Residual Limb Research Articles

Innovative Stress-responsive Liner Design for Lower Limb Disability

After lower limb amputation or disability, prosthetic limbs are essential for regaining mobility, but skin integrity often degrades due to mechanical stresses at the stump–prosthesis interface. In this study, the finite element method was utilized to predict the areas at the stump–prosthetic interface experiencing the highest levels and distributions of mechanical stresses. The empirical results of the finite element analysis (FEA) delineated the stress concentration sites. Consequently, we devised an innovative liner design tailored to these stress patterns, which was subsequently implemented. The simulation outcomes validated the effectiveness of the liner, demonstrating significant reductions in stress levels at the junction of the residual limb and the prosthetic socket. The results demonstrated that the designed liner was highly effective in reducing stress, particularly in three critical areas: the lateral area of the tibia head (LTH), the tibia end area (TE), and the fibular end (FE). Stress values at the LTH were reduced from 55 to 10 kPa, at the TE from 60 to 28 kPa, and at the FE from 72.3 to 14 kPa. In essence, this liner represents a bespoke intervention, with the FEA serving as a predictive tool that not only identifies critical stress points but also guides the design of personalized prosthetic liners. These findings will improve the structural and functional compatibility of the prosthesis, thereby enhancing wearer comfort and reducing the risk of skin-related complications for persons with disabilities.

Discrete-Target Prosthesis Control Using Uncertainty-Aware Classification for Smooth and Efficient Gross Arm Movement.

Current control approaches for gross prosthetic arm movement mainly regulate movement over a continuous range of target poses. However, these methods suffer from output fluctuation caused by input signal variations during gross arm movements. Prosthesis control approaches with a finite number of discrete target poses can address this issue and reduce the complexity of the pose control process. However, it remains under-explored in the literature and suffers from the consequences of misclassifying the target poses. Here, we propose a novel Uncertainty-Aware Discrete-Target Prosthesis Control (UA-DPC) approach. This approach consists of (1) an uncertainty-aware classification scheme to reduce unintended pose switches caused by misclassifications, and (2) real-time trajectory planning that adjusts motion to be rapid or conservative based on low or high quantified uncertainty, respectively. By addressing the impact of misclassification, this approach facilitates more efficient and smooth movements. Human-in-the-loop experiments were conducted in a virtual reality environment with 12 non-disabled participants. The participants controlled a transhumeral prosthesis using three approaches: the proposed UA-DPC, a discrete-target approach based on a traditional off-the-shelf classifier, and a continuous-target approach. The results demonstrate the superior performance of UA-DPC, which provides more efficient task completion with fewer misclassification instances as well as smoother residual limb and prosthesis movement.

Constructing an Osseointegrated Prosthetic Leg.

Constructing an osseointegrated prosthetic leg is the necessary subsequent phase of care for patients following the surgical implantation of an osseointegrated prosthetic limb anchor. The surgeon implants the bone-anchored transcutaneous implant1,2 and the prosthetist constructs the prosthetic leg, which then attaches to the surgically implanted anchor. An osseointegration surgical procedure is usually considered in patients who are unable to use or are dissatisfied with the use of a socket prosthesis. This present video article describes the techniques and principles involved in constructing a prosthetic leg for transfemoral and transtibial amputees, as well as postoperative patient care. Preoperatively, as part of a multidisciplinary team approach, the prosthetist should assist in patient evaluation to determine suitability for osseointegration surgery. Postoperatively, when approved by the surgeon, the first step is to perform an implant inspection and to take patient measurements. A temporary loading implant is provided to allow the patient to start loading the limb. When the patient is approved for full-length leg to begin full weight-bearing, the implant and prosthetic quality are evaluated, including torque, implant position, bench alignment, static alignment in the standing position, and initial dynamic alignment. This surgical procedure also requires long-term, continued patient care and prosthetic maintenance. For patients who are dissatisfied with the use of a socket prosthesis, adjustments can often be made to improve the comfort, fit, and performance of the prosthesis. Non-osseointegration surgical options include bone lengthening and/or soft-tissue contouring. Osseointegration can be provided for amputees who are expressing dissatisfaction with their socket prosthesis, and typically provides superior mobility and quality of life compared with nonoperative and other operative options3,4. Specific differences between the appropriate design and construction of osseointegrated prostheses versus socket prostheses include component selection, component fit, patient-prosthesis static and dynamic alignment, tolerances and accommodations, and also the expected long-term changes in patient joint mobility and behavior. Providing an osseointegrated prosthesis according to the principles appropriate for socket prostheses may often leave an osseointegrated patient improperly aligned and provoke maladaptive accommodations, hindering performance and potentially putting patients at unnecessary risk for injury. Review articles describing the clinical outcomes of osseointegration consistently suggest that patients with osseointegrated prostheses have improved prosthesis wear time, mobility, and quality of life compared with patients with socket prostheses. Importantly, studies have shown that osseointegrated prostheses can be utilized in patients with short residual limbs that preclude the use of a socket prosthesis, allowing them to regain or retain function of the joint proximal to the short residuum5,6. Osseoperception improves patient confidence during mobility7. Because there is an open skin portal, low-grade soft-tissue infection can occur, which is usually treated with a short course of oral antibiotics. Much less often, soft-tissue debridement or implant removal may be needed to treat infection8. Periprosthetic fractures can nearly always be treated with familiar fracture fixation techniques and implant retention9,10. Falls can lead to periprosthetic fractures.Malalignment can lead to unnecessary pathologic joint forces, soft-tissue contractures, and an accommodative gait.Inadequately sophisticated components can leave patients at a performance deficit.Wearing the prosthetic leg while sleeping may lead to rotational forces exerted on the limb, which may cause prolonged tension on the soft tissue. QTFA = Questionnaire for Persons with a Transfemoral AmputationLD-SRS = Limb Deformity Modified Scoliosis Research SocietyPROMIS = Patient-Reported Outcomes Measurement Information SystemEQ-5D = EuroQol 5 Dimensions.

Walking Ankle Biomechanics of Individuals With Transtibial Amputations Using a Prescribed Prosthesis and a Portable Bionic Prosthesis Under Myoelectric Control.

Individuals with transtibial amputation can activate residual limb muscles to volitionally control robotic ankle prostheses for walking and postural control. Most continuous myoelectric ankle prostheses have used a tethered, pneumatic device. The Open Source Leg allows for myoelectric control on an untethered electromechanically actuated ankle. To evaluate continuous proportional myoelectric control on the Open Source Ankle, we recruited five individuals with transtibial amputation. Participants walked over ground with an experimental powered prosthesis and their prescribed passive prosthesis before and after multiple powered device practice sessions. Participants averaged five hours of total walking time. After the final testing session, participants indicated their prosthesis preference via questionnaire. Participants tended to increase peak ankle power after practice (powered 0.80 ± 1.02 W/kg and passive 0.39 ± 0.31 W/kg). Additionally, participants tended to generate greater ankle work with the powered prosthesis compared to their passive device ( 0.13 ± .15 J/kg increase). Although work and peak power generation were not statistically different between the two prostheses, participants preferred walking with the prosthesis under myoelectric control compared to the passive prosthesis. These results indicate individuals with transtibial amputation learned to walk with an untethered powered prosthesis under continuous myoelectric control. Four out 5 participants generated larger magnitudes in peak power compared to their passive prosthesis after practice sessions. An additional important finding was participants chose to walk with peak ankle powers about half of what the powered prosthesis was capable of based on mechanical testing.

Insights into the spectrum of transtibial prosthetic socket design from expert clinicians and their digital records.

Transtibial prosthetic sockets are often grouped into patella tendon bearing (PTB) or total surface bearing (TSB) designs, but many variations in rectifications are used to apply these principles to an individual's personalised socket. Prosthetists currently have little objective evidence to assist them as they make design choices. To compare rectifications made by experienced prosthetists across a range of patient demographics and limb shapes to improve understanding of socket design strategies. 163 residual limb surface scans and corresponding CAD/CAM sockets were analysed for 134 randomly selected individuals in a UK prosthetics service. This included 142 PTB and 21 TSB designs. The limb and socket scans were compared to determine the location and size of rectifications. Rectifications were compiled for PTB and TSB designs, and associations between different rectification sizes were assessed using a variety of methods including linear regression, kernel density estimation (KDE) and a Naïve Bayes (NB) classification. Differences in design features were apparent between PTB and TSB sockets, notably for paratibial carves, gross volume reduction and distal end elongation. However, socket designs varied across a spectrum, with most showing a hybrid of the PTB and TSB principles. Pairwise correlations were observed between the size of some rectifications (e.g., paratibial carves; fibular head build and gross volume reduction). Conversely, the patellar tendon carve depth was not associated significantly with any other rectification, indicating its relative design insensitivity. The Naïve Bayes classifier produced design patterns consistent with expert clinician practice. For example, subtle local rectifications were associated with a large volume reduction (i.e., a TSB-like design), whereas more substantial local rectifications (i.e., a PTB-like design) were associated with a low volume reduction. This study demonstrates how we might learn from design records to support education and enhance evidence-based socket design. The method could be used to predict design features for newly presenting patients, based on categorisations of their limb shape and other demographics, implemented alongside expert clinical judgement as smart CAD/CAM design templates.

A Novel Approach to Lower Extremity Residual Limb Revision to Augment Volitional Motor Control, Restore Proprioception and Reverse Limb Atrophy; The Regenerative Agonist-Antagonist Myoneural Interface

A Novel Approach to Lower Extremity Residual Limb Revision to Augment Volitional Motor Control, Restore Proprioception and Reverse Limb Atrophy; The Regenerative Agonist-Antagonist Myoneural Interface

Prosthetic hand for phocomelia patients with enhanced pain management using EMG signal processing and biofeedback control system

Denoising is an essential step in data mining. It makes an effort to remove noise from the picture without sacrificing any of the important elements. The primary method utilized in this project to assess the effectiveness of phocomelia images is Kmeans clustering. The PSNR and MSE values of the denoised image are computed. In the end, the best technique for denoising medical images is chosen based on the PSNR values from the collection of patient data necessary for the fitting of upper limb devices. Using image processing, the bone health of phocomelia patients are evaluated and specific information extracted from MRI scans. Electromyography (EMG) sensors pick up electrical impulses, convert them into hand movements that the user wants, and flex the muscles in the residual limb directly below the elbow. The same muscles that enable hand function in humans are also felt by the system using microcontrollers. Through the integration of sophisticated sensor technologies with responsive prosthetic design idea, this newly developed technique enhances feedback from the proprioceptive system for patients with phocomelia, hence promoting natural movement and improving functional outcomes. As a result, it provides phocomelia patients a special method for acquiring superior result from biofeedback system.

Human Collaborative Control of Lower-Limb Prosthesis Based on Game Theory and Fuzzy Approximation.

For leg prosthesis user, the soft tissue and skin under the stump of are not accustomed to weight bearing, excessive continuous contact pressure can lead to the risk of degenerative tissue ulceration. This article presents a novel human-robot collaborative control scheme that achieves control weight self-adjustment for robotic prostheses to minimize interaction torque. To establish the human-robot interaction relationship, we regard the contact pressure between human residual limb and the prosthetic receiving cavity as the interaction force. We aim at reducing the interaction force under the premise of minimally changing the original motion trajectory of the robotic prosthesis. The control scheme mainly includes trajectory optimization based on a dual-agent game control scheme under a cooperative relationship, and a fuzzy logic system for improving the control accuracy of trajectory tracking of robotic prostheses with unknown dynamic parameters. Experiments were carried out on two amputee participants to verify the proposed human-robot interactive control scheme in a robotic prosthesis. The results show that the interaction torque could be reduced while maintaining minimal trajectory tracking error. The proposed control scheme could potentially facilitate the dexterous manipulation of leg prostheses, thus benefiting amputees.

A Pneumatically Controlled Prosthetic Socket for Transfemoral Amputees.

Amputees typically experience changes in residual limb volume in their daily lives. It causes an uncomfortable fit of the socket by applying high pressure on the sensitive area of the residual limb or by loosening the socket. In this study, we developed a transfemoral prosthetic socket for above-the-knee amputees that ensures a good socket fit by maintaining uniform and constant contact pressure despite volume changes in the residual limb. The socket has two air bladders in the posterior femoral region, and the pneumatic controller is located on the tibia of the prosthesis. The pneumatic system aims to minimize unstable fitting of the socket and improve walking performance by inflating or deflating the air bladder. The developed socket autonomously maintains the air pressure inside the prosthetic socket at a steady-state error of 3 mmHg or less by adjusting the amount of air in the air bladder via closed-loop control. In the clinical trial, amputee participants walked on flat and inclined surfaces. The displacement between the residual limb and socket during the gait cycle was reduced by up to 33.4% after air injection into the socket. The inflatable bladder increased the knee flexion angle on the affected side, resulting in increased stride length and gait velocity. The pneumatic socket provides a stable and comfortable walking experience not only when walking on flat ground but also on slopes.

The gait1415+2 OpenSim musculoskeletal model of transfemoral amputees with a generic bone-anchored prosthesis

This short communication presents the gait1415+2 musculoskeletal model, that has been developed in OpenSim to describe the lower-extremity of a human subject with transfemoral amputation wearing a generic lower-limb bone-anchored prosthesis. The model has fourteen degrees of freedom, governed by fifteen musculotendon units (placed at the contralateral and residual limbs) and two generic actuators (one placed at the knee joint and one at the ankle joint of the prosthetic leg). Even though the model is a simplified abstraction, it is capable of generating a human-like walking gait and, specifically, it is capable of reproducing both the kinematics and the dynamics of a person with transfemoral amputation wearing a bone-anchored prosthesis during normal level-ground walking. The model is released as support material to this short communication with the final goal of providing the scientific community with a tool for performing forward and inverse dynamics simulations, and for developing computationally-demanding control schemes based on artificial intelligence methods for lower-limb prostheses.

The LIBRA NeuroLimb: Hybrid Real-Time Control and Mechatronic Design for Affordable Prosthetics in Developing Regions.

Globally, 2.5% of upper limb amputations are transhumeral, and both mechanical and electronic prosthetics are being developed for individuals with this condition. Mechanics often require compensatory movements that can lead to awkward gestures. Electronic types are mainly controlled by superficial electromyography (sEMG). However, in proximal amputations, the residual limb is utilized less frequently in daily activities. Muscle shortening increases with time and results in weakened sEMG readings. Therefore, sEMG-controlled models exhibit a low success rate in executing gestures. The LIBRA NeuroLimb prosthesis is introduced to address this problem. It features three active and four passive degrees of freedom (DOF), offers up to 8 h of operation, and employs a hybrid control system that combines sEMG and electroencephalography (EEG) signal classification. The sEMG and EEG classification models achieve up to 99% and 76% accuracy, respectively, enabling precise real-time control. The prosthesis can perform a grip within as little as 0.3 s, exerting up to 21.26 N of pinch force. Training and validation sessions were conducted with two volunteers. Assessed with the "AM-ULA" test, scores of 222 and 144 demonstrated the prosthesis's potential to improve the user's ability to perform daily activities. Future work will prioritize enhancing the mechanical strength, increasing active DOF, and refining real-world usability.

Distal weight bearing in transtibial prosthesis users wearing pin suspension.

Low-level distal weight bearing in transtibial prosthesis users may help maintain perfusion and improve both proprioception and residual limb tissue health. The primary objectives of this research were to develop a sensor to continuously measure distal weight bearing, evaluate how prosthesis design variables affected weight bearing levels, and assess fluctuations in distal weight bearing during at-home and community use. In-lab testing on a small group of participants wearing adjustable sockets demonstrated that if distal contact was present, when socket size was increased distal weight bearing increased and when socket size was reduced distal weight bearing decreased. During take-home use, participants accepted the distal weight bearing level set by the research team. It ranged between 1.1% and 6.4% BW for all days tested. The coefficient of variation (standard deviation/mean) ranged from 25% to 43% and was expected due in part to differences in walking style, speed, terrain, direction of ambulation, and bout duration. Two participants commented that they preferred presence of distal weight bearing to non-presence. Next steps in this research are to develop clinical practices to determine target distal weight bearing levels and ranges, and to simplify the design of the sensor and weight bearing adjustment mechanism for clinical use.

The application of biomimetic limbs in postoperative rehabilitation of amputees

Due to the inability to provide recovery opportunities, amputation is generally considered a failure of treatment. Traditional prostheses cannot interact with the surrounding environment, and the contact surface between the prosthesis and the residual limb is prone to wear and tear, causing pain to patients. Therefore, prostheses are generally regarded by patients as tools rather than a part of the body. In recent years, with the continuous development of artificial intelligence, materials science, and biomedical engineering technology, bionic limb technology has received widespread attention and application. Currently, bone integration and electromyography interface technology are widely applied in bionic limbs, allowing for more realistic and diverse options for prostheses for patients. Material innovation and machine learning technology can improve the mechanical performance, perceptual feedback effects, and autonomous learning ability of bionic limbs, but further research and exploration are still needed. This review paper aims to summarize and evaluate the current development status, application areas, and future research directions of bionic limb technology.

Hip joint and muscle loading for persons with bilateral transfemoral/through-knee amputations: biomechanical differences between full-length articulated and foreshortened non-articulated prostheses

BackgroundCurrently, there is little available in-depth analysis of the biomechanical effect of different prostheses on the musculoskeletal system function and residual limb internal loading for persons with bilateral transfemoral/through-knee amputations (BTF). Commercially available prostheses for BTF include full-length articulated prostheses (microprocessor-controlled prosthetic knees with dynamic response prosthetic feet) and foreshortened non-articulated stubby prostheses. This study aims to assess and compare the BTF musculoskeletal function and loading during gait with these two types of prostheses.MethodsGait data were collected from four male traumatic military BTF and four able-bodied (AB) matched controls using a 10-camera motion capture system with two force plates. BTF completed level-ground walking trials with full-length articulated and foreshortened non-articulated stubby prostheses. Inverse kinematics, inverse dynamics and musculoskeletal modelling simulations were conducted.ResultsFull-length articulated prostheses introduced larger stride length (by 0.5 m) and walking speed (by 0.3 m/s) than stubbies. BTF with articulated prostheses showed larger peak hip extension angles (by 10.1°), flexion moment (by 1.0 Nm/kg) and second peak hip contact force (by 3.8 bodyweight) than stubbies. There was no difference in the hip joint loading profile between BTF with stubbies and AB for one gait cycle. Full-length articulated prostheses introduced higher hip flexor muscle force impulse than stubbies.ConclusionsCompared to stubbies, BTF with full-length articulated prostheses can achieve similar activity levels to persons without limb loss, but this may introduce detrimental muscle and hip joint loading, which may lead to reduced muscular endurance and joint degeneration. This study provides beneficial guidance in making informed decisions for prosthesis choice.

Antibacterial evaluation of different prosthetic liner textiles coated by CuO nanoparticles

Prosthetic liners are mainly used as an interface between residual limbs and prosthetic sockets to minimize physical and biological damage to soft tissue. However, the closed and moist conditions within liners and the amputee's skin provide a suitable environment for bacterial growth to cause infections. This study aimed to coat a comprehensive variant material with copper oxide nanoparticles (CuO NPs) and compare their surface analysis and antibacterial properties. These materials were covered with CuO NPs solution at a concentration of 70 μg mL−1 to achieve this purpose. After drying, their surface characteristics were analyzed by measuring zeta potential, contact angle, surface roughness, and fiber arrangement. Cu-released concentration from the coatings into the acetate buffer solution by inductively coupled plasma mass spectrometry indicated that lycra and nylon quickly released Cu ions to concentrations up to ∼0.2 μg mL−1 after 24 h, causing low metabolic activity of human bone–marrow mesenchymal stem cells (bMSC) in the indirect assay. Antibacterial activity of the coated specimens was evaluated by infecting their surfaces with the Gram-positive bacteria Staphylococcus epidermidis, reporting a significant ∼40 % reduction of metabolic activity for x-dry after 24 h; in addition, the number of viable bacterial colonies adhered to the surface of this material was reduced by ∼23 times in comparison with non-treated x-dry that were visually confirmed by scanning electron microscope. In conclusion, CuO NPs x-dry shows optimistic results to pursue further experiments due to its slow speed of Cu release and prolonged antibacterial activity, as well as its compatibility with human cells.

Combining Surgical Innovations in Amputation Surgery-Robotic Harvest of the Rectus Abdominis Muscle, Transplantation and Targeted Muscle Reinnervation Improves Myocontrol Capability and Pain in a Transradial Amputee.

Adding robotic surgery to bionic reconstruction might open a new dimension. The objective was to evaluate if a robotically harvested rectus abdominis (RA) transplant is a feasible procedure to improve soft-tissue coverage at the residual limb (RL) and serve as a recipient for up to three nerves due to its unique architecture and to allow the generation of additional signals for advanced myoelectric prosthesis control. A transradial amputee with insufficient soft-tissue coverage and painful neuromas underwent the interventions and was observed for 18 months. RA muscle was harvested using robotic-assisted surgery and transplanted to the RL, followed by end-to-end neurroraphy to the recipient nerves of the three muscle segments to reanimate radial, median, and ulnar nerve function. The transplanted muscle healed with partial necrosis of the skin mesh graft. Twelve months later, reliable, and spatially well-defined Hoffmann-Tinel signs were detectable at three segments of the RA muscle flap. No donor-site morbidities were present, and EMG activity could be detected in all three muscle segments. The linear discriminant analysis (LDA) classifier could reliably distinguish three classes within 1% error tolerance using only the three electrodes on the muscle transplant and up to five classes outside the muscle transplant. The combination of these surgical procedure advances with emerging (myo-)control technologies can easily be extended to different amputation levels to reduce RL complications and augment control sites with a limited surface area, thus facilitating the usability of advanced myoelectric prostheses.

Development of a hand prosthesis with a heating system to prevent residual limb pain for upper limb amputee

Development of a hand prosthesis with a heating system to prevent residual limb pain for upper limb amputee

Soft robotics-inspired sensing system for detecting downward movement and pistoning in prosthetic sockets: A proof-of-concept study.

Vertical displacement of the residual limb within transtibial prosthetic socket, often known as "pistoning" or downward movement, may lead to skin breakdowns and ulcers. Downward movement is particularly difficult to self-manage for diabetic individuals living with amputation because of diminished sensation in the residual limb from peripheral neuropathy. Therefore, a customizable sensor at the distal end that can alert the users when high-risk downward movement and pistoning occurs is urgently needed. Presented herein for the first time is a lightweight, inexpensive sensing system inspired by soft robotics that can detect the occurrence and severity of downward movement at the distal end. The sensing system consists of a multilayered torus-shaped balloon, allowing easy integration with pin-lock socket systems. The design allows sensing of vertical displacement without imparting high reaction forces back onto the distal end. A benchtop compression tester was used to characterize system performance. Systematic and parametric benchtop tests were conducted to examine the sensor's physical characteristics. Long-term (24-h) stability of the sensor was also recorded. Compared with water, air was determined to be a better medium with a higher linear full-scale span (FSS) because of its compressible nature. Repeatable 0.5-mm vertical displacements yielded a linear (>0.99 R2) FSS of 4.5 mm and a sensitivity of 0.8 kPa/mm. The sensing system is highly precise, with as low as 1% FSS total error band and average hysteresis of 2.84% of FSS. Over 24 h, a 4% FSS drift was observed. Sensing system characteristics, coupled with low-cost, customizable fabrication, indicates promising performance for daily use to notify and alert transtibial prosthetic users of downward movement and/or pistoning.

Ten-year phantom limb pain with only four sessions of Fu's subcutaneous needling: A case report and systematic review

Phantom limb pain (PLP) is a distressing consequence commonly encountered by individuals who have undergone amputations. The efficacy of treatment options for PLP is limited. In this study, we present a case of a 64-year-old male who suffered from PLP for a duration of 10 years following an above-the-knee amputation. Despite unsuccessful attempts with painkillers and neurotrophic drugs over the course of a decade, the patient sought relief through Fu's Subcutaneous Needling (FSN), an innovative acupuncture therapy that specifically targets the subcutaneous tissue for pain management. Remarkably, the patient experienced a significant reduction in PLP and subsequently decreased his reliance on medication, as well as experiencing improved sleep after undergoing one session of FSN per day for four consecutive days. A follow-up conducted three years later demonstrated positive treatment outcomes. FSN demonstrated a significant influence on PLP, resulting in reduced analgesic requirements and enhanced quality of life. Therefore, FSN may be recommended as an additional treatment option for PLP. In order to gain a comprehensive understanding of the effects of acupuncture on PLP, a systematic review of relevant literature was conducted in PubMed, Embase, Cochrane Library and Web of Science in recent 20 years (from January 1, 2003 to October 16, 2023), using different combinations of the following terms: (phantom acrodynia), (residual limb pain), (phantom limb pain), (acupuncture), (electroacupuncture), (auriculoacupuncture), and (needling). 9 articles with 18 cases including one randomized controlled trial (n = 8) were obtained. This review provided additional evidence supporting the efficacy and safety of needling therapies for PLP. This systematic review offers additional evidence supporting the effectiveness and safety of needling therapies for PLP. However, there were no precedent reports using FSN treatment for PLP. Hence, this case may provide some implications for clinicians in practice.

Pain, Balance-Confidence, Functional Mobility, and Reach Are Associated With Risk of Recurrent Falls Among Adults With Lower-Limb Amputation

ObjectiveThe study evaluated whether pain intensity and extent, balance-confidence, functional mobility, and balance (eg, functional reach) are potential risk factors for recurrent falls among adults with a lower-limb amputation. DesignCross-sectional study. SettingResearch laboratory. ParticipantsEighty-three adults with unilateral lower-limb amputation that occurred >1 year prior (26 transfemoral- and 57 transtibial-level amputation; 44.6% women; 51.8% traumatic cause of amputation; N=83). InterventionNot applicable. Main Outcome MeasuresParticipants reported on the number of falls in the past year, as well as pain intensity in the low back, residual, and sound limbs. Balance-confidence (per the Activities-Specific Balance-Confidence Scale [ABC]), functional mobility (per the Prosthetic Limb Users Survey of Mobility ([PLUS-M]), and balance (per the Functional Reach and modified Four Square Step Tests) were obtained. ResultsAfter considering non-modifiable covariates, greater extent of pain, less balance-confidence, worse self-reported mobility, and reduced prosthetic-side reach were factors associated with recurrent fall risk. Adults reporting pain in the low back and both lower-limbs had 6.5 times the odds of reporting recurrent falls as compared with peers without pain. A 1-point increase in ABC score or PLUS-M T score, or 1-cm increase in prosthetic-side reaching distance, was associated with a 7.3%, 9.4%, and 7.1% decrease in odds of reporting recurrent falls in the past year, respectively. ConclusionsOf the 83 adults, 36% reported recurrent falls in the past year. Presence of pain in the low back and both lower-limbs, less balance-confidence, worse PLUS-M score, and less prosthetic-side reaching distance were identified as modifiable factors associated with an increased odd of recurrent falls.