Residual Limb
Volume Fluctuation
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> Residual Limb Volume Fluctuation
> Advanced Socket Fabrication
> Interface Materials
> Compartment Syndrome
Purpose/objectives: The purpose of this research is to develop a means to measure fluid volume changes in different quadrants of the residual limb while a person wears a prosthesis, and then use the instrument to better understand how design features of the prosthesis affect changes in size of a person's residual limb over the day. We see our role as providing key insight to practitioners and patients treating volume management challenges, and to engineers developing novel volume management systems to overcome the detrimental effects of limb volume change on prosthetic fit and patient quality of life.
Findings to date: Our results to date show the instrument to meet the measurement need, detecting changes in residual limb fluid volume as low as 0.1%.

For individuals without co-morbidities, the residual limb typically undergoes fluid volume changes opposite in direction to that of the non-amputated contralateral limb [#5] (see left panel below), probably because residual limb tissues, unlike the contralateral limb, experience compressive stress applied via the prosthetic socket. In case studies we found that the instrument was helpful as a diagnostic tool to visualize subject limb volume changes in real time [#5]. Results shown in the right panel below helped this person with severe peripheral arterial disease understand that limb fluid loss over time was a source of his prosthetic fit problems and pain. The subject responded and became more receptive to accomodation recommendations by his practitioner.
When some subjects used an elevated vacuum system, we found that peak-to-peak fluid volume changes during walking reduced compared to when no vacuum was applied, suggesting better suspension using elevated vacuum [#3]. In a different study we asked subjects to add a 1-ply soft sock in between 5-minute periods of walking. As shown in the chart at the left we found that most subjects (about 75%) experienced fluid volume changes less than 1.0% [#2], but some subjects experienced fluid volume losses as much as 4.0%.
We have also investigated residual limb fluid volume changes over the course of the day [C], as well as those induced by filling bladders positioned between the limb and socket with fluid [B]. In a more recent study we investigated the effects of periodic doffing on residual limb fluid volume recovery [A].

We gratefully acknowledge our current funding source-
Department of Defense US Army Medical Research and Materiel Command CDMRP
and prior funding sources-
American Reinvestment and Recovery Act grant from the National Institutes of Health
* Orthotic and Prosthetic Education and Research Foundation (OPERF)

Recent peer-reviewed publications:
#1. Sanders JE, Harrison DS, Cagle JC, Myers TR, Ciol MA, Allyn KJ. Post-doffing residual limb fluid volume change in people with trans-tibial amputation. Prosthet Orthot Int, 2012; 36(3): in press.
#2. Sanders JE, Harrison DS, Allyn KJ, Myers TR, Ciol MA, Tsai EC. How do sock ply changes affect residual limb fluid volume in people with trans-tibial amputation? J Rehabil Res Dev, 2012; 49(2). PMID: 241-256.
#3. Sanders JE, Harrison DS, Myers TR, and Allyn KJ. Effects of elevated vacuum on in-socket residual limb fluid volume: Case study results using bioimpedance analysis. J Rehabil Res Dev, 2011; 48(10): in press.
#4. Sanders JE, Fatone S. Residual limb volume change: systematic review of measurement and management. J Rehabil Res Dev. 2011; 48(8): in press.
#5. Sanders JE, Harrison DS, Allyn KJ, Myers TR. Clinical utility of in-socket residual limb volume change measurement: case study results. Prosthet Orthot Int. 2009 Dec; 33(4): 378-90. PMID:19961297.
#6. Sanders JE, Rogers EL, Abrahamson DC. Assessment of residual-limb volume change using bioimpedence. J Rehabil Res Dev. 2007; 44(4): 525-35. PMID:18247249.

Recent meetings presentations:
A. Maintaining limb volume: Effects of doffing between periods of activity. Thranhardt Lecture Finalist, American Academy of Orthotists and Prosthetists 38th Academy Annual Meeting and Scientific Symposium, Atlanta, Georgia, 2012
B. How does socket volume affect limb volume in trans-tibial amputee patients? OPERF Lecture. American Academy of Orthotists and Prosthetists 37th Academy Annual Meeting and Scientific Symposium, Orlando, Florida, 2011
C. Are short-term fluid volume changes representative of diurnal changes? American Academy of Orthotists and Prosthetists 37th Academy Annual Meeting and Scientific Symposium, Orlando, Florida, 2011
D. Effects of adding and removing socks on residual limb fluid volume. American Academy of Orthotists and Prosthetists 37th Academy Annual Meeting and Scientific Symposium, Orlando, Florida, 2011
E. Comparison of in-socket and post-doffing residual limb extracellular fluid volume. Thranhardt Lecture Finalist, American Academy of Orthotists and Prosthetists 36th Academy Annual Meeting and Scientific Symposium, Chicago, Illinois, 2010

Residual Limb Volume Fluctuation
Results from study described in Prosthet Orthot Int. 2009 Dec;33(4):378-90. PMID:19961297.
Results from study described in J Rehabil Res Dev. 2012; 49(2):241-256.
We have developed a novel bioimpedance analysis instrument and use it regularly in clinical studies. Thin electrodes are placed on the skin with very small wires exiting at the brim and extending to a data storage unit. The instrumentation is worn by subject participants for several hours.
Primary funding for this project is currently from the Department of Defense. We appreciate the participation of present and former military personnel in our research efforts. This former soldier explains why he participates.