Biochemical profile of the “red kapsiki” beer.
\\n\\n
These books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\\n\\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\\n\\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
\\n\\n\\n\\n\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
IntechOpen and Knowledge Unlatched formed a partnership to support researchers working in engineering sciences by enabling an easier approach to publishing Open Access content. Using the Knowledge Unlatched crowdfunding model to raise the publishing costs through libraries around the world, Open Access Publishing Fee (OAPF) was not required from the authors.
\n\nInitially, the partnership supported engineering research, but it soon grew to include physical and life sciences, attracting more researchers to the advantages of Open Access publishing.
\n\n\n\nThese books synthesize perspectives of renowned scientists from the world’s most prestigious institutions - from Fukushima Renewable Energy Institute in Japan to Stanford University in the United States, including Columbia University (US), University of Sidney (AU), University of Miami (USA), Cardiff University (UK), and many others.
\n\nThis collaboration embodied the true essence of Open Access by simplifying the approach to OA publishing for Academic editors and authors who contributed their research and allowed the new research to be made available free and open to anyone anywhere in the world.
\n\nTo celebrate the 50 books published, we have gathered them at one location - just one click away, so that you can easily browse the subjects of your interest, download the content directly, share it or read online.
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In particular, various methods for vascular access were discussed by many contributors. From these reviews, the reader will gain precious hints and suggestions in every day practice. Previously, many textbooks on "Hemodialysis" have been published but they were written by only a couple of authors. However, in this special issue several authors discussed similar subjects, producing precious and fruitful suggestions. This will be very helpful for readers to understand and carry out HD practice. I hope this special issue will contain useful information for those who are involved in HD therapy.',isbn:null,printIsbn:"978-953-51-0988-4",pdfIsbn:"978-953-51-7095-2",doi:"10.5772/45929",price:169,priceEur:185,priceUsd:219,slug:"hemodialysis",numberOfPages:882,isOpenForSubmission:!1,isInWos:1,isInBkci:!1,hash:"960f1c2998be5bdb86d0b9412f13fb0b",bookSignature:"Hiromichi Suzuki",publishedDate:"February 27th 2013",coverURL:"https://cdn.intechopen.com/books/images_new/3267.jpg",numberOfDownloads:113504,numberOfWosCitations:41,numberOfCrossrefCitations:37,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:80,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:158,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 12th 2012",dateEndSecondStepPublish:"May 3rd 2012",dateEndThirdStepPublish:"August 7th 2012",dateEndFourthStepPublish:"November 5th 2012",dateEndFifthStepPublish:"December 5th 2012",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"156403",title:"Prof.",name:"Hiromichi",middleName:null,surname:"Suzuki",slug:"hiromichi-suzuki",fullName:"Hiromichi Suzuki",profilePictureURL:"https://mts.intechopen.com/storage/users/156403/images/3426_n.jpg",biography:"Dr. Suzuki graduated from Hokkaido University School of Medicine in 1975 and received the residency program of internal medicine in Keio University Hospital. He spent four years as clinical fellow in Nephrology and Endocrinology, Keio University Hospital from 1977 to 1982. After that, Dr. Suzuki studied as a Research Fellow of Basic Nephrology and Hypertension in Cleveland Clinic Foundation, Ohio, USA. from 1982 to 1984. Coming back to Japan, he became an Assistant & Associate Professor, Department of Internal Medicine, Keio University, School of Medicine and carried out these Professor ship until 1995. Dr. Suzuki became a Professor, Department of Nephrology, Saitama Medical School and continued this job until the present time. He is involved in clinical nephrology including dialysis and hypertension.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Saitama Medical University",institutionURL:null,country:{name:"Japan"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1163",title:"Nephrology",slug:"nephrology"}],chapters:[{id:"42994",title:"Cardiovascular Disease in Hemodialysis Patients",doi:"10.5772/53071",slug:"cardiovascular-disease-in-hemodialysis-patients",totalDownloads:2911,totalCrossrefCites:1,totalDimensionsCites:3,hasAltmetrics:0,abstract:null,signatures:"Han Li and Shixiang Wang",downloadPdfUrl:"/chapter/pdf-download/42994",previewPdfUrl:"/chapter/pdf-preview/42994",authors:[{id:"157642",title:"Dr",name:null,surname:"Wang",slug:"wang",fullName:"Wang"}],corrections:null},{id:"42054",title:"Medical Nutrition Therapy for Hemodialysis Patients",doi:"10.5772/53473",slug:"medical-nutrition-therapy-for-hemodialysis-patients",totalDownloads:6387,totalCrossrefCites:0,totalDimensionsCites:3,hasAltmetrics:0,abstract:null,signatures:"F. 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\r\n\tAs the global, regional and national climate continues to change, there is an increasing need to better understand how climate affects land-use systems and how different levels of governance initiatives affect this process. The developing world comes out prominent as often such regions are the most affected by climate change. In addition, it is no longer sufficient to simply suggest adaptation and mitigation options but to assess the level of readiness and performance of climate change using novel approaches. This book on climate change will consist of five key chapters. It will begin by looking into the relationship between climate change and food security in the developing world. Chapter two, will examine the effects of climate change on forests in the developing world while chapter three will focus on climate governance with emphasis on several sub-national, national and global climate governance initiatives. Chapter four will look at the concepts of climate change readiness and performance within the context of key indicators and approaches to assessment. Finally, chapter five focuses on the relationship between yield and precipitation gaps with emphasis on actual gaps, approaches, data, and challenges.
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August 2019-December 2020.\n•\tPost-Doctoral Research Fellow/Lecturer: Department of Geography, McGill University. May 2016-July 30, 2019.\n•\tPost-Doctoral Research Fellow: Département de Géographie, Université de Montréal. May 2014-April 2016. \n•\tResearch and Project Assistant: Ecological modelling and carbon science laboratory (ECO MCS) : Institute des Sciences de l’environnement, Université du Québec à Montréal (UQAM), Montréal. Septembre 2010-April 2014.",institutionString:"Université Mohammed VI Polytechnique",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Université Mohammed VI Polytechnique",institutionURL:null,country:{name:"Morocco"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"10",title:"Earth and Planetary Sciences",slug:"earth-and-planetary-sciences"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"418641",firstName:"Iva",lastName:"Ribic",middleName:null,title:"M.Sc.",imageUrl:"https://mts.intechopen.com/storage/users/418641/images/16830_n.png",email:"iva.r@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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The traces of the first artisanal fermentation were found by archaeologists in the Blue Nile region of Sudan [1, 2]. In mountainous area of central African savannah, cereals, mainly millet and sorghum, are the most important crops used for fermented beverage [3]. One of these drinks is an opaque alcoholic beer‐like beverage made from fermented sorghum gritz and malted maize, mainly used for rituals and festivities [4]. Two types of this beverage are produce in “Kapsiki land.” They are “tè” and “mpedli.” The first one, “tè,” also called “red kapsiki,” is the ritual beer. And the second, “mpedli,” is the “white kapsiki” beer which is mainly brewed by women for commercial purpose and has no ritual significance. “Mpedli” is made by a quick process for immediate consumption [5, 6]. The red “tè” beer in which we focus our study is traditionally a man’s brew. Its processing follows a strict procedure, with numerous prohibitions, and “red kapsiki” was for long time mainly used for ritual purposes than festivities. Symbolism was more focused on this beer rather than commercial and technical [6]. However, “red kapsiki” has increasingly become a sales commodity for women both at the village markets and in the cities as it is generally preferred by the population over “mpedli” [7, 8]. Though most of the symbolism around beer is a male‐dominated discourse which concentrates on bonding and power, the symbolism is less straight forward and more hidden [6]. Despite the importance of the “red kapsiki” beer among this tribe, the beer itself remains unknown in scientific community and little is known on it processing and quality. This chapter thus aims at valorizing this opaque beer by describing its processing technique and provides some data in regard with its quality.
In order to describe and follow the process production, a survey was conducted in three “kapsiki” rural villages of Cameroon, namely, Rhumsiki, Rhumzu, and Mogodé. Later on, some samples from one urban town close to the area Mokolo were also collected for comparison purpose. The choice of this urban area is justified by the fact that Mokolo is the immediate administrative area populated in majority by “kapsiki” populations. The sampling method used for processing description was cluster sampling [9] with two degrees of units. At the primary level, we have considered the cities surveyed, production sites and markets. At the secondary level, we have interviewed individuals and groups of individual respondents. Two layers were formed: rural area and urban area. As urban area, Mokolo was chosen because of the possibility of finding markets as well as production sites. In mountainous “Kapsiki” land, three villages were selected: Rhumsiki, Rhumzu, and Mogodé. As for the surveyed markets, we conducted a random choice in Mokolo. In the rural areas, Rhumsiki, Rhumzu, and Mogodé, all markets were taken into account because of the very limited number of markets and their periodical characters. Producers and women retailers were also randomly chosen in the areas and markets selected for the survey. A total of 15 production sites and 7 markets were visited, and 50 producers and 23 women retailers were interviewed. The interviews were conducted on the basis of a questionnaire, and collected data were processed using the software Winstat through a counting sheet constructed from the questionnaire.
For characterization, 40 samples of the “red kapsiki” were collected from production sites and sales points. The sample pH was measured directly onsite using a portable pH meter. The conductivity, density, and brix were also recorded onsite using portables devices conductometer, densitometer, and brix meter, respectively. Around 10 ml of each sample was introduced into test tubes and gently shaken. The probe of designated apparatus (pH meter, conductometer, and densitometer) was then deepening into the test tube, and the values were read directly on the screen of the device. The experiment was repeated four times for each sample. The mean of each read result was considered. For total soluble solids (% Brix), the refractometric method was used to determine the soluble solids in beer samples [10]. The portable refractometer was first thermostated at 20°C using boiled water and regularly calibrated with cooled distilled water until the screen of the device showed 20°C. Soluble solids were then obtained from read refractive index on device screen, by reference to a standard table.
Titrable acidity (as percentage (w/w) tartaric acid) was determined according to the Association of Analytical Chemists’ method [11]. Acidity was evaluated by the alkali‐potentiometric method using a 0.1‐N sodium hydroxide solution in the presence of 0.4% bromothymol blue used as an indicator.
Total polyphenols were assayed by calorimeter using the Folin‐Dennis Ciocalteau reagent as described by Mangas et al. [12], and the results were expressed as mg/l of gallic acid.
Total ethanol content was preceded by a Spectrophotometric micro‐method for the determination of ethanol after distillation of beer that was made alkaline by a suspension of calcium hydroxide [13].
Specific density at 15°C was evaluated as described by Nanda et al. [14]. The specific gravity determination was done as follows: 20 ml of sample was poured into the specific gravity test tube to overflow, then the stopper was inserted, and the whole was incubated in water bath at 200°C for 30 minutes. The test tube was removed from the water bath, wiped, and then weighed. Thereafter, the sample was boiled. The specific gravity was calculated as the ratio of weight of ash over the weight of fresh sample time 100.
The volatile acidity was determined using the Mathieu method by titration of the volatile acids separated from wine by steam distillation and titration of the distillate [15].
Around 10 ml of “red kapsiki” samples from each site was mixed with 90‐ml sterile peptone physiological saline solution (1 g Peptone, 8.5 g NaCl, and 1000‐ml distilled water). Decimal dilutions were prepared up to 106 from initial sample as described by Loyer and Hamilton [16]. All enumeration in solid media was carried out in triplicate, and the plates containing between 33 and 333 colonies were considered. The enumeration in liquid media was evaluated according to deMan most probable number.
Total aerobic mesophilic bacteria were enumerated on Plate Count Agar (PCA‐OXOID) supplemented with cycloheximide 0.5% [17]. The plates were incubated at 28°C for 48–72 hours.
Total coliforms and
Fecal Streptococcus was enumerated on Slant Agar (SL‐Merck) supplemented with cycloheximide at 0.5% after 48 hours of incubation at 37°C [19].
Yeasts and molds were enumerated on PDA‐Chloramphenicol (200 g potatoes extract, 10 g peptone, 20 g glucose, 15 g agar, 0.5 g chloramphenicol, and 1000 ml distilled water, pH was adjusted to 5.2) after 48–72 hours of incubation at 30°C [18].
Enumeration of sulfite-reducing clostridia was done according to Mossel [21] method in anaerobic jar.
Total spore‐forming bacteria were evaluated on GPB agar medium (10‐g peptone, 2‐g starch, 5‐g glucose, 15‐g agar, 40‐mg bromocresol purple, and 1000‐ml distilled water) after 10 minutes of pre‐heating of the samples at 80°C [22]. Colony counts were performed after 48 hours of incubation at 35°C.
Comparison of the means was performed by the ANOVA associated with Tukey’s honest significant difference (HSD) test to discriminate significantly different pairs of means values. Means values were considered statistically different at
Sorghum beer is generally made from grain and water, sometimes a gelatinous or mucilaginous agent [23]. In Cameroon, most of non‐Islamized ethnic groups process it even in different forms. The obtained beer is named according to ethnic groups and countries. Names of beer are as follows: “Tchoukoutou” in Togo and Benin, “Pito” and “Burukutu” in Ghana and Nigeria, “Dolo” in Burkina‐Faso, “Tchapalo” in Ivory Coast, “Busaa” and “Bushera” in Kenya, “Ikigage” in Rwanda, Kaffir in South Africa, “Mahewu” in Zimbabwe, “Malwa” in Uganda, “Munkoyo” in DR Congo, and “Bili‐Bili” in Cameroon. Figure 1 describes the traditional processing of “red kapsiki” beer which commonly includes the following:
Technological diagram of homemade “red kapsiki” beer.
In the case of “red kapsiki,” as most of beers, the process production starts by the selection of grains. The “red kapsiki” being a noble beer, only good quality grains are considered. Mostly, the sorghum variety “mouskwari” is selected for the “red kapsiki” production. However, in raining season, “Djigari” variety can also be chosen.
After being washed, the grains are immersed in water for 12–24 hours so as to obtain a moisture content of 35–40% for germination. The temperature of water is very important: at high temperature, the quenching is rapid. The immersion temperature is close to that of room temperature (around 40–45°C in the region). The grains are first drained on tissue and then stabled in double layer on cotton cloth bags or on woven mats.
The soft grains are covered and placed in dark area for 2–3 days for germination. Water is sprayed sometimes, when the ambient air is dry or when the temperature is hot. Alternatively, the grains are left on the ground and sprayed until the germination process starts and rootlets appear. The high temperature facilitates the beginning of germination. In this case, the germination time can last for 4 days. It should be noted that the same technique is used at the household level to improve the energy density of slurries [24]. During germination, amylolytic enzymes are produced and protein digestibility of sorghum, which is generally low, is improved [25]. It was also demonstrated that after 3 days of malting, there was production of amylolytic enzymes, including α‐amylase, β‐amylase, and dextrinase, which are all essential for good quality of malt [26].
This corresponds to the “Kilning” and brings moisture to malt to keep 15–20% without mold. The malt is dried in sun for one or more days, sometimes less if the process goes straight to the brewing stage. In case of the production of special “red kapsiki,” it was noticed that after malting, grains are roasted in firewood and ground coarsely. The obtained powder is kept in dark for 2 days before brewing.
The previously malt is crushed in a mortar/pestle in rural sites or in a wen in urban area.
In fact, the malt is brought to a motorized milling machine sets to crushing mode, to obtain a coarse flour.
The grind is mixed with water and a gelatinous or mucilaginous agent (okra or sap of various trees that improve flocculation and filtration of insoluble in suspension). After an hour of storage at temperature of 25 to 35°C, the mixture was separated into two phases, the upper liquid phase which is collected. The upper liquid phase already contains a soluble portion of malt sugar.
The lower phase containing malt flour is cooked slowly to boiling so as to obtain a starch paste (slurry consistency). The upper liquid base is then mixed with a water to be more easily saccharified than if it was not being cooked, and the diastatic actions being more effective on cooked starch than on raw starch. Alternatively, like for other sorghum beer processing, where the raw grain is added [27, 28, 29], in the case of the “red kapsiki,” production may continue with malted sorghum powder. In fact, ground malted sorghum is dissolved in water at the ratio of 1/9 (w/v). After 1–3 hours of soaking, supernatant is removed and kept for a later use. The remaining mealy material at the bottom of the soaking container is then removed and cooked for 3–5 hours. It must be noticed here that some enzymes produced during the malting stage seem not digested. This may be due to the soaking temperature, which is not optimal for enzymes. The mealy deposit is constituted by 80% raw starch. This starch is cooked and lightly cooled before previously removed soaking water probably containing starch‐digesting enzymes is added. The mixture is then kept warm for 1–5 hours or let stand overnight at room temperature.
After the decoction phase, the paste‐like mixture previously removed becomes liquid and is filtrated. The dry matter is discarded, while the sour mash obtained is kept for the next step of the process. The filtration is mostly done through polypropylene bags, and the slurry obtained after decoction is passed through this polypropylene bag. The filtrate now called “liquid must” is kept for further processing when the drench is used as animal feed.
The liquid must be concentrated and clarified by skimming. This operation is stopped by several criteria: clarity, color of the must, cold consistency (syrupy appearance) and also the flavor of the must. This operation consisted of two cooking steps. The first step is a precooking of mealy deposit during 3–5 hours to produce a “sour liquid must.” The second one is a cooking of the “sour liquid must” 5–10 hours to produce a “sweetish liquid must” which is called “tè kwarhèni” in the local Kapsiki dialect.
The sweetish must is cooled either spontaneously or by successive decanting and then starter culture is added. Fermentation lasts 12–24 hours at room temperature. This last step is stopped when supernatant liquid foam. The beverage obtained at the end is called “tè” or “red kapsiki.”
As presented in Table 1 and compared to other African beer as described by Lyumugabe et al. [29], the “red kapsiki” presents a greater alcohol content (3.85–4.28% v/v). This beer seems more alcoholic than “Bushera” 0.27% [30], “Burukutu” 1.63% [31], “Munkoyo” 2.1% [32], “Dolo” 2.3% [33], “white Kapsiki” beer (2.48 ± 0.14%) [34], and “Pito” (3.09%) [35]. However, the “red kapsiki” would be less alcoholic than “Tchapalo” (5.03–5.22%) [28]. We noticed a pH between 2.40 ± 0.19 and 3.26 ± 0.03. With an average pH below 4.5, the “red kapsiki” beer samples would be of satisfactory quality according to the CODEX STAN 243. Soluble extract varies from 6.30 to 7.29 °P,Brix from 7.0 to 7.46 °B, and total sugar from 41.8 to 72.9 g/l. Compared with the literature, this beer seems to be sweeter than “Tchapalo” 5.3 g/l [28], “Dolo” 7.7 g/l [33], and “Pito” 34 g/l [35]. This beer has a conductivity from 1919 to 1990 (μS/cm) and a specific density (g/cm) at 15°C of about 1.33. The color of the “red kapsiki” varies from a pinky brown to reddish according the variety of sorghum used. As most of African sorghum beers, the “red kapsiki” presents a touch of fruitiness added to their fermentation odor. This beer is mainly consumed in an actively fermenting state leading to a short shelf life as mentioned for other African beer in literature [20, 29, 36, 37]. Statistical analyses carried out on the physicochemical composition of “kapsiki red” beers show generally that there is no significant difference between the samples from the different sites. Indeed, the physicochemical parameters of this beer are substantially the same from one site to another. Despite a difference in the manufacturing process, the results obtained with this beer are similar to those of Yao et al. [38], which showed a consistency in the physicochemical properties of “Tchapalo” taken from nine different sites in the city of Abidjan. At first glance, this regularity seems surprising since the artisanal production of “kapsiki red” beer is made without measuring and precision equipment. The operations are done by simple visual and sensorial appreciation [28]. This apparent invariability could be explained by the fact that manufacturing being empirical, brewers have kept the same reflexes and habits. This allows them to obtain more or less identical finished products.
Mogodé | Mokolo | Rhumsiki | Rhumzu | |
---|---|---|---|---|
pH | 2.46 ± 0.08a | 2.42 ± 0.12a | 2.40 ± 0.19a | 3.26 ± 0.03a |
Total titrable acidity (mg/l) | 6.7 ± 0.4a | 8.1 ± 0.5b | 7.7 ± 0.1b,c | 7.2 ± 0.6a,c |
Soluble extract (°P) | 7.28 ± 1.29a | 7.29 ± 0.26a | 7.29 ± 0.26a | 6.30 ± 1.09a |
Brix (°B) | 7.0 ± 1.06b | 7.46 ± 0.83b | 7.42 ± 0.84b | 7.0 ± 0.16b |
Total ethanol (% vol) | 3.85 ± 0.58a | 4.10 ± 0.46a | 4.08 ± 0.46a | 4.28 ± 0.78a |
Total sugars (g/l) | 72.8 ± 1.29a | 72.9 ± 0.30a | 72.9 ± 0.40a | 41.8 ± 0.39a |
Conductivity (μS/cm) | 1919.23 ± 8.12a | 1990.0 ± 4.08b | 1990.0 ± 3.53b | 1929.00 ± 4.02a |
Specific density (g/cm) 15°C | 1.03 ± 0.00 a | 1.33 ± 0.00a | 1.00 ± 0.00a | 1.62 ± 0.00a |
Biochemical profile of the “red kapsiki” beer.
NOTE: Mean values preceded by at least one common letter (a, b, c) in the same line are not significantly different (
As present in Table 2, the “red kapsiki” contains a quite good amount of polyphenols. The recorded amount varies from 843 ± 27 mg/l in Mogodé samples to 1150 ± 27 mg/l in Rhumzu samples. It must be noticed that some of these polyphenols are too low or absent in other “industrial” beer. As indicated by Bröhan et al. [39], when barley malt is used for mashing, around 30% of total beer polyphenols are issued from hop, although added in 100 times lesser quantity than malt. In the case of the “te” or “red kapsiki,” the sorghum contribution to beer polyphenols could be much higher. In fact, sorghum phenolic acids include hydroxybenzoic (mainly protocatechuic acid) and hydroxycinnamic acids [40, 41] both free and bound as esters. Most of them are found in usual lager beers brewed either from barley malt or from hop [42]. Sorghum anthocyanins are unique, as they lack the hydroxyl group at the 3‐position of the C ring. These 3‐deoxyanthocyanins such as luteolinidin and apigeninidin are used as natural food colorings because they are more stable than anthocyanidins in both organic solvents and acidic solutions. Amount of 1500 mg/l of flavonol was recorded in “red kapsiki.” Bröhan et al. [39] indicate that flavonols such as apiforol (leucoapigeninidin) and luteoforol (leucoluteolinidin) are sorghum polyphenols as precursors of sorghum 3‐deoxyanthocyanins. Never reported in beer, they have been found at concentrations up to 4200 mg/kg in sorghum [43]. Other sorghum flavonoids include the flavones apigenin and luteolin [44], the flavanones naringenin and eriodictyol [45], the flavonol kaempferol, the dihydroflavonol taxifolin, and the flavan‐3‐ols (þcatechin and epicatechin. Hop brings similar flavonols and flavan‐3‐ols to wort, in industrial brewing.
Sample | Volatile acidity (g/l) | Total polyphenols (mg/l) | Flavonol (mg/l) |
---|---|---|---|
Rhumzu | 0.3 ± 0.00a | 1150 ± 27a | 1300 ± 27a |
Rhumsiki | 0.2 ± 0.00b,c | 911 ± 22b | 1000 ± 32c |
Mogodé | 0.1 ± 0.00c | 843 ± 27b,a | 834 ± 16a,d |
Mokolo | 0.2 ± 0.00b,c | 1111 ± 32c,a | 750 ± 23e,a |
Some essential biochemical compounds of the “red kapsiki”.
NOTE: Mean values preceded by at least one common letter (a, b, c, d, e) in the same line are not significantly different (
The results of the microbiological analysis of beers obtained are shown in Table 3. Analysis of these results shows that the parameters sought in the produced beers are not in accordance with international microbiological criteria [46]. The presence of pathogens as Coliforms,
Mogodé | Mokolo | Rhumsiki | Rhumzu | Standards | |
---|---|---|---|---|---|
Total count (cfu/ml) | (6.1 ± 0.2) 105 b | (6.2 ± 0.5) 107 a | (5.1 ± 0.3) 105 b | (7.4 ± 0.1) 104 b | <106 |
Total coliform (cfu/ml) | (7.2 ± 0.5) 104 b | (2.4 ± 0.7) 105 a | (4.2 ± 0.4) 103 b | (1.4 ± 0.3) 104 b | <103 |
Total thermo‐tolerant coliforms (cfu/ml) | (9.2 ± 0.4) 101 a | (3.1 ± 0.4) 103 b | (5.2 ± 0.7) 101 a | (3.1 ± 0.5) 102 a,c | <102 |
Fecal Streptococcus (cfu/ml) | (2.2 ± 0.2) 102 c | (3.7 ± 0.4) 104 a | (3.2 ± 0.3) 103 c | (2.2 ± 0.2) 104 b | <103 |
(8.1 ± 0.7) 101 b | (4.5 ± 0.2) 103 a | (9.2 ± 0.7) 102 b | (7.2 ± 0.5) 103 c | Absence/20g | |
Sulfite‐reducing clostridia (cfu/ml) | (5.0 ± 0.4) 101 b | (7.7 ± 0.3) 103 a | (7.2 ± 0.9) 101 b | (2.5 ± 0.6) 102 b | Not known |
Total fungi (cfu/ml) | (3.5 ± 0.8) 103 b | (3.2 ± 0.7) 105 a | (4.5 ± 0.4) 104 b | (6.1 ± 0.2) 104 b | <105 |
Total spore‐forming bacteria (cfu/ml) | (2.7 ± 0.2) 102 a | (3.9 ± 0.6) 103 b | (2.4 ± 0.2) 102 a | (9.7 ± 0.2) 102 a | <104 |
Microbial profile of the “red kapsiki”.
NOTE: Mean values preceded by at least one common letter (a, b, c) in the same line are not significantly different (
Indeed, studies on traditional sorghum beer in West Africa show that these drinks are a complex biotope composed of several genera and species of microorganisms dominated by yeast [29, 52, 53]. Their prevalence is probably because they are added by inoculation of the traditional starter in the sweet wort to ensure alcoholic fermentation [38, 54]. During fermentation, we initially have a yeast growth which is accompanied by the production of ethanol after the logarithmic growth phase, and which continues during the stationary phase. It has been observed that during this time, very little or no increase in the number of contaminating organisms seems to occur [18]. However, the presence of yeast in beer would also be due to adaptation in response to the accumulation of ethanol produced. According to Dombek and Ingram [55], this adaptation was accompanied by a change in the composition of membrane lipids after accumulation of ethanol. This changes in the composition and structure membrane would allow the yeasts to escape at the solubilizing action of ethanol. The surviving yeasts can readily begin another post‐adaptation growth cycle. The isolated pathogenic bacteria can originate from the environment, the raw material, and the equipment used. The hygienic quality of beer produced depends closely on the conditions of fermentation of the must. Indeed, the levels of total sugar and vitamin C are relatively high in beers obtained from the fermented mash. The recorded values for the “red kapsiki” are higher than those in the “Tchapalo” [28, 54] where the fermentation is carried out at a room temperature with a starter culture based on previous productions. It must also be noticed, to explain the prevalence of pathogens, that after few days of fermentation, the amount of yeasts decreases because of autolysis. With little or no competition from yeasts for the readily available nutrients, contaminating microorganisms increase rapidly in number and their metabolites may change and spoil the beer. Because of the relatively high temperature of the “red kapsiki” fermentation, these sequential events occur within a short‐time period. This period does not usually exceed more than 3 days in summer or 5 days in winter before this spoilage occurs. The metabolic activities of mesophilic bacteria are primarily responsible for the spoilage. These bacteria, along with other undesirable bacteria, may produce acetic acid, volatile off‐flavors, fruity odors, and pellicles which render the taste, odor, and texture of the beer unacceptable to consumers.
The color of the “red kapsiki” is pink brown to reddish according the variety of sorghum used. This artisanal beverage requires steps of malting, quenching, germination and “kilning,” decoction, filtration, boiling and sterilizing, cooling, sowing, and fermentation for its production. The “red kapsiki” presents an interesting physicochemical profile, but has a high degree of microbial contamination for consumption, and we noticed the presence of pathogens such as coliforms,
This work was done with the support of Institut de Recherches pour le Developpement (IRD), France, through JEAIRD funding to TABITAL research team of the University of Maroua, Cameroon, which partially funded the field work.
This chapter is written to give information about the basic knowledge about the prosthesis, its types, its application and its advantages. The readers can understand the concept of Prosthesis with respect to biomechanical principles and how the Amputee can adapt himself to the usage of prosthesis with simple explanation. Hence, the chapter gives a overview about the lower limb prosthesis with illustrated pictures for better understanding.
Prosthetics are otherwise known as artificial limbs. They are the device used to replace a missing limb, either upper limb or lower limb. Thereby, the prosthesis are used by a amputee. The amputee by wearing this device, can able to stand walks, maintain balance and regain erect posture. The science of creating artificial body parts is called prosthetics. This prosthesis is designed and manufactured by prosthetist. He also fits the artificial limbs (prosthesis) for people with disabilities especially amputees.
Prostheses is most commonly prescriped for lower limb amputation. Amputation is defined as the removal of the limb through a part of the bone [1] the lower limb amputation is the most common amputation nearly 85 percent of all amputations. The function of lower limb is weight bearing and locomotion. Lower limb prostheses is used to provide an individual who has an amputated limb with the opportunity to perform functional tasks, particularly ambulation (walking) which may not be possible without the limb.
The types of prostheses (Figure 1) is determined by an extend of the level of amputation (Figure 2). The lower limb amputation are performed at different levels based on that the prostheses are developed. The types of prostheses are
Hemipelvectomy prostheses – for hemipelvectomy surgeries
Hip disarticulation prostheses – for hip disarticulation
Above knee prostheses – Transfemoral/Above knee amputation.
Below knee prostheses - Transtibial/below knee amputation. The prosthetic socket encases the residual limb , and is often classified as either “Patellar tendon bearing” - dispersing weight distribution onto several pressure tolerance areas including patellar tendon or “Total surface bearing” creating more equal weight distribution throughout the entire socket.
Symes prostheses - Symes amputation/Ankle disarticulation [1]
Types of Prostheses.
Levels of amputation.
The prosthetics are designed into two types
Endoskeletal prostheses
Exoskeletal prostheses
Endoskeletal prostheses (Figure 3) is a type of prostheses in which the supporting structure is internal it is also called as modular prostheses, it is most commonly used type of prostheses. The endoskeletal prostheses use the human skeleton as the model it has the tube frame provides the weight bearing function and a foam cover gives the prostheses it’s near natural appearance [2]. A tube frame is a central part it is called as pylon. The pylon is constructed from Aluminium, Titanium or Stainless steel, it connect proximally socket and distally prosthetic foot. The endoskeletal prostheses includes the joint components to suit the need of the individual amputee.
Endoskeletal prostheses.
Advantages of endoskeletal prostheses are
Changes may be done at any point of time
Light weight and comfortable for weight bearing
Cosmetically acceptable and it gives the appearance of near to normal
Suitable for all levels of amputation
It gives adequate adjustment and good dynamic alignment.
Disadvantages
Less resistant to external wear
The foam cover is not last for a longer period and needs to be changed often.
The exoskeletal prostheses (Figure 4) is a type of prostheses in which the supporting structure are on outside. It is also called as conventional or crustacean prostheses. The exoskeletal prostheses has a rigid outer shell as a supporting structure it provides shape and weight bearing function. The weight is beared through the outer shell. It is constructed of wood, or rigid polyurethane covered with a rigid plastic lamination [3].
Exoskeletal prostheses.
Advantages of exoskeletal prostheses are
Lasted for a longer period
More resistant to external wear
Cost effective
Disadvantages are
Heavy & uncomfortable for use
Fabrication time is longer
Alignment cannot be changed & couldn’t be adjusted
Not suitable for through knee amputation.
The lower limb prostheses has the following components (Figure 5)
Socket : Is the most important part it is the connection between the stump and the prosthesis. It protects the stump and transmits forces. Contoured sockets fit closer to bone, muscle, soft tissue. It provide support. It can be made of thermoplastic or metal.
Suspension : This holds the artificial limb on to stump. Eg. Sleeve, belt, straps, cuffs, suction prostheses.
Liner : This is a removable inner socket made of flexible material.
Pylon or Shank : This lies between the socket and the prosthetic foot. It is made of strong and lightweight material such as Carbon fibre, Aluminium & Titanium.
Prosthetic foot & ankle : Designed to provide support during standing/walking and shock absorption.
Components of lower limb prostheses.
The prostheses required a high level of customization and represents the interface with the human body or parts of it, the artificial prostheses that have to be designed according to the shape of the specific anatomical area. Considerations taken into account when designing prostheses are basic structure of a lower limb prostheses, materials, weight and mass considerations, power requirements, biomechanics, and tradeoffs in motion and stability.
The temporary prostheses is also called as preparatory prostheses. Temporary prostheses are used for early rehabilitation purpose to speeds the recovery process and it ease the transition into a definitive prostheses. The advantage of the temporary prostheses is it fastened the mobility of the amputee postoperatively, prevents the complications of prolonged bed rest and it promote early discharge from the hospital. It’s applied within few days after surgery and limited early gait training is given.
Indications are
Applied for early rehabilitation
Unhealed residual limb like Burns, Skin grafts, Open wounds, Infection.
Dermatological condition
Painful residual limb
Fracture healing process
The permanent prosthesis is also called as definitive prostheses. It is applied when the surgical wound is completely healed and the residual limb become shrinken and shaped. The permanent prostheses is changed when the prostheses become excess wear and the atrophy of the residual limb. The permanent prostheses are should be proper fit there by the patient will get proper weight bearing & movement.
The prostheses are specifically designed for certain number of patients will require special-use prostheses and it is designed specifically for sports activities such as running, swimming, or skiing. Special-use prostheses can be valuable to the amputee who wishes to expand his activities and participate in a full range of sports and recreation.
The various materials are used to design the prostheses, the materials should be strong enough, light weight, resistant to thermal conditions, longer durability and biocompatible it should not cause allergic reactions to the body. The materials are
Metals: Titanium, Aluminium and stainless steel. The metals are used both in exo & endoskeletal prostheses e.g Socket, Pylon.
Plastic: Socket is made of plastic, the thermoplastic materials like polypropylene, polyethylene, polyurethane, acrylic are commonly used. The thermosetting plastic also used for laminated sockets in which the resin is combined with the reinforcing materials like glass fibre, nylon,carban fibre.
Wood: Is used in lowerlimb prostheses for foot assembly e.g SACH foot Solid-ankle, cushion-heel (SACH) feet have an interior hardwood heel that provides structural strength to the foot. This heel is bolted to the rest of the prosthesis.
Leather: Is used for suspension straps, socket linings.
Rubber: The foot in the prostheses made by vulganised rubber
Fabric/cotton: Socks is made of cotton. Socks are used as an interface between residual limb & socket and it provides comfort & prevent friction between the residual limb and socket.
Fiber reinforcement: Two basic types of high-strength fiber reinforcements are used in prosthetics are glass and carbon. Carbon fibers are more expensive than fiberglass but have superior strength and stiffness. Carbon fibers are generally set in epoxy and can provide a material with a stiffness. In addition to this high strength-to-weight ratio, carbon fiber composites have a fatigue resistance. Prefabricated carbon fiber prosthetic components such as pylon tubes, knee joints, and connectors can significantly reduce the weight of the prosthesis while increasing its strength.
To substitute for a lost limb
To restore function of Amputee
Comfortable ambulation
Reduce expenditure of energy
Minimizing the shift of the center of gravity of the body during gait.
Loss of limb not only causes physical handicap but also leads to Social, Psychological and economic effects on the individual and family. This loss can be overcome to a greater extent by the application of artificial limb which restores the function as well as total body image.
Choke syndrome - caused by obstructed venous outflow due to tight socket leads to red, indurated skin with orange-peel appearance, venous stasis ulcers.
Skin problems:
Contact dermatitis most commonly caused by liner, socks, and suspension mechanism
Cysts
Hyperhydrosis
Erythema, skin damage – due to shear forces and improperly fit of prostheses.
Painful residual limb – due to pressure in the bony prominence.
Above Knee Amputation (AK Amputation) is Removing the Three Fourth Of The Leg from the body by cutting through femoral muscle and bone. The optimum length of the residual bone is approximately 7.5 – 10cm proximal to the superior border of the patella. With a AK amputation the distal attachments of the femoral muscles are lost, in order to preserve their length and functions myodesis may be performed.
Trauma
Malignant Tumors
Diabetic Gangrene
Infections
Peripheral Artery Disease
Burns
An above knee prosthesis also known as transfemoral prosthesis. It is custom made for the person who have undergone above knee amputation.
Suspension
Cosmesis
Socket
Knee Joint
Shank
Foot Ankle Unit
Suspension is the part which holds the residual limb into the Socket. Rigid belts or straps can be used as primary suspension which is suspended around the pelvis. This helps the socket on and prevent it from falling off during swing phase. A good suspension will enhance the control of prosthesis, improve energy transfer and decrease discomfort or difficulty during walking. The disadvantages of suspension includes causes pressure around the pelvis, needs good strength and dexterity of hand, moves when sitting, can cause bruising and irritation.
It is the cosmetic cover that gives a shape and apprearence to the artificial limb. Most of the aritificial limbs are covered with a continous foamtube. This foam tube is made to match with the remaining limb as close as possible. Later it is covered with stockings.
The socket for an above knee amputee has two basic categories.\t\t
ISCHIAL CONTAINMENT SOCKETS: This type of socket have a rigid frame with a flexible inner socket, which holds the pelvis inside the socket.
QUADRILATERAL SOCKET: This type of socket provides a shelf for the pelvis to sit on the brim of the socket.
This part is designed to stabilise the individual during standing and walking by transmitting weight throught he prosthesis.it is of two types
A SINGLE AXIS: This type enables the individual to bent and straight knee joint in single direction.
POLYCENTRIC KNEE: This type allows knee to bend in different directions. this helps in walking on uneven surfaces.
This part connects the foot and ankle with the socket. There are two types of shanks.
Endoskeletal design: This is lightweighted soft foam gives appearance of skin .It is easily adjustable and compatible with advance technology. But the disadvantage is foam cover is fragile and can be damaged.
Exoskeletal design: This type has rigid and durable shell made up of laminated material. This is more durable than endoskeleton .It the ability to transfer weight throught the entire design.
This is the vital part prosthetics to provide support while the individual stands on the prosthesis. The following are the various designs of prosthetic feet.
SACH (SOLID ANKLE CUSHION HEEL). It provides a single motion on the joint. This is relatively lightweighted, durable and less expessive.
SINGLE AXIS FOOT. This provides up and down movement enhancing knee stability.
MULTIAXIS FOOT. This provides increased mobility at the ankle, which helps stabilize the individual on uneven surfaces.
DYNAMIC RESPONSE FOOT. This type is more preferable for the individual who can vary in walking speed, change directions quickly and for long distances.it provides a normal range of motion and more symmetric gait [4].
STEP 1- Check for any signs of skin breakdown in residual limb
STEP 2- Open areas should be cleaned and covered with proper gauze bandage
STEP 3- Put on adequate number of socks to fit the residual limb into socket too loose and too tight socks should be avoided.
STEP 4- Clear the wrinkles on the sock to smoothen the surface
STEP 5-Bend the prosthesis knee to 90 degree with the foot flat
STEP 6- Slide the residual limb into the socket and fasten the suspension system loosely.
STEP 7- Stand up holding a stable surface like walker or table
STEP 8- Bring the prosthesis under the hip joint and straighten the prosthenic knee completely
STEP 9- Adjust the residual limb to fit into the socket and finally fasten the suspension system completely.
STEP 1- Sit down and remove the suspension system
STEP 2- Remove the socket by slipping it off from the residual limb
STEP3- Check the limb for any signs of skin breakdown [5].
It is also known as stubby prosthesis or stubbies. These are specially designed for individual with bilateral above knee amputation and those who are not eligible for full length prosthesis. They are custom fitted and are usually made up of standard sockets, no articulated knee joint with modified rocket bottom foot to prevent them from falling. Stubbies are foreshortened prostheses to bring down the center of gravity and thereby increase the stability. Suspension is achieved through the use of waist belts or pelvic straps. Advantages include stubbies are easy to apply and needs lesser energy expenditure from the patient. Disadvantages include sitting in a chair and stair climbing is difficult. Short canes and crutches are usually needed for the support. Cosmetically unaccepted because of the extreme reduction in height of the patient.
Below knee amputation (BK) also known as trastibial amputation. It is the surgical removal of foot , ankle and lower third of tibia and fibula. During BK Amputaion fibula is normally 2-3 cm shorter than the tibia to avoid pressure points.
Diabetic Foot
Traumatic Injury
Vascular Disease
Malignant Bone Tumors
Congenital Defects
Infections
Knee Contracture
Neuroma
Hetertopic Ossification
DVT
Pulmonary Embolism
Phantom Limb Pain
Below knee prosthesis also known as transtibialprosthesis. It is custom made for individual who have undergone bk amputation.
Suspension
Socket
Pylon
Ankle And Foot Unit
It is the part which holds the residual limb into the socket. Straps are used as support system to hold the socket into place. There are various types of suspension supracondylar cuff most common type, waist belt, cuff strap, thigh corset, vaccum suspension.
This forms a connection between stump and prosthesis. It protects the stump and transmits the force. There are various types of sockets.\t\t
Conventional below knee socket
Patellar tendon bearing socket
Patellar tendon bearing and supracondylar suprapatellar socket
Bent knee socket
Slip socket
Conventional below knee socket: this is custom made for elderly people those with quadriceps weakening. It is fabricated with no pressure over distal tibia, fibula, head and tibial crest. It has disadvantage of skin irritation and stump chocking by edema.
Patellar tendon bearing socket: This is the commonly used socket. It is designed to load the weight in pressure bearing areas like patellor tendon and medial tibial flare. It has got a bar that is built in to patella tendon patella and tibial tubercle. Socket maintained at 50 of knee flexion.
Patella tendon bearing supracondylar suprapatellar socket: It has anterior trim line to support suprapatellar region. It gives good suspension. It is very much useful for people with short stump and genu recurvatum.
Bent knee socket: It is designed for people with fixed flexion deformity. Upto 200 of flexion can be accomodated.
Slip socket: It has two layers fine leather internally and wooden or plastic socket lines externally. It is also used for short stump.
It transfers the body weight from the socket to the foot.
Types of pylon
Exoskeletal
Endoskeletal
Exoskeletal: This is also known as conventinal type. Commonly designed with wood or plastic. The walls of the wooden components are resuced from inside. The exterior provides final shape and cannot be changed nce it is done.
Disadvantages-Fabrication time is much longer and does not provide efficient stance phase and swing phase.
Endoskeletal: These are light weight and much rom is available when compared with exoskeletal. Cosmetically much accepted. The prostheis has adequate provision foe adjustments to achieve good dynamic alignment. It needs much less time for fabrication.
An ideal prosthetic foot should perform plantar flexion, dorsiflexion, inversion and eversion. It should stimulate muscle activity and shock absorber. It should provide a stable surface during stance phase.
Types of foot
Solid ankle cushion heel (SACH): It is the most common type. It has no articulation presents with solid heel made upof wood or metal , a cushion heel with rubber heel edge which gets compressed during heel strike. It has advantages of less maintenance, durable and light weight.
Madras foot: This is modified version of sach. It has space between heel and ground filled with sponge rubber, toes are shaped like normal and rubber sole is provided for bare foot walking.
Jaipur foot: It was developed by prof, pk sethi and team at sms medical college, Jaipur. It is modified version of sach in order to make it cheaper and cosmetic. But it has disadvantage it can be used only with shoes because the shapes of toes are not discernible. Advantages: It is cheaper, cosmetically well accepted, waterproof.
Turn the sock inside out
Place the end of the sock against residual limb and roll on the sock with no air and wrinkles formed.
Adequate number of socks are needed to fit the socket appropriately
Place the residual limb inside the socket and try to ensure that the foot is correctly placed.
Push the residual limb into the socket .there should be mild resistance while applying prostheis. If there is no resistance then it indicates that less number of socks being used. So ensure adewuate number of socks
Check the knee cap in relation with the socket.
Buckle the suspension. Keep checking throughout the day for any discomfort or pain.
Remove the one way valve at the end of the socet and pull the limb out of the socket.
Remove the socks and check for any skin irritation or damage [6].
Syme’s amputation (SA) includes ankle disarticulation which is done at the level of the ankle joint in which there is removal of malleoli and the heel pad is protected. It is performed based on indications particularly in pediatric population. SA has the advantage of permitting weight bearing without prosthesis.
Indications:\t\t
Foot trauma
Diseased tissue/ non-usuable foot
Infection
Tumors
Certain limb deformities which needs excision
Syme’s level of amputation needs to encompass on several objectives for prosthetic management. It should pay back for the missing foot along with ankle motion which provides propulsive energy during ambulation. Limb length discrepancy (LLD) should be considered before preparing of prosthesis has it needs to suspend during the swing phase of the individual during gait.
Essential socket fit will maintain fat pad beneath the distal end of the tibia and fibula. SA has many functional advantages but when suggested with prosthesis it has various cosmetic limitations depending upon the shape and nature of the limb being treated.
In Biomechanical aspect, the prosthesis must provide comfortable transition, minimize shear and provide comfort for gait.
Currently four types of basically designed prostheses are used for SA.
Medial door design.
Rigid outer shell.
A modified Jones compression dressing is used postoperatively to control edema and to help shape the stump [7].
The main aim of rehabilitation followed by a lower limb amputation is to restore daily activities by means of gait. In order to acquire full accomplishment the patient must be trained psychologically to obtain physical performances without any hindrance (Figure 8).
BK Socket.
Donning- Initially the patient is demonstrated with fitting step. Initial fitting refers to the very first time the individual wears the prosthesis and stands, during which; patient should be stable enough to overcome disappointment about amputation and get adjusted to the prosthesis. Any discomfort should be immediately reported to the prosthetist. It is considered as the initial communication between prosthetist and the patient which will be followed by gait training.
Doffing- The patient is likely advised to sit down and remove the socket by slipping it off from the residual limb. After removal instruct the patient to check for any signs of ulcer or skin breakdown [8].
Maintain and improve range of motion
improve muscle strength
balance training along with single leg standing using parallel bars or a walker.
Balance and Gait using assistive devices (walker or crutch)
gait training within parallel bars.
Hygienic management of the prosthesis.
Stairs - Outdoor gait (on rough road, slope)
Sports and recreation
Explain about socket fitting and how it may change as the limb matures. As gait training progresses edema of the residual limb will be reduced, and it may fluctuate between morning and evening. Educating the patients about self management post discharge regarding adjustment of the fitting and maintaining hygiene.
Instruct patients about the alignment of the prosthesis which varies according to the weight loaded during gait. Educate them to adjust accordingly to avoid pain.
Provide the patient with a complete rehabilitation program.
Even though there is a rehabilitation team supporting and encouraging the patient still it is difficult for the patient to overcome certain circumstances. Therefore, it is the patient\'s capability to withstand and progress further with continuous use of prosthesis by maintain body weight and residual limb related problems.
All types of prosthesis are well explained with their application and advantages. Each prosthesis has its own uniqueness and the patient will be well rehabilitated with those prosthesis. Not all the patients are permitted into rehabilitation stage. It depends on factors like age, built of the patient, involvement of the limb (bilateral or unilateral), Psychology of the patient, socio-economical status of the patient. A multi- specialist Rehabilitation team has to be set to rehabilitate the Amputee.
The gait cycle which consists of two stages will also be termed as walking cycle. Initial contact is the first step in the starting point and the end point in every gait cycle. A single gait cycle has two phases. The stance phase and the swing phase. The stance phase is the initial step in which the foot contact starts followed by other steps in the ground. The stance phases contribute about 60% of the gait cycle and the swing phase contributes about 40% of the gait cycle. The swing denotes the single leg support in which the foot is off the ground.
The pattern of gait in subjects with prosthesis will present an altered gait pattern. Here the foot contact on the ground and the weight distribution on the foot is the key factor to be noted. The foot contact will occur on the heel in such a way the walking cycle will be as natural as possible. In this situation the sole of the foot will contact the ground and the weight is transmitted to the foot. Thus, the selection of foot component and the knee joint must be proper. This is because this will have an influence on the subject’s gait when he turns on to the next phase [9].
During swing phase, the knee function is so important so that the mobility on the knee joint performing both flexion and extension facilitating the foot transition from plantar flexion to dorsiflexion i.e toe elevation. This will prevent the subject from stumbling and subsequent fall.
The residual limb must be placed on the socket which provides rigid and stable attachment to the limb. This aids control over the subject’s limb during walking. The prosthesis socket can be divided into 3 parts. The top region of the socket is known as seating face. The central part of the socket is the primary control area. The function of the central part is to ensure correct movement and restrain it in the PA direction during walking. The last part is the distal socket end. This part will transfer only 10% of the subject weight to avoid abnormal weight transfer and this will cause subsequent damage to the soft tissues. The socket must be able to transfer the load thereby it ensures good stability of the subject’s gait with better control [10].
During standing, there will be a stretching of gluteus medius muscle. This will maintain the pelvis in a balanced position. For a subject with lower limb amputation this pelvis position is taken care by the prosthetic socket. In a transverse oval socket of transfemoral prosthesis, the pressure on the distal femur end increases and the body is excessively bending aside to reduce the pressure. It is a non-physiological load transfer, as the load is transferred through the tuberosity of the ischium which reduces the arm of the exerted force and the overturning moments are increased.
If there is any problem in procedure of construction and principles in aligning the prosthesis, there will be an abnormal deviation that may develop during gait. This gait deviations uses more energy expenditure during walking. Once this is practiced as a routine, may result in over use of certain muscle groups which also causes muscle imbalance.
In most cases, the improper construction of the transfemoral prosthesis and transtibial prosthesis includes
On circumduction, the foot swings outward which increases resistance to knee flexion with prosthesis. Here the prosthesis knee flexion has been limited for a reason. Thus, the subject has developed the avoidance mechanism.
The lateral flexion of the spine, the subject presents a leaning gait with the shoulder depressed towards the affected side. This is due to prosthetic foot is outset greater than 25mm, incorrect prosthesis length, insufficient adduction or amputee sensitivity.
Excessive heel raise, where the heel of the prosthetic foot comes up too far and too quickly. This is due to prosthetic knee flexion resistance is inadequate for the patient.
Drop off during the late stance, the subject presents excessive knee flexion. This is due to softness of the keel of the prosthetic foot. Also, the toe lever of the foot is too short of the heel height of the shoe is too high.
Foot slap, this occurs along with rapid and abnormal plantar flexion movement immediately after heel contact. This is due to insufficient resistance to plantar flexion on the prosthetic foot.
Thus, if there is an improper prosthetic fitting, there will be pain and altered muscle activity during execution of the normal daily activities. This pain may cause lateral asymmetry of the body which is due to incorrect length of the prosthesis or incorrect selection of the prosthetic component. This wrong construction can lead to abnormal force transmission, overloading the various muscles involved and also damage to the soft tissues which may affect the integration of the stump function.
Thus, this chapter gives us knowledge about the types, application, advantages, and disadvantages of Prosthesis for lower limb amputation. The biomechanics and Gait through Prosthetic leg is also explained for the readers. There are few limitations in this chapter. The content on latest Prosthetic application through Robotics, Myoelectrical prosthesis are not included in this chapter. Further research has to be done on these contents to include in further revision of the chapter. Thus the chapter is fully concentrated on prosthesis for lower limb amputation with its types and application.
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The area covers many techniques that offer solutions to emerging problems in robotics and enterprise-level software systems. Collaborative intelligence is highly and effectively achieved with multi-agent systems. Areas of application include swarms of robots, flocks of UAVs, collaborative software management. Given the level of technological enhancements, the popularity of machine learning in use has opened a new chapter in multi-agent studies alongside the practical challenges and long-lasting collaboration issues in the field. It has increased the urgency and the need for further studies in this field. We welcome chapters presenting research on the many applications of multi-agent studies including, but not limited to, the following key areas: machine learning for multi-agent systems; modeling swarms robots and flocks of UAVs with multi-agent systems; decision science and multi-agent systems; software engineering for and with multi-agent systems; tools and technologies of multi-agent systems.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",keywords:"Collaborative Intelligence, Learning, Distributed Control System, Swarm Robotics, Decision Science, Software Engineering"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:{title:"Artificial Intelligence",id:"14"},selectedSubseries:null},seriesLanding:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. This series is intended for doctors, engineers, and scientists involved in biomedical engineering or those wanting to start working in this field.",coverUrl:"https://cdn.intechopen.com/series/covers/7.jpg",latestPublicationDate:"May 7th, 2022",hasOnlineFirst:!0,numberOfOpenTopics:3,numberOfPublishedChapters:96,numberOfPublishedBooks:12,editor:{id:"50150",title:"Prof.",name:"Robert",middleName:null,surname:"Koprowski",fullName:"Robert Koprowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTYNQA4/Profile_Picture_1630478535317",biography:"Robert Koprowski, MD (1997), PhD (2003), Habilitation (2015), is an employee of the University of Silesia, Poland, Institute of Computer Science, Department of Biomedical Computer Systems. For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. Osma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDv7QAG/Profile_Picture_1626602531691",institutionString:null,institution:{name:"Universidad de Los Andes",institutionURL:null,country:{name:"Colombia"}}},{id:"69697",title:"Dr.",name:"Mani T.",middleName:null,surname:"Valarmathi",fullName:"Mani T. Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"chapter.detail",path:"/chapters/56040",hash:"",query:{},params:{id:"56040"},fullPath:"/chapters/56040",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()