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Castro-Franco AD, Siqueiros-Hernández M, García-Angel V, Mendoza-Muñoz I, Vargas-Osuna LE, Magaña-Almaguer HD. A Review of Natural Fiber-Reinforced Composites for Lower-Limb Prosthetic Designs. Polymers (Basel) 2024; 16:1293. [PMID: 38732761 PMCID: PMC11085599 DOI: 10.3390/polym16091293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
This paper presents a comprehensive review of natural fiber-reinforced composites (NFRCs) for lower-limb prosthetic designs. It covers the characteristics, types, and properties of natural fiber-reinforced composites as well as their advantages and drawbacks in prosthetic designs. This review also discusses successful prosthetic designs that incorporate NFRCs and the factors that make them effective. Additionally, this study explores the use of computational biomechanical models to evaluate the effectiveness of prosthetic devices and the key factors that are considered. Overall, this document provides a valuable resource for anyone interested in using NFRCs for lower-limb prosthetic designs.
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Affiliation(s)
- Angel D. Castro-Franco
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali 21280, Baja California, Mexico; (A.D.C.-F.); (V.G.-A.); (I.M.-M.); (L.E.V.-O.)
| | - Miriam Siqueiros-Hernández
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali 21280, Baja California, Mexico; (A.D.C.-F.); (V.G.-A.); (I.M.-M.); (L.E.V.-O.)
| | - Virginia García-Angel
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali 21280, Baja California, Mexico; (A.D.C.-F.); (V.G.-A.); (I.M.-M.); (L.E.V.-O.)
| | - Ismael Mendoza-Muñoz
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali 21280, Baja California, Mexico; (A.D.C.-F.); (V.G.-A.); (I.M.-M.); (L.E.V.-O.)
| | - Lidia E. Vargas-Osuna
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali 21280, Baja California, Mexico; (A.D.C.-F.); (V.G.-A.); (I.M.-M.); (L.E.V.-O.)
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Gstoettner C, Salminger S, Sturma A, Moser V, Hausner T, Brånemark R, Aszmann OC. Successful salvage via re-osseointegration of a loosened implant in a patient with transtibial amputation. Prosthet Orthot Int 2021; 45:76-80. [PMID: 33834747 DOI: 10.1177/0309364620953985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CASE DESCRIPTION Osseointegration is a relatively new technique for prosthetic limb attachment that offers various improvements for patients with amputation and facilitates joint preservation. We present a case of implant loosening during rehabilitation in a patient with transtibial amputation that was successfully managed through a combination of measures, aiming to promote re-osseointegration of the implant. OBJECTIVES Not much is known about structured management of adverse events after osseointegration. Septic or aseptic loosening is currently regarded as implant failure, prompting removal and possible re-implantation at a later stage. The objective of this case report was to evaluate the feasibility of salvaging a loosened implant. STUDY DESIGN Case report. TREATMENT A novel treatment approach was employed to enable renewed osseointegration of the implant. First, the bone-implant interface was disrupted and renewed through axial rotation and distal repositioning of the implant. Afterwards, extracorporal shockwave therapy and antibiotic treatment were administered. Prosthetic rehabilitation was then started anew. Regular follow-up x-rays and clinical evaluations were conducted, including standardized outcome tests. OUTCOMES These combined measures led to a successful re-osseointegration of the implant. In a 21-month follow-up, the patient regained a stable and secure gait pattern, using his prosthesis every day for 15 hours and scoring above average on standardized outcome measures. CONCLUSION This represents the first report of implant salvage after failed primary osseointegration. As the associated risks of this novel treatment are very low, investigations are warranted to evaluate this approach on a larger scale.
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Affiliation(s)
- Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Salminger
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Agnes Sturma
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Department of Bioengineering, Imperial College London, London, UK
| | - Veith Moser
- AUVA Trauma Hospital Lorenz Böhler-European Hand Trauma Center, Vienna, Austria
| | - Thomas Hausner
- AUVA Trauma Hospital Lorenz Böhler-European Hand Trauma Center, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria
| | - Rickard Brånemark
- Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Biomechatronics Group, Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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Weathersby EJ, Garbini JL, Larsen BG, McLean JB, Vamos AC, Sanders JE. Automatic Control of Prosthetic Socket Size for People WithTranstibial Amputation: Implementation and Evaluation. IEEE Trans Biomed Eng 2020; 68:36-46. [PMID: 32386137 DOI: 10.1109/tbme.2020.2992739] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose was to design, implement, and test a control system for a motor-actuated, cable-panel prosthetic socket that automatically maintains socket fit by continuous adjustment of the socket size. METHODS Sockets with motor-driven adjustable panels were fabricated for participants with transtibial amputation. A proportional-integral control system was implemented to adjust socket size based on Socket Fit Metric (SFM) data collected by an inductive sensor embedded within the socket wall. The sensed distance was representative of limb-to-socket distance. Testing was conducted with participants walking on a treadmill to characterize the system's capability to maintain a set point and to respond to a change in the set point. RESULTS Test results from 10 participants with transtibial amputation showed that the Integral of Absolute Error (IAE) to maintain a set point ranged from 0.001 to 0.046 mm with a median of 0.003 mm. When the set point was changed, IAE errors ranged from 0.001 to 0.005 mm, with a median of 0.003 mm. An IAE of 0.003 mm corresponded to approximately a 0.08% socket volume error, which was considered clinically acceptable. CONCLUSION The capability of the control system to maintain and respond to a change in set point indicates that it is ready for evaluation outside of the laboratory. SIGNIFICANCE Integration of the developed control system into everyday prostheses may improve quality of life of prosthesis users by relieving them of the burden of continually adjusting socket size to maintain fit.
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Schnall BL, Dearth CL, Elrod JM, Golyski PR, Koehler-McNicholas SR, Ray SF, Hansen AH, Hendershot BD. A more compliant prosthetic foot better accommodates added load while walking among Servicemembers with transtibial limb loss. J Biomech 2020; 98:109395. [PMID: 31668413 DOI: 10.1016/j.jbiomech.2019.109395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/03/2019] [Accepted: 10/06/2019] [Indexed: 11/16/2022]
Abstract
Selecting an optimal prosthetic foot is particularly challenging for highly active individuals with limb loss, such as military personnel, who need to seamlessly perform a variety of demanding activities/tasks (often with and without external loads) while minimizing risk of musculoskeletal injuries over the longer term. Here, we expand on prior work by comparing biomechanical and functional outcomes in two prosthetic feet with the largest differences in mechanical response to added load (i.e., consistently "Compliant" and "Stiff" forefoot properties). In each foot, fourteen male Servicemembers with unilateral transtibial limb loss (from trauma) completed instrumented gait analyses in all combinations of two loading conditions (with and without 22 kg weighted vest) and two walking speeds (1.34 and 1.52 m/s), as well as the Prosthesis Evaluation Questionnaire. With the Stiff foot, sound limb peak loading was 2% smaller (p = 0.043) in the loaded versus unloaded condition, but similar between loading conditions in the Compliant foot (note, the Stiff foot was associated with larger loads, overall). Independent of load or walking speed, the Compliant (versus Stiff) foot provided 67.9% larger (p < 0.001) prosthetic push-off, 17.7% larger (p = 0.01) roll-over shape radii, and was subjectively favored by 10 participants. A more Compliant versus Stiff prosthetic foot therefore appears to better accommodate walking with and without added load, and reinforce the notion that mechanical properties of prosthetic feet should be considered for near-term performance and longer-term (joint) health.
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Affiliation(s)
- Barri L Schnall
- Research & Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Christopher L Dearth
- Research & Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jonathan M Elrod
- Research & Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Pawel R Golyski
- Research & Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Sara R Koehler-McNicholas
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, MN, USA; Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Samuel F Ray
- Research & Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Andrew H Hansen
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, MN, USA; Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Brad D Hendershot
- Research & Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD, USA; Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Hedrick EA, Malcolm P, Wilken JM, Takahashi KZ. The effects of ankle stiffness on mechanics and energetics of walking with added loads: a prosthetic emulator study. J Neuroeng Rehabil 2019; 16:148. [PMID: 31752942 PMCID: PMC6873504 DOI: 10.1186/s12984-019-0621-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/07/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The human ankle joint has an influential role in the regulation of the mechanics and energetics of gait. The human ankle can modulate its joint 'quasi-stiffness' (ratio of plantarflexion moment to dorsiflexion displacement) in response to various locomotor tasks (e.g., load carriage). However, the direct effect of ankle stiffness on metabolic energy cost during various tasks is not fully understood. The purpose of this study was to determine how net metabolic energy cost was affected by ankle stiffness while walking under different force demands (i.e., with and without additional load). METHODS Individuals simulated an amputation by using an immobilizer boot with a robotic ankle-foot prosthesis emulator. The prosthetic emulator was controlled to follow five ankle stiffness conditions, based on literature values of human ankle quasi-stiffness. Individuals walked with these five ankle stiffness settings, with and without carrying additional load of approximately 30% of body mass (i.e., ten total trials). RESULTS Within the range of stiffness we tested, the highest stiffness minimized metabolic cost for both load conditions, including a ~ 3% decrease in metabolic cost for an increase in stiffness of about 0.0480 Nm/deg/kg during normal (no load) walking. Furthermore, the highest stiffness produced the least amount of prosthetic ankle-foot positive work, with a difference of ~ 0.04 J/kg from the highest to lowest stiffness condition. Ipsilateral hip positive work did not significantly change across the no load condition but was minimized at the highest stiffness for the additional load conditions. For the additional load conditions, the hip work followed a similar trend as the metabolic cost, suggesting that reducing positive hip work can lower metabolic cost. CONCLUSION While ankle stiffness affected the metabolic cost for both load conditions, we found no significant interaction effect between stiffness and load. This may suggest that the importance of the human ankle's ability to change stiffness during different load carrying tasks may not be driven to minimize metabolic cost. A prosthetic design that can modulate ankle stiffness when transitioning from one locomotor task to another could be valuable, but its importance likely involves factors beyond optimizing metabolic cost.
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Affiliation(s)
- Erica A Hedrick
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Philippe Malcolm
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Jason M Wilken
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Kota Z Takahashi
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA.
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Müller R, Tronicke L, Abel R, Lechler K. Prosthetic push-off power in trans-tibial amputee level ground walking: A systematic review. PLoS One 2019; 14:e0225032. [PMID: 31743353 PMCID: PMC6863538 DOI: 10.1371/journal.pone.0225032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Unilateral trans-tibial amputation signifies a challenge to locomotion. Prosthetic ankle-foot units are developed to mimic the missing biological system which adapts push-off power to walking speed in some new prosthetic ankle-foot designs. The first systematic review including the two factors aims to investigate push-off power differences among Solid Ankle Cushion Heel (SACH), Energy Storage And Return (ESAR) and Powered ankle-foot units (PWR) and their relation to walking speed. DATA SOURCES A literature search was undertaken in the Web of Science, PubMed, IEEE xplore, and Google Scholar databases. The search term included: ampu* AND prosth* AND ankle-power AND push-off AND walking. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were included if they met the following criteria: unilateral trans-tibial amputees, lower limb prosthesis, reported analysis of ankle power during walking. Data extracted from the included studies were clinical population, type of the prosthetic ankle-foot units (SACH, ESAR, PWR), walking speed, and peak ankle power. Linear regression was used to determine whether the push-off power of different prosthetic ankle-foot units varied regarding walking speed. Push-off power of the different prosthetic ankle-foot units were compared using one-way between subjects' ANOVAs with post hoc analysis, separately for slower and faster walking speeds. RESULTS 474 publications were retrieved, 28 of which were eligible for inclusion. Correlations between walking speed and peak push-off power were found for ESAR (r = 0.568, p = 0.006) and PWR (r = 0.820, p = 0.000) but not for SACH (r = 0.267, p = 0.522). ESAR and PWR demonstrated significant differences in push-off power for slower and faster walking speeds (ESAR (p = 0.01) and PWR (p = 0.02)). CONCLUSION Push-off power can be used as a selection criterion to differentiate ankle-foot units for prosthetic users and their bandwidth of walking speeds.
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Affiliation(s)
- Roy Müller
- Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, Bayreuth, Germany
- Institute of Sport Sciences, Friedrich Schiller University Jena, Jena, Germany
| | | | - Rainer Abel
- Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, Bayreuth, Germany
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Koehler-McNicholas SR, Nickel EA, Barrons K, Blaharski KE, Dellamano CA, Ray SF, Schnall BL, Hendershot BD, Hansen AH. Mechanical and dynamic characterization of prosthetic feet for high activity users during weighted and unweighted walking. PLoS One 2018; 13:e0202884. [PMID: 30208040 PMCID: PMC6135372 DOI: 10.1371/journal.pone.0202884] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 08/12/2018] [Indexed: 11/19/2022] Open
Abstract
Many Service members and Veterans with lower-limb amputations have the potential for high function and the desire to resume physically demanding occupations that require them to carry heavy loads (e.g., military service, firefighters, farmers, ranchers, construction workers). However, it is currently unclear which prosthetic feet best accommodate heavy load carriage while also providing good overall function and mobility during unweighted activities. The main objective of this study was to investigate the ability of currently available prosthetic ankle-foot systems to accommodate weighted walking by examining the mechanical characteristics (i.e., forefoot stiffness) and dynamic function (i.e., rocker radius, effective foot length ratio, and late-stance energy return) of prosthetic feet designed for high activity users. Load versus deflection curves were obtained for nine prosthetic ankle-foot systems using a servohydraulic test frame and load cell. Effective roll-over shape characteristics and late-stance energy return measures were then obtained using quantitative gait analysis for three users with unilateral, transtibial amputation. Results from mechanical and dynamic testing showed that although forefoot stiffness varied across the nine feet investigated in this study, changes measured in roll-over shape radius and effective foot length ratio were relatively small in response to weighted walking. At the same time, prosthetic feet with more compliant forefoot keel structures appeared to provide more late-stance energy return compared to feet with stiffer forefoot keel structures. These results suggest that prosthetic ankle-foot systems with compliant forefoot keel structures may better accommodate weighted walking by reducing the metabolic cost of physically demanding activities. However, to more fully understand the biomechanical and functional implications of these results, other factors, such as the residual-limb strength of the user and the overall stiffness profile of the prosthetic foot, should also be considered.
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Affiliation(s)
- Sara R. Koehler-McNicholas
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Eric A. Nickel
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
| | - Kyle Barrons
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
| | - Kathryn E. Blaharski
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
| | - Clifford A. Dellamano
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
- Department of Biomedical Engineering, College of Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Samuel F. Ray
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Barri L. Schnall
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Brad D. Hendershot
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Department of Defense-Veterans Affairs Extremity Trauma and Amputation Center of Excellence, Bethesda, Maryland, United States of America
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Andrew H. Hansen
- Minneapolis Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
- Program in Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
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Brandt A, Wen Y, Liu M, Stallings J, Huang HH. Interactions Between Transfemoral Amputees and a Powered Knee Prosthesis During Load Carriage. Sci Rep 2017; 7:14480. [PMID: 29101394 PMCID: PMC5670174 DOI: 10.1038/s41598-017-14834-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 10/17/2017] [Indexed: 11/29/2022] Open
Abstract
Machines and humans become mechanically coupled when lower limb amputees walk with powered prostheses, but these two control systems differ in adaptability. We know little about how they interact when faced with real-world physical demands (e.g. carrying loads). Here, we investigated how each system (i.e. amputee and powered prosthesis) responds to changes in the prosthesis mechanics and gravitational load. Five transfemoral amputees walked with and without load (i.e. weighted backpack) and a powered knee prosthesis with two pre-programmed controller settings (i.e. for load and no load). We recorded subjects' kinematics, kinetics, and perceived exertion. Compared to the no load setting, the load setting reduced subjects' perceived exertion and intact-limb stance time when they carried load. When subjects did not carry load, their perceived exertion and gait performance did not significantly change with controller settings. Our results suggest transfemoral amputees could benefit from load-adaptive powered knee controllers, and controller adjustments affect amputees more when they walk with (versus without) load. Further understanding of the interaction between powered prostheses, amputee users, and various environments may allow researchers to expand the utility of prostheses beyond simple environments (e.g. firm level ground without load) that represent only a subset of real-world environments.
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Affiliation(s)
- Andrea Brandt
- University of North Carolina, Joint Department of Biomedical Engineering, Chapel Hill, Raleigh, 27514, USA
- North Carolina State University, Joint Department of Biomedical Engineering, Chapel Hill, Raleigh, 27695, USA
| | - Yue Wen
- University of North Carolina, Joint Department of Biomedical Engineering, Chapel Hill, Raleigh, 27514, USA
- North Carolina State University, Joint Department of Biomedical Engineering, Chapel Hill, Raleigh, 27695, USA
| | - Ming Liu
- University of North Carolina, Joint Department of Biomedical Engineering, Chapel Hill, Raleigh, 27514, USA
- North Carolina State University, Joint Department of Biomedical Engineering, Chapel Hill, Raleigh, 27695, USA
| | - Jonathan Stallings
- North Carolina State University, Department of Statistics, Raleigh, 27695, USA
| | - He Helen Huang
- University of North Carolina, Joint Department of Biomedical Engineering, Chapel Hill, Raleigh, 27514, USA.
- North Carolina State University, Joint Department of Biomedical Engineering, Chapel Hill, Raleigh, 27695, USA.
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Brandt A, Huang HH. Does the impedance of above-knee powered prostheses need to be adjusted for load-carrying conditions? ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:5075-5078. [PMID: 28269409 DOI: 10.1109/embc.2016.7591868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Powered knee prostheses provide substantial advantages for amputees compared to traditional passive devices during basic walking tasks (i.e. level-ground, stairs, ramps), but the impedance control parameters are fixed. For environments that differ from the well-controlled setting of the clinic, amputees must compensate their gait patterns because fixed control parameters ideal for walking on level ground in the clinic do not meet real-life task demands. Load carriage is one instance where fixed control parameters may lead to undesired gait patterns and potentially result in injury. To evaluate the importance of impedance control parameters for different walking tasks, we tested one above-knee amputee walking using an experimental powered prosthesis under four walking conditions. The amputee walked with and without added mass with both load-specific and non-specific impedance control parameters. The load-specific parameters significantly reduced the amputee's intact-leg compensations, asymmetry, and perceived exertion compared to the non-specific control parameters. Powered lower limb prostheses that modulate impedance control parameters for load-carrying tasks may improve the gait performance, safety, and comfort of amputees.
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Sinitski EH, Herbert-Copley AG, Lemaire ED, Doyle SS, Besemann M, Dudek NL. Center of pressure and total force analyses for amputees walking with a backpack load over four surfaces. APPLIED ERGONOMICS 2016; 52:169-176. [PMID: 26360208 DOI: 10.1016/j.apergo.2015.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 05/13/2015] [Accepted: 07/10/2015] [Indexed: 06/05/2023]
Abstract
Understanding how load carriage affects walking is important for people with a lower extremity amputation who may use different strategies to accommodate to the additional weight. Nine unilateral traumatic transtibial amputees (K4-level) walked over four surfaces (level-ground, uneven ground, incline, decline) with and without a 24.5 kg backpack. Center of pressure (COP) and total force were analyzed from F-Scan insole pressure sensor data. COP parameters were greater on the intact limb than on the prosthetic limb, which was likely a compensation for the loss of ankle control. Double support time (DST) was greater when walking with a backpack. Although longer DST is often considered a strategy to enhance stability and/or reduce loading forces, changes in DST were only moderately correlated with changes in peak force. High functioning transtibial amputees were able to accommodate to a standard backpack load and to maintain COP progression, even when walking over different surfaces.
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Affiliation(s)
- Emily H Sinitski
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
| | | | - Edward D Lemaire
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada; University of Ottawa, Faculty of Medicine, 451 Smyth Rd., Ottawa, ON, K1H 8M5, Canada
| | - Sean S Doyle
- University of Ottawa, School of Human Kinetics, 125 University Private, Ottawa, ON K1N 6N5, Canada
| | - Markus Besemann
- Canadian Forces Health Services Group, 1745 Alta Vista Drive, Ottawa ON, K1A 0K6, Canada
| | - Nancy L Dudek
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada; University of Ottawa, Faculty of Medicine, 451 Smyth Rd., Ottawa, ON, K1H 8M5, Canada
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Doyle SS, Lemaire ED, Besemann M, Dudek NL. Changes to transtibial amputee gait with a weighted backpack on multiple surfaces. Clin Biomech (Bristol, Avon) 2015; 30:1119-24. [PMID: 26476601 DOI: 10.1016/j.clinbiomech.2015.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 05/21/2015] [Accepted: 08/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Modern prosthetic technology and rehabilitation practices have enabled people with lower extremity amputations to participate in almost all occupations and physical activities. Carrying backpack loads can be an essential component for many of these jobs and activities; however, amputee gait with backpack loads is poorly understood. This knowledge gap must be addressed in order to further improve an individual's quality of living through changes in rehabilitation programs and prosthesis development. METHODS Ten male, unilateral, K4-level (ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels), transtibial amputees completed ten walking trials at a self-selected pace on simulated uneven ground, ramp ascent, and ramp descent. Five trials were with a 24.5 kg backpack load and five trials without. Temporal-spatial parameters and kinematic peak values for the ankle, knee, hip, pelvis, and trunk were collected and analyzed for differences between backpack conditions. FINDINGS Each surface had novel findings not found on the other surfaces. However differences in temporal-spatial parameters were congruent with the literature on able bodied individuals. Pelvis and trunk angular velocities decreased with the backpack. Hip flexion on both limbs increased during weight acceptance while wearing the backpack, a common adaptation seen in able-bodied individuals on level ground. INTERPRETATION A 24.5 kg backpack load can be accommodated by transtibial amputees at the K4 functional level. Future studies on load carriage and gait training programs should include incline and descent due to the increased difficulty. Rehabilitation programs should verify hip and knee flexor strength and work to reduce intact limb reliance.
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Affiliation(s)
- Sean S Doyle
- University of Ottawa, School of Human Kinetics, Canada.
| | - Edward D Lemaire
- Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Canada; University of Ottawa, Faculty of Medicine, Canada.
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Schnall BL, Hendershot BD, Bell JC, Wolf EJ. Kinematic analysis of males with transtibial amputation carrying military loads. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2014; 51:1505-14. [PMID: 25815769 DOI: 10.1682/jrrd.2014.01.0022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 09/18/2014] [Indexed: 11/05/2022]
Abstract
The biomechanical responses to load carriage, a common task for dismounted troops, have been well studied in nondisabled individuals. However, with recent shifts in the rehabilitation and retention process of injured servicemembers, there remains a substantial need for understanding these responses in persons with lower-limb amputations. Temporal-spatial and kinematic gait parameters were analyzed among 10 male servicemembers with unilateral transtibial amputation (TTA) and 10 uninjured male controls. Participants completed six treadmill walking trials in all combinations of two speeds (1.34 and 1.52 m/s) and three loads (none, 21.8, and 32.7 kg). Persons with TTA exhibited biomechanical compensations to carried loads that are comparable to those observed in uninjured individuals. However, several distinct gait changes appear to be unique to those with TTA, notably, increased dorsiflexion (deformation) of the prosthetic foot/ankle, less stance knee flexion on the prosthetic limb, and altered trunk forward lean/excursion. Such evidence supports the need for future work to assess the risk for overuse injuries with carried loads in this population in addition to guiding the development of adaptive prosthetic feet/components to meet the needs of redeployed servicemembers or veterans/civilians in physically demanding occupations.
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Affiliation(s)
- Barri L Schnall
- Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD
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