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PURPOSE: Little information is available to women with lower limb absence (LLA) and their health care providers regarding the impacts they may experience during the perinatal period. This study explores the physical impacts of pregnancy on women with LLA, including mobility, prosthesis fit and prosthesis use. METHODS: We conducted semi-structured interviews with 19 women with LLA who had experienced pregnancy in the last 10 years. Interviews were analyzed using thematic analysis. RESULTS: Substantial variation exists in the experience of women's physical symptoms, prosthesis management and mobility. Physical symptoms were similar to any pregnant individual, but the impacts were more substantial. As volume change in the residual limb can impact prosthesis fit, self-management techniques and prosthetist adjustments were used to manage it. Pregnancy impacted the way in which women were mobile and the activities they chose to participate in. A wide variety of creative mobility solutions were utilized to complete activities including prosthesis use, assistive equipment and adaptive movement. CONCLUSIONS: Women with LLA and their health care providers must be aware of the wide range of experiences women face during pregnancy and treat each pregnancy uniquely. Planning ahead and working with a health care team can mitigate many of these challenges.

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BACKGROUND: There is limited research on the unique needs of women with lower limb absence (LLA) during pregnancy and postpartum. The lack of information can negatively impact women's physical and emotional experiences. OBJECTIVE: The purpose of this study is to explore the psychosocial experiences of individuals with LLA through the pregnancy and postpartum periods, and to provide information to women and health care providers (HCPs) on what they can expect. METHODS: Semi-structured interviews were conducted with 19 women with LLA who had been pregnant in the previous 10 years. Interviews were analyzed using thematic analysis. RESULTS: Participants experienced uncertainty due to a lack of information and limited resources related to pregnancy and LLA. While most women had strong support networks including family, other mothers with LLA and HCPs, some women faced stigma or judgement from HCPs and people in their social networks. Some women had periods where they struggled mentally due to a temporary loss of independence. Despite these challenges, they demonstrated tremendous resilience and noted that their ability to adapt helped them to navigate the difficulties they experienced in the perinatal period (PNP). CONCLUSION: There is an immediate need to fill the 'information gap' about pregnancy and LLA. We recommend the development of support networks, informational guidelines, and further education for HCPs to better support women with LLA through the PNP. Further research is warranted to gain a better understanding of the mental health experiences of women with LLA in the PNP.

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BACKGROUND: Outcome measures (OMs) are useful tools; however, clinicians may find implementing them into clinical practice challenging. OBJECTIVES: To characterize Canadian prosthetists' use of OMs for people with lower-limb amputation, including motivations for use, comfort selecting OMs, resources available for administration, and barriers to implementation. METHODS: A cross-sectional study was conducted between March and July 2021. Orthotics Prosthetics Canada sent Canadian prosthetists an invitation to take the online survey. RESULTS: Forty-nine Certified Prosthetists completed the survey. Only 16% of participants reported that they were expected to use OMs. Participants reported being more comfortable administering performance-based OMs than self-report surveys. More than two-thirds of participants agreed that OMs "can be administered with knowledge they have" and are "within their scope of practice." However, less than 25% agreed that OMs are "administered in a standardized way in the profession," and less than 40% indicated they are "easy to make part of my routine." Participants reported they generally have time and space to do OMs, but there was no agreed-on reason to use them. CONCLUSIONS: Use of OMs among Canadian prosthetists seems to be low relative to prosthetists in the United States. Education, financial incentives, or changes to professional expectations are likely needed to increase routine OM use. Efforts to improve the standardization of OM administration and ease the incorporation of OMs into routine practice may also increase use. Canadian prosthetists may elevate their standards of clinical practice and better understand the impact of prosthetic treatments on their patients by more routinely using OMs.

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BACKGROUND: Outcome measures (OMs) are important in healthcare, but there are barriers to their use. A blended education program was designed to teach orthotic and prosthetic professionals a standard practice of collecting and using OMs in their facility. This study used a single group pretest and post-test mixed methods survey to evaluate the effects of a blended education program for orthotic and prosthetic professionals to incorporate OMs into routine clinical practice. METHODS: Fifteen learners (seven practitioners, four technicians, and four administrative staff) completed online education and in-person training. Learners' attitudes toward knowledge of confidence administering and rate of adoption of OMs into clinical practice were assessed before the start of the program, immediately upon completion, and four months after completion. Performance indicators were accessed through electronic medical records (EMRs). RESULTS: Participants' attitudes toward OMs were overwhelmingly positive and remained positive (P = .64). Practitioners' posteducation knowledge scores on the standardized use of OMs increased significantly (P = .046) as did their confidence administering OMs (F = 8.47, P = .007). Practitioners' reported using OMs significantly more 4 months after the program (F = 19.7, P < .001), and they doubled the number of times OMs were collected each month resulting in a 3000% increase and a 500 data points recorded in the electronic medical record at the end of the 4 months. CONCLUSIONS: This education program had a significant and positive lasting impact on practitioners' knowledge of confidence and use of OMs demonstrating an overall change in everyday clinical practice and clinic operations.

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INTRODUCTION: Balance confidence and perception of task challenge is an important construct to measure in rehabilitation of people with lower-limb amputation (LLA). Measurement of electrodermal activity (EDA) captures physiological arousal responses reflecting an individual's perceived challenge in a task. This study explores the feasibility of the use of EDA during outdoor walking tasks to capture task-specific physiological arousal changes associated with perception of challenge in people with amputation. OBJECTIVE: To develop and demonstrate feasibility of a portable EDA/GPS system mapping physiological arousal while challenging walking balance outdoors in individuals with LLA and controls. METHODS: Sixteen people (eight with LLA and eight age-/sex-matched controls) completed an outdoor walking course in the community (3 laps). A battery-powered portable device was developed containing EDA/GPS sensors with data logged on a microcontroller. Phasic EDA response was extracted from EDA signal to explore the physiological arousal response to walking tasks. RESULTS: Physiological arousal demonstrated task-specific modulation with ascending stairs without a handrail showing higher levels of phasic EDA than walking on a paved incline (p = 0.01) or a gravel decline (p = 0.01) in people with LLA. While evidence of habituation over repeated trials was shown in controls with lap 1 of walking down a gravel decline showing higher levels of phasic EDA than lap 3 (p = 0.01). Phasic EDA maps, representative of arousal levels throughout the walking course, showed individual-specific response. CONCLUSION: Mapping of EDA during outdoor walking is feasible. Modulation of physiological arousal between outdoor walking tasks and over repeated trials is suggestive of clinical utility. Further research is warranted to explore how EDA may be incorporated into assessment of response to outdoor walking amongst individuals following LLA.

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Background: Various human machine interfaces (HMIs) are used to control prostheses, such as robotic hands. One of the promising HMIs is Force Myography (FMG). Previous research has shown the potential for the use of high density FMG (HD-FMG) that can lead to higher accuracy of prosthesis control. Motivation: The more sensors used in an FMG controlled system, the more complicated and costlier the system becomes. This study proposes a design method that can produce powered prostheses with performance comparable to that of HD-FMG controlled systems using a fewer number of sensors. An HD-FMG apparatus would be used to collect information from the user only in the design phase. Channel selection would then be applied to the collected data to determine the number and location of sensors that are vital to performance of the device. This study assessed the use of multiple channel selection (CS) methods for this purpose. Methods: In this case study, three datasets were used. These datasets were collected from force sensitive resistors embedded in the inner socket of a subject with transradial amputation. Sensor data were collected as the subject carried out five repetitions of six gestures. Collected data were then used to asses five CS methods: Sequential forward selection (SFS) with two different stopping criteria, minimum redundancy-maximum relevance (mRMR), genetic algorithm (GA), and Boruta. Results: Three out of the five methods (mRMR, GA, and Boruta) were able to decrease channel numbers significantly while maintaining classification accuracy in all datasets. Neither of them outperformed the other two in all datasets. However, GA resulted in the smallest channel subset in all three of the datasets. The three selected methods were also compared in terms of stability [i.e., consistency of the channel subset chosen by the method as new training data were introduced or some training data were removed (Chandrashekar and Sahin, 2014)]. Boruta and mRMR resulted in less instability compared to GA when applied to the datasets of this study. Conclusion: This study shows feasibility of using the proposed design method that can produce prosthetic systems that are simpler than HD-FMG systems but have performance comparable to theirs.

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Advancement in assistive technology has led to the commercial availability of multi-dexterous robotic prostheses for the upper extremity. The relatively low performance of the currently used techniques to detect the intention of the user to control such advanced robotic prostheses, however, limits their use. This article explores the use of force myography (FMG) as a potential alternative to the well-established surface electromyography. Specifically, the use of FMG to control different grips of a commercially available robotic hand, Bebionic3, is investigated. Four male transradially amputated subjects participated in the study, and a protocol was developed to assess the prediction accuracy of 11 grips. Different combinations of grips were examined, ranging from 6 up to 11 grips. The results indicate that it is possible to classify six primary grips important in activities of daily living using FMG with an accuracy of above 70% in the residual limb. Additional strategies to increase classification accuracy, such as using the available modes on the Bebionic3, allowed results to improve up to 88.83 and 89.00% for opposed thumb and non-opposed thumb modes, respectively.