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Dynamic alignment using external socket reaction moments in trans-tibial amputees.

N Jonkergouw1, M R Prins2, P van der Wurff3

  • 1Orthopedie Techniek Aardenburg, Military Rehabilitation Centre Aardenburg, Doorn, The Netherlands; Department of Research and Development, Military Rehabilitation Centre Aardenburg, Doorn, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Department of Biomedical Engineering, Faculty of Biomechanical Engineering, University of Strathclyde, Glasgow, Scotland, United Kingdom.

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|November 26, 2018
PubMed
Summary

This study explored using external socket reaction moments (ESRM) to fine-tune prosthetic alignment in transtibial amputees. While ESRM improved alignment, it did not significantly change socket comfort scores.

Keywords:
AlignmentGait analysisProstheticQuantificationTrans-tibial

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Area of Science:

  • Prosthetics and Biomechanics
  • Gait Analysis
  • Rehabilitation Engineering

Background:

  • Traditional prosthetic alignment relies on spatio-temporal and kinematic gait parameters, which can be affected by compensatory movements.
  • External Socket Reaction Moments (ESRM) offer a potential alternative for quantifying prosthetic alignment by measuring moments at the socket base.

Purpose of the Study:

  • To investigate the efficacy of a kinetic alignment criterion (0 Nm average ESRM) for refining prosthetic alignment in transtibial amputees.
  • To assess changes in gait parameters and socket comfort following alignment adjustments guided by ESRM.

Main Methods:

  • 10 transtibial amputees underwent conventional prosthetic alignment (IA).
  • Coronal plane ESRM was measured during gait and used in real-time to guide iterative alignment adjustments towards a 0 Nm target (FA).
  • Kinetic parameters and Socket Comfort Score (SCS) were compared between IA and FA conditions using paired t-tests.

Main Results:

  • A significant reduction in absolute coronal plane ESRM was observed from IA to FA (p<0.001).
  • External coronal adduction knee moments also changed significantly but with greater inter-participant variability (p<0.001).
  • No significant change in Socket Comfort Score (SCS) was found between alignment conditions (p=0.37).

Conclusions:

  • Quantifying and guiding prosthetic alignment using kinetic criteria like ESRM shows promise.
  • Sole reliance on ESRM as a singular alignment criterion may be insufficient for optimizing overall prosthetic outcomes, including comfort.