Management of residual limb volume affects decisions regarding timing of fit of the first prosthesis, when a new prosthetic socket is needed, design of a prosthetic socket, and prescription of accommodation strategies for daily volume fluctuations. This systematic review assesses what is known about measurement and management of residual limb volume change in persons with lower-limb amputation. Publications that met inclusion criteria were grouped into three categories: group I: descriptions of residual limb volume measurement techniques; group II: studies investigating the effect of residual limb volume change on clinical care in people with lower-limb amputation; and group III: studies of residual limb volume management techniques or descriptions of techniques for accommodating or controlling residual limb volume. We found that many techniques for the measurement of residual limb volume have been described but clinical use is limited largely because current techniques lack adequate resolution and in-socket measurement capability. Overall, limited evidence exists regarding the management of residual limb volume, and the evidence available focuses primarily on adults with transtibial amputation in the early postoperative phase. While we can draw some insights from the available research about residual limb volume measurement and management, further research is required.

/pdf/residual-limb-volume-change-systematic-review-of-measurement-4ikm6l38mo.pdf

Residual limb volume change: systematic review of measurement and management.

Finite element modelling of a residual lower-limb in a prosthetic socket: a survey of the development in the first decade.

Parameters related to use of a prosthesis by a patient with a limb amputation are monitored using a tool that includes one or more piezoelectric force sensors. The resulting data are processed for use both in short and long term management of amputee patients. The sensor is a small modular unit that fits within or between traditional prosthetic components, e.g., below a prosthesis socket. The data produced by the tool are collected, processed, and stored. Optionally, the data are periodically communicated to a remote site via a network, e.g., over the Internet. The device and associated software used to process the data can be used to characterize activities conducted by a prosthesis user, to determine pistoning or threatening interface stress distributions between the limb and socket, mal-alignment of the socket, use of improper components, and other possibly undesired conditions that the amputee patient using the prosthesis may be experiencing.

Prosthetic limb monitoring system

https://www.archives-pmr.org/article/S0003-9993(97)90160-X/pdf

Lower extremity residual limb slippage within the prosthesis

A PC-based ultrasound data acquisition system has been developed which uses compound scanning techniques to image a residual limb in a water tank. From the received ultrasonic echo data, the system produces cross-sectional images and reconstructs a three-dimensional (3-D) model of the limb. A commercial software for computer-aided prosthetic socket design was modified so that it can display both the external shape and cross-sectional image of the limb and allow the prosthetist to perform socket design with the help of a visualization of the limb's internal structure. The image resolution and measurement accuracy of the system were tested using a wire phantom and a contrast tissue mimicking phantom, respectively, preliminary results from amputee patients are presented and the sources of measurement error are discussed.

A PC-based ultrasonic data acquisition system for computer-aided prosthetic socket design

In the development of a three dimensional (3-D) ultrasound scanner to obtain the images of internal soft tissue distribution and external topographic shape of a human leg, the authors use the ultrasound B-scan spatial compounding technique to acquire high resolution cross-sectional images of a residual limb. The 3-D structural information can be used in prosthesis design for below knee amputees and also in sports medicine. In the clinical test of the scanner, the authors found that some of their patients had difficulty in keeping their limb still during the 10 to 12 second scanning time in order to acquire one cross-sectional image. To produce a high resolution cross-sectional compound image, the motion displaced B-scan image data needs to be compensated. This paper reports the authors' finding on the image feature based motion compensation algorithm to produce a high resolution compound image. Some experimental results using simulated motion as well as real motion data are presented. This project is sponsored by National Institute on Disability and Rehabilitation Research (NIDRR), U.S. Department of Education.

A motion compensated ultrasound spatial compounding algorithm

In lower limb prosthetic socket design, lack of information about the internal structure of the residual limb often contribute to the difficulties in achieving the desired weight bearing characteristics of the prosthesis. The authors describe a PC-based ultrasound scanning system which uses compound imaging technique to reconstruct cross sectional images of the limb, showing bones and other soft tissues within the limb. With such a visualization of the internal structure, a prosthetist is able to perform socket design more objectively and consistently. The relatively low cost and non-invasive nature of the system should make it a practical tool for prosthetic socket design. >

https://ieeexplore.ieee.org/iel5/3230/9197/00411944.pdf

A PC-based ultrasound scanning system for imaging a residual limb

For a typical ultrasound scanner which has a lateral resolution several times worse than the axial resolution, computer simulation indicates that spatial compounding can significantly improve the lateral resolution while slightly worsens the axial resolution. The mean resolution of the compound image improves continuously when the compound angle is increased from 0/spl deg/ to 120/spl deg/, and then changes insignificantly when the compound angle is further increased to 360/spl deg/. The resolution of the compound image however, can be severely deteriorated by the position error of the center of rotation of compound scan. A two-step calibration procedure is developed for accurately determining the location of the center of rotation.

http://ieeexplore.ieee.org/iel4/6085/16362/00757681.pdf

Effects of spatial compounding upon image resolution

Current CAD/CAM software in prosthesis design is based on various landmark positions on a residual limb, such as, weight bearing areas: patellar notch, medial and lateral flares of tibia and pressure relief areas: fibular head, distal tibia and fibular. A 3D visualization tool to explore ultrasound data of both external shape and internal tissue and bony structure of a residual limb is developed to aid landmark allocation. This study demonstrates the potential to improve prosthetic CAD/CAM practice using ultrasound.

https://ieeexplore.ieee.org/iel5/6513/17397/00802729.pdf

A 3D visualization tool for landmark allocation

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