Transtibial Prosthetic Socket Design and Suspension Mechanism: A Literature Review
Introduction The body weight of the prosthetic user is supported and distributed by the prosthetic socket during the stance phase of gait. Throughout swing phase, inertial forces (pressure and shear) are exerted by the socket suspension mechanism onto the residuum to facilitate suspension. Objectives in the study were to identify and investigate available evidence in transtibial (TT) socket design and suspension to highlight the most effective weight transfer mechanisms and suspension techniques. Methods A literature research was conducted comprising two parts: socket design and suspension. Boolean search terms and truncation were used using relevant keywords in online search engines to obtain precise results. Results Seventeen articles that met inclusion criteria were reviewed. Conclusions A conclusion on whether socket preference is due to the suspension mechanism or socket design itself cannot be drawn. Patellar tendon bearing (PTB) sockets are still successfully used and, in some studies, preferred over total surface bearing (TSB) sockets. Biomechanically, however, TSB sockets allow for a more even weight distribution when combined with suction, particularly vacuum-assisted socket suspension (VASS). Some limited evidence exists to support that such designs may have some effect on wound healing and early ambulation. Further research must be conducted to standardize acclimation periods. Crossover randomized controlled trials with larger sample sizes are required to establish an evidence base to improve clinical practice.

Unlimbited Wellness: Telehealth for Adults with Upper-Limb Difference
Introduction Individuals with upper-limb loss/difference often require specialized services, including occupational therapy that may be difficult to access. Also, individuals are likely to encounter secondary conditions that include pain, overuse, perceptions of isolation, and social stigma. The program was developed to meet the needs vocalized by the target population, to offer a pathway using telehealth (TH) to access peers, and to become better informed about strategies that would help to prevent physical overuse and social isolation and facilitate improved self-advocacy skills with medical practitioners. Methods Unlimbited Wellness is based on results of a needs assessment that specifically focused on the challenges experienced by this population. Participants of the Unlimbited Wellness program interacted with peers via a TH model to learn about physical and psychosocial health conditions that may cause them disparity and to share strategies to prevent or manage them. Results Effectiveness of the program was assessed via a survey of participant TH experiences and changes in perceptions of pain, ability, and quality of life as measured by the McGann Client Feedback Form and the Pizzi Health and Wellness Assessment. Overall, participant post-group perceptions of health, well-being, and prosthetic satisfaction improved as compared with pre-group experiences. During the 1:1 interviews, all participants stated they felt empowered due to their engagement in peer discussions and collaborative exercises during the Unlimbited Wellness program. Conclusions The program results indicate that a TH service delivery can be beneficial to enact health behavior change and empower individuals with upper-limb difference.

The Accuracy of Variously Positioned Pedometers for Lower-Limb Prosthesis Users
Introduction Tracking the physical activity of persons with amputation is a valuable outcome measure. Identifying affordable and accurate ways of measuring activity for individuals with amputation in developed and resource-limited environments is equally valuable. Limited walking data and methods to reliably measure walking of persons with amputation exist. The purpose of this study was to evaluate accuracy of the Omron HJ-329 worn by persons with lower-limb amputations at different locations. Methods Nineteen lower-limb prosthesis wearers wore pedometers around the neck, in both affected and nonaffected side pockets, and on the hip of both the affected side and the contralateral side while walking at a self-selected pace for 200 m. Actual step counts (ACs) were recorded by a hand tally counter. Repeated-measures analysis of variance was used to determine differences in pedometer counts between affected and nonaffected sides and between ACs. Agreement was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots, and absolute percent error was calculated using ([steps detected by pedometer − AC]/AC) × 100. Alpha was set at 0.05 for all tests. Results No significant differences existed in pedometer counts between affected and nonaffected sides (P > 0.05), nor were any significant differences evident between any of the pedometers and ACs (P > 0.05). In our sample, there were more left affected participants; among all participants, ICCs were highest on the left hip followed by the right hip, and least in the left pocket and around the neck. Limits of agreement in the Bland-Altman plots reflected this trend as well. Absolute percentage error of pedometers was greatest in the left pocket (6.8%) and lowest for the pedometer located at the left hip (2.2%) and right hip (2.6%). Conclusions The individual with amputation can wear the activity monitor at any of the locations and on either the affected or nonaffected side, and it seems wearing the devices on the hip will provide the most accurate results. Among the individuals with unilateral amputation, there were no differences in metrics between affected and nonaffected limbs. For our bilateral participants, the same nondifferences were observed. The Omron HJ-329 is thus an affordable, viable activity monitor for the population of persons with lower-limb amputation.

Method to Evaluate the Sagittal Plane Mobility of the Medial Arch of the Shod Foot with Foot Orthosis
Introduction Midfoot mobility plays an important role in the orthotic treatment of foot pathomechanical disorders, such as flexible pes planus and abnormal foot pronation. The sagittal plane mobility of the medial arch of only the unshod foot with a foot orthosis has been evaluated for improving therapeutic outcomes. Because foot orthoses are in-shoe devices, it is necessary to evaluate the sagittal plane mobility of the medial arch of the shod foot with a foot orthosis to optimize in-shoe orthotic effectiveness. Materials and Methods This technical note describes a procedure using digital photography to evaluate the sagittal plane mobility of the medial arch of the shod foot with a foot orthosis. The procedure involves digitally photographing two weight-bearing states of the shoe in which the foot orthosis supports the foot: 1) 10% of body weight achieved by sitting, and 2) 50% of body weight achieved by standing. The two digital images of the shoe are then geometrically analyzed to calculate the displacement of the medial height of the dorsal surface of the shoe in response to the change in the two weight-bearing states. Conclusions Clinicians and researchers can use the method described in this note to evaluate the sagittal plane mobility of the medial arch of the shod foot with a foot orthosis. The method is clinically useful for optimizing the in-shoe effectiveness of foot orthoses to treat foot pathomechanical disorders.