selected speed, at a walking speed 10% faster, and during a step-down movement. The performance of the 2 suspension techniques will be evaluated by quantifying the 3D bone movement of the residual tibia with respect to the socket and quantifying liner and skin deformation at the socket-residuum interface. RESULTS This study was funded in October 2021. Cadaver testing began in January 2023. Enrollment began in February 2024. Data collection is expected to conclude in December 2025. The initial dissemination of results is expected in November 2026. CONCLUSIONS The successful completion of this study will help develop analytical methods for the accurate assessment of residual limb-socket motion. The results will significantly advance the understanding of the complex biomechanical interactions between the residual limb and the socket, which can aid in evidence-based clinical practice and socket prescription guidelines. This critical foundational information can aid in the development of future socket technology that has the potential to reduce secondary comorbidities that result from complications of poor prosthesis load transmission. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/57329

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Residual limb shear strain during gait is correlated with patient reported outcomes for persons with transfemoral amputation

Cited by 2 publications

References 22 publications

Quantifying Bone and Skin Movement in the Residual Limb-Socket Interface of Individuals With Transtibial Limb Loss Using Dynamic Stereo X-Ray: Protocol for a Lower Limb Loss Cadaver and Clinical Study

Quantifying Bone and Skin Movement in the Residual Limb-Socket Interface of Individuals With Transtibial Limb Loss Using Dynamic Stereo X-Ray: Protocol for a Lower Limb Loss Cadaver and Clinical Study

Quantifying Bone and Skin Movement in the Residual Limb-Socket Interface of Individuals With Transtibial Limb Loss Using Dynamic Stereo X-Ray: Protocol for a Lower Limb Loss Cadaver and Clinical Study (Preprint)

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