Investigation of lower-limb tissue perfusion during loading.

An extant tissue indentor used for amputee residual limb tissue indentation studies was modified to include laser Doppler flowmetry (LDF) to enable measurement of tissue perfusion during indentation. This device allows quantitative assessment of the mechanical and physiological response of soft tissues to load, as demonstrated by indentation studies of the lower-limb tissues of young healthy subjects. Potential measures of interest include the relative change in tissue perfusion with load and the time delays associated with the perfusion response during tissue loading and unloading. Such measures may prove useful in future studies of residual limb tissues, improving our understanding of tissue viability risk factors for individuals with lower-limb amputation.

In vivo indentation of lower extremity limb soft tissues.

In vivo rate-controlled indentation tests were conducted on the soft tissues of the residual limbs of five individuals with trans-tibial amputation and the right calf of five nonamputees. Force relaxation trials were also conducted. The cyclic indentation tests indicated that the bulk soft tissue response to compressive load is nonlinear and rate-dependent. Inter- and intrasubject stiffness variations were observed. The force relaxation studies indicated that approximately 55-95% relaxation may occur, with equilibration typically occurring in less than 60 s. Most of this relaxation (35-80%) occurred within 5 s after loading.

Finite element analysis of anterior tooth root stresses developed during endodontic treatment.

Vertical tooth root fractures are diagnostically challenging, frustrating, and an increasingly common cause of failure of tooth restoration. These vertical root fractures have been associated with many causes, including the endodontic process itself. To investigate these endodontic causes, various phases of crown replacement for an anterior tooth were modeled using nonlinear, plane strain finite element (FE) analysis. Stresses developed during obturation, post positioning, crown placement, and masticatory and occlusal loading of the restored tooth were estimated using this analysis method. The minimum (compressive) principal stress was greatest during obturation of cones 1 and 2, and during mastication of the restored tooth. Although these stresses were significant (-150 to -280 MPa), they did not exceed the compressive strength of dentin. The maximum (tensile) principal stresses, 160 to 300 MPa, were also observed during obturation of cones 1 and 2. These peak stresses exceed the dentin tensile strength.

A rate-controlled indentor for in vivo analysis of residual limb tissues.

A tissue tester was designed to enable rate-controlled indentation of the bulk soft tissues of lower extremity residual limbs. The tissue tester employs a digital linear actuator that implements rate-controlled indentation, and a load cell that measures the reaction force resulting from tissue indentation. Viscoelastic phenomena such as preconditioning, hysteresis and force relaxation can be assessed, and the effect of varying indentation rates on soft tissue stiffness can be investigated. The device accommodates indentor excursions up to 30 mm, indentation at rates of 0 to 10 mm/s, reaction forces up to 44 N, and multiple loading/unloading cycles. The tissue tester is controlled via a notebook personal computer with a PCMCIA data acquisition card. The tissue testing trials are automated and the entire test system is portable and amenable for use in a clinical or research environment. System output consists of force-displacement curves from cyclic loading, and force-time curves following ramped-step indentation. The mean indentor positioning error was 0.071 (+/-0.75)% of the desired displacement. This error varied as a function of indentation and was approximately independent of the indentation rate. Indentation rates were accurate to within 0.94(+/-0.68)% of the desired value and also varied with indentation. Indentation of a viscoelastic foam yielded force-displacement curves that were consistent with that obtained from an Instron universal testing machine.

Sensory changes in adults with unilateral transtibial amputation.

The purpose of this study was to describe the sensory changes in adults with unilateral transtibial amputation (TTA), as any loss of sensation may have significant impact on the successful use of a prosthesis. Sensory modalities of light touch, deep pressure, vibration, and superficial pain (pinprick) were examined on the residual and contralateral limbs of 16 veterans with TTA. Six Subjects demonstrated normal sensation on the contralateral limb and impaired sensation of superficial pain, vibration, and/or light touch on the residual limb. Superficial pain was the most frequently impaired sensation, and vibration and superficial pain sensation appeared to be age-dependent, with increased impairment observed in the elderly. Deep pressure sensation was intact in all subjects. These preliminary data suggest that although neither the amputation nor the prosthetic rehabilitation resulted in impaired deep pressure sensation, these two factors contributed to minimal impairment of light touch and vibration, and significant impairment of the superficial pain sensation.

Generic, geometric finite element analysis of the transtibial residual limb and prosthetic socket.

Finite element (FE) analysis was used to investigate the stress distribution between the residual limb and prosthetic socket of persons with transtibial amputation (TTA). The purpose of this study was to develop a tool to provide a quantitative estimate of prosthetic interface pressures to improve our understanding of residual limb/prosthetic socket biomechanics and prosthetic fit. FE models of the residual limb and prosthetic socket were created. In contrast to previous FE models of the prosthetic socket/residual limb system, these models were not based on the geometry of a particular individual, but instead were based on a generic, geometric approximation of the residual limb. These models could then be scaled for the limbs of specific individuals. The material properties of the bulk soft tissues of the residual limb were based upon local in vivo indentor studies. Significant effort was devoted toward the validation of these generic, geometric FE models; prosthetic interface pressures estimated via the FE model were compared to experimentally determined interface pressures for several persons with TTA in a variety of socket designs and static load/alignment states. The FE normal stresses were of the same order of magnitude as the measured stresses (0-200 kPa); however, significant differences in the stress distribution were observed. Although the generic, geometric FE models do not appear to accurately predict the stress distribution for specific subjects, the models have practical applications in comparative stress distribution studies.

Parametric analysis using the finite element method to investigate prosthetic interface stresses for persons with trans-tibial amputation.

A finite element (FE) model of the below-knee residual limb and prosthetic socket was created to investigate the effects of parameter variations on the interface stress distribution during static stance. This model was based upon geometric approximations of anthropometric residual limb geometry. The model was not specific to an individual with amputation, but could be scaled to approximate the limb of a particular subject. Parametric analyses were conducted to investigate the effects of prosthetic socket design and residual limb geometry on the residual limb/prosthetic socket interface stresses. Behavioral trends were illustrated via sensitivity analysis. The results of the parametric analyses indicate that the residual limb/prosthetic socket interface stresses are affected by variations in both prosthetic design and residual limb geometry. Specifically, the analyses indicate: 1) the residual limb/prosthetic liner interface pressures are relatively insensitive to the socket stiffness; 2) the stiffness of the prosthetic liner influences the interface stress distribution for both the unrectified and patellar-tendon-bearing (PTB) rectified models-the external load state appears to influence the interface pressure distribution, while the prosthetic socket rectification appears to influence the interface shear stress distribution; 3) the interface pressures are very sensitive to the prosthetic rectification; 4) the shape and relative bulk of soft tissue may significantly influence the interface pressure distribution; 5) the interface pressure distribution is also influenced by the residual limb length; and 6) the stiffness/compliance of the residual limb soft tissues may significantly alter the interface pressure distribution.

A review of prosthetic interface stress investigations.

Over the last decade, numerous experimental and numerical analyses have been conducted to investigate the stress distribution between the residual limb and prosthetic socket of persons with lower limb amputation. The objectives of these analyses have been to improve our understanding of the residual limb/prosthetic socket system, to evaluate the influence of prosthetic design parameters and alignment variations on the interface stress distribution, and to evaluate prosthetic fit. The purpose of this paper is to summarize these experimental investigations and identify associated limitations. In addition, this paper presents an overview of various computer models used to investigate the residual limb interface, and discusses the differences and potential ramifications of the various modeling formulations. Finally, the potential and future applications of these experimental and numerical analyses in prosthetic design are presented.