This document generally relates to the field of prosthetic liners and sockets having information systems for managing the comfort level of the user.
A lower limb prosthetic liner provides optimum functionality when the distribution of patient's weight in a prosthetic socket is one third distal and two thirds proximal. Currently there is no feasible way for a prosthetist to measure weight distributing during the fitting of a new socket to an amputee. The prosthetist relies on experience to make an approximate evaluation of weight distribution. An inappropriate distribution of weight may result in discomfort poor gait, and damage to the limb. Many of the lower limb amputees are vascular with poor circulation in the residual limb and poor sensory perception. Excessive pressure points are likely to go unnoticed by the amputees which result in wounds that are difficult to heal. Even if the initial socket is properly made and allows an optimal distribution of weight therein, with the maturing of the residual limb over time, the size of the limb shrinks and the pressure of the distal end of the residual limb against the distal end surface of the socket increases. Vascular patients are subjected to positive and negative volume fluctuations more than healthy individuals and such fluctuations affect the distribution of weight in the socket. This problem is address by the prosthetist by training the patient to use additional prosthetic socks or a different ply sock for the management of the volume fluctuations of the residual limb. This solution is only partially effective with many older amputees who are not able to assess how many prosthetic socks or what ply of sock to use.
As a solution to this problem, prosthetic socks and/or liners now on the market have been designed to have residual limb monitoring systems built into them. For example, Patent Application No. US 2012/0226197 to Sanders, et al. disclose a prosthetic liner having sensors built into the liner for monitoring various activities of the amputee that effect the volume of an amputee's residual limb. The sensors on the liner further include a transmitter for transmitting the collected data to a remote computer system of the user, a doctor, or prosthetist for developing a sock monitoring strategy. Such data is useful in determining what adjustments must be made to the interface between the residual limb and socket, such as adding or eliminating extra socks, or using socks of a different ply thickness.
However, to date, such prior art systems either have the sensors built into the liner or into the socket. Such liners and sockets are complicated to manufacture and expensive, not to mention the fact that costs rise dramatically if they have to be replaced. Thus, the present invention provides another and simpler solution to this problem without having to mount the sensors in the liner and/or socket. The present invention provides a simple resilient insert having force sensing and transmitting electronics for continuous and accurate measurement of the distal contact of an amputee's residual limb against the inside distal surface of a prosthetic socket.
The field of prosthetics as it relates to lower limb amputees generally relies on the craftsmanship and skill of an individual, often CPO or technician, to fabricate the socket. Once the socket is fabricated the means of measuring the fit is often overlooked due to the complexity of taking such a measurement. The typical residual lower limb to socket configuration is comprised of a lower limb, donned over said lower limb a prosthetic liner, said lower limb with donned prosthetic liner then into a socket. Prosthetic liners come in several variations including thermoplastic elastomer (TPE), urethane, and silicone. Liners comprised of these material variations often have an outer fabric covering. Sockets are generally fabricated using composite materials such as fiberglass or carbon fiber though a check socket formed using a thermoplastic maybe used on a temporary basis.
For the purpose of discussion, the method of determining the fit of the residual lower limb to socket will be compared to the fit of a shoe over a non-ambulatory individual. Said fit is often determined by the feel during walking, standing, and by pressing on the soft shoe material at the end of the toe to determine if the sizing is appropriate. For adults this process is often intuitive and obvious as foot growth is no longer a factor and the individual adult has already formed an idea on how the correct shoe should “feel.” Certainly the “feel” portion is non-quantitative and based on experience. However, measurements of the foot prior to the shoe selection can often result in the correctly sized shoe, or at least very close. The average individual is able to appropriately and satisfactorily determine their own shoe fit using the described method. One within the field of prosthetics can appreciate the incongruences between the described method of determining shoe fit and the methods in determining socket fit.
Notably, in the time period between the initial amputation and receipt of the first socket/prosthesis assembly, the residual limb experiences drastic volume change. The tissue towards the bottom of the limb is where the majority of the shrinkage occurs. While a shoe is generally soft and pliable, and in some cases open, the socket is rigid and opaque. This makes it impossible to observe, at least from an external perspective, if areas exist within the socket that does not contact the residual limb. Regions of the residual limb with excessive pressure cannot be observed externally from the socket.
In general terms the residual limb and corresponding socket can be considered conical in which the proximal cross-sectional area is greater than the distal cross-sectional area. The result of this tapered geometry is that the forces are not only applied distally but are also applied against the walls of the socket. During socket construction a prosthetic liner is usually considered to be a component of the assembly. In many instances this is similar to wearing a sock over a foot during the show trial process. As a result, the inside surface of the socket is offset some predetermined distance from the outside surface of the residual limb to account for said prosthetic liner. A key difference is that said prosthetic liner is 1 to 9 mm in thickness. In such an assembly, the prosthetic liner functions to reduce the shear forces that would be present if the residual limb were in direct contact with the inside surface of the socket. Regardless of composition, prosthetic liners utilize materials that with elasticity to provide even distribution of forces between the residual limb and socket. This assists in reducing the effects of any socket defects during construction and also accounts for slight volume changes in the residual limb. The prosthetic liner also provides cushioning at the regions of the residual limb that that have experienced the trauma of an amputation or have paid due the nerve endings.
Another dissimilarity in the foot to residual limb comparison is in regard to the sensitivity of nerve endings within the residual limb. The sensations experienced when wearing a socket are new and therefore make it difficult for the amputee to determine whether the socket “feels” good. Due to the new environment the amputee is able to decipher pain in the residual limb but often such feelings may not be necessarily due to an improper fit. It may be as a result of the amputation. Conversely, an experienced amputee who's residual limb has adapted to the pressure environment of a socket may not be able to detect, when fitted with a new socket, if there are regions that do not have contact with the socket. This could result in pistoning or other adverse effects on the residual limb. Considering that the vast majority of amputees have a compromised vascular system it is important that the socket fit is appropriate to facilitate the health of the residual limb and thus the patient. In an ideal scenario, the inside surface of the socket and the outside surface of the prosthetic liner are flush, or a perfect mate when the socket is donned.
Various inventions have been devised to measure the fit of the residual limb into the socket. U.S. Pat. No. 8,784,340, describes a prosthetic sock monitoring system with one or more sensors coupled to a prosthetic sock. While providing a possible solution, said sock monitoring system does not provide a solution to the powering of the sensors. Attaching wires or batteries to said sensors would not be feasible as the prosthetic sock is a laundered article. Furthermore, the coupling of the sensor and accompanying means of power would create a pressure point between the residual limb and rigid socket wall resulting in discomfort and a possibly harm to the residual limb. Lastly, and most prominently, the meaningfulness of the data gathered from any sensor is based on the stability of the location in which it is originally installed. Due their construction and material properties prosthetic socks stretch considerably. Over the course of laundering cycles the prosthetic sock changes size. Such an invention would require alignment marks corresponding to marking on the residual limb or prosthetic liner to ensure that the sensor location is in the same location from one donning to the next. The stretch of said sock further diminishes the likelihood that the amputee is able to repeatedly don said sock. In the unlikely event that all such circumstances are overcome and amputee is able to insert said sock into the socket without shift, it would be an increasingly difficult challenge should the system require donning of additional socks to compensate for volume loss. Then, the prosthetic assembly would have to be removed, the procedure repeated with an additional prosthetic sock over said sensor coupled sock, without shift, and the assembly reinserted into the socket.
Another method for determining proper socket fit is by incorporating strain gauges in various locations on the socket wall. Such a method requires extensive skill to fabricate but also extensive testing to determine how the measured results relate to the fit of the residual limb within the socket.
Another method for determining proper socket fit is by inserting a soft and pliable material into the distal region of the socket, inserting the limb, performing an activity involving the limb such as walking, removing the socket, and evaluating the shape of the inserted soft and pliable material. Said soft and pliable material is non-compressible and has nowhere to escape when confined between surfaces. As a result, the soft and pliable material prevents the residual limb and liner assembly from full contact, often misrepresenting a void.
The present invention relates generally to a pressure measurement device that is inserted into a prosthetic socket at the distal end and located between the socket and a socket liner. The device comprises a molded replaceable cushion insert made of resilient silicone or polymeric material shaped to have a lower surface to complementally fit firmly against the interior distal end surface of the socket and an upper concave surface that is contiguous with the concave surface of the distal interior of the socket. The insert is removable from the socket and therefore replaceable. The insert further includes at least one force sensor and electronic receiving and transmitting circuitry associated therewith either embedded or removable mounted therein. In the embodiment where the force sensor and circuitry are embedded therein such as during the molding process, the entire device would be replaceable. In the embodiment where the force sensor and circuitry are removably mounted therein, only the force sensor and/or the transmitting circuitry would have to be replaced. Each force sensor is disposed in the insert and adapted to detect downward pressure caused by a distal end of an amputee's residual limb against the distal end of the socket. Throughout the day, an amputee's residual limb may change in volume such as by swelling or contraction of the residual limb for various reasons. Such volumetric changes will affect the fit of the residual limb within the socket which in turn affects the downward pressure of the residual limb against the distal end of the socket. The present invention is designed to measure these pressure variations and provide feedback to the user, rehabilitation doctor, and/or CPO (Certified Prosthetist/Orthotist). The electronic circuitry transmits the pressure measurements wirelessly to a personal computer or mobile computing device throughout the day. This invention is designed to systematically inform the user, rehabilitation doctor, and/or a CPO (Certified Prosthetist/Orthotist) of the degree of force or pressure that the distal end of the residual limb is exerting against the distal end of the prosthetic socket throughout the time of use. Accordingly, such information is useful in determining whether a new socket, a new sock, additional socks or elimination of socks may be needed.
In a first embodiment, the insert is molded of a resilient silicone or polymeric material to have a concave shape with the concave side molded to match the interior concave surface of a distal end of a socket. This embodiment could be molded to have at least one force sensor and transmitter circuitry embedded therein or molded to have a cavity in the concave side in which the at least one force sensor and transmitting circuitry can be removably secured.
In a second embodiment, the insert is also molded to have a concave shape with the concave side molded to match the interior concave surface of a distal end of a socket. However, in this embodiment, the concave side of the insert includes an extension leading therefrom which is complementally shaped to fit inside a well or recess defined by a lower section of the socket depending from the distal end thereof. This embodiment could be molded to have at least one force sensor and transmitter circuitry embedded in the extension or molded to have a cavity in the extension in which the at least one force sensor and transmitting circuitry can be removably secured.
The present invention is a device for measuring the force applied by the residual limb distal region of an amputee to the distal region of a socket. Accordingly, the Distal Force Measuring Device (hereinafter, “DFMD”) is an enclosed body with a concave upper surface that is affixed to the inside surface of the socket lying on an axis approximately central to the socket, albeit the socket is asymmetrical it will be considered conical for discussion of said axis. A fundamental concept of the present invention is that the force between the distal region of a residual limb and socket will fluctuate between a series of values representing healthy and unhealthy conditions. During periods of rest and activity, the DFMD measures the distal force between socket and residual limb. In one embodiment the DFMD monitors the force readings, executes algorithms, and provides feedback to the patient concerning the fit of the socket. In another embodiment, the DFMD transmits the force readings to a separate cloud based database.
An object of the present invention is to utilize the distal force data to create a limb-to-socket force tolerance (hereinafter “force tolerance”) from which a range of force values may be derived to suggest acceptable distal force conditions. Likewise, limb-to-socket force values that are outside of the force tolerance are used to represent unacceptable distal force conditions. The data collected by the DFMD enables the user and/or medical professional to understand said residual limb conditions and make adjustments to prosthesis to ensure the health of the residual limb.
A method of the present invention in making said adjustments to said prosthesis is to provide instructions for volume management of the limb within the socket. If the force measured by the DFMD is outside of the force tolerance for an excessive time period the patient is automatically prompted to take action. More specifically, if the force is in excess of the force tolerance the patient is prompted to reduce the number of sock plys. If the force is below the force tolerance the patient is prompted to increase the number of sock plys.
In a second object of the present invention, the force readings relate to the proper or improper sizing of the socket with respect to the limb. It is well known that the residual limb experiences drastic volume reduction and shape within the initial time period following the amputation of said limb. As the reduction in residual limb volume occurs, the net result may be measured by the distal force against the DFMD. If the socket is too large, the distal force reading would be excessively high implying that the force value is beyond the threshold that is correctable by the addition of sock plys.
In a third object of the present invention, the force readings relate to the measurement of vacuum within the socket. The applicability of this embodiment is unique in prosthesis' utilizing vacuum suspension systems. The efficacy of the vacuum system is based on the vacuum level being properly maintained. Should a failure occur in the system, and a leak develop, the distal force detected by the DFMD would detect a shift in force data as compared to previous average values.
The present invention is a distal force measuring device with a sensor that is affixed to the distal inside surface of the socket allowing for measurements to be repeatable and consistent. The DFMD measures values that relate specifically to the residual limb, socket, liner, and prosthetic sock(s).
For a more complete understanding of the present disclosure and its advantages, reference is now made to the following descriptions, taken in conjunction with the accompanying drawings, in which:
Similar reference numerals refer to similar parts throughout the several views of the drawings.
The various components of the present invention, and the manner in which they interrelate, are described in greater detail hereinafter.
Referring to
The present invention's insert 4 is not limited for use with any particular prosthetic liner and socket arrangement. The embodiment of
The insert 4 is made of a thermoplastic elastomeric material, preferably gel materials, for example by injection molding techniques, such as silicone, copolymer Styrenic gels, polyurethane, block copolymers or other TPE elastomers. A wide variety of thermoplastic materials that could be used to manufacture the present invention are disclosed in U.S. Pat. No. 5,633,286, incorporated herein by reference.
The force sensor 5 is comprised of an ultra-thin flexible force sensing element used to measure a relative change in force or applied load. It may be used for measuring rate of change and identifying force thresholds to trigger an appropriate action. The sensor may be also used as a means of switching a device on therefore detecting presence, contact, and/or touch. The device used in this design is a durable piezoresistive force sensor created in various shapes and sizes tailored to the gel apparatus. The resistance measured is inversely proportional to the applied force. One type of force sensor is the FlexiForce® sensor manufactured and patented by Tekscan, this type of sensor provides a linear force measurement ±3% and can withstand high temperature environments up to 400° F. (HT201). The FlexiForce® sensor can measure up to 100 lbs or force with <5 microseconds response time. The sensor 5 is connected through pins to a flexible conductive fabric, thread, or elastic bonded wire 6 which carries the signal to a receiver/transmitter microcontroller 7. The force sensor cables may also contain a resistor or resistive device to provide a ground reference to the controller.
The receiver/transmitter microcontroller 7 receives data from the force sensor 5 and relays such data via Bluetooth technology 29 to an external electronic device such as a personal computer 30 or cell phone 31 as illustrated in
One of the main advantages of this RF module and other types are the ultra-low power sleep mode that provides efficient battery use while asleep. The module will maintain a heartbeat looking for a control signal to wake up and transmit data again. The receiving data may be processed, saved, cataloged, and displayed to the end user. The EEDS may be a hand-held electronic device or software application, the software is designed to be compatible with Android, iOS, or other major smart-phone device operating systems. The software application is an integral component of the system. The software is necessary in order to record a historical trend of the patients fit as well as perform sensor calibration. The EEDS can be also used by the clinician to provide feedback on the socket fit. The software also allows the ability to set how many data-points per day, and generate a report and send it through email. The EEDs also has the ability to alert the patient of low battery levels in the device.
The battery 9 is a power supply of the PSBL type and may be lithium ion, lithium polymer, lithium iron phosphate, nickel-cadmium, or any rechargeable battery source. A single supply is used with an on-board voltage regulator to power 1.8V, 3.3V, and 5V levels. The cells may be configured in a single or multiple parallel, series, or similar layout.
As a wearable device, battery life, energy density, accessibility, and rechargeable capabilities are essential. In the first embodiment, the force sensor, electronic circuitry and batter are adhered to each by adhesive layers 10a and 10b and full embedded within the elastomeric material 4 during the molding process. Thus, the entire unit may be disposable or, if not, may include a conventional recharging circuit (not shown) by plugging in the apparatus through a charging port. In the second and third embodiments illustrated in
All of the embodiments disclosed herein could be molded in various sizes to fit different size sockets or could be custom fitted to the distal interior surface of a prosthetic socket that may be in use by the user.
Referring to
Referring to
Referring to
Referring to
Referring to
In
Referring to
Illustrated in
The next component of an assembly common to the present invention is a sock 36 or prosthetic sock. These are common within the market place and typically are of knit construction using synthetic fibers. Common thicknesses available for prosthetic socks are 1, 3, and 5 ply. Due to the knit construction, and to facilitate donning and doffing, prosthetic socks are capable of stretch in the vertical and horizontal direction in excess of 40 percent. Illustrated is a singular prosthetic sock but it should be noted that an assembly utilizing the present invention may be comprised of a plurality of prosthetic socks that may differ in sock plys. The prosthetic sock is donned over the outside surface of the liner such that the inside surface of the sock interfaces with the outside surface of the liner. The outside surface of the sock interfaces with the inside surface of the socket. It should be noted that in an assembly comprising a plurality of socks the outermost sock would have an outer surface in contact with the socket. Said socket then attached to various mechanical devices including a prosthetic foot. The socket, prosthetic foot, and all related mechanical components there between represent what is considered the prosthesis 37.
The present invention is a prosthetic distal force measurement device (“DFMD”) 38 for measuring the distal force between the socket and residual limb of an amputee that is affixed to the distal most inside surface of the socket.
The processor enclosure and the sensor enclosure are coupled by a wire 60. The wire may be detachable from either the processor enclosure or the sensor enclosure via any commonly used detachable electronic connector. In this configuration the wire that connects the two enclosures is preferably routed through an aperture in the socket. Many alternatives exist such as routing the wire along the outside of the socket, over the upper peripheral socket edge, along the inside socket surface, and to the sensor enclosure.
The illustration in
The invention has been described in terms of various embodiments. It will be appreciated by those skilled in the art that various changes and modifications may be made to the embodiments without departing from the spirit or scope of the invention. It is not intended that the invention be limited to the embodiment shown and described. It is intended that the invention include all foreseeable modifications to the embodiments shown and described. It is intended that the invention be limited in scope only by the claims appended thereto.
This application is a continuation-in-part application of application entitled “Prosthetic Distal Force Measurement Device”, Ser. No. 14/172,123 filed Feb. 4, 2014, the disclosure of which is hereby incorporated by reference herein.
Number | Date | Country | |
---|---|---|---|
Parent | 14172123 | Feb 2014 | US |
Child | 15380400 | US |