Prosthethic legs: Shoe selection, socket liners, physical activity

September 10, 2004

The current issue of the Journal of Rehabilitation Research and Development (JRRD) includes five articles that focus on lower-limb prosthetics that influence physical activity and health. Also included in this issue are articles that evaluate rehabilitation therapies, investigate adjunct therapies for stroke and traumatic injury, and validate diagnostic tools for osteoarthritis and traumatic brain injury. Full-text articles are available for free online at

MANUSCRIPTS FEATURED IN VOLUME 41, ISSUE 4 Exercising brain holds promise to preserve sensorimotor function following traumatic injury, pg. 505.
This study examines whether motor imagery complements and/or supplements more traditional therapies for motor rehabilitation. Investigators found that physical practice produced greater improvements in motor behavior than mental practice and no practice. Mental practice led to greater improvements than no physical practice. Motor recovery from central nervous system trauma such as spinal cord injury or stroke may involve the use of compensatory brain sensorimotor processes. While physical practice effectively produces those changes, mental practice may preserve pretrauma sensorimotor processes or produce compensatory processes before and during physical rehabilitation.

Adding Donepezil to physical therapy may improve health outcomes for people with stroke, pg. 525.
This study investigates whether donepezil, a drug important in forming new memories and developing new skills, enhances the impact of constraint-induced therapy for arm and hand impairment caused by stroke. The results showed that donepezil produced a somewhat better outcome for patients receiving therapy for limb impairment following stroke. This study suggests that donepezil might improve the efficiency of vigorous physical therapies.

Shoe choice impacts soft tissue damage to residual limb of people with amputations, pg. 535.
This study quantifies the structural properties and energy dissipation capacity of prosthetic feet and footwear. Excessive impact forces arising from heel-ground contact during walking may increase soft tissue damage to the residual limb of the lower-limb amputee. Prosthetic feet and footwear can attenuate these forces and protect the amputee. Dissipation of impact energy by prosthetic feet ranged from 34 percent to 53 percent. Donning a shoe substantially increased energy dissipation to 63 percent, 73 percent, and 82 percent for a walking, running, and orthopaedic shoe, respectively. Energy dissipation capacity knowledge can aid in prosthetic foot and shoe selection to reduce the risk of residual limb soft tissue damage.

Shoes worn during lower-limb prosthesis fitting limits shoe choice later, pg. 547.
This study examines how shoe heel height affects the rollover characteristics of the biologic foot and ankle. The rollover shape directly measures the rocker that the ankle-foot-shoe system conforms to between heel contact and heel contact of the opposite foot. The results provide an explanation of shoe heel height problems for persons who use lower-limb prostheses. Artificial feet generally replace the ankle joint with a passive system that cannot automatically adapt to changing shoe heel heights to maintain a similarly oriented rollover shape. The initial alignment of the prosthesis with a particular pair of shoes creates a heel height constraint for other shoes that might be used with the device without further manual adjustments of the alignment.

Literature review reveals huge gaps in prosthetics research, pg. 555.
This study reports the results of a literature review on the effects of prosthetic components on human functioning with a lower-limb prosthesis. Some studies have shown that energy-storing feet result in a comfortable walking speed and stride length that are about 7 percent to 13 percent higher than with a conventional foot in both traumatic and vascular below knee amputees. With regard to the prosthetic knee, active prosthetic users may profit from the advanced characteristics of swing-phase controllers, whereas the elderly vascular patients tend to profit more from the stance-phase stability provided by a conventional locked-knee unit. This literature review points out considerable gaps in knowledge concerning the effects of prosthetic components on human functioning with a lower-limb prosthesis.

People walk less than they think they do, pg. 571.
This study determines the relationship between self-report of physical activity and actual physical activity. The physical activity of 57 men with diabetes was studied using step-count monitoring and a questionnaire. The relationship between total daily steps and self-report of activity were only fair. The data show that physical activity is a complex concept. The correlation between actual walking activity and self-report of physical activity is not as strong as many researchers believe. This could have major implications for some outcome studies that measure walking activity only with self-report as a major health outcome.

Greissinger Plus foot outperforms SACH foot for individuals with limb loss, pg. 581.
This study evaluates the SACH and the Greissinger Plus prosthetic feet during gait in below-knee amputees during early rehabilitation. Investigators compared spatial (hip, knee, and ankle joint range of motion) and temporal (walking speed, cadence, and stance phase period) parameters of gait and corresponding symmetry indexes, using three different methods. The Greissinger Plus foot significantly improved both spatial and temporal parameters, and provided increased interlimb symmetry for the range of motion in the hip and ankle, and for the stance phase period.

Individuals who use gel liner socket with prosthesis more physically active, pg. 591.
This study compares two socket liner/suspension systems for below-knee artificial legs on patient satisfaction, comfort, pain, and walking activity during normal daily life. The Alpha® Liner (a gel-type liner) with locking pin suspension and the Pe-LiteTM socket liner (a firm foam-type liner) with a neoprene knee sleeve for suspension were studied. On average, participants took 83 percent more steps per day and wore the prosthesis an estimated 82 percent more with the Pe-Lite system versus the Alpha system. This study provides information that may guide prosthetists in choosing the most appropriate socket system for patients.

Scale reliable measures family satisfaction following traumatic brain injury, pg. 603.
This study investigates the consistency and validity of the Family Satisfaction Scale (FSS) following traumatic brain injury (TBI). Volunteers with TBI were surveyed at 12 and 60 months postinjury. The results indicate a high degree of internal consistency of the FSS. Married and widowed survivors scored significantly higher on the FSS than single or separated/divorced survivors. There also was a moderate positive relationship between family satisfaction and life satisfaction. Individuals with higher family satisfaction scores also had higher life satisfaction scores.

Training program increases fitness level and functional ability of elderly after total hip arthroplasty, pg. 611.
This study measures the effects of traditional rehabilitation with a 6-week arm-crank exercise rehabilitation training program on the physiological perceptual functional responses in osteoarthrosis (OA) elderly patients immediately after total hip arthroplasty. At the end of the training program, patients more accurately perceived their actual physical exertion during physical activity. The arm-crank exercise rehabilitation program also resulted in higher cardiorespiratory and physical fitness levels compared to traditional rehabilitation after total hip arthroplasty.

Questionnaire reliably measures physical activity in people with knee osteoarthritis, pg. 621.
This study evaluates if the Human Activity Profile (HAP), a questionnaire measuring physical activity level, is a useful measure for people with knee joint osteoarthritis (OA). Even though physical activity is essential for health and well-being, physical activity levels are often not measured in knee OA. This study found that HAP is a reliable and sensitive questionnaire for measuring physical activity in people with knee OA, more so in women than men. People with knee OA are less active than healthy people of a similar age, which may have negative consequences for their overall health status.

Conservative rehabilitation reduces chronic neck pain and head side shift, pg. 631.
This study evaluates mirror image methods, a new inpatient rehabilitation technique aimed at improving posture, in treating chronic neck pain and side shift. This study is the first to show improvement in side shift of the head with conservative methods. While no statistically significant changes were observed for control subjects' pain and radiographic measurements, treatment subjects showed improvement in radiographic measurements of head posture and pain. These findings aid researchers studying new treatments for persons with chronic neck pain and abnormal side shift head posture.
JRRD is a peer-reviewed, scientifically indexed journal covering all rehabilitation research disciplines: neurology, orthopedics, engineering, audiology, ophthalmology, outcomes, prosthetics, geriatrics, psychiatry, and social integration. First published in 1964 as the Bulletin of Prosthetics Research, JRRD is celebrating 40 years of disseminating research to the rehabilitation community. JRRD accepts original research papers and review articles, as well as clinical and technical commentary from U.S. and international rehabilitation researchers.

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