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Automated transtibial prosthesis alignment: A systematic review

Khamis T, Khamis AA, Al Kouzbary M, Al Kouzbary H, Mokayed H, AbdRazak NA, et al.

Artif Intell Med, 2024 Oct;156:102966.
PMID: 39197376 DOI: 10.1016/j.artmed.2024.102966

This comprehensive systematic review critically analyzes the current progress and challenges in automating transtibial prosthesis alignment. The manual identification of alignment changes in prostheses has been found to lack reliability, necessitating the development of automated processes. Through a rigorous systematic search across major electronic databases, this review includes the highly relevant studies out of an initial pool of 2111 records. The findings highlight the urgent need for automated alignment systems in individuals with transtibial amputation. The selected studies represent cutting-edge research, employing diverse approaches such as advanced machine learning algorithms and innovative alignment tools, to automate the detection and adjustment of prosthesis alignment. Collectively, this review emphasizes the immense potential of automated transtibial prosthesis alignment systems to enhance alignment accuracy and significantly reduce human error. Furthermore, it identifies important limitations in the reviewed studies, serving as a catalyst for future research to address these gaps and explore alternative machine learning algorithms. The insights derived from this systematic review provide valuable guidance for researchers, clinicians, and developers aiming to propel the field of automated transtibial prosthesis alignment forward.

Matched MeSH terms: Prosthesis Fitting/methods
Pistoning assessment in lower limb prosthetic sockets

Eshraghi A, Osman NA, Gholizadeh H, Karimi M, Ali S

Prosthet Orthot Int, 2012 Mar;36(1):15-24.
PMID: 22269941 DOI: 10.1177/0309364611431625

One of the main indicators of the suspension system efficiency in lower limb prostheses is vertical displacement or pistoning within the socket. Decreasing pistoning and introducing an effective system for evaluating pistoning could contribute to the amputees' rehabilitation process.

Matched MeSH terms: Prosthesis Fitting/methods*
An experimental study of the interface pressure profile during level walking of a new suspension system for lower limb amputees

Eshraghi A, Abu Osman NA, Gholizadeh H, Ali S, Sævarsson SK, Wan Abas WA

Clin Biomech (Bristol, Avon), 2013 Jan;28(1):55-60.
PMID: 23157843 DOI: 10.1016/j.clinbiomech.2012.10.002

Different suspension systems that are used within prosthetic devices may alter the distribution of pressure inside the prosthetic socket in lower limb amputees. This study aimed to compare the interface pressure of a new magnetic suspension system with the pin/lock and Seal-In suspension systems.

Matched MeSH terms: Prosthesis Fitting/methods
Clinical evaluation of a prosthetic suspension system: Looped silicone liner

Abu Osman NA, Gholizadeh H, Eshraghi A, Wan Abas WAB

Prosthet Orthot Int, 2017 Oct;41(5):476-483.
PMID: 28946824 DOI: 10.1177/0309364616670396

OBJECTIVES: This study aimed to evaluate and compare a newly designed suspension system with a common suspension in the market.
STUDY DESIGN: Prospective study.
METHODS: Looped liners with hook fastener and Iceross Dermo Liner with pin/lock system were mechanically tested using a tensile testing machine in terms of system safety. A total of 10 transtibial amputees participated in this study and were asked to use these two different suspension systems. The pistoning was measured between the liner and socket through a photographic method. Three static axial loading conditions were implemented, namely, 30, 60, and 90 N. Furthermore, subjective feedback was obtained.
RESULTS: Tensile test results showed that both systems could safely tolerate the load applied to the prosthesis during ambulation. Clinical evaluation confirmed extremely low pistoning in both systems (i.e. less than 0.4 cm after adding 90 N traction load to the prosthesis). Subjective feedback also showed satisfaction with both systems. However, less traction at the end of the residual limb was reported while looped liner was used.
CONCLUSION: The looped liner with hook fastener is safe and a good alternative for individuals with transtibial amputation as this system could solve some problems with the current systems. Clinical relevance The looped liner and hook fastener were shown to be good alternative suspension for people with lower limb amputation especially those who have difficulty to use and align the pin/lock systems. This system could safely tolerate centrifugal forces applied to the prosthesis during normal and fast walking.

Matched MeSH terms: Prosthesis Fitting/methods*
Fulltext Gait biomechanics of individuals with transtibial amputation: effect of suspension system

Eshraghi A, Abu Osman NA, Karimi M, Gholizadeh H, Soodmand E, Wan Abas WA

PLoS One, 2014;9(5):e96988.
PMID: 24865351 DOI: 10.1371/journal.pone.0096988

Prosthetic suspension system is an important component of lower limb prostheses. Suspension efficiency can be best evaluated during one of the vital activities of daily living, i.e. walking. A new magnetic prosthetic suspension system has been developed, but its effects on gait biomechanics have not been studied. This study aimed to explore the effect of suspension type on kinetic and kinematic gait parameters during level walking with the new suspension system as well as two other commonly used systems (the Seal-In and pin/lock). Thirteen persons with transtibial amputation participated in this study. A Vicon motion system (six cameras, two force platforms) was utilized to obtain gait kinetic and kinematic variables, as well as pistoning within the prosthetic socket. The gait deviation index was also calculated based on the kinematic data. The findings indicated significant difference in the pistoning values among the three suspension systems. The Seal-In system resulted in the least pistoning compared with the other two systems. Several kinetic and kinematic variables were also affected by the suspension type. The ground reaction force data showed that lower load was applied to the limb joints with the magnetic suspension system compared with the pin/lock suspension. The gait deviation index showed significant deviation from the normal with all the systems, but the systems did not differ significantly. Main significant effects of the suspension type were seen in the GRF (vertical and fore-aft), knee and ankle angles. The new magnetic suspension system showed comparable effects in the remaining kinetic and kinematic gait parameters to the other studied systems. This study may have implications on the selection of suspension systems for transtibial prostheses. Trial registration: Iranian Registry of Clinical Trials IRCT2013061813706N1.

Matched MeSH terms: Prosthesis Fitting/methods
Satisfaction and problems experienced with wrist movements: comparison between a common body-powered prosthesis and a new biomechatronics prosthesis

Abd Razak NA, Abu Osman NA, Kamyab M, Wan Abas WA, Gholizadeh H

Am J Phys Med Rehabil, 2014 May;93(5):437-44.
PMID: 24429510 DOI: 10.1097/PHM.0b013e3182a51fc2

This report compares wrist supination and pronation and flexion and extension movements with the common body-powered prosthesis and a new biomechatronics prosthesis with regard to patient satisfaction and problems experienced with the prosthesis. Fifteen subjects with traumatic transradial amputation who used both prosthetic systems participated in this study. Each subject completed two questionnaires to evaluate their satisfaction and problems experienced with the two prosthetic systems. Satisfaction and problems with the prosthetic's wrist movements were analyzed in terms of the following: supination and pronation; flexion and extension; appearance; sweating; wounds; pain; irritation; pistoning; smell; sound; durability; and the abilities to open a door, hold a cup, and pick up or place objects. This study revealed that the respondents were more satisfied with the biomechatronics wrist prosthesis with regard to supination and pronation, flexion and extension, pain, and the ability to open a door. However, satisfaction with the prosthesis showed no significant differences in terms of sweating, wounds, irritation, pistoning, smell, sound, and durability. The abilities to hold a cup and pick up or place an object were significantly better with the body-powered prosthesis. The results of the survey suggest that satisfaction and problems with wrist movements in persons with transradial amputation can be improved with a biomechatronics wrist prosthesis compared with the common body-powered prosthesis.

Matched MeSH terms: Prosthesis Fitting/methods
Transtibial prosthetic socket pistoning: static evaluation of Seal-In(®) X5 and Dermo(®) Liner using motion analysis system

Gholizadeh H, Osman NA, Kamyab M, Eshraghi A, Abas WA, Azam MN

Clin Biomech (Bristol, Avon), 2012 Jan;27(1):34-9.
PMID: 21794965 DOI: 10.1016/j.clinbiomech.2011.07.004

The method of attachment of prosthesis to the residual limb (suspension) and socket fitting is a critical issue in the process of providing an amputee with prosthesis. Different suspension methods try to minimize the pistoning movement inside the socket. The Seal-In(®) X5 and Dermo(®) Liner by Ossur are new suspension liners that intend to reduce pistoning between the socket and liner. Since the effects of these new liners on suspension are unclear, the objective of this study was to compare the pistoning effect of Seal-In(®) X5 and Dermo(®) Liner by using Vicon Motion System.

Matched MeSH terms: Prosthesis Fitting/methods
Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

Amri NA, Quar TK, Chong FY

Am J Audiol, 2019 Dec 16;28(4):877-894.
PMID: 31600460 DOI: 10.1044/2019_AJA-18-0156

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight (N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23-48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

Matched MeSH terms: Prosthesis Fitting/methods