The Relationship Between Vestibular Sensory Integration and Prosthetic Mobility in Community Ambulators With Unilateral Lower Limb Amputation.

OBJECTIVE: The modified Clinical Test of Sensory Interaction and Balance (mCTSIB) is used to clinically assess vestibular sensory integration (VSI), the process by which the central nervous system integrates vestibular afference to maintain balance. The rate and effects of impaired VSI (IVSI) on prosthetic mobility in people with lower limb amputation (LLA) is unknown. The objective of this study was to use the mCTSIB to classify VSI in active community ambulators with LLA and to examine the relationship between IVSI and prosthetic mobility, as measured by the Component Timed Up and Go (cTUG) test. METHODS: This was a cross-sectional study with a convenience sample of 130 community ambulators with unilateral LLA. Classification of VSI was determined based on a time-based pass/fail mCTSIB performance. Participants were classified as having normal sensory integration (NSI) if they could balance for 30 seconds in every mCTSIB condition. Participants who failed condition 4 exclusively were classified as IVSI. Prosthetic mobility, as measured by the cTUG, was compared between NSI and IVSI groups. RESULTS: Of the 130 participants, 29 (22%) were classified as IVSI and 95 (73%) were classified as having NSI. Prosthetic mobility significantly differed between IVSI and NSI groups, with IVSI participants performing all components of the cTUG significantly slower. Medium to large effect sizes were found between groups during cTUG. CONCLUSIONS: These results suggest that 1 in 5 community ambulators with LLA have IVSI, with associated limitations in balance confidence and prosthetic mobility. IMPACT: The ability to integrate vestibular information was found to have a strong relationship with prosthetic mobility in active community ambulators with LLA, especially with performing a 180-degree step turn. Physical therapists can use the mCTSIB to classify sensory integration during prosthetic rehabilitation and develop an appropriate balance intervention. LAY SUMMARY: Active adults with LLA can use information from their senses to maintain their standing balance. Adults with LLA who have difficulty balancing on foam with closed eyes were slower to get in and out of a chair, walk, and perform a 180-degree step turn.

Mobility Analysis of AmpuTees (MAAT 4): classification tree analysis for probability of lower limb prosthesis user functional potential.

Purpose: To develop a predictive model to inform the probability of lower limb prosthesis users' functional potential for ambulation.Materials and Methods: A retrospective analysis of a database of outcomes for 2770 lower limb prosthesis users was used to inform a classification and regression tree analysis. Gender, age, height, weight, body mass index adjusted for amputation, amputation level, cause of amputation, comorbid health status and functional mobility score [Prosthetic Limb Users Survey of Mobility (PLUS-M™)] were entered as potential predictive variables. Patient K-Level was used to assign dependent variable status as unlimited community ambulator (i.e., K3 or K4) or limited community/household ambulator (i.e., K1 or K2). The classification tree was initially trained from 20% of the sample and subsequently tested with the remaining sample.Results: A classification tree was successfully developed, able to accurately classify 87.4% of individuals within the model's training group (standard error 1.4%), and 81.6% within the model's testing group (standard error 0.82%). Age, PLUS-M™ T-score, cause of amputation and body weight were retained within the tree logic.Conclusions: The resultant classification tree has the ability to provide members of the clinical care team with predictive probabilities of a patient's functional potential to help assist care decisions.Implications for RehabilitationClassification and regression tree analysis is a simple analytical tool that can be used to provide simple predictive models for patients with a lower limb prosthesis.The resultant classification tree had an 81.6% (standard error 0.82%) accuracy predicting functional potential as an unlimited community ambulator (i.e., K3 or K4) or limited community/ household ambulator (i.e., K1 or K2) in an unknown group of 2770 lower limb prosthesis users.The resultant classification tree can assist with the rehabilitation team's care planning providing probabilities of functional potential for the lower limb prosthesis user.

Spatiotemporal parameters in sprinters with unilateral and bilateral transfemoral amputations and functional impairments.

PURPOSE: Although sprinters with unilateral (UTF) and bilateral transfemoral (BTF) amputations and functional impairments (FIs) without amputation were allocated into different classifications because of the recent revision of the International Paralympic Committee Athletics Rules and Regulations, it is unclear whether running mechanics differ among the three groups. The aim of this study was to investigate the differences in the spatiotemporal parameters of the three groups during 100-m sprint in official competitions. METHODS: Using publicly available Internet broadcasts, we analyzed 11 elite-level sprinters with UTF amputation, 4 sprinters with BTF amputation, and 5 sprinters with FI without amputation. The best personal times for nearly all individuals were included. For each sprinter's race, the average speed, step frequency, and step length were calculated using the number of steps in conjunction with the official race time. RESULTS: Although there were no significant differences in the average speed among the UTF, BTF, and FI groups (7.95 ± 0.22, 7.90 ± 0.42, and 7.93 ± 0.14 m/s, respectively, p = 0.87), those with BTF amputation showed significantly lower step frequency (UTF: 4.20 ± 0.20 Hz, BTF: 3.71 ± 0.32 Hz, FI: 4.20 ± 0.10 Hz, p < 0.05) and longer step length (UTF: 1.90 ± 0.08 m, BTF: 2.14 ± 0.02 m, FI: 1.89 ± 0.06 m, p < 0.05) than the other two groups. CONCLUSION: These results suggest that the step characteristics during sprinting are not the same among sprinters with UTF amputation, BTF amputations, or FI without amputations.

The role of exercise testing in predicting successful ambulation with a lower extremity prosthesis: a systematic literature review and clinical practice guideline.

BACKGROUND: Growing discontent with the k-level system for functional classification of patients with limb loss and movement of healthcare toward evidence-based practice has resulted in the need for alternative forms of functional classification and development of clinical practice guidelines to improve access to quality prosthetic interventions. The purpose of this project was to develop and present a clinical practice recommendation for exercise testing in prosthetic patient care based on the results and synthesis of a systematic literature review. METHODS: Database searches of PubMed, Google Scholar, Web of Science, and Cochrane were conducted and articles reviewed. Of the potential 1386 articles 10 met the criteria for inclusion. These articles were assessed using the critical appraisal tool of the United Kingdom National Service Framework for Long-Term Conditions. Of the 10 included articles eight were of high, one of medium, and one of low, quality. Data from these articles were synthesized into 6 empirical evidence statements, all qualifying for research grade A. These statements were used to develop the proposed clinical practice guideline. RESULTS: While the results of this systematic review were not able to support the direct connection between cardiorespiratory performance and K-levels, the literature did support the ability of exercise testing results to predict successful prosthetic ambulation in some demographics. Both continuous maximum-intensity single lower extremity ergometer propelled by a sound limb and intermittent submaximal upper extremity ergometer protocols were found to be viable evaluation tools of cardiorespiratory fitness and function in the target population. CONCLUSION: The ability to sustain an exercise intensity of ≥50% of a predicted VO2max value in single leg cycle ergometry testing and achievement of a sustained workload of 30 W in upper extremity ergometry testing were found to be the strongest correlates to successful ambulation with a prosthesis. VO2 values were found to increase in amputee subjects following a 6-week exercise program. These synthesized results of the systematic literature review regarding exercise testing in patients with loss of a lower extremity were used to develop and a present a clinical treatment pathway.

Benefits of microprocessor-controlled prosthetic knees to limited community ambulators: systematic review.

The benefits of microprocessor-controlled prosthetic knees (MPKs) have been well established in community ambulators (Medicare Functional Classification Level [MFCL]-3) with a transfemoral amputation (TFA). A systematic review of the literature was performed to analyze whether limited community ambulators (MFCL-2) may also benefit from using an MPK in safety, performance-based function and mobility, and perceived function and satisfaction. We searched 10 scientific databases for clinical trials with MPKs and identified six publications with 57 subjects with TFA and MFCL-2 mobility grade. Using the criteria of a Cochrane Review on prosthetic components, we rated methodological quality moderate in four publications and low in two publications. MPK use may significantly reduce uncontrolled falls by up to 80% as well as significantly improve indicators of fall risk. Performance-based outcome measures suggest that persons with MFCL-2 mobility grade may be able to walk about 14% to 25% faster on level ground, be around 20% quicker on uneven surfaces, and descend a slope almost 30% faster when using an MPK. The results of this systematic review suggest that trial fittings may be used to determine whether or not individuals with TFA and MFCL-2 mobility grade benefit from MPK use. Criteria for patient selection and assessment of trial fitting success or failure are proposed.

Performance of elite seated discus throwers in F30s classes: part I: does whole body positioning matter?

BACKGROUND: Studies on the relationship between performance and design of the throwing frame have been limited and therefore require further investigation. OBJECTIVES: The specific objectives were to provide benchmark information about performance and whole body positioning of male athletes in F30s classes. STUDY DESIGN: Descriptive analysis. METHODS: A total of 48 attempts performed by 12 stationary discus throwers in F33 and F34 classes during seated discus throwing event of 2002 International Paralympic Committee Athletics World Championships were analysed in this study. The whole body positioning included overall throwing posture (i.e. number of points of contact between the thrower and the frame, body position, throwing orientation and throwing side) and lower limb placements (i.e. seating arrangements, points of contact on the both feet, type of attachment of both legs and feet). RESULTS: Three (25%), five (42%), one (8%) and three (25%) athletes used from three to six points of contact, respectively. Seven (58%) and five (42%) athletes threw from a standing or a seated position, respectively. A straddle, a stool or a chair was used by six (50%), four (33%) or two (17%) throwers, respectively. CONCLUSIONS: This study provides key information for a better understanding of the interaction between throwing technique of elite seated throwers and their throwing frame. Clinical relevance This study aimed at improving the understanding of the relationship between athletic performance and the design of the throwing frame for seated discus throwers, with a particular emphasis on the description of whole body positioning. This knowledge is particularly important in the current debate around general principles underlying the design of throwing frames and classification of athletes with a disability, including those with lower limb amputation.

Performance of elite seated discus throwers in F30s classes: part II: does feet positioning matter?

BACKGROUND: Studies on the relationship between performance and design of the throwing frame have been limited. Part I provided only a description of the whole body positioning. OBJECTIVES: The specific objectives were (a) to benchmark feet positioning characteristics (i.e. position, spacing and orientation) and (b) to investigate the relationship between performance and these characteristics for male seated discus throwers in F30s classes. STUDY DESIGN: Descriptive analysis. METHODS: A total of 48 attempts performed by 12 stationary discus throwers in F33 and F34 classes during seated discus throwing event of 2002 International Paralympic Committee Athletics World Championships were analysed in this study. Feet positioning was characterised by tridimensional data of the front and back feet position as well as spacing and orientation corresponding to the distance between and the angle made by both feet, respectively. RESULTS: Only 4 of 30 feet positioning characteristics presented a coefficient correlation superior to 0.5, including the feet spacing on mediolateral and anteroposterior axes in F34 class as well as the back foot position and feet spacing on mediolateral axis in F33 class. CONCLUSIONS: This study provided key information for a better understanding of the interaction between throwing technique of elite seated throwers and their throwing frame. CLINICAL RELEVANCE: This study aimed at improving the understanding of the relationship between performance and the design of the throwing frame of seated discus throwers, with a particular emphasis on the importance of feet positioning. This knowledge is particularly important in the current debate around general principles underlying design of throwing frame and classification of athletes with a disability, including those with lower limb amputation.

Persona postamputada portadora de dolor de miembro fantasma: Dolor y cuerpo / Person carrying postamputed phantom limb pain: Pain and body

La presente investigación se plantea a través de un abordaje descriptivo-cualitativo. El objetivo fue describir y analizar “lo cotidiano” de la persona postamputada con dolor de miembro fantasma en el estado de Durango, México. El método utilizado fue exploratorio-descriptivo, y como técnica se empleó la entrevista semiestructurada. Los sujetos seleccionados provenían de seis municipios del estado de Durango, México. Debido a la naturaleza del estudio, participaron cuatro personas que al ser amputadas debutaron con dolor de miembro fantasma. El soporte teórico de la presente investigación está integrado y complementado por el pensamiento respecto a lo cotidiano de Maffesoli (1998),1 la corporalidad de David Le Breton (2002)2 y el dolor de David Le Breton (1999).3 Se construyeron tres categorías: 1. Lo corporal, 2. El tiempo y movimiento y 3. Trabajo y ocio.

This research is descriptive-qualitative approach, the aim was to describe and analyze the daily life of the person carrying postamputed phantom limb pain on state of Durango in Mexico. The method used was exploratory-descriptive, semistructured interview technique. The key informants selected as acting subjects, came from six municipalities of Durango’ State, Mexico. Due to the nature of this study, participated four people being amputated debut with Phantom Limb Pain. The theoretical support of this research is integrated and complemented by thinking about the daily life of Maffesoli (1998), the corporeality of David Le Breton (2002) and the pain of David Le Breton (1999). They built three categories: 1. The body, 2. Time and movement, 3. Work and Leisure.

Impact of stance phase microprocessor-controlled knee prosthesis on ramp negotiation and community walking function in K2 level transfemoral amputees.

BACKGROUND: Microprocessor controlled prosthetic knees (MPK) offer opportunities for improved walking stability and function, but some devices' swing phase features may exceed needs of users with invariable cadence. One MPK offers computerized control of only stance (C-Leg Compact). OBJECTIVE: To assess Medicare Functional Classification Level K2 walkers' ramp negotiation performance, function and balance while using a non-MPK (NMPK) compared to the C-Leg Compact. STUDY DESIGN: Crossover. METHODS: Gait while ascending and descending a ramp (stride characteristics, kinematics, electromyography) and function were assessed in participant's existing NMPK and again in the C-Leg Compact following accommodation. RESULTS: Ramp ascent and descent were markedly faster in the C-Leg Compact compared to the NMPK (p ≤ 0.006), owing to increases in stride length (p ≤ 0.020) and cadence (p ≤ 0.020). Residual limb peak knee flexion and ankle dorsiflexion were significantly greater (12.9° and 4.9° more, respectively) during single limb support while using the C-Leg Compact to descend ramps. Electromyography (mean, peak) did not differ significantly between prosthesis. Function improved in the C-Leg Compact as evidenced by a significantly faster Timed Up and Go and higher functional questionnaire scores. CONCLUSIONS: Transfemoral K2 walkers exhibited significantly improved function and balance while using the stance-phase only MPK compared to their traditional NMPK.

Systematic review of concepts measured in individuals with lower limb amputation using the International Classification of Functioning, Disability and Health as a reference.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) is comprehensive but difficult to use in clinical practice. ICF Core Sets are one method of increasing the use of the ICF in clinical practice. To develop a condition-specific core set requires identification of the concepts measured in current clinical practice. OBJECTIVE: To identify and quantify concepts contained in functional measurements used in published clinical studies utilising the ICF as a reference, for individuals with an amputation of the lower limb. STUDY DESIGN: Systematic literature review. METHODS: The concepts of published clinical and outcome measures used in individuals with a lower limb amputation were extracted and linked to the categories of ICF. RESULTS: The 113 outcome measures identified in the literature search contained 2210 functional concepts. Of the identified concepts, nearly 90% could be linked to ICF categories. The identified concepts linked to 44 categories in the domain of body functions and structures, 56 categories in the domain of activities and participation and 30 categories in the domain of environment. CONCLUSIONS: Using the ICF as a reference, we could identify and quantify the majority of concepts in the outcome measures used in published clinical studies. The ICF categories identified will assist in the development of ICF Core Sets for persons with an amputation. CLINICAL RELEVANCE: The ICF is available in over 25 languages. Improving the usefulness of the classification for clinicians will assist in standardising clinical practice and in comparison of outcomes nationally and internationally. ICF Core Sets are designed to use a manageable number of categories from the ICF to allow application in day-to-day clinical practice.

A candidate core set of outcome measures based on the International Classification of Functioning, Disability and Health for clinical studies on lower limb orthoses.

BACKGROUND: Although many core sets of measurement concepts have been published in the literature, this has not been done for the field of lower limb orthoses. OBJECTIVES: This paper provides an overview of the measurement concepts that are relevant in lower limb orthotic evaluations, and it proposes a candidate Core Set of outcome measures to be used in clinical studies on ankle-foot orthoses (AFOs) and knee-ankle-foot orthoses (KAFOs). STUDY DESIGN: Literature review. METHODS: The International Classification of Functioning, Disability and Health (ICF) was used as framework to select relevant concepts. RESULTS AND CONCLUSION: Measurement concepts covering all ICF levels of functioning were identified as relevant for the Core Set, including functions of the joints and bones (b710-b729), muscle functions (b730-b749), gait pattern functions (b770), walking (b450), moving around in different locations (d460), and daily-life functioning (d5-d9). Further validation of this candidate Core Set through a formal decision-making process is needed to obtain consensus among experts in the field. Based on such a consensus, the next step will be to systematically review the literature and identify those measurement instruments that are best suited to assess the proposed concepts, based on their psychometric properties in a given sample and context. Thereafter, we suggest that this ICF Core Set of measurement instruments should be applied in orthotic studies on AFOs and KAFOs in ambulatory patients with gait problems. CLINICAL RELEVANCE: Although many ICF Core Sets have been published, this has not been done for the field of lower limb orthoses. We feel that such a Core Set is urgently needed, to enable comparison of results, and establish evidence on the efficacy of orthotic treatment, which will improve patient care.

Feasibility of using a checklist based on the International Classification of Functioning, Disability and Health as an outcome measure in individuals following lower limb amputation.

BACKGROUND: The International Classification of Function, Disability and Health (ICF) has been promoted for use in clinical practice but few articles have demonstrated that it can be used as a sensitive outcome measure, and there has been no published evidence that it can be used for individuals following a lower limb amputation. We developed an ICF-based checklist for individuals who had an amputation. OBJECTIVE: To evaluate the feasibility of this checklist in detecting meaningful changes of function and quality of life in persons following an amputation using the ICF qualifiers as an outcome measure. STUDY DESIGN: Time series study. METHODS: Twenty patients were rated on the ICF checklist items for four time points; preadmission status, one week post-amputation, on discharge from the acute hospital and three months post-amputation. RESULTS: Seventeen patients completed the full study, having data collected at each of the four time points. Using the ICF checklist, we could demonstrate a significant functional deterioration immediately after amputation with a gradual improvement in function over the following three weeks consistent with our direct observations of these patients. CONCLUSIONS: The ICF checklist has the potential to be used as an outcome instrument as it appears to have content validity and sensitivity as a measure of changes in patients following an amputation. CLINICAL RELEVANCE: Clinical outcome measures based on the ICF potentially improve the ability to record, monitor and benchmark patient and treatment outcomes nationally and internationally. This paper addresses the feasibility of ICF categories and qualifiers when used as an outcome measure and indicates that further development and analysis of the psychometric properties of such measures is warranted.

The use of the ICF in the process of supplying assistive products: discussion paper based on the experience using a general Dutch prescription guideline.

For many people assistive products are important to perform daily activities and to participate in society. In the process of selecting the proper assistive product for a person, it is important to describe in a uniform and transparent way his/her present functioning and wishes with respect to functioning. To indicate how the ICF (the International Classification of Functioning, Disability and Health) can be used during the supply process, we have taken as a framework a general guideline describing this process. The guideline distinguishes seven steps in the supply process and for each step an inventory is made of the actions of the client, the actions of the care professional, the instruments used, the decisions made, the data generated, relevant classifications (including the ICF) to code these data, and the results for the client. It is the aim of this discussion paper to describe the role of the ICF in the prescription and supply of assistive products and to discuss the specific data in this process that can be classified using the ICF. Although the ICF is not perfect, it is a useful tool to code important data in the process of supplying assistive products. Clinical relevance Assistive products - used worldwide by millions of people - are used to maintain or enhance functioning, rather than to cure a disease.( 1 ) As functioning can be classified with the International Classification of Functioning, Disability and Health (ICF), it can be expected that the use of ICF terminology in the supply process of assistive products will result in a better match between the characteristics of the person and the characteristics of the assistive product.

Can the International Classification of Functioning, Disability and Health (ICF) be used in a prosthetics and orthotics outpatient clinic?

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) covers all aspects and levels of human functioning. OBJECTIVES: The aim of the study was to find out whether the ICF can be used in everyday prosthetics and orthotics (P&O) clinical practice for description of human functioning, and whether it can demonstrate the influence of a prosthesis or an orthosis on a person's functioning. STUDY DESIGN: Prospective clinical study. METHODS: A short list of ICF codes was compiled from Annex 9 and used for one month for all patients seen at the author's P&O outpatient clinics. RESULTS: One hundred patients (59 men, average age 58 years) with different medical problems were included in the study. From 6 to 27 (14 on average) ICF categories from all four components of ICF were used in these patients. The most frequently used category for body functions was mobility of joint functions, for body structures it was structure of the skin and for activities and participation it was walking. Public and private buildings were the only barriers identified. CONCLUSIONS: It can be concluded that the ICF can be used in everyday P&O clinical practice. An ICF list of categories provides quick additional information. To be able to demonstrate the influence of P&O devices on person's functioning, at least for activities and participation, one has to use qualifiers. CLINICAL RELEVANCE: For clinicians it is important to know that it is possible to use the ICF in clinical practice and that it can demonstrate the impact of P&O devices on a person's functioning.

An ICF-based education programme in amputation rehabilitation for medical residents in the Netherlands.

BACKGROUND AND AIM: Education programmes of the International Society for Prosthetics and Orthotics (ISPO) are directed primarily at prosthetists and orthotists. In a multidisciplinary setting, greater attention should be given to other professionals working in the field of amputation, prosthetics and orthotics. This includes, among others, physiotherapists, occupational therapists and residents and physicians from orthopaedics, vascular surgery and physical medicine and rehabilitation (PM&R). The aim of this paper is to describe the education programme in amputation and prosthetics for residents in PM&R in the Netherlands. The programme is based on concepts of the International Classification on Functioning, Disability and Health (ICF). TECHNIQUE: This narrative paper presents the amputation and prosthetics education programme for residents in PM&R in the Netherlands. The programme is based on two models: the ICF and the Canadian Medical Education Directives for Specialists (CanMEDS). DISCUSSION: ICF core sets for amputation and prosthetics need further development. Subsequently, the application of these core sets can help stimulate the education of residents in PM&R, and other multidisciplinary team members who work in amputation rehabilitation. CLINICAL RELEVANCE: Through this education programme, residents work closely with other team members using the common language of the ICF, enhancing treatment and technical advice in amputee care.

Functional added value of microprocessor-controlled knee joints in daily life performance of Medicare Functional Classification Level-2 amputees.

OBJECTIVE: To assess the effects of using a microprocessor-controlled prosthetic knee joint on the functional performance of activities of daily living in persons with an above-knee leg amputation. OBJECTIVE: To assess the effects of using a microprocessor-controlled prosthetic knee joint on the functional performance of activities of daily living in persons with an above-knee leg amputation. DESIGN: Randomised cross-over trial. SUBJECTS: Forty-one persons with unilateral above-knee or knee disarticulation limb loss, classified as Medicare Functional Classification Level-2 (MFCL-2). METHODS: Participants were measured in 3 conditions, i.e. using a mechanically controlled knee joint and two types of microprocessor-controlled prosthetic knee joints. Functional performance level was assessed using a test in which participants performed 17 simulated activities of daily living (Assessment of Daily Activity Performance in Transfemoral amputees test). Performance time was measured and self-perceived level of difficulty was scored on a visual analogue scale for each activity. RESULTS: High levels of within-group variability in functional performance obscured detection of any effects of using a microprocessor-controlled prosthetic knee joint. Data analysis after stratification of the participants into 3 subgroups, i.e. participants with a "low", "intermediate" and "high" functional mobility level, showed that the two higher functional subgroups performed significantly faster using microprocessor-controlled prosthetic knee joints. CONCLUSION: MFCL-2 amputees constitute a heterogeneous patient group with large variation in functional performance levels. A substantial part of this group seems to benefit from using a microprocessor-controlled prosthetic knee joint when performing activities of daily living.

Consistency, precision, and accuracy of optical and electromagnetic shape-capturing systems for digital measurement of residual-limb anthropometrics of persons with transtibial amputation.

Computer-aided design (CAD) and computer-aided manufacturing systems have been adapted for specific use in prosthetics, providing practitioners with a means to digitally capture the shape of a patient's limb, modify the socket model using software, and automatically manufacture either a positive model to be used in the fabrication of a socket or the socket itself. The digital shape captured is a three-dimensional (3-D) model from which standard anthropometric measures can be easily obtained. This study recorded six common anthropometric dimensions from CAD shape files of three foam positive models of the residual limbs of persons with transtibial amputations. Two systems were used to obtain 3-D models of the residual limb, a noncontact optical system and a contact-based electromagnetic field system, and both experienced practitioners and prosthetics students conducted measurements. Measurements were consistent; the mean range (difference of maximum and minimum) across all measurements was 0.96 cm. Both systems provided similar results, and both groups used the systems consistently. Students were slightly more consistent than practitioners but not to a clinically significant degree. Results also compared favorably with traditional measurement, with differences versus hand measurements about 5 mm. These results suggest the routine use of digital shape capture for collection of patient volume information.

Consistency and accuracy of measurement of lower-limb amputee anthropometrics.

Lower-limb amputees often exhibit large fluctuation in residual-limb shape, necessitating careful observation and anthropometric measurement for prosthetists to ensure socket fit. Anthropometric measurement may become more important as an outcome measure indicating success in rehabilitation. This study investigated the accuracy and reliability of seven prosthetic anthropometric measurement devices as used by a group of eight prosthetic-orthotic practitioners and a group of five prosthetic-orthotic students to measure six common anthropometric dimensions on three foam positive models of transtibial amputee residual limbs. Two of the models were identical, enabling assessment of individual repeatability. Some clinically significant errors were noted in the results; however, the general variability in measurements was not clinically significant. Students were slightly more consistent than practitioners; students were more consistent with linear measurements, while practitioners were more consistent with circumferential measures. The results further demonstrated that the VAPC measurement device used in the study was both inaccurate and unreliable.