Congenital or acquired hand differences, including unilateral below-elbow deficiencies, present complex challenges in pediatric rehabilitation. Surgical management and prosthetic provision represent a big challenge to find a good balance for guaranteeing optimal hand function. There is no specific assessment tool for measuring these aspects in the Italian context. The present study investigates the psychometric properties of the ABILHAND-Kids in children with congenital unilateral below-elbow deficiencies and acquired amputation of the upper limb. We measure internal consistency using Cronbach coefficient alpha and the intraclass correlation coefficient (ICC) for measuring test-retest reliability. Differences in hand function in both children with acquired or congenital diseases were also investigated. Participants to the study were 107 (49 F and 58 M) children, with a mean (SD) age of 8.88 (4.25). For test retest reliability, conducted on a sub-sample of 58 children, the ICC was 0.92, while for internal consistency, the Cronbach coefficient alpha was 0.90. We did not find statistically significant differences in scoring (p = 0.33) in the use (mean 29.25 SD 6.58) or non-use of a prosthetic device (mean 30.74 SD 7.43), while statistically significant differences were found in hand function (p < 0.01) for children who had a congenital impairment (mean 31.87 SD 6.49) and children who had an acquired amputation (mean 27.77 SD 6.60). In conclusion, the ABILHAND-Kids showed good internal consistency and reliability and can capture differences in hand function in children with both congenital and acquired hand disorders.

BACKGROUND: The purpose of this study was to compare the microgap size between engaging (E) and non-engaging (NE) abutments and screw morphology changes between E and NE abutments using scanning electron microscopy (SEM) before and after cyclic loading (CL).
METHODS: Thirty-six implants were arranged into four groups as follows: Group 1, single units with E abutments; Group 2, single units with NE abutments; Group 3, three-unit fixed partial dentures with a hemi-engaging design; and Group 4, three-unit FPDs with two NE abutments. The microgap was evaluated using a stereomicroscope. SEM was used to qualitatively evaluate screw morphology. The specimens were subjected to axial loading first and then lateral loading (30°) using the settings; one million cycles (1.0 × 106 cycles) for each loading axis.
RESULTS: There were no significant differences detected in the microgap sizes between the E and NE abutment groups. In addition, there were no significant changes in the microgap sizes after CL in the E or NE abutment specimens. More damage to the screws was noticed after CL compared to before, with no difference in the patterns of damage detected between the E and NE abutments.
CONCLUSIONS: No significant difference in microgap size was detected between the E and NE abutments. Furthermore, there was no significant difference in microgap size between the different prosthetic designs. From the SEM qualitative evaluation, there were similar screw morphology changes after CL between the E and NE abutments.

Recent advancements in soft robotics have been emerging as an exciting paradigm in engineering due to their inherent compliance, safe human interaction, and ease of adaptation with wearable electronics. Soft robotic devices have the potential to provide innovative solutions and expand the horizons of possibilities for biomedical applications by bringing robots closer to natural creatures. In this review, we survey several promising soft robot technologies, including flexible fluidic actuators, shape memory alloys, cable-driven mechanisms, magnetically driven mechanisms, and soft sensors. Selected applications of soft robotic devices as medical devices are discussed, such as surgical intervention, soft implants, rehabilitation and assistive devices, soft robotic exosuits, and prosthetics. We focus on how soft robotics can improve the effectiveness, safety and patient experience for each use case, and highlight current research and clinical challenges, such as biocompatibility, long-term stability, and durability. Finally, we discuss potential directions and approaches to address these challenges for soft robotic devices to move toward real clinical translations in the future.

OBJECTIVE: Investigating doctors\' communicative practices for recommending surgery to amputees when the proposal counters patients\' expectation.
METHODS: Conversation Analysis of 77 videorecorded medical consultations at an Italian prosthesis clinic.
RESULTS: Compared to the direct format doctors used to prescribe prosthesis, when suggesting surgery doctors adopted a more circuitous, indirect approach. They used a range of communication strategies, orientating to patients\' likely resistance - indeed, patients were frequently observed to reject surgical options.
CONCLUSIONS: Considering patients\' expectations is part of a patient centred approach, hence the cautious ways in which doctors introduce the option of surgery. Moreover, doctors do not pursue recommending surgery when patients display their reluctance or resistance.
CONCLUSIONS: Doctors in prosthetics clinics might adopt a more balanced communicative strategy that takes into account patients\' perspectives, concerns and expectations, whilst but also providing patients with the necessary information to collaborate meaningfully to decision making.

Collaborative robots, or cobots, have become popular due to their ability to safely operate alongside humans in shared environments. These robots use compliant actuators as a key design element to prevent damage during unintended collisions. In prosthetic and orthotic applications, compliant actuators are crucial for ensuring user safety and comfort. However, most compliant cobots for these applications are excessively expensive and complex to construct. Our study introduces an innovative, cost-effective, and sensorised elastic actuator design tailored for prosthetics and orthotics. The design uses a modular approach and leverages 3D printing technology for rapid customisation, enabling efficient and affordable fabrication. Both hardware and software components are open-source, facilitating unrestricted access for students, researchers, and practitioners. Our design supports impedance and admittance control techniques, enhancing the system\'s capabilities. Validation results show a standard deviation of 9.67 Nm between calculated and measured torque in impedance control and 0.2563 radians between calculated and measured angles in admittance control. This allows for improved adaptability to varying operational requirements in prosthetics and orthotics. By introducing this educational framework encompassing a low-cost, sensorised elastic actuator design, we aim to address the need for accessible solutions in the field of collaborative robotics for prosthetics and orthotics.

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Prehension movements in primates have been extensively studied for decades, and hand transport and hand grip adjustment are usually considered as the main components of any object reach-to-grasp action. Evident temporal patterns were found for the velocity of the hand during the transport phase and for the digits kinematics during pre-shaping and enclosing phases. However, such kinematics were always analysed separately in regard to time, and never studied in terms of dependence one from another. Nevertheless, if a reliable one-to-one relationship is proven, it would allow reconstructing the digit velocity (and position) simply by knowing the hand acceleration during reaching motions towards the target object, ceasing the usual dependence seen in literature from time of movement and distance from the target. In this study, the aim was precisely to analyse reach-to-grasp motions to explore if such relationship exists and how it can be formulated. Offline and real-time results not only seem to suggest the existence of a time-independent, one-to-one relationship between hand transport and hand grip adjustment, but also that such relationship is quite resilient to the different intrinsic and extrinsic properties of the target objects such as size, shape and position.

It remains a significant challenge in prosthetic rehabilitation for combined hard and soft palate defects on account of two primary reasons. At first, conventional impressions can hardly get an accurate analogue and usually bring about a terrible experience for the patients. Secondly, conventional hard denture base resins used in obturator prostheses exhibit limitations in marginal sealing, undercut retention, and elastic buffering when in contact with the soft palate. This article presents a case where combined hard and soft palate defects were successfully and rapidly reconstructed by using digital intraoral impression technology and denture soft reline material.

The last years brought many advances relevant to lower limb reconstruction. It feels like guided growth has been looked at from every angle, and still there are new emerging concepts like rotational guided growth waiting to be validated. New hexapod external devices are more accurate and easier to use, and new unilateral fixators allow for more versatile and stable fixation and lengthening. Intramedullary nail lengthening has found its place as a standard procedure for various diagnoses in children and young adults. First results of new and exciting approaches like extramedullary implantable nail lengthening and lengthening plates have been reported. Pharmaceutical treatment has changed the course of certain diseases and must be integrated and considered when making a reconstructive treatment plan. As reconstructive surgery is rapidly advancing so are the technical options for prosthetic fitting, which makes it difficult for caregivers as well as for parents to make the decision between reconstruction and amputation surgery for the most severe cases of congenital deficiencies. This review is highlighting new developments of lower limb reconstruction and is reviewing the current literature.

UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.