A Prosthetic Foot Emulator to Optimize Prescription of Prosthetic Feet in Veterans and Service Members with Leg Amputations
Abstract
Objectives and Rationale: Severe injury to a foot or leg may necessitate amputation of the limb. Use of a prosthesis allows many who experience lower leg amputation to regain functional abilities, but walking may be more difficult, and a suboptimal prosthesis can substantially restrict participation in desired vocational and avocational activities. Prescription of an optimal prosthetic foot is an important aspect of maximizing walking ability and the achievement of functional goals for people with lower leg amputation; however, there is limited evidence to guide this process. The current prosthetic prescription process relies on clinician experience and typically does not allow people with a leg amputation to try out different prosthetic feet. We have developed a customizable robotic prosthetic foot that mimics the mechanical properties of commercial prosthetic feet without physically changing feet. This "prosthetic foot emulator" can be attached to the prescribed prosthetic socket and worn like a regular prosthetic foot within the laboratory or clinic, providing people with leg amputations the opportunity to quickly "test drive" many prosthetic foot designs within a single test session. In the proposed work, we will rigorously test the ability of the emulator to accurately reproduce the experience of wearing the corresponding commercial (actual) prosthetic feet. We will accomplish this by testing whether brief in-laboratory experiences with emulated or actual feet can accurately predict longer-term foot preference, satisfaction, and walking ability in the community. Applicability of the Research: This research aims to help patients with leg amputations. Approximately one million people in the United States are living with leg amputations, and this number is projected to more than double by 2050. Over 17,200 U.S. Service members have been medically evacuated from theater due to battle- or musculoskeletal-related injuries sustained during Operations Iraqi Freedom (OIF), Enduring Freedom (OEF), and New Dawn (OND). Global military figures show that the largest burden of injury from the global war on terrorism is extremity trauma, and nearly 50% of all extremities injuries involve the legs. The number of Veterans with amputations who are receiving treatment in Department of Veterans Affairs facilities has more than tripled (now 80,000) since the year 2000. There has also been a 48% increase in the total number of Veteran amputee patient clinic visits in the past 5 years nationally (with a 78% increase in Veterans who served in OIF/OEF/OND). Improving mobility and health-related satisfaction in this growing population is clearly of great importance. The proposed approach to prosthesis prescription could resolve longstanding uncertainty in the prescription of prosthetic feet. Unfortunately, it is difficult to generalize the merits of a particular device across different patients, even patients of similar characteristic. Trial and error with actual commercial prosthetic feet can be inefficient given the time and expense required for the purchasing and fitting of prosthetic feet. The emulator could provide a means to explore a range of feet in a very short period of time. This approach would also allow patients a chance to offer valuable experiential feedback during the prescription process. Typically patients who are engaged in medical decision making are known to have better outcomes. Risks to this approach are minimal; however, there may be challenges to implementation in the clinical setting. In order to explore these potential challenges, we will explore barriers and facilitators by pilot testing use of the emulator as a part of the prosthetic prescription process in the Veteran and Military healthcare settings. Upon completion of the proposed work, we will aggressively pursue a multi-faceted approach towards integrating the prosthetic foot emulator into clinical practice. Preliminary results f
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 31, 2017
- Source ID
- W81XWH1610569
Entities
People
- David C Morgenroth
Organizations
- Seattle Institute for Biomedical and Clinical Research
- United States Army