Residual-limb skin temperature in transtibial sockets

BACKGROUND: Interventions to resolve thermal discomfort as a common complaint in amputees are usually chosen based on the residual limb skin temperature while wearing prosthesis; whereas, less attention has been paid to residual limb skin temperature while outside of the prosthesis. The objective of this study was to explore the localized and regional skin temperature over the transtibial residual limb (TRL) while outside of the prosthesis. METHODOLOGY: Eight unilateral transtibial adults with traumatic amputation were enrolled in this cross-sectional study. Participants sat to remove their prostheses and rested for 30 minutes. Twelve sites were marked circumferentially in four columns (anterolateral, anteromedial, posteromedial, and posterolateral) and longitudinally in three rows (proximal, middle, and distal) over the residual limb and used for attachment of analog thermistors. Skin temperature was recorded and compared for 11 minutes. Furthermore, the relationship of skin temperature with participants’ demographic and clinical characteristics was explored. FINDINGS: The whole temperature of the TRL was 27.73 (SD=0.83)°C. There was a significant difference in skin temperature between anterior and posterior columns. Likewise, the distal row was significantly different from the proximal and middle rows. The mean temperature at the middle and distal zones of the anteromedial column had the highest and lowest skin temperatures (29.8 and 26.3°C, p<0.05), respectively. The mean temperature of the whole TRL had no significant relationships (p>0.05) with participants’ demographic and clinical characteristics. CONCLUSIONS: An unequal distribution of temperature over the TRL was found with significantly higher and lower temperatures at its anterior column and distal row, respectively. This temperature pattern should be considered for thermoregulation strategies. Further investigation of the residual limb temperature with and without prosthesis, while considering muscles thickness and blood perfusion rate is warranted. Layman's Abstract The socket is a plastic hard-shell interface between the residual limb, the remaining part of the amputated limb, and a prosthesis. Heat buildup inside the prosthetic socket and perspiration of the residual limb are major discomforts in amputees when wearing a prosthesis. The majority of prior research measured residual limb skin temperature while the prosthesis was worn. However, less attention has been paid to skin temperature without prostheses. Skin temperature of eight adults with one-sided traumatic below-knee amputation was measured. Participants sat and removed their prostheses. Twelve anatomical sites were marked circumferentially in four columns and longitudinally in three rows over the residual limb and used for temperature recording using temperature sensors. The whole temperature of the residual limb was 27.73 (SD=0.83)°C. Skin temperature was higher at anterior columns compared to posterior columns. Similarly, the distal row of the residual limb had the lowest temperature compared to its middle and proximal rows. From a localized standpoint, the middle part at the anterior medial surface of the residual limb had the highest temperature, whereas the distal part at the anterior-medial surface had the lowest skin temperature. There was no noticeable relationship between the average of the residual limb skin temperature and participants’ demographic and clinical characteristics. Some strategies need to be developed to regulate and control heat dissipation over the residual limb's surface when amputees do not wear prostheses. Further temperature recording research by considering muscle thickness and arterial blood flow rate of the residual limb with and without prosthesis is suggested. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35070/27313 How To Cite: Ghoseiri K, Allami M, Murphy J.R, Page P, Button D.C. Investigation of localized skin temperature distribution across the transtibial residual limb. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.2. https://doi.org/10.33137/cpoj.v4i1.35070 Corresponding Author: Duane C Button, PhDSchool of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada.E-mail: [email protected]: https://orcid.org/0000-0001-6402-8545

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Determination of Localized Skin Temperature of the Transtibial Residual Limb

10.21203/rs.3.rs-46079/v1 ◽

2020 ◽

Author(s):

Kamiar Ghoseiri ◽

Mostafa Allami ◽

Justin R. Murphy ◽

Phil Page ◽

Duane C. Button

Keyword(s):

Skin Temperature ◽

Clinical Characteristics ◽

Blood Perfusion ◽

Cross Sectional Study ◽

Temperature Pattern ◽

Residual Limb ◽

Cross Sectional ◽

Unequal Distribution ◽

Study Participants ◽

Transtibial Amputees

Abstract Background: Interventions to resolve thermal discomfort as a common complaint in amputees, are usually chosen based on the residual limb skin temperature while wearing prosthesis; whereas, less attention was paid to residual limb skin temperature while outside of the prosthesis. The objective of this study was to explore the localized and regional skin temperature over the transtibial residual limb (TRL) while outside of the prosthesis.Methods: Eight unilateral transtibial amputees were enrolled in this cross sectional study. Participants sat on a chair and rested for 30 minutes while their prosthesis was removed. Twelve sites were marked in four columns (anterolateral, anteromedial, posteromedial, and posterolateral) and three rows (proximal, middle, and distal) over the residual limb and used for attachment of analog thermistors. Skin temperature was recorded and compared during 11 minutes. Furthermore, the relationship of skin temperature with participants’ demographic and clinical characteristics were explored.Results: The middle and distal zones of the anteromedial column had the highest and lowest skin temperatures (29.8 and 26.3°C, p<0.05), respectively. The average temperature of the TRL was 27.73±0.83°C and had no significant relationships (p>0.05) with participants’ demographic and clinical characteristics.Conclusions: An unequal distribution of temperature over the TRL was found with significantly higher and lower temperatures at its anterior column and distal row, respectively. This temperature pattern should be considered for thermoregulation strategies. Further investigation of the residual limb temperature while considering muscles thickness and blood perfusion rate are warranted with and without prosthesis.

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A personalised prosthetic liner with embedded sensor technology: a case study

BioMedical Engineering OnLine ◽

10.1186/s12938-020-00814-y ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Linda Paternò ◽

Vimal Dhokia ◽

Arianna Menciassi ◽

James Bilzon ◽

Elena Seminati

Keyword(s):

Thermal Properties ◽

Skin Temperature ◽

Three Dimensional ◽

Cnc Machining ◽

Machining Process ◽

Residual Limb ◽

Humidity Sensors ◽

Skin Contact ◽

Temperature And Humidity

Abstract Background Numerous sensing techniques have been investigated in an effort to monitor the main parameters influencing the residual limb/prosthesis interface, fundamental to the optimum design of prosthetic socket solutions. Sensing integration within sockets is notoriously complex and can cause user discomfort. A personalised prosthetic liner with embedded sensors could offer a solution. However, to allow for a functional and comfortable instrumented liner, highly customised designs are needed. The aim of this paper is to presents a novel approach to manufacture fully personalised liners using scanned three-dimensional image data of the patient’s residual limb, combined with designs that allow for sensor integration. To demonstrate the feasibility of the proposed approach, a personalised liner with embedded temperature and humidity sensors was realised and tested on a transtibial amputee, presented here as a case study. Methods The residual limb of a below knee amputee was first scanned and a three-dimensional digital image created. The output was used to produce a personalised prosthesis. The liner was manufactured using a cryogenic Computer Numeric Control (CNC) machining approach. This method enables fast, direct and precise manufacture of soft elastomer products. Twelve Hygrochron Data Loggers, able to measure both temperature and humidity, were embedded in specific liner locations, ensuring direct sensor-skin contact. The sensor locations were machined directly into the liner, during the manufacturing process. The sensors outputs were assessed on the below amputee who took part in the study, during resting (50 min) and walking activities (30 min). To better describe the relative thermal properties of new liner, the same tests were repeated with the amputee wearing his existing liner. Quantitative comparisons of the thermal properties of the new liner solution with that currently used in clinical practice are, therefore, reported. Results The liner machining process took approximately 4 h. Fifteen minutes after donning the prosthesis, the skin temperature reached a plateau. Physical activity rapidly increased residuum skin temperatures, while cessation of activity caused a moderate decrease. Humidity increased throughout the observation period. In addition, the new liner showed better thermal properties with respect to the current liner solution (4% reduction in skin temperature). Conclusions This work describes a personalised liner solution, with embedded temperature and humidity sensors, developed through an innovative approach. This new method allows for a range of sensors to be smoothly embedded into a liner, which is capable of measuring changes in intra-socket microclimate conditions, resulting in the design of advanced socket solutions personalised specifically for individual requirements. In future, this method will not only provide a personalised liner but will also enable dynamic assessment of how a residual limb behaves within the socket during daily activities.

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