Research & Presentations
Mobile Technology: Empowering Prosthesis Wearers To Problem-Solve Socket Fit Issues By Daniel J. Lee, PT, DPT, GCS
The Problem A client is in the early stages of prosthesis wearing. The prosthetist has educated the client on how to selfmanage the residual limb/socket interface, ensured that the fit of the socket is correct, and instructed the client to follow up immediately if the prosthesis is uncomfortable or fitting poorly. Despite best efforts by the prosthetist, the client ultimately is dependent on himself or herself to ensure that he or she is donning, managing volume fluctuations, and achieving a congruent fit of the prosthetic socket on the residual limb when outside of the clinic. The client may find that because of natural changes in the residual limb’s volume throughout the day, he or she may need to add or subtract sock ply or adjust the suspension mechanism to maintain the congruent fit. While the client has been educated on how to perform this function, it is a complex task that requires practice, problemsolving skills, knowledge, and the ability to recognize when the assistance of the prosthetist is needed. While some clients may easily adapt to the process of problem solving the fit of the prosthesis, others will struggle. Some may attempt to solve fit issues without an organized and deliberate approach, which can result in poor suspension or possible skin breakdown. Others may
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not wear the prosthesis at all and call on the prosthetist instead of performing his or her role in self-management and problem solving, decreasing both the utilization of the prosthesis and the prosthetist’s productivity. In either scenario, the result is antithetical to functionally implementing the prosthesis and can create a barrier to independence.
The Solution A simple-to-use, client-centered mobile application that guides the prosthesis wearer in the problem solving of common prosthetic socket fit issues for most suspension types can help solve the problem. With such a mobile app, the client creates an account, selects his or her level of amputation and suspension type, then navigates the one-press interface to explore solutions to frequently encountered issues experienced with the prosthesis. Major problems are categorized in easy-to-understand terms like, “My prosthesis is fitting loosely,” or, “My prosthesis is fitting too tight.” Under each major problem, individual issues and their corresponding solution sets are presented in a hierarchical and logical order, from simplest to most complex, specific to each suspension type. The client can navigate each issue and, based on a “Yes” or “No” response to the question, be presented with a specific solution to his or her problem.
If the client tries the solution (e.g., adds a one-ply sock) and it works, he or she is presented with a “Problem Solved” screen, and the fit should be comfortable and congruent. If the solution does not meet the client’s needs, he or she will be presented with a finite number of other potential solutions to try before finally being presented with an instructional message to contact a prosthetist as the client is unable to problem-solve the fit issue with the app alone. The app not only empowers the prosthesis wearer to solve problems within his or her control, it also encourages communication with the prosthetist in the case that the client cannot determine a solution on his or her own. It is believed that the app can reduce client frustration, improve communication, and ultimately improve outcomes after an individual receives a prosthesis.
Experiment To understand if this mobile app interface is usable and acceptable to prosthesis wearers, a multiphase testing protocol was performed. First, a paper form of the decision trees was developed and validated. The decision trees provided the content for the mobile app and served as a comparison for the usability and acceptability testing. More on the decision trees can be found in a 2017 Disability &
