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
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):
#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
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