Relaxed versus activated stump muscles during casting for trans-tibial prostheses

Abstract

In prosthetic practice, the question often arises as to whether the hand cast should be made from a contracted or from a non-contracted amputation stump. To elucidate this question, the authors have performed a study to quantify the volume difference between these 2 conditions, and to relate the differences to prosthetic fitting. Sixteen (16) trans-tibial amputees participated in the study. All of them were fitted with an ICEROSS silicone socket. Electromyographic studies, with electrodes attached to the anterior tibial and medial gastrocnemius muscles, were carried out to determine muscle contraction levels. Volume determinations were made with the CAPOD laser scanning system. Measurements were performed with and without the silicone liner on the stump. Without a silicone liner, the volume of the stump increased by 5.8% (SD=5.3) as the muscles contracted. This increase was statistically significant. With the liner donned the volume increased 3.5% (SD=3.3). This increase was also statistically significant. The volume of the prosthetic socket was also compared with the stump volume with a silicone liner on. For the relaxed stump, the difference was 1.8% (SD=10.1), and for the contracted stump -1.7% (SD=11.3). Neither difference was statistically significant. The importance of these volume changes and how they influence stiffness of the coupling between the stump and the socket are discussed. It is concluded, that the observed difference in volume between a contracted and a non-contracted stump are large enough to be considered by the prosthetist in his decision on how to make a hand cast.