As for the functional tests, a number of outcome measures have been proposed in the field of prosthetics, but still there has not been reached a concordance among clinicians on when and which measurements to conduct. Some of these measures have proven validity and reliability, while others appear to be more critical regarding their sensitivity and repeatability (Condie et al., 2006). For these reasons, at present there is no consensus among the various rehabilitation specialists such as doctors, physiotherapists and prosthetists about the general criteria for the most proper choice of lowerlimb prosthesis that can respond to the needs and residual abilities of the amputee patient (Sagawa et al., 2011). Therefore, the various prosthetic modules are chosen based on the subjective empirical knowledge of the specific clinical rehabilitation team (Schaffalitzky et al., 2011). Standard measures for the assessment of the amputee’s motorability entail the self-selected walking speed (Boonstra et al., 1993; Nolan et al., 2003) and analysis the spatio-temporal parameters of the gait (Highsmith et al., 2010, Houdijk et al., 2008), functional assessments as the Six-minute walking (Lin t al., 2008) and the Timed Up & Go tests (Schoppen et al., 1999), as well as clinical and subjective approaches such as questionnaires and clininimetric scales (Rommers et al., 2001). These latter measures are simple to administer and does not require particular specialized equipment, are designed in order to evaluate the basal functional capacity, the quality of life and the general health conditions. As such, however, these can measure only limited aspects of mobility and motorability (Rommers et al., 2001) and may thus have insufficient sensitivity to the higher levels of the function (Pasquina et al., 2006).
biofeedback coherent by using the reflected image of their body on the mirror to improve their upright stance . Of the reasons for this latter inconsistency could be different method of introducing visual data and different assessment tools by Hlavackova, et al. (2009) and Damayanti-Sethy et al. (2009) have investigated the effect of sight and hearing exercises for controlling balance, and have pointed out that sight and hearing feedback can improve the balance in the amputee [8, 32]. This is inconsistent with the findings of the present study. One of the reasons for this inconsistency might be the fact that Nicholas et al. have used different tools for assessing balance. The examinee of the balance and mirror balance groups in post-test of sixth condition (manipulation of vestibular and proprioception), had lower performance and balance than other stages. Peterka, (2002) has stated that healthy people rely %70 on proprioception, %20 on vestibular and %10 on sight, to control posture. They have shown that the coherence of the data received by these three senses plays a pivotal role in postural control . Given these studies and the findings in the present study, the manipulation of two or three senses at the same time causes imbalance in the amputee.
AIT Analysis is a useful assessment tool to evaluate and assess the rehabilitation progress of patients with gait disorders or facilitate for decision making in developing a control system for lowerlimb prostheses, orthoses and exoskeletons. Timing information of the gait events can be used to switch the controller states using a finite state machine to provide the necessary control actuations either for damping resistances in actively microprocessor controlled prostheses or actuation action in the powered prostheses while the amputees are in ambulatory action. Estimation of the temporal gait events/phases has been used for the assessment and control in functional electrical stimulation (FES) and prosthetics/orthotics systems [1-5]. Initial contact (IC) and toe-off (TO) are the main key gait events commonly used to segment the gait cycle into stance and swing phases. Temporal (time-based) parameters such as stride time, stance and swing duration can be computed from IC and TO. Foot-Flat (FF) and heel-off (HO) can provide additional insight in the analysis of inner-stance phases and can provide useful information to evaluate other gait parameters such as asymmetry during the inner-stance phases, stride length and walking speed . In clinical applications, the information from these events were utilized to assess the improvement of patients with neurological disorders and to assess the gait symmetry of amputees [7-9]. By detecting the temporal gait events, stance phase can be segmented into different phases namely loading-response, foot-flat and push-off. The importance of identifying the gait sub-phases in a control scheme such as in state machine is to enhance users’ control over the prostheses/orthoses to provide necessary stability and safety required during general ambulation [1, 6, 10-12].
The target population for the device is children aged 4–14 years with body mass of up to 50 kg. The device was required to be capable of generating a total continuous force on the footplates correspond- ing to 1.2 × body mass, i.e. a combined left + right equivalent mass of ∼60 kg. The pedals are actuated by two independent drives (left and right legs) each of which is capable of producing a continuous force of 354 N and a peak force of 1024 N. Because of the pedal geometry and available lever arms, the arrangement can generate a contin- uous force of 288 N at each footplate. This gives a total continuous force magnitude of 288 × 2 =576 N, corresponding to an equivalent body mass of 59 kg, which, according to the above speciﬁcations and given the ability of the motors to generate short-term forces of nearly three times the continuous levels, is deemed appropriate for therapy of children with impairments.
GMFM scores increased at group level, items that showed changes were most often standing on one leg, step up and step down and stair climbing with alternate foot without support. The ability to balance on one leg is very important for many tasks in everyday life, such as negotiating obstacles and climbing stairs. Reduction in antagonistic co-contraction improves gross motor function and also enhanced muscle performance: restoration, improvement, or maintenance of muscle strength, power, and endurance. 10
However, the literature does not clearly indicate that striving for perfect symmetry is really and always the best option. Already in 1998, Winter & Sienko  stated that “human system with major structural asymmetries in the neuromuscular skeletal system cannot be optimal when gait is symmetrical. Rather, a new non-symmetrical opti- mal is probably being sought by the amputee within the constraints of his residual system and the mechanics of his prosthesis ” . Later in 2005, Schmid and co-workers  compared the center of pressure trajectories under the sound and prosthetic foot of transfemoral amputees and concluded that the longer stance on the sound side can be ascribed to the greater ability of the sound leg to advance the step and maintain balance until the prosthetic limb can sustain the body weight. Hof et al.  corroborated this explanation in the theoretical framework of the “extrapolated center of mass” , concluding that stance time asymmetry is a “ sensible adaptation ” of experienced transfemoral amputees to improve stability during walking, to overcome the missing lateral ankle strategy of prosthetic feet. More recently, Adamczyk & Kuo , with a theoret- ical and experimental approach involving transtibial ampu- tees, concluded that “ some asymmetry may be unavoidable in cases of unilateral limb loss ” due to the reduced ankle plantar flexion of the ankle, with direct consequences on stance duration, greater collision work at the sound side, greater work overall, and increased peak force at loading response [25 – 27]. Imposing symmetry can actually be detrimental, as also observed by [27, 28].
Despite these early suggestions, it is only recently that there have been empirical reports showing that participants rate life- like prosthetic hands to be eerier than either mechanical hands or anatomic human hands (Poliakoff, Beach, Best, Howard, & Gowen, 2013; Poliakoff, O’Kane, Carefoot, Kyberd, & Gowen, 2018). Both of these studies, however, have been undertaken in populations without any significant experience of upper-limb prostheses (i.e., university students), and no empirical work has examined the degree to which prosthetic limb users experience this phenomenon. Indeed, little is known at all about how experience with the target stimuli affects the uncanny phenomenon. A recent study in the con- text of human-robot interaction suggests that repeated interac- tions with a lifelike robot appeared to reduce the feelings of unease towards it (Burleigh & Schoenherr, 2014; Złotowski et al., 2015). How these findings would generalize to the use of an upper-limb prosthesis is, however, unclear. Prosthesis users, perhaps unsurprisingly, generally express a preference for life-like devices, particularly in the context of the upper limbs (Biddiss, Beaton, & Chau, 2007). Prosthetic limb users, of course, represent a group who have a particular type of experience, having actively used a prosthetic limb, possibly embodying it (Murray, 2004; Niedernhuber, Barone, & Lenggenhager, 2018). Indeed, there have been reports that the use of a prosthetic limb fundamentally changes one ’ s hap- tic experience of object weight (Buckingham et al., 2018), categorization ability (van den Heiligenberg, Yeung, Brugger, Culham, & Makin, 2017), and even visual percep- tion (Nico, Daprati, Rigal, Parsons, & Sirigu, 2004).
- Time T2: 24-26 days after entry into the Rehabilitation Unit completed the pre-prosthetic rehabilitation and post-prosthesis procedure (after the acquisition of the temporary prosthesis) according to the PRIA prepared, each patient was again subjected to the measurement of the VAS scale, Barthel scale and cirrhometry of the amputation stump; in line with the subsequent evaluation phase of the results as per step 4 of the TRIA-MF protocol, the patient receives the discharge letter with the description of all the re-evaluation dates by the physiatrist (evaluation of the clinical- functional status of the abutment of amputation, motor performances achieved by the patient and functional appropriateness of the temporary prosthesis acquired) and by the orthopedic technician (evaluation of the technical-functional appropriateness of the components of the temporary prosthesis in use).
In addition to presenting features useful for signaling, ERD/S is somatotopic; for instance, ME/MI of right hand movement is reflected by ERD/S in the left sensorimotor area (position C3 of the international 10–20 system). Thus, we can discriminate the body region of MI (e.g., right or left hand) using a classifier [ 5 , 6 , 14 ] such as a support vector machine (SVM) [ 15 ]. In neurorehabilitation, it is crucial to detect the MI online with high accuracy, however, control- ling ERD to reliably reflect the appropriate mental images (for desired movement) is a difficult skill to master, and is strongly dependent on individual MI ability [ 8 , 16 , 17 ]. It is known that the use of ERD/S induced by MI requires efficient and effective neurofeedback training. How- ever, training programs for BCI control are further hampered by a lack of insight into the func- tional and physiological mechanisms of MI induction. Thus, this study aimed to identify effective MI training conditions that can enhance the generation of ERD/S. Effective training is expected to increase ERD/S intensity, thereby improving the accuracy of BCI classifiers and reducing the training period required to effectively use the BCI. It has been known for several decades that ERD can also be triggered by the observation of an others’ action [ 18 ]. The recent discovery of mirror neurons, a set of motor neurons that discharge during both action
A limitation of the current study is that we did not in- clude a measure of quadriceps muscle strength and/or activation. As such, we cannot be sure that quadriceps AMI occurred during knee pain. However, as strong voluntary contractions are known to produce large and persistent changes in corticospinal excitability , in- cluding these measures would almost certainly have ob- scured our ability to observe changes in the dependent variables in response to knee pain. Importantly, previ- ous studies using the same model of experimental knee pain have demonstrated an immediate decrease in quadriceps peak torque [23, 24], voluntary activation  and H-reflex amplitude  during pain. Finally, it should be noted that hypertonic saline injection pro- duces transient knee pain that may not accurately mimic the pain experienced by clinical populations after acute knee injury, surgery or pathology. However, the infrapatellar fat pad is richly innervated by nociceptors  and is a clinically important source of pain in com- mon knee joint pathologies such as patellofemoral
On this study, the non-self-care activities that include the physical activity on domestic activity (such as cleaning the house, mobility activity to a community), social, leisure activity and also working activity. After the post- amputation, the rehabilitation teams are more focusing the ability of the amputees to regain back their mobility function. The self-care and non-self-care activities are requiring the amputees to have a good walking ability to enhance their mobility function while performing activities. In the recent study by Mohanty, Lenka, Equebal and Kumar (2012) explained that by used of prosthesis, it will replace the lost of anatomical limb with regain cosmetic points and regain maximum of weight lost in this lowerlimb. Besides that the used of prosthesis reduced the use of upper limb muscle and energy required when compare with the used of axilla crutches among lowerlimbamputees. Contrast with this study findings it shows that uses of axilla crutches and walking frames while at community shows more independence and satisfied when performing with self-care activities (m=75.00) compare with other devices only (m=65.00 and m=68.00). The some of the participants used axilla crutches and walking frames as the primary AD because of in the process of making prosthesis ( 1st time prosthesis user) or due to poor prosthetic fit and this leads to small numbers of participants used this type AD compare with prosthetic user. It indicates, the axilla crutches and walking frames are not their permanent AD because the used of current axilla crutches and walking frames as the transition before used new prosthesis.
Current evidence suggests podiatrists rely on subject- ive findings including pulse palpation and visual appear- ance to identify PAD, while objective assessment is often limited to CWD which we have shown to have poor reli- ability [2, 15]. The method we have developed offers a potential mechanism to improve the diagnostic accuracy of vascular assessments currently performed by podia- trists by targeting the type of objective test to be used using patient medical history. In addition, increasing the use of the TBI, which has been shown to have high reli- ability in diabetes and non diabetes cohorts for initial testing for PAD , offers a more time efficient object- ive test that may be more widely adopted in clinical practice. There is also growing evidence that tests such as the TBI may be a valuable adjunct to clinical practice and could be more widely used, particularly in popula- tions at risk of foot complications .
This was assessed by the Turkish version of the Leeds Assessment of Neuropathic symptoms and signs (LANSS) scale used to assess neuropathic pain for the residual limb (18). Patients were asked questions about the characterization of pain in the preceding week, and additional sensorial testing was performed to determine any current allodynia and the pinprick threshold. A 23-gauge needle inserted into a syringe barrel was used to measure pinprick threshold (19). A score of 12 or more on the LANSS pain scale was classified as neuropathic pain, and a score under 12 was classified as nociceptive pain (18).
Fifteen amputees agreed to participate in the study as sample of convenience and were asked to sign a written consent form. Ethical approval was obtained from the University of Malaya Ethics Committee prior to the study. The subjects were required to conform to the following criteria in order to be included in the study: no ulcer on the residuum, no volume change at the residual limb and the ability to ambulate without assistance. As the minimum length for eligibility to use Seal-In liners is 11 cm based on the manufacturer guidelines, only those amputees with adequate residuum length were eligible to participate. The subjects were also considered for participation if they had used prosthesis in the last 6 months.
in the residual limb, and the ability to ambulate independently. The stump length, measured from the inferior edge of the patella to the distal end of the stump, had to be no less than 13 cm. All participants used transtibial prostheses with the pin lock suspension system before the initiation of this study. Table 1 lists the individual characteristics of all subjects. The University of Malaya
scanning time). Laser scanning methods, including CAD/CAM systems [1, 9, 17–21], have been introduced to aid the manufacture of prosthetic sockets, reducing fitting errors, fabrica- tion time and overall costs. Some of these techniques have shown promise, with the Omega Tracer scanner being the method of choice for current clinical practice in the UK [2, 9]. Repeatability coefficients for this system appear relatively high and range from 45 ml (~5% of volume) when scanning residual limb models  to 129 ml (~13% of volume) when scanning human transtibial residual limbs . A recent study evaluated the accuracy of the imaging/ acquisition process of three new surface 3D scanners and suggested that the VIUScan marker assisted laser scanner was the most accurate for determining residual limb model volume and shape. The systematic bias/error reported between the VIUScan scanner and the criterion was lower than 1%, but they used a single 3D printed transtibial model of known geometry as a gold standard, without considering the effect of different model sizes . The method revealed estimated repeatability coefficients <45 ml for within and between observer assess- ments. However, a full comparison is limited because of the statistical methods adopted. Fur- thermore, as with many other similar studies, this method has not yet been tested on human residual limbs.
questionnaire was intended to guide the future improve- ments of cosmesis design, and the authors and industry partners considered three features a manageable list to focus the research. The most important cosmesis feature identified by the sample was the shape match to the sound limb, followed by free prosthetic joint movement under the cosmesis and the natural fit of clothing over the cosme- sis. The importance rankings identify areas of priority for research and development in the near future. In addition, the features with the highest percentage of dissatisfied/ neutral amputee opinion (colour, waterproof quality and ability to keep clean) were not ranked with high impor- tance. This demonstrates the need to question both satis- faction, to gauge approval and acceptance of current products, and importance, to extract the appropriate data to inform future cosmesis design.
As expected, the walking ability and dependency of patients with diabetes following minor amputation are better than those following major amputation at six months. The quality of life of patients with minor amputation is better than those with major amputation in the PF, RP, GH, RE and MH domains. However, patients with minor amputation have more pain and poorer social function than those with major amputation. Despite the risk of persistent infection and stump complications, minor amputation should be attempted in suitable patients with diabetes.
With respect to our comparison between lowerlimbamputees and orthopedic patients, we found the mean score of the orthopedic patients was much higher than that of the amputees in the GLFS-25. However, orthopedic patient group was older and included a greater proportion of female patients. In general aging and female sex are associated with a lower locomotor function. Contrary to our original hypothesis the similarity of these scores indicates that lowerlimbamputees have the same degree of locomotor trouble as general orthopedic patients. However, all of the amputees were assessed when using a prosthetic limb; thus the similarity was very dependent on their prosthesis. This assessment was based on a simple comparison of the GLFS- 25 and should only be used as a guide.
The prosthetics is done in order to help the persons with various degrees of amputation to regain their normal functioning. The prosthetics used for rehabilitation (regaining of body functionality) should be comfortable for the patient and should be durable. After lowerlimb prosthesis, the most important goal in the rehabilitation process of the amputee is the regaining of walking. The walking ability is very essential for proper functioning. There are two different types of foot available that are used based on function. These are the dynamic and non dynamic response foot (e.g. solid ankle cushion heel). The non dynamic foot is basic for appearance and the functions such as standing and walking, while the dynamic can be used for more intense activities like running. Current prosthetic foot designs do not exactly match the characteristics of normal human foot. Human foot is a multi-functional device that performs various activities, but the functions of prosthetic feet are limited to only few. A person’s prosthesis should be designed and assembled according to the patient’s appearance and functional needs. Over the years there have been significant advancements in prosthetics. New plastics and other materials, such as carbon fiber, have made artificial limbs stronger and lighter, reducing the amount of extra energy necessary to operate the limb. This is very important for trans-femoral amputees. Additional materials have made artificial limbs to look much like real limbs, which is important to trans-radial and trans-humeral amputees because they are more likely to have the artificial limb exposed. The foot provides shock absorption and stability during stance by providing contact to the ground. Additionally it influences the gait biomechanics by its shape and stiffness. The basis of this project is to provide standing and walking functions as well as to make the appearance attractive. The available below knee prosthesis device employs silicon material for the foot which is imported and expensive; hence there is a need to use a cost effective and easily available material (wood). The main problem associated with current feet is durability and endurance. The different characteristics on the basis of which the prosthetics are used include: cosmetics, cost, and ease of use, size availability, weight, rotation, and energy absorption and ground compliance. The objective of this project is to design a prosthetic feet model that can function as a normal human foot, whose characteristics match the most with the normal human foot and to evaluate the functioning of prosthetics in rehabilitation. The designed prosthetic feet model can then be used to evaluate the durability, endurance and comfort level provided by the designed SACH prosthetic foot. On the basis of this model further studies can be conducted to evaluate the effect of prosthetic feet in the rehabilitation of patients with lowerlimb prosthesis.